BJS Open最新文献

{"title":"Reducing surgical instrument usage: systematic review of approaches for tray optimization and its advantages on environmental impact, costs and efficiency.","authors":"Myrthe M M Eussen, Esmee Logghe, Stijn Bluiminck, Daan J Comes, Merel L Kimman, Brigitte A B Essers, Lianne M Wellens, Schelto Kruijff, Philip R de Reuver, Nicole D Bouvy","doi":"10.1093/bjsopen/zraf030","DOIUrl":"10.1093/bjsopen/zraf030","url":null,"abstract":"<p><strong>Background: </strong>Operating rooms generate substantial waste and budget expenditure due to extensive material usage. Reusable instruments are often packaged in trays, which accumulate instruments over time. This review quantifies the advantages of tray optimization (removing redundant instruments), including reduced environmental impact, costs, operating room and processing time.</p><p><strong>Methods: </strong>Following PRISMA guidelines, searches were conducted in PubMed, Embase, Web of Science and The Cochrane Library in August 2024 for studies on optimizing surgical trays in human surgeries. Studies were included if they reported on optimization approaches and outcomes related to environmental, economic or efficiency improvements. Exclusions included studies on disposable instruments, animal or veterinary research and patient-specific trays. Risk of bias was assessed using the ROBINS-I (Risk Of Bias In Non-randomised Studies - of Interventions) tool.</p><p><strong>Results: </strong>The search identified 4511 studies, with 45 meeting the inclusion criteria. Half of the studies showed a serious risk of bias, while the rest had a moderate risk. Three main optimization strategies were identified, with expert analysis being the most common (n = 29), followed by mathematical modelling. Environmental benefits were reported in all three included studies, although limited in number. Studies reported that 19 to 89% of instruments could be removed from trays, with 31 studies unanimously reporting cost reductions. Additionally, 17 studies demonstrated improved operational efficiency.</p><p><strong>Conclusion: </strong>Tray optimization strategies effectively reduce resource use, resulting in environmental and economic benefits. Although no standard method exists, effective strategies such as procedure observation and clinician feedback may eliminate over half of the instruments, offering a significant opportunity to minimize resource consumption in the operating room.</p>","PeriodicalId":9028,"journal":{"name":"BJS Open","volume":"9 3","pages":""},"PeriodicalIF":3.5,"publicationDate":"2025-05-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12084675/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144085911","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Oncological, surgical, and cosmetic outcomes of endoscopic versus conventional nipple-sparing mastectomy: meta-analysis.","authors":"Ayla Carroll, Carlos Robles, Hung-Wen Lai, Lidia Blay, Piotr Pluta, Gauthier Rathat, Guillermo Peralta, Rami Younan, Giada Pozzi, Daniel Martinez Campo, Robert Milligan, Glenn Vergauwen, Paolo Carcoforo, Antonio Toesca","doi":"10.1093/bjsopen/zraf011","DOIUrl":"10.1093/bjsopen/zraf011","url":null,"abstract":"<p><strong>Background: </strong>Endoscopic nipple-sparing mastectomy has been developed to improve the cosmetic outcomes of conventional nipple-sparing mastectomy. This meta-analysis compares surgical, quality of life and oncological outcomes of endoscopic nipple-sparing mastectomy versus conventional nipple-sparing mastectomy.</p><p><strong>Methods: </strong>PubMed and Embase were systematically reviewed to identify literature relevant to endoscopic nipple-sparing mastectomy and conventional nipple-sparing mastectomy literature published through to August 2023. The risk of bias was assessed using the Newcastle-Ottawa Scale, and proportional and pairwise random-effects meta-analysis was performed. Surgical (operative time, duration of hospital stay, blood loss, necrosis, overall complications), quality of life (cosmesis, pain, nipple-areolar complex sensitivity) and oncological outcomes (margin positivity, recurrence, metastasis and breast cancer-specific mortality rate) were evaluated.</p><p><strong>Results: </strong>Of 1286 articles retrieved, 51 endoscopic nipple-sparing mastectomy studies and 12 conventional nipple-sparing mastectomy reviews were analysed; 10 non-randomized comparative studies (656 patients) were included in the pairwise analysis and 36 studies (comparative and single-group cohort studies; 2612 patients) in the proportional meta-analysis. Results showed no differences in oncological outcomes (mean follow-up of up to 52 months), comparable overall (OR = 0.49; P = 0.100) and necrotic complications (OR = 0.45; P = 0.150), and improved cosmetic satisfaction (OR = 1.88; P = 0.020). Comparing only single-incision endoscopic nipple-sparing mastectomy to conventional nipple-sparing mastectomy significantly reduced postoperative necrosis (OR = 0.19; P = 0.008). The proportional meta-analysis produced oncological and surgical outcome rates comparable to or lower than conventional nipple-sparing mastectomy rates. However, longer operative time (weighted mean difference = 43.08 min; P < 0.00001) and duration of hospital stay (weighted mean difference = 0.72 days; P = 0.0007) were observed.