Pub Date : 2026-01-15eCollection Date: 2025-01-01DOI: 10.3389/fsurg.2025.1731596
Yuliang Fu, Yuan Cao, Zengzhen Cui, Liangyu Bai, Xiaoyu Norman Pan, Yang Lv
Background: This retrospective study aimed to compare the efficacy of internal fixation using headless compression screws (HCS) and radial head locking plate (RLP) for comminuted radial head and neck fractures with no more than 3 displaced fragments.
Methods: This retrospective study included 84 patients with radial head and neck fractures treated at Peking University Third Hospital between January 2013 and December 2022, with 38 and 46 patients in the HCS and RLP groups, respectively. The main outcome was the comparison of complications between the two groups. Demographic data, pre-operative time (POT), operation time (OT), and hospital stay time (HST) were also recorded. The Mayo Elbow Performance Score (MEPS), range of movement of the elbow and forearm, and reasons for re-operation were compared between the two groups.
Results: All patients were followed up for an average of 66.4 months (range, 20-135 months). One patient in each group underwent radial head replacement due to non-union, while the remaining patients achieved bone union. There was no statistically significant difference in the clinical outcomes between the two groups (p > 0.0023). Additionally, the re-operation rate due to symptomatic hardware was significantly higher in the RLP group (28.3%) than that in the HCS group (2.6%, p = 0.002).
Conclusion: For internal fixation of comminuted radial head and neck fractures with no more than three displaced fragments, both HCS and RLP achieved good outcomes. However, the RLP increased the incidence of complications and re-operation associated with internal fixation compared to HCS.
{"title":"Comparative study on complications of screws versus plates for comminuted radial head and neck fractures with two or three fragments.","authors":"Yuliang Fu, Yuan Cao, Zengzhen Cui, Liangyu Bai, Xiaoyu Norman Pan, Yang Lv","doi":"10.3389/fsurg.2025.1731596","DOIUrl":"10.3389/fsurg.2025.1731596","url":null,"abstract":"<p><strong>Background: </strong>This retrospective study aimed to compare the efficacy of internal fixation using headless compression screws (HCS) and radial head locking plate (RLP) for comminuted radial head and neck fractures with no more than 3 displaced fragments.</p><p><strong>Methods: </strong>This retrospective study included 84 patients with radial head and neck fractures treated at Peking University Third Hospital between January 2013 and December 2022, with 38 and 46 patients in the HCS and RLP groups, respectively. The main outcome was the comparison of complications between the two groups. Demographic data, pre-operative time (POT), operation time (OT), and hospital stay time (HST) were also recorded. The Mayo Elbow Performance Score (MEPS), range of movement of the elbow and forearm, and reasons for re-operation were compared between the two groups.</p><p><strong>Results: </strong>All patients were followed up for an average of 66.4 months (range, 20-135 months). One patient in each group underwent radial head replacement due to non-union, while the remaining patients achieved bone union. There was no statistically significant difference in the clinical outcomes between the two groups (<i>p</i> > 0.0023). Additionally, the re-operation rate due to symptomatic hardware was significantly higher in the RLP group (28.3%) than that in the HCS group (2.6%, <i>p</i> = 0.002).</p><p><strong>Conclusion: </strong>For internal fixation of comminuted radial head and neck fractures with no more than three displaced fragments, both HCS and RLP achieved good outcomes. However, the RLP increased the incidence of complications and re-operation associated with internal fixation compared to HCS.</p>","PeriodicalId":12564,"journal":{"name":"Frontiers in Surgery","volume":"12 ","pages":"1731596"},"PeriodicalIF":1.6,"publicationDate":"2026-01-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12852477/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146104946","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}
Pub Date : 2026-01-15eCollection Date: 2025-01-01DOI: 10.3389/fsurg.2025.1731485
Panagiotis Mourmouris, Nikolaos Kostakopoulos, Omer Burak Argun, Ioannis Georgopoulos, Vasillios Klapsis, Nikolaos Pisiotis, Ioannis Salmas, Tunkut Doganca, Sotirios Charamoglis
Background: Robotic Radical Prostatectomy has become the dominant surgical approach for localized prostate cancer, offering offers many advantages in postoperative recovery and quality of life. Despite these advances, the standard duration of urethral catheterization- typically 7 days- has remained largely unchanged.
Objective: To systematically evaluate the feasibility and safety of early urethral catheter removal after robotic radical prostatectomy and to identify the optimal timing for catheter removal.
Methods: A systematic review was conducted according to PRISMA guidelines. PubMed, Web of Science, Cochrane Library, Google Scholar and Scopus databases were searched from inception to August 2025. Case reports, non robotic studies and non English publications were excluded Study quality was assessed using the Newcastle-Ottawa Scale for non randomized studies and the Jadad scale for randomized controlled trials.
Results: Thirteen studies involving 4.055 patients met inclusion criteria, including three randomized controlled trials. Early catheter removal was variably defined, most commonly between 1 and 4 post operative days. Across studies early removal was not associated with increased rates of anastomotic leakage, urethral stricture or bladder neck contracture. Continence recovery seams to be occur earlier with early removal although higher short term urinary retention rates were reported. Overall complications and readmission rates were low. Study quality was acceptable despite the limited evidence from high quality randomized studies.
Conclusions: Early catheter removal after robotic radical prostatectomy appears both safe and feasible in appropriate selected patients and may accelerate continence recovery without compromising long-term outcomes. Catheter removal on postoperative days 3-4 appears to offer the most favora.
