Chirurgie (Heidelberg, Germany)最新文献

{"title":"[Update on papillary thyroid cancer-What is relevant for surgeons?]","authors":"Ann-Kathrin Lederer, Thomas J Musholt","doi":"10.1007/s00104-025-02275-2","DOIUrl":"10.1007/s00104-025-02275-2","url":null,"abstract":"<p><p>Papillary thyroid cancer (PTC) is the most frequent malignant thyroid tumor in Germany. The diagnosis can only be confirmed by histological examination of the suspicious tissue. The clinical signs, sonographic findings, and the results of fine-needle aspiration, possibly supplemented by subsequent molecular genetic analysis, can confirm the suspected diagnosis before surgery. The prognosis is very good if the diagnosis is made early and, depending on the size of the tumor, complete surgical removal is achieved, with a 10-year survival rate of more than 90%; however, histologically PTC has several variants that are associated with either a high or low risk of metastases and recurrence in patients. Therefore, the extent of necessary treatment, in particular surgical interventions for PTC has been discussed for years. This article provides an overview of the current knowledge on the diagnosis, treatment and prognosis of PTC.</p>","PeriodicalId":72588,"journal":{"name":"Chirurgie (Heidelberg, Germany)","volume":" ","pages":"537-543"},"PeriodicalIF":0.0,"publicationDate":"2025-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143765941","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"[Time for change: what must the high-quality surgical training network of tomorrow offer? : Perspectives and demands of the Young Forums of the Surgical Societies in Germany].","authors":"Frederik Schlottmann, Sebastian Schaaf, Romina Maria Rösch, Maria E Dey Hazra, Marit Herbolzheimer, Sabine Drossard, Louisa Schuffert, Benedikt J Braun, Sarah Lif Keller, Arash Motekallemi, Joscha Mulorz, Hruy Menghesha, Anna Lawson McLean, Tobias Huber, Frederic Bouffleur, Gerrit Freund","doi":"10.1007/s00104-025-02269-0","DOIUrl":"10.1007/s00104-025-02269-0","url":null,"abstract":"<p><strong>Background: </strong>The hospital structural reform through the Hospital Treatment Remuneration Improvement Act (Krankenhausversorgungsverbesserungsgesetz, KHVVG) will fundamentally change the medical care landscape in Germany starting in 2025. Outpatient care and cross-sectoral care models will substantially influence advanced surgical training. In particular, comprehensive training networks between hospitals and outpatient facilities are being discussed as a core solution to ensure surgical training.</p><p><strong>Objective: </strong>The aim of this position paper is to highlight the wishes and demands of young surgeons regarding training alliances. These should serve as guidelines for the stakeholders involved for a successful implementation.</p><p><strong>Material and methods: </strong>The position paper is based on discussions of the Young Forums of surgical societies, analyses of current further training models and experiences from pilot projects. It describes measures that promote cross-sectoral structured further training with clear legal, financial and didactic framework conditions.</p><p><strong>Results: </strong>Successful models, such as rotation in outpatient facilities, show a positive effect on further training and practical experience. Necessary steps include simplifications of labor legislation, transparent curricula, adequate financing and certified didactic qualifications for those providing surgical residency training. Pilot projects underline the potential of intersectoral cooperation, while inadequate legal and financial structures have been identified as the main obstacles.</p><p><strong>Conclusion: </strong>The introduction of mandatory continuous education networks is essential to ensure surgical residency training and improving the quality of surgical patient care. In addition to political action to finance and adapt the framework conditions, hospitals and outpatient facilities need to take the initiative. In the long term surgical continuing education in Germany should be of exceptional quality.