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

{"title":"Gastrotomy incision to Bogotá bag suturing (GIBBS) technique for trichobezoar extraction.","authors":"M Mardan, Y-W Tan","doi":"10.1308/rcsann.2025.0115","DOIUrl":"10.1308/rcsann.2025.0115","url":null,"abstract":"","PeriodicalId":8088,"journal":{"name":"Annals of the Royal College of Surgeons of England","volume":" ","pages":"564-566"},"PeriodicalIF":2.0,"publicationDate":"2026-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13529378/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147353512","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":"The non-slip suture: tissue approximation in high-tension wounds using a stepwise instrument-based suture method.","authors":"T Shoaib, J Lucocq","doi":"10.1308/rcsann.2025.0082","DOIUrl":"10.1308/rcsann.2025.0082","url":null,"abstract":"","PeriodicalId":8088,"journal":{"name":"Annals of the Royal College of Surgeons of England","volume":" ","pages":"561-565"},"PeriodicalIF":2.0,"publicationDate":"2026-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13529379/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145197965","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":"Balloon sinuplasty: does a model simulator improve ENT trainee competence?","authors":"R Pinto, R Sharma, G Khong","doi":"10.1308/rcsann.2024.0075","DOIUrl":"10.1308/rcsann.2024.0075","url":null,"abstract":"<p><strong>Introduction: </strong>Balloon sinuplasty is an established technique for treating chronic rhinosinusitis and its role in managing complicated acute rhinosinusitis (ARS) is emerging. Complicated ARS is a potentially life-threatening condition and balloon sinuplasty is not currently a competency required by UK otolaryngology trainees. To our knowledge, we are the first to investigate whether a balloon sinuplasty model simulator was able to improve trainee self-perceived competence.</p><p><strong>Methods: </strong>A prospective, qualitative-based study was carried out including all candidates attending a national paediatric course rotating through our balloon sinuplasty model simulator station. Candidates returned a questionnaire to evaluate their experience.</p><p><strong>Results: </strong>Twenty feedback forms were returned. Candidates ranged from core trainees to consultants, with the majority being registrar or senior clinical fellow level (89.4%). Three candidates had previously performed balloon sinuplasty in adults and none in children. The number of candidates rating their understanding of how to perform balloon sinuplasty as ≥7 increased after the simulator experience from 9 of 20 (45%) to 20 of 20 (100%). Following the model simulator experience, 45% felt confident in performing balloon sinuplasty in adult patients and 25% in children. In all, 40% of candidates were confident in using balloon sinuplasty electively and 35% felt they would be able to use it in an emergency procedure.</p><p><strong>Conclusions: </strong>Surgical confidence in performing balloon sinuplasty is generally low, especially among trainees. A balloon sinuplasty model simulator is able to improve this but further training and hands-on experience is required to facilitate translation of simulation acquired surgical skills to the operating theatre.</p>","PeriodicalId":8088,"journal":{"name":"Annals of the Royal College of Surgeons of England","volume":" ","pages":"531-535"},"PeriodicalIF":2.0,"publicationDate":"2026-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13529385/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145336344","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":"Expanding use of the Foley catheter in maxillofacial surgery.","authors":"Z Bhatti, J Thacker","doi":"10.1308/rcsann.2025.0099","DOIUrl":"10.1308/rcsann.2025.0099","url":null,"abstract":"","PeriodicalId":8088,"journal":{"name":"Annals of the Royal College of Surgeons of England","volume":" ","pages":"574"},"PeriodicalIF":2.0,"publicationDate":"2026-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13529389/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145601742","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":"Penetrating neck trauma and the rising rates of deliberate self-harm: a single trauma centre experience.","authors":"M Qasem, M E Ryan, T Davies, A J Kinshuck","doi":"10.1308/rcsann.2025.0072","DOIUrl":"10.1308/rcsann.2025.0072","url":null,"abstract":"<p><strong>Introduction: </strong>Self-inflicted harm is a complex behavioural phenomenon and a manifestation of a variety of underlying factors. Penetrating trauma is increasingly common, with rising knife crimes, gun violence and terrorism-related ballistics in the civilian arena. The study aims to review the changing patterns of penetrating neck injury (PNI) over a period of six years in our major trauma service (MTS).