ANZ Journal of Surgery最新文献

{"title":"Traffic Light Coding System for Engaging With AI in Surgery.","authors":"Payal Mukherjee, Amin Beheshti, Shivani Angelique Kumar, Gordon Wallace, Neil Merrett, Jonathan Clark, Simon Kos, Ellen Rawstron, Jian Yang, Stuart Grieve, Amith Shetty, Simon Singer","doi":"10.1111/ans.70172","DOIUrl":"https://doi.org/10.1111/ans.70172","url":null,"abstract":"<p><p>Artificial Intelligence (AI) is generally defined as the development of computer systems or machines that can perform tasks typically requiring human intelligence and is increasingly being used in modern healthcare. While, various AI systems have existed for decades, its scale in healthcare has been escalated by global crises such as the COVID-19 pandemic and military conflicts, which has demanded rapid implementation of health system processes that improve efficiency in resource constrained environments. As AI-enabled technologies gain prominence, it is vital for surgeons to understand the various types of AI systems and their applications in medical practice.</p>","PeriodicalId":8158,"journal":{"name":"ANZ Journal of Surgery","volume":" ","pages":""},"PeriodicalIF":1.5,"publicationDate":"2025-05-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144075568","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":"Laboratory Assessment of Anastomotic Configurations Utilized for Intracorporeal Anastomosis in Laparoscopic Right Hemicolectomy.","authors":"Ali Hooshyari, Sina Karimian, Malsha Kularatna, Mark Omundsen, Benjamin Cribb","doi":"10.1111/ans.70147","DOIUrl":"https://doi.org/10.1111/ans.70147","url":null,"abstract":"<p><strong>Background: </strong>An intracorporeal anastomosis for colorectal resections has several advantages over a traditional extracorporeal anastomosis. A double stapled intracorporeal anastomosis compared to a single-stapled technique could reduce operative time and increase uptake of this beneficial technique. However, the patency and calibre of this anastomosis require laboratory assessment.</p><p><strong>Objective: </strong>The aim of the study was to assess and compare the luminal diameter and patency of the double-stapled (intracorporeal type) anastomosis (DICA) with a single-stapled (intracorporeal type) anastomosis (SICA) and a double-stapled (extra-corporeal type) anastomosis (ECA).</p><p><strong>Methods: </strong>Experimental laboratory-based study using fresh bovine intestine. Construction and assessment of two of each of the following anastomotic types: DICA, SICA, and ECA. The primary outcome measure was the luminal diameter of the anastomosis, comparing the ratios of the narrowest point of the anastomosis to the narrowest luminal diameter. Secondary outcome tests were leak and patency testing for each anastomosis.</p><p><strong>Results: </strong>All six anastomoses were found to be patent and without any anastomotic leakage. The ratio of narrowest anastomotic diameter to narrowest luminal diameter for all three anastomoses was comparable (extracorporeal anastomosis 1.16, single-stapled intracorporeal anastomosis 1.0 and double-stapled intracorporeal anastomosis 0.97).</p><p><strong>Conclusion: </strong>This study confirms the in vitro patency and the adequacy of luminal diameter of the double stapled (intracorporeal type) anastomosis.</p>","PeriodicalId":8158,"journal":{"name":"ANZ Journal of Surgery","volume":" ","pages":""},"PeriodicalIF":1.5,"publicationDate":"2025-05-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143969307","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":"3D-reconstruction printed models could enhance understanding of Crohn's disease complex perianal fistulas?","authors":"Sebastián Jerí-McFarlane, Álvaro García-Granero, Aina Ochogavía-Seguí, Daniel Ginard-Vicens, Leandro Brogi, Marc Ferrà-Canet, Margarita Gamundí-Cuesta, Francisco Xavier González-Argenté","doi":"10.1111/ans.70140","DOIUrl":"https://doi.org/10.1111/ans.70140","url":null,"abstract":"<p><strong>Background: </strong>3D image processing and reconstruction (3D-IPR) is increasingly used in surgical applications for enhanced planning and intraoperative visualization. 3D-printed models, created from 3D-IPR, have the potential to improve understanding of anatomical structures and simulate surgical procedures. However, evidence supporting their educational benefits, particularly for complex perianal Crohn's disease (pCD) fistulas, remains limited.</p><p><strong>Methods: </strong>This study assessed the role of 3D-printed models as teaching tools for general surgery and gastroenterology trainees/attendants. Two courses were developed, incorporating pre-tests, lessons, real case presentations with MRI scans, and discussions using 3D-printed models. Pre- and post-course test scores were analyzed to evaluate learning outcomes.</p><p><strong>Results: </strong>Participants demonstrated significant improvement in post-test scores compared to pre-test scores, highlighting the educational impact of 3D models. Course satisfaction surveys revealed high satisfaction, with most participants likely to recommend the course.