</p>","PeriodicalId":72588,"journal":{"name":"Chirurgie (Heidelberg, Germany)","volume":" ","pages":"568-573"},"PeriodicalIF":0.0,"publicationDate":"2025-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12202498/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143652256","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"[Presentation of a new pre-emptive endoscopic treatment concept in duodenal interventions exemplified by an iatrogenic duodenal perforation after percutaneous transrenal nephrostomy. German version].","authors":"V Betz, A Goerdt, R Kiesow, J Müller, B Riefel, E Scharsack, U Zimmermann, M Reeh, G Loske","doi":"10.1007/s00104-025-02256-5","DOIUrl":"10.1007/s00104-025-02256-5","url":null,"abstract":"","PeriodicalId":72588,"journal":{"name":"Chirurgie (Heidelberg, Germany)","volume":" ","pages":"593-597"},"PeriodicalIF":0.0,"publicationDate":"2025-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12202674/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144121543","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"[Increasing infection parameters after initiation of nasal tube feeding].","authors":"Kilian Doßow, Steffi Peglow, Frank Benedix, Ahmed Afifi, Mohammad Abdallah Alhabahbeh, Christine March, Roland Croner, Frank Meyer","doi":"10.1007/s00104-025-02325-9","DOIUrl":"https://doi.org/10.1007/s00104-025-02325-9","url":null,"abstract":"","PeriodicalId":72588,"journal":{"name":"Chirurgie (Heidelberg, Germany)","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2025-06-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144478044","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"[Development of surgical intensive care medicine and status quo in Germany].","authors":"René Wildenauer, Uwe Hamsen","doi":"10.1007/s00104-025-02320-0","DOIUrl":"https://doi.org/10.1007/s00104-025-02320-0","url":null,"abstract":"<p><strong>Introduction: </strong>Intensive care medicine in Germany has fundamentally developed in the context of medical progress and changed treatment requirements. Originally preceded by pioneer work in surgery, intensive medical care facilities are nowadays decisive cost drivers in patient care. Earlier models from around the 1930s were replaced by specialization and interdisciplinary cooperation. Against this background the present study investigated the current state of care, the structures for continuing education and the implementation of surgical intensive and intermediate care (IMC) wards.</p><p><strong>Material and methods: </strong>Between 27 February 2023 and 8 May 2023, a representative sample of 1106 intensive care wards was pooled using an anonymous online survey on a German web server (lamapoli.de) and 181 complete replies could be evaluated. The survey incorporated 42 questions, which in addition to the demographic acquisition also requested data on the resources, leadership and continuing education modalities of personnel on independent surgical intensive care wards as well as interdisciplinary surgical intensive care wards (IOI) and IMCs.</p><p><strong>Results: </strong>Approximately 17% of the hospitals surveyed had their own surgical intensive care ward, predominantly in university hospitals. These units are characterized by a high presence of the specialist discipline and qualified personnel with additional qualifications in intensive care medicine. In contrast, interdisciplinary intensive care wards were used in facilities with a lower level of care, frequently managed by anesthesiology departments. The continuing education times for assistant surgeons were in most cases longer than 6 months, which promotes an intensive transfer of knowledge and interdisciplinary cooperation. The IMC wards are also an integral component of surgical care even though they are personnel intensive and more economically challenging. The study shows that surgical intensive care medicine has a well-structured, discipline-specific care and training, especially at university locations. In facilities with lower levels of care interdisciplinary models dominate, which also enable an adequate training. Nevertheless, the debate on the retention of discipline-specific knowledge in intensive care medicine remains a current topic in order to ensure a high quality of perioperative care.</p>","PeriodicalId":72588,"journal":{"name":"Chirurgie (Heidelberg, Germany)","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2025-06-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144327899","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"[Underfunding of surgical services in sarcoma treatment: a retrospective analysis of inpatient treatment costs at a university sarcoma center].","authors":"Vladyslav Kavaka, Rose Haag, Louisa Sarica, Johannes C Heinzel, Sebastian Hoffmann, Lukas Bankamp, Ingmar Rieger, Claudius Illg, Sabrina Krauß, Katarzyna Rachunek-Medved, Michael Cerny, Dominik Steiner, Henrik Lauer, Jonas Kolbenschlag, Adrien Daigeler, Johannes Tobias Thiel","doi":"10.1007/s00104-025-02322-y","DOIUrl":"https://doi.org/10.1007/s00104-025-02322-y","url":null,"abstract":"<p><strong>Background and objective: </strong>Soft tissue sarcomas are rare heterogeneous tumors that require extensive treatment and should only be treated in specialized sarcoma centers. Surgical R0 resection with negative margins is one of the most important positive predictors of disease-specific survival. Comprehensive healthcare economic analyses of inpatient treatment costs are largely lacking but are essential to ensure sustainable and cost-effective care.