Annals of the Royal College of Surgeons of England最新文献

{"title":"Improving communication during damage control surgery: a survey of adult major trauma centres in England.","authors":"E N Patton, I Lisagors, I Tyrrell-Marsh, S Agarwal, L V Wee, A Darwish, S R Smith","doi":"10.1308/rcsann.2024.0087","DOIUrl":"10.1308/rcsann.2024.0087","url":null,"abstract":"<p><strong>Introduction: </strong>Deficiencies in non-technical skills can severely impede the functioning of teams in high-intensity scenarios, such as in damage control surgery for the critically injured trauma patient. Truncated preoperative checklists, modified from the standard World Health Organization preoperative checklist, and situational reporting at intervals during surgery are long-established practices in the military, and are recommended in the National Health Service guidelines on major incidents. These tools allow the multiprofessional team to create a shared mental model of the anaesthetic and operative plan, thereby improving team efficiency. Our aim was to establish whether adult major trauma centres in England are using truncated preoperative checklists and situational reporting for damage control surgery.</p><p><strong>Methods: </strong>An online survey was devised and distributed via the national programme of care for trauma in November 2020.</p><p><strong>Results: </strong>Responses were received from all 23 adult major trauma centres in England. Nine centres (39.1%) reported using a truncated preoperative checklist for damage control surgery albeit in a variety of formats. Common components were blood products received and/or available, presence of allergies, tranexamic acid and antibiotic administration, availability of viscoelastic tests, equipment required, availability of cell saver, role allocation and reference to other personnel needed, and discussion of the plan. Twelve centres (52.2%) have formal policies in place for situational reporting. Again, these were in multiple formats but all focused on patient physiology to direct surgical planning.</p><p><strong>Conclusions: </strong>We have identified key components to advanced communication aids for damage control surgery, providing a foundation on which other major trauma centres can build their own versions of these potentially lifesaving tools.</p>","PeriodicalId":8088,"journal":{"name":"Annals of the Royal College of Surgeons of England","volume":" ","pages":"318-325"},"PeriodicalIF":1.1,"publicationDate":"2025-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12043366/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142456672","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Management of metacarpal shaft fractures: a survey of current UK practice.","authors":"R Taha, T R Davis, A A Montgomery, A Karantana","doi":"10.1308/rcsann.2024.0070","DOIUrl":"10.1308/rcsann.2024.0070","url":null,"abstract":"<p><strong>Introduction: </strong>Metacarpal shaft fractures (MSF) are common injuries that predominantly affect young, economically active people. However, there is limited evidence to guide their management. The aims of this study were to: evaluate the management of extra-articular MSF of the fingers; assess equipoise for surgical and nonsurgical treatments; and explore factors influencing clinician decision making to inform the design of a randomised controlled trial (RCT) comparing surgical and nonsurgical treatments.</p><p><strong>Methods: </strong>A cross-sectional, web-based survey was distributed to UK hand surgeons using membership directories of different professional networks. Practice setting, clinical experience, management strategies, willingness to participate in a RCT and factors affecting suitability for randomisation were recorded.</p><p><strong>Results: </strong>There were 108 responses eligible for analysis. Distribution of clinical experience ranged from <5 to >20 years. A variety of treatments were used for transverse, long oblique/spiral and comminuted MSF. Rotational deformity (90%), step-off deformity (5%) and angulation (5%) were the most important indications for surgical fixation. Acceptable limits of fracture angulation and shortening varied among surgeons. Over 85% expressed interest in participating in a RCT and most showed equipoise and were willing to offer operative or nonoperative treatment as part of a research study.