Pub Date : 2026-02-12DOI: 10.1016/j.surge.2026.02.003
N Christodoulides, N Quirke, R Leon, A Ghinis, Q Jeantet, S Potter
Background: Sentinel lymph node biopsy (SLNB) is an important prognostic tool in cutaneous malignant melanoma. Nomograms such as those from Memorial Sloan Kettering (MSK), the Melanoma Institute of Australia (MIA), and LifeMath aim to predict SLNB positivity. We sought to compare and validate these tools in an Irish cohort.
Methods: Clinical and pathological data were extracted from patient records to calculate predicted SLNB positivity using each of the three nomograms. Model performance was assessed for discrimination and calibration. Sensitivity, specificity, negative predictive value (NPV) and potential SLNB reduction were examined at thresholds of 5-15%. Decision curve analysis (DCA) was used to evaluate clinical utility.
Results: Among 215 patients, 35 (16%) had a positive SLNB. All three models showed good predictive ability, with the MSK nomogram performing best. At a 5% threshold, DCA demonstrated minimal clinical benefit compared to a treat-all approach. In tumours with a predicted SLNB positivity risk of 10%, all three nomograms demonstrated clear net benefit and the potential to reduce unnecessary biopsies.
Conclusion: The MSK, MIA and LifeMath nomograms are well calibrated in an Irish melanoma cohort, with the MSK model showing the strongest performance. While limited at the 5% threshold, these tools may help refine patient selection for SLNB at a 10% threshold, acting as an adjunct to clinical decision-making and potentially reducing unnecessary procedures and associated morbidity.
{"title":"Validation and clinical utility of predictive nomograms for sentinel node positivity in cutaneous malignant melanoma in Ireland.","authors":"N Christodoulides, N Quirke, R Leon, A Ghinis, Q Jeantet, S Potter","doi":"10.1016/j.surge.2026.02.003","DOIUrl":"https://doi.org/10.1016/j.surge.2026.02.003","url":null,"abstract":"<p><strong>Background: </strong>Sentinel lymph node biopsy (SLNB) is an important prognostic tool in cutaneous malignant melanoma. Nomograms such as those from Memorial Sloan Kettering (MSK), the Melanoma Institute of Australia (MIA), and LifeMath aim to predict SLNB positivity. We sought to compare and validate these tools in an Irish cohort.</p><p><strong>Methods: </strong>Clinical and pathological data were extracted from patient records to calculate predicted SLNB positivity using each of the three nomograms. Model performance was assessed for discrimination and calibration. Sensitivity, specificity, negative predictive value (NPV) and potential SLNB reduction were examined at thresholds of 5-15%. Decision curve analysis (DCA) was used to evaluate clinical utility.</p><p><strong>Results: </strong>Among 215 patients, 35 (16%) had a positive SLNB. All three models showed good predictive ability, with the MSK nomogram performing best. At a 5% threshold, DCA demonstrated minimal clinical benefit compared to a treat-all approach. In tumours with a predicted SLNB positivity risk of 10%, all three nomograms demonstrated clear net benefit and the potential to reduce unnecessary biopsies.</p><p><strong>Conclusion: </strong>The MSK, MIA and LifeMath nomograms are well calibrated in an Irish melanoma cohort, with the MSK model showing the strongest performance. While limited at the 5% threshold, these tools may help refine patient selection for SLNB at a 10% threshold, acting as an adjunct to clinical decision-making and potentially reducing unnecessary procedures and associated morbidity.</p>","PeriodicalId":49463,"journal":{"name":"Surgeon-Journal of the Royal Colleges of Surgeons of Edinburgh and Ireland","volume":" ","pages":""},"PeriodicalIF":2.3,"publicationDate":"2026-02-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146195907","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2026-02-04DOI: 10.1016/j.surge.2026.01.004
T J Crotty, G P Sexton, E F Cleere, M L Healy, C Grant, R S R Woods, J P O'Neill, J Kinsella, P Lennon, C V Timon, C W R Fitzgerald
Introduction: Medullary thyroid cancer (MTC) is a potentially aggressive thyroid malignancy arising from parafollicular C-cells. While current evidence demonstrates a rising incidence of differentiated thyroid cancer (DTC) both in Ireland and globally, trends in MTC incidence and prognosis remain less well defined. This study aims to analyse the incidence, management and survival of patients with MTC in the Irish population.
