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

{"title":"Waste production following Shouldice and transabdominal preperitoneal inguinal hernia repair.","authors":"S Lünse, R Hunger, M Mainprize, N Pickhardt, R Mantke, C Paasch","doi":"10.1308/rcsann.2026.0097","DOIUrl":"https://doi.org/10.1308/rcsann.2026.0097","url":null,"abstract":"<p><strong>Introduction: </strong>Surgical procedures generate significant amounts of waste, which contribute to environmental pollution and carbon emissions. Although previous studies have analysed waste from various surgeries, no data exist on hernia repair procedures. This study aimed to quantify and compare the surgical waste produced during Shouldice and laparoscopic transabdominal preperitoneal (TAPP) procedures for unilateral primary inguinal hernia repair.</p><p><strong>Methods: </strong>Between August 2024 and February 2025, waste from 20 Shouldice repairs at Shouldice Hospital (Canada) and 20 TAPP procedures at University Hospital Brandenburg (Germany) were measured. Waste was categorised into eight groups: plain paper/cardboard, laminated paper, soft plastics, hard plastics, latex material, metal foil, fabrics and metal. Carbon dioxide (CO₂) emissions were estimated using emission factors provided by the Intergovernmental Panel on Climate Change.</p><p><strong>Results: </strong>Fabrics constituted the largest waste component, with an average of 737.1 ± 548.2g per procedure. TAPP procedures generated significantly more waste in plain paper/cardboard, soft plastics, hard plastics and fabrics than Shouldice repairs. The most notable difference was in fabric waste, which was approximately sixfold higher in TAPP (1,263.6 ± 169.5g) compared with Shouldice (210.7 ± 68.6g). Conversely, Shouldice repairs resulted in significantly higher waste from latex and metal.</p><p><strong>Conclusions: </strong>This study demonstrates substantial differences in surgical waste production between Shouldice and TAPP procedures. The findings emphasise the environmental impact of different surgical techniques, highlighting the need for waste-reduction strategies in hernia repair. Further research should focus on sustainable practices to minimise the carbon footprint of surgical procedures.</p>","PeriodicalId":8088,"journal":{"name":"Annals of the Royal College of Surgeons of England","volume":" ","pages":""},"PeriodicalIF":2.0,"publicationDate":"2026-10-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149103033","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"A scoping review of point-of-care blood testing to assess utility in ambulatory general surgery.","authors":"Ccg Davies, H Clark, N Amtul, N S Blencowe","doi":"10.1308/rcsann.2026.0096","DOIUrl":"https://doi.org/10.1308/rcsann.2026.0096","url":null,"abstract":"<p><strong>Introduction: </strong>Ambulatory care is a national priority in the UK. Blood results play a crucial role in safe ambulatory management, but create significant time delays. Point-of-care blood testing (POCBT) could improve delivery of effective ambulatory care in General Surgery (GS). This scoping review summarises published literature on use of POCBT in hospital settings.</p><p><strong>Methods: </strong>Systematic searches (MEDLINE, Embase, Emcare and CINAHL, from inception to January 2025) identified published studies reporting on POCBT in adult hospital settings. Searches were limited to common blood tests used for emergency GS decision-making. Abstracts and full texts were screened independently by two authors against pre-agreed eligibility criteria. Data extraction included general study and participant characteristics, details of point-of-care devices used, and outcomes, grouped into: Reliability and Accuracy, Clinical and Patient Impact, Staff Impact, and Financial Impact.</p><p><strong>Findings: </strong>Thirty-five full-text papers were included, reporting on 56,160 patients. Most were cross-sectional studies (<i>n</i>=27) and set in Emergency Departments (<i>n</i>=15). Twenty-nine different analysers were reported across the studies; 24 studies reported on accuracy of POCBT, with 16 demonstrating good levels of concordance with central laboratory results. Of 15 studies reporting Clinical/Patient Impact outcomes, 7 described time savings with POCBT (<i>n</i>=7). Although four studies reported high staff satisfaction with POCBT, one suggested increased staff workload. All three studies reporting Financial Impact (<i>n</i>=3) identified a positive impact of POCBT on overall cost savings.