</p><p><strong>Conclusions: </strong>This survey demonstrates that UK hand surgeons have varying views on treatments, acceptable parameters of deformity and indications for surgical fixation of displaced MSF. There is equipoise for surgical and nonsurgical treatments, variability in factors influencing clinical decision making and support for RCTs to investigate best practice.</p>","PeriodicalId":8088,"journal":{"name":"Annals of the Royal College of Surgeons of England","volume":" ","pages":"346-353"},"PeriodicalIF":1.1,"publicationDate":"2025-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12043361/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142387483","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Rare case of combined vascular malformation of the face: a successful surgical management.","authors":"S Bhatt, R M Karmacharya, S Vaidya, D Prajapati, R Napit, K Chapagain, N Bhandari, A Tamang","doi":"10.1308/rcsann.2022.0073","DOIUrl":"10.1308/rcsann.2022.0073","url":null,"abstract":"<p><p>Combined vascular malformation affecting the facial region is an extremely rare clinical entity that is debilitating both functionally and emotionally. Treatment warrants a multidisciplinary approach with the aim of removing the vascular anomalies and ameliorating any functional facial disfigurement. Here, we present a case of a 40-year-old female with combined vascular malformation of the face who was treated successfully with surgical intervention accompanying significant resolution of facial disfigurement.</p>","PeriodicalId":8088,"journal":{"name":"Annals of the Royal College of Surgeons of England","volume":" ","pages":"374-377"},"PeriodicalIF":1.1,"publicationDate":"2025-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12043363/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141174615","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Laparoscopic versus open repair for peptic ulcer perforation: a systematic review, meta-analysis and trial sequential analysis of randomised controlled trials. Time to conclude!","authors":"B S Sokhal, Ayy Mohamedahmed, S Zaman, A A Wuheb, H E Abdalla, N Husain, S Hajibandeh, S Hajibandeh","doi":"10.1308/rcsann.2024.0082","DOIUrl":"10.1308/rcsann.2024.0082","url":null,"abstract":"<p><strong>Introduction: </strong>The aim of this study was to investigate comparative outcomes of laparoscopic and open repair for peptic ulcer perforation (PUP).</p><p><strong>Methods: </strong>A PRISMA-compliant systematic review with a PROSPERO-registered protocol (registration number CRD42024529286) was conducted. All randomised controlled trials (RCTs) involving PUP patients managed by laparoscopic or open repair were identified and their risk of bias assessed. Outcome syntheses for perioperative mortality and morbidities, need for reoperation, procedure time and length of hospital stay were conducted using random-effects modelling to calculate risk ratios (RR) or mean difference (MD) with 95% confidence intervals (CI).</p><p><strong>Findings: </strong>Nine RCTs met the inclusion criteria, enrolling 670 patients of whom 317 were randomised to receive laparoscopic surgery and 353 were managed with open surgery. Laparoscopic repair of PUP significantly reduced mortality (RR 0.37, <i>p</i> = 0.03), total complications (RR 0.57, <i>p</i> = 0.0009), ileus (RR 0.43, <i>p</i> = 0.04), wound complications (RR 0.36, <i>p</i> < 0.0001) and length of hospital stay (MD -2.37, <i>p</i> = 0.0003) compared with the open approach. There were no significant differences in rate of postoperative leak (RR 2.00, 95% CI 0.74-5.41, <i>p</i> = 0.17), abdominal collection (RR 1.19, 95% CI 0.46-3.07, <i>p</i> = 0.72), sepsis (RR 1.17, 95% CI 0.39-3.52, <i>p</i> = 0.65), respiratory complications (RR 0.68, 95% CI 0.32-1.46, <i>p</i> = 0.32), reoperation (RR 1.74, 95% CI 0.57-5.30, <i>p</i> = 0.33) and operating time (MD 15.31, 95% CI -4.86 to 35.47, <i>p</i> = 0.14) between the two groups.</p><p><strong>Conclusions: </strong>Laparoscopic repair of PUP is associated with significantly lower mortality and morbidity and shorter length of stay compared with the open approach. The laparoscopic approach should be the management of choice subject to the existence of laparoscopic expertise.</p>","PeriodicalId":8088,"journal":{"name":"Annals of the Royal College of Surgeons of England","volume":" ","pages":"331-345"},"PeriodicalIF":1.1,"publicationDate":"2025-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12043367/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142364175","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Analysis of the outcomes of postdiverticulitis investigations: a multicentre cohort study including 1,120 patients.","authors":"A Abdelrahim, O Ali, D Kamali, A Reddy, S Harrison, M Boshnaq, H Abudeeb, F Ashoush, M Qulaghassi, S Eldesouky, M Mansour, S F Rahman-Casans, K Osman","doi":"10.1308/rcsann.2024.0077","DOIUrl":"10.1308/rcsann.2024.0077","url":null,"abstract":"<p><strong>Introduction: </strong>The aim of this study was to assess the yield of the endoscopic investigations performed following the resolution of acute diverticulitis.