Chirurgie (Heidelberg, Germany)最新文献

{"title":"[Implementation and benefits of healthcare apps in surgical disciplines-A Delphi expert consensus].","authors":"C Groeben, P Karschuck, F Kormann, M Baunacke, L Wiemer, H Krause, K Fuchs, A Wiedemann, A A Schnitzbauer, A Schmitz, D Ebert, J P Struck, H Borgmann","doi":"10.1007/s00104-025-02329-5","DOIUrl":"https://doi.org/10.1007/s00104-025-02329-5","url":null,"abstract":"<p><strong>Background: </strong>Healthcare apps or healthcare applications (DiHA) offer great potential for the modernization of healthcare treatment but place high demands on the digital health landscape. In order to achieve a real additional value for the treatment of patients, clear criteria must be fulfilled. This article is based on a consensus conference of the Digital Health Summit (29-30 August 2024) at the Technical University Brandenburg.</p><p><strong>Material and method: </strong>A modified multistage Delphi survey procedure was carried out with interdisciplinary experts from clinical, scientific and industrial sectors to achieve a consensus on the requirements for surgical healthcare apps.</p><p><strong>Results: </strong>The Delphi procedure led to 30 statements on requirements for surgical apps in Germany. They can provide evidence-based benefits for patient information and reduction of symptoms but must be more stringently tested in clinical studies on benefits and safety. In addition, apps can support training, simplify documentation and organize processes more efficiently. Uniform quality criteria are necessary in the European context. Patient data should be anonymized to assist research, whereby the sovereignty of the data lies by the patients. Regulatory hurdles should be dismantled and DiHAs should be classified according to the evidence and the risk-benefit profile.</p><p><strong>Conclusion: </strong>In our statements we recommend to actively promote the development and use of healthcare apps to improve the treatment of patients in surgery. This requires targeted support for licensing, research and use, particularly by academic groups, as well as studies on the efficacy of healthcare apps.</p>","PeriodicalId":72588,"journal":{"name":"Chirurgie (Heidelberg, Germany)","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2025-07-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144610457","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":"[Update on thyroid cancer].","authors":"Detlef K Bartsch","doi":"10.1007/s00104-025-02305-z","DOIUrl":"https://doi.org/10.1007/s00104-025-02305-z","url":null,"abstract":"","PeriodicalId":72588,"journal":{"name":"Chirurgie (Heidelberg, Germany)","volume":"96 7","pages":"535-536"},"PeriodicalIF":0.0,"publicationDate":"2025-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144499629","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":"[Management of venous aneurysms and the vascular surgical treatment options : Selection of representative case constellations illustrating experiences at a center for vascular surgery].","authors":"U Barth, M Stojkova, F Meyer, Z Halloul","doi":"10.1007/s00104-024-02191-x","DOIUrl":"10.1007/s00104-024-02191-x","url":null,"abstract":"<p><strong>Introduction: </strong>Venous aneurysms are a rare entity in vascular surgery, which are mostly described in individual case series and meta-analyses generated from them. The treatment concepts are diverse and surgical treatment is highlighted due to the risk of thrombosis and pulmonary embolism. There is still an ongoing debate regarding the postoperative necessity and duration of anticoagulation.</p><p><strong>Method: </strong>Case series of a consecutive patient cohort with venous aneurysms from the last 18 years in a center of (highly specialized care) vascular surgery including i) own experiences obtained in daily vascular surgical practice and ii) a selected and current literature search of relevant references on possible and, in particular, established diagnosis-specific therapeutic concepts.</p><p><strong>Results: </strong>Between 2005 and 2023, a total of 11 cases of venous aneurysms were reported in patients aged 30-84 years (mean: 52.5, median: 50), with 1 patient requiring surgery for a recurrence after 2 years. The gender ratio was 7:3 (m:f) and the popliteal vein was the most frequently affected anatomical region with 36.4%, followed by the internal jugular vein and axillary/subclavian vein each with 18.2%. Aneurysms of the inferior vena cava, the common iliac vein and the cubital vein occurred only once. Surgical treatment of the aneurysms was performed in 9 cases. The surgical methods used were i) tangential resection of the aneurysm wall and continuous purse-string suture, ii) resection of the aneurysm and interposition of an 8‑mm GORE-TEX® vascular graft prosthesis (Gore, Putzbrunn, Germany), iii) ligation of the aneurysm and iv) ligation with subsequent resection of the aneurysm.