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

{"title":"Out of this world: can surgery learn from NASA's approach to leadership and safety culture?","authors":"O Al-Gholmy, M Davidson, E S Brennan, R Kerstein, P A Brennan","doi":"10.1308/rcsann.2025.0079","DOIUrl":"10.1308/rcsann.2025.0079","url":null,"abstract":"<p><p>The US National Aeronautics and Space Administration (NASA) will be familiar to most across the world. Leading highly dangerous and innovative space travel, NASA has gone from a blame culture in the 1960s to an environment that keeps safety at the forefront and a top priority. NASA culture aims to ensure that staff work safely through balancing challenges and risks, feel comfortable communicating safety issues and learn from both successes and error. Surgery, and healthcare in general, still has a long way to go to embed a safety culture that values staff and looks at why incidents and errors have happened, and what can be learnt from them, instead of who was to blame. NASA's safety journey is a powerful study in learning from failure, evolving culture and leading with humility. From the Apollo 1, Challenger and Columbia disasters, NASA built a more transparent, accountable and resilient safety system and one that continues to evolve with the frontiers of space exploration. In many ways, surgeons can learn a lot from NASA to improve both patient safety and culture.</p>","PeriodicalId":8088,"journal":{"name":"Annals of the Royal College of Surgeons of England","volume":" ","pages":"416-420"},"PeriodicalIF":2.0,"publicationDate":"2026-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13318460/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145487527","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 effectiveness of nonsurgical nasal devices in relieving nasal obstruction.","authors":"A Ahmed, C Gakpetor, D Yang, B Oremule, B Ranganathan, A Jaiswal, R K Bhalla","doi":"10.1308/rcsann.2025.0103","DOIUrl":"10.1308/rcsann.2025.0103","url":null,"abstract":"<p><strong>Introduction: </strong>Nasal obstruction secondary to septal deformity is a common problem, for which surgery is the gold-standard treatment. Long waiting times for surgery, however, leave patients in need of effective, patient-led strategies in the interim. Many wearable nasal devices are commercially available for patients to help relieve nasal obstruction while waiting for surgery; however, the literature around their efficacy is limited.</p><p><strong>Methods: </strong>A scoping review of the literature was conducted using Medline, Embase, PubMed and Cochrane Library. This was in accordance with the 2018 PRISMA (Preferred Reporting Items for Systematic reviews and Meta Analyses) extension for scoping reviews (PRISMA-ScR).</p><p><strong>Results: </strong>A total of 186 records were identified from the search, of which 13 met the inclusion criteria. Most studies assessed external nasal devices, in particular the Breathe Right nasal strips, with fewer assessing internal nasal devices. Both devices appear to relieve nasal obstruction; however, objective and subjective outcomes demonstrated greater relief with internal nasal devices. Data on long-term effects were limited.</p><p><strong>Conclusions: </strong>Nasal valve devices, in particular internal nasal devices, appear to be an effective and accessible method of relieving nasal obstruction. In patients struggling with symptoms and awaiting surgery, these devices could be recommended by clinicians to offer relief in the interim. Further studies on emerging devices such as magnetic nasal strips, which theoretically could be more comfortable to wear, are needed to allow clinicians to fully counsel patients on potential options for treatment.</p>","PeriodicalId":8088,"journal":{"name":"Annals of the Royal College of Surgeons of England","volume":" ","pages":"476-483"},"PeriodicalIF":2.0,"publicationDate":"2026-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13321171/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145601804","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":"Frailty: new horizons in older patients needing surgery.","authors":"I Wilkinson","doi":"10.1308/rcsann.2026.0068","DOIUrl":"10.1308/rcsann.2026.0068","url":null,"abstract":"","PeriodicalId":8088,"journal":{"name":"Annals of the Royal College of Surgeons of England","volume":"108 6","pages":"410-412"},"PeriodicalIF":2.0,"publicationDate":"2026-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13318467/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148359121","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":"Effectiveness of epidural anaesthesia induced by different dosages of ropivacaine combined with lidocaine in geriatric orthopaedic surgery.","authors":"J Li, Q Yao, J Shi, P Jiang","doi":"10.1308/rcsann.2025.0055","DOIUrl":"10.1308/rcsann.2025.0055","url":null,"abstract":"<p><strong>Objective: </strong>This paper unravelled the effectiveness of epidural anaesthesia induced by different dosages of ropivacaine combined with lidocaine in geriatric orthopaedic surgery.</p><p><strong>Methods: </strong>Elderly orthopaedic surgical patients who underwent epidural anaesthesia were allocated into three groups: Group I (0.375% ropivacaine+1% lidocaine), Group II (0.50% ropivacaine+1% lidocaine) and Group III (0.75% ropivacaine+1% lidocaine), to compare the sensory and motor blockade effects, the occurrence of cognitive function and cognitive dysfunction, and the occurrence of adverse reactions.