Chirurgie (Heidelberg, Germany)最新文献

{"title":"[Reform proposal \"Occasional surgical oncology\" : Medical strategic analysis and ramifications of the draft bill within the framework of the Hospital Treatment Improvement Act (KHVVG) from the perspective of a university hospital].","authors":"Valesca Spreider, Stefan Fichtner-Feigl, Frederik Wenz, Dalibor Bockelmann","doi":"10.1007/s00104-024-02146-2","DOIUrl":"https://doi.org/10.1007/s00104-024-02146-2","url":null,"abstract":"<p><strong>Background: </strong>Cancer remains the second most common cause of death in Germany. Performance management and specialization concepts in medicine have the potential to positively influence the care and chances of survival of patients.</p><p><strong>Objective: </strong>From the perspective of the University Hospital Freiburg (UKF), the legislative initiative within the framework of the Hospital Treatment Improvement Act (KHVVG) results in a number of medical strategic implications. This article explains and discusses the background, objectives and contents of the reform project \"Occasional surgical oncology\" and provides perspectives on strategic fields of action.</p><p><strong>Material and methods: </strong>Analysis and interpretation of the draft of the Act for improvement of the treatment quality in hospitals and on the reform of the remuneration structures (Federal Government draft act).</p><p><strong>Results: </strong>From the point of view of the UKF hospitals should engage in cooperative discussions with neighboring hospitals at the earliest opportunity to shape regional healthcare with the goals of mapping the local allocation of oncology patients for optimal treatment, mitigating the loss of patients at affected locations and preparing for patient growth at facilities that will continue to provide treatment in surgical oncology.</p><p><strong>Discussion: </strong>The ongoing legislative process and the fact that a reliable analysis of relevant treatment areas will be possible for hospitals in the first half of 2025, presents particular challenges for hospitals and the strategic planning of activities. The gaps in the bill presented in this article should be urgently addressed to avoid undermining the project's goals and to support the hospitals remaining in the healthcare system in their preparations.</p>","PeriodicalId":72588,"journal":{"name":"Chirurgie (Heidelberg, Germany)","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-08-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141984072","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":"[Fostering young talents for surgery : Laparoscopy in preclinical education-Too early or exactly right?]","authors":"Marvin Heimke, Tillmann Heinze, Jorun Baumann, Bodo Kurz, Ibrahim Alkatout, Thilo Wedel","doi":"10.1007/s00104-024-02145-3","DOIUrl":"https://doi.org/10.1007/s00104-024-02145-3","url":null,"abstract":"<p><strong>Background: </strong>Due to the declining interest among medical students in pursuing a surgical career, the impact of demographic changes and the technical challenges, there is an increasing need to attract medical students to the surgical profession. Against this backdrop, a teaching project was developed to familiarize medical students with minimally invasive surgical techniques early in the preclinical education, thereby increasing the interest in surgery.</p><p><strong>Material and methods: </strong>Within the framework of the regular anatomical dissection course the following modules on laparoscopic surgery were integrated: (1) clinical lecture on the technique and application of laparoscopy, (2) exploratory live laparoscopy on a body donor and (3) practical exercises on laparoscopic trainers. The impact of this teaching project on the interest in a surgical career and on the clinical anatomical understanding was evaluated among 295 participating medical students.</p><p><strong>Results: </strong>The evaluation revealed a pronounced gender-independent interest in learning surgical skills early in the preclinical study phase. The teaching project led to a significantly increased interest in pursuing a surgical career. Moreover, the incorporation of laparoscopic teaching modules into the preclinical anatomy course enhanced the learning motivation and understanding of clinically relevant topographic anatomy.</p><p><strong>Conclusion: </strong>The integration of practical surgical content into preclinical anatomical education can increase the attractiveness of surgical disciplines and simultaneously optimize teaching of anatomy. Longitudinal studies are required to examine the sustainability of these clinical teaching modules in career decisions of medical students.