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

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.

Background: Operating theatres significantly impact healthcare's carbon footprint. Surgeons, as key decision-makers, are essential in driving sustainable practices. This study evaluates the attitudes and practices of Irish surgeons towards environmental sustainability, identifies barriers to implementation, and explores opportunities for improvement.

Methodology: A cross-sectional survey was distributed to members and fellows of the Royal College of Surgeons in Ireland (RCSI). The structured questionnaire comprised demographic items, Likert-scale statements, and open-ended questions, addressing awareness of sustainability, waste management behaviours, and individual commitment to sustainable practices.

Results: A total of 177 responses (response rate of 85.9 %) were received; 74 % (n = 131) of respondents were male and 55.4 % (n = 98) were consultant surgeons. While most respondents acknowledged the importance of sustainability in surgery, many reported limited familiarity with the concept. The volume of non-clinical waste generated in surgical settings was frequently underestimated. Reported barriers to implementing sustainable practices included insufficient education and awareness, financial constraints, and dependence on single-use instruments. Concerns regarding sterility and infection prevention also emerged as deterrents to adopting reusable alternatives. In addition to the quantitative findings, open-ended responses were analysed using thematic analysis, which revealed nuanced insights into surgeons' perceptions of sustainability, including underlying concerns, motivations, and system-level barriers.

Conclusions: There is a clear disconnect between the perceived importance of sustainability and its practical application in surgical settings. Barriers exist at multiple levels - individual, institutional, and systemic. These findings underscore the urgent need for targeted educational and policy-driven interventions to embed sustainability into surgical practice.

Background: Peritoneal metastases (PM) are a common site of spread in colorectal cancer (CRC) and are associated with poor survival outcomes. The true burden of disease is difficult to quantify due to limitations in imaging and limited symptoms until advanced disease. Systemic therapy has limited benefits and there is an increasing interest in the use of cytoreductive surgery (CRS) and hyperthermic intraperitoneal chemotherapy (HIPEC). This narrative review summarises the current literature on epidemiology of PM in CRC and evidence based current management strategies.

Methods: PubMed was search for the terms "Peritoneal Metastases" or "Peritoneal carcinomatosis" and "Colorectal Cancer" from inception to December 2024. Titles of all English language articles were considered and backwards referencing screening was undertaken in key articles. Inclusion criteria included all original articles with a focus on the clinical management of PM and CRC.

Findings: PM occur in 5-10 % of patients with CRC. The current literature likely underestimates the true burden of disease due to reliance on accurate registry data, and little is published on UK data. Systemic therapy has limited benefit in patients with PM. The PRODIGE-7 trial highlighted the benefits of CRS in select patients but raised questions about the benefits of HIPEC. Prophylactic HIPEC remains controversial but the findings of HIPECT4 show promising results.

Conclusion: The true burden of PM and CRC remains unclear particularly in the UK population. CRS has clear benefits in patients that undergo complete cytoreduction. Further work is required to determine the benefits of HIPEC and how to optimise this for patients.

Background: Clinical documentation is essential for safe and effective patient care but places a considerable clerical burden on clinicians. Ambient artificial intelligence (AI) systems, which capture clinical conversations and generate structured notes in real time, have shown promise in primary and outpatient care but remain underexplored in the inpatient setting. This study examined the impact of an ambient AI scribe on documentation timing, quality, and workload in a simulated orthopaedic inpatient setting.

Methods: Seven postgraduate year one junior doctors participated in simulated orthopaedic ward rounds incorporating an ambient AI scribe (Heidi Health, Melbourne, Australia). A total of 150 clinical documents were generated: 120 progress notes (60 manual, written retrospectively, and 60 produced in real time using ambient AI) and 30 discharge summaries (15 manual and 15 AI-generated). Documentation time was recorded, and quality was assessed using the Physician Documentation Quality Instrument-9 (PDQI-9) for each clinical document. Workload was evaluated using the NASA-TLX instrument.

Results: Ambient AI significantly reduced documentation time for both progress notes (median 27s vs. 128s; P < .0001) and discharge summaries (median 114s vs. 459s; P < .0001). Time savings persisted across all complexity levels. AI-generated progress notes achieved higher overall PDQI-9 scores than manual notes (median 43.5 vs. 41; P = .002), with significant gains in thoroughness, currency, and usefulness, without compromising accuracy. Similarly, AI-generated discharge summaries scored higher (median 40 vs. 33; P < .0001), with improvements in comprehensibility, organisation, internal consistency, and synthesis. Junior doctors reported reduced workload across all NASA-TLX domains, with the largest improvements in frustration (-79 %) and effort (-81 %).

Conclusion: In simulated orthopaedic ward rounds, ambient AI substantially reduced documentation time, improved document quality, and alleviated workload for junior doctors.