</p><p><strong>Conclusions: </strong>POCBT could deliver timely, reliable blood results and be of benefit in ambulatory GS settings. A prospective pilot study may be the next appropriate step.</p>","PeriodicalId":8088,"journal":{"name":"Annals of the Royal College of Surgeons of England","volume":" ","pages":""},"PeriodicalIF":2.0,"publicationDate":"2026-10-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149102974","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Trial and error: a mapping review of operative and perioperative strategies to reduce post-appendicectomy abdominal infection.","authors":"A Malde, H Adeel, H Javanmard-Emamghissi, Sah Will, A Kirby, L Magill, N Blencowe, M J Lee","doi":"10.1308/rcsann.2026.0060","DOIUrl":"https://doi.org/10.1308/rcsann.2026.0060","url":null,"abstract":"<p><strong>Introduction: </strong>Post-appendicectomy abdominal infection (PAAI) is a frequent event, both in clinical practice and in research studies. There is a need to reduce PAAI to improve outcomes and avoid antibiotic resistance. We systematically mapped published evidence evaluating the delivery of components of appendicectomy hypothesised to influence PAAI.</p><p><strong>Methods: </strong>Systematic searches of MEDLINE, Embase and Cochrane Central were performed from 2005 to 2025, to identify published and ongoing randomised controlled trials (RCTs) registered in trials databases, and systematic reviews of RCTs, where PAAI was reported as an outcome. Abstracts and full texts were screened independently. Data extraction included study populations, inclusion/exclusion criteria, interventions/comparators and outcomes. Appendicectomy was deconstructed into component parts and identified interventions were grouped and reported accordingly.</p><p><strong>Results: </strong>From 613 abstracts, 97 studies were included: 13 systematic reviews, 53 RCTs and 31 registered RCTs. Thirty studies were adult-only, 31 child-only and 35 had mixed populations. Exclusion criteria frequently included pregnancy, immunosuppression, diabetes, sepsis and prior antibiotic use. PAAI was the primary outcome in 22 of 53 RCTs, usually defined by postoperative imaging. Interventions assessed for reduction of PAAI included laparoscopic surgery, method of stump closure, suction and irrigation, and perioperative antibiotics. Although results for intraoperative technical interventions were conflicting, a review of preoperative antibiotics showed significant benefit despite heterogeneity of regimens.</p><p><strong>Conclusion: </strong>Preoperative antibiotics reduce PAAI, although the optimal regimen is uncertain. Evidence for intraoperative techniques such as stump closure and contamination management is inconsistent and unclear, warranting assessment in a large, pragmatic, platform style RCT.</p>","PeriodicalId":8088,"journal":{"name":"Annals of the Royal College of Surgeons of England","volume":" ","pages":""},"PeriodicalIF":2.0,"publicationDate":"2026-10-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149103020","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Potential treatment-cost savings from stage-shift in head and neck cancer in England.","authors":"J Patel, A Kanatas","doi":"10.1308/rcsann.2026.0101","DOIUrl":"https://doi.org/10.1308/rcsann.2026.0101","url":null,"abstract":"<p><strong>Background: </strong>Head and neck cancer (HNC) poses a significant and growing economic burden on the NHS. Treatment costs are higher for late-stage disease, yet most patients in England present at advanced stages. Population-level screening may shift stage distribution at diagnosis, but its economic rationale has not previously been quantified using contemporary patient-level cost data.</p><p><strong>Design: </strong>We undertook a cost analysis using patient-level secondary care treatment data from a tertiary NHS centre, supplemented by a large national population-based NHS cost dataset, epidemiological data, and published health-related quality-of-life estimates. Stage-stratified treatment costs were applied to the reported national stage distributions to model the potential cost impact of a stage shift attributable to screening. Scenario analysis estimated annual NHS-wide treatment cost savings.