Chirurgie (Heidelberg, Germany)最新文献

{"title":"[Success factors and obstacles in the implementation of competence-oriented teaching in surgery].","authors":"C Kruppa, M Rudzki, D J Baron, M Dudda, T A Schildhauer, S Herbstreit","doi":"10.1007/s00104-024-02107-9","DOIUrl":"10.1007/s00104-024-02107-9","url":null,"abstract":"<p><strong>Background and objectives: </strong>For successful competence-oriented teaching at the medical faculties it is important to identify the factors that influence its implementation in order to benefit from the strengths and balance out weaknesses. The present study examined the success factors and obstacles of the implementation of competence-oriented teaching in the surgical discipline from the point of view of students and lecturers.</p><p><strong>Methods: </strong>After implementation of competence-oriented teaching based on the teaching goals of the NKLM, in clinical examination courses (bedside teaching and block internship, BP) at two hospitals, a qualitative content analysis and quantification of the answers were performed using focus group interviews and questionnaires with students (S) and lecturers (D).</p><p><strong>Results: </strong>During the summer semester 2022 a total of 31 students and 14 lecturers were interviewed in focus groups and 143 questionnaires (123 S, 20 D) were analyzed. For the students the presence of concrete competences/teaching goals, guidelines for the lesson, transparent goals and ability to demand teaching goals as well as structured lessons and mentoring were the main success factors. Lecturers on the other hand reported the presence of concrete goals, assistance for the lesson preparation and the activity of the students as success factors. The results of the questionnaires showed that the majority (88% S, 75% D) were informed about the teaching goals and considered them to be followed (84%S, 95% D). Obstacles were the factors \"time\", \"mentoring\" and \"information\". Factors that were between negative and positive (indifferent factors) were \"uncertainty about competence-orientation\" and \"uncertainty how to examine the teaching success\".</p><p><strong>Discussion: </strong>Transparent structure and teaching goals as well as a mentoring system are the success factors for the implementation of competence-oriented lessons and should be used as strengths. Indifferent factors represent weaknesses and need to be addressed by training and instruction. Restricted time and personnel resources are the immanent problems that hamper the implementation and require fulminant structural changes.</p>","PeriodicalId":72588,"journal":{"name":"Chirurgie (Heidelberg, Germany)","volume":" ","pages":"833-840"},"PeriodicalIF":0.0,"publicationDate":"2024-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11413039/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141201637","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":"[Treatment reality of esophageal cancer in the Federal State of Brandenburg : Comparison between squamous cell carcinoma and adenocarcinoma].","authors":"Andreas Loew, Constanze Schneider, Maren Pflüger, René Mantke, Karsten H Weylandt, Stephan Gretschel","doi":"10.1007/s00104-024-02110-0","DOIUrl":"10.1007/s00104-024-02110-0","url":null,"abstract":"<p><strong>Background: </strong>Clinical cancer registries are intended to reflect the reality of care through differentiated data analysis and, if necessary, to offer approaches for improving care.</p><p><strong>Methods: </strong>For the years 2000-2018, the data of the Clinical Epidemiological Cancer Registry Brandenburg-Berlin were examined separately for adenocarcinoma and squamous cell carcinoma with respect to epidemiology and health care reality.</p><p><strong>Results: </strong>Between 2000 and 2018 a total of 3207 esophageal cancers were documented in the cancer registry, of which 2182 were squamous cell carcinomas (ESCC), 843 adenocarcinomas (EAC) and 182 various others or missing histology. During the observation period there was a clear dominance of ESCC but with a significant increase in EAC in both sexes. Overall, the rate of new cases was 5 times higher for men than for women. The relative 5‑year survival probability of all esophageal cancers was 17.4% in men and 22.5% in women. Patients with EAC survived significantly longer than those with ESCC. Radiotherapy and chemotherapy, individually or in combination, were mainly used as treatment methods. Surgery was performed on 19% of ESCC and 42% of EAC.</p><p><strong>Conclusion: </strong>The proportion of ESCC in Brandenburg is still significantly higher than EAC, with a significant increase for the latter, especially in men. Although locally advanced tumors have been significantly more common, modern neoadjuvant concepts have rarely been documented, and although the quality of the surgery is comparable to the international standard, surgery is carried out in relatively few patients.