背景:机器人根治性前列腺切除术已成为局部前列腺癌的主要手术方式,在术后恢复和生活质量方面具有许多优势。尽管取得了这些进展,但导尿的标准时间(通常为7天)基本保持不变。目的:系统评价机器人根治性前列腺切除术后早期拔除导尿管的可行性和安全性,并确定最佳拔除时间。方法:根据PRISMA指南进行系统评价。检索了PubMed、Web of Science、Cochrane Library、b谷歌Scholar和Scopus数据库,检索时间从成立到2025年8月。排除病例报告、非机器人研究和非英文出版物。研究质量采用纽卡斯尔-渥太华量表评估非随机研究,Jadad量表评估随机对照试验。结果:13项研究共纳入4.055例患者,其中3项为随机对照试验。早期拔除导管的定义不同,最常见的是在术后1至4天。在所有研究中,早期切除与吻合口漏、尿道狭窄或膀胱颈挛缩的发生率增加无关。尽管近期尿潴留率较高,但早期切除术后尿失禁恢复时间较早。总体并发症和再入院率较低。尽管来自高质量随机研究的证据有限,但研究质量是可以接受的。结论:在适当选择的患者中,机器人根治性前列腺切除术后早期拔除导管既安全又可行,并可能加速失禁恢复,而不影响长期预后。术后3-4天拔除导管似乎是最有利的。
{"title":"Optimal urethral catheter removal time after robotic radical prostatectomy: a systematic review of the current evidence.","authors":"Panagiotis Mourmouris, Nikolaos Kostakopoulos, Omer Burak Argun, Ioannis Georgopoulos, Vasillios Klapsis, Nikolaos Pisiotis, Ioannis Salmas, Tunkut Doganca, Sotirios Charamoglis","doi":"10.3389/fsurg.2025.1731485","DOIUrl":"10.3389/fsurg.2025.1731485","url":null,"abstract":"<p><strong>Background: </strong>Robotic Radical Prostatectomy has become the dominant surgical approach for localized prostate cancer, offering offers many advantages in postoperative recovery and quality of life. Despite these advances, the standard duration of urethral catheterization- typically 7 days- has remained largely unchanged.</p><p><strong>Objective: </strong>To systematically evaluate the feasibility and safety of early urethral catheter removal after robotic radical prostatectomy and to identify the optimal timing for catheter removal.</p><p><strong>Methods: </strong>A systematic review was conducted according to PRISMA guidelines. PubMed, Web of Science, Cochrane Library, Google Scholar and Scopus databases were searched from inception to August 2025. Case reports, non robotic studies and non English publications were excluded Study quality was assessed using the Newcastle-Ottawa Scale for non randomized studies and the Jadad scale for randomized controlled trials.</p><p><strong>Results: </strong>Thirteen studies involving 4.055 patients met inclusion criteria, including three randomized controlled trials. Early catheter removal was variably defined, most commonly between 1 and 4 post operative days. Across studies early removal was not associated with increased rates of anastomotic leakage, urethral stricture or bladder neck contracture. Continence recovery seams to be occur earlier with early removal although higher short term urinary retention rates were reported. Overall complications and readmission rates were low. Study quality was acceptable despite the limited evidence from high quality randomized studies.</p><p><strong>Conclusions: </strong>Early catheter removal after robotic radical prostatectomy appears both safe and feasible in appropriate selected patients and may accelerate continence recovery without compromising long-term outcomes. Catheter removal on postoperative days 3-4 appears to offer the most favora.</p>","PeriodicalId":12564,"journal":{"name":"Frontiers in Surgery","volume":"12 ","pages":"1731485"},"PeriodicalIF":1.6,"publicationDate":"2026-01-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12852333/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146105073","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}
Pub Date : 2026-01-15eCollection Date: 2025-01-01DOI: 10.3389/fsurg.2025.1722354
Xiao Wang, Haohua Lai, Songyan Zhang, Zhiheng Tu, Zhaowei Yin, Gadisa Musa Wako, Junwei Yan, Bin Liang
Background: Surgical fixation for Schatzker IV tibial plateau fractures presents a clinical dilemma: achieving robust stability while avoiding impingement on the pes anserinus tendons. This study evaluated the biomechanical profile of a novel hockey-stick locking plate (NHLP), which is anatomically contoured to address this challenge by being placed anteriorly.
Methods: A finite element model of a standardized Schatzker IV fracture was created. Three fixation methods were simulated: the novel hockey-stick locking plate (NHLP), the traditional T-shaped locking plate (TTLP), and the double reconstruction locking plates (DRLP). The models were subjected to four loading conditions: three physiological loads, a low axial load (500 N), a moderate combined load (1,500 N axial compression plus 150 N anterior shear force), and a high axial load (2,500 N) and a fourth "worst-case" load scenario combining a 1,700 N axial force, a 200 N anterior shear force, and a 10° varus tilt. Key biomechanical metrics, including implant stress, construct stability, fragment displacement, fracture interface mechanics and fatigue safety factor, were analyzed.
Results: Under physiological loading, the NHLP construct demonstrated the lowest peak von Mises stress on the implant. At the high axial load of 2,500 N, the peak stress on the NHLP (159.8 MPa) was 15% lower than that on the TTLP (188.1 MPa) and 35% lower than that on the DRLP (245.5 MPa). In the "worst-case" scenario, all constructs exhibited high safety factors. In terms of stability, the NHLP provided displacement comparable to that of the TTLP, and both were substantially more stable than the DRLP construct, which exhibited the largest displacement under high load. Paradoxically, the DRLP construct consistently resulted in the highest degree of implant stress and the least stability. At the fracture interface, the NHLP maintained a stable environment across all loads, with key metrics remaining within a range conducive to bone healing.
