ANZ Journal of Surgery最新文献

{"title":"Robotic- Versus Video-Assisted Thoracoscopic Lobectomy and Persistent Air Leak: A Systematic Review and Meta-Analysis.","authors":"Alexander Lombardo, Angela Chen","doi":"10.1111/ans.70940","DOIUrl":"https://doi.org/10.1111/ans.70940","url":null,"abstract":"<p><strong>Introduction: </strong>Minimally invasive approaches are widely adopted for anatomical lung resection in early-stage non-small cell lung cancer, with video-assisted thoracoscopic surgery (VATS) representing the established standard. Robotic-assisted thoracoscopic surgery (RATS) has emerged as an alternative platform, although its clinical advantages remain uncertain. Persistent air leak (PAL) is a common complication following lobectomy, occurring in up to 8%-19% of patients and contributing to prolonged hospitalization and morbidity. Prior comparative studies of RATS and VATS have been limited by heterogeneity in operative procedures and inclusion of sublobar resections. This study aimed to compare PAL following RATS versus VATS lobectomy, restricting inclusion to lobectomy-only cohorts to reduce procedural heterogeneity.</p><p><strong>Methods: </strong>A systematic review and meta-analysis of studies comparing RATS and VATS lobectomy was performed. Exclusively lobectomy-only cohorts were included to reduce procedural heterogeneity. The primary outcome was PAL (> 5 days). Random-effects models were used to calculate pooled risk ratios (RR).</p><p><strong>Results: </strong>Thirteen studies comprising 16 252 patients (RATS, n = 2427; VATS, n = 13 825) were included. There was no significant difference in PAL between RATS and VATS (RR, 1.01; 95% CI, 0.75-1.37; p = 0.93). Moderate heterogeneity was observed (I² = 44%). No evidence of publication bias was identified (Egger's test; intercept -0.54; 95% CI, -1.74 to 0.67; p = 0.41). Secondary outcomes were largely comparable, although length of stay was modestly shorter following RATS.</p><p><strong>Discussion: </strong>In this lobectomy-restricted analysis, surgical platform was not associated with differences in persistent air leak. These findings suggest that PAL is primarily driven by patient- and technique-related factors rather than operative platform. Restriction to lobectomy improves comparability relative to prior studies. However, incomplete baseline reporting and observational design limit causal inference.</p><p><strong>Conclusions: </strong>In lobectomy-only cohorts, RATS and VATS are associated with comparable rates of persistent air leak. Surgical platform alone does not appear to independently influence this outcome.</p>","PeriodicalId":8158,"journal":{"name":"ANZ Journal of Surgery","volume":" ","pages":""},"PeriodicalIF":1.5,"publicationDate":"2026-09-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148966482","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":"Hemithyroidectomy Is Associated With a Lower Rate of Hypothyroidism Than Radioactive Iodine Therapy for Solitary Toxic Nodules.","authors":"Marianne S Elston, Indika Ranasinghe, Goswin Y Meyer-Rochow, Jade A U Tamatea, Veronica Boyle","doi":"10.1111/ans.70970","DOIUrl":"https://doi.org/10.1111/ans.70970","url":null,"abstract":"<p><strong>Background: </strong>For solitary toxic adenoma (STA) hemithyroidectomy and radioactive iodine (RAI) both cure hyperthyroidism, but their hypothyroidism risks differ.</p><p><strong>Aim: </strong>To review the thyroid status of patients who had received definitive therapy for a STA to determine differences in the hypothyroidism rates between those who underwent surgery as compared with RAI.</p><p><strong>Methods: </strong>Retrospectively collected cohort study (2010-2020) from a single centre in New Zealand. STA was defined by a low TSH and solitary hot nodule on ⁹⁹ᵐTc imaging. Primary outcome was hypothyroidism at 12 months.</p><p><strong>Results: </strong>Among 98 patients (RAI 48; surgery 50), cure of hyperthyroidism was 98% (RAI) versus 100% (surgery). After excluding those with missing data, hypothyroidism at 12 months occurred in 12/44 (27%) after RAI versus 3/45 (6.7%) after surgery (absolute risk difference ~20%; NNT≈5). Of those with biochemical hypothyroidism, 9/12 RAI patients were treated with levothyroxine and 2/3 in the surgical group. In multivariable analysis, RAI was associated with higher odds of hypothyroidism versus surgery.</p><p><strong>Conclusion: </strong>Both treatments are effective, but when using a fixed dose 555 MBq RAI protocol, hemithyroidectomy is associated with substantially lower hypothyroidism risk. Findings support shared decision-making that weighs patient preference to avoid lifelong levothyroxine against operative risks and local expertise.