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

{"title":"Tight application of a surgical tourniquet prior to inflation increases venous pressure in the upper limb; Potentially resulting in increased blood loss and poorer visibility","authors":"Ross Condell ,&nbsp;Dhruv Kapoor ,&nbsp;Alexander Price ,&nbsp;David O'Briain","doi":"10.1016/j.surge.2024.08.015","DOIUrl":"10.1016/j.surge.2024.08.015","url":null,"abstract":"<div><h3>Background</h3><div>Tourniquets are commonly used in extremity surgery to help provide a bloodless operative field to improve visibility and reduce length of procedures. With the development of WALANT (wide awake, local anaesthetic, no tourniquet) techniques, many surgeons undertake surgery without tourniquet inflation. The correct technique of pneumatic tourniquet application is poorly understood by healthcare staff. The application of a tight tourniquet when applied for optional use or use for only a portion of a procedure, rather than for inflation throughout can cause venous engorgement of an extremity leading to increased blood loss and reduced operative field visualisation thereby discouraging surgeons from persevering with WALANT strategies.</div></div><div><h3>Aim</h3><div>To determine the effect of tourniquet application tension on limb volume prior to skin incision.</div></div><div><h3>Methods</h3><div>30 volunteers had the volume of their non-dominant forearm measured post-inflation of a surgical tourniquet using two different application techniques. Tight application was defined as the tourniquet fastened using a dynamometer to a tension of 100 N. Loose application was defined as the tourniquet fastened using a dynamometer to a tension of 50 N. The tourniquet was then inflated to 200 mmHg after both application techniques. Exsanguination was performed by elevation of the arm for 1 min prior to tourniquet inflation. At 5 min the forearm volume was measured using a volume displacement technique.</div></div><div><h3>Results</h3><div>93 % of participants (28/30) had a higher volume of water displaced when the tourniquet was applied tightly. The mean difference between the loose and tight applications was 30.06 mls.</div></div><div><h3>Conclusion</h3><div>The increase in volume in tightly applied tourniquets is believed to result from increased intravascular volume. This increase in blood volume can lead to increased intra-operative blood loss and poor intra-operative visualisation when operating without tourniquet inflation. Loose application of the tourniquet pre-inflation appears to prevent sequestration of venous blood in the limb, therefore decreasing operative blood loss and improving view for operating.</div></div><div><h3>Level of evidence</h3><div>Level 1; Symptom Prevalence Study.</div></div>","PeriodicalId":49463,"journal":{"name":"Surgeon-Journal of the Royal Colleges of Surgeons of Edinburgh and Ireland","volume":"23 1","pages":"Pages 23-26"},"PeriodicalIF":2.3,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142127156","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}

{"title":"Supporting trainees in difficulty: A guiding hand through challenging times","authors":"Michael El Boghdady","doi":"10.1016/j.surge.2024.11.013","DOIUrl":"10.1016/j.surge.2024.11.013","url":null,"abstract":"","PeriodicalId":49463,"journal":{"name":"Surgeon-Journal of the Royal Colleges of Surgeons of Edinburgh and Ireland","volume":"23 1","pages":"Pages e35-e36"},"PeriodicalIF":2.3,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142848198","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}

{"title":"Embracing change: The potential of artificial intelligence in transforming surgical practice","authors":"Kaiser O'Sahil Sadiq","doi":"10.1016/j.surge.2025.01.002","DOIUrl":"10.1016/j.surge.2025.01.002","url":null,"abstract":"","PeriodicalId":49463,"journal":{"name":"Surgeon-Journal of the Royal Colleges of Surgeons of Edinburgh and Ireland","volume":"23 1","pages":"Pages e44-e45"},"PeriodicalIF":2.3,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143015002","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}