Conclusion: This finite element analysis demonstrated that the NHLP provides fracture stability while reducing peak implant stress under physiological loading. These findings support the biomechanical feasibility of its pes anserinus-sparing design, providing a strong rationale for further investigation.
{"title":"Biomechanical evaluation of a novel hockey-stick locking plate featuring a pes anserinus-sparing design: a finite element analysis.","authors":"Xiao Wang, Haohua Lai, Songyan Zhang, Zhiheng Tu, Zhaowei Yin, Gadisa Musa Wako, Junwei Yan, Bin Liang","doi":"10.3389/fsurg.2025.1722354","DOIUrl":"10.3389/fsurg.2025.1722354","url":null,"abstract":"<p><strong>Background: </strong>Surgical fixation for Schatzker IV tibial plateau fractures presents a clinical dilemma: achieving robust stability while avoiding impingement on the pes anserinus tendons. This study evaluated the biomechanical profile of a novel hockey-stick locking plate (NHLP), which is anatomically contoured to address this challenge by being placed anteriorly.</p><p><strong>Methods: </strong>A finite element model of a standardized Schatzker IV fracture was created. Three fixation methods were simulated: the novel hockey-stick locking plate (NHLP), the traditional T-shaped locking plate (TTLP), and the double reconstruction locking plates (DRLP). The models were subjected to four loading conditions: three physiological loads, a low axial load (500 N), a moderate combined load (1,500 N axial compression plus 150 N anterior shear force), and a high axial load (2,500 N) and a fourth \"worst-case\" load scenario combining a 1,700 N axial force, a 200 N anterior shear force, and a 10° varus tilt. Key biomechanical metrics, including implant stress, construct stability, fragment displacement, fracture interface mechanics and fatigue safety factor, were analyzed.</p><p><strong>Results: </strong>Under physiological loading, the NHLP construct demonstrated the lowest peak von Mises stress on the implant. At the high axial load of 2,500 N, the peak stress on the NHLP (159.8 MPa) was 15% lower than that on the TTLP (188.1 MPa) and 35% lower than that on the DRLP (245.5 MPa). In the \"worst-case\" scenario, all constructs exhibited high safety factors. In terms of stability, the NHLP provided displacement comparable to that of the TTLP, and both were substantially more stable than the DRLP construct, which exhibited the largest displacement under high load. Paradoxically, the DRLP construct consistently resulted in the highest degree of implant stress and the least stability. At the fracture interface, the NHLP maintained a stable environment across all loads, with key metrics remaining within a range conducive to bone healing.</p><p><strong>Conclusion: </strong>This finite element analysis demonstrated that the NHLP provides fracture stability while reducing peak implant stress under physiological loading. These findings support the biomechanical feasibility of its pes anserinus-sparing design, providing a strong rationale for further investigation.</p>","PeriodicalId":12564,"journal":{"name":"Frontiers in Surgery","volume":"12 ","pages":"1722354"},"PeriodicalIF":1.6,"publicationDate":"2026-01-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12852395/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146104984","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}
Ganglioneuroma is defined as a rare, benign neurogenic tumor. This paper reports a case of pelvic retroperitoneal ganglioneuroma in a 12-year-old girl and reviews the relevant literature. The patient was found to have a pelvic retroperitoneal mass incidentally during a health check-up and had no significant clinical symptoms. Gynecological ultrasound revealed a hypoechoic mass posterior to the uterus, measuring approximately 63 × 52 mm, with clear boundaries. No obvious abnormalities were observed in the uterus and adnexa. Pelvic CT showed a well-defined, low-density mass measuring 59 mm × 55 mm with mild enhancement at the posterior margin, the adjacent coccygeal bone showed discontinuity and was closely related to the mass, the rectum was displaced anteriorly with clear demarcation from the mass, and no enlarged lymph nodes or effusion were found in the pelvis. The tumor was successfully and completely resected via laparoscopy, and pathological examination confirmed the diagnosis of ganglioneuroma. The standard surgical methods and approaches for retroperitoneal ganglioneuroma have not yet been established. The successful diagnosis and treatment of this case highlight the importance of accurate preoperative assessment and appropriate surgical planning. The literature review summarizes the clinical manifestations, diagnostic methods, and therapeutic strategies of ganglioneuroma, aiming to provide references for clinicians.