</p><p><strong>Conclusion: </strong>The rarity of venous aneurysms should be a reason to register these cases centrally (possibly, nationwide diagnosis-related register). Surgical treatment is usually unproblematic and associated with few complications. The risk of pulmonary embolism appears to be significantly increased in venous aneurysms of the extremities, pelvic veins and inferior vena cava, while venous aneurysms of the head and neck are significantly less prone to this. Perioperative and postoperative anticoagulation has been adapted to the development of specific anticoagulants and novel drugs, in favor of treatment with direct oral anticoagulants (DOAC). In personal experience, immediate postoperative heparin perfusion (low dose) and subsequent therapeutic bridging with low-molecular-weight heparin before switching to an anticoagulant for outpatient clinic-based care appears to safeguard the perioperative phase with respect to keeping the surgery-related complication rate (e.g., thrombosis, bleeding) low.</p>","PeriodicalId":72588,"journal":{"name":"Chirurgie (Heidelberg, Germany)","volume":" ","pages":"583-592"},"PeriodicalIF":0.0,"publicationDate":"2025-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12202514/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142633283","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":"[Challenges in outpatient surgical treatment in Germany].","authors":"Johannes Klose, Claudia Rudroff, Lars Fischer, Artur Rebelo, Jörg Kleeff, Ralf Michael Wilke","doi":"10.1007/s00104-025-02263-6","DOIUrl":"10.1007/s00104-025-02263-6","url":null,"abstract":"<p><strong>Background: </strong>In Germany the proportion of outpatient and day clinic surgery within the surgical service provision is still increasing. Recently, the catalogue of operations which can be carried out in outpatient surgery was revised and an intersectoral remuneration was introduced; however, the prerequisites in the surgical departments for an increased provision of outpatient services are very heterogeneous.</p><p><strong>Objective: </strong>The aim of this study was to analyze the current situation and challenges of outpatient care in general and visceral surgery in Germany.</p><p><strong>Material and methods: </strong>A questionnaire with 26 questions on the current situation of the treatment structure for outpatient surgery was constructed and the possibility for surgical training under outpatient conditions was surveyed. The questionnaire was digitally sent via the mailing list of the German Society for General and Visceral Surgery and the Convention of Senior Hospital Surgeons (Konvent der leitenden Krankenhauschirurginnen und -chirurgen) and the completed questionnaires were analyzed.</p><p><strong>Results: </strong>A total of 204 head physicians took part in the survey. In 54.4% the surgeons were in charge of basic care hospitals followed by specialized and maximum care hospitals. An outpatient structure was present in 95.5% of the hospitals with a high proportion of medical care centers. The majority of the surgeons planned to extend outpatient services despite the lack of comprehensive structures. Even if a structured education curriculum for junior doctors does not exist up to 70% of outpatient operations are performed by junior doctors. The current status of outpatient surgery care in Germany was evaluate as weak by 70% of the participants. An improvement due to the implementation of a new intersectoral remuneration is not expected.</p><p><strong>Discussion: </strong>Within the hospital landscape the structures for outpatient surgery show clear differences.</p><p><strong>Conclusion: </strong>Of the participants two thirds felt that despite the existing infrastructure their hospital was not well-prepared for the increased provision of outpatient services and assessed the associated remuneration as insufficient.