Methods: A retrospective analysis of patients diagnosed with MTC between 1994 and 2019 was performed using data from the Irish National Cancer Registry (NCRI). Patients were grouped into two time periods: 1994-2007 and 2008-2019. Kaplan-Meier survival analysis was used to estimate overall survival (OS) and disease-specific survival (DSS). Univariate and multivariate Cox proportional hazard models were applied to identify factors associated with survival outcomes.
Results: A total of 152 patients were diagnosed with MTC. The median age at diagnosis was 53 years. The incidence rate was 0.14 cases per 100,000 person-years. Five-year OS and DSS were 67% and 73.2%, respectively. On multivariate analysis, surgical management was independently associated with improved OS and DSS (HR 0.18, p = 0.013), while chemotherapy was associated with significantly poorer survival (HR 4.29, p = 0.014).
Conclusion: This study highlights evolving trends in the incidence, management and survival of patients with MTC in Ireland over a 25-year period. A trend towards improved overall survival was observed in patients diagnosed in the later cohort.
简介：甲状腺髓样癌（MTC）是一种由滤泡旁c细胞引起的潜在侵袭性甲状腺恶性肿瘤。虽然目前的证据表明分化型甲状腺癌（DTC）的发病率在爱尔兰和全球都在上升，但MTC发病率和预后的趋势仍然不太明确。本研究旨在分析爱尔兰人口中MTC患者的发病率、管理和生存率。方法：使用爱尔兰国家癌症登记处（NCRI）的数据，对1994年至2019年诊断为MTC的患者进行回顾性分析。患者分为两个时间段：1994-2007年和2008-2019年。Kaplan-Meier生存分析用于估计总生存期（OS）和疾病特异性生存期（DSS）。应用单因素和多因素Cox比例风险模型来确定与生存结果相关的因素。结果：152例患者被诊断为MTC。诊断时的中位年龄为53岁。发病率为每10万人年0.14例。5年OS和DSS分别为67%和73.2%。在多因素分析中，手术治疗与改善OS和DSS独立相关（HR 0.18, p = 0.013），而化疗与明显较差的生存相关（HR 4.29, p = 0.014）。结论：这项研究强调了25年来爱尔兰MTC患者发病率、管理和生存率的发展趋势。在后期队列中诊断的患者中观察到总生存率提高的趋势。
{"title":"Trends in incidence, management and survival in medullary thyroid cancer in Ireland - A 25-year population-based study.","authors":"T J Crotty, G P Sexton, E F Cleere, M L Healy, C Grant, R S R Woods, J P O'Neill, J Kinsella, P Lennon, C V Timon, C W R Fitzgerald","doi":"10.1016/j.surge.2026.01.004","DOIUrl":"https://doi.org/10.1016/j.surge.2026.01.004","url":null,"abstract":"<p><strong>Introduction: </strong>Medullary thyroid cancer (MTC) is a potentially aggressive thyroid malignancy arising from parafollicular C-cells. While current evidence demonstrates a rising incidence of differentiated thyroid cancer (DTC) both in Ireland and globally, trends in MTC incidence and prognosis remain less well defined. This study aims to analyse the incidence, management and survival of patients with MTC in the Irish population.</p><p><strong>Methods: </strong>A retrospective analysis of patients diagnosed with MTC between 1994 and 2019 was performed using data from the Irish National Cancer Registry (NCRI). Patients were grouped into two time periods: 1994-2007 and 2008-2019. Kaplan-Meier survival analysis was used to estimate overall survival (OS) and disease-specific survival (DSS). Univariate and multivariate Cox proportional hazard models were applied to identify factors associated with survival outcomes.</p><p><strong>Results: </strong>A total of 152 patients were diagnosed with MTC. The median age at diagnosis was 53 years. The incidence rate was 0.14 cases per 100,000 person-years. Five-year OS and DSS were 67% and 73.2%, respectively. On multivariate analysis, surgical management was independently associated with improved OS and DSS (HR 0.18, p = 0.013), while chemotherapy was associated with significantly poorer survival (HR 4.29, p = 0.014).</p><p><strong>Conclusion: </strong>This study highlights evolving trends in the incidence, management and survival of patients with MTC in Ireland over a 25-year period. A trend towards improved overall survival was observed in patients diagnosed in the later cohort.</p>","PeriodicalId":49463,"journal":{"name":"Surgeon-Journal of the Royal Colleges of Surgeons of Edinburgh and Ireland","volume":" ","pages":""},"PeriodicalIF":2.3,"publicationDate":"2026-02-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146127145","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Background: The association between diverticulitis and colorectal (CRC) remains controversial, with current guidelines differing significantly in terms of post-diverticulitis endoscopic assessment. This study is aimed at developing an exploratory model to identify patients at high risk of CRC following diverticulitis.
