Surgeon-Journal of the Royal Colleges of Surgeons of Edinburgh and Ireland最新文献

{"title":"Use of the contour ® curved cutter stapler device for rectal transection during robotic assisted surgery","authors":"Fraser Sneddon,&nbsp;Colin H. Richards,&nbsp;Raymond Oliphant","doi":"10.1016/j.surge.2024.11.007","DOIUrl":"10.1016/j.surge.2024.11.007","url":null,"abstract":"<div><h3>Background</h3><div>Rectal division during minimally invasive surgery including robotic assisted surgery remains challenging, with current techniques often requiring multiple stapler firings to achieve effective transection.</div></div><div><h3>Aims</h3><div>We propose a novel technique which allows the use of a Contour® Curved Cutter Stapler to achieve rectal division during robotic assisted surgery.</div></div><div><h3>Methods</h3><div>The stapler is inserted through the routinely made pfannenstiel incision and a glove, over an Alexis® port used to create an airtight seal.</div></div><div><h3>Conclusion</h3><div>This simple technique enables reliable perpendicular single stapler firing to achieve rectal transection during colorectal robotic assisted surgery without the requirement for any further incisions.</div></div>","PeriodicalId":49463,"journal":{"name":"Surgeon-Journal of the Royal Colleges of Surgeons of Edinburgh and Ireland","volume":"23 1","pages":"Pages 30-32"},"PeriodicalIF":2.3,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142689392","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Are all surgeons the same? Assessing emotional intelligence and gender differences amongst surgical residency applicants in Ireland","authors":"F. O’Kelly ,&nbsp;B.R. O’Connor ,&nbsp;E. O’Dowd ,&nbsp;K. Neylon ,&nbsp;D.H. Shackleton ,&nbsp;K. Sheehan ,&nbsp;E. Cotter ,&nbsp;R.M. Conroy ,&nbsp;D. O’Keeffe ,&nbsp;B.B. McGuire ,&nbsp;O. Traynor ,&nbsp;E.M. Doherty","doi":"10.1016/j.surge.2024.08.007","DOIUrl":"10.1016/j.surge.2024.08.007","url":null,"abstract":"","PeriodicalId":49463,"journal":{"name":"Surgeon-Journal of the Royal Colleges of Surgeons of Edinburgh and Ireland","volume":"23 1","pages":"Pages 6-12"},"PeriodicalIF":2.3,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141983689","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"The rise and fall of “marginal gains” – Lessons for surgery?","authors":"Connor Boyle,&nbsp;Calum Arthur,&nbsp;Steven Yule","doi":"10.1016/j.surge.2024.12.004","DOIUrl":"10.1016/j.surge.2024.12.004","url":null,"abstract":"","PeriodicalId":49463,"journal":{"name":"Surgeon-Journal of the Royal Colleges of Surgeons of Edinburgh and Ireland","volume":"23 1","pages":"Pages e39-e41"},"PeriodicalIF":2.3,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142916115","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"The impact of inadequate disclosure and patient recall on the consent process in neurosurgery: A systematic literature review","authors":"Ashraf Elmahdi,&nbsp;David Smith","doi":"10.1016/j.surge.2024.11.009","DOIUrl":"10.1016/j.surge.2024.11.009","url":null,"abstract":"<div><h3>Background</h3><div>The informed consent process in neurosurgery aims to uphold patient autonomy and provide comprehensive information for decision-making. However, gaps in communication and understanding between patients and surgeons persist. This systematic review examined the impact of consent on neurosurgical practice, exploring the effectiveness of different consent approaches.</div></div><div><h3>Methods</h3><div>A comprehensive search of databases and relevant sources identified twenty-eight studies for inclusion. Prospective and retrospective studies were assessed to examine the effect of consent on neurosurgical practice. Data collection and analysis involved independent reviewers assessing eligibility, study quality, and risk of bias. Findings from the included studies were used to write the review.</div></div><div><h3>Main results</h3><div>Randomized controlled trials specific to the impact of consent in neurosurgery needed to be included. Nevertheless, the reviewed twenty-nine studies revealed a significant risk of litigation due to inadequate information provision. Neurosurgeons' adherence to the standard of competent peers was identified as crucial in bridging the gap between desired and actual patient-surgeon interactions.</div></div><div><h3>Authors conclusions</h3><div>This review underscores the need to address communication gaps between patients and surgeons within the informed consent process in neurosurgery. Neurosurgeons must strive to meet the standard of competent peers and implement effective consent strategies involving multiple modalities. Enhancing communication and patient comprehension can mitigate potential litigation risks, ensuring better patient-centred care and shared decision-making in neurosurgical practice.