</p><p><strong>Conclusions: </strong>3D-IPR and 3D-printed models hold promise as effective tools for teaching complex pCD anatomy, enhancing surgical education, and improving understanding of 3D structures. These findings enhance the growing importance of integrating 3D technologies into modern surgical training.</p>","PeriodicalId":8158,"journal":{"name":"ANZ Journal of Surgery","volume":" ","pages":""},"PeriodicalIF":1.5,"publicationDate":"2025-05-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143956919","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":"Rapunzel Syndrome, a Rare Cause of Acute Abdomen.","authors":"Sriram Deivasigamani, Vibhu Jain, Santhosh Irrinki, Satish Subbiah Nagaraj, Kailash Chand Kurdia","doi":"10.1111/ans.70165","DOIUrl":"https://doi.org/10.1111/ans.70165","url":null,"abstract":"","PeriodicalId":8158,"journal":{"name":"ANZ Journal of Surgery","volume":" ","pages":""},"PeriodicalIF":1.5,"publicationDate":"2025-05-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143963868","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":"Changing Trends in Carotid Revascularization in Australia: A Nationwide Study Over 30 Years.","authors":"David F Sun, Kevin Tian, Amanda Seneviratne, Oh Sung Choy, Daphne Wang, Vimalin Vedanayagam, Michelle T Sun, Christopher X Wong","doi":"10.1111/ans.70159","DOIUrl":"https://doi.org/10.1111/ans.70159","url":null,"abstract":"<p><strong>Background: </strong>Carotid artery stenosis is one of the causes of acute ischaemic stroke. Carotid endarterectomy (CEA) and carotid artery stenting (CAS) are the main procedural treatment options. This study investigates the changing trends in carotid revascularisation in Australia over the last 30 years.</p><p><strong>Methods: </strong>Two population level datasets were used, the Australian Institute of Health and Welfare (AIHW) and Medicare Australia. Patients who had either CEA or CAS procedures between 1993 and 2024 were identified, and procedural trends were analyzed over a 30-year period.</p><p><strong>Results: </strong>Data from AIHW was available from 2000 to 2021, over which 66 983 patients underwent carotid revascularisation (58 932 CEA and 8051 CAS). There was a 47.4% relative decrease in the absolute number of CEA procedures over the study period (3702-1948). There was a relative 23.1% increase in CAS procedures over this period (524-645). Data from the Medicare dataset was available from 1993 until 2024, over which 41 860 patients had carotid revascularisation (38 118 CEA and 3742 CAS). There was a relative 51.0% decrease in the absolute number of CEA procedures (1733-849). There was a 1.6% relative decrease in the absolute number of CAS procedures over the study period (187-184).</p><p><strong>Conclusion: </strong>The number of carotid revascularisation procedures performed has steadily decreased over the last 30 years. CEA procedures have declined to a greater extent compared to CAS procedures, though CEA procedures remain significantly more common. These trends likely reflect evolving medical therapy for carotid artery disease.</p>","PeriodicalId":8158,"journal":{"name":"ANZ Journal of Surgery","volume":" ","pages":""},"PeriodicalIF":1.5,"publicationDate":"2025-05-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143952650","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":"Surgical Trainees' Lived Experience of Entrustable Professional Activities: Assessment in the Australasian Context","authors":"Balakavitha Balaravi Pillai,&nbsp;Eugenia Ip,&nbsp;Kirstin Stuart James,&nbsp;Jenepher Martin","doi":"10.1111/ans.70171","DOIUrl":"10.1111/ans.70171","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Background</h3>\u0000 \u0000 <p>The Royal Australasian College of Surgeons' Board in General Surgery implemented Entrustable Professional Activities (EPAs) in its competency-based training programme in 2022. As this is a new method for surgical trainees, a qualitative study was performed to evaluate its implementation and use by exploring the pioneer trainees' perceptions and experiences of EPAs.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>Seven first-year general surgery trainees were recruited to participate in semi-structured interviews. The interviews explored the trainees' experiences of EPAs, their perceptions of the effect on their independence with completing clinical activities and patient safety, and their suggestions for how to improve this form of assessment in the training program.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>The findings of the study suggest that EPAs can be a useful tool for assessing the competence of trainees. However, the study also found that EPAs can be challenging for trainees, particularly in terms of the level of self-regulation and independence required.