Methods: This retrospective cohort study analyzed 1546 patients diagnosed with diverticulitis between January 2021 and December 2023 at a UK tertiary care hospital. Ordinal logistic regression was used to identify predictors associated with CRC risk.
Results: Of 1546 patients, the mean age was 69.2 years SD ± 12.9, and 51.5 % were female. Increasing age (OR 1.28 per SD, 95 % CI 1.14-1.45, p < 0.001) and male sex (OR 1.75, 95 % CI 1.39-2.21, p < 0.001) were high risk predictors associated with increased risk of CRC. Conversely, abdominal pain (OR 0.60, 95 % CI 0.44-0.80, p = 0.001) and per-rectal bleeding (OR 0.71, 95 % CI 0.56-0.89, p = 0.004), and presence of diverticulosis showed a protective association (OR 0.68, 95 % CI 0.47-0.97, p = 0.033), which could be due to confounding. CT findings did not achieve statistical significance as independent predictors in the multivariable model.
Conclusions: This exploratory model identifies patient characteristics that stratify CRC risk following diverticulitis. These findings may help personalize decisions regarding post-diverticulitis colonoscopy, optimizing resource allocation while maintaining appropriate cancer surveillance. However, this model would require external validation before use in clinical practice.
背景：憩室炎和结直肠（CRC）之间的关系仍然存在争议，目前的指南在憩室炎后的内镜评估方面存在显着差异。本研究旨在建立一种探索性模型，以识别憩室炎后结直肠癌的高风险患者。方法：这项回顾性队列研究分析了2021年1月至2023年12月在英国一家三级保健医院诊断为憩室炎的1546例患者。使用有序逻辑回归来确定与结直肠癌风险相关的预测因素。结果：1546例患者平均年龄69.2岁（SD±12.9），女性占51.5%。增加年龄（OR 1.28 / SD, 95% CI 1.14-1.45, p）结论：该探索性模型确定了憩室炎后结直肠癌风险分层的患者特征。这些发现可能有助于憩室炎后结肠镜检查的个性化决策，优化资源分配，同时保持适当的癌症监测。然而，该模型在临床应用前需要外部验证。
{"title":"Rethinking the role of endoscopy for colorectal cancer following diverticulitis: An exploratory model for guiding endoscopic assessment.","authors":"Muhammad Usman, Elon Correa, Wenyuan Chung, Lasitha Samarakoon, Deepak Paul, Sudarshan Rao Kadri","doi":"10.1016/j.surge.2026.01.002","DOIUrl":"https://doi.org/10.1016/j.surge.2026.01.002","url":null,"abstract":"<p><strong>Background: </strong>The association between diverticulitis and colorectal (CRC) remains controversial, with current guidelines differing significantly in terms of post-diverticulitis endoscopic assessment. This study is aimed at developing an exploratory model to identify patients at high risk of CRC following diverticulitis.</p><p><strong>Methods: </strong>This retrospective cohort study analyzed 1546 patients diagnosed with diverticulitis between January 2021 and December 2023 at a UK tertiary care hospital. Ordinal logistic regression was used to identify predictors associated with CRC risk.</p><p><strong>Results: </strong>Of 1546 patients, the mean age was 69.2 years SD ± 12.9, and 51.5 % were female. Increasing age (OR 1.28 per SD, 95 % CI 1.14-1.45, p < 0.001) and male sex (OR 1.75, 95 % CI 1.39-2.21, p < 0.001) were high risk predictors associated with increased risk of CRC. Conversely, abdominal pain (OR 0.60, 95 % CI 0.44-0.80, p = 0.001) and per-rectal bleeding (OR 0.71, 95 % CI 0.56-0.89, p = 0.004), and presence of diverticulosis showed a protective association (OR 0.68, 95 % CI 0.47-0.97, p = 0.033), which could be due to confounding. CT findings did not achieve statistical significance as independent predictors in the multivariable model.</p><p><strong>Conclusions: </strong>This exploratory model identifies patient characteristics that stratify CRC risk following diverticulitis. These findings may help personalize decisions regarding post-diverticulitis colonoscopy, optimizing resource allocation while maintaining appropriate cancer surveillance. However, this model would require external validation before use in clinical practice.</p>","PeriodicalId":49463,"journal":{"name":"Surgeon-Journal of the Royal Colleges of Surgeons of Edinburgh and Ireland","volume":" ","pages":""},"PeriodicalIF":2.3,"publicationDate":"2026-02-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146114665","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2026-02-01Epub Date: 2025-09-05DOI: 10.1016/j.surge.2025.08.005
Moustafa Mabrouk , Ahmed Fouda , Mohammed ElKassaby
Background
The management of diabetic foot infections (DFIs) is a complex multidisciplinary process and often necessitates surgical interventions. Unfortunately, amputations such as single or multiple toes amputations (MTA) or full transmetatarsal amputation (TMA) are often the unavoidable solution. This study aimed to compare the clinical outcomes of TMA versus MTA in managing non-ischemic diabetic foot infections.
