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

{"title":"Quantifying the current impact of listing ACL reconstructions as low priority on subsequent meniscal pathology.","authors":"M Bellamy, S Allan, L Pearce, T Stedman, A Legg, A Anderson","doi":"10.1308/rcsann.2026.0054","DOIUrl":"https://doi.org/10.1308/rcsann.2026.0054","url":null,"abstract":"<p><strong>Introduction: </strong>Anterior cruciate ligament (ACL) ruptures can cause knee instability, potentially leading to meniscal and chondral injury if left untreated. Recent guidance suggests listing ACL reconstruction as lower priority without meniscal pathology. This study examines the risk of subsequent meniscal tears with delayed surgery.</p><p><strong>Methods: </strong>We conducted a retrospective cohort study (January 2018-March 2024) of consecutive patients who underwent ACL reconstruction. Patients were categorised by preoperative magnetic resonance imaging (MRI) findings of meniscal tears, and time from listing to surgery. Intraoperative findings of meniscal tears were recorded. Nonparametric testing and binary logistic regression determined risk factors for meniscal pathology with delayed surgery.</p><p><strong>Results: </strong>Among 272 patients, 15.1% had new meniscal tears identified intraoperatively that were absent on initial MRI scan, with a male-to-female ratio of 3:1. Additionally, 5% had MRI-detected pathology not confirmed surgically. Median time to diagnosis was 21 days, and median time to surgery was 140 days. Age and time to diagnosis did not affect outcomes (<i>p</i>>0.05). Body mass index (BMI) differences were not significant overall but became significant when outliers (BMI>43) were excluded (<i>p</i>=0.038). Logistic regression, adjusting for sex and BMI, showed a 0.3% increase in meniscal tear risk per waiting day (<i>p</i>=0.013).</p><p><strong>Conclusions: </strong>This study highlights the risk factors and progression of meniscal tears following delayed ACL reconstruction. Patient BMI and waiting list duration are important factors for risk reduction. With a delay of a month to surgery, the likelihood of developing a meniscal tear increases by nearly 10%. These findings emphasise the importance of early intervention, and potential re-evaluation of the current guidance.</p>","PeriodicalId":8088,"journal":{"name":"Annals of the Royal College of Surgeons of England","volume":" ","pages":""},"PeriodicalIF":2.0,"publicationDate":"2026-07-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148560528","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":"Barn theatres and conventional theatres: a non-inferiority analysis of hip fracture arthroplasty outcomes.","authors":"R Galloway, T Soh, A Behl, K Rauf, M Kent, K Gallagher","doi":"10.1308/rcsann.2026.0080","DOIUrl":"https://doi.org/10.1308/rcsann.2026.0080","url":null,"abstract":"<p><strong>Introduction: </strong>Hip fractures represent a major health burden in the elderly. The increasingly adopted \"barn\" theatre model, characterised by open-plan operating space, aims to improve surgical efficiency, but its safety in trauma remains unreported. This study analyses whether barn theatres are non-inferior to conventional theatres for hip fracture arthroplasty outcomes.</p><p><strong>Methods: </strong>We undertook a retrospective, single-centre, cohort study in a high-volume UK trauma unit, comparing consecutive patients undergoing arthroplasty for femoral neck fracture before and after barn theatre implementation (May 2022 to December 2023). The primary outcome was 30-day all-cause mortality, with a non-inferiority margin of +2.5 percentage points. Secondary outcomes included 1-year mortality, 30-day readmission, reoperation and length of stay (LOS). Outcomes were adjusted for age, American Society of Anesthesiologists' grade and Charlson Comorbidity Index, and were benchmarked against National Hip Fracture Database (NHFD) standards.</p><p><strong>Results: </strong>In total, 475 patients were included (238 pre-barn, 237 post-barn). Groups were demographically similar, although Charlson scores were higher post-barn. Adjusted odds ratio (aOR) for 30-day mortality in barn vs conventional theatres was 0.77 (95% confidence interval [CI] 0.36-1.71), meeting non-inferiority criteria. One-year mortality (aOR 1.10, 95% CI 0.66-1.82), readmission (aOR 0.83, 95% CI 0.45-1.54) and reoperation (aOR 1.06, 95% CI 0.39-2.89) showed no significant differences. Mortality and readmission outcomes were comparable with NHFD benchmarks, while post-barn LOS was shorter (median 12 vs 13 days).</p><p><strong>Conclusion: </strong>Barn theatres were non-inferior to conventional theatres for hip fracture arthroplasty, producing mortality and complication rates within national standards while demonstrating potential efficiency gains. These findings support barn theatres as a safe and scalable model for trauma surgery, although multicentre studies are warranted to confirm generalisability.