</p>","PeriodicalId":72588,"journal":{"name":"Chirurgie (Heidelberg, Germany)","volume":" ","pages":"825-832"},"PeriodicalIF":0.0,"publicationDate":"2024-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11413088/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141302266","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":"[Tumorous lesion of the pancreas with unclear dignity].","authors":"Kilian Dossow, Sara Acciuffi, Christine March, Dörthe Jechorek, Roland S Croner, Frank Meyer, Sara Al-Madhi","doi":"10.1007/s00104-024-02132-8","DOIUrl":"10.1007/s00104-024-02132-8","url":null,"abstract":"","PeriodicalId":72588,"journal":{"name":"Chirurgie (Heidelberg, Germany)","volume":" ","pages":"841-846"},"PeriodicalIF":0.0,"publicationDate":"2024-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11413098/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141908516","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":"[Indications and technique for transoral thyroid gland and parathyroid gland surgery].","authors":"S Schopf, C Umschlag, R Mechera, E Karakas","doi":"10.1007/s00104-024-02118-6","DOIUrl":"10.1007/s00104-024-02118-6","url":null,"abstract":"<p><p>The conventional Kocher collar incision is the standard access to the thyroid and parathyroid glands. Although the incision length has been significantly shortened in recent years with this approach, there is increasing interest among patients in a surgical technique without visible scars in the décolleté. Transoral endoscopic thyroid gland surgery via the vestibular approach (TOETVA) is a modern technique that can be learned relatively quickly and leaves no visible scars because it is carried out exclusively through a natural orifice (natural orifice transluminal endoscopic surgery, NOTES). For retrieval of larger specimens, the transoral approach can be combined with a retroauricular access and thus covers a larger range of indications. The indications must be strictly followed, analogous to conventional surgery. Once the transoral access has been established, the operation is carried out as in open surgery but strictly from cranial to caudal. The classical complications are comparable to the results of conventional surgery. Specific complications include perioral, mandibular or cervical dysesthesia and hypesthesia.</p>","PeriodicalId":72588,"journal":{"name":"Chirurgie (Heidelberg, Germany)","volume":" ","pages":"801-809"},"PeriodicalIF":0.0,"publicationDate":"2024-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142082742","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":"[Long-term comparison between oral and the combination of oral and intravenous antibiotic treatment for uncomplicated appendicitis].","authors":"Patrick S Plum, Matthias Mehdorn, Ines Gockel","doi":"10.1007/s00104-024-02171-1","DOIUrl":"10.1007/s00104-024-02171-1","url":null,"abstract":"","PeriodicalId":72588,"journal":{"name":"Chirurgie (Heidelberg, Germany)","volume":" ","pages":"849-850"},"PeriodicalIF":0.0,"publicationDate":"2024-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142115583","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":"[Local resection of small intestine neuroendocrine neoplasms (SI-NEN) : Current principles].","authors":"Elisabeth Maurer, Detlef K Bartsch","doi":"10.1007/s00104-024-02102-0","DOIUrl":"10.1007/s00104-024-02102-0","url":null,"abstract":"<p><strong>Background: </strong>Neuroendocrine tumors of the small bowel (small intestine neuroendocrine neoplasms, SI-NEN) are the most frequent tumors of the small intestine and approximately 30-40% are still surgically treatable with curative intent at the time of diagnosis. Certain surgical principles must be followed for optimal oncological outcomes and good postoperative quality of life.</p><p><strong>Methods: </strong>Based on international guidelines and own experiences, the locoregional surgical treatment of SI-NENs is presented.</p><p><strong>Results: </strong>Locoregional SI-NENs should always be resected if technically feasible, as only this approach can achieve a long-term cure and even small primary tumors (< 10 mm) often already show lymphatic metastasis. The resectability of SI-NENs and their difficulty depend on the extent of lymphatic metastasis, which should be assessed based on preoperative imaging of the extent around the superior mesenteric artery. Currently, the surgical gold standard for SI-NENs is open surgery with bidigital palpation of the entire small intestine followed by primary tumor resection via small bowel segment resection, right hemicolectomy or ileocecal resection and vessel-sparing, and therefore organ-preserving lymphadenectomy (≥ 8 lymph nodes). The guidelines consider that laparoscopic or robotic approaches are justified only for early stages of SI-NENs.