Zentralblatt fur Chirurgie最新文献

Ergonomics remain an underestimated challenge in medicine, particularly in robotic surgery. Despite technical advances, surgeons often suffer from musculoskeletal disorders often involving the neck, back, and wrist. Previous studies have shown that a lack of knowledge and awareness of ergonomic recommendations for the use of the console, unnatural or poor physiological postures, and a lack of training are common causes of poor posture and associated complaints. A physiological posture is the basis for a healthy workspace, both when standing and sitting. Of particular relevance are a neutral head, pelvis, and spine position, as well as core stability and regular training of the critical muscles for a stable posture.A comparison of different robotic systems revealed significant differences in console design and associated ergonomic challenges. Systems with adjustable headpieces, for example, improve neck posture, while open consoles facilitate communication in the operating room.In addition, the role of the bedside assistant is critical from an ergonomic perspective. The discrepancy between the motor and visual axes quickly leads to discomfort in the neck, shoulder, and arm areas. Structured training curricula and ergonomic guidelines are lacking in everyday surgical practice.To prevent musculoskeletal pain and potential disorders, targeted stretching and mobilization exercises can be performed during so-called micro breaks, which have been proven to reduce pain and improve concentration and performance. Correct adjustment of the console can also significantly improve the ergonomics in the robotic operating theatre.

Vascular graft infections pose as severe complications in vascular surgery and are linked to high morbidity and mortality. Guidelines recommend resection of infected grafts and concomitant autologous reconstruction, though redo-surgery might not always be reasonable in high-risk patients with significant comorbidities. Additionally, conservative antibiotic treatment is hindered by increasing antibiotic resistance rates and biofilm formation.Bacteriophages are viruses that selectively infect and eradicate bacteria and are therefore a promising anti-infective therapeutic strategy. Though the therapeutic potential of bacteriophages has been known since the early 20th century, in western medicine only a few clinical studies on bacteriophage treatment in infectious diseases exist to date.This review aims to outline history, biology and challenges of bacteriophage therapy. It summarizes 9 cases published in literature as case reports or small case series in which the treatment of vascular graft infections with bacteriophages is used to circumvent high-risk graft explantation surgery.

Midaortic syndrome (MAS) is a rare vascular disorder characterised by segmental hypoplasia or stenosis of the thoracoabdominal aorta and possible involvement of renovisceral branches.In the case presented here, a 19-year-old female patient with thoracoabdominal aortic hypoplasia combined with multiple aortic and visceral aneurysms and a genetically confirmed COL3A1 variant (vascular Ehlers-Danlos syndrome) underwent open surgical thoracoabdominal type II aortic replacement.Using a multimodal neuro- and organ-protective approach, including perioperative CSF drainage, MEP monitoring, mechanical selective and distal extremity and organ perfusion, and targeted blood product and volume management, a complication-free thoracoabdominal reconstruction was performed.The postoperative course was normal but required subsequent interventional endovascular treatment of an anastomotic stenosis of the right renal artery.This case highlights the need for a tailored therapeutic approach for this complex, genetic aortic pathology. It demonstrates that not all aortic diseases are amenable to endovascular treatment and that open surgical treatment remains highly important, especially in younger patients with hereditary aortic diseases.