</p><p><strong>Methods: </strong>A retrospective multicentre study included patients with multislice computed tomography (MSCT)-proven diverticulitis, in four NHS hospitals, between January 2016 and April 2023. The primary outcome was the rate of colonic cancer in the diseased segment. Secondary outcomes included the rate of malignancy in the nondiseased colonic segments, the benign colonic polyp detection rate, the rate of malignancy in the resected surgical specimens in patients who underwent an emergency surgery on the index admission and the rate of complications in the investigated group.</p><p><strong>Results: </strong>A total of 1,120 patients were included in the study, out of which 604 were females, with a median age of 61 years; 731 patients (65%) had uncomplicated diverticulitis (Hinchey 1A) while 389 (35%) had complicated diverticulitis (Hinchey 1B-4). Following the acute episode, 757 (74%) patients had subsequent endoscopic evaluation. The incidence of colorectal cancer (CRC) or advanced adenomas (AA) in patients with uncomplicated diverticulitis was 0.14%. In the complicated diverticulitis group, the incidence of CRC/AA in patients with Hinchey 1b and Hinchey 2 was 1.4% and 5.4%, respectively. Out of the 107 patients who underwent emergency colonic resection for suspected perforated diverticulitis, 18 (16.8%) had histological evidence of colonic malignancy.</p><p><strong>Conclusions: </strong>Endoscopic investigations following uncomplicated diverticulitis have a low yield for sinister colonic pathology. Colonoscopy should be planned following complicated diverticulitis and in patients with uncomplicated diverticulitis with suspicious radiological finding on index imaging or in patients with ongoing clinical manifestations. In patients who undergo emergency surgery, oncological principles should be applied whenever possible.</p>","PeriodicalId":8088,"journal":{"name":"Annals of the Royal College of Surgeons of England","volume":" ","pages":"326-330"},"PeriodicalIF":1.1,"publicationDate":"2025-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12043365/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142387482","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Patient compliance with medications, nasal douching, smoking cessation and long-term outcomes of surgical septorhinoplasty - a prospective series of 56 cases.","authors":"A Garrard, T Davies, N Walker, H Raja","doi":"10.1308/rcsann.2024.0081","DOIUrl":"10.1308/rcsann.2024.0081","url":null,"abstract":"<p><strong>Introduction: </strong>Septorhinoplasty addresses both functional and cosmetic concerns with the nose and has been shown to have consistent, long-term benefits for patients. Nasal irrigation and medication such as antimicrobials are prescribed postoperatively to improve outcomes. Patient compliance with these interventions and outcomes of surgery have not been described. We aim to describe what the effects of compliance with these interventions may be in long-term follow-up.</p><p><strong>Methods: </strong>Patients undergoing septorhinoplasty were reviewed prospectively from 2015 to 2022. At time of operation, patients were prescribed medications, saline douching and given smoking cessation advice. Patients underwent rhinoplasty outcomes evaluation (ROE) preoperatively, at four weeks, and 3, 12, 24 and 36 months postoperatively. Compliance with postoperative interventions was measured at four weeks. Statistical tests were performed.</p><p><strong>Results: </strong>A total of 56 patients underwent septorhinoplasty. Preoperative ROE scores were improved significantly at all stages of postprocedure follow-up (<i>p</i><0.0001). Multiple linear regression found no significant differences in patients who were not compliant with medications (<i>p</i>>0.40), nasal douching (<i>p</i>>0.22), both medication and nasal douching (<i>p</i>>0.40), and a positive smoking status (<i>p</i>>0.11) at four weeks. At 3- and 24-months follow-up, there were no significant differences in ROE scores between compliant patients and those who were noncompliant with medications, nasal douching or both (<i>p</i>>0.13).