Updates in Surgery最新文献

Identifying the parathyroids is compulsory for success of parathyroidectomy for parathyroid adenoma. The aim of the present study is to evaluate and compare the efficacy of PTeye™ and FLUOBEAM® LX in identifying parathyroid adenomas. Patients undergoing parathyroidectomy due to a parathyroid adenoma were enrolled prospectively in this study and were randomly included to Group A (PTeye™) or Group B (FLUOBEAM® LX). After intraoperative identification of parathyroid adenomas and before tissue dissection (minute 0), we evaluated the efficacy of both devices in confirming the adenomas. We re-evaluated devices' efficacy in minutes 1, 3 and 5 during tissue dissection and before adenoma excision. All PAs were confirmed and identified with PTeye™, while FLUOBEAM® LX could not identify 3/20 adenomas (15%). PTeye™ confirmed parathyroid tissue in less than 1 min in 13 cases (65%), in < 3 min in 7 (35%), whereas FLUOBEAM® LX identified 4 adenomas in < 3 min (20%), in < 5 min 9 adenomas (60%) and > 5 min in 4 (20%). PTeye™ and FLUOBEAM® LX are both useful tools in confirming parathyroid tissue intraoperatively. PTeye™ confirmed the suspected adenoma earlier before tissue dissection, while FLUOBEAM® LX demands tissue dissection as it identifies the normal parathyroid tissue.

Robotic surgery has significantly advanced over the last decade, proving to be a safe and feasible technique in minimally invasive surgery. The latest innovation in robotic-assisted surgery is the da Vinci single-port (SP^®) by Intuitive, designed for greater precision and ergonomic efficiency. This report is supposed to be the first Spanish case of robot-assisted cholecystectomy performed using the da Vinci SP^® system, detailing system specifications, docking configurations, and surgical outcomes. The procedure was completed without complications or technical failures, with an operative time of 38 min and a docking time of 10 min. The patient was discharged the following day, demonstrating the system's efficacy in routine cholecystectomy procedures.

Background: Anorectal melanoma (AM) is a rare and aggressive malignancy, often misdiagnosed due to its clinical resemblance to benign anorectal conditions. Early diagnosis remains challenging, with a poor prognosis and high rates of metastasis at presentation.

Methods: We conducted a retrospective multicenter study of 21 patients diagnosed with AM between 2013 and 2023 across four high-volume Italian surgical centers. Patients were stratified into two groups based on whether AM was suspected at initial evaluation (Group A) or incidentally diagnosed after surgery for presumed benign disease (Group B). Clinical, diagnostic, treatment, and outcome data were analyzed.

Results: Only 24% of patients had AM suspected at first presentation. These patients were younger (median age 49 vs. 70 years) and had larger, more readily identifiable tumors. However, nodal and distant metastases were equally frequent in both groups (lymph node metastases: 52.4%; distant metastases: 19%). Most patients underwent wide local excision (71.4%), while only one required abdominoperineal resection. Postoperative recurrence occurred in 47.6% of cases. Median survival was 11 months in Group A and 24 months in Group B. In 90.5% of cases, previous specialist consultations had failed to achieve timely diagnosis, highlighting missed diagnostic opportunities.

Conclusions: AM is frequently overlooked due to its rarity and non-specific presentation. Earlier recognition alone may not improve outcomes, but systematic histopathological assessment, targeted biopsy, and multidisciplinary management remain essential. Conservative surgery with early use of systemic therapy should be prioritized when feasible.

Negative pressure wound therapy (NPWT) has been shown to be beneficial for improving the wound healing process and reducing flap complications. However, the ideal NPWT settings, especially the pressure levels and application modes, are still debatable. This study examines the efficacy and safety of NPWT at different pressure gradients, namely, high (HNPWT) and low (LNPWT), to determine the optimal conditions for improving flap outcomes and minimizing complications. Over a 30-month period, 65 patients who underwent flap reconstruction were randomly assigned to three groups: HNPWT (75-125 mmHg, continuous mode), LNPWT (50-75 mmHg, intermittent mode), and conventional wound dressing (CWD). Patients were evaluated prospectively for post-operative complications, flap viability, infection, edema, and wound dehiscence. Complications were more common in the CWD group than in the HNPWT group, while the HNPWT group  had the highest incidence of flap ischemia (41%). NPWT significantly reduced post-operative edema (P = 0.003) and lower infection and dehiscence rates than the CWD group (P = 0.015 and P = 0.029, respectively). Compared with HNPWT, LNPWT showed superior safety and efficacy, with fewer ischemic events, lower pain scores, faster wound healing times, and better esthetic and function outcomes. Although NPWT offers benefits over conventional wound dressing in flap reconstructions, pressure settings should be carefully adjusted. LNPWT is safer and has more satisfactory outcomes than HNPWT, with reduced ischemia and better overall healing. These findings suggest that LNPWT in the intermittent mode is most favorable for improving flap viability and minimizing adverse effects.Registration identification number NCT06080958- July 22, 2024. "Retrospectively registered" URL for the registry: http://www.clinicaltrials.gov/.

