Chirurgie (Heidelberg, Germany)最新文献

{"title":"[Influencing factors and results of conversions in minimally invasive liver surgery : A single-center analysis of over 1200 consecutive cases].","authors":"Nils Haep, Lucas Illies, Yun Jung Choi, Sebastian Knitter, Philipp Haber, Felix Krenzien, Nathanael Raschzok, Johann Pratschke, Wenzel Schöning","doi":"10.1007/s00104-025-02374-0","DOIUrl":"https://doi.org/10.1007/s00104-025-02374-0","url":null,"abstract":"<p><strong>Background: </strong>Minimally invasive liver surgery is associated with lower complication rates compared to open liver surgery. Due to the growing acceptance and increasing experience with minimally invasive liver resections, open conversions have become rare but are associated with inferior postoperative outcomes.</p><p><strong>Objectives: </strong>We aimed to investigate the risk factors for conversion and outcomes in patients undergoing minimally invasive liver resections.</p><p><strong>Material and methods: </strong>We performed a post hoc analysis of 1209 consecutive minimally invasive liver resections at our center between 2015 and 2024. The factors and perioperative outcomes of conversion to open procedures were analyzed.</p><p><strong>Results: </strong>The conversion rate was 4.1% and left hemihepatectomy was associated with an increased conversion rate. The Harmonic Ace® and Waterjet® parenchyma dissectors were associated with lower conversion rates. The most common reasons for conversion were technical and adhesions. Major complications (Clavien Dindo ≥ III) within the first 90 days occurred in 18.3% of cases and conversions were associated with an increased complication rate.</p><p><strong>Conclusion: </strong>In conclusion, this study highlights the influencing factors which correlate to open conversion in minimally invasive liver resections. Open conversion was an independent predictor of an increased complication rate.</p>","PeriodicalId":72588,"journal":{"name":"Chirurgie (Heidelberg, Germany)","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2025-09-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145066655","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":"[Biliodigestive anastomosis: technique and outcome].","authors":"Maximilian Brunner, Robert Grützmann","doi":"10.1007/s00104-025-02372-2","DOIUrl":"https://doi.org/10.1007/s00104-025-02372-2","url":null,"abstract":"<p><p>The biliodigestive anastomosis represents a core element of hepatopancreatobiliary surgery. It requires a precise surgical technique and detailed knowledge of biliary anatomy and vascular supply. A tension-free suture, sufficient perfusion of the anastomosed structures and an exact mucosa-to-mucosa adaptation using delicate absorbable suture material are decisive for a successful construction. Hepaticojejunostomy has become established as the gold standard for a biliodigestive anastomosis. Currently available studies show no significant differences in morbidity between open and minimally invasive techniques, whereby the latter is becoming increasingly more important. There was also no difference in the clinical results with respect to the suture technique (interrupted vs. continuous suture); however, the continuous suture technique is associated with a shortening of the placement time and a reduction in costs. Complications after biliodigestive anastomosis, such as insufficiency and stenosis, are clinically relevant and substantially influence the morbidity and mortality; however, many of these complications can nowadays be effectively treated by interventional procedures.</p>","PeriodicalId":72588,"journal":{"name":"Chirurgie (Heidelberg, Germany)","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2025-09-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145024825","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":"[Predictive factors for failure of antibiotic treatment of uncomplicated appendicitis: secondary analysis of 2 randomized studies].","authors":"C Germer, J Reibetanz","doi":"10.1007/s00104-025-02383-z","DOIUrl":"https://doi.org/10.1007/s00104-025-02383-z","url":null,"abstract":"","PeriodicalId":72588,"journal":{"name":"Chirurgie (Heidelberg, Germany)","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2025-09-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145016682","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":"[500 minimally invasive liver resections-Experiences, results and technical developments of a high-volume center].","authors":"Schaima Abdelhadi, Mohamad El-Ahmar, Flavius Sandra-Petrescu, Christoph Reissfelder","doi":"10.1007/s00104-025-02373-1","DOIUrl":"https://doi.org/10.1007/s00104-025-02373-1","url":null,"abstract":"<p><strong>Background: </strong>Minimally invasive liver surgery has rapidly evolved in recent years. In addition to the laparoscopic liver resection (LLR), robot-assisted liver resection (RLR) is increasingly gaining in importance; however, although the robotic-assisted approach offers clinical benefits, particularly in complex procedures, it remains a matter of debate.</p><p><strong>Objective: </strong>The aim of this study was to present the development, perioperative outcomes, key challenges, and insights from over 500 minimally invasive liver resections performed at a specialized high-volume center. It focused on the comparison between LLR and RLR based on the IWATE difficulty score.</p><p><strong>Material and methods: </strong>A retrospective single-center analysis of 526 consecutive elective minimally invasive liver resections (2018-2024) was conducted. All cases were stratified using the IWATE score. The LLR and RLR were compared in terms of operative parameters, conversion rate and postoperative complications. Additionally, the annual procedural development was analyzed.</p><p><strong>Results: </strong>The RLR was established in 2021 and accounted for over 50% of all minimally invasive liver resections by 2024. Compared to LLR, RLR was associated with significantly reduced intraoperative blood loss as well as lower conversion and complication rates, particularly in technically demanding resections. Despite an increasing proportion of advanced/expert resections, the rate of major complications could be reduced over time.