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

Introduction: The 2024 European Society for Vascular Surgery (ESVS) guidelines mark a paradigm shift in recommendations for abdominal aortic aneurysm (AAA) screening, moving from population-specific to risk-based criteria. Whilst the aim of this approach is to foster local adaptation, countries, like Ireland, have yet to develop corresponding national guidance.

Aim: This commentary explores the implications of this shift, contrasts the 2019 and 2024 ESVS recommendations, and highlights the critical need for updates in Irish-specific screening framework grounded in local epidemiology and international best practice.

Methods: The paper incorporates evidence from ESVS guidelines, systematic reviews, cost-benefit analyses, and international comparisons to create a narrative discussion on AAA screening in the Irish context and recommend proposals for change.

Results: The results of this review support ultrasound screening for men aged 65 years or older with a smoking history or atherosclerotic disease risk factors. Screening should also be recommended for individuals with peripheral aneurysms or a history of organ transplantation. Individuals with a strong family history (i.e. first degree relative) should continue ultrasound screening at the age of 50.

Conclusion: The shift in guidelines toward localised, high-risk screening frameworks requires countries to act. Ireland currently lacks the infrastructure and policy to support this change, leaving vulnerable populations at risk. Until a formal national screening strategy is implemented, informal and inconsistent screening will continue to depend on individual physician initiative. In this interim period, it is essential to equip clinicians with updated contemporary literature to accurately identify high-risk individuals who would benefit from screening.

Background: There exists an established need for adequate early and equitable surgical exposure during medical school, potentially further constrained by the post-COVID virtualisation of teaching and placements. The Perspectives on Research and Surgical Opportunities for UK Medical Students (PRiSM) study aimed to evaluate current access to surgical experience, skills teaching, and research opportunities, as well as impact on career aspirations.

Methods: PRiSM was a national, cross-sectional survey of UK medical students conducted between May and August 2025, following a collaborator-led distribution model. A 13-item questionnaire explored student perspectives on surgical opportunities across three domains: observational experience, surgical skills, and research access. Quantitative data were analysed using descriptive statistics, Mann-Whitney U and Chi-squared tests. Free-text responses underwent thematic analysis.

Results: In total, 462 responses were received from 22 UK medical schools, including 239 students who had completed at least their penultimate year. Of these, 18.0 % had never received formal surgical skills teaching, with almost a quarter (24.0 %) of all students having never scrubbed into theatre. Median satisfaction with regards to surgical skills and research was low (2/10 for both). Thematic analysis revealed a need for more consistent hands-on surgical teaching within curricula, as well as more accessible networking and research opportunities. Insufficient exposure and support appeared to negatively impact career decision-making. No regional differences were identified with respect to any outcome.

Conclusion: PRiSM provides novel post-COVID national insight into surgical education inequities, demonstrating that structured, curriculum-integrated, and mentored surgical experiences are key to fostering engagement, confidence, and informed career decisions.

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: 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.