</p><p><strong>Methods: </strong>This retrospective single center study analyzed the inpatient costs of 112 sarcoma cases treated at this university tumor center between 2020 and 2022. The statistical analyses were performed to identify variables that influence case underfunding. Additionally, the revenue distribution was examined with respect to the frequency and extent of underfunding using the cost matrix of the Institute for the Remuneration System in Hospitals (InEK).</p><p><strong>Results: </strong>A negative revenue balance was observed in 66.1% of cases, leading to a total deficit exceeding € 222,000. Significant predictors of underfunding included prolonged operation times, duration of intensive care stay and exceeding the average length of stay. The highest negative revenues were identified in the categories of \"infrastructure costs\", \"medical technical services\" and \"operating room costs\".</p><p><strong>Conclusion: </strong>The results reveal significant underfunding of surgical sarcoma treatment in a specialized university sarcoma center. Adjustments to diagnosis-related groups (DRG)-based reimbursement are urgently needed to ensure the economic sustainability of care while safeguarding patient safety, academic training and making clinical decisions.</p>","PeriodicalId":72588,"journal":{"name":"Chirurgie (Heidelberg, Germany)","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2025-06-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144236016","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"[Treatment results after vascular extremity trauma-Initial results of the vascular trauma register Augsburg (VascTR-Aux)].","authors":"Tobias Dominik Warm, Yaser Souri, Alexander Hyhlik-Dürr, Yvonne N Goßlau","doi":"10.1007/s00104-025-02317-9","DOIUrl":"https://doi.org/10.1007/s00104-025-02317-9","url":null,"abstract":"<p><strong>Background: </strong>A prospective vascular trauma registry (VascTR-Aux) is being conducted at Augsburg University Hospital. This first evaluation of the registry data aims to present the treatment results after vascular extremity injuries at discharge.</p><p><strong>Material and methods: </strong>From 1 January 2016 to 31 March 2024, a total of155 injured persons were included in the VascTR-Aux. Extremity vessels were affected in 83 patients.</p><p><strong>Results: </strong>Of the 83 injured people included, 62 were male. The average age was 37 years. The vascular injuries affected the upper limb in 28 cases and the lower limb in 55 cases. In 14 cases, the injuries were severe. The patients presented clinically with 29 hemorrhages, 32 ischemia and 14 combinations of both entities and 7 cases were asymptomatic. Patients were treated surgically (n = 51), as a hybrid procedure (n = 7) and as endovascular procedures (n = 8). In 76 cases functional preservation of the extremity was possible. Major amputation was necessary in six cases and minor amputation in two cases. The average length of stay was 23 days.</p><p><strong>Discussion: </strong>The initial treatment was often interdisciplinary, whereas inpatient follow-up care is often provided by specialist departments other than vascular surgery due to the concomitant injuries requiring treatment. The vascular surgery procedure for treatment and follow-up care must be discussed and communicated individually in the case of vascular injuries, and a vascular surgery follow-up protocol must be established for post-inpatient follow-up examinations. Both endovascular and open surgical treatment options should be available for the treatment of vascular limb injuries. The aim of the registry is to contribute to evidence for the treatment of vascular trauma and to collect long-term results for reconstructions after vascular trauma.