</p>","PeriodicalId":72588,"journal":{"name":"Chirurgie (Heidelberg, Germany)","volume":" ","pages":"574-582"},"PeriodicalIF":0.0,"publicationDate":"2025-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12202669/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143560223","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":"[Robotic liver surgery].","authors":"Michael N Thomas, Thomas Schmidt, Hans Fuchs, Dirk Stippel, Tristan Wagner, Marielle Hummels, Denise Buchner, Mirka Hiort, Dolores Kraus, Christiane J Bruns","doi":"10.1007/s00104-025-02268-1","DOIUrl":"10.1007/s00104-025-02268-1","url":null,"abstract":"<p><p>Minimally invasive surgery is currently undergoing a paradigm shift from the classical laparoscopic approach to robot-assisted minimally invasive surgery. Robotic surgery has made significant progress in various surgical disciplines in recent years and is increasingly being used. This is due to the increasing clinical availability of robotic systems as well as better visualization, an increased surgical precision and a higher degree of freedom of the robotic instruments used, compared to classical laparoscopy, resulting in a flatter learning curve and better ergonomics for the surgeon. This article examines the current status of robot-assisted liver surgery, highlights the technical and clinical challenges and discusses future perspectives and potential developments in this dynamic field.</p>","PeriodicalId":72588,"journal":{"name":"Chirurgie (Heidelberg, Germany)","volume":" ","pages":"607-615"},"PeriodicalIF":0.0,"publicationDate":"2025-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144047583","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":"[Randomized, controlled trial evaluating perioperative risk stratification after elective major cancer surgery].","authors":"F Sayrafi, M Ardelt, U Settmacher","doi":"10.1007/s00104-025-02310-2","DOIUrl":"10.1007/s00104-025-02310-2","url":null,"abstract":"","PeriodicalId":72588,"journal":{"name":"Chirurgie (Heidelberg, Germany)","volume":" ","pages":"598-599"},"PeriodicalIF":0.0,"publicationDate":"2025-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144103176","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":"[Patients with pHPT and negative standard imaging or with recurrent disease benefit from preoperative ¹⁸F-choline PET/CT].","authors":"Katharina Holzer, Detlef K Bartsch","doi":"10.1007/s00104-025-02309-9","DOIUrl":"10.1007/s00104-025-02309-9","url":null,"abstract":"","PeriodicalId":72588,"journal":{"name":"Chirurgie (Heidelberg, Germany)","volume":" ","pages":"604-605"},"PeriodicalIF":0.0,"publicationDate":"2025-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144103175","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":"[Update on follicular thyroid cancer-What is relevant for surgeons?]","authors":"Nicolas Schlegel","doi":"10.1007/s00104-025-02276-1","DOIUrl":"10.1007/s00104-025-02276-1","url":null,"abstract":"<p><p>Follicular thyroid cancer (FTC) is the second most frequent form of differentiated thyroid cancer, accounting for approximately 5-15% of all thyroid malignancies. According to the World Health Organization (WHO) classification from 2022 FTC is divided into three subtypes, which clearly differ in the overall prognosis and probability of recurrence. Furthermore, knowledge about benign follicular tumors and low-grade neoplasms is important. Prognostic factors for malignant alterations include patient age, tumor size, invasive growth, the presence of angioinvasion and the occurrence of distant metastases. The surgical management is guided by these factors and therefore varies between the different FTC subtypes. In summary, a precise understanding of the individual subtypes of thyroid tumors is essential to be able to make an appropriate and personalized decision on surgical treatment.</p>","PeriodicalId":72588,"journal":{"name":"Chirurgie (Heidelberg, Germany)","volume":" ","pages":"544-550"},"PeriodicalIF":0.0,"publicationDate":"2025-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12202622/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143722806","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":"[Sigmoid resection vs. conservative treatment following diverticulitis: long-term results of the LASER randomized clinical trial].","authors":"C Germer, J Reibetanz","doi":"10.1007/s00104-025-02314-y","DOIUrl":"10.1007/s00104-025-02314-y","url":null,"abstract":"","PeriodicalId":72588,"journal":{"name":"Chirurgie (Heidelberg, Germany)","volume":" ","pages":"600-601"},"PeriodicalIF":0.0,"publicationDate":"2025-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144082334","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":"[Impact of centralization on esophageal cancer surgery in Ireland].","authors":"L M Schiffmann, C J Bruns","doi":"10.1007/s00104-025-02308-w","DOIUrl":"10.1007/s00104-025-02308-w","url":null,"abstract":"","PeriodicalId":72588,"journal":{"name":"Chirurgie (Heidelberg, Germany)","volume":" ","pages":"602-603"},"PeriodicalIF":0.0,"publicationDate":"2025-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144103098","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}