</div></div>","PeriodicalId":49463,"journal":{"name":"Surgeon-Journal of the Royal Colleges of Surgeons of Edinburgh and Ireland","volume":"23 1","pages":"Pages 45-51"},"PeriodicalIF":2.3,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142807418","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"A boost to concentration or a distracting noise? A systematic review of surgeon and anaesthetist perspectives of the benefit of intra-operative music","authors":"K. Onuoha ,&nbsp;D. Jones ,&nbsp;W. Eardley","doi":"10.1016/j.surge.2024.11.002","DOIUrl":"10.1016/j.surge.2024.11.002","url":null,"abstract":"<div><h3>Background</h3><div>The surgical team should be as harmonious and focussed as possible in the operating theatre. Whilst there is evidence of benefit for the use of music in the perioperative period for patient, little exists to inform of impact on those doing the surgery or anaesthesia. This review focuses on the perspectives of surgeons and anaesthetists, their views and opinions on the effect and impact of music during surgery.</div></div><div><h3>Methods</h3><div>A systematic review was conducted using narrative synthesis. The PRISMA guidelines were followed with the use of PICO and PRISMA guided search strategy. PubMed, CINAHL and Medline were searched but filtered to only published English language papers.</div></div><div><h3>Results</h3><div>Of 329 papers identified 42 duplicates were removed. 287 were screened; of which 276 were excluded and 11 sought for retrieval. Of these, 8 were excluded for wrong population or study design, leaving 3 for analysis.</div><div>Narrative synthesis revealed three themes to guide discussion: (1) Views of surgeons and anaesthetists and the effect on music; (2) effect of music on other staff members; and (3) differences in music choices and balance of power.</div></div><div><h3>Conclusion</h3><div>Music has an overall beneficial effect on surgeons and anaesthetists, especially with regards improved concentration. As an intervention, it has global generalisability and requires little resource. Investigation across different surgical specialities and use of flexible control models in terms of choosing music is a natural subsequent research question.</div></div>","PeriodicalId":49463,"journal":{"name":"Surgeon-Journal of the Royal Colleges of Surgeons of Edinburgh and Ireland","volume":"23 1","pages":"Pages 61-66"},"PeriodicalIF":2.3,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142734150","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Scottish Open Fractures of Tibia (SOFT) audit; a multi-centre retrospective review of ortho-plastic management of tibial shaft fractures at major trauma centres (MTCs) in Scotland","authors":"J.E. Dixon ,&nbsp;I.A. Rankin ,&nbsp;S. Rangarajan ,&nbsp;J. Brennan ,&nbsp;A. Varma ,&nbsp;D.W. Shields ,&nbsp;I.M. Stevenson","doi":"10.1016/j.surge.2025.01.006","DOIUrl":"10.1016/j.surge.2025.01.006","url":null,"abstract":"<div><h3>Aims</h3><div>Open fractures of the tibia are associated with significant complications, for which attempts have been made to standardise and optimise their management.</div><div>In the UK, this standard is the British Orthopaedic Association Standards for Trauma (BOAST) guidelines. The Scottish Open Fracture of Tibia (SOFT) Audit is a national review of open tibial shaft fractures across all four Scottish Trauma Networks, which aims to provide a definite review of ortho-plastic care for open tibial shaft fractures in Scotland.</div></div><div><h3>Methods</h3><div>A retrospective audit of all adult patients who sustained open tibial shaft fractures in Scotland from June 2021 to June 2023 was performed. The primary outcome measure was compliance with BOAST guidelines. Secondary outcome measures included infection, return to theatre, soft-tissue failure, and amputation.</div></div><div><h3>Results</h3><div>196 open tibial shaft fractures were identified. Common complications included infection (24 %), return to theatre (17 %), soft-tissue failure (9.7 %) and amputation (7.1 %). Complete compliance with BOAST guidelines was documented in 8.8 % of cases. Significant variation was seen between geographical regions of Scotland. No significance was seen between compliance to BOAST guidelines and any of the secondary outcome measures. Multivariate analysis identified Grade 3 Gustilo-Anderson injuries as significantly associated with post-operative infection, post-operative infection significantly associated with return to theatre, and return to theatre significantly associated with soft-tissue failure and/or amputation.</div></div><div><h3>Conclusion</h3><div>This study demonstrates in Scotland there is scope for improvement in cohesion with national guidance including timing of antibiotic delivery, combined ortho-plastics approach, and soft-tissue cover within 72 h of definitive fixation.</div></div>","PeriodicalId":49463,"journal":{"name":"Surgeon-Journal of the Royal Colleges of Surgeons of Edinburgh and Ireland","volume":"23 2","pages":"Pages 87-93"},"PeriodicalIF":2.3,"publicationDate":"2025-01-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143061159","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Where do we go from here? The personal impact of adverse events and complications in surgeons: Results from a cross-sectional study","authors":"S. O'Meara ,&nbsp;E. Doherty ,&nbsp;K. Walsh","doi":"10.1016/j.surge.2025.01.001","DOIUrl":"10.1016/j.surge.2025.01.001","url":null,"abstract":"<div><h3>Objective</h3><div>Medical error is an inevitable part of modern healthcare, with a potential harmful impact for the patient and the surgeon. The phenomenon of negative personal responses for healthcare workers in the aftermath of adverse events is described as the “second casualty” and can involve significant physical and psychological distress. We present results from a cross-sectional survey of surgeons and their experience in the aftermath of adverse events or complications.