</p>","PeriodicalId":8088,"journal":{"name":"Annals of the Royal College of Surgeons of England","volume":" ","pages":""},"PeriodicalIF":2.0,"publicationDate":"2026-07-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148560704","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":"Interpreting troponin elevation after surgery: diagnostic challenges and a pragmatic approach.","authors":"M Dave, K Mokrzycki, C Bailey","doi":"10.1308/rcsann.2026.0070","DOIUrl":"https://doi.org/10.1308/rcsann.2026.0070","url":null,"abstract":"<p><strong>Introduction: </strong>Cardiac troponin is a highly sensitive marker of myocardial injury, although its interpretation after non-cardiac surgery remains challenging. Postoperative troponin elevation is common, frequently asymptomatic and associated with a markedly increased risk of short-term mortality, yet it is often misinterpreted or overlooked in surgical practice.</p><p><strong>Methods: </strong>We performed a narrative review of contemporary evidence and international guidelines addressing perioperative troponin measurement, myocardial injury after non-cardiac surgery (MINS), and perioperative myocardial infarction (MI), with a focus on their relevance to surgical teams. MEDLINE and Embase were searched for adult English-language studies, prioritising the past 10-15 years and key consensus statements. Studies relevant to postoperative outcomes, risk stratification and management were synthesised into a pragmatic stepwise approach for surgical teams.</p><p><strong>Findings: </strong>Studies including VISION and POISE demonstrate that even modest postoperative troponin rises are independently associated with substantially increased 30-day mortality, most often in the absence of ischaemic symptoms. Differentiating type 1 MI, type 2 MI and non-ischaemic myocardial injury is difficult in the perioperative setting because clinical features, electrocardiography and baseline troponin values are frequently non-specific. Contemporary European and North American guidelines now support targeted perioperative troponin surveillance in high-risk patients to allow early detection and risk stratification.</p><p><strong>Conclusions: </strong>Postoperative troponin elevation represents a powerful prognostic marker rather than a single disease entity. A structured, stepwise approach incorporating preoperative risk assessment, serial troponin measurement, clinical correlation and selective imaging can help surgical teams distinguish clinically significant myocardial injury from chronic or non-ischaemic elevation, enabling timely multidisciplinary management and potentially improving outcomes.</p>","PeriodicalId":8088,"journal":{"name":"Annals of the Royal College of Surgeons of England","volume":" ","pages":""},"PeriodicalIF":2.0,"publicationDate":"2026-07-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148560686","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":"Graft and patient outcomes after abdominal normothermic regional perfusion in liver transplantation.","authors":"S Komperla, K Chall, R Seeruthun, B Clay","doi":"10.1308/rcsann.2026.0076","DOIUrl":"https://doi.org/10.1308/rcsann.2026.0076","url":null,"abstract":"<p><strong>Introduction: </strong>Donation after circulatory death (DCD) liver transplantation is currently limited by inferior outcomes compared with donation after brain death (DBD), predominantly due to ischaemia-reperfusion injury and biliary complications. Abdominal normothermic regional perfusion (aNRP) is an emerging graft-preservation technique that aims to improve graft viability, patient outcomes and reduce rate of complications in DCD liver transplantation. The aim of this review is to appraise the current literature on the utility of aNRP in liver transplantation surgery.</p><p><strong>Methods: </strong>The PRISMA guidelines for systematic reviews were followed and relevant databases searched. Primary outcomes were graft and patient survival rates. Secondary outcomes were primary non-function, early allograft dysfunction, biliary complications including ischaemic cholangiopathy (IC)/ischaemic type biliary lesions (ITBL) and retransplantation rates. Risk-of-bias analysis was conducted. Narrative synthesis was performed due to marked heterogeneity in the included studies.</p><p><strong>Results: </strong>Fourteen studies (2014-2026) encompassing 1,278 transplanted aNRP liver grafts were included in this review. aNRP was associated with a reduction in IC/ITBL rates, lower rates of primary non-function and lower early allograft dysfunction compared with conventional retrieval (super rapid recovery followed by static cold storage). Graft loss and retransplantation rates were also lower in aNRP cohorts. Compared with DBD transplantation, aNRP outcomes were similar with near-zero rates of IC in both groups. No significant differences were also observed between aNRP and ex situ normothermic machine perfusion (NMP).</p><p><strong>Conclusions: </strong>aNRP is associated with reductions in biliary complications, graft loss and retransplantation compared with conventional DCD retrieval, with outcomes comparable to DBD and ex situ NMP and offers a solution to expand the donor pool.