神经节神经瘤是一种罕见的良性神经源性肿瘤。本文报告一例12岁女童骨盆腹膜后神经节神经瘤,并复习相关文献。病人在健康检查时偶然发现盆腔腹膜后肿块,并无明显临床症状。妇科超声示子宫后方低回声肿块,大小约63 × 52 mm,边界清晰。子宫及附件未见明显异常。盆腔CT示清晰低密度肿块,大小为59 mm × 55 mm,后缘轻度强化,相邻尾骨间断,与肿块密切相关,直肠前移,与肿块分界清晰,骨盆未见淋巴结肿大或积液。经腹腔镜成功完全切除肿瘤,病理证实为神经节神经瘤。腹膜后神经节神经瘤的标准手术方法和入路尚未建立。该病例的成功诊断和治疗突出了准确的术前评估和适当的手术计划的重要性。本文对神经节神经瘤的临床表现、诊断方法及治疗策略进行综述,旨在为临床医生提供参考。
{"title":"Total laparoscopic excision of pelvic retroperitoneal ganglioneuroma: a case report and review of the literature.","authors":"Kangyun Lan, Hongfan Ding, Wenli Liu, Hanmei Tang, Guangyuan Chen, Ping Huang","doi":"10.3389/fsurg.2025.1707642","DOIUrl":"10.3389/fsurg.2025.1707642","url":null,"abstract":"<p><p>Ganglioneuroma is defined as a rare, benign neurogenic tumor. This paper reports a case of pelvic retroperitoneal ganglioneuroma in a 12-year-old girl and reviews the relevant literature. The patient was found to have a pelvic retroperitoneal mass incidentally during a health check-up and had no significant clinical symptoms. Gynecological ultrasound revealed a hypoechoic mass posterior to the uterus, measuring approximately 63 × 52 mm, with clear boundaries. No obvious abnormalities were observed in the uterus and adnexa. Pelvic CT showed a well-defined, low-density mass measuring 59 mm × 55 mm with mild enhancement at the posterior margin, the adjacent coccygeal bone showed discontinuity and was closely related to the mass, the rectum was displaced anteriorly with clear demarcation from the mass, and no enlarged lymph nodes or effusion were found in the pelvis. The tumor was successfully and completely resected via laparoscopy, and pathological examination confirmed the diagnosis of ganglioneuroma. The standard surgical methods and approaches for retroperitoneal ganglioneuroma have not yet been established. The successful diagnosis and treatment of this case highlight the importance of accurate preoperative assessment and appropriate surgical planning. The literature review summarizes the clinical manifestations, diagnostic methods, and therapeutic strategies of ganglioneuroma, aiming to provide references for clinicians.</p>","PeriodicalId":12564,"journal":{"name":"Frontiers in Surgery","volume":"12 ","pages":"1707642"},"PeriodicalIF":1.6,"publicationDate":"2026-01-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12852388/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146105033","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}
Pub Date : 2026-01-15eCollection Date: 2025-01-01DOI: 10.3389/fsurg.2025.1703168
Yiyang Lu, Guochen Zhu, Jianxin Hu, Hui Lv, Yan Xiao
Peripheral nerve cavernous hemangioma refers to cavernous vascular malformations occurring on peripheral nerves outside the cranial and spinal nerves. It is a rare non-neoplastic condition. We report a case of a 53-year-old female patient who presented with a painless mass in the right mid-lower neck and a foreign body sensation in the pharynx for five months. Preoperative ultrasonography (US), computed tomography (CT), and magnetic resonance imaging (MRI) revealed a well-delineated lesion with minimal blood flow signals, heterogeneous enhancement on contrast-enhanced CT and T1-weighted imaging, and high signal intensity on T2-weighted imaging. The patient underwent complete surgical excision of the lesion. Intraoperatively, the lesion was found to be located between the epineurium and perineurium of the vagus nerve and was completely enucleated. Postoperative histopathological and immunohistochemical analyses confirmed the diagnosis of cavernous hemangioma. The patient recovered without complications and exhibited no hoarseness or other neurological deficits postoperatively. No signs of lesion recurrence were observed during a 28-month follow-up. This case suggests that when managing tumors of the cervical vagus nerve, vascular lesions should be included in the differential diagnosis, although such instances are relatively rare.
{"title":"Cavernous hemangioma originating from the cervical vagus nerve masquerading as a schwannoma: a case report.","authors":"Yiyang Lu, Guochen Zhu, Jianxin Hu, Hui Lv, Yan Xiao","doi":"10.3389/fsurg.2025.1703168","DOIUrl":"10.3389/fsurg.2025.1703168","url":null,"abstract":"<p><p>Peripheral nerve cavernous hemangioma refers to cavernous vascular malformations occurring on peripheral nerves outside the cranial and spinal nerves. It is a rare non-neoplastic condition. We report a case of a 53-year-old female patient who presented with a painless mass in the right mid-lower neck and a foreign body sensation in the pharynx for five months. Preoperative ultrasonography (US), computed tomography (CT), and magnetic resonance imaging (MRI) revealed a well-delineated lesion with minimal blood flow signals, heterogeneous enhancement on contrast-enhanced CT and T1-weighted imaging, and high signal intensity on T2-weighted imaging. The patient underwent complete surgical excision of the lesion. Intraoperatively, the lesion was found to be located between the epineurium and perineurium of the vagus nerve and was completely enucleated. Postoperative histopathological and immunohistochemical analyses confirmed the diagnosis of cavernous hemangioma. The patient recovered without complications and exhibited no hoarseness or other neurological deficits postoperatively. No signs of lesion recurrence were observed during a 28-month follow-up. This case suggests that when managing tumors of the cervical vagus nerve, vascular lesions should be included in the differential diagnosis, although such instances are relatively rare.</p>","PeriodicalId":12564,"journal":{"name":"Frontiers in Surgery","volume":"12 ","pages":"1703168"},"PeriodicalIF":1.6,"publicationDate":"2026-01-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12852428/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146105019","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}
Pub Date : 2026-01-14eCollection Date: 2025-01-01DOI: 10.3389/fsurg.2025.1740276
Zsolt Madarasz, Krysztof Nowakowski, Michael Leitz, Bogdan-Cornel Sturzu, Anas Baltamar, Kira Baginski, Annika Hoyer, Jens Hoeppner, Fabian Nimczewski, Miljana Vladimirov
Background: Robotic right colectomy (RRC) with complete mesocolic excision (CME) and central vascular ligation (CVL) has become a standard oncologic approach for right-sided colon cancer. However, evidence regarding hand-sewn intracorporeal anastomosis (ICA) and its associated learning curve remains limited.