</p><p><strong>Methods: </strong>This was a retrospective review of all cases of adult patients presenting with PNI to Aintree University Hospital (AUH) between January 2017 and January 2023. Cases were identified through medical coding and review of electronic medical records.</p><p><strong>Results: </strong>A total of 71 cases of PNIs were identified from January 2017 to January 2023, marking a 13% increase in comparison with previous reports. Presentations due to deliberate self-harm (DSH) rose from 27% to 51%, representing an increase of 89% between the two time frames (<i>p</i>=0.0008), peaking at 77% of total presentations during the first wave of COVID-19. The prevalence of mental health disorders increased by 65% during the six years, reaching peak levels at 92% in the year 2020.</p><p><strong>Conclusions: </strong>This study highlights the rise of self-inflicted PNI in the context of increasing prevalence of psychiatric disorders, demonstrating the importance of reallocation of healthcare resources for health promotion, prevention and treatment in mental health services.</p>","PeriodicalId":8088,"journal":{"name":"Annals of the Royal College of Surgeons of England","volume":" ","pages":"555-560"},"PeriodicalIF":2.0,"publicationDate":"2026-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13529376/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145342860","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":"Evaluating large language models in patient education: a comparative analysis addressing frequently asked questions in peri-acetabular osteotomy.","authors":"T P Davis, B Guevel, K Logishetty, A G Dick, J Hutt","doi":"10.1308/rcsann.2026.0056","DOIUrl":"10.1308/rcsann.2026.0056","url":null,"abstract":"<p><strong>Introduction: </strong>Large language models (LLMs) are increasingly used as sources of information across many fields, including healthcare. As patients turn to these models for health-related queries, evaluating the accuracy and reliability of their responses is essential. Peri-acetabular osteotomy (PAO) is performed on younger patients - a group more likely to use digital tools like LLMs for health information. This study assesses the accuracy and readability performance of two leading LLMs, ChatGPT and Google Gemini, in addressing common patient questions on PAO.</p><p><strong>Methods: </strong>A panel of fellowship-trained PAO surgeons created ten commonly asked patient questions based on real-world experience. Responses from each LLM were assessed by the same three surgeons, blinded to response origin, using a 5-point Likert scale to evaluate clarity, accuracy, and completeness. Readability was measured with Flesch-Kincaid Reading scores.</p><p><strong>Results: </strong>ChatGPT outperformed Gemini with an average score of 4.17 vs 3.13 (<i>t</i> = -3.08, <i>p</i> = 0.006). ChatGPT's responses were often rated higher for completeness and clarity, particularly in areas needing detailed explanation, and usually required minimal clarification. Gemini sometimes lacked specificity or included minor inaccuracies that reduced its perceived reliability. Both LLMs produced responses with similar \"difficult\" Flesch Reading Ease scores.</p><p><strong>Conclusions: </strong>There may be significant differences in how effectively LLMs support patients with surgical queries. ChatGPT more consistently met expert standards for clarity and thoroughness. As LLM usage expands, ChatGPT may aid patient education on hip surgery, supporting consultations, informed decisions and postoperative guidance.