Cirugia Espanola最新文献

{"title":"The impact and role of shared decision-making in surgical practice: A systematic review","authors":"Danilo Vinci,&nbsp;Beatriz Febrero,&nbsp;José Ignacio Pérez García,&nbsp;Gianluca Pellino","doi":"10.1016/j.ciresp.2026.800328","DOIUrl":"10.1016/j.ciresp.2026.800328","url":null,"abstract":"<div><h3>Background</h3><div>Shared decision-making (SDM) is a collaborative approach that integrates clinical evidence with patient values to guide healthcare decisions. Although widely promoted as a quality indicator, its adoption in surgical care remains variable. Understanding its impact and implementation in surgery is essential to improve patient-centred outcomes.</div></div><div><h3>Methods</h3><div>A systematic review with narrative synthesis was conducted in accordance with PRISMA guidelines and registered in PROSPERO (ID 1145717). MEDLINE, EMBASE, Ovid and Cochrane databases were searched for studies published between 1995 and 2025. Randomized trials and comparative observational studies evaluating shared decision-making (SDM) interventions in adult surgical patients were included. Two reviewers independently performed study screening, data extraction and quality assessment. Primary outcomes were patient-reported measures (satisfaction, perceived involvement, decisional conflict, and knowledge). Secondary outcomes included postoperative complications and length of stay. Risk of bias was assessed using the Newcastle–Ottawa Scale, and certainty of evidence was graded using the GRADE approach. Due to heterogeneity across interventions and surgical subspecialties, a narrative synthesis was performed.</div></div><div><h3>Results</h3><div>The search identified 4119 records, among which 29 studies met inclusion criteria. Most were randomized controlled trials or prospective cohorts, spanning orthopaedic, breast, colorectal, gynaecologic, vascular, and general surgery. SDM interventions were diverse, including decision aids, question prompt lists, smartphone applications, and surgeon–patient communication training. Compared with usual care, SDM consistently improved patient knowledge, involvement, satisfaction, and reduced decisional conflict. Evidence for clinical outcomes, such as complication rates or length of stay, was limited and inconsistent. Quality appraisal showed most studies were of moderate to high quality, although several pilot trials had small samples and limited generalizability.</div></div><div><h3>Conclusions</h3><div>SDM improves patient-centred outcomes in surgical practice, though its effect on clinical endpoints remains uncertain. The evidence highlights stronger benefits in elective than in emergency contexts, where time constraints and patient frailty limit feasibility. Standardized measurement tools, validated surgery-specific decision aids, and integration of digital technologies are needed to strengthen implementation. Broader institutional support and training in SDM communication should be prioritized to embed SDM as a routine component of surgical care.</div></div>","PeriodicalId":50690,"journal":{"name":"Cirugia Espanola","volume":"104 7","pages":"Article 800328"},"PeriodicalIF":1.5,"publicationDate":"2026-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148499689","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":"Robotic thoracic surgery: association between operative time and complications in 454 patients","authors":"Inés Serratosa,&nbsp;Carlos Déniz,&nbsp;Iván Macia,&nbsp;Francisco Rivas,&nbsp;Anna Muñoz,&nbsp;Marina Paradela,&nbsp;Samuel García-Reina,&nbsp;Amaia Ojanguren","doi":"10.1016/j.ciresp.2026.800329","DOIUrl":"10.1016/j.ciresp.2026.800329","url":null,"abstract":"<div><h3>Introduction</h3><div>The relationship between operative time and postoperative complications in robotic-assisted thoracic surgery (RATS) remains unclear. This study analyzes that association, focusing on prolonged air leak (PAL) and other early complications.</div></div><div><h3>Methods</h3><div>A retrospective observational study was conducted on 454 consecutive patients with non-small cell lung cancer who underwent robotic-assisted anatomical pulmonary resection between 2019 and 2024. The association between operative time and the incidence of PAL was evaluated, as well as other postoperative complications within the first 30 days. We applied a logistic regression model adjusted for age, BMI, FEV₁, DLCO, smoking status, neoadjuvant therapy, tumor size and type of resection, assessing its discriminative ability using pseudo R² and ROC curve analysis.