Methods: This single-center retrospective study analyzes a series of consecutive patients with histologically confirmed right-sided colon adenocarcinoma who underwent fully robotic RRC with CME, CVL, and hand-sewn ICA. Perioperative outcomes, pathological results, and the learning curves of three colorectal surgeons were evaluated using cumulative sum (CUSUM) and risk-adjusted CUSUM (RA-CUSUM) methods.
Results: Overall, 71 patients were treated by RRC from April 2021 through December 2024. All surgical procedures were completed robotically. The median operative time was 165 min (Q1-Q3: 147-192). Major complications (Clavien-Dindo ≥ IIIb) occurred in 9.9% of cases, with an anastomotic leak rate of 5.6%. Mean lymph-node yield was 29.6 ± 11.2, and R0 resection was achieved in 98.6%. The CUSUM learning curves for the three surgeons revealed a comparable trend, starting with a rise during the learning phase and followed by a decline reflecting increased efficiency. The learning curve plateau was reached after approximately 16 cases for each surgeon.
Conclusion: RRC with CME, CVL, and hand-sewn ICA is feasible, safe, and oncologically effective. Proficiency is typically achieved after 15-20 cases, supporting its role as a reproducible and teachable procedure in structured robotic colorectal programs.
背景:机器人右结肠切除术(RRC)与全肠系膜切除(CME)和中央血管结扎(CVL)已成为治疗右侧结肠癌的标准肿瘤学方法。然而,关于手工缝合体内吻合(ICA)及其相关学习曲线的证据仍然有限。方法:这项单中心回顾性研究分析了一系列连续的组织学证实的右侧结肠腺癌患者,这些患者接受了全机器人RRC治疗,包括CME、CVL和手缝ICA。采用累积和(CUSUM)和风险调整的CUSUM (RA-CUSUM)方法评估三名结直肠外科医生的围手术期结局、病理结果和学习曲线。结果:从2021年4月到2024年12月,总共有71例患者接受了RRC治疗。所有手术过程均由机器人完成。中位手术时间165 min (Q1-Q3: 147-192)。主要并发症(Clavien-Dindo≥IIIb)发生率为9.9%,吻合口漏率为5.6%。平均淋巴结清扫率为29.6±11.2,R0切除率为98.6%。三位外科医生的CUSUM学习曲线显示出类似的趋势,在学习阶段开始上升,随后下降,反映出效率的提高。每位外科医生大约16例后达到学习曲线平台期。结论:RRC联合CME、CVL和手工缝合ICA是可行、安全、有效的。熟练程度通常在15-20例后达到,支持其作为结构化机器人结肠直肠项目中可重复和可教的程序的作用。
{"title":"Robotic right colectomy with complete mesocolic excision, central vascular ligation and hand-sewn intracorporeal anastomosis: feasibility, safety, and learning curve analysis.","authors":"Zsolt Madarasz, Krysztof Nowakowski, Michael Leitz, Bogdan-Cornel Sturzu, Anas Baltamar, Kira Baginski, Annika Hoyer, Jens Hoeppner, Fabian Nimczewski, Miljana Vladimirov","doi":"10.3389/fsurg.2025.1740276","DOIUrl":"10.3389/fsurg.2025.1740276","url":null,"abstract":"<p><strong>Background: </strong>Robotic right colectomy (RRC) with complete mesocolic excision (CME) and central vascular ligation (CVL) has become a standard oncologic approach for right-sided colon cancer. However, evidence regarding hand-sewn intracorporeal anastomosis (ICA) and its associated learning curve remains limited.</p><p><strong>Methods: </strong>This single-center retrospective study analyzes a series of consecutive patients with histologically confirmed right-sided colon adenocarcinoma who underwent fully robotic RRC with CME, CVL, and hand-sewn ICA. Perioperative outcomes, pathological results, and the learning curves of three colorectal surgeons were evaluated using cumulative sum (CUSUM) and risk-adjusted CUSUM (RA-CUSUM) methods.</p><p><strong>Results: </strong>Overall, 71 patients were treated by RRC from April 2021 through December 2024. All surgical procedures were completed robotically. The median operative time was 165 min (Q1-Q3: 147-192). Major complications (Clavien-Dindo ≥ IIIb) occurred in 9.9% of cases, with an anastomotic leak rate of 5.6%. Mean lymph-node yield was 29.6 ± 11.2, and R0 resection was achieved in 98.6%. The CUSUM learning curves for the three surgeons revealed a comparable trend, starting with a rise during the learning phase and followed by a decline reflecting increased efficiency. The learning curve plateau was reached after approximately 16 cases for each surgeon.</p><p><strong>Conclusion: </strong>RRC with CME, CVL, and hand-sewn ICA is feasible, safe, and oncologically effective. Proficiency is typically achieved after 15-20 cases, supporting its role as a reproducible and teachable procedure in structured robotic colorectal programs.</p>","PeriodicalId":12564,"journal":{"name":"Frontiers in Surgery","volume":"12 ","pages":"1740276"},"PeriodicalIF":1.6,"publicationDate":"2026-01-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12847402/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146085560","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}
Pub Date : 2026-01-14eCollection Date: 2025-01-01DOI: 10.3389/fsurg.2025.1719153
Michał Stańczak, Wiesław Kruszewski, Maciej Ciesielski, Jakub Walczak, Piotr Kurek, Tomasz Buczek, Mariusz Szajewski