Methods
This was a retrospective study on non-ischemic diabetic foot infection patients comparing the results of TMA and MTA in terms of healing, ulcer recurrence and overall complications, including further formal amputations.
Results
The healing rate was substantially higher in TMA group (89.3 % vs. 74.5 %, p=0.004). TMA group exhibited a significantly lower incidence of further proximal amputation (8.7 % vs. 21.3 %, p=0.002) and ulcer recurrence (11.3 % vs. 25.3 %, p=0.002). Tissue necrosis occurred less frequently in TMA group (4.5 % vs. 12.8 %, p<0.05). No significant differences were found between the groups regarding infection, hematoma, or residual edema.
Conclusions
Transmetatarsal amputation for diabetic foot infection demonstrated superior healing rates, lower ulcer recurrence, and reduced need for proximal amputation compared to multiple toe amputations for managing non-ischemic diabetic foot infections.
Level of evidence
level 3 retrospective study
背景：糖尿病足感染（dfi）的治疗是一个复杂的多学科过程，经常需要手术干预。不幸的是，截肢，如单趾或多趾截肢（MTA）或全跖骨截肢（TMA）往往是不可避免的解决方案。本研究旨在比较TMA与MTA治疗非缺血性糖尿病足部感染的临床结果。方法：对非缺血性糖尿病足感染患者进行回顾性研究，比较TMA和MTA在愈合、溃疡复发和包括进一步正式截肢在内的总体并发症方面的结果。结果：TMA组愈合率明显高于TMA组（89.3% vs. 74.5%, p=0.004）。TMA组进一步近端截肢发生率（8.7%比21.3%,p=0.002）和溃疡复发率（11.3%比25.3%,p=0.002）显著降低。TMA组的组织坏死发生率较低（4.5% vs. 12.8%）。结论：与多趾截肢相比，经跖骨截肢治疗糖尿病足感染的治愈率更高，溃疡复发率更低，并且治疗非缺血性糖尿病足感染的近端截肢需求减少。证据等级：3级回顾性研究。
{"title":"Transmetatarsal amputation versus multiple toes amputations for non-ischemic diabetic foot infection management","authors":"Moustafa Mabrouk , Ahmed Fouda , Mohammed ElKassaby","doi":"10.1016/j.surge.2025.08.005","DOIUrl":"10.1016/j.surge.2025.08.005","url":null,"abstract":"<div><h3>Background</h3><div>The management of diabetic foot infections (DFIs) is a complex multidisciplinary process and often necessitates surgical interventions. Unfortunately, amputations such as single or multiple toes amputations (MTA) or full transmetatarsal amputation (TMA) are often the unavoidable solution. This study aimed to compare the clinical outcomes of TMA versus MTA in managing non-ischemic diabetic foot infections.</div></div><div><h3>Methods</h3><div>This was a retrospective study on non-ischemic diabetic foot infection patients comparing the results of TMA and MTA in terms of healing, ulcer recurrence and overall complications, including further formal amputations.</div></div><div><h3>Results</h3><div>The healing rate was substantially higher in TMA group (89.3 % vs. 74.5 %, p=0.004). TMA group exhibited a significantly lower incidence of further proximal amputation (8.7 % vs. 21.3 %, p=0.002) and ulcer recurrence (11.3 % vs. 25.3 %, p=0.002). Tissue necrosis occurred less frequently in TMA group (4.5 % vs. 12.8 %, p<0.05). No significant differences were found between the groups regarding infection, hematoma, or residual edema.</div></div><div><h3>Conclusions</h3><div>Transmetatarsal amputation for diabetic foot infection demonstrated superior healing rates, lower ulcer recurrence, and reduced need for proximal amputation compared to multiple toe amputations for managing non-ischemic diabetic foot infections.</div></div><div><h3>Level of evidence</h3><div>level 3 retrospective study</div></div>","PeriodicalId":49463,"journal":{"name":"Surgeon-Journal of the Royal Colleges of Surgeons of Edinburgh and Ireland","volume":"24 1","pages":"Pages 39-42"},"PeriodicalIF":2.3,"publicationDate":"2026-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145008551","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2026-02-01Epub Date: 2025-12-01DOI: 10.1016/j.surge.2025.08.008
E. Linehan , J.D. Kehoe , T. Gall , G. McEntee , J. Conneely , R.M. O'Connell
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.