</p>","PeriodicalId":8088,"journal":{"name":"Annals of the Royal College of Surgeons of England","volume":" ","pages":""},"PeriodicalIF":2.0,"publicationDate":"2026-07-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148560630","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":"Re: 'A simple trick for supinated hand positioning during hand surgery'.","authors":"T Burge","doi":"10.1308/rcsann.2026.0053","DOIUrl":"https://doi.org/10.1308/rcsann.2026.0053","url":null,"abstract":"","PeriodicalId":8088,"journal":{"name":"Annals of the Royal College of Surgeons of England","volume":" ","pages":""},"PeriodicalIF":2.0,"publicationDate":"2026-07-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148535005","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":"Penile cutting-edge technology: using common theatre equipment to safely remove stuck penile constriction rings.","authors":"R Karanjia, E Tsialogiannis, J Hadley, M Mikhail","doi":"10.1308/rcsann.2026.0077","DOIUrl":"https://doi.org/10.1308/rcsann.2026.0077","url":null,"abstract":"","PeriodicalId":8088,"journal":{"name":"Annals of the Royal College of Surgeons of England","volume":" ","pages":""},"PeriodicalIF":2.0,"publicationDate":"2026-07-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148534994","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":"Cemented vs uncemented hip replacement: implications for operating theatre productivity.","authors":"T Wainwright, R Matzko, T Immins, R Middleton","doi":"10.1308/rcsann.2026.0075","DOIUrl":"https://doi.org/10.1308/rcsann.2026.0075","url":null,"abstract":"<p><strong>Introduction: </strong>The National Health Service (NHS) is struggling to meet elective surgery recovery targets set by the UK government. Increasing productivity by maximising the number of cases performed through current operating list capacity will be crucial to reduce waiting times.</p><p><strong>Methods: </strong>This is a retrospective analysis of total hip replacement (THR) procedures performed in a single NHS general hospital using cemented or uncemented prostheses. Data were collected routinely between August 2007 and May 2009. A probabilistic analysis using the Monte Carlo simulation approach was conducted to estimate the probability of completing four cemented or four uncemented THR surgeries within a standard 8-h operating list, and if there was a 15- or a 30-min start delay.</p><p><strong>Results: </strong>There were 236 surgeries with a cemented prosthesis (mean surgical case time 117.96min) and 333 using an uncemented prosthesis (mean surgical case time 101.54min). For the standard operating list duration of 8h, the probability of completing four cemented hip replacements was approximately 63%, compared with 96% for uncemented procedures. Delayed starts of 15 and 30min resulted in significant reductions in the probability of completing four cemented procedures, decreasing to 44% and 26%, respectively. Uncemented procedures were less affected by these delays, with probabilities of 93% and 87%, respectively.</p><p><strong>Conclusions: </strong>The use of uncemented prostheses, where clinically suitable, may contribute to increased theatre throughput within current NHS operating list capacity.</p>","PeriodicalId":8088,"journal":{"name":"Annals of the Royal College of Surgeons of England","volume":" ","pages":""},"PeriodicalIF":2.0,"publicationDate":"2026-07-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148534963","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":"The incidence of complex regional pain syndrome following total knee arthroplasty: a prospective multicentre observational study of 1,026 patients with no cases identified according to the Budapest criteria.","authors":"D Hill, B Waterson, J Phillips, A D Toms","doi":"10.1308/rcsann.2026.0055","DOIUrl":"10.1308/rcsann.2026.0055","url":null,"abstract":"<p><strong>Aim: </strong>Our aim was to determine the incidence of complex regional pain syndrome (CRPS) according to the Budapest diagnostic criteria of the International Association for the Study of Pain (IASP) in patients following primary total knee replacement (TKR) surgery for osteoarthritis.</p><p><strong>Methods: </strong>Patients undergoing primary TKR were recruited prospectively. At routine postoperative follow-up, all participants were assessed systematically for CRPS using the Budapest criteria.</p><p><strong>Results: </strong>A total of 1,026 patients were recruited across three hospitals during a four-year period. Symptoms reported included: sensory 6% (<i>n</i>=61), vasomotor 7% (<i>n</i>=71), sudomotor 4% (<i>n</i>=41) and motor 1% (<i>n</i>=10). Signs observed included: sensory 7% (<i>n</i>=71), vasomotor 2% (<i>n</i>=20), sudomotor 3% (<i>n</i>=30) and motor 1% (<i>n</i>=10). No cases of CRPS according to the Budapest diagnostic criteria were identified.</p><p><strong>Conclusion: </strong>CRPS appears to be an exceptionally rare diagnosis following primary TKR. We did not identify any cases in this prospectively designed adequately powered multicentre study.