Peritoneal metastases (PM) from colorectal cancer (CRC) represent a unique clinical challenge with distinct biological behavior and therapeutic implications. Although PM has traditionally been associated with poor prognosis, recent advances in diagnostics, surgical techniques, and intraperitoneal therapies have offered selected patients opportunities for prolonged survival and, in some cases, long-term disease-free status. This review discusses the pathophysiology, risk factors, diagnostic strategies, and treatment options for CRC patients with PM. The peritoneum is the second most common site of CRC metastasis after the liver, with synchronous and metachronous PM occurring at similar rates. Risk factors include right-sided colon tumors, BRAF mutations, and mucinous histology. Diagnosis relies on imaging modalities such as CT, MRI, PET/CT, and laparoscopy, although sensitivity remains limited for small-volume disease. The peritoneal carcinomatosis index (PCI) is a critical prognostic and therapeutic decision-making tool. Cytoreductive surgery (CRS) with or without hyperthermic intraperitoneal chemotherapy (HIPEC) has been shown to improve survival, particularly in well-selected patients with limited PCI and resectable disease. While the role of HIPEC remains debated following the PRODIGE 7 trial, alternative approaches such as pressurized intraperitoneal aerosol chemotherapy (PIPAC) are emerging. Systemic chemotherapy remains foundational, but response in PM can differ from parenchymal metastases due to the peritoneal-plasma barrier. Overall, outcomes are most favorable when patients are managed in specialized centers by multidisciplinary teams offering individualized, biomarker-informed treatment strategies. Ongoing research into molecular predictors and innovative drug delivery methods is critical to further improving prognosis for this complex patient population.
{"title":"What is worth knowing about peritoneal metastases in colorectal cancer?","authors":"Michał Stańczak, Wiesław Kruszewski, Maciej Ciesielski, Jakub Walczak, Piotr Kurek, Tomasz Buczek, Mariusz Szajewski","doi":"10.3389/fsurg.2025.1719153","DOIUrl":"10.3389/fsurg.2025.1719153","url":null,"abstract":"<p><p>Peritoneal metastases (PM) from colorectal cancer (CRC) represent a unique clinical challenge with distinct biological behavior and therapeutic implications. Although PM has traditionally been associated with poor prognosis, recent advances in diagnostics, surgical techniques, and intraperitoneal therapies have offered selected patients opportunities for prolonged survival and, in some cases, long-term disease-free status. This review discusses the pathophysiology, risk factors, diagnostic strategies, and treatment options for CRC patients with PM. The peritoneum is the second most common site of CRC metastasis after the liver, with synchronous and metachronous PM occurring at similar rates. Risk factors include right-sided colon tumors, BRAF mutations, and mucinous histology. Diagnosis relies on imaging modalities such as CT, MRI, PET/CT, and laparoscopy, although sensitivity remains limited for small-volume disease. The peritoneal carcinomatosis index (PCI) is a critical prognostic and therapeutic decision-making tool. Cytoreductive surgery (CRS) with or without hyperthermic intraperitoneal chemotherapy (HIPEC) has been shown to improve survival, particularly in well-selected patients with limited PCI and resectable disease. While the role of HIPEC remains debated following the PRODIGE 7 trial, alternative approaches such as pressurized intraperitoneal aerosol chemotherapy (PIPAC) are emerging. Systemic chemotherapy remains foundational, but response in PM can differ from parenchymal metastases due to the peritoneal-plasma barrier. Overall, outcomes are most favorable when patients are managed in specialized centers by multidisciplinary teams offering individualized, biomarker-informed treatment strategies. Ongoing research into molecular predictors and innovative drug delivery methods is critical to further improving prognosis for this complex patient population.</p>","PeriodicalId":12564,"journal":{"name":"Frontiers in Surgery","volume":"12 ","pages":"1719153"},"PeriodicalIF":1.6,"publicationDate":"2026-01-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12850711/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146085548","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}
Pub Date : 2026-01-14eCollection Date: 2025-01-01DOI: 10.3389/fsurg.2025.1708726
Zhongfang Hu, Huan Liu
Objective: To explore the effects of multimodal nursing intervention combined with health education on postoperative recovery, pain management, and psychological state in patients undergoing laparoscopic cholecystectomy.
Methods: The clinical data of 100 patients who underwent laparoscopic cholecystectomy in our hospital from January 2023 to December 2024 were retrospectively analyzed. The patients were divided into a control group (CG, n = 50, routine care) and an intervention group (IG, n = 50, multimodal nursing intervention combined with health education) according to the nursing method. The two groups were compared in terms of postoperative recovery indicators, pain scores, psychological state, immune function indicators, incidence of complications, and functional recovery scores.
Results: The IG demonstrated significantly shorter time to first flatus, first defecation, first ambulation, hospital stay, and incision healing than the CG (P < 0.05). VAS scores were significantly lower in the IG at all postoperative time points (P < 0.05). SAS and SDS scores were significantly lower in the IG at discharge (P < 0.05). The IG displayed higher CD4+ level than the CG at discharge (P < 0.05). The IG exhibited significantly lower incidence of abdominal distension and total incidence of postoperative complications than the CG (P < 0.05). The scores of daily activities, self-care ability, pain control, and overall recovery in the IG were significantly higher than those in the CG (P < 0.05).
