Zentralblatt fur Chirurgie最新文献

Fenestrated or branded prostheses are used to treat complex abdominal aortic aneurysms. In urgent cases, "Physician-modified endografts" (PMEG) are used when delivery times for customised prostheses are long. In this technique, the distances between the fenestrations are measured on the patient's computer tomography data set, manually transferred to the three-dimensional surface of the prosthesis by the surgeon and the fenestrations are cut into the endoprosthesis accordingly. This process is highly dependent on the surgeon's experience. This paper provides an overview of current modification processes and presents a new, simplified workflow to produce a template for modification within 12 hours of receiving the CT data set.Preoperative CT data sets served as the basis for the development of the patient-specific templates. The three-dimensional, individualised templates were to be additively manufactured using a transparent material and placed over the standard tubular prostheses. Due to the transparency of the material and the possibility of rotating the prosthesis within the template, the optimal position of the fenestrations on the prosthesis was to be found independently of experience.Patient-specific templates for modifying prostheses were developed and additively manufactured using CT data (n = 22). For each template design, the segmentation, design and additive manufacturing process could be completed within 12 hours in a standardised manufacturing process. Material transparency, template design and easy handling of the templates permitted the positioning of the fenestrations regardless of experience. Low-resolution CT data sets, extreme curvatures or angles of the aorta were considered exclusion criteria.The patient-specific templates could be created within 12 hours using a standardised procedure with a simple development process. The transparent templates are a further step towards patient-specific medicine.

Aortic malignancies are rare diseases, of which only about 200 cases have been described in the literature. Most common forms are high-grade sarcomas, in over 80% of patients, which predominantly grow intimately and which can occur at any location in the aorta. In addition to non-specific symptoms, such as fever, hypertension and general weakness, aortic sarcomas in one third of patients manifest as peripheral embolism or, in the case of mural sarcoma, as an aneurysm or aortic rupture. In diagnostic testing, MRI is considered the gold standard, as CT angiography or PET CT can only show non-specific signs. Since aortic malignancies often manifest themselves as other diseases, diagnosis and therapy are often delayed. In therapy, the focus is on radial tumour resection with aortic replacement, possibly followed by adjuvant medical therapy. The 1-, 3- and 5-year survival rates are 26%, 7.6% and 3.5%, respectively.

Despite the increasing number of female medical graduates, women remain underrepresented in surgical leadership roles. Previous studies have highlighted gender disparities in operative autonomy, self-assessment, and psychological burden. Simulation-based training may offer a means to reduce such disparities. This study aimed to assess gender-specific differences in the evaluation of various endovascular training models.Between March and August 2024, 32 physicians (16 female, 16 male) from vascular surgery and radiology departments participated in a prospective study at the University Hospital in Innsbruck. Each participant performed a standardised iliac artery procedure using three training models: a flexible and a stiff 3D-printed vascular model, and a digital simulator. A structured questionnaire evaluated face validity, construct validity, and concurrent validity. Gender differences were analysed statistically.There were no significant gender differences in face validity ratings or model preferences. However, female participants consistently rated the construct validity of all models significantly higher (p < 0.05). Male participants had greater procedural experience, despite similar durations of professional experience. Both genders expressed strong support for regular simulation-based training.Simulation-based training is broadly recognised as a key educational tool across genders. The higher construct validity ratings by female participants suggest that simulation is perceived as a compensatory method for developing procedural skills. Structured implementation of simulation training may help reduce disparities in endovascular education.

The nut cracker syndrome (NCS) can be considered as an under-diagnosed disease, which the patients have usually suffered from for a prolonged time prior to correct diagnosis and subsequent initiation of adequate therapy. There are several possible therapies, the most promising - transposition of the superior mesenteric artery (SMA) - from the perspective of its aetiopathogenesis - has rarely been used.Based on selective references from the scientific medical literature and our own clinical experiences in vascular medicine, the important characteristics of the "nut cracker" phenomenon and syndrome are described.A topic-related narrative review has been based on a literature search in PubMed using the key words "Nut cracker syndrome", "May-Turner syndrome", "Wilkie syndrome", "aorto-mesenteric angle", "pelvic congestion syndrome".There are diverse symptoms in NCS, which is unspecific; however, in particular, the combination of signs and symptoms associated with a suspicious pathological urine finding may indicate NCS. Duplex ultrasonography and CT-scan are very accurate diagnostic procedures and include an adequate search for simultaneously occurring vascular anomalies. Taken together, clinical findings and laboratory parameters may lead to a patient-specific and graduated therapeutic plan, in which transposition of SMA is a causal, effective and safe procedure, particularly when there are combined vascular anomalies, e.g., the combination of NCS with May-Turner syndrome in young patients.The nutcracker syndrome as venous congestion of the kidney may be a "hard nut". Modern medicine aims at achieving evidence for the best approach by case reports and retrospective cohort studies and can - in the meanwhile - provide a verified diagnostic work-up. In addition, is a therapeutic algorithm comprising a spectrum of highly effective measures, particularly for young patients, who frequently exhibit additional vascular anomalies.

In order to ensure a good outcome after thoracic surgical procedures and to minimise the complication rate, prompt and adequate complication management is of fundamental importance.After a questionnaire had been compiled by a working group of three thoracic surgical experts of the German Society of Thoracic Surgery (DGT) in leading positions, an attempt was made to develop a consensus recommendation (> 75%) for adequate complication management in thoracic surgery, within the framework of a multi-stage "Delphi process" among suitable experts. In this process, after conducting two anonymous online question rounds, a final discussion and summary of the results took place within a DGT expert conference.Of 93 selected experts, 63 (68%) participated in the 1st and 41 (44%) in the 2nd online question round. 54 experts participated in the final TED voting at the 2020 expert conference. After division into the different categories "haemorrhage", "parenchymal fistulae", "bronchial stump insufficiency", "nerve lesions" and "varia", consensus was achieved on a recommended course of action for a large number of the questions.This paper is a summary of the "Delphi consensus process" of the Expert Conference 2020 of the German Society for Thoracic Surgery for the management of peri-operative complications.

Thoracolumbar A3 and A4 fractures involving the anterior column are at greater risk of correction loss and implant failure than with stand-alone posterior fixation. The LLIF technique, established in degenerative spine surgery, may offer advantages in selected trauma cases.We describe the surgical technique and our own experience with it. A retrospective single centre cohort study included 61 neurologically intact patients with thoracolumbar fractures (T10-L3) treated over 12 years using circumferential surgery (posterior + LLIF). The anterior reconstruction was performed either primarily or secondarily via retroperitoneal (lumbar) or transthoracic (thoracic) approaches. Primary endpoints were segmental correction, fusion, complications, and clinical outcome.Segmental Cobb angle significantly improved (preoperative 14.6°, postoperative 6.7°, final follow-up 8.1°; p < 0.001). The fusion rate was 98.4%. The overall complication rate was moderate (18%), mostly related to the posterior approach. According to MacNab criteria, 95.1% of patients achieved a good or excellent outcome. No adjacent segment degeneration was observed.LLIF provides a reliable anterior reconstruction in unstable thoracolumbar fractures, with good correction maintenance, high fusion rates, and favourable clinical results. It may be a valuable addition to posterior instrumentation in selected trauma cases.