Surgeon-Journal of the Royal Colleges of Surgeons of Edinburgh and Ireland最新文献

Background: Post-hemorrhoidectomy pain remains a common and distressing factor that negatively affects the patient's recovery and satisfaction following the operation. Preemptive analgesia is a therapeutic measure before surgery initiation to prevent central sensitization and reduce the postoperative pain in the early period.

Objective: To evaluate the preemptive effect of intravenous ketorolac on pain severity in patients post-hemorrhoidectomy.

Methods: In this randomized clinical trial, 61 adults scheduled for hemorrhoidectomy were allocated to receive either 30 mg intravenous ketorolac just before induction (intervention group) or no preemptive analgesic (control). Both groups received postoperative pethidine as needed for breakthrough pain. Pain severity was assessed at 1 and 4 h postoperatively using the verbal rating scale (VRS), and postoperative opioid consumption was recorded.

Results: 32 out of 61 patients were enrolled in the intervention group and 29 in the control group. There was no difference in age or sex between the two groups (p > 0.05). The results showed that pain severity in the 1st and 4th hours after the operation was significantly lower in the intervention group (p < 0.001). Also, the postoperative demand for opioids was significantly lower in the intervention group (p = 0.002).

Conclusion: We found that NSAIDs, particularly ketorolac, can be used as preemptive medication to reduce postoperative pain and decrease the use of opioids. This might lead to a decrease in the side effects of opioids. However, further evaluations with larger populations and longer follow-up periods are essential. This randomized clinical trial registration code is IRCT20240808062692N1.

Introduction: Biliary pathology can have an enormous burden on both the patient and the health service with acute cholecystitis being diagnosed in 10 % of patients that present with acute abdominal pain. Emergency or elective laparoscopic cholecystectomy is the recommended treatment option for these patients. It has been shown previously that surgical and hospital volume affect outcomes from emergency abdominal surgery in Ireland, but no such investigation has been done specifically for cholecystectomies.

Aim: To determine if there is a link between the hospital and surgeon volume of cholecystectomies performed and their associated outcomes in Irish hospitals.

Methods: This was a retrospective registry study using National Quality Assurance & Improvement System (NQAIS). All patients who underwent cholecystectomy in Irish public hospitals from January 2017 until December 2023 were identified. Hospitals and surgeons were divided into groups of high, medium and low volume based on the number of cholecystectomies performed per year during the study period. Data including the demographics, admission details and outcomes of patients who underwent cholecystectomy were extracted from the database for analysis.

Results: A total of 28,835 patients in 35 hospitals were included. Adverse outcomes were reported in 1952 patients who underwent a cholecystectomy. An association was found between adverse outcomes including bile duct injury (0.10 % vs 0.03 %, p < 0.001) and critical care admission (2.7 % vs 1.97 %, p < 0.022) and patients who had surgery in low volume hospitals compared to high volume centres. No statistically significant difference in adverse outcome was reported for the low surgical volume patients. Risk factors associated with adverse outcome following cholecystectomy were age >65, high pre-operative morbidity, emergency surgery and low hospital volume (p < 0.001).

Discussion: Patients undergoing cholecystectomy in low volume hospitals have a higher risk of adverse events. Surgeons who perform low volumes of cholecystectomies appear to perform a higher percentage of emergency cholecystectomies without a statistically significant difference in their outcomes.

Introduction: Major trauma is associated with significant morbidity and mortality. Facial injuries are often present in those sustaining major trauma. We sought to examine the Irish trauma registry to further assess this association.

Materials and methods: A retrospective analysis of the Irish trauma registry, the Major Trauma Audit, from 2017 to 2022 was performed. Patients over 16 years who had sustained major trauma were included in the analysis. The presence of an associated facial injury was further analysed.

Results: A total of 8943 patients were included in the analysis. A facial injury was seen in 18.9 % of patients. The majority of those sustaining a concurrent facial injury were male (69 %) and the median age was 59 years. Falls <2m (42.9 %) and road traffic collisions (27.6 %) were the commonest mechanisms of injury. A significant head injury was more commonly seen in those who also sustained facial trauma (84.9 % vs 58 %).

Conclusion: Facial injuries are commonly seen in patients who sustain major trauma. They may also indicate the presence of a concurrent head injury.

Background: The Lancet Commission on Global Surgery (LCoGS) highlighted a critical gap in global health by emphasising the lack of access to safe surgery in low- and middle-income countries (LMICs). With five billion people unable to access safe and affordable surgical care, the commission called for innovations tailored to local needs rather than high-income solutions. The Karad Consensus further emphasised the need for context-specific solutions for India's rural populations, advocating for innovative approaches to tackle surgical disparities. Inspired by these calls, the Innovations in Global Surgery (IGS) group was formed, aiming to foster a multidisciplinary and collaborative ecosystem to address surgical access challenges in LMICs.