Since 2004, the European Society of Endocrine Surgeons (ESES) has hosted biennial congresses as a platform for presenting key research. However, the publication rate of abstracts presented at these congresses is unknown. We searched for full publications using titles and authors of abstracts presented orally or as posters at ESES congresses from 2004 to 2018. Abstract factors, such as type of study and number of patients, were investigated in relation to publication rate, journal impact factor, and citation rates of published studies. Out of 733 abstracts presented at ESES during this period, 207 (28%) were presented orally and 528 (72%) as a poster, Overall, 456 of the abstracts (62%) were published, with a median time of 11.4 months from the ESES congress to publication [range - 64.5 to 156]. The median number of citations per published abstract was 21 [range 0-821], the average annual citation rate was 2.3 [0-54], and the median journal impact factor was 2.2 [0-21.3]. The median number of patients included per study was small, accounting for 71.5 [range 1-22,580]. While factors predicting higher chances for publication were oral format (OR 5), 2006 and 2008 ESES congresses (OR 21 and 12.6, respectively), larger sample sizes, oral presentation format, native English authorship, and randomized trials had higher annual citation rates. While the publication rates of ESES congress abstracts are high, collaborative efforts to conduct multicentric prospective studies could increase the publication rate of abstracts and enhance the overall scientific impact of the ESES congresses.

Benign esophageal perforations present a significant clinical challenge due to their high morbidity and potential for fatal outcomes. The complex nature of these perforations demands prompt diagnosis and effective management to mitigate the associated risks. This study aims to evaluate the clinical outcomes of various management strategies for esophageal perforations, focusing on the effectiveness of organ-preserving approaches. We retrospectively analyzed patients diagnosed with benign esophageal perforation between January 2011 and December 2021. Patients were stratified into two groups: those who underwent resection and those who did not. Subgroup analysis was performed on patients managed initially without resection to assess the success of organ-preserving strategies (successful organ preservation, SOP) vs. either salvage resection or death (unsuccessful organ preservation, UOP). Forty-two patients were included: 22 underwent esophageal resection, while 20 were managed non-operatively. The overall 90-day mortality rate was 26%, with higher mortality observed in the resection group. In patients managed initially without resection, 62.1% had successful outcomes, while 37.9% required salvage esophagectomy or died within 90 days. The Pittsburgh Severity Score (PSS) did not significantly predict the need for resection. Distal perforations underwent resection more frequently (p < .001). Overall 90-day mortality was high both among patients who underwent initial resection (5/13, 38.5%) and salvage esophagectomy (3/8, 37.5%). Twenty-nine patients did not initially undergo resection, of which n = 18 (62.1%) were categorized as SOP and n = 11 (37.9%) as UOP. Among the latter, n = 3 (10.3%) died within 90 days and n = 8 (27.6%) underwent salvage esophagectomy. On subgroup analysis on initially unresected patients, delayed diagnosis ≥ 24 h was higher among UOP than SOP patients (n = 5, 45.5% vs. n = 2, 11.1%, p = 0.49). Our findings underscore the importance of early diagnosis and the feasibility of a step-up approach in a select group of patients presenting with favorable variables.

