Updates in Surgery最新文献

Objective: To evaluate the effectiveness of integrating 3D digital holographic reconstruction and intraoperative navigation with case-based learning (CBL) in enhancing the educational outcomes of laparoscopic partial nephrectomy training for urology residents.

Methods: A prospective randomized controlled trial was conducted at the Second People's Hospital of Hefei from August 2021 to May 2024. A total of 120 urology residents were randomly assigned to either a combined teaching group (3D holography + CBL, n = 60) or a conventional CBL-only group (n = 60). The experimental group utilized reconstructed CT/MRI DICOM data rendered into interactive holographic models via Microsoft HoloLens 2 for real-time anatomical visualization and intraoperative guidance. Key outcome measures included post-training performance (theoretical and practical scores), self-directed learning ability, teaching satisfaction, critical thinking disposition, and knowledge retention at 1-, 3-, and 6-month follow-ups.

Results: The combined teaching group demonstrated significantly superior outcomes across all measured domains (P < 0.05). Post-training scores were higher in theoretical knowledge (44.58 ± 2.09 vs. 40.28 ± 2.96), practical skills (44.63 ± 2.69 vs. 40.00 ± 2.64), and total score (89.21 ± 4.33 vs. 80.28 ± 5.55). Additionally, the group showed enhanced self-directed learning (4.38 ± 0.74 vs. 3.07 ± 0.73), higher teaching satisfaction (4.30 ± 0.74 vs. 3.15 ± 0.58), and improved critical thinking, notably in analyticity and cognitive maturity. Longitudinal assessments revealed better knowledge retention at all time points, with 6-month total scores of 76.92 ± 2.25 vs. 60.77 ± 5.97.

Conclusions: Integrating 3D holographic reconstruction and intraoperative navigation into CBL teaching significantly improves urology residents' comprehension, critical thinking, surgical preparedness, and long-term knowledge retention during laparoscopic partial nephrectomy training. This multimodal teaching model may serve as a valuable adjunct to traditional residency training frameworks.

To analyze independent risk factors for distant metastasis of Hurthle cell carcinoma (HCC)of the thyroid and to construct and validate a nomogram, thereby assisting clinicians in making more individualized clinical decisions. Patient data were retrieved from the Surveillance, Epidemiology, and End Results (SEER) database. Chi-square tests and Logistic regression analysis were used to determine independent risk factors for distant metastasis of HCC. Logistic regression models based on significant independent risk factors were established using the rms package of R software (version 4.3.3) and visualized as a nomogram. The performance of the nomogram was evaluated using subject operating characteristic (ROC) curves, calibration curves, and decision curve analysis (DCA). A total of 1312 HCC patients were included, among whom 48 patients developed distant metastasis, accounting for 3.66% of the entire cohort. Results of chi-square test and univariate logistic regression analysis indicated that age, gender, marital status, tumor size, and lymph node metastasis were significantly associated with distant metastasis of HCC. Multifactorial logistic regression analysis revealed that age, gender, marital status and lymph node metastasis were independent risk factors for distant metastasis of HCC, which were used to construct the nomogram. Results of ROC curve analysis, calibration curves, and DCA demonstrated that the nomogram had good predictive performance. We successfully constructed and validated a nomogram for predicting distant metastasis of HCC. This nomogram is important for clinicians to promptly identify patients at high risk of distant metastasis and formulate more individualized clinical decisions.

To evaluate the impact of early (< 8 weeks) versus late (≥ 8 weeks) stoma closure on postoperative recovery and complications in preterm infants following surgery for necrotizing enterocolitis (NEC). In this multicenter retrospective cohort study, we analyzed data from preterm infants who underwent stoma closure between 2011 and 2022. Propensity score matching (PSM) was applied in a 1:2 ratio to balance baseline characteristics between early and late closure groups. Outcomes assessed included stoma-related complications, operative characteristics, gastrointestinal recovery, and postoperative complications. Of 367 eligible infants, 80 in the early closure group and 186 in the late closure group were included after matching. Baseline characteristics were well-balanced. The early closure group had significantly lower median weight at closure (2674 g vs. 3374 g, p = 0.038) and shorter stoma duration (48 vs. 69 days, p = 0.0064). Time to first flatus/defecation was shorter in the early group (2.7 ± 1.8 days vs. 3.2 ± 1.9 days, p = 0.012). There were no significant differences in overall complication rates, reoperation, readmission, mortality, duration of parenteral nutrition, or hospital stay. A non-significant trend toward higher median weight at 6 months corrected age was observed in the early group (6548 g vs. 6287 g, p = 0.12). Early stoma closure (< 8 weeks) is associated with faster recovery of gastrointestinal function and does not increase the risk of postoperative complications. These findings support the feasibility and safety of early closure in selected NEC infants, though timing should be individualized based on clinical assessment.

We investigated changes in platelet count after surgery for strangulated bowel obstruction (SBO), evaluated associations between postoperative thrombocytopenia and short-term outcomes, and identified risk factors for postoperative thrombocytopenia. This study included 109 patients who underwent emergency surgery for SBO between January 2014 and December 2023. Postoperative short-term outcomes were compared among three groups according to the lowest postoperative platelet count. Logistic regression analysis was used to identify risk factors associated with severe thrombocytopenia. All patients had platelet counts below the preoperative level within 72 h post-surgery. The severe thrombocytopenia (postoperative platelet count < 10 × 10⁴/µL) group exhibited significantly increased postoperative complications, 28-day mortality, and length of hospital stay. Preoperative thrombocytopenia, Sequential Organ Failure Assessment score, and bowel resection were independent risk factors for severe thrombocytopenia. Postoperative platelet counts fell below preoperative levels in all patients with SBO. Severe thrombocytopenia was associated with poor postoperative outcomes.