</p>","PeriodicalId":8088,"journal":{"name":"Annals of the Royal College of Surgeons of England","volume":" ","pages":""},"PeriodicalIF":2.0,"publicationDate":"2026-08-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148824394","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 day-case parathyroidectomy in a large multi-site UK trust: a prospective case series.","authors":"M Anas, G Abdelhalim, R H Al-Deen, M Choudhry, S Germain, B Kaur, T Masters, M Suseeharan, Z Siddiqui, A Al-Lami","doi":"10.1308/rcsann.2026.0069","DOIUrl":"https://doi.org/10.1308/rcsann.2026.0069","url":null,"abstract":"<p><strong>Introduction: </strong>Advancements in minimally invasive techniques, coupled with structured perioperative protocols, have rendered same-day discharge following parathyroidectomy increasingly viable. National recommendations, including those from the Getting It Right First Time (GIRFT) national programme, propose that 90% of procedures for primary hyperparathyroidism be performed as day cases; however, uptake remains variable across UK centres.</p><p><strong>Methods: </strong>A retrospective audit of 107 consecutive parathyroidectomy cases (October 2019-October 2022) informed the development of a standardised day-case pathway across a multi-site National Health Service trust. The pathway incorporated defined eligibility criteria, prioritisation on morning operating lists, expedited postoperative biochemical assessment and protocolised discharge procedures. Data from the subsequent implementation phase (October 2023-June 2025) were collected prospectively. The audit loop was closed through a re-audit from July 2025 to February 2026 after emphasis on more judicious drain usage.</p><p><strong>Results: </strong>In the retrospective baseline cohort, only 7% of patients were discharged within 24h. In the initial implementation cycle, 22 patients underwent surgery under the pathway and 11 (50.0%) achieved same-day discharge. Drain insertion was the principal modifiable barrier identified in the first cycle. In the re-audit, 16 were suitable for day-case surgery and 5 of these (31.3%) were discharged the same day. Drain use fell to 1 case (6.3%). However, same-day discharge remained below target because logistical factors, particularly afternoon surgery or late list starts, accounted for most failed discharges among suitable patients. Overall there were no 30-day readmissions, re-operations for haematoma and 2 cases with significant hypocalcaemia requiring supplementation orally leading to overnight stays.</p><p><strong>Conclusions: </strong>Implementation of a pragmatic, checklist-guided pathway facilitated safe same-day discharge in a subset of patients during early implementation. However, it did not achieve the 90% target as per the GIRFT recommendations. An algorithm alone is insufficient, because surgeon-specific drain practice and theatre scheduling must be addressed if national day-case targets are to be approached.</p>","PeriodicalId":8088,"journal":{"name":"Annals of the Royal College of Surgeons of England","volume":" ","pages":""},"PeriodicalIF":2.0,"publicationDate":"2026-08-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148824410","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":"Rethinking postoperative wound care: PRINEO may reduce surgical-site infection by eliminating dressing changes. A response to Hwang <i>et al</i>.","authors":"Z Gunga, M Kirsch","doi":"10.1308/rcsann.2026.0048","DOIUrl":"https://doi.org/10.1308/rcsann.2026.0048","url":null,"abstract":"","PeriodicalId":8088,"journal":{"name":"Annals of the Royal College of Surgeons of England","volume":" ","pages":""},"PeriodicalIF":2.0,"publicationDate":"2026-08-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148824436","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":"TOEPVA: a systematic review and meta-analysis of safety, efficacy and feasibility.","authors":"J Patel, S Gupta, Y Devabalan, S Nagala, R Moorthy","doi":"10.1308/rcsann.2026.0084","DOIUrl":"https://doi.org/10.1308/rcsann.2026.0084","url":null,"abstract":"<p><strong>Introduction: </strong>We aim to critically evaluate existing literature on transoral endoscopic parathyroidectomy via the vestibular approach (TOEPVA) - a remote-access technique developed to eliminate visible cervical scarring in the management of primary hyperparathyroidism (pHPT) while preserving optimal cure rates. This systematic review evaluates the safety, efficacy and operative outcomes of TOEPVA.</p><p><strong>Methods: </strong>A total of 1,991 records across PubMed, Cochrane, Embase and Scopus were identified following PRISMA 2020 guidelines. Eligible designs included case series and nonrandomised comparative cohort studies reporting TOEPVA in adults. Primary outcome was biochemical cure; secondary outcomes included operative time, length of stay, complication rates, cosmetic satisfaction and pain scores. Meta-analysis was performed using the Freeman-Tukey double arcsine transformation.