Local advanced rectal cancer (LARC) carries high recurrence risks, especially with lateral lymph node (LLN) involvement. This study aims to evaluate the role of ICG-guided sentinel lymph node biopsy (SLNB) in patients with clinical negative LLNs (maximum diameter < 7 mm), potentially reducing unnecessary surgeries and associated complications in patients with LARC. A retrospective analysis of 301 consecutive patients with lower LARC who underwent fluorescent lateral pelvic sentinel lymph node biopsy (FL-SLNB) or conventional LLND at the Cancer Hospital, Chinese Academy of Medical Sciences between 2018 and 2022 was conducted. Clinical and pathological data were collected, and the patients were grouped into FL-SLNB and non-SLNB groups. Postoperative complications, recurrence rates, and survival outcomes were assessed. Statistical analysis was performed using χ² tests, Mann-Whitney U tests, Kaplan-Meier survival curves, and Cox proportional hazards models. FL-SLNB (173 patients) showed better perioperative outcomes than non-SLNB (128 patients), with shorter hospital stays (7 vs. 10 days, P = 0.027), less blood loss (150 vs. 180 mL, P = 0.032), and fewer complications: intraoperative bleeding (2.9% vs. 6.3%, P = 0.041), anastomotic leakage (1.7% vs. 3.9%, P = 0.045), and urinary dysfunction (3.5% vs. 7.0%, P = 0.039). No significant differences were observed in survival or recurrence rates (P > 0.05). pN stage was a significant predictor of distant metastasis (HR 1.953, P = 0.037). ICG-guided SLNB enhanced surgical precision and reduced unnecessary LLND in lower LARC with clinically negative LLNs, and improved surgical decision-making and minimizes postoperative complications.

Robotic-assisted hepatopancreatobiliary (HPB) surgery is increasingly adopted in high-volume centers. This study evaluated the feasibility, safety, and technical characteristics of the Toumai® robotic system in HPB surgery. We retrospectively analyzed 160 consecutive patients who underwent HBP surgery using the Toumai® system at the Chinese People's Liberation Army General Hospital between November 2024 and June 2025. Procedures included liver resection (92 cases: 32 lobectomies/segmentectomies and 60 local resections), pancreatic surgery (23 cases: 2 pancreaticoduodenectomies, 9 distal pancreatectomies, 11 tumor resections, 1 pancreatic duct incision and pancreaticojejunostomy), and biliary surgery (37 cases: 3 radical resections for hilar cholangiocarcinoma, 23 biliary explorations and stone removals, 6 gallbladder cancer resections, 3 choledochojejunostomies, and 2 cholecystectomies). Of the cohort, 46 patients (28.8%) had prior abdominal surgery. Conversion to open surgery occurred in 3 cases (1.9%). Postoperatively, one patient developed pancreatic fistula managed with percutaneous drainage; no other Clavien-Dindo III-IV complications or in-hospital deaths were observed. Median postoperative length of stay was 5 days (range, 1-27 days). Toumai® robotic-assisted surgery demonstrates preliminary feasibility and safety across a spectrum of HPB procedures. With technical refinements and device iterations, broader adoption may enhance the accessibility and affordability of robotic surgery in resource-variable settings.​.

Accurate preoperative evaluation of lymph-node metastasis (LNM) in patients with pathological T1 (pT1) colon cancer is essential for determining the appropriate extent of colectomy and lymphadenectomy. This study aimed to identify clinical and pathological predictors of LNM and to develop a practical tool for individualized risk assessment. Patients with pT1 colon adenocarcinoma diagnosed between 2010 and 2015 were identified from the Surveillance, Epidemiology, and End Results (SEER) database. After applying exclusion criteria-including distant metastases, multiple primaries, missing key clinical data, and incomplete records-2700 cases were included. LNM status was compared across baseline variables using Chi-square and t tests. Multivariable logistic regression was used to identify independent predictors of LNM, reported as odds ratios (ORs) with 95% confidence intervals (CIs). A nomogram was constructed based on significant variables and validated internally using 1,000 bootstrap resamples. Model performance was evaluated through area under the curve (AUC), calibration, and decision-curve analysis (DCA). Kaplan-Meier methods were used to estimate cancer-specific survival (CSS) and overall survival (OS). LNM was present in 12.8% (n = 345) of cases. Patients with LNM were younger and more likely to present with sigmoid tumors, high-grade histology, perineural invasion, tumor deposits, and surgical delays. On multivariable analysis, factors independently associated with LNM included younger age, Black race (OR 1.55, 95% CI 1.08-2.20), sigmoid location (OR 1.70, 1.30-2.23), higher histological grade, surgical delay beyond 14 days, perineural invasion (OR 4.93, 2.24-10.77), and presence of tumor deposits (OR 4.70, 1.86-11.56). The nomogram demonstrated good discrimination (corrected AUC = 0.664) and calibration, with favorable net benefit at threshold probabilities below 20%. Five-year CSS was modestly lower in the LNM group (94.7 vs. 96.8%, P = 0.019), while OS showed no significant difference (P = 0.36). LNM is not uncommon in pT1 colon cancer. Several clinical and pathological features can help predict LNM risk. The proposed nomogram offers a useful, evidence-based tool to guide surgical decision-making and patient counseling. External validation is needed before routine clinical application.