</p><p><strong>Results: </strong>The onset time of sensory blockade and the appearance time of the highest plane were significantly earlier and the maintenance time of the highest plane was significantly longer, the onset time of motor blockade was notably earlier, the maintenance time of the highest plane was markedly longer, and the modified Bromage score was distinctly higher in Group II and Group III in comparison with Group I (<i>p</i><0.05). The postoperative 12- and 24-h Mini-Mental State Examination scores were higher and the incidence of postoperative 12h-cognitive impairment was lower in Group III than in Group I and Group II (<i>p</i><0.05). There was no statistically significant difference in the incidence of adverse reactions in patients among the three groups (<i>p</i>>0.05).</p><p><strong>Conclusions: </strong>Epidural anaesthesia combining 0.75% ropivacaine with 1% lidocaine in elderly orthopaedic surgical patients has a rapid onset of action, a long duration of anaesthesia maintenance, a low overall impact on cognitive function, and good medication safety.</p>","PeriodicalId":8088,"journal":{"name":"Annals of the Royal College of Surgeons of England","volume":" ","pages":"438-443"},"PeriodicalIF":2.0,"publicationDate":"2026-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13318458/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144726879","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 and meta-analysis comparing the safety and efficacy of open oesophagectomy and hybrid minimally invasive oesophagectomy.","authors":"N Naim, Mds Reza","doi":"10.1308/rcsann.2025.0066","DOIUrl":"10.1308/rcsann.2025.0066","url":null,"abstract":"<p><strong>Introduction: </strong>Surgical resection, with or without neoadjuvant therapy, remains the primary treatment for oesophageal cancer. The two main surgical approaches are open oesophagectomy (OE) and hybrid minimally invasive oesophagectomy (HMIE). However, their relative safety and efficacy remain controversial. This review aims to compare perioperative and postoperative complications between OE and HMIE in the management of oesophageal cancer.</p><p><strong>Methods: </strong>Web of Science, EMBASE, PubMed, Scopus and the Cochrane Library were searched for relevant studies. Odds ratios (OR), standard mean differences (SMD) and 95% confidence intervals (CI) were used for statistical analysis.</p><p><strong>Results: </strong>Eight studies involving 6,053 patients were included. HMIE was associated significantly with lower rates of conduit necrosis (risk ratio (RR)=3.54, 95% CI [1.07, 11.73]; <i>p</i>=0.04), postoperative pneumonia (RR=1.29, 95% CI [1.05, 1.57]; <i>p</i>=0.01) and recurrent laryngeal nerve paralysis (RR=2.51, 95% CI [1.13, 5.55]; <i>p</i>=0.02). No significant differences were observed in Clavien-Dindo complication grades IIIa-IVb (RR=1.13, 95% CI [0.92, 1.38]; <i>p</i>=0.24), grade V complications (RR=1.03, 95% CI [0.30, 3.51]; <i>p</i>=0.96), bleeding, inhospital mortality, 90-day mortality, duration of surgery, hospital stay or intensive care unit stay. Although not statistically significant, OE was associated with fewer cases of anastomotic and chyle leaks.</p><p><strong>Conclusions: </strong>Both OE and HMIE have distinct advantages and drawbacks. HMIE appears superior in reducing conduit necrosis, postoperative pneumonia and nerve paralysis, whereas OE has slightly lower rates of anastomotic and chyle leaks. Surgical approach should be tailored to individual patient profiles. Further studies are needed to assess long-term oncologic outcomes.</p>","PeriodicalId":8088,"journal":{"name":"Annals of the Royal College of Surgeons of England","volume":" ","pages":"421-429"},"PeriodicalIF":2.0,"publicationDate":"2026-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13318470/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144991425","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":"Long-term outcomes of bovine pericardium neo-aortic reconstructions in infected vascular fields.","authors":"M Bakheet, T Babiker, I Zeynali, B Rawshdeh, G Riding, M Banihani","doi":"10.1308/rcsann.2025.0116","DOIUrl":"10.1308/rcsann.2025.0116","url":null,"abstract":"<p><strong>Introduction: </strong>Infected aortic fields are among the most complex surgical challenges, often requiring urgent intervention and associated with a high risk of morbidity and mortality. Bovine pericardium offers a customisable, off-the-shelf option for in situ reconstruction using biological material. We evaluate long-term outcomes following emergency bovine pericardium neo-aorta reconstruction in infected aortic fields.</p><p><strong>Methods: </strong>Prospectively collected data for all patients treated with bovine pericardium neo-aorta reconstructions from 2018 to date were analysed. The surgical approach included resection of the infected aortic segment, explantation of previous grafts and/or stents, and reconstruction of the neo-aorta using a bovine pericardium sheet. Data collected included patient demographics, comorbidities, clinical presentation, previous interventions, blood tests, complications, length of antibiotic treatment and long-term survival. All neo-aortas were enrolled in an annual ultrasound surveillance programme to monitor for aneurysmal degeneration.