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

Background & aims: Sleeve gastrectomy is a widely performed bariatric surgery, yet its outcomes can vary significantly depending on environmental factors such as high altitude. High altitude, characterized by hypobaric hypoxia, may affect oxygen delivery, recovery, and metabolic processes post-surgery. This study aims to evaluate high altitude as a prognostic factor in sleeve gastrectomy outcomes, focusing on complication rates, weight loss, and recovery duration.

Results: The meta-analysis revealed a significantly higher postoperative complication rate for the high-altitude group, with a relative risk (RR) of 1.45 (95 % CI: 1.35-1.55, p < 0.05) [9, 14]. To address heterogeneity in altitude definitions [6, 9], we performed a sensitivity analysis excluding the study with the highest altitude cutoff (≥2500 m). The results remained consistent (RR: 1.42, 95 % CI: 1.32-1.53) [14, 19], confirming the robustness of our primary finding.

Conclusions: High altitude is a critical factor influencing sleeve gastrectomy outcomes, leading to increased complications and prolonged recovery. Preoperative assessments and postoperative care must address altitude-specific challenges, including enhanced oxygenation strategies, to optimize patient recovery and surgical success. These findings emphasize the need for tailored clinical approaches to improve outcomes for bariatric surgery patients in high-altitude environments.

Background: Given changing demographics in surgery, this study aimed to assess the representation and diversity of speaker pool in the last decade of Conjoint Scientific Congresses by analysing the participating speakers, both the invited speakers and presenting trainees, in terms of their gender, affiliations and origin.

Methods: This study retrospectively reviewed online program leaflets to collect information on the gender, origin, presentation role, invitation status, and affiliation of speakers. Information on invited speakers were evaluated from 2013 to 2022, and for presenting trainees, from 2015 to 2023, due to data availability.

Results: This study identified 1817 speakers, including invited speakers (2013-2023) and 791 trainees (2015-2023). The percentage of female invited speakers increased significantly from 7.7 % in 2013 to 27.5 % in 2023 (p < 0.05; 95 % CI [0.46, 0.95]). The mean percentage of female trainees was 37.4 % (range 28.7 %-48.7 %), and there was no significant change in this percentage over the years (p = 0.44; 95 % CI). Local speakers increased significantly from 69.2 % in 2013 to 83.8 % in 2022 (p < 0.05; 95 % CI [0.91, 0.99]), associated with a greater involvement from the public sector, from 57.8 % in 2013 to 92.3 % in 2023 (p < 0.05; 95 % CI [0.64, 0.96]).

Conclusion: Over the years, female invited speakers increased, and female trainee participation remained similar, suggesting better representation of surgical community. There was an increasing participation of local speakers, particularly in the public sector, which may lead to potentially less diversity in the speaker pool.

Introduction: Surgical care is an essential, resource-intensive component of healthcare. It contributes a significant carbon footprint and waste production. As part of Ireland's commitment to achieving net-zero emissions by 2050, surgical services have emerged as a critical focus area for sustainability reforms.

Aims: This review explores national policies, research contributions, and the leadership role of institutions in driving sustainable practices.

Discussion: Ireland has made significant strides in incorporating sustainability into its healthcare system, particularly within surgical care. National initiatives and efforts led by institutions are commendable steps toward reducing the environmental footprint of healthcare. The integration of sustainability into education and research is assessed, along with challenges and barriers to systemic change. Significant gaps remain in terms of implementing Ireland's sustainability policies effectively across all hospitals. Issues include the disparity in resources between urban and rural hospitals and patient engagement practices.

Recommendations: Four key findings are recommended. Stronger national policies on sustainability audits and practices are essential. An increased focus on sustainability in research is required. An emphasis on training and teaching sustainable surgical practices is needed. Improving patient education will aid in the goal of increasing surgical sustainability in Ireland.

Conclusions: Ireland continues to focus on enhancing policy frameworks, expanding research, building capacity across the healthcare workforce, and engaging the public in sustainable healthcare practices. Several challenges persist that hinder the scaling and broad implementation of these initiatives. Evidence from global studies supports actionable recommendations for Ireland's future sustainability agenda.

Introduction: Mentorship is perceived to influence the nuanced decisions of medical students on the precipice of their chosen career path. No previous study has evaluated whether formalised mentorship ab initio impacts medical students attitudes towards a career in surgery.

Methods: A crossover, randomised controlled trial (RCT) was performed. Medical students were randomised to: (1) lack of exposure to a mentor (control/crossover arm) and assessment using a questionnaire, and (2) exposure to a mentor (intervention arm) and assessment. The control/crossover arm were then exposed to a mentor and underwent re-assessment and comparison with their initial results.