</p>","PeriodicalId":72588,"journal":{"name":"Chirurgie (Heidelberg, Germany)","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-08-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141972345","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":"[Xenotransplantation of solid organs].","authors":"Michael Schmoeckel, Matthias Längin, Bruno Reichart, Jan-Michael Abicht, Martin Bender, Joachim Denner, Georg Marckmann, Paolo Brenner, Eckhard Wolf, Christian Hagl","doi":"10.1007/s00104-024-02093-y","DOIUrl":"10.1007/s00104-024-02093-y","url":null,"abstract":"<p><p>Transplantation of genetically modified porcine hearts and kidneys could become a solution to the persistent shortage of human organ donors. Progress has been made in genetic engineering of donor pigs, preservation techniques after organ harvesting and immunosuppression using co-stimulation blockade with anti-CD40/CD40L monoclonal antibodies. Progress has also been made in in the development of methods that detect pathogenic porcine viruses and prevent their transmission to the recipient. As normal land breed pig organs continue to grow in the recipient to their original size, different pig breeds (such as Auckland Island pigs) are now used which reach a final size suitable for humans. Alternatively, a knock-out of the growth hormone receptor gene has been established, e.g., in the 10GM genetically modified pigs from Revivicor/United Therapeutics, USA. The first clinical pilot studies including patients suffering from terminal heart failure are expected to start in Germany in about 2 years.</p>","PeriodicalId":72588,"journal":{"name":"Chirurgie (Heidelberg, Germany)","volume":" ","pages":"603-609"},"PeriodicalIF":0.0,"publicationDate":"2024-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11286678/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140920911","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":"[The role of the musculoadipose status in the assessment of the risk profile before liver transplantation].","authors":"Aladdin Ali Deeb, Falk Rauchfuß, Utz Settmacher","doi":"10.1007/s00104-024-02111-z","DOIUrl":"10.1007/s00104-024-02111-z","url":null,"abstract":"<p><p>Sarcopenia and sarcopenic obesity worsen the prognosis after liver transplantation; however, the assessment of body composition is not yet considered in the evaluation prior to liver transplantation to estimate the risk profile of the recipient. Prehabilitation, which includes the nutritional supplementation and physiotherapy, represents a recent focus of interest in clinical transplantation research. This article gives an overview of the recent knowledge about the role of the musculoadipose status and the available methods for the estimation in the assessment of the recipient's risk profile.</p>","PeriodicalId":72588,"journal":{"name":"Chirurgie (Heidelberg, Germany)","volume":" ","pages":"632-637"},"PeriodicalIF":0.0,"publicationDate":"2024-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141201641","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":"[Severe cholecystitis during the COVID-19 pandemic : Influence of the COVID-19 pandemic on the frequency of surgery and outcome for elective and emergency cholecystectomy: a monocentric retrospective cohort analysis].","authors":"Maria Neve Stolberg-Stolberg, Felix Becker, Joachim Gerß, Matthias Brüwer","doi":"10.1007/s00104-024-02085-y","DOIUrl":"10.1007/s00104-024-02085-y","url":null,"abstract":"<p><strong>Background: </strong>With the outbreak of the COVID-19 pandemic medical care focused on management of the infectious event. Elective interventions were cancelled and the general advice was to stay at home. How this impacted urgent and elective cholecystectomies is the subject of this work.</p><p><strong>Method: </strong>Urgent and elective cholecystectomy patients during the first year of the pandemic were compared with those of the previous year. The primary endpoint was the frequency of surgery. Furthermore, the American Society of Anesthesiologists (ASA) score, symptom duration until presentation as well as until surgery, preoperative inflammatory parameters, imaging, positive Murphy's sign, type and duration of surgery, intraoperative drain placement, intraoperative and histological severity, need for and duration of postoperative antibiotic therapy, intensive care stay, length of stay and occurrence of postoperative complications were recorded.</p><p><strong>Results: </strong>During the pandemic patients were sicker (ASA 2.13 vs. 2.31; p = 0.039), the operating time was prolonged (64.4 min vs. 74.9 min; p = 0.001) and patients were more likely to have concomitant peritonitis (15.4% vs. 29.1%: p = 0.007). Furthermore, there was a trend in the presence of leukocytosis, a positive Murphy's sign, intraoperative drain placement, intraoperative severity of inflammation, duration of postoperative antibiotic therapy and complication rate.</p><p><strong>Conclusion: </strong>During the COVID-19 pandemic cholecystitis presented with more pronounced inflammation, the surgical conditions were more difficult and postoperative recovery was prolonged.</p>","PeriodicalId":72588,"journal":{"name":"Chirurgie (Heidelberg, Germany)","volume":" ","pages":"656-662"},"PeriodicalIF":0.0,"publicationDate":"2024-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140920638","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 outcome after Roux-en-Y gastric bypass vs. duodenal switch with high body mass index: a randomized clinical study].","authors":"Maike Hermann, Mirko Otto, Christoph Reißfelder","doi":"10.1007/s00104-024-02130-w","DOIUrl":"10.1007/s00104-024-02130-w","url":null,"abstract":"","PeriodicalId":72588,"journal":{"name":"Chirurgie (Heidelberg, Germany)","volume":" ","pages":"669-670"},"PeriodicalIF":0.0,"publicationDate":"2024-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141731677","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":"[Machine perfusion in transplantation surgery].","authors":"Felicia Kneifel, Florian Vondran, Thomas Vogel","doi":"10.1007/s00104-024-02122-w","DOIUrl":"10.1007/s00104-024-02122-w","url":null,"abstract":"<p><p>The