Conclusion: Multimodal nursing intervention combined with health education can significantly promote postoperative recovery of patients undergoing laparoscopic cholecystectomy, effectively control postoperative pain, improve psychological state and immune function, reduce the incidence of complications, and improve the quality of functional recovery.
目的:探讨多模式护理干预结合健康教育对腹腔镜胆囊切除术患者术后恢复、疼痛管理及心理状态的影响。方法:回顾性分析我院2023年1月至2024年12月行腹腔镜胆囊切除术的100例患者的临床资料。根据护理方法将患者分为对照组(CG, n = 50,常规护理)和干预组(IG, n = 50,多模式护理干预结合健康教育)。比较两组患者术后恢复指标、疼痛评分、心理状态、免疫功能指标、并发症发生率、功能恢复评分。结果:IG组首次排气时间、首次排便时间、首次下床时间、住院时间、切口愈合时间均明显短于CG组(P P P P P P P P)。多模式护理干预结合健康教育,可显著促进腹腔镜胆囊切除术患者术后恢复,有效控制术后疼痛,改善心理状态和免疫功能,减少并发症发生率,提高功能恢复质量。
{"title":"Effects of multimodal nursing intervention with health education on recovery, pain, and psychological outcomes after laparoscopic cholecystectomy: a retrospective cohort study.","authors":"Zhongfang Hu, Huan Liu","doi":"10.3389/fsurg.2025.1708726","DOIUrl":"10.3389/fsurg.2025.1708726","url":null,"abstract":"<p><strong>Objective: </strong>To explore the effects of multimodal nursing intervention combined with health education on postoperative recovery, pain management, and psychological state in patients undergoing laparoscopic cholecystectomy.</p><p><strong>Methods: </strong>The clinical data of 100 patients who underwent laparoscopic cholecystectomy in our hospital from January 2023 to December 2024 were retrospectively analyzed. The patients were divided into a control group (CG, <i>n</i> = 50, routine care) and an intervention group (IG, <i>n</i> = 50, multimodal nursing intervention combined with health education) according to the nursing method. The two groups were compared in terms of postoperative recovery indicators, pain scores, psychological state, immune function indicators, incidence of complications, and functional recovery scores.</p><p><strong>Results: </strong>The IG demonstrated significantly shorter time to first flatus, first defecation, first ambulation, hospital stay, and incision healing than the CG (<i>P</i> < 0.05). VAS scores were significantly lower in the IG at all postoperative time points (<i>P</i> < 0.05). SAS and SDS scores were significantly lower in the IG at discharge (<i>P</i> < 0.05). The IG displayed higher CD4+ level than the CG at discharge (<i>P</i> < 0.05). The IG exhibited significantly lower incidence of abdominal distension and total incidence of postoperative complications than the CG (<i>P</i> < 0.05). The scores of daily activities, self-care ability, pain control, and overall recovery in the IG were significantly higher than those in the CG (<i>P</i> < 0.05).</p><p><strong>Conclusion: </strong>Multimodal nursing intervention combined with health education can significantly promote postoperative recovery of patients undergoing laparoscopic cholecystectomy, effectively control postoperative pain, improve psychological state and immune function, reduce the incidence of complications, and improve the quality of functional recovery.</p>","PeriodicalId":12564,"journal":{"name":"Frontiers in Surgery","volume":"12 ","pages":"1708726"},"PeriodicalIF":1.6,"publicationDate":"2026-01-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12847252/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146085440","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}
Pub Date : 2026-01-14eCollection Date: 2025-01-01DOI: 10.3389/fsurg.2025.1639750
Guili Wang, Donglin Lu, Ding Wu, Xiaoli Wang, Yi Rong, Xiwen Liu, Zhaoxuan Liu
Background: This investigation aimed to assess the long-term effectiveness and symptomatic manifestations of the combined therapy of sclerosing foam and endovenous laser ablation (ELA) for treating lower-extremity varicose veins.
Materials and methods: In this study, we examined 2,118 patients (2,324 limbs) diagnosed with varicose veins in one or both lower extremities. These patients were treated at our center between January 2019 and December 2021. All individuals underwent the combined treatment of sclerosing foam and ELA. We closely monitored the occlusion status of the great saphenous vein (GSV) trunk and its tributaries, along with the postoperative therapeutic outcomes and symptomatic presentations. The average follow-up duration was 41.3 months, and data were collected via outpatient appointments and telephone follow-up inquiries.
Results: The success rate of the treatment procedure was 100%. Based on the outcomes of continuous follow-up spanning from 1 to 3 years after the surgery, among the 2,324 legs, 16 legs still required repeated foam sclerotherapy for varicose veins, 2 legs exhibited venous edema, and 11 legs showed skin pigmentation. At one week and one year after the procedure, incomplete closure of the GSV trunk (characterized by patency, blood flow, and reflux) was observed in 1.8% (38 limbs) and 1.1% (23 limbs), respectively. Nineteen patients with local recurrence of varicose veins decided not to undergo further treatment.
Conclusion: The long-term follow-up data demonstrated that the combination of sclerosing foam and endovenous laser was highly efficacious in treating varicose veins. The main postoperative symptoms included the requirement for additional sclerosing foam injections, skin pigmentation, pain and tissue induration.