Results: Overall, 43 students were enrolled with no significant difference observed in student age, gender, or nationality (all P > 0.050). In the intervention arm, students were less likely to feel a lack of mentorship in surgery (P = 0.021) or be discouraged by the 'unknowns' of surgical training (P = 0.001). Furthermore, mentorship provided them with significant clarity regarding training (P = 0.032) and made the recommendation for mentorship more likely (P < 0.001). Following crossover, students felt significantly more interested in a surgical career (P = 0.001). Students also felt less concerned regarding competition (P = 0.032), the 'unknowns' (P = 0.007), workload (P = 0.006), and lack of direction (P = 0.016) within surgical training, while also reporting less concern regarding a lack of mentorship (P = 0.010) and less insecurity about their ability to succeed in surgery (P = 0.003). Lastly, crossover provided students with clarity regarding training (P = 0.033), while making mentor recommendation more likely (P = 0.001).

Conclusion: Formalised mentorship has a positive impact upon medical students' attitudes through structured support towards a career in surgery. Medical education institutions should consider the inclusion of formalised mentorship programmes in their curricula.

Introduction: Breast-cancer-related-lymphoedema (BCRL) remains problematic clinically. A recent meta-analysis showed a pooled incidence of 21.9 %. Greater lymph node dissection increases BCRL incidence with a pooled average of 5.9 % for sentinel lymph node biopsy (SLNB) versus 23.6 % for axillary lymph node dissection (ALND). The primary aim was to assess the BCRL incidence in symptomatic breast cancer patients undergoing axillary surgery.

Methods: A prospective, single centre study was carried out whereby included patients had limb volumes assessed pre-operatively and at 1 and 2 years post-operatively between January 2016 and July 2019. Assessment involved two standardised methods; arm circumference measurement and water displacement.

Results: 147 patients, mean age 56.4 years (±sd 14.0, range 28-86) were included. 97/147(66 %) of patients underwent SLNB, with 50/147(34 %) undergoing ALND. 70/97(72.2 %) of the SLNB group had a wide local excision versus 24/50(48.0 %) in the ALND group (p = 0.004). Mean lymph nodes excised was 8.0(±sd 7.4, range 1-30) for all patients, 3.3(±sd 2.2, range 1-11) for SLNB and 17.1(±sd 5.1, range 9-30) for ALND (p < 0.001). Overall incidence of BCRL was 6.1 %(9/147) using arm circumference measurement and 15.7 %(23/147) with water displacement at 2 year follow-up. BCRL incidence determined using arm circumference measurement was found to be 4.3 % (4/94), 33.3 % (1/33), 11.5 % (3/26) and 4.2 % (1/24) for SLNB alone, SLNB + RLNR, ALND alone and ALND + RLNR respectively. Using water displacement, BCRL incidence in the SLNB alone, SLNB + RLNR, ALND alone and ALND + RLNR groups was 10.6 % (10/94), 33.3 % (1/3), 15.4 % (4/26), and 33.3 % (8/24) respectively.

Conclusion: This study gives a real world perspective on the diagnosis, incidence and subsequent management of BCRL whilst showing that the incidence of BCRL is low at our institution by international standards.

Background: Given the complexity and evolution of modern surgical procedures, there is a need for training methods to develop and keep pace. Digital Twins Assisted Surgery (DTAS) offers a novel opportunity to enhance both surgical education and intraoperative decision-making.

Patients and methods: We propose a conceptual framework for integrating DTAS into surgical education. Hypothetical case examples are presented to illustrate how DTAS could be utilized for preoperative planning, intraoperative guidance, and individualized skill development in surgical trainees.

Results: DTAS demonstrates potential for improving surgical precision, skill acquisition, and patient safety. By integrating real-time data, 3D modelling, and predictive analytics, DTAS holds promise for improving surgical outcomes and facilitating skill acquisition in complex procedures.

Conclusions: DTAS could transform surgical training and navigation. Pilot studies and validation trials are needed to assess its integration into curricula and its impact on clinical outcomes.

Introduction: Effective collaboration between surgeons and anesthesiologists is critical to managing intraoperative challenges and ensuring patient safety. Despite its importance, the specific dynamics of this relationship remain underexplored, with few studies providing quantitative assessments.

Methods: A structured literature review was conducted following PRISMA guidelines, focusing on studies that examined the surgeon-anesthesiologist relationship and its impact on surgical outcomes. Data were extracted on measurement methodologies, relationship indicators, reported outcome effects, identified barriers, and proposed interventions.

Results: Eleven papers met inclusion criteria, all employing surveys or field observations to evaluate communication frequency, content, and patterns. Methods were similar to general team collaboration assessments, lacking multidimensional measures. Potential complementary metrics include collaborative behaviors such as anticipatory movements and eye-tracking to assess shared visual attention. Evidence linking relationship quality to patient outcomes was limited and inconsistent. Reported barriers included operating room culture, negative perceptions, and communication gaps. Suggested interventions included pre-surgical briefings, debriefings, and enhanced visualization of patient and surgical information.

Discussion: Current evidence on the surgeon-anesthesiologist relationship is sparse and methodologically limited. Future research should incorporate advanced behavioral and technological metrics to enable robust quantification, inform targeted interventions, and strengthen interprofessional collaboration to improve patient safety and surgical performance.