</div></div><div><h3>Results</h3><div>The incidence of PAL was 33.3%. Operative time was longer in PAL cases (210 vs 190 min; Mann–Whitney <em>P</em> = .006). In the multivariable model, operative time was not an independent predictor of PAL (OR 1.003 per min; <em>P</em> = .081), whereas higher BMI was protective (OR 0.935; <em>P</em> = .007) and FEV₁ showed a borderline protective association (OR 0.989; <em>P</em> = .059); segmentectomy had lower odds than lobectomy (OR 0.379; <em>P</em> = .006). Model performance was AUC = 0.676 with Nagelkerke’s R² = 0.105. Weak correlations were observed between operative time and respiratory failure, reoperation, and readmission. No differences in PAL or other complications were found according to the number of ports used (uniportal, biportal, multiportal).</div></div><div><h3>Conclusion</h3><div>In RATS, operative time appears to be a surrogate of case complexity rather than a stand-alone target. Prevention of PAL should prioritize modifiable technical and perioperative factors and preoperative optimization within ERAS pathways, supported by a multifactorial risk assessment approach.</div></div>","PeriodicalId":50690,"journal":{"name":"Cirugia Espanola","volume":"104 7","pages":"Article 800329"},"PeriodicalIF":1.5,"publicationDate":"2026-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148499690","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":"Intraoperative management of iatrogenic bile duct injury during robotic Whipple procedure","authors":"Aram Rojas ,&nbsp;Sarah B. Hays ,&nbsp;Syed Mehdi ,&nbsp;Melissa E. Hogg","doi":"10.1016/j.ciresp.2026.800300","DOIUrl":"10.1016/j.ciresp.2026.800300","url":null,"abstract":"","PeriodicalId":50690,"journal":{"name":"Cirugia Espanola","volume":"104 6","pages":"Article 800300"},"PeriodicalIF":1.3,"publicationDate":"2026-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148187019","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":"Dexketoprofen-mediated attenuation of ischemia-reperfusion injury in a rat model of lower limb ischemia","authors":"Pablo Martínez-Rubio ,&nbsp;Ignacio García-Alonso ,&nbsp;Amador García Ruiz de Gordejuela ,&nbsp;Daniel Alonso-Alconada ,&nbsp;Sira Iturrizaga ,&nbsp;Iñigo Cearra ,&nbsp;Inmaculada Ruiz-Montesinos ,&nbsp;Borja Herrero de la Parte","doi":"10.1016/j.ciresp.2026.800302","DOIUrl":"10.1016/j.ciresp.2026.800302","url":null,"abstract":"<div><div>Lower limb ischemia/reperfusion injury (IRI-LL) triggers a systemic inflammatory response after restoring blood flow to an ischemic limb. This study evaluated whether dexketoprofen (DEX) given before reperfusion mitigates IRI-LL. Fifty-six male WAG/RijHsd rats were assigned to one control, 3 vehicles, and 3 DEX-treated groups. After 3 h of hindlimb ischemia, reperfusion lasted 3 h, 24 h, or 14 days. Either DEX (1 mg/kg, po) or saline was administered 30 min before reperfusion. Biochemical markers, limb circumference, and motor performance (rotarod and treadmill) were assessed. DEX significantly reduced serum markers of muscle and hepatic injury but had no effect on renal parameters or edema. Functional recovery improved from day 5 onwards in treated animals. Prophylactic DEX administration effectively attenuated biochemical and functional damage secondary to IRI-LL, supporting its potential as a protective therapy against reperfusion injury.</div></div>","PeriodicalId":50690,"journal":{"name":"Cirugia Espanola","volume":"104 6","pages":"Article 800302"},"PeriodicalIF":1.3,"publicationDate":"2026-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148187020","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 TROPIS technique for complex anal fistula: A promising but still evolving approach","authors":"V.D. Yagnik ,&nbsp;P.R. Choudhary","doi":"10.1016/j.ciresp.2025.800261","DOIUrl":"10.1016/j.ciresp.2025.800261","url":null,"abstract":"","PeriodicalId":50690,"journal":{"name":"Cirugia Espanola","volume":"104 6","pages":"Article 800261"},"PeriodicalIF":1.3,"publicationDate":"2026-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148187021","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":"One-year outcomes by index treatment in older patients with acute cholecystitis. Protocol of the international, prospective, observational GOLDENEYE study","authors":"Núria Lluís ,&nbsp;Sara Pérez-Brotons ,&nbsp;Isabel de Castro ,&nbsp;Belén Martínez ,&nbsp;José R Aparicio ,&nbsp;Pedro Zapater ,&nbsp;Fèlix Lluís ,&nbsp;Enrique de-Madaria","doi":"10.1016/j.ciresp.2025.800282","DOIUrl":"10.1016/j.ciresp.2025.800282","url":null,"abstract":"<div><h3>Background</h3><div>This research project is motivated by the increasing prevalence of gallstones and biliary tract diseases in patients of advanced age, while also recognizing that the comorbidity burden of this population may necessitate a tailored treatment approach. Acute cholecystitis can rapidly progress to systemic inflammatory response syndrome, sepsis and even death. Age <em>per se</em> has no bearing on the severity of acute cholecystitis, but the burden of comorbidity in older patients may lead to rapid disease progression.