</p><p><strong>Results: </strong>Fifteen aortic reconstructions were performed. The most common indication was aorto-enteric fistulas (<i>n</i> = 7), followed by infected aortic grafts (<i>n</i> = 4), mycotic aneurysms (<i>n</i> = 3) and one contaminated field due to emergency colectomy. Median follow-up was 34 months (range 9-84). Thirty-day mortality was 7%, with another 7% at 10 weeks. Antibiotic-free survival rate was 86%. One patient (7%) required long-term antibiotics post-partial endovascular aneurysm repair explant. Complications included one graft occlusion with limb loss and one case of end-stage renal failure. No aneurysmal degeneration was identified during follow-up.</p><p><strong>Conclusion: </strong>Bovine pericardial neo-aorta reconstructions have shown excellent long-term resistance to infections and very good durability. Our data add to growing evidence supporting off-the-shelf use of bovine pericardium in emergency aortic reconstruction. Larger numbers through multicentre studies or special registries would help support more regular use.</p>","PeriodicalId":8088,"journal":{"name":"Annals of the Royal College of Surgeons of England","volume":" ","pages":"465-468"},"PeriodicalIF":2.0,"publicationDate":"2026-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13318463/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145951378","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":"Double lumen concentric frontal sinus irrigation device.","authors":"J Kirk, S Arman, R Gohil","doi":"10.1308/rcsann.2024.0083","DOIUrl":"10.1308/rcsann.2024.0083","url":null,"abstract":"","PeriodicalId":8088,"journal":{"name":"Annals of the Royal College of Surgeons of England","volume":" ","pages":"485-486"},"PeriodicalIF":2.0,"publicationDate":"2026-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13318466/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145336306","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":"Frailty in emergency surgery: expanding the role of biomarkers.","authors":"H J Ng, N Rattray, T Quasim, S Moug","doi":"10.1308/rcsann.2026.0051","DOIUrl":"10.1308/rcsann.2026.0051","url":null,"abstract":"","PeriodicalId":8088,"journal":{"name":"Annals of the Royal College of Surgeons of England","volume":"108 6","pages":"413-415"},"PeriodicalIF":2.0,"publicationDate":"2026-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13318457/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148359166","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":"Virtual joint school prior to hip and knee arthroplasty: patient feedback and carbon footprint savings.","authors":"D Pinto, M Clarke, M Ganapathi","doi":"10.1308/rcsann.2025.0080","DOIUrl":"10.1308/rcsann.2025.0080","url":null,"abstract":"<p><strong>Introduction: </strong>Patient education programmes prior to hip and knee arthroplasty reduce anxiety and create realistic expectations. We describe a 'virtual joint school' (VJS) model and analyse patient feedback and environmental impact.</p><p><strong>Methods: </strong>Eligible patients first viewed online educational videos, and then attended an interactive virtual session during which knowledge was reinforced. Each session was attended by eight to ten patients along with a relative or friend, and was hosted by a multidisciplinary team consisting of nurses, physiotherapists, occupational therapists and a former patient who provided personal insight. Feedback was obtained prospectively using an electronic questionnaire, and travel savings were calculated using Python software.</p><p><strong>Results: </strong>From July 2022 to February 2023, 267 patients attended the VJS; of whom 117 (44%) responded to the questionnaire. Among them, 87% found the pre-learning videos helpful and comprehensible, 92% felt their concerns were adequately addressed, 96% felt they had sufficient opportunity to ask questions and 96% were happy with the level of confidentiality involved. Although 83% felt they received sufficient support from the health board to access the virtual session, 63% also took support from family/friends to attend it. Only 15% felt they would have preferred a face-to-face format. By having 'virtual' sessions, each patient saved, on average, 38 miles and 62min of travel (10,070 miles and 274h saved for 267 patients). Each VJS session produced 0.32kg of CO₂ compared with 110kg of CO₂ per face-to-face session.</p><p><strong>Conclusions: </strong>Virtual joint schools are acceptable to patients and reduce the carbon footprint of healthcare. We recommend their implementation at other arthroplasty centres.</p>","PeriodicalId":8088,"journal":{"name":"Annals of the Royal College of Surgeons of England","volume":" ","pages":"444-448"},"PeriodicalIF":2.0,"publicationDate":"2026-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13321172/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146002970","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":"Competence over case count: rethinking paediatric orthopaedic training.","authors":"A T Schade, A Pilarski, D Waugh, D Eastwood","doi":"10.1308/rcsann.2025.0105","DOIUrl":"10.1308/rcsann.2025.0105","url":null,"abstract":"","PeriodicalId":8088,"journal":{"name":"Annals of the Royal College of Surgeons of England","volume":" ","pages":"495-496"},"PeriodicalIF":2.0,"publicationDate":"2026-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13318456/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145755071","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}