The aim of this study is to present initial experiences with AI-assisted EVAR planning in cases of different complexity, and to discuss its potential clinical benefits, current limitations, and future development perspectives.Starting from March 2024, this single centre study included prospectively the first infrarenal and complex EVAR cases that were planned with additional preoperative simulation using the AI-based Digital Twin technology (Predisurge SAS, St. Etienne, France). The study assessed the concordance between simulation results, clinical planning, and postoperative outcomes, focusing on the occurrence of Type Ia endoleaks after infrarenal EVAR and target vessel complications during the implantation of fenestrated/branched endografts (F/BEVAR). Additionally, the potential impact of the simulation on therapeutic decision-making was evaluated.9 infrarenal EVAR cases (all male, median age 74 [61-80] years) and 10 F/BEVAR cases (4 male, median age 73 [58-82] years) were included. 7/9 patients with infrarenal pathology were treated with Endurant IIs endografts (Medtronic, Dublin, Ireland), one patient with a Zenith Alpha endograft (Cook Medical, Australia Pty Ltd., Brisbane, Australia), and one patient with an Anaconda endograft (Terumo Aortic, Inchinnan, Scotland). In 2 cases, a larger main body was selected based on the simulation results. In 3 cases, the simulation indicated an elevated Endoleak Risk Index (ERI), although no Type Ia endoleak was observed during follow-up; in these cases, the simulation results differed from the surgeon's assessment. Among the F/BEVAR patients (7/10 Cook Medical, 3/10 Terumo Aortic), the simulation led to a change in graft design or fenestration position (1/10 each) and predicted target vessel complications in three cases.AI-assisted EVAR planning is still in its early stages but offers numerous opportunities for further development, which are eagerly anticipated. Initial clinical experiences are promising; however, larger studies are needed to confirm and validate these findings. It is expected that preoperative AI-assisted EVAR simulation will play a significant role in the future - not only in clinical decision-making for both simple and complex cases, but also in education and training.

Benign paravertebral tumours of the spine are uncommon lesions, predominantly arising from Schwann cells. Despite their benign nature, their proximity to the spinal canal, pleura, and thoracic vessels makes surgical management challenging.We report four cases of benign paravertebral thoracic tumours treated surgically between 2021 and 2025 using different approaches, including dorsal, retropleural, anterolateral, and thoracoscopic techniques.Complete resection was achieved in all cases without postoperative neurological deficits. Histopathology confirmed three schwannomas (WHO grade I) and one benign fibrous tumour.An individualised, anatomy-based surgical strategy is crucial. Thoracoscopic approaches (VATS) offer a minimally invasive and safe option for selected cases, while total resection remains the key determinant of long-term tumour control.

In spinal surgery, endoscopic surgical techniques have been gaining increasing importance in recent years. Although the technique itself has existed for decades, it has only begun to spread more widely in recent years due to technological advancements and increasingly structured training concepts. Nowadays, endoscopic procedures can be performed on all regions of the spine, including the thoracic spine.The two standardised endoscopic techniques for the thoracic spine are the interlaminar and the transforaminal approaches. Additionally, there are individual case reports describing an endoscopic transthoracic or retropleural approach. These approaches are primarily used to treat degenerative pathologies such as spinal canal stenosis and herniated discs, but also ossifications of the ligamentum flavum or the posterior longitudinal ligament. In individual cases, the endoscopic approach can also be utilised for the treatment of rarer conditions such as infections, tumours, and spontaneously occurring dural injuries.As in other areas of the spine, endoscopic techniques for the thoracic spine are believed to offer potential advantages over traditional methods, such as reduced postoperative pain and a shorter hospital stay or overall quicker recovery time.Endoscopic approaches to the thoracic spine presumably offer advantages over conventional surgical techniques. However, the currently available literature is insufficient to make well-founded statements about clinical outcomes and about future developments. Since these approaches consistently pose a challenge, they should only be performed by surgeons experienced in endoscopic techniques.

Thoracic Outlet Syndrome (TOS) refers to the compression of the neurovascular structures at the thoracic outlet. Its incidence is estimated at 2-3 cases per 100000 individuals per year. Patients are frequently affected by pain and/or functional impairment. The diagnostic and therapeutic process typically involves multiple medical specialties. Diagnosis is primarily clinical and requires the exclusion of differential diagnoses. Additional diagnostic modalities, such as ultrasound, MRI, angiography, or electroneurography, may provide supportive information. Depending on the treating discipline, different classifications and therapeutic strategies are applied. The availability of high-quality studies on treatment remains limited, although evidence has improved in recent years. To date, no standardised, interdisciplinary guidelines for the diagnosis and management of Thoracic Outlet Syndrome have been established.