</p><p><strong>Conclusion: </strong>Endoscopic nipple-sparing mastectomy does not affect oncological outcomes in up to 52 months mean follow-up when compared with conventional nipple-sparing mastectomy and provides better cosmetic satisfaction, with a reduced risk of necrosis after single-incision endoscopic nipple-sparing mastectomy. As such, endoscopic nipple-sparing mastectomy may become a viable breast surgery option.</p>","PeriodicalId":9028,"journal":{"name":"BJS Open","volume":"9 3","pages":""},"PeriodicalIF":3.5,"publicationDate":"2025-05-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12090896/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144109462","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Benefit of splenectomy in distal pancreatectomy for neuroendocrine tumours: multicentre retrospective study.","authors":"Elise Clément, Pietro Addeo, Alain Sauvanet, Célia Turco, Ugo Marchese, Safi Dokmak, Christophe Laurent, Ahmet Ayav, Olivier Turrini, Laurent Sulpice, Régis Souche, Julie Perinel, David J Birnbaum, Olivier Facy, Johan Gagnière, Lilian Schwarz, Guillaume Piessen, Nicolas Regenet, Antonio Iannelli, Jean Marc Regimbeau, Xavier Lenne, Bruno Heyd, Sébastien Gaujoux, Mehdi El Amrani, Alexandre Doussot","doi":"10.1093/bjsopen/zraf038","DOIUrl":"10.1093/bjsopen/zraf038","url":null,"abstract":"<p><strong>Background: </strong>Distal pancreatectomy is frequently indicated for left-sided pancreatic neuroendocrine tumour (NET). When combined lymphadenectomy is warranted, distal pancreatectomy with splenectomy (DPS) is generally advocated to optimize lymph node dissection. The spleen-preserving distal pancreatectomy (SPDP) may represent an alternative approach. This study aimed to evaluate postoperative and oncological results of distal pancreatectomy with and without splenectomy for pancreatic NET.</p><p><strong>Methods: </strong>This multicentre retrospective study included all distal pancreatectomy for pancreatic NET performed between 2014 and 2018. Patients with functional NET or multiple endocrine neoplasia type 1 were excluded. Indications and results were compared between DPS, distal pancreatectomy according to Kimura (K-SPDP) and distal pancreatectomy according to Warshaw (W-SPDP), before and after propensity score matching (PSM).</p><p><strong>Results: </strong>Among 251 patients included (108 DPS (43%), 73 K-SPDP (29%), and 70 W-SPDP (28%)), there was no difference in terms of patients' characteristics, surgical approach, and conversion. Tumour size (P = 0.005), grade (P < 0.001) and the number of nodes analysed (P < 0.001) were significantly lower in patients undergoing K-SPDP as compared to W-SPDP or DPS. Apart from a difference in readmission rate (P = 0.002), there was no difference in terms of mortality rate or severe morbidity rate between the three techniques. After PSM comparing DPS (n = 70) and W-SPDP (n = 70), there was no difference in morbidity and mortality rates. R0 resection rate (91% versus 97%; P = 0.165), the number of nodes analysed (8 versus 7; P = 0.495), and median overall survival (P = 0.493) were not different.</p><p><strong>Conclusion: </strong>In cases of distal pancreatectomy for NET, splenectomy did not seem to improve lymph node dissection or survival. When lymph node dissection associated with distal pancreatectomy is justified, the benefit of splenectomy appears questionable.</p>","PeriodicalId":9028,"journal":{"name":"BJS Open","volume":"9 3","pages":""},"PeriodicalIF":3.5,"publicationDate":"2025-05-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12070039/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143973598","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Feasibility and responsiveness to an electronic system to collect long-term patient-reported outcome measures after rectal cancer resection.","authors":"Annalisa Maroli, Filippo Bianchi, Caterina Foppa, Stefano De Zanet, Federico Zangrandi, Michele Carvello, Carlotta La Raja, Antonino Spinelli","doi":"10.1093/bjsopen/zraf053","DOIUrl":"10.1093/bjsopen/zraf053","url":null,"abstract":"","PeriodicalId":9028,"journal":{"name":"BJS Open","volume":"9 3","pages":""},"PeriodicalIF":3.5,"publicationDate":"2025-05-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12084676/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144085905","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Deep learning implementation for extrahepatic bile duct detection during indocyanine green fluorescence-guided laparoscopic cholecystectomy: pilot study.","authors":"Shih-Min Yin, Jenn-Jier J Lien, I Min Chiu","doi":"10.1093/bjsopen/zraf013","DOIUrl":"10.1093/bjsopen/zraf013","url":null,"abstract":"<p><strong>Background: </strong>A real-time deep learning system was developed to identify the extrahepatic bile ducts during indocyanine green fluorescence-guided laparoscopic cholecystectomy.