</p>","PeriodicalId":8158,"journal":{"name":"ANZ Journal of Surgery","volume":" ","pages":""},"PeriodicalIF":1.5,"publicationDate":"2026-09-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148966370","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":"Long-Term Health-Related Quality of Life After Jaw Reconstruction With Fibula Free Flaps Using Primary Endosseous Implants and Buried Skin Grafts to Facilitate Implant-Retained Dental Prostheses.","authors":"Yu Jin Jeong, Masako Dunn, Emma Charters, Rebecca Venchiarutti, Timothy Manzie, Dale Howes, James Wykes, Carsten E Palme, David Leinkram, Tsu-Hui Hubert Low, Yee Mon Aung, Sydney Ch'ng, Jonathan R Clark","doi":"10.1111/ans.70978","DOIUrl":"https://doi.org/10.1111/ans.70978","url":null,"abstract":"<p><strong>Background: </strong>Data on health-related quality-of-life (HRQoL) is indispensable in understanding patient outcomes following jaw reconstruction. This study aims to evaluate long-term HRQoL using validated patient-reported outcome measures (PROMs) following jaw reconstruction using buried skin grafts to facilitate implant-retained dental prosthetic rehabilitation.</p><p><strong>Methods: </strong>A cohort study of all patients that underwent prelamination as described by Rohner or the Sydney Modified-Alberta Reconstruction Technique (SM-ART) from October 2012 to June 2023 at Chris O'Brien Lifehouse, Sydney, Australia with HRQoL data was conducted. HRQoL was assessed using the FACE-Q Head and Neck Cancer Module, MD Anderson Dysphagia Inventory (MDADI), and Speech Handicap Index (SHI) at one-year intervals from baseline to 5 years post-operatively.</p><p><strong>Results: </strong>Twenty-eight cases (Rohner technique; n = 19 or SM-ART; n = 9) were included (median age, 52 years). Six dental implant losses were recorded across five patients (median time to implant loss, 21.5 months). Three patients required denture removal; however, all had an implant-retained prosthesis at end of follow-up. While cross-sectional HRQoL scores were lower across most subscales at 12 months post-operatively as compared with baseline, mean scores among available respondents showed favourable trends towards baseline by 60 months. Appearance distress notably improved beyond baseline (mean difference [MD] +19.9, 95% confidence interval [CI] -4.1 to 43.9), while oral competence (MD -16.6, 95% CI -53.4 to 20.2) and eating distress (MD -8.5, 95% CI -50.3 to 33.3) suggested a more persistent deficit.</p><p><strong>Conclusions: </strong>Favourable trends in long-term HRQoL were observed following these reconstructive techniques to optimise dental rehabilitation, although long-term estimates should be interpreted cautiously. These data may help inform patient counselling regarding the anticipated trajectory of recovery.</p>","PeriodicalId":8158,"journal":{"name":"ANZ Journal of Surgery","volume":" ","pages":""},"PeriodicalIF":1.5,"publicationDate":"2026-09-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148966401","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":"Integrated Perioperative Lung Cancer Care Should Make Psychological Support Measurable.","authors":"Chi-Hua Lan, Lien-Chung Wei","doi":"10.1111/ans.70974","DOIUrl":"https://doi.org/10.1111/ans.70974","url":null,"abstract":"","PeriodicalId":8158,"journal":{"name":"ANZ Journal of Surgery","volume":" ","pages":""},"PeriodicalIF":1.5,"publicationDate":"2026-09-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148954700","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 Descriptive Literature Review of Biologics and Immunomodulators in IBD for the Surgeon.","authors":"Gary Sharp, William Manners, Peter Gourlas, Neal Martin","doi":"10.1111/ans.70969","DOIUrl":"https://doi.org/10.1111/ans.70969","url":null,"abstract":"<p><p>This review focusses on the use of pharmacological therapies in the management of Inflammatory bowel disease (IBD). Understanding the pathophysiology of IBD has guided the development of medical therapies. This review discusses the shift towards a more personalised approach to IBD management and aims to improve the surgeons' understanding of available pharmacological agents. We discuss the use of immunomodulators and biologics, plus potential adverse reactions and contraindications. Lastly, we discuss future pharmacological therapies.</p>","PeriodicalId":8158,"journal":{"name":"ANZ Journal of Surgery","volume":" ","pages":""},"PeriodicalIF":1.5,"publicationDate":"2026-09-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148954728","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":"Temporal Trends in the Management of Urethral Stricture Disease in Australia Over the 21st Century.","authors":"Yam Ting Ho, Omattage M Perera, Femi E Ayeni, Nicola Jeffery, Isaac A Thangasamy, Devang Desai","doi":"10.1111/ans.70963","DOIUrl":"https://doi.org/10.1111/ans.70963","url":null,"abstract":"<p><strong>Objective: </strong>To identify trends in the management and prevalence of urethral stricture disease in Australia over a period of two decades: METHODS: Databases related to urethral procedures between financial year (FY) 2000/01 and 2022/23 were sourced from Australian Institute of Health & Welfare and Medicare Benefits Scheme. The data include length of stay and procedure counts based on age, gender and procedure type. Nationwide subsidy burden was estimated from Service Australia data.