</p><p><strong>Results: </strong>Using patient-level costing from a tertiary NHS centre, stage-stratified median treatment costs ranged from £37,201 (stage I) to £60,376 (stage III). A complementary national dataset of 31,184 HNC patients reported mean costs of £32,095 (stage I) versus £43,981 (stage IV) across up to six years of NHS hospital care. Applying these differentials to the approximately 5,720 annual late-stage diagnoses in England, scenario analysis suggests potential treatment cost savings of £6.8-8.0 million per annum from a 10% stage-shift, rising to £20.4-24.0 million annually from a 30% stage-shift. Post-treatment EQ-5D-5L utility values of 0.78-0.79 (intervention group) and 0.75-0.76 (standard care) confirm a substantial quality-adjusted life-year burden in HNC survivors.</p><p><strong>Conclusion: </strong>This study quantifies the potential treatment-cost savings associated with a stage-shift in HNC diagnosis in England.</p>","PeriodicalId":8088,"journal":{"name":"Annals of the Royal College of Surgeons of England","volume":" ","pages":""},"PeriodicalIF":2.0,"publicationDate":"2026-10-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149103008","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Artificial intelligence in urology: from pattern recognition to clinical authority.","authors":"E Alford, B Birch","doi":"10.1308/rcsann.2026.0088","DOIUrl":"https://doi.org/10.1308/rcsann.2026.0088","url":null,"abstract":"","PeriodicalId":8088,"journal":{"name":"Annals of the Royal College of Surgeons of England","volume":" ","pages":""},"PeriodicalIF":2.0,"publicationDate":"2026-10-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149102972","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Implementing a peer-support programme for surgeons following adverse events.","authors":"M Greville-Harris, G Scrimgeour, O Donnelly, A Kane, A Wezyk, K Thomas, B Tatar, R Tomlinson, S Macsween, E King, K Turner","doi":"10.1308/rcsann.2026.0090","DOIUrl":"10.1308/rcsann.2026.0090","url":null,"abstract":"<p><strong>Introduction: </strong>Despite the known impact of adverse events (AEs) for surgeons, and the potential for AE peer-support models, little is known about usefulness of AE peer-support initiatives in UK surgical settings. This study evaluated: (1) surgeons' perceptions of current AE support, and (2) the usefulness of a novel peer-support improvement collaborative initiative (SUPPORT) for surgeons.</p><p><strong>Methods: </strong>Part 1 surveyed 151 surgeons from 12 hospital trusts/groups in the UK and Ireland. Perceived organisational compassion, attitudes towards support-seeking and vulnerability stigma were assessed. Part 2 surveyed 17 surgical team members pre and post participating in SUPPORT. Surveys measured perceived organisational compassion, confidence in fostering a caring culture, peer-support skills, understanding of barriers to support-seeking and recognition of common responses to AEs.</p><p><strong>Results: </strong>Some 88.1% of respondents endorsed the need for surgeon-specific peer support following AEs, while only 24.5% perceived existing support as adequate. In addition, 58.5% reported that there was stigma towards showing vulnerability as a surgeon and only 43.9% of respondents agreed that colleagues would respond compassionately following an AE. Participation in SUPPORT led to improved perceived organisational compassion and increased confidence in fostering a caring culture, peer-support skills, understanding of barriers to support-seeking and recognition of common psychological responses to AEs (<i>p</i> = 0.028 to <0.001). No improvements were observed in vulnerability-related stigma.</p><p><strong>Conclusions: </strong>This study highlighted the mismatch between the perceived need for, and provision of, peer support for surgeons following AEs. Despite cultural barriers, the SUPPORT collaborative showed promise in enhancing compassion and key peer-support skills.</p>","PeriodicalId":8088,"journal":{"name":"Annals of the Royal College of Surgeons of England","volume":" ","pages":""},"PeriodicalIF":2.0,"publicationDate":"2026-09-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148987850","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Olfactory testing as a deployable frailty measure.","authors":"S Gane, C Huart","doi":"10.1308/rcsann.2026.0087","DOIUrl":"https://doi.org/10.1308/rcsann.2026.0087","url":null,"abstract":"","PeriodicalId":8088,"journal":{"name":"Annals of the Royal College of Surgeons of England","volume":" ","pages":""},"PeriodicalIF":2.0,"publicationDate":"2026-09-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148966364","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Response