导言：10%的急性腹痛患者被诊断为急性胆囊炎，胆道病理对患者和卫生服务都是巨大的负担。紧急或选择性腹腔镜胆囊切除术是这些患者的推荐治疗选择。以前有研究表明，在爱尔兰，外科手术和医院的数量会影响急诊腹部手术的结果，但没有专门针对胆囊切除术进行过这样的调查。目的：确定爱尔兰医院胆囊切除术的医院和外科医生数量及其相关结果之间是否存在联系。方法：采用国家质量保证与改进系统（NQAIS）进行回顾性登记研究。从2017年1月到2023年12月，所有在爱尔兰公立医院接受胆囊切除术的患者都被确定。根据研究期间每年进行的胆囊切除术数量，将医院和外科医生分为高、中、低容量组。从数据库中提取胆囊切除术患者的人口统计学、入院细节和结局等数据进行分析。结果：共纳入35家医院28835例患者。报告了1952例胆囊切除术患者的不良结果。发现不良结局包括胆管损伤（0.10% vs 0.03%, p 65）、术前高发病率、急诊手术和低医院容量(p讨论：在小容量医院接受胆囊切除术的患者有更高的不良事件风险。施行小容量胆囊切除术的外科医生施行急诊胆囊切除术的比例似乎更高，但其结果没有统计学上的显著差异。
{"title":"Do hospital and surgeon volumes impact the outcomes of patients undergoing cholecystectomy in Ireland? A national registry based study","authors":"E. Linehan , J.D. Kehoe , T. Gall , G. McEntee , J. Conneely , R.M. O'Connell","doi":"10.1016/j.surge.2025.08.008","DOIUrl":"10.1016/j.surge.2025.08.008","url":null,"abstract":"<div><h3>Introduction</h3><div>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.</div></div><div><h3>Aim</h3><div>To determine if there is a link between the hospital and surgeon volume of cholecystectomies performed and their associated outcomes in Irish hospitals.</div></div><div><h3>Methods</h3><div>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.</div></div><div><h3>Results</h3><div>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).</div></div><div><h3>Discussion</h3><div>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.</div></div>","PeriodicalId":49463,"journal":{"name":"Surgeon-Journal of the Royal Colleges of Surgeons of Edinburgh and Ireland","volume":"24 1","pages":"Pages 18-23"},"PeriodicalIF":2.3,"publicationDate":"2026-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145662589","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
We aim to describe our centre's one-year experience after establishing our robotic programme for colorectal surgery.
Method
Demographic, peri-operative, and follow-up data from a prospectively maintained database were collected for all laparoscopic and robotic-assisted colorectal procedures carried out at our centre. All robotic colorectal resections were completed with the DaVinci Xi (Intuitive Surgical, USA) robotic platform.
Results
Fifty-eight robotic colorectal resections were compared to 58 from the laparoscopic cohort, all indicated for malignancy. No statistical difference was observed between the demographics of the two cohorts regarding sex, age, body mass index (BMI), and American Society of Anesthesiologists (ASA) grade. 33/58 (56.9 %) robotic resections were left-sided compared to 36/58 (62.1 %) laparoscopic resections. One robotic case was converted to open (1.7 %), with four (6.9 %) in the laparoscopic group converted to open. Laparoscopic procedures were shorter (median operative time 282 min compared to 384 min, p < 0.001, Wilcoxon rank-sum). Subgroup analysis for patients with ASA grades 1&2 showed shorter operative times in the laparoscopic cohort compared to the robotic cohort (p = 0.003, Wilcoxon rank-sum). The median length of stay was five days for both cohorts. Significant postoperative complications (Clavien-Dindo ≥3) occurred in 3.45 % (n = 2/58) vs. 10.3 % (n = 6/58), which was not significantly different statistically. No mortalities were recorded within 90 days of the procedures in both cohorts, but at one-year follow-up, we observed one mortality in each cohort.
Conclusions
Other than longer operative times for ASA grades 1/2 patients, robotic colorectal resection outcomes in a small district hospital setting are comparable to laparoscopic resections.