</p><p><strong>Conclusion: </strong>Minimally invasive liver resections can be safely performed at high-volume centers. The robotic-assisted technique offers specific advantages especially in complex resections, with respect to complication rates, reduced conversion rates and decreased blood loss. A key success factor in the implementation of robotic liver surgery is the pre-existing expertise in laparoscopic techniques, which significantly shortened the learning curve. The use of standardized techniques such as the scissor hepatectomy may have contributed to the comparatively low rate of bile leaks observed in RLR.</p>","PeriodicalId":72588,"journal":{"name":"Chirurgie (Heidelberg, Germany)","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2025-09-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145007003","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":"[Is splenectomy necessary during distal pancreatectomy for a non-functional pNET?]","authors":"Imane Zahidi, Detlef K Bartsch","doi":"10.1007/s00104-025-02382-0","DOIUrl":"https://doi.org/10.1007/s00104-025-02382-0","url":null,"abstract":"","PeriodicalId":72588,"journal":{"name":"Chirurgie (Heidelberg, Germany)","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2025-09-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145002033","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":"[Entrustable professional activities-A paradigm shift in the surgical training from quantity to quality].","authors":"Mohammed Ibrahim, Steffen Axt, Judith Dechantsreiter, Adrian P Marty, Alfio Milazzo, André L Mihaljevic, Philipp Kron","doi":"10.1007/s00104-025-02370-4","DOIUrl":"10.1007/s00104-025-02370-4","url":null,"abstract":"<p><strong>Background: </strong>Since the 2020 revision of the medical training regulations surgical training in Germany has been based on the acquisition of knowledge (cognitive and methodological competence) as well as experience and skills (practical competence). As in previous training catalogues, minimum numbers are defined for essential operations; however, these operation catalogues do not reflect the actual surgical competence of residents.</p><p><strong>Objective: </strong>This paper highlights the current challenges faced by prospective surgeons. It presents a perspective on a core competency-oriented surgical training model using entrustable professional activities (EPAs) and provides suggestions for the implementation and digitalization of surgical education based on EPAs.</p><p><strong>Material and methods: </strong>Overview in the sense of a narrative review.</p><p><strong>Results: </strong>The EPAs are clearly defined clinical tasks in the medical practice that can be entrusted to residents, observed and evaluated. The purpose of EPAs is the structured and continuous assessment of individual competencies in medical training. They are specific, embedded in the surgical routine and can support supervisors in implementing competency-based training. The EPAs serve to assess and promote surgical skills. Through digitalization tools such as smartphone applications, these evaluations can be integrated into daily clinical practice.</p><p><strong>Discussion: </strong>In the future, surgical education should evolve towards competency-based learning. The use of EPAs enables a more practice-oriented training approach: moving away from the quantitative focus of procedure catalogues toward a qualitative improvement of surgical training.</p>","PeriodicalId":72588,"journal":{"name":"Chirurgie (Heidelberg, Germany)","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2025-09-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144994559","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":"[Comparison of early versus late oral feeding after esophagectomy: results of a prospective randomized study].","authors":"L M Schiffmann, C J Bruns","doi":"10.1007/s00104-025-02381-1","DOIUrl":"10.1007/s00104-025-02381-1","url":null,"abstract":"","PeriodicalId":72588,"journal":{"name":"Chirurgie (Heidelberg, Germany)","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2025-09-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144980754","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":"[Near-infrared autofluorescence during bilateral neck exploration for mild primary hyperparathyroidism].","authors":"Imane Zahidi, Detlef K Bartsch","doi":"10.1007/s00104-025-02356-2","DOIUrl":"10.1007/s00104-025-02356-2","url":null,"abstract":"","PeriodicalId":72588,"journal":{"name":"Chirurgie (Heidelberg, Germany)","volume":" ","pages":"779-780"},"PeriodicalIF":0.0,"publicationDate":"2025-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144638827","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":"[Oncological outcome after TME versus selective watch and wait after total neoadjuvant treatment of rectal cancer : A pooled analysis of the randomized CAO/ARO/AIO-12 and OPRA studies].","authors":"J Reibetanz, C Germer","doi":"10.1007/s00104-025-02354-4","DOIUrl":"10.1007/s00104-025-02354-4","url":null,"abstract":"","PeriodicalId":72588,"journal":{"name":"Chirurgie (Heidelberg, Germany)","volume":" ","pages":"783-784"},"PeriodicalIF":0.0,"publicationDate":"2025-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144638828","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":"[COMPARE study: dV-RAS versus Lap/VATS and open].","authors":"Mika Henkenjohann, Michael Ardelt, Utz Settmacher","doi":"10.1007/s00104-025-02358-0","DOIUrl":"10.1007/s00104-025-02358-0","url":null,"abstract":"","PeriodicalId":72588,"journal":{"name":"Chirurgie (Heidelberg, Germany)","volume":" ","pages":"781-782"},"PeriodicalIF":0.0,"publicationDate":"2025-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144661147","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}