</p>","PeriodicalId":72588,"journal":{"name":"Chirurgie (Heidelberg, Germany)","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2025-06-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144227829","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"[Surgery meets palliative care : Should palliative care be integrated into surgical training?]","authors":"Karin Koisser","doi":"10.1007/s00104-025-02319-7","DOIUrl":"https://doi.org/10.1007/s00104-025-02319-7","url":null,"abstract":"<p><p>The transfer of knowledge, experience and practical skills in the care of patients in palliative settings takes place in a largely unstructured and sporadic manner in surgical resident training in Austria. The present work assesses the status quo using an online survey of residents in general and visceral surgery, presents their subjective experiences with palliative care and expectations on palliative care providers and their training needs. Over 80% of residents have frequent contact with patients in palliative settings and nearly 60% care for patients in end-of-life situations. Support from a palliative care team is experienced as helpful. Residents would like more support and articulate how they envision this form of support. They rate their own palliative skills as medium to good but 85% would still like additional training and 68% advocate for the integration of palliative care into the surgical curriculum.</p>","PeriodicalId":72588,"journal":{"name":"Chirurgie (Heidelberg, Germany)","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2025-06-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144236015","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"[Transition phase to robot-assisted surgery for colorectal cancer: a comparative consecutive cohort study].","authors":"U A Dietz, M Kalisvaart, S Maksimovic, R Frey, M Ramser, B M Erhart, U Pfefferkorn","doi":"10.1007/s00104-025-02316-w","DOIUrl":"https://doi.org/10.1007/s00104-025-02316-w","url":null,"abstract":"<p><strong>Background: </strong>Colorectal cancer is increasingly being treated with a minimally invasive approach and, more recently, also robot-assisted surgery.</p><p><strong>Methods: </strong>This controlled cohort study of colorectal cancer surgery compares the results during the transition period from conventional laparoscopy (2015-2017) to robot-assisted surgery (2018-2022). The parameters examined included postoperative complications according to the Clavien-Dindo classification, the TNM classification, the number of resected lymph nodes, and the Textbook Oncologic Outcome (TOO).</p><p><strong>Results: </strong>In the robotic group there were more patients with ASA classification grades 3-4 (p = 0.016), in the laparoscopic group there were more left-sided and rectal tumors and in the robotic group there were more tumors of the transverse colon and right-sided colon (p < 0.001). In the laparoscopic group more patients required a reoperation (R 5% vs. L 19%; p = 0.007), there were more complications in general (R 22% vs. L 40%) and more severe complications in particular (CDC grade ≥ III, R 8% vs. L 25%; p = 0.023). Anastomotic leaks occurred more often in the laparoscopic group (R 5% vs. L 17%, p = 0.032). No significant differences were found in either the 2‑year survival (OS) or recurrence-free survival (RFS, OS: R 97% vs. L 98%, p = 0.455. RFS: R 98% vs. L 92%, p = 0.232). In the laparoscopy group, significantly more tumor recurrences occurred over the course of 4 years (R 1% vs. L 14%; p = 0.009). There were more patients with TOO in the robot-assisted (89.53%) than in the laparoscopic groups (53.79%).</p><p><strong>Conclusion: </strong>The transition phase from laparoscopy to robotics was safe: complications were reduced and TOOs increased, lymph node resection and 2‑year survival were comparable. Robotic-assisted oncological surgery can be offered in a high-quality manner at a central hospital and makes an important contribution to the quality of patient care.</p>","PeriodicalId":72588,"journal":{"name":"Chirurgie (Heidelberg, Germany)","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2025-06-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144227828","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"[10-year results of the SM-BOSS study on Roux-en-Y gastric bypass vs. sleeve gastrectomy for obesity].","authors":"Alida Finze, Mirko Otto, Christoph Reissfelder","doi":"10.1007/s00104-025-02290-3","DOIUrl":"10.1007/s00104-025-02290-3","url":null,"abstract":"","PeriodicalId":72588,"journal":{"name":"Chirurgie (Heidelberg, Germany)","volume":" ","pages":"520-521"},"PeriodicalIF":0.0,"publicationDate":"2025-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144059355","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}