目的：我们的目标是描述我们中心在建立结直肠手术机器人程序后一年的经验。方法：从前瞻性维护的数据库中收集所有在本中心进行的腹腔镜和机器人辅助结直肠手术的人口统计学、围手术期和随访数据。所有的机器人结肠切除术都是在DaVinci Xi （Intuitive Surgical， USA）机器人平台上完成的。结果：58例机器人结肠直肠切除术与58例腹腔镜结肠直肠切除术相比，均显示为恶性肿瘤。在性别、年龄、体重指数（BMI）和美国麻醉医师协会（ASA）评分方面，两个队列的人口统计学数据没有统计学差异。33/58（56.9%）的机器人切除为左侧，36/58（62.1%）的腹腔镜切除为左侧。1例机器人病例转为开放（1.7%），4例（6.9%）腹腔镜组转为开放。腹腔镜手术时间较短（中位手术时间282分钟，中位手术时间384分钟）。结论：除了ASA 1/2级患者的手术时间较长外，小型地区医院的机器人结肠直肠切除术结果与腹腔镜切除术相当。
{"title":"One-year comparative outcomes of robotic vs. laparoscopic colorectal cancer resections in a UK district hospital","authors":"Mathew Cherian Moolamannil , Abigail Mwendauya , Yüksel Gerçek , Katharine Bevan , Kanapathi Rajaratnam , Fanourios Georgiades","doi":"10.1016/j.surge.2025.11.004","DOIUrl":"10.1016/j.surge.2025.11.004","url":null,"abstract":"<div><h3>Aim</h3><div>We aim to describe our centre's one-year experience after establishing our robotic programme for colorectal surgery.</div></div><div><h3>Method</h3><div>Demographic, peri-operative, and follow-up data from a prospectively maintained database were collected for all laparoscopic and robotic-assisted colorectal procedures carried out at our centre. All robotic colorectal resections were completed with the DaVinci Xi (Intuitive Surgical, USA) robotic platform.</div></div><div><h3>Results</h3><div>Fifty-eight robotic colorectal resections were compared to 58 from the laparoscopic cohort, all indicated for malignancy. No statistical difference was observed between the demographics of the two cohorts regarding sex, age, body mass index (BMI), and American Society of Anesthesiologists (ASA) grade. 33/58 (56.9 %) robotic resections were left-sided compared to 36/58 (62.1 %) laparoscopic resections. One robotic case was converted to open (1.7 %), with four (6.9 %) in the laparoscopic group converted to open. Laparoscopic procedures were shorter (median operative time 282 min compared to 384 min, p < 0.001, Wilcoxon rank-sum). Subgroup analysis for patients with ASA grades 1&2 showed shorter operative times in the laparoscopic cohort compared to the robotic cohort (p = 0.003, Wilcoxon rank-sum). The median length of stay was five days for both cohorts. Significant postoperative complications (Clavien-Dindo ≥3) occurred in 3.45 % (n = 2/58) vs. 10.3 % (n = 6/58), which was not significantly different statistically. No mortalities were recorded within 90 days of the procedures in both cohorts, but at one-year follow-up, we observed one mortality in each cohort.</div></div><div><h3>Conclusions</h3><div>Other than longer operative times for ASA grades 1/2 patients, robotic colorectal resection outcomes in a small district hospital setting are comparable to laparoscopic resections.</div></div>","PeriodicalId":49463,"journal":{"name":"Surgeon-Journal of the Royal Colleges of Surgeons of Edinburgh and Ireland","volume":"24 1","pages":"Pages 24-30"},"PeriodicalIF":2.3,"publicationDate":"2026-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145483493","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2026-02-01Epub Date: 2025-11-22DOI: 10.1016/j.surge.2025.11.007
Joseph E. McKay, Lachlan Dick
{"title":"Mentorship may benefit medical student learning in theatre as well as career aspirations in surgery","authors":"Joseph E. McKay, Lachlan Dick","doi":"10.1016/j.surge.2025.11.007","DOIUrl":"10.1016/j.surge.2025.11.007","url":null,"abstract":"","PeriodicalId":49463,"journal":{"name":"Surgeon-Journal of the Royal Colleges of Surgeons of Edinburgh and Ireland","volume":"24 1","pages":"Page 70"},"PeriodicalIF":2.3,"publicationDate":"2026-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145589833","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2026-02-01Epub Date: 2025-09-22DOI: 10.1016/j.surge.2025.09.004
Mingxuan Liu, Hanjun Ma, Ju Liao, Qunqiang Luo
{"title":"Beyond structural outcomes: functional and biomechanical considerations in partial foot amputations","authors":"Mingxuan Liu, Hanjun Ma, Ju Liao, Qunqiang Luo","doi":"10.1016/j.surge.2025.09.004","DOIUrl":"10.1016/j.surge.2025.09.004","url":null,"abstract":"","PeriodicalId":49463,"journal":{"name":"Surgeon-Journal of the Royal Colleges of Surgeons of Edinburgh and Ireland","volume":"24 1","pages":"Pages 66-67"},"PeriodicalIF":2.3,"publicationDate":"2026-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145132247","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2026-02-01Epub Date: 2025-11-06DOI: 10.1016/j.surge.2025.10.007
R.A. Keenan , D.A. O'Keeffe , A. O'Neill , C.A. Fleming , R. McVey , T. Moran , G. Fitzmaurice , E. Okereke , F.E. Rowan , K. Barry , B.B. McGuire , RCSI National Robotic Surgery Leads Group
Background