Colonic stenting for malignant large bowel obstruction (LBO) is established as an effective option for palliation and bridging to more definitive surgery. However, stenting of flexural tumours (hepatic or splenic) is comparatively technically challenging due to colonic angulation and tortuosity. To assess its relative safety and feasibility we have analysed its outcomes against stenting elsewhere in the colon. Retrospective data, including baseline demographics, mortality/morbidity data, and patency rates, were collected on patients diagnosed with malignant LBO at our centre between August 2007 and August 2024. Colonic stenting was performed by advanced endoscopists with fluoroscopic guidance. Malignant flexural and non-flexural stenting outcomes were compared through chi-squared testing and Kaplan-Meier analysis using SPSS. A total of 86 patients underwent colonic stenting, with 13 patients stented in the colonic flexures. Comparison of outcomes between flexural and non-flexural stenting revealed no statistically significant differences. Primary patency at 90 days was higher in the flexure group (69.23%) compared to the non-flexure group (46.15%) (p = 0.195). Kaplan-Meier analysis showed a median primary patency of 164 days (95% CI: 70-258) for flexural stenting and 98 days (95% CI: 13-183) for non-flexural stenting (p = 0.453). No statistically significant difference was found between the two groups in terms of the stent-related complications of migration, re-stenosis and perforation. Flexural colonic stenting for malignant LBO does not appear to be inferior to stenting elsewhere in the colon, highlighting its potential safety and feasibility in experienced hands. Flexural colonic stenting may be considered an option in the management of malignant LBO, for both palliation and bridging.

Lymph node metastasis (LNM) plays a key role in the treatment of patients with early gastric cancer (EGC), especially elderly patients (over 65 years old). The accurate preoperative prediction of LNM is still a challenge, and studies of elderly patients are lacking. The purpose of this study was to develop and validate an effective model based on machine learning to predict the risk of preoperative LNM in elderly patients with EGC. The data of 1578 patients from 2010 to 2020 were extracted from the Surveillance Epidemiology and End Results (SEER) database. Five different machine learning algorithms were applied to construct the models. The external validation data were obtained from 127 elderly patients in our hospital. The area under the receiver operating characteristic curve (AUC), accuracy, sensitivity and specificity of the models were compared and evaluated. A Cox regression model was used to determine the prognostic factors for overall survival (OS) in elderly patients with EGC. Of the 1578 patients included in this study, 165 (10.46%) had LNM. Multivariate logistic regression analysis revealed that differentiation grade, T stage, tumour size were independent predictors of LNM. The performance of the random forest (RF) model was the best, with an AUC of 0.771 in the training cohort, 0.733 in the internal validation cohort and 0.796 in the external test. Multivariate Cox regression analysis confirmed that sex, age, primary site, tumour size, T stage, radiotherapy and RNE were independent prognostic factors for OS in elderly patients with EGC. Based on RF model, clinicians can develop more reasonable treatment plans to improve the prognosis of patients and reduce the burden on the medical system and patients.

Background: Bullfighting-related trauma, common in rural Spain, often results in polytrauma requiring urgent care. This study evaluates the management and outcomes of bullfighting-related trauma at a level I hospital in Medina del Campo, Spain.

Methods: A retrospective study of 154 patients with bullfighting-related trauma from 1998 to 2024 was conducted. Patients were classified by trauma severity using the New Injury Severity Score (NISS): mild (MT), moderate (MoT), moderate-severe (MST), and severe (ST). Demographic data, injury characteristics, surgical procedures, complications, and outcomes were analyzed, with comparisons made using trauma severity scales (RTS, AIS, ISS, NISS).

Results: The cohort had a mean age of 32 years (IQR 23-52), with a male predominance (97%). Open trauma (74.7%) was most common, especially goring (85.1%) to the lower extremities and pelvis. Significant findings included fewer deep goring injuries in MT (77% vs. 100%, p = 0.013) and more lower extremity injuries in MT (65% vs. 44%, p < 0.001). Mortality was higher in the ST group (p < 0.001), with one intraoperative death. Surgical intervention was needed in 92.2% of cases, and the reoperation rate was higher in the ST group (p < 0.001). The NISS scale effectively predicted severity, with MT having a median NISS of 5 (IQR 4-9) compared to 57 in the ST group (p < 0.001).

Conclusion: Bullfighting-related trauma often requires urgent care, and the NISS scale is effective in predicting injury severity. Early surgical intervention improves outcomes. Further multicenter studies are needed to confirm these findings.

Background: Graduate medical education (GME) programmes are integral to healthcare systems, providing clinical manpower through medical residents whose compensation is externally funded in Italy. The financial impact of resident integration on public hospital budgets, particularly amid rising healthcare expenditures, remains poorly quantified.

Methods: We conducted a deterministic 12-month Budget Impact Analysis from the hospital perspective (EUR 2024), comparing an attending-only workforce with a resident-integrated configuration. Inputs included attending full-cost FTE (salary + employer on-costs), resident productivity by setting, supervision shares (translated into effective attending FTE), and departmental workload. Uncertainty was addressed through Monte Carlo probabilistic sensitivity analysis.

Results: This Budget Impact Analysis (hospital perspective; EUR 2024; 12-month horizon) found that integrating Ministry-funded residents reduced annual personnel expenditure by 40-50%. Replacing 40% of attending FTEs produced mean savings of €240,000 (95% CI: €205,000-€275,000). Sensitivity analyses confirmed the robustness of these savings across variations in staffing mix, supervision requirements, and resident productivity rates.

Conclusion: Externally funded residency programmes provide substantial, direct cost savings and support flexible workforce planning in Italian public hospitals. These findings support strategic investment in GME as a driver of economic sustainability and healthcare resource optimisation. Further research should address broader impacts on care quality and workforce stability.