{"title":"Distant lymph node metastasis in differentiated thyroid cancer: A population-based cohort study","authors":"Ying Ding ,&nbsp;Ruixin Zhou","doi":"10.1016/j.surge.2024.07.004","DOIUrl":"10.1016/j.surge.2024.07.004","url":null,"abstract":"<div><h3>Background</h3><div><span>Cervical lymph node metastasis (LNM) is the most common clinical event in patients with </span>differentiated thyroid cancer<span> (DTC). However, the incidence, pattern, treatment, and prognosis of distant LNM are yet to be reported.</span></div></div><div><h3>Methods</h3><div><span>DTC patients with distant LNM were identified from the Surveillance, Epidemiology, and End Results (SEER) database between 2016 and 2020. Multivariate models and </span>propensity score matching<span> (PSM) were used to account for the effects of covariates. The Kaplan-Meier method was used to evaluate the overall survival (OS) and cancer-specific survival (CSS). A nomogram was established to predict the probability of distant LNM in DTC patients, with calibration and Receiver Operating Characteristic (ROC) curves utilized to validate the nomogram's accuracy.</span></div></div><div><h3>Results</h3><div><span><span>Of the 42,339 DTC patients screened, 100 (0.24 %) patients presented with distant LNM. Risk factors including age, sex, T stage, N stage, bone metastasis<span>, brain metastasis, and </span></span>lung metastasis were included in the nomogram to predict the probability of distant LNM. The calibration curve of the nomogram was close to the ideal diagonal line and the area under the curve (AUC) of the ROC curve is 0.953. Distant LNM showed a worse prognosis after adjusting for confounders compared with non-distant LNM (</span><em>P</em><span> &lt; 0.05). Remarkably, radioactive iodine (RAI) therapy did not improve the OS and CSS in DTC patients with distant LNM in the overall or PSM cohort.</span></div></div><div><h3>Conclusions</h3><div><span>Distant LNM presents as a comparatively rare but grave condition with a substantial negative impact on prognosis in patients with DTC. Identified risk factors of distant LNM are older age, male, advanced T stage and N stage, bone metastasis<span>, brain metastasis, and </span></span>lung metastasis. Remarkably, the current RAI therapy does not appear to significantly improve the survival outcome of DTC patients with distant LNM.</div></div>","PeriodicalId":49463,"journal":{"name":"Surgeon-Journal of the Royal Colleges of Surgeons of Edinburgh and Ireland","volume":"23 1","pages":"Pages 38-44"},"PeriodicalIF":2.3,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141602037","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}

{"title":"Talent Drain in Neurosurgery","authors":"Lia Ubillus Peña ,&nbsp;Yaritza La Torre ,&nbsp;Carlos Gonzales Fernández ,&nbsp;Gonzalo Jair Callahuanca-Flores ,&nbsp;Irving Gabriel Calisaya-Madariaga","doi":"10.1016/j.surge.2024.12.005","DOIUrl":"10.1016/j.surge.2024.12.005","url":null,"abstract":"","PeriodicalId":49463,"journal":{"name":"Surgeon-Journal of the Royal Colleges of Surgeons of Edinburgh and Ireland","volume":"23 1","pages":"Pages e42-e43"},"PeriodicalIF":2.3,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142933277","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}

{"title":"Use of the contour ® curved cutter stapler device for rectal transection during robotic assisted surgery","authors":"Fraser Sneddon,&nbsp;Colin H. Richards,&nbsp;Raymond Oliphant","doi":"10.1016/j.surge.2024.11.007","DOIUrl":"10.1016/j.surge.2024.11.007","url":null,"abstract":"<div><h3>Background</h3><div>Rectal division during minimally invasive surgery including robotic assisted surgery remains challenging, with current techniques often requiring multiple stapler firings to achieve effective transection.</div></div><div><h3>Aims</h3><div>We propose a novel technique which allows the use of a Contour® Curved Cutter Stapler to achieve rectal division during robotic assisted surgery.</div></div><div><h3>Methods</h3><div>The stapler is inserted through the routinely made pfannenstiel incision and a glove, over an Alexis® port used to create an airtight seal.</div></div><div><h3>Conclusion</h3><div>This simple technique enables reliable perpendicular single stapler firing to achieve rectal transection during colorectal robotic assisted surgery without the requirement for any further incisions.</div></div>","PeriodicalId":49463,"journal":{"name":"Surgeon-Journal of the Royal Colleges of Surgeons of Edinburgh and Ireland","volume":"23 1","pages":"Pages 30-32"},"PeriodicalIF":2.3,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142689392","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}

{"title":"Are all surgeons the same? Assessing emotional intelligence and gender differences amongst surgical residency applicants in Ireland","authors":"F. O’Kelly ,&nbsp;B.R. O’Connor ,&nbsp;E. O’Dowd ,&nbsp;K. Neylon ,&nbsp;D.H. Shackleton ,&nbsp;K. Sheehan ,&nbsp;E. Cotter ,&nbsp;R.M. Conroy ,&nbsp;D. O’Keeffe ,&nbsp;B.B. McGuire ,&nbsp;O. Traynor ,&nbsp;E.M. Doherty","doi":"10.1016/j.surge.2024.08.007","DOIUrl":"10.1016/j.surge.2024.08.007","url":null,"abstract":"","PeriodicalId":49463,"journal":{"name":"Surgeon-Journal of the Royal Colleges of Surgeons of Edinburgh and Ireland","volume":"23 1","pages":"Pages 6-12"},"PeriodicalIF":2.3,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141983689","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}