and methods: Robotic-assisted surgery has become a cornerstone of modern surgical innovation, offering enhanced precision, minimal invasiveness, and improved recovery compared with conventional techniques. Its rapid adoption across multiple specialties in Ireland has brought substantial benefits for patients but also challenges regarding surgeon training, programme oversight, and patient safety. Until recently, Ireland lacked a unified national governance framework for robotic surgery. In recognition of this, the Royal College of Surgeons in Ireland (RCSI) established the National Robotic Surgery Leads Group in 2023, tasked with creating national standards for governance, training, and safe practice.
Results
This paper outlines the framework developed by the Leads Group, presenting a model that balances innovation with robust clinical governance. Central to this approach is the establishment of hospital-based Robotic Surgery Governance Committees (RSGCs), responsible for credentialing, training oversight, and monitoring key safety indicators. Training is structured around vendor-led pathways, mentorship, modular component training, and telementoring, with hybrid approaches recommended to optimise safety. Safety monitoring includes key performance indicators such as case volume, console times, transfusion rates, conversion to open surgery, ICU admissions, and morbidity and mortality outcomes. Additional considerations addressed include recognition of surgeon vulnerability during the early learning curve, emergency preparedness, case-mix management, consent processes, and the safe introduction of new robotic platforms.
Conclusion
A national survey of all robotic surgeons in Ireland, with a 76 % response rate, demonstrated overwhelming support for the establishment of RSGCs and KPI monitoring. This framework represents Ireland's first national governance model for robotic surgery and positions the country as a leader in fostering a culture of safety, innovation, and excellence in surgical care.
{"title":"Robotic surgery in Ireland: national governance framework and a guide to good practice","authors":"R.A. Keenan , D.A. O'Keeffe , A. O'Neill , C.A. Fleming , R. McVey , T. Moran , G. Fitzmaurice , E. Okereke , F.E. Rowan , K. Barry , B.B. McGuire , RCSI National Robotic Surgery Leads Group","doi":"10.1016/j.surge.2025.10.007","DOIUrl":"10.1016/j.surge.2025.10.007","url":null,"abstract":"<div><h3>Background</h3><div>and methods: Robotic-assisted surgery has become a cornerstone of modern surgical innovation, offering enhanced precision, minimal invasiveness, and improved recovery compared with conventional techniques. Its rapid adoption across multiple specialties in Ireland has brought substantial benefits for patients but also challenges regarding surgeon training, programme oversight, and patient safety. Until recently, Ireland lacked a unified national governance framework for robotic surgery. In recognition of this, the Royal College of Surgeons in Ireland (RCSI) established the National Robotic Surgery Leads Group in 2023, tasked with creating national standards for governance, training, and safe practice.</div></div><div><h3>Results</h3><div>This paper outlines the framework developed by the Leads Group, presenting a model that balances innovation with robust clinical governance. Central to this approach is the establishment of hospital-based Robotic Surgery Governance Committees (RSGCs), responsible for credentialing, training oversight, and monitoring key safety indicators. Training is structured around vendor-led pathways, mentorship, modular component training, and telementoring, with hybrid approaches recommended to optimise safety. Safety monitoring includes key performance indicators such as case volume, console times, transfusion rates, conversion to open surgery, ICU admissions, and morbidity and mortality outcomes. Additional considerations addressed include recognition of surgeon vulnerability during the early learning curve, emergency preparedness, case-mix management, consent processes, and the safe introduction of new robotic platforms.</div></div><div><h3>Conclusion</h3><div>A national survey of all robotic surgeons in Ireland, with a 76 % response rate, demonstrated overwhelming support for the establishment of RSGCs and KPI monitoring. This framework represents Ireland's first national governance model for robotic surgery and positions the country as a leader in fostering a culture of safety, innovation, and excellence in surgical care.</div></div>","PeriodicalId":49463,"journal":{"name":"Surgeon-Journal of the Royal Colleges of Surgeons of Edinburgh and Ireland","volume":"24 1","pages":"Pages 31-38"},"PeriodicalIF":2.3,"publicationDate":"2026-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145472420","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Differential attainment (DA), defined as unexplained variation in educational outcomes, persists throughout medical training. This study investigates whether demographic characteristics are associated with differences in the likelihood of receiving a Core Surgical Training (CST) offer during the 2024 UK national selection round.