use of machine perfusion in solid organ transplantation has developed tremendously worldwide in recent years. Although the number of randomized controlled trials in the field of organ preservation is still limited, machine perfusion has been shown to be superior to static cold storage of donor organs. Various devices for clinical use with hypothermia or normothermia are already available for most organs. Whether and which perfusion strategy is superior to the others is the subject of current clinical research. This also applies to the further evaluation of possible synergistic effects in the sequential use of the various protocols. The common goal of all dynamic perfusion technologies is to optimize organ preservation between removal and transplantation. By testing the quality of marginal donor organs prior to transplantation, it should also be possible to use these organs without exposing the patient to increased risk. This can lead to a significant expansion of the donor pool. This is particularly important in Germany, where there is an ongoing shortage of organs and restrictive legislation regarding the expansion of the donor pool. Furthermore, the perfusion technology offers the possibility to serve as a platform for other ex situ and in situ therapies on isolated organs. In addition to the conditioning of pre-damaged organs for transplantation, this could lead to further applications in the context of targeted organ therapies and also to improved transplant logistics in the future.</p>","PeriodicalId":72588,"journal":{"name":"Chirurgie (Heidelberg, Germany)","volume":" ","pages":"610-617"},"PeriodicalIF":0.0,"publicationDate":"2024-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141763021","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":"[Innovations in transplantation].","authors":"Utz Settmacher, Falk Rauchfuß","doi":"10.1007/s00104-024-02126-6","DOIUrl":"10.1007/s00104-024-02126-6","url":null,"abstract":"","PeriodicalId":72588,"journal":{"name":"Chirurgie (Heidelberg, Germany)","volume":"95 8","pages":"601-602"},"PeriodicalIF":0.0,"publicationDate":"2024-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141790190","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":"[Influence of steatosis and fibrosis on the outcome after major liver resection of perihilar cholangiocarcinoma].","authors":"Oliver Rohland, Michael Ardelt, Utz Settmacher","doi":"10.1007/s00104-024-02128-4","DOIUrl":"10.1007/s00104-024-02128-4","url":null,"abstract":"","PeriodicalId":72588,"journal":{"name":"Chirurgie (Heidelberg, Germany)","volume":" ","pages":"665-666"},"PeriodicalIF":0.0,"publicationDate":"2024-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141581710","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":"[Organ donation and organ assessment after primary circulatory death and secondary brain death].","authors":"Philip C Müller, Beat P Müller, Philipp Dutkowski","doi":"10.1007/s00104-024-02094-x","DOIUrl":"10.1007/s00104-024-02094-x","url":null,"abstract":"<p><strong>Background: </strong>The global organ shortage is the biggest obstacle to expand urgently needed liver transplantation activities. In addition to donation after brain death (DBD), donation after primary circulatory death (DCD) has also been introduced in many European countries to increase the number of donated organs.</p><p><strong>Objective: </strong>This article summarizes the legal and ethical aspects of DCD, the practical donation process of DCD, the clinical results of DCD liver transplantation with a special focus on organ assessment before a planned DCD liver transplantation.</p><p><strong>Results: </strong>In Europe 11 countries have active DCD liver transplantation programs and a total of 1230 DCD liver transplantations were performed in Europe in 2023. The highest proportion of DCD liver transplantations were recorded in Belgium (52.8%), the Netherlands (42.8%) and Switzerland (32.1%). The adequate selection of donors and recipients is crucial in DCD transplantation and the use of DCD livers particularly depends on the preparedness of the healthcare system for routine machine perfusion. The leaders are Belgium, France and Italy which implant around 68-74% of DCD organs. With an adequate organ assessment, the long-term results of DBD and DCD liver transplantations are comparable. To assess mitochondrial damage and thus organ quality, hypothermic oxygenated machine perfusion (HOPE) was introduced and has the secondary benefit of mitochondrial protection through oxygenation. The establishment of aerobic metabolism in mitochondria under hypothermia leads to a reduction of toxic metabolites and the restoration of ATP storage, which subsequently leads to a reperfusion light during implantation.</p><p><strong>Conclusion: </strong>Expanding the donor pool with DCD donors can counteract the global organ shortage. With adequate patient selection and routine organ assessment short-term and also long-term outcomes of DBD and DCD liver transplantation are comparable.</p>","PeriodicalId":72588,"journal":{"name":"Chirurgie (Heidelberg, Germany)","volume":" ","pages":"618-626"},"PeriodicalIF":0.0,"publicationDate":"2024-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11286625/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140946479","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}