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusion</h3>\u0000 \u0000 <p>Although EPAs may positively contribute to a trainee's experience, considerations to support trainees and trainers in their practical implementation may increase the value of the learning encounter. Graded assessment of entrustment and explicit year-level milestone progress points could promote more effective learning and support developmental feedback by trainers.</p>\u0000 </section>\u0000 </div>","PeriodicalId":8158,"journal":{"name":"ANZ Journal of Surgery","volume":"95 6","pages":"1068-1073"},"PeriodicalIF":1.5,"publicationDate":"2025-05-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1111/ans.70171","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143953863","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":"International Region of Birth and Long-Term Outcomes for Patients Undergoing Colorectal Cancer Resection in an Australian Population.","authors":"James A Pasch, Kar Yin Fok, David Goltsman, Chatika Premaratne, Ewan MacDermid","doi":"10.1111/ans.70160","DOIUrl":"https://doi.org/10.1111/ans.70160","url":null,"abstract":"<p><strong>Background: </strong>Overseas birth is associated with a survival advantage in colorectal cancer in Australia. We wished to analyse this survival based on global region of birth, controlling for cancer-specific and other causes of death.</p><p><strong>Methods: </strong>A database of resected colorectal cancers from 2010 to 2016 (n = 1596) was grouped according to patient global region of birth. Chi-squared testing was used to compare factors including patient demographics and AJCC stage. Kaplan-Meier and competing-risk analysis were used to compare 5-year survival outcomes between patients born in different regions, and regression analysis was used to control for age.</p><p><strong>Results: </strong>751 (47.1%) patients were born overseas. 385 (24.1%) originated from Europe, 124 (7.8%) from East and SE Asia, 92 (5.8%) from the Middle East, and the remainder from other global regions. Immigrants from East or SE Asia were more likely to present with node-positive disease (p = 0.048) than those born in Australia. Immigrants from East and SE Asia and the Middle East had significantly better all-cause 5-year survival than patients born in Australia (73.4% and 80.4% vs. 60.4%, p < 0.0001). Immigrants from the Middle East retained their cancer-specific survival advantage after competing risk analysis (HR 0.76, p = 0.027). Immigrants from Europe displayed no significant difference in all-cause or disease-specific survival compared to individuals born in Australia.</p><p><strong>Conclusion: </strong>Patients born in the Middle East appear to have a colorectal cancer-specific survival advantage compared to those born in Australia, unrelated to stage at presentation. This has significant implications for prognosis and future research directions.</p>","PeriodicalId":8158,"journal":{"name":"ANZ Journal of Surgery","volume":" ","pages":""},"PeriodicalIF":1.5,"publicationDate":"2025-05-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143962405","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":"Contemporary Long-Term Patient Reported Outcomes of Pilon Fractures","authors":"Thomas J. Ryan,&nbsp;Natalie Enninghorst,&nbsp;Jessica Partridge,&nbsp;Ahmed Sulemain,&nbsp;Jacqueline Du Plessis,&nbsp;Chris Henry,&nbsp;Natasha Weaver,&nbsp;Seth M. Tarrant,&nbsp;Zsolt J. Balogh","doi":"10.1111/ans.70164","DOIUrl":"10.1111/ans.70164","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Background</h3>\u0000 \u0000 <p>Pilon fractures are historically associated with suboptimal outcomes. No long-term Australian data is available on patient-reported outcomes. We hypothesised that pilon fracture long-term outcomes are inferior to Australian population norms.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>A 14-year retrospective study was conducted in a Level-1 trauma centre on AO/OTA type-B/C fractures. Type-A fractures, skeletally immature, interpreter requirement and primary amputation were excluded. Demographics, injury characteristics, management and complications were collected. The primary outcome was SF-36 with adjusted Australian norms.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>From 127 eligible patients, 73 were included in the study (age: 46 ± 17 years; 50 [69%] males) with 8.7 ± 3.9 years follow-up. Management included ORIF 46 (61%), external fixation (EF) with staged ORIF 17 (23%), definitive EF 4 (5%) and 8 (11%) non-operative. Further surgical intervention was required in 25 (34%) patients, with the majority for hardware removal (14 [19%]). Compared with Australian SF-36 norms, the mean Physical Component Score was lower (44.7 ± 8.9 vs. 50.3, <i>p</i> ≤ 0.001) whereas the Mental Component Score (51.2 ± 12.5 vs. 51.2, <i>p</i> = 0.24) was not. Median return to work was 4.5 months (IQR 5), with 47 (87%) of the 54 employed pre-injury working at 12 months. Two (3.7%) patients did not return to work and 24 (44%) returned at a reduced capacity.