Methods
A retrospective cross-sectional analysis of anonymised applicant-level data from UK-wide CST recruitment was performed. All applicants with complete demographic and outcome data were included. The primary outcome was the offer of a CST training post. Logistic regression evaluated associations between offer outcomes with gender, ethnicity, nationality, age, country of qualification, and disability status.
Results
Applicants applying directly from FY2 were significantly more likely to receive CST offers than those from other backgrounds (RR = 1.73, 95 % CI: 1.51–2.00). Female applicants had higher odds of receiving an offer compared to male applicants (aOR = 1.44, 95 % CI: 1.19–1.74, p < 0.001). Applicants identifying as Asian (OR = 0.54), black (OR = 0.31), and other/Chinese (OR = 0.67), as well as non-UK nationals (OR = 0.24), non-UK graduates (OR = 0.68), and applicants aged >30 (OR = 0.39) had significantly lower odds of receiving an offer (all p < 0.001). Applicants reporting disabilities had increased odds of success (OR = 3.36, 95 % CI: 1.53–7.38, p = 0.002). No significant difference was observed related to sexual orientation or pregnancy/maternity leave.
Conclusions
Despite structured recruitment processes and individual portfolio scoring, differential attainment persists across multiple demographic groups in CST selection. Targeted early support is essential to improve equity, especially for international medical graduates, older applicants and applicants from minoritised ethnic backgrounds.
{"title":"Mapping equity at the gateway to surgical training: National CST selection outcomes in 2024","authors":"Jaspreet Kaur Seehra , Ricky Ellis , Brett Doleman , Esther McLarty , Jonathan Lund","doi":"10.1016/j.surge.2025.10.005","DOIUrl":"10.1016/j.surge.2025.10.005","url":null,"abstract":"<div><h3>Background</h3><div>Differential attainment (DA), defined as unexplained variation in educational outcomes, persists throughout medical training. This study investigates whether demographic characteristics are associated with differences in the likelihood of receiving a Core Surgical Training (CST) offer during the 2024 UK national selection round.</div></div><div><h3>Methods</h3><div>A retrospective cross-sectional analysis of anonymised applicant-level data from UK-wide CST recruitment was performed. All applicants with complete demographic and outcome data were included. The primary outcome was the offer of a CST training post. Logistic regression evaluated associations between offer outcomes with gender, ethnicity, nationality, age, country of qualification, and disability status.</div></div><div><h3>Results</h3><div>Applicants applying directly from FY2 were significantly more likely to receive CST offers than those from other backgrounds (RR = 1.73, 95 % CI: 1.51–2.00). Female applicants had higher odds of receiving an offer compared to male applicants (aOR = 1.44, 95 % CI: 1.19–1.74, p < 0.001). Applicants identifying as Asian (OR = 0.54), black (OR = 0.31), and other/Chinese (OR = 0.67), as well as non-UK nationals (OR = 0.24), non-UK graduates (OR = 0.68), and applicants aged >30 (OR = 0.39) had significantly lower odds of receiving an offer (all p < 0.001). Applicants reporting disabilities had increased odds of success (OR = 3.36, 95 % CI: 1.53–7.38, p = 0.002). No significant difference was observed related to sexual orientation or pregnancy/maternity leave.</div></div><div><h3>Conclusions</h3><div>Despite structured recruitment processes and individual portfolio scoring, differential attainment persists across multiple demographic groups in CST selection. Targeted early support is essential to improve equity, especially for international medical graduates, older applicants and applicants from minoritised ethnic backgrounds.</div></div>","PeriodicalId":49463,"journal":{"name":"Surgeon-Journal of the Royal Colleges of Surgeons of Edinburgh and Ireland","volume":"24 1","pages":"Pages 8-13"},"PeriodicalIF":2.3,"publicationDate":"2026-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145379559","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
扫码关注我们
求助内容：
应助结果提醒方式：
京公网安备 11010802042870号