</div></div><div><h3>Subjects and methods</h3><div>Following ethical approval an anonymous online survey was distributed to all training and consultant surgeons in the Republic of Ireland. Data collected included basic demographics, personal response to an adverse event, coping strategies, contributing factors and perception of potential support structures.</div></div><div><h3>Results</h3><div>A total of 110 responses were received representing surgeons with a broad range of experience and specialty. Eighty-nine percent (n = 98) of surgeons described negative psychological symptoms in the aftermath of adverse events. The predominant responses were anxiety, guilt and low mood. Sixty-seven percent (n = 74) reported that their training did not prepare them for the personal impact of events but found informal peer and family support to be beneficial and were open to the implementation of formal support structures.</div></div><div><h3>Conclusion</h3><div>Surgeons suffer in the aftermath of negative outcomes and feel unprepared to manage the personal consequences. Institutions and representative bodies must step forward to change culture and develop supports for surgeons in the aftermath of adverse events and complications.</div></div>","PeriodicalId":49463,"journal":{"name":"Surgeon-Journal of the Royal Colleges of Surgeons of Edinburgh and Ireland","volume":"23 2","pages":"Pages 73-77"},"PeriodicalIF":2.3,"publicationDate":"2025-01-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142985241","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"New technologies for future of surgery in Ireland: An RCSI working Group report 2024","authors":"Future of New Technologies In Ireland Working Group,&nbsp;Writing Group,&nbsp;Alice Moynihan,&nbsp;Debbie Killeen,&nbsp;Ronan Cahill,&nbsp;Ashokkumar Singaravelu,&nbsp;Steering Group,&nbsp;David Healy,&nbsp;Carmel Malone,&nbsp;Enda Mulvany,&nbsp;Fergal O'Brien,&nbsp;Paul Ridgway,&nbsp;Kieran Ryan,&nbsp;Contributors,&nbsp;Mary Barry,&nbsp;Donal Brennan,&nbsp;John Caird,&nbsp;Camilla Carroll,&nbsp;Calvin Coffey,&nbsp;Kevin Conlon,&nbsp;Mark Wilson","doi":"10.1016/j.surge.2024.11.012","DOIUrl":"10.1016/j.surge.2024.11.012","url":null,"abstract":"<div><h3>Introduction</h3><div>Surgery is a cognitive discipline whose practitioners characteristically use technology during operations for patients. With accelerating technological innovation throughout society and healthcare, we sought to develop a shared position for Irish surgery via a commissioned work programme by the Royal College of Surgeons in Ireland.</div></div><div><h3>Methods</h3><div>Using Stanford design principles, representative clinical specialty and academic leads and higher trainee representatives across 15 specialties were surveyed regarding sentiments, perspectives and concerns regarding now and near future technology in clinical practice, career considerations and training/education. Selected participants proceeded to semi-structured interview as deeper dive including use-case exemplar development with narrative thematic analysis.</div></div><div><h3>Results</h3><div>New technologies matter to surgeons and surgical practice for patients as evidenced by the high level of engagement and rich perspectives provided. However there is concern, particularly among academic groups, that Irish Surgery could be better positioned for the opportunities inherent in new technologies and better prepared strategically regarding stakeholder (surgical units, healthcare institutions, universities and especially management, health service executive and government) alignment. Investment levels are felt to be insufficient to maximally leverage new technology effectively including training investment where new ways of learning are needed as technologies such as artificial intelligence and data and analytics become more important to surgical practice beyond the current prioritisation of robotics and biomaterials.</div></div><div><h3>Conclusion</h3><div>While there is high engagement, clear ambition and confidence with role of new technologies in the now and near future of Irish Surgery, there is opportunity to demonstrate leadership and synergise stake holders for better healthcare.</div></div>","PeriodicalId":49463,"journal":{"name":"Surgeon-Journal of the Royal Colleges of Surgeons of Edinburgh and Ireland","volume":"23 2","pages":"Pages 120-132"},"PeriodicalIF":2.3,"publicationDate":"2025-01-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142957806","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Optimising topical wound care outcomes for fungating breast wounds - A systematic review of current institutional practice.","authors":"Ryan Seng Hong Wong, Trishan Manav Sri Ram, Zhi Min Lin, Clement Luck Khng Chia","doi":"10.1016/j.surge.2024.12.003","DOIUrl":"https://doi.org/10.1016/j.surge.2024.12.003","url":null,"abstract":"<p><strong>Background: </strong>Fungating breast wounds cause significant complications and morbidity to patients. Wound care is of paramount importance in optimising care and alleviating suffering for patients with malignant breast wounds. Currently, routinely implemented objective assessment tools for fungating breast wound treatment outcomes are non-existent, and institutional practice varies.