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusion</h3>\u0000 \u0000 <p>This study provides a contemporary reference for pilon fractures managed in Australia. Outcomes were favourable when compared internationally. These patients are likely to resume employment, often at reduced capacity, while experiencing moderate long-term impacts to their physical well-being due to persistent pain.</p>\u0000 </section>\u0000 </div>","PeriodicalId":8158,"journal":{"name":"ANZ Journal of Surgery","volume":"95 6","pages":"1247-1252"},"PeriodicalIF":1.5,"publicationDate":"2025-05-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1111/ans.70164","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143966901","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":"Safety of Single Preoperative Dose of Enoxaparin for Hepatectomy: A Study in a Country With Low Venous Thromboembolism Incidence.","authors":"Thakerng Pitakteerabundit, Utcharee Intusoma, Nan-Ak Wiboonkhwan, Tortrakoon Thongkan","doi":"10.1111/ans.70168","DOIUrl":"https://doi.org/10.1111/ans.70168","url":null,"abstract":"<p><strong>Background: </strong>Postoperative venous thromboembolism (VTE) prophylaxis for hepatectomy is debated in low-VTE incidence regions like Thailand due to bleeding risks. This study evaluated single-dose preoperative enoxaparin safety for VTE prophylaxis, focusing on post-hepatectomy hemorrhage (PHH).</p><p><strong>Methods: </strong>This retrospective review compared VTE and PHH incidence before (no prophylaxis) and after implementation of a single preoperative dose of enoxaparin 40 mg for all patients undergoing elective hepatectomy in a center in Thailand. PHH and post-hepatectomy liver failure (PHLF) were defined per International Study Group of Liver Surgery criteria. Factors associated with PHH were analyzed using logistic regression.</p><p><strong>Results: </strong>One hundred eighty-six patients underwent elective hepatectomy (mean age 58 years). Fifty-two percent underwent major hepatectomy. PHLF occurred in 11% of patients. VTE occurred in 0% (0/96) of the pre-protocol and 1.1% (1/90) of the post-protocol group. PHH rate was 3.8%, with no difference between pre-protocol (3/96) and post-protocol groups (4/90). Factors associated with PHH were intraoperative transfusion > 2 units (OR 33.3; 95% CI 1.9-587.7) and PHLF (OR 17.2; 95% CI 2.1-140.8), but not enoxaparin (OR 1.9; 95% CI 0.3-12.8).</p><p><strong>Conclusions: </strong>Single preoperative enoxaparin did not increase PHH risk in this low VTE incidence cohort and may be considered for VTE prophylaxis in similar populations.</p>","PeriodicalId":8158,"journal":{"name":"ANZ Journal of Surgery","volume":" ","pages":""},"PeriodicalIF":1.5,"publicationDate":"2025-05-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143966834","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":"Endovascular Treatment of Acute Large Vessel Occlusion in the Anterior and Posterior Circulation.","authors":"Yong-Feng Han, Qian Zhao, Dong-Liang Zhang, Lei Yang, Bulang Gao","doi":"10.1111/ans.70166","DOIUrl":"https://doi.org/10.1111/ans.70166","url":null,"abstract":"<p><p>Endovascular treatment (EVT) has been strongly recommended as a first-line treatment for acute ischemic strokes (AIS) caused by large vessel occlusion (LVO). To evaluate the efficacy, safety, and predictors of favorable outcomes of EVT for LVO-caused AIS in both the anterior and posterior circulations, consecutive patients who had undergone EVT for AISs caused by LVO were retrospectively enrolled, and the clinical data, symptomatic intracranial hemorrhage (sICH), modified Rankin Scale (mRS) score, and mortality at 90 days were analyzed. In total, 231 patients were enrolled with a mean age of 63.25 ± 11.48 years, including 167 (72.29%) patients with anterior circulation occlusion (ACO) and 64 (27.71%) patients with posterior circulation occlusion (PCO) treated with EVT. The median baseline National Institutes of Health Stroke Scale (NIHSS) Score on admission was 17 (12-20). The median time from symptom onset to recanalization (OTR) was 380 (307.5-461) minutes. Successful recanalization was achieved in 90.04% of patients. At 3-month follow-up, 118 (51.08%) patients had favorable clinical outcomes (mRS 0-2), with a mortality rate of 18.61% (43/231). Younger age (p = 0.001), a lower baseline NIHSS score (p < 0.001), a higher recanalization rate (p = 0.018), and shorter OTR time (p = 0.026) were significant independent risk factors for favorable outcomes. Compared to patients with ACO, PCO patients had a lower favorable outcome rate (p = 0.049) and a higher mortality rate (p < 0.001). In conclusion, EVT is safe and effective for patients with LVO-caused AIS, and younger age, lower baseline NIHSS scores, a higher recanalization rate, and shorter OTR time are independent risk factors for favorable outcomes. PCO patients may have worse clinical outcomes and a higher mortality rate than ACO patients.</p>","PeriodicalId":8158,"journal":{"name":"ANZ Journal of Surgery","volume":" ","pages":""},"PeriodicalIF":1.5,"publicationDate":"2025-05-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143966904","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}