</p><p><strong>Conclusions: </strong>Our data represent the only series of patient-reported outcomes from septorhinoplasty patients where compliance with nasal irrigation, smoking cessation and antimicrobials is considered. Compliance with nasal irrigation, topical antimicrobials or smoking cessation did not influence postoperative ROE scores.</p>","PeriodicalId":8088,"journal":{"name":"Annals of the Royal College of Surgeons of England","volume":" ","pages":"369-372"},"PeriodicalIF":1.1,"publicationDate":"2025-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12043364/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142307005","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"CORESS Feedback: Cases from the Confidential Reporting System for Surgery.","authors":"H Corbett","doi":"10.1308/rcsann.2025.0029","DOIUrl":"https://doi.org/10.1308/rcsann.2025.0029","url":null,"abstract":"<p><p>CORESS is an independent charity. The online reporting form is available via the CORESS website (coress.org.uk), which also includes previous Feedback reports. Published cases are acknowledged by a Certificate of Contribution, which may be included in the contributor's record of continuing professional development, or which may form part of appraisal or annual review of competence progression portfolio documentation. Contributions from surgeons in training are particularly welcome.</p>","PeriodicalId":8088,"journal":{"name":"Annals of the Royal College of Surgeons of England","volume":"107 5","pages":"1-5"},"PeriodicalIF":1.1,"publicationDate":"2025-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12054551/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143952325","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Validation of a novel simulated tendon model for core suture tendon repair.","authors":"L Western, P G Roberts, J Rees, D Howgate","doi":"10.1308/rcsann.2024.0064","DOIUrl":"10.1308/rcsann.2024.0064","url":null,"abstract":"<p><strong>Introduction: </strong>Simulation training can develop surgical procedural skills in a safe environment. Able to offer high-intensity exposure, simulation is increasingly important as working time for surgeons becomes more protected. Materials used in simulated tendon repair play a critical role in the fidelity and face validity of the model. Although organic materials like porcine tendon are commonly used, non-organic materials offer advantages such as accessibility, reproducibility, cost-effectiveness and ease of use without the need for special licences or facilities. This study aims to establish the face, content and concurrent validity of using a novel silicone material in a simulated tendon repair model.</p><p><strong>Methods: </strong>Three tendon models, bathroom silicone sealant, DragonSkin^® silicone and organic porcine tendons, were evaluated for concurrent validity through mechanical load to failure testing. Face and content validity were assessed, following participant repair of a DragonSkin^® tendon, using a 5-point Likert scale for five clinically relevant parameters.</p><p><strong>Results: </strong>Significant differences in load to failure were observed among bathroom sealant, DragonSkin^® and porcine tendon (11.1N, 31.7N and 56.2N; <i>p</i> < 0.001). Participant feedback on the DragonSkin^® tendon indicated that it was suitably representative, easy to use and useful for training (agreement rates 58%, 75% and 83%, respectively). However, participants noted that the model did not handle or glide like human tendon (both 8% agreement).</p><p><strong>Conclusion: </strong>DragonSkin^® silicone is an adaptable and valid material for simulated tendon repair models. It is low cost, widely available and shows promise as a training tool. Future research will focus on exploring its effectiveness in training settings.</p>","PeriodicalId":8088,"journal":{"name":"Annals of the Royal College of Surgeons of England","volume":" ","pages":"364-368"},"PeriodicalIF":1.1,"publicationDate":"2025-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12043360/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142307007","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Role of procedure-specific consent forms in clinical practice: a systematic review.","authors":"J Norvill, C Bent, J A Mawhinney, N Johnson","doi":"10.1308/rcsann.2024.0079","DOIUrl":"10.1308/rcsann.2024.0079","url":null,"abstract":"<p><strong>Introduction: </strong>Consent forms play an active role in the consent process with generic, handwritten consent forms (GCF) often the standard across the National Health Service. Increasingly, procedure-specific consent forms (PSCF) are being used as an alternative. However, concerns remain about whether they meet the standard for consent. We therefore conducted a systematic review with the objectives of investigating evidence for PSCF, study methodology and medicolegal criteria.