</p><p><strong>Methods: </strong>Two expert surgeons annotated surgical videos from 113 patients and six class structures. YOLOv7, a real-time object detection model that enhances speed and accuracy in identifying and localizing objects within images, was trained for structures identification. To evaluate the model's performance, single-frame and short video clip validations were used. The primary outcomes were average precision and mean average precision in single-frame validation. Secondary outcomes were accuracy and other metrics in short video clip validations. An intraoperative prototype was developed for the verification experiments.</p><p><strong>Results: </strong>A total of 3993 images were extracted to train the YOLOv7 model. In single-frame validation, all classes' mean average precision was 0.846, and average precision for the common bile duct and cystic duct was 0.864 and 0.698 respectively. The model was trained to detect six different classes of objects and exhibited the best overall performance, with an accuracy of 94.39% for the common bile duct and 84.97% for the cystic duct in video clip validation.</p><p><strong>Conclusion: </strong>This model could potentially assist surgeons in identifying the critical landmarks during laparoscopic cholecystectomy, thereby minimizing the risk of bile duct injuries.</p>","PeriodicalId":9028,"journal":{"name":"BJS Open","volume":"9 2","pages":""},"PeriodicalIF":3.5,"publicationDate":"2025-03-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11928939/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143676577","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Importance of increasing resection rates in pancreatic cancer treatment.","authors":"Marco Del Chiaro, Hiroyuki Ishida, Richard D Schulick","doi":"10.1093/bjsopen/zraf029","DOIUrl":"10.1093/bjsopen/zraf029","url":null,"abstract":"","PeriodicalId":9028,"journal":{"name":"BJS Open","volume":"9 2","pages":""},"PeriodicalIF":3.5,"publicationDate":"2025-03-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11934916/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143708361","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"BJS Open 2024 best colorectal surgery articles: editors' choices.","authors":"","doi":"10.1093/bjsopen/zraf005","DOIUrl":"10.1093/bjsopen/zraf005","url":null,"abstract":"","PeriodicalId":9028,"journal":{"name":"BJS Open","volume":"9 2","pages":""},"PeriodicalIF":3.5,"publicationDate":"2025-03-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11891654/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143584524","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Circular staplers and anastomotic leakage in colorectal surgery: meta-analysis.","authors":"Claudio Fiorillo, Vincenzo Tondolo, Beatrice Biffoni, Elisabetta Gambaro, Chiara Lucinato, Davide De Sio, Sergio Alfieri, Giuseppe Quero","doi":"10.1093/bjsopen/zrae170","DOIUrl":"10.1093/bjsopen/zrae170","url":null,"abstract":"<p><strong>Background: </strong>Anastomotic leakage is a feared complication after colorectal resection. Recent advancements in surgical techniques, particularly the use of circular staplers, have aimed to improve postoperative outcomes. However, the optimal choice of circular stapler remains uncertain, with debate surrounding its impact on anastomotic leakage rates. The aim of this meta-analysis was to evaluate the impact of different circular stapler characteristics on anastomotic leakage occurrence after left colorectal resection.</p><p><strong>Methods: </strong>A systematic review and meta-analysis using PubMed, Scopus, and Web of Science databases to identify studies on the correlation between circular staplers and anastomotic leakage occurrence were performed up to November 2023 (PROSPERO registration: CRD42024519036). The literature search was conducted according to the PRISMA guidelines and performed using the following search terms: 'colorectal surgery', 'staplers', 'complications'. Only retrospective, cohort, prospective and randomized clinical trials on anastomotic leakage rate after left colorectal resection, including adult patients (over 18 years of age) and published in English were included. Exclusion criteria were articles with different designs, and studies including extra-colonic or right/transverse colon diseases. The quality assessment of the study was performed using the Newcastle-Ottawa classification. The outcome of interest was the analysis of each staplers' characteristics including: diameter, number of rows, technology (manual versus powered) and anastomotic technique (single- versus double-stapling technique) on anastomotic leakage occurrence.