Zentralblatt fur Chirurgie最新文献

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.

The covid 19 pandemic has had a significant impact on healthcare worldwide, yet the effects on the surgical treatment of lung cancer patients in Germany have not yet been adequately studied.This retrospective analysis used data from the German Thoracic Register. The surgical treatment of 2989 patients with bronchial carcinoma was analysed in two periods: 2020-2021 (pandemic phase: 1297 patients) and 2018-2019 (pre-pandemic phase: 1692 patients) across 8 German hospitals.During the pandemic phase, the number of complex surgeries decreased, and the need for intensive care dropped from 39.7% to 19.4% (p < 0.001). The rates of neoadjuvant chemotherapy and radiation therapy decreased from 44% to 17% and 20% to 5%, respectively (both p < 0.001). Simultaneously, a significant reduction in postoperative complications, particularly pneumonia (8.5% to 6.2%, p = 0.020), was observed.The lower complication rates may be attributed to stricter hygiene measures and reduced visitor access during the pandemic. Consideration of these risk factors in postoperative patient care may help improve the prognosis of surgically treated lung cancer patients in the future.

Based on i) selective references from the medical scientific literature and ii) our own clinical and interdisciplinary management experiences from daily practice, vascular surgical care of vascular alterations in childhood, in particular, in trauma-associated injuries, will be illustrated.Narrative review by means of a literature search in PubMed using the key words "vascular surgery", "childhood", "vascular injury" and "vascular intervention".The development of the vascular system is a complex process, during which neoformation and degeneration processes proceed, closely associated to genetic factors, as well as to achieve complete maturation by epigenetic factors, but only at the age of approximately 16 years, which has to be included in the consideration of vascular diseases in children and their treatment concepts.The relatively rarely occurring vascular surgical diseases and the specifics of the young patient clientele demand the highest measure of vascular medical expertise in both clinical examination (e.g., marfanoid habitus, extremity-dependent blood pressure levels in aortic stenosis, unspecific symptoms of arterial hypertension in renal artery stenoses) and instrument-based diagnostics, such as Duplex ultrasonography.Suitable autologous material for artery replacement with proper quality and quantity is only scarcely available, resulting so that i) endovascular therapeutic concepts (e.g., angioplastic "bridging" procedures or usage of re-dilating stents in definitive intention, in particular, in aortic diseases) become increasingly more important and ii) xenogenic material taps new fields for vascular substitution, in addition to "tissue engineering" in this specific patient clientele and disease profile.The specific patient clientele and disease profile emphasise the necessity of i) a highly specialised interdisciplinary team comprising paediatricians, radiologists, vascular and paediatric surgeons as well as ii) the great value of a sufficient physical examination using Duplex ultrasonography primarily - but also provide immediate access to angiographic diagnostics and therapeutic procedures (adapted to the specific age) as it can only be done in centres of highly specialised care.

Large and bulky soft tissue defects in the gluteal, perineal and sacral regions are a reconstructive challenge, especially if suitable local flaps are not available. In such cases, a free flap may be necessary, the choice of which depends on the size and depth of the defect and the available recipient vessels.In this study, different options for defect coverage in this area are analysed and evaluated. Particular attention is paid to the choice of recipient vessel, flap and surgical planning.Free flap is an effective and safe method for the reconstruction of large soft tissue defects in the gluteal, perineal and sacral regions. The superior and inferior gluteal arteries are the preferred recipient vessels, but arteriovenous (AV) loops can serve as alternatives when primary vessels are not available. While the latissimus dorsi flap is particularly suitable for flat defects, the vastus lateralis flap offers advantages for deep or voluminous defects, due to its volume.Microsurgical reconstruction of these defects requires individual planning, depending on patient factors, defect morphology and vascular conditions. The choice of the appropriate flap and careful selection of the recipient vessel are decisive for the reconstructive success of this complex procedure.

Infections involving vascular prostheses in the groin region are a major surgical challenge, associated with substantial morbidity and mortality rates. The complex anatomical structures and high density of bacterial colonisation considerably complicate their surgical management. Consequently, reconstructive therapy demands individualised and interdisciplinary strategies to achieve optimal outcomes.A systematic search was conducted using PubMed and the Cochrane Library to collect and evaluate current evidence and recommendations regarding the reconstructive management of infected vascular prostheses. The developed algorithm incorporated essential factors, such as defect size, infection severity, and patient-specific characteristics to guide therapeutic decision making.Pedicled flap techniques, particularly those employing the M. sartorius or M. gracilis, are rapid and reliable reconstructive solutions - due to their robust vascular supply. In cases of larger defects, the transverse myocutaneous gracilis (TMG), Rectus femoris, and anterolateral thigh (ALT) flaps proved to be suitable alternatives. Prophylactic use of pedicled flaps was associated with a reduction in postoperative complications, particularly in high-risk patientsThe surgical management of deep groin infection requires meticulous individualised and interdisciplinary planning and plastic reconstructive experience. The proposed algorithm provides a structured and evidence-based framework to improve healing rates and minimise the risk of complications.