</p><p><strong>Results: </strong>Between FY2000/01 and 2022/23, there is a decreasing trend in urethral procedures performed. We observed a 9% increase in urethroplasty procedures and a 9% decrease in urethral dilatation procedures. Urethral procedures are commonly performed in 70-79 years old, though a rise in urethroplasty in younger patients over time was observed. The ratio of urethroplasty to endoscopic procedures has shifted from 1:13 to 1:5 in the last two decades. The estimated length of stay related to urethral procedures has reduced from 2.1 to 1.4 days. The nationwide subsidy burden between FY2002/03 and 2022/23 has increased from $23 113 to $26 825 per 100 000 persons.</p><p><strong>Conclusion: </strong>Within the last two decades, there is a reduction in urethral procedures performed nationwide; however, among the procedures performed, we observed a rise in urethroplasty and reduction in dilatation procedures. We observed more urethral procedures performed in older males, with a notable increased uptake in urethroplasty in younger patients. This suggests that there is a shift to more sub-specialised reconstructive surgical techniques for the management of urethral stricture disease within Australia. Finally, the nationwide estimated subsidy burden has increased slightly.</p>","PeriodicalId":8158,"journal":{"name":"ANZ Journal of Surgery","volume":" ","pages":""},"PeriodicalIF":1.5,"publicationDate":"2026-09-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148954740","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":"Application of AI-Enhanced Teaching Combined With Traditional Instruction in Cardiac and Great Vessel Surgery.","authors":"Chengxin Zhang, Jinguo Xu","doi":"10.1111/ans.70972","DOIUrl":"https://doi.org/10.1111/ans.70972","url":null,"abstract":"<p><strong>Objective: </strong>To investigate the feasibility and effectiveness of combining AI-enhanced teaching with traditional instruction for clinical skills training of resident physicians undergoing standardized training in cardiac and great vessel surgery.</p><p><strong>Methods: </strong>Forty resident physicians were randomly divided into two groups. The AI-combined teaching group (n = 20) received an 8-week AI-enhanced teaching program (including intelligent learning planning, an intelligent surgical video library, and an intelligent case analysis library) combined with traditional instruction; the traditional teaching group (n = 20) received only conventional teaching. Before and after the training, Objective Structured Clinical Examinations (OSCE) and porcine heart model assessments for mitral valve replacement and coronary artery bypass grafting were conducted, and satisfaction was surveyed.</p><p><strong>Results: </strong>After training, the total OSCE score of the AI-combined teaching group was significantly higher than that of the traditional teaching group (85.6 ± 4.2 vs. 78.3 ± 5.1, p < 0.01), with notable advantages in image interpretation and skill operation. Surgical skill scores were also significantly better (92.4 ± 3.7 vs. 86.1 ± 4.9, p < 0.001). All members of the AI-combined teaching group expressed satisfaction, and their surgical confidence scores increased significantly (p < 0.001).</p><p><strong>Conclusion: </strong>AI-enhanced teaching combined with traditional instruction significantly improves the clinical and surgical skills of resident physicians in cardiac and great vessel surgery and represents a feasible and efficient human-computer collaborative teaching model.</p>","PeriodicalId":8158,"journal":{"name":"ANZ Journal of Surgery","volume":" ","pages":""},"PeriodicalIF":1.5,"publicationDate":"2026-09-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148954778","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":"Diffuse Idiopathic Skeletal Hyperostosis: A Surgically Treatable Cause of Dysphagia in the Elderly Patient.","authors":"Rhea Darbari Kaul, Santhosh George Thomas, Tsu-Hui Hubert Low","doi":"10.1111/ans.70971","DOIUrl":"https://doi.org/10.1111/ans.70971","url":null,"abstract":"","PeriodicalId":8158,"journal":{"name":"ANZ Journal of Surgery","volume":" ","pages":""},"PeriodicalIF":1.5,"publicationDate":"2026-09-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148954772","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":"Robotic Surgical Curriculum for Medical Students-1 Year of Implementation.","authors":"Jade El-Mohamed, Nyasha Sibanda, Nicholas Sinnett, Siobhan McKay, Matthew Gray, Paul Anderson, Justin Bilszta, Satish Warrier, Tony Costello, Michael W Hii, Helen Mohan","doi":"10.1111/ans.70892","DOIUrl":"https://doi.org/10.1111/ans.70892","url":null,"abstract":"<p><strong>Objective: </strong>To develop and evaluate a 4-week robotic surgery curriculum for penultimate-year medical students.