</div></div><div><h3>Methods</h3><div>The GOLDENEYE study is an international, multicenter, prospective, observational research project designed to compare the outcomes of different management strategies for acute cholecystitis in seniors. The primary aims are to evaluate the efficacy of different treatments—supportive care, percutaneous gallbladder drainage, early or delayed cholecystectomy, and EUS-guided gallbladder drainage—on one-year additional treatment modalities, hospital readmissions, and outpatient care. Secondary outcomes are quality of life and survival rates. The study implements propensity score matching analysis to account for the non-randomized allocation of treatment modalities. Patients ≥ 70 years diagnosed with acute cholecystitis, as per the Tokyo guidelines, are included. Exclusion criteria include prior episodes of cholecystitis or pancreatitis, terminal illness, and concurrent diagnosis of acute pancreatitis, cholangitis, bile duct disease, or digestive malignancy. Data collection is performed with the REDCap platform for data entry and monitoring.</div></div><div><h3>Discussion</h3><div>The GOLDENEYE study aims to generate evidence-based insights that will significantly influence the management of acute cholecystitis in elderly patients, ultimately improving patient outcomes and healthcare practices in this growing demographic population. ClinicalTrials.gov, NCT07006298.</div></div>","PeriodicalId":50690,"journal":{"name":"Cirugia Espanola","volume":"104 6","pages":"Article 800282"},"PeriodicalIF":1.3,"publicationDate":"2026-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148187022","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 stepwise approach to totally robotic pancreas-sparing duodenectomy with intracorporeal duodenojejunostomy","authors":"Giuseppe Serena ,&nbsp;Naib Chowdhury ,&nbsp;Gary Bernard Deutsch ,&nbsp;Sandeep Anantha Sathyanarayana","doi":"10.1016/j.ciresp.2025.800273","DOIUrl":"10.1016/j.ciresp.2025.800273","url":null,"abstract":"<div><div>While pancreaticoduodenectomy is the standard for duodenal malignancy, pancreas-sparing duodenectomy (PSD) is a surgical option for benign duodenal disease. Robotic surgery for PSD offers advantages, such as enhanced visualization, improved instrument dexterity, and optimized dissection, while maintaining resection quality. After preoperative imaging review, we performed a totally robotic PSD with intracorporeal duodenojejunostomy in a 70-year-old patient with a 2.2-cm sessile polyp and dysplasia in the D3 portion of the duodenum. Although PSD is not indicated for malignancy, a negative intraoperative frozen section is critical before proceeding in select cases. A key learning point is combining robotic visualization with upper endoscopy to accurately define the distance between the ampulla and the lesion, ensuring oncologic margins. This manuscript outlines a stepwise surgical approach in a technically challenging scenario, aiming to preserve patient safety and provide an oncologically sound resection using totally robotic techniques.</div></div>","PeriodicalId":50690,"journal":{"name":"Cirugia Espanola","volume":"104 6","pages":"Article 800273"},"PeriodicalIF":1.3,"publicationDate":"2026-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148187018","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":"Pósteres","authors":"","doi":"10.1016/S0009-739X(26)01312-6","DOIUrl":"10.1016/S0009-739X(26)01312-6","url":null,"abstract":"","PeriodicalId":50690,"journal":{"name":"Cirugia Espanola","volume":"104 ","pages":"Pages 25-76"},"PeriodicalIF":1.3,"publicationDate":"2026-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148247467","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":"Comunicaciones orales","authors":"","doi":"10.1016/S0009-739X(26)01311-4","DOIUrl":"10.1016/S0009-739X(26)01311-4","url":null,"abstract":"","PeriodicalId":50690,"journal":{"name":"Cirugia Espanola","volume":"104 ","pages":"Pages 1-24"},"PeriodicalIF":1.3,"publicationDate":"2026-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148247469","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":"Pósteres enfermería","authors":"","doi":"10.1016/S0009-739X(26)01315-1","DOIUrl":"10.1016/S0009-739X(26)01315-1","url":null,"abstract":"","PeriodicalId":50690,"journal":{"name":"Cirugia Espanola","volume":"104 ","pages":"Pages 94-98"},"PeriodicalIF":1.3,"publicationDate":"2026-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148247466","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}