{"title":"The rise and fall of “marginal gains” – Lessons for surgery?","authors":"Connor Boyle,&nbsp;Calum Arthur,&nbsp;Steven Yule","doi":"10.1016/j.surge.2024.12.004","DOIUrl":"10.1016/j.surge.2024.12.004","url":null,"abstract":"","PeriodicalId":49463,"journal":{"name":"Surgeon-Journal of the Royal Colleges of Surgeons of Edinburgh and Ireland","volume":"23 1","pages":"Pages e39-e41"},"PeriodicalIF":2.3,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142916115","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}

{"title":"The impact of inadequate disclosure and patient recall on the consent process in neurosurgery: A systematic literature review","authors":"Ashraf Elmahdi,&nbsp;David Smith","doi":"10.1016/j.surge.2024.11.009","DOIUrl":"10.1016/j.surge.2024.11.009","url":null,"abstract":"<div><h3>Background</h3><div>The informed consent process in neurosurgery aims to uphold patient autonomy and provide comprehensive information for decision-making. However, gaps in communication and understanding between patients and surgeons persist. This systematic review examined the impact of consent on neurosurgical practice, exploring the effectiveness of different consent approaches.</div></div><div><h3>Methods</h3><div>A comprehensive search of databases and relevant sources identified twenty-eight studies for inclusion. Prospective and retrospective studies were assessed to examine the effect of consent on neurosurgical practice. Data collection and analysis involved independent reviewers assessing eligibility, study quality, and risk of bias. Findings from the included studies were used to write the review.</div></div><div><h3>Main results</h3><div>Randomized controlled trials specific to the impact of consent in neurosurgery needed to be included. Nevertheless, the reviewed twenty-nine studies revealed a significant risk of litigation due to inadequate information provision. Neurosurgeons' adherence to the standard of competent peers was identified as crucial in bridging the gap between desired and actual patient-surgeon interactions.</div></div><div><h3>Authors conclusions</h3><div>This review underscores the need to address communication gaps between patients and surgeons within the informed consent process in neurosurgery. Neurosurgeons must strive to meet the standard of competent peers and implement effective consent strategies involving multiple modalities. Enhancing communication and patient comprehension can mitigate potential litigation risks, ensuring better patient-centred care and shared decision-making in neurosurgical practice.</div></div>","PeriodicalId":49463,"journal":{"name":"Surgeon-Journal of the Royal Colleges of Surgeons of Edinburgh and Ireland","volume":"23 1","pages":"Pages 45-51"},"PeriodicalIF":2.3,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142807418","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}

{"title":"A boost to concentration or a distracting noise? A systematic review of surgeon and anaesthetist perspectives of the benefit of intra-operative music","authors":"K. Onuoha ,&nbsp;D. Jones ,&nbsp;W. Eardley","doi":"10.1016/j.surge.2024.11.002","DOIUrl":"10.1016/j.surge.2024.11.002","url":null,"abstract":"<div><h3>Background</h3><div>The surgical team should be as harmonious and focussed as possible in the operating theatre. Whilst there is evidence of benefit for the use of music in the perioperative period for patient, little exists to inform of impact on those doing the surgery or anaesthesia. This review focuses on the perspectives of surgeons and anaesthetists, their views and opinions on the effect and impact of music during surgery.</div></div><div><h3>Methods</h3><div>A systematic review was conducted using narrative synthesis. The PRISMA guidelines were followed with the use of PICO and PRISMA guided search strategy. PubMed, CINAHL and Medline were searched but filtered to only published English language papers.</div></div><div><h3>Results</h3><div>Of 329 papers identified 42 duplicates were removed. 287 were screened; of which 276 were excluded and 11 sought for retrieval. Of these, 8 were excluded for wrong population or study design, leaving 3 for analysis.</div><div>Narrative synthesis revealed three themes to guide discussion: (1) Views of surgeons and anaesthetists and the effect on music; (2) effect of music on other staff members; and (3) differences in music choices and balance of power.</div></div><div><h3>Conclusion</h3><div>Music has an overall beneficial effect on surgeons and anaesthetists, especially with regards improved concentration. As an intervention, it has global generalisability and requires little resource. Investigation across different surgical specialities and use of flexible control models in terms of choosing music is a natural subsequent research question.</div></div>","PeriodicalId":49463,"journal":{"name":"Surgeon-Journal of the Royal Colleges of Surgeons of Edinburgh and Ireland","volume":"23 1","pages":"Pages 61-66"},"PeriodicalIF":2.3,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142734150","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}