</p>","PeriodicalId":8088,"journal":{"name":"Annals of the Royal College of Surgeons of England","volume":" ","pages":""},"PeriodicalIF":2.0,"publicationDate":"2026-07-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148366739","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":"Designing sustainable robotic surgery for NHS scale-up: direct electricity measurement and an implementation-ready energy mitigation bundle in colorectal cancer resections.","authors":"S Lodhia, V Pegna, T Rockall","doi":"10.1308/rcsann.2026.0065","DOIUrl":"https://doi.org/10.1308/rcsann.2026.0065","url":null,"abstract":"<p><strong>Introduction: </strong>Robotic-assisted surgery is expanding across specialties due to advantages including instrument dexterity, depth perception and improved ergonomics. NHS England projections indicate rapid scale-up of robotic surgery to ∼500,000 robot-supported operations annually by 2035, with robotic assistance becoming the default for ∼90% of keyhole procedures. Operating theatres are a key focus for decarbonisation, and equipment energy demand represents an actionable lever. This study quantified electricity consumption for robotic versus laparoscopic cancer surgery, translating to an implementation-ready mitigation bundle to support robotic programme expansion while minimising avoidable energy use.</p><p><strong>Methods: </strong>Electricity consumption on robotic and laparoscopic equipment was measured during colorectal cancer resections, capturing standby during setup/turnover, in-use during operating and out-of-hours standby. Readings were obtained during defined operating states, then modelled using prespecified setup, operative and clear-away durations based on local theatre workflow observations and published evidence of longer operative times associated with robotic colorectal surgery. Energy consumption, costs and annualised projections were calculated.</p><p><strong>Results: </strong>Robotic equipment drew substantially higher power than laparoscopic stacks in both standby and in-use states. Robotic cases used over six times more electricity per operation than laparoscopic cases, driven by longer operative duration and higher system power. Out-of-hours standby for robotic components contributed materially to annual electricity use and cost.</p><p><strong>Conclusions: </strong>Alongside clinical outcomes and productivity metrics, energy use and carbon implications should be incorporated into robotic surgery programme governance. Mitigations include routine measurement, standby power management within manufacturer constraints, theatre workflow optimisation and procurement standards aligned to sustainable operating theatre guidance.</p>","PeriodicalId":8088,"journal":{"name":"Annals of the Royal College of Surgeons of England","volume":" ","pages":""},"PeriodicalIF":2.0,"publicationDate":"2026-07-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148366691","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":"Modified meatal-based tube-flipping technique for distal and mid-shaft hypospadias: clinical outcomes in a large cohort.","authors":"M Breesam, Ma-A Aljodah","doi":"10.1308/rcsann.2026.0050","DOIUrl":"https://doi.org/10.1308/rcsann.2026.0050","url":null,"abstract":"<p><strong>Introduction: </strong>The aim of this work was to assess the functional, cosmetic and complication outcomes of meatal-based tube-flipping urethroplasty in the management of distal and mid-shaft hypospadias.</p><p><strong>Methods: </strong>This retrospective study included 244 patients presenting with distal or mid-shaft hypospadias, with or without associated chordee, regardless of age. All patients underwent urethral reconstruction using the meatal-based tube-flipping technique. Postoperative evaluation was performed to determine urinary function, cosmetic appearance and the incidence of postoperative complications. Specific outcomes assessed included recurrence of chordee, meatal stenosis and urethrocutaneous fistula formation. Follow-up was conducted in the outpatient clinic with clinical examination and cosmetic assessment by the operating surgeon.</p><p><strong>Results: </strong>Satisfactory urinary flow and penile appearance were achieved in the majority of patients. No cases of recurrent chordee or meatal stenosis were recorded during follow-up. Urethrocutaneous fistula occurred in 8.6% of patients, representing the primary postoperative complication.</p><p><strong>Conclusion: </strong>Meatal-based tube-flipping urethroplasty demonstrates favourable functional and cosmetic outcomes in the management of distal and mid-shaft hypospadias. This technique represents a practical modification of established methods, demonstrating reliable outcomes with an acceptable complication profile.</p>","PeriodicalId":8088,"journal":{"name":"Annals of the Royal College of Surgeons of England","volume":" ","pages":""},"PeriodicalIF":2.0,"publicationDate":"2026-07-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148366744","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}