</p><p><strong>Results: </strong>Twenty-one retrospective studies were selected including 24 511 patients. A higher anastomotic leakage rate was documented for 31/33 mm stapler diameters compared with the 28/29 mm (OR -0.92, 95% c.i. -1.74 to -0.10; P = 0.02), while no significant difference was found between the 25 mm and 28/29 mm diameters (OR -0.46, 95% c.i. -1.39 to 0.46; P = 0.2). Similar anastomotic leakage rates were found for the two- and three-row circular stapler groups (OR -0.01, 95% c.i. -0.16 to 0.13; P = 0.85). Conversely, the powered technology related to a significantly lower rate of anastomotic leakage compared with the manual technology (OR -0.83, 95% c.i. -1.13 to -0.35; P < 0.001). Similarly, the single-stapling technique related to a lower rate of anastomotic leakage compared with the double-stapling technique (OR 0.79, 95% c.i. 0.33 to 1.25; P < 0.001).</p><p><strong>Conclusion: </strong>This study shows a higher anastomotic leakage rate for larger circular staplers and manual technology. Similarly, the single-stapling technique has advantages over the double-stapling technique, while the tri-staple technology does not appear to confer advantages on anastomotic leakage occurrence.</p>","PeriodicalId":9028,"journal":{"name":"BJS Open","volume":"9 2","pages":""},"PeriodicalIF":3.5,"publicationDate":"2025-03-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11979101/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143810434","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Venous thromboembolism risk in the postoperative interval during the COVID-19 pandemic: meta-analysis.","authors":"Andrew Jackson, Christopher A Lewis-Lloyd, Oluwademilade Merotohun, Colin J Crooks, David J Humes","doi":"10.1093/bjsopen/zraf039","DOIUrl":"https://doi.org/10.1093/bjsopen/zraf039","url":null,"abstract":"<p><strong>Background: </strong>During the COVID-19 pandemic, global trends emerged, indicating increased venous thromboembolism (VTE) incidence among postoperative patients, potentially attributable to perioperative COVID-19 infection. However, there are insufficient data on VTE incidence among postoperative patients in the context of the pandemic. The aim of this study was to examine the global incidence of postoperative VTE during the COVID-19 pandemic.</p><p><strong>Methods: </strong>A systematic search of MEDLINE and Embase databases, as well as three other registered databases, was conducted from 1 January 2019 to 3 November 2023, with pre-registration in PROSPERO, the international prospective register of systematic reviews (CRD42023460464). Any study reporting patients aged ≥18 years undergoing surgery during the COVID-19 pandemic was included. Outcomes were aggregated absolute and unadjusted relative risks, plus incidence rates per 1000 person-years, of 30- or 90-day postoperative VTE in patients operated on before or during the COVID-19 pandemic and those with or without perioperative COVID-19 infection during the pandemic.</p><p><strong>Results: </strong>Of 5943 studies, 17 were available for meta-analysis, reporting on 3 035 037 patients. VTE incidence rates in perioperative COVID-19-positive compared with COVID-19-negative patients were significantly higher after total joint arthroplasty (244 (95% c.i. 110 to 541) versus 71 (95% c.i. 47 to 108) per 1000 person-years), other orthopaedic surgery (253 (95% c.i. 240 to 266) versus 138 (95% c.i. 84 to 229) per 1000 person-years), and emergency general and gastrointestinal surgery (474 (95% c.i. 226 to 995) versus 97 (95% c.i. 61 to 157) per 1000 person-years). No significant differences in VTE rates were reported in studies comparing pre-pandemic and pandemic VTE incidence rates.</p><p><strong>Conclusion: </strong>There were consistent increased VTE rates in perioperative COVID-19-positive patients, particularly those undergoing orthopaedic surgery, and emergency general and gastrointestinal surgery. Further investigation is required to delineate postoperative VTE risk and how it varies by COVID-19 variant and vaccination to inform future practice.</p>","PeriodicalId":9028,"journal":{"name":"BJS Open","volume":"9 2","pages":""},"PeriodicalIF":3.5,"publicationDate":"2025-03-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11997968/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143953362","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Best of upper GI and general surgery in 2024.","authors":"Marcel André Schneider","doi":"10.1093/bjsopen/zraf009","DOIUrl":"10.1093/bjsopen/zraf009","url":null,"abstract":"","PeriodicalId":9028,"journal":{"name":"BJS Open","volume":"9 2","pages":""},"PeriodicalIF":3.5,"publicationDate":"2025-03-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11954445/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143741859","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}