</p><p><strong>Conclusion: </strong>Guideline-compliant surgical treatment of locoregional SI-NEN enables recurrence-free long-term survival with good quality of life.</p>","PeriodicalId":72588,"journal":{"name":"Chirurgie (Heidelberg, Germany)","volume":" ","pages":"818-824"},"PeriodicalIF":0.0,"publicationDate":"2024-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141072451","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":"[Local ablative procedures for treatment of thyroid nodules].","authors":"Christian Vorländer","doi":"10.1007/s00104-024-02101-1","DOIUrl":"10.1007/s00104-024-02101-1","url":null,"abstract":"<p><p>Thyroid nodules are very frequent in the iodine deficiency regions of central Europe and some of the affected patients are referred for definitive treatment, such as surgery and radioiodine treatment. In recent years nonsurgical and non-radioiodine techniques have been introduced to treat thyroid gland pathologies. These techniques include the probe-based techniques of radiofrequency, microwave and laser application. The only noninvasive technique is high-intensity focused ultrasound. All mentioned techniques have the goal to reduce the volume of the thyroid nodule by application of energy/heat. The knowledge of all techniques and their advantages and risks is necessary to help physicians and patients in making decisions for the appropriate method of treatment of thyroid nodules.</p>","PeriodicalId":72588,"journal":{"name":"Chirurgie (Heidelberg, Germany)","volume":" ","pages":"793-800"},"PeriodicalIF":0.0,"publicationDate":"2024-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141077377","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":"[Robotic adrenalectomy-current evidence].","authors":"S Flemming, A Wiegering, C-T Germer, J Reibetanz","doi":"10.1007/s00104-024-02137-3","DOIUrl":"10.1007/s00104-024-02137-3","url":null,"abstract":"<p><p>Laparoscopic adrenalectomy is worldwide currently considered the gold standard technique for patients suffering from benign lesions. There has been an increasing number of robotic-assisted adrenalectomies in the last decade due to the systematic further development of minimally invasive surgery resulting in the implementation of robot-assisted surgery. Interestingly, the available studies show some perioperative advantages for robotic surgery but overall the current evidence is weak and there are economic aspects that are not negligible. Therefore, further high-quality studies about robotic-assisted adrenalectomy are mandatory to strengthen the current evidence.</p>","PeriodicalId":72588,"journal":{"name":"Chirurgie (Heidelberg, Germany)","volume":" ","pages":"810-817"},"PeriodicalIF":0.0,"publicationDate":"2024-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141735860","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":"[Initial hemithyroidectomy in comparison to total thyroidectomy for low risk differentiated thyroid cancer : Results of a national observational study].","authors":"Elisabeth Maurer, Detlef K Bartsch","doi":"10.1007/s00104-024-02162-2","DOIUrl":"10.1007/s00104-024-02162-2","url":null,"abstract":"","PeriodicalId":72588,"journal":{"name":"Chirurgie (Heidelberg, Germany)","volume":"95 10","pages":"847-848"},"PeriodicalIF":0.0,"publicationDate":"2024-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142302402","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":"[Peripheral extracorporeal membrane oxygenation in perioperative medicine : Principles, indications and challenges].","authors":"Stany Sandrio, Grietje Beck, Joerg Krebs, Matthias Otto","doi":"10.1007/s00104-024-02135-5","DOIUrl":"10.1007/s00104-024-02135-5","url":null,"abstract":"<p><p>In recent years the number of patients treated in intensive care units by extracorporeal membrane oxygenation (ECMO) due to severe respiratory failure or cardiogenic shock has steadily increased [1]. Consequently, the number of invasive procedures and operations in these patients has also increased. A fundamental understanding of these systems and the clinical indications is therefore helpful for the practicing (non-cardiac) surgeon. This review article focuses on peripheral ECMO procedures: venovenous (V-V) ECMO for patients with respiratory failure and venoarterial (V-A) ECMO for circulatory support in cardiogenic shock.</p>","PeriodicalId":72588,"journal":{"name":"Chirurgie (Heidelberg, Germany)","volume":" ","pages":"859-868"},"PeriodicalIF":0.0,"publicationDate":"2024-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141984071","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}