</p><p><strong>Findings: </strong>Nine studies comprising 259 patients were analysed. Biochemical cure was achieved in 98.8% (<i>n</i> = 256). Complication rates were low: transient recurrent laryngeal nerve (RLN) paresis 2.73% (<i>n</i> = 4), permanent RLN injury 0%, mental nerve dysfunction 1.94% (<i>n</i> = 5), transient hypocalcaemia 5.55% (<i>n</i> = 10) and permanent hypoparathyroidism 0%; 4.37% (<i>n</i> = 11) required conversion to open surgery. Mean operative time was 108 minutes; median hospital stay was 3 days.</p><p><strong>Conclusions: </strong>In a highly selected patient cohort, TOEPVA offers short-term efficacy and low morbidity similar to that of conventional open parathyroidectomy, with the potential for improved cosmetic outcomes. However, current evidence is limited to small single-centre experiences. Prospective multicentre randomised studies with standardised reporting are required to clarify its role among conventional and other remote-access approaches. Further evidence is required to define its role in patients with nonconcordant or negative preoperative imaging.</p>","PeriodicalId":8088,"journal":{"name":"Annals of the Royal College of Surgeons of England","volume":" ","pages":""},"PeriodicalIF":2.0,"publicationDate":"2026-08-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148786997","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":"Comparative outcomes of genicular nerve block and radiofrequency ablation in knee osteoarthritis.","authors":"D Onobun, O Mohammad, M-U Undie, T Awe, A Dwyer, Z Hafeez, M Hefny","doi":"10.1308/rcsann.2026.0058","DOIUrl":"https://doi.org/10.1308/rcsann.2026.0058","url":null,"abstract":"<p><strong>Introduction: </strong>Genicular nerve block (GNB) and radiofrequency ablation (RFA) are increasingly utilised for pain management in knee osteoarthritis, yet their comparative effectiveness, durability and clinical role remain uncertain. This systematic review aimed to compare outcomes of GNB and RFA in patients with knee osteoarthritis.</p><p><strong>Methods: </strong>A systematic review was conducted in accordance with PRISMA guidance. MEDLINE, Embase, CENTRAL, CINAHL and Web of Science were searched for randomised controlled trials and comparative observational studies evaluating GNB and/or RFA for knee osteoarthritis. Outcomes included pain, function, durability of effect, safety and reported progression to total knee replacement (TKR). Random-effects meta-analysis was performed where data were sufficiently homogeneous; otherwise, structured narrative synthesis was undertaken.</p><p><strong>Findings: </strong>Nineteen studies were included, comprising sham-controlled trials, active-comparator trials and prospective or retrospective cohorts. Both GNB and RFA were associated with reductions in pain compared with comparators. Across studies, RFA demonstrated larger and more durable pain relief than GNB, with benefits commonly sustained for 6-12 months and, in some cohorts, beyond 1 year. Functional improvements were variable but were most consistently observed following RFA using broader genicular nerve targeting strategies. No serious procedure-related adverse events were reported, and minor complications were infrequent and self-limiting. Reported conversion to TKR during study follow-up was rare, though follow-up duration and study design limited causal inference.</p><p><strong>Conclusions: </strong>Genicular nerve interventions provide clinically meaningful pain relief with favourable safety profiles in knee osteoarthritis. Across the available studies, RFA was associated with larger and more durable improvements in pain than GNB, although most evidence derives from indirect comparisons rather than direct head-to-head trials. Further high-quality studies with standardised protocols and longer follow-up are required to clarify long-term outcomes and surgical implications.</p>","PeriodicalId":8088,"journal":{"name":"Annals of the Royal College of Surgeons of England","volume":" ","pages":""},"PeriodicalIF":2.0,"publicationDate":"2026-08-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148786953","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}