</p><p><strong>Aims: </strong>This review aims to evaluate current evidence regarding various wound care methodologies for fungating breast tumours on their effectiveness at targeting established fungating wound-specific complications: malodour, pain, exudates, bleeding, wound characteristics, emotional and quality-of-life outcomes.</p><p><strong>Data sources: </strong>We conducted a systematic review of four databases (PubMed, Embase, Scopus, The Cochrane Library) and hand-search of bibliographies of relevant reviews, in accordance to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA-P) guidelines.</p><p><strong>Results: </strong>The search strategy yielded 1319 articles, of which, 8 studies involving 188 patients were included in the review. Studies examined the effects of wound care products such as but not limited to calcium alginate, hydrocellular dressing and metronidazole and looked at outcomes such as bleeding (6), malodour (5), exudates (3), pain (4), wound size/length (2), emotion (3) and quality-of-life (1).</p><p><strong>Conclusion: </strong>There is a wide variety of options for wound care which is able to target the various complications of fungating breast wounds. Certain wound care methods are effective in alleviating patient morbidity. However, key barriers toward establishing evidenced-based management of patients with fungating breast wounds were identified in the paucity of studies, lack of standardisation of interventions and objective outcome measures.</p>","PeriodicalId":49463,"journal":{"name":"Surgeon-Journal of the Royal Colleges of Surgeons of Edinburgh and Ireland","volume":" ","pages":""},"PeriodicalIF":2.3,"publicationDate":"2024-12-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142883529","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Time to surgery for acute uncomplicated appendicitis in an adult university teaching hospital","authors":"Stuart J. Cook ,&nbsp;Kieran M. O'Driscoll ,&nbsp;Ahmed Al Maksoud ,&nbsp;Denis Evoy ,&nbsp;Damian McCartan ,&nbsp;Helen M. Heneghan ,&nbsp;Ruth S. Prichard","doi":"10.1016/j.surge.2024.11.011","DOIUrl":"10.1016/j.surge.2024.11.011","url":null,"abstract":"<div><h3>Aims</h3><div>Both patient and hospital-related factors determine the timing of appendicectomy for acute uncomplicated appendicitis. Recent literature suggests appendicectomy more than 24 h after hospital admission is associated with increased morbidity in adults. Current guidelines from the World Society of Emergency Surgery (WSES) recommend surgery within this timeframe to reduce the risk of complications. The aim of this study was to determine the time to surgery for patients with acute uncomplicated appendicitis and to compare this to the current WSES recommendations. This study also aimed to identify potential reasons for any in-hospital delay.</div></div><div><h3>Methods</h3><div>This study is a retrospective review of all patients who underwent appendicectomy for confirmed acute uncomplicated appendicitis at an adult university teaching hospital between September 2021 and September 2022. Patient demographics, clinical information, time of admission, time of surgery, time of discharge and surgical complication data were collected.</div></div><div><h3>Results</h3><div>A total of 229 appendicectomies were performed during the study period. 138 (60 %) had a preoperative diagnosis of acute uncomplicated appendicitis. The median age was 36 years (range 17–93). Time to surgery was &lt;24 h in 80 (58 %) patients and &gt;24 h in 58 (42 %) patients. In patients with a delay of &gt;24 h, 28 (48 %) had their surgery 24–36 h after admission, 23 (40 %) had their surgery between 36 and 48 h, and 7 (12 %) had their surgery &gt;48 h after admission. Patients who were operated &gt;24 h after admission had a higher rate of readmission, 4/58 (6.9 %) compared to 1/80 (1.25 %) in the less than 24 h group (<em>p</em> = 0.09). Delays in radiology, surgical ward beds and the lack of a dedicated emergency theatre may have contributed to extended waiting times.</div></div><div><h3>Conclusion</h3><div>The results of this study show that the majority (58 %) of patients within our cohort were operated on within the WSES guidelines. However, 42 % of patients had their surgery in excess of these recommendations. Extended waiting periods may be related to delays in radiology, surgical ward beds and a lack of a dedicated emergency theatre. Patients who were operated on greater than 24 h following their admission also had a higher rate of readmission.</div></div>","PeriodicalId":49463,"journal":{"name":"Surgeon-Journal of the Royal Colleges of Surgeons of Edinburgh and Ireland","volume":"23 2","pages":"Pages 94-97"},"PeriodicalIF":2.3,"publicationDate":"2024-12-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142840095","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}