to: \"An unusual case of recurrent massive urethral bleeding following Optilume urethral dilatation needing selective embolisation of the bleeding vessel\".","authors":"P Rehder, F Obrecht, L A Jelisejevas, C Achermann","doi":"10.1308/rcsann.2026.0085","DOIUrl":"https://doi.org/10.1308/rcsann.2026.0085","url":null,"abstract":"","PeriodicalId":8088,"journal":{"name":"Annals of the Royal College of Surgeons of England","volume":" ","pages":""},"PeriodicalIF":2.0,"publicationDate":"2026-09-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148966372","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Use of four-dimensional computed tomography to aid parathyroid localisation in primary hyperparathyroidism in British surgical practice.","authors":"N Sawhney, H Findlater, S Hussain, S Rajan, D Bhatt, D McAteer, P Abraham, A Graveling, S Aspinall","doi":"10.1308/rcsann.2025.0062","DOIUrl":"10.1308/rcsann.2025.0062","url":null,"abstract":"<p><strong>Introduction: </strong>Four-dimensional computed tomography (4DCT) has emerged as an effective imaging modality to aid parathyroid localisation before surgery. Following a service change in 2018, we evaluated the accuracy of 4DCT to lateralise culprit parathyroid glands causing primary hyperparathyroidism (PHPT) in patients undergoing parathyroid surgery in our centre.</p><p><strong>Methods: </strong>A total of 117 patients underwent 4DCT before parathyroidectomy for PHPT in NHS Grampian between March 2018 and January 2023, of whom 112 underwent first-time operations. Results of imaging, histopathology and surgery type along with biochemical follow-up were evaluated retrospectively to assess the sensitivity and specificity of 4DCT imaging.</p><p><strong>Results: </strong>In our centre, 4DCT imaging showed results comparable with those reported previously, with 77.6% sensitivity to lateralise to one side of the neck, 89.1% specificity and an overall accuracy of 83.5%. A total of 58% of patients underwent targeted parathyroidectomy. At three- to six-month follow-up, 94.5% had achieved biochemical cure; 4DCT identified culprit lesions in four out of five patients undergoing reoperation. Age and corrected calcium did not affect accuracy of 4DCT.</p><p><strong>Conclusions: </strong>4DCT is an effective first-line imaging modality before first-time parathyroidectomy for PHPT in patients aged >60 years as well as in cases of reoperation. Use as the first-line imaging modality in younger patients may reduce overall radiation exposure by minimising the need for additional imaging, but further study is needed in this age group.</p>","PeriodicalId":8088,"journal":{"name":"Annals of the Royal College of Surgeons of England","volume":" ","pages":"518-523"},"PeriodicalIF":2.0,"publicationDate":"2026-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13529388/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145487597","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 brush with danger: operative management of a through and through urethral and rectal injury following paintbrush insertion into the urethra.","authors":"R Karanjia, D Whiting, M Qureshi, H Dowson, A Chetwood","doi":"10.1308/rcsann.2025.0033","DOIUrl":"10.1308/rcsann.2025.0033","url":null,"abstract":"<p><p>Iatrogenic injury from urethral foreign body insertion is rare but a recognised urological emergency. We present a case of a 61-year-old man who presented to the emergency department having inserted a 15cm-long paintbrush into his urethra, resulting in two 'exit' wounds in his urethra with an associated rectal injury. The patient was taken to theatre and a primary perineal repair of the two 'exit' defects in his urethra was performed over a urethral catheter and covering suprapubic catheter. His rectal injury was also repaired with a covering laparoscopic defunctioning colostomy performed. The patient recovered fully, without any residual urinary symptoms. To our knowledge, there are no reported cases of concomitant urethral and rectal injury following urethral foreign body insertion.</p>","PeriodicalId":8088,"journal":{"name":"Annals of the Royal College of Surgeons of England","volume":" ","pages":"566-569"},"PeriodicalIF":2.0,"publicationDate":"2026-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13529380/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144940147","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}