{"title":"Long-term efficacy of sclerosing foam combined with endovenous laser treatment for varicose veins of the lower extremities.","authors":"Guili Wang, Donglin Lu, Ding Wu, Xiaoli Wang, Yi Rong, Xiwen Liu, Zhaoxuan Liu","doi":"10.3389/fsurg.2025.1639750","DOIUrl":"10.3389/fsurg.2025.1639750","url":null,"abstract":"<p><strong>Background: </strong>This investigation aimed to assess the long-term effectiveness and symptomatic manifestations of the combined therapy of sclerosing foam and endovenous laser ablation (ELA) for treating lower-extremity varicose veins.</p><p><strong>Materials and methods: </strong>In this study, we examined 2,118 patients (2,324 limbs) diagnosed with varicose veins in one or both lower extremities. These patients were treated at our center between January 2019 and December 2021. All individuals underwent the combined treatment of sclerosing foam and ELA. We closely monitored the occlusion status of the great saphenous vein (GSV) trunk and its tributaries, along with the postoperative therapeutic outcomes and symptomatic presentations. The average follow-up duration was 41.3 months, and data were collected via outpatient appointments and telephone follow-up inquiries.</p><p><strong>Results: </strong>The success rate of the treatment procedure was 100%. Based on the outcomes of continuous follow-up spanning from 1 to 3 years after the surgery, among the 2,324 legs, 16 legs still required repeated foam sclerotherapy for varicose veins, 2 legs exhibited venous edema, and 11 legs showed skin pigmentation. At one week and one year after the procedure, incomplete closure of the GSV trunk (characterized by patency, blood flow, and reflux) was observed in 1.8% (38 limbs) and 1.1% (23 limbs), respectively. Nineteen patients with local recurrence of varicose veins decided not to undergo further treatment.</p><p><strong>Conclusion: </strong>The long-term follow-up data demonstrated that the combination of sclerosing foam and endovenous laser was highly efficacious in treating varicose veins. The main postoperative symptoms included the requirement for additional sclerosing foam injections, skin pigmentation, pain and tissue induration.</p>","PeriodicalId":12564,"journal":{"name":"Frontiers in Surgery","volume":"12 ","pages":"1639750"},"PeriodicalIF":1.6,"publicationDate":"2026-01-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12847415/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146085386","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}
Pub Date : 2026-01-14eCollection Date: 2025-01-01DOI: 10.3389/fsurg.2025.1756065
Tian Wang, Yichi Xu, Jiawen Xu, Chunhua Zhen
Introduction: Small bowel obstruction is a common acute abdominal condition in adults, but obstruction caused by midgut malrotation-a congenital anomaly affecting the normal rotation of the intestine during fetal development-is rare. However, among infants and children, midgut malrotation is more frequently observed.
Case presentation: We report the case of a 40-year-old male patient who presented with vomiting, accompanied by cessation of passing flatus and defecation, along with mild abdominal pain. After emergency admission and an enhanced CT scan of the abdomen, a typical mesenteric whirlpool sign was observed, with the cecum and appendix located in the left lower abdomen. The patient underwent emergency surgery and recovered well postoperatively.
Discussion: Midgut malrotation may be asymptomatic in the early stages but is accompanied by an increased risk of intestinal obstruction and intestinal necrosis with an increased angle of torsion, and early surgical intervention is recommended for midgut malrotation in adults.
Conclusion: Midgut malrotation often leads to the development of intestinal obstruction in adults and is a rare cause. Imaging can be well defined, as well as determining the presence of critical conditions such as intestinal necrosis. Surgery is the only effective method of treatment at present, and early surgery after definitive diagnosis is very important.
{"title":"A rare case of midgut malrotation leading to small bowel obstruction in an adult: a case report.","authors":"Tian Wang, Yichi Xu, Jiawen Xu, Chunhua Zhen","doi":"10.3389/fsurg.2025.1756065","DOIUrl":"10.3389/fsurg.2025.1756065","url":null,"abstract":"<p><strong>Introduction: </strong>Small bowel obstruction is a common acute abdominal condition in adults, but obstruction caused by midgut malrotation-a congenital anomaly affecting the normal rotation of the intestine during fetal development-is rare. However, among infants and children, midgut malrotation is more frequently observed.</p><p><strong>Case presentation: </strong>We report the case of a 40-year-old male patient who presented with vomiting, accompanied by cessation of passing flatus and defecation, along with mild abdominal pain. After emergency admission and an enhanced CT scan of the abdomen, a typical mesenteric whirlpool sign was observed, with the cecum and appendix located in the left lower abdomen. The patient underwent emergency surgery and recovered well postoperatively.</p><p><strong>Discussion: </strong>Midgut malrotation may be asymptomatic in the early stages but is accompanied by an increased risk of intestinal obstruction and intestinal necrosis with an increased angle of torsion, and early surgical intervention is recommended for midgut malrotation in adults.</p><p><strong>Conclusion: </strong>Midgut malrotation often leads to the development of intestinal obstruction in adults and is a rare cause. Imaging can be well defined, as well as determining the presence of critical conditions such as intestinal necrosis. Surgery is the only effective method of treatment at present, and early surgery after definitive diagnosis is very important.</p>","PeriodicalId":12564,"journal":{"name":"Frontiers in Surgery","volume":"12 ","pages":"1756065"},"PeriodicalIF":1.6,"publicationDate":"2026-01-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12847330/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146085421","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}