</p><p><strong>Methods: </strong>This systematic review was prospectively registered on PROSPERO (CRD42023392693) and conducted from 1 January 1990 to 17 March 2023 using the MEDLINE, Embase, CINAHL, CENTRAL and Emcare databases. A grey literature search was also performed. All studies evaluating PSCF in medical and surgical settings were included. Risk-of-bias analysis was performed using 'RoB 2' and 'ROBINS-I'. Meta-analysis was not possible because of the results' heterogeneity.</p><p><strong>Findings: </strong>We identified 21 studies investigating PSCF with no systematic reviews and meta-analyses reported. Most studies were quality improvement projects (<i>n</i> = 10) followed by randomised studies (<i>n</i> = 5). No definitive legal guidance for PSCFs and no studies assessing their role in litigation post-procedural complications were identified. PSCFs were associated with improved documentation (70%-100%; <i>n</i> = 11) and legibility (100%; <i>n</i> = 2) compared with GCF. Randomised studies (<i>n</i> = 4) investigating patient understanding and recall for PSCF were inconclusive compared with GCF.</p><p><strong>Conclusions: </strong>The heterogeneous evidence available merely demonstrates superior documentation of PSCF compared with GCF. Studies do not adequately investigate the impact on informed consent and fail to address the associated legal concerns. Further randomised studies with patient-centric outcomes and consideration for medicolegal criteria are needed.</p>","PeriodicalId":8088,"journal":{"name":"Annals of the Royal College of Surgeons of England","volume":" ","pages":"354-363"},"PeriodicalIF":1.1,"publicationDate":"2025-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12043358/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142364176","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"A systematic review of ultrasonography-guided transcutaneous fine needle aspiration cytology in the diagnosis of laryngeal malignancy.","authors":"A Ahmed, D Yang, M Eastwood, T Saunders, S F Ahsan","doi":"10.1308/rcsann.2024.0095","DOIUrl":"10.1308/rcsann.2024.0095","url":null,"abstract":"<p><strong>Introduction: </strong>Direct laryngoscopy and biopsy is the gold standard for obtaining a tissue diagnosis in patients with suspected laryngeal cancer. In patients with advanced disease or other medical comorbidities, this may come with significant anaesthetic risks, including tracheostomy. Ultrasonography-guided biopsy has been widely used in the diagnosis of malignancy involving cervical lymph nodes but it is not commonly employed in the diagnosis of laryngeal tumours. A systematic review was undertaken to assess the literature looking at whether ultrasonography-guided transcutaneous fine needle aspiration cytology (FNAC) is an adequate method in diagnosing laryngeal malignancy.</p><p><strong>Methods: </strong>Two independent researchers conducted a systematic review of the literature using the MEDLINE^® and Cochrane Library databases in accordance with the PRISMA (Preferred Reporting Items for Systematic reviews and Meta-Analyses) guidelines.</p><p><strong>Results: </strong>A total of 568 studies were identified from the search, of which 3 met the inclusion criteria, resulting in 162 patient episodes. The pooled accuracy of transcutaneous FNAC in acquiring a sample adequate for histological diagnosis was 74.9%. Data on complications were limited, with a few cases of mild haemoptysis being recorded.</p><p><strong>Conclusions: </strong>Transcutaneous FNAC can be considered a safe and quick method for establishing a histological diagnosis of laryngeal lesions, particularly in patients who may be severely comorbid, and it could therefore could reduce the risks of general anaesthesia and tracheostomy prior to commencing definitive treatment.</p>","PeriodicalId":8088,"journal":{"name":"Annals of the Royal College of Surgeons of England","volume":" ","pages":"313-317"},"PeriodicalIF":1.1,"publicationDate":"2025-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12043362/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142613753","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}