</p><p><strong>Design: </strong>A prospective mixed-methods evaluation was conducted during the first year of implementation (2024). The curriculum, designed using Kern's six-step framework, integrated asynchronous learning, simulator training, technical workshops and human factors simulation. Students were assessed using structured rubrics, including the Global Evaluative Assessment of Robotic Skills (GEARS) performed on the ImraSurgical Roboset Hydroskin™, a checklist for open access (Hasson technique) performed on the ImraSurgical Hydrogel Abdominal Wall Model™ and a structured assessment tool for non-technical skills evaluating communication, leadership and situational awareness. Pre- and post-course surveys evaluated learner perceptions and self-reported knowledge (Kirkpatrick Levels 1-2).</p><p><strong>Setting: </strong>This study was conducted at the International Medical Robotics Academy (IMRA), a dedicated surgical simulation and robotics training centre in Melbourne, Australia, in collaboration with the University of Melbourne Medical School. The curriculum was delivered as an elective Discovery subject within the Doctor of Medicine programme. Thirty-five penultimate-year medical students enrolled in the subject during the 2024 academic year.</p><p><strong>Results: </strong>At baseline, all respondents reported limited or no prior knowledge of robotic surgery and felt unprepared to care for patients undergoing robotic procedures. The programme was delivered with high fidelity. Mean GEARS score was 21.9 (SD 3.4). Mean non-technical skills score was 3.83/5 (SD 0.7) and mean open access score was 3.85/5. Group presentations achieved a pooled mean of 4.83/5. Post-course, all respondents reported increased knowledge and 80% felt better prepared for future clinical roles. Hands-on simulation was rated the most valuable component.</p><p><strong>Conclusions: </strong>A structured, competency-aligned robotic surgery curriculum for medical students is feasible and associated with positive educational outcomes. Early integration of robotic literacy, simulation and human factors training may better prepare future clinicians for technology-enabled surgical practice. Further study should examine long-term impact and clinical transfer.</p>","PeriodicalId":8158,"journal":{"name":"ANZ Journal of Surgery","volume":" ","pages":""},"PeriodicalIF":1.5,"publicationDate":"2026-09-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148928627","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":"Outcomes and Trends of Anal Squamous Cell Carcinoma in Queensland: A 26-Year Review.","authors":"Amanda G Liesegang, Joseph C Kong, Nicholas Lutton, Glen R Guerra","doi":"10.1111/ans.70930","DOIUrl":"https://doi.org/10.1111/ans.70930","url":null,"abstract":"<p><strong>Background: </strong>Anal cancer is rare, with anal squamous cell carcinoma (ASCC) being the most common histological type. ASCC incidence has rapidly increased in western populations over recent decades; however, outcomes for patients in Queensland, Australia, have not been previously described. The aim of this study was to report on local ASCC incidence and survival over time and identify predictive factors for survival.</p><p><strong>Methods: </strong>A prospectively maintained database was searched to identify anal cancer cases in Queensland between January 1991 and December 2016. Kaplan-Meier analysis was used to calculate overall survival (OS) of all anal cancer patients. Further analysis was performed for ASCC patients specifically relating to age (< 60 years old, > 60 years old), era of diagnosis (1991-2010, 2011-2016), geographical remoteness (urban and remote) and whether they required salvage surgery.</p><p><strong>Results: </strong>A total of 1106 patients were included. Eighty two percent (899 patients) were diagnosed with ASCC. ASCC incidence increased by 54.4% over the study period. Five-year OS of ASCC, adenocarcinoma and melanoma was 67%, 46.6% and 25.5%, respectively. Five-year OS of ASCC patients who underwent salvage surgery was 56%. Though age significantly predicted survival (p < 0.001), era of diagnosis and geographical remoteness were not significant prognostic factors (p = 0.11 and p = 0.8).</p><p><strong>Conclusion: </strong>This study is the first state-wide assessment of ASCC outcomes in Queensland across 26 years. A rapidly increasing incidence and mortality rate was observed. Though younger ASCC patients have better outcomes, there is no survival disadvantage to geographic remoteness. Survival outcomes have not changed significantly throughout the study period.</p>","PeriodicalId":8158,"journal":{"name":"ANZ Journal of Surgery","volume":" ","pages":""},"PeriodicalIF":1.5,"publicationDate":"2026-09-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148928597","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}