Methods: This consensus statement, derived from three international conferences, explores key challenges and offers actionable solutions in areas such as context-specific surgical needs, training, communication between medical and engineering professionals, funding, credibility building, and regulatory processes.

Results: The IGS group emphasises the importance of inclusive and frugal innovations that involve end-users and respond to the unique challenges of resource-limited settings. It aims to bridge the gap between disciplines and regions, ensuring that new technologies and practices can be effectively adapted and scaled to meet the needs of underserved populations. The proposed action items will be tested and refined over the coming years to enhance global surgical care and improve health equity.

Conclusion: This consensus statement serves as a roadmap for driving sustainable, context-aware innovations in global surgery, leveraging the expertise of multidisciplinary stakeholders and creating a platform for continuous collaboration and knowledge sharing.

Background: Lung segmentectomy offers the advantages of preserving pulmonary function and improving patient survival, leading to its increased adoption. However, this procedure is technically demanding, especially when compared with lobectomy, owing to anatomical shifts from intraoperative lung collapse and manipulation. To support thoracic surgeons and enhance their surgical training, we developed a low-cost, patient-specific, and bendable three-dimensional (3D) pulmonary vessel model. This study describes the development, clinical application, and evaluation of this model.

Methods: A flexible 3D pulmonary vessel model was created using thermoplastic polyurethane (TPU) filaments. Preoperative thin-slice computed tomography images were processed using SYNAPSE VINCENT® (FUJIFILM, Japan) to annotate the pulmonary arteries, veins, bronchi, and tumors. Data were converted into stereolithography format using OsiriXMD (Pixmeo SARL, Switzerland) and printed using Adventure 5M Pro (FLASHFORGE JAPAN, Japan). These models were used for surgical planning, intraoperative navigation, and resident education.

Results: Between September 2024 and January 2025, 31 lung segmentectomies were performed with reference to TPU-based models. Cost of the TPU filament was approximately $1 per vessel, totaling approximately $2 per patient, and printing time was approximately 3 h per model. Compared with polylactic acid models, TPU models demonstrated superior flexibility in simulating vascular deformation caused by lung traction. Their use has improved anatomical understanding, facilitated intraoperative vessel recognition, and proved valuable in surgical training.

Conclusion: Bendable TPU-based 3D pulmonary vessel models are cost-effective and anatomically accurate tools with broad potential for use in thoracic surgery, particularly in planning, navigation, and education.

Background: Burnout among surgical trainees is a growing concern, with UK urology trainees facing unique stressors including increasing service demands, prolonged training, and limited specialty-specific data. This narrative review synthesizes current evidence on burnout and satisfaction among UK urology trainees and evaluates available interventions and contrast it to international cohorts.

Methods: A systematic search was conducted following PRISMA guidelines across six databases. Studies published over the last 25 years addressing burnout in UK urology trainees were identified, screened, and analyzed thematically.

Results: Four studies met inclusion criteria, underscoring the scarcity of targeted research. Burnout prevalence among UK urology trainees ranged from 28.4 % to 56 %. Key contributing factors included rota gaps, excessive workloads, limited protected training time, financial strain, and toxic organizational culture. Despite these challenges, 69 % of trainees reported they would choose the specialty again, highlighting the mitigating role of job satisfaction drivers such as operative experience, team camaraderie, and patient impact. Intervention-wise, the Reboot-C coaching program demonstrated a 12 % reduction in burnout scores and improved resilience, although its scalability and long-term effects remain uncertain. Broader cultural and structural interventions, such as mentorship programs, flexible training pathways, and resilience training, show promise but require further evaluation.

Conclusion: Burnout among UK urology trainees is a significant and multifactorial issue. While isolated interventions show benefit, systemic reform is essential. Future research should adopt longitudinal, intersectional approaches to inform evidence-based policy and workforce planning.

Introduction: Even after two major RCTs, the BEST CLI and BASIL II, the debate about best strategy to address infra-inguinal arterial disease continues. Damage of distal outflow vessels after failed angioplasties and compromise to future options remains the main concern of bypass-first strategy advocates versus endovascular enthusiasts.

Objectives: To assess the degree of target outflow vessels damage after failed angioplasties.

Methods: This was a retrospective study looking at all episodes of failed angioplasties for infra-inguinal arterial disease over 5 years. Primary end points were the presence and extent of damage to target outflow vessels. Secondary endpoints included complications, mortality, re-intervention types, and their success rates.

Results: There were 101 failed episodes out of 724 infra-inguinal angioplasties (primary success 86 %). The mean age of failed angioplasty cases was 73 (+- 10.5) years. There was no damage to target outflow vessels after failed angioplasty in 78.2 % of the episodes. Redo angioplasty was attempted in 43 %, with 42 % success rate (p-value 0.069), while Open surgical bypass "OSB" was performed for 21 % of the cases with a success rate of 91 % (p-value 0.009) CONCLUSION: An endovascular-first strategy for treatment of peripheral arterial disease "PAD is safe and effective. The concern for compromised future options is not justified.