Chirurg最新文献

Aim: To investigate the value of intraoperative angiography and its ad hoc evaluation with respect to cases of surgical technical inaccessibility.

Methods: Overall, 523 consecutive carotid artery thrombendarterectomy (TEA) patients with intraoperative control angiography, postoperative color-coded duplex sonography and retrospective re-evaluation of documented angiographic images were included in the evaluation.

Results: In the retrospective angiographic re-evaluation 23 (4.4%) occlusions or high-grade stenoses of the common carotid artery (CCA) or internal carotid artery (ICA) in the surgical field (12, 2.3%) or of downstream ICA or middle cerebral artery (MCA, 11, 2.1%) were detected. The detection rate was significantly lower in the intraoperative ad hoc evaluation with overall only 13 (2.5%) detected pathologies (7, 1.3% in the surgical field, 6, 1.1% in large downstream arteries, p=0.002). Postoperative duplex sonography performed in 505 patients detected 50 cases (10.1%) of local surgical technical inaccessibility, which was significantly more than in the angiography (p<0.001). In most cases these were nonocclusive, low-grade stenosing detachments of the intima media (n=19), 13 suture contractions, and 14 kinking/abrupt diameter changes at the distal end of the patch. Suture contractions and kinking/diameter changes were associated with a left-sided TEA (adjusted odds ratio, OR 2.4, 95% confidence interval, CI 1.1-5.1), an operation without a patch (adjusted OR, 16.6, 95% CI 1.3-215.0), and using Dacron patches in contrast to PTFE patches (adjusted OR 3.0, 95% CI 1.4-6.6).

Conclusion: The ad hoc evaluation of intraoperative completion angiography by surgeons missed a substantial number also of occluding and severely stenosing pathologies. Angiography is not suitable for the detection of nonocclusive and low-grade stenosing cases of operative inaccessibility. Postoperative color-coded duplex sonography is an adequate tool for surgical quality control.

Wilhelm Baum was born on 10 November 1799 in Elbing and died at 84 years old on 6 September 1883. In Danzig he made a name for himself in the fight against cholera. He was the first honorary citizen of the Hanseatic city. At 43 years old he was appointed to the chair for surgery in Greifswald without having published any works. 1849 he transferred to Göttingen. As a result of his bibliophilism and inclination towards philology, he had collected the largest library on surgery in Germany. He was famous as an academic teacher. Although in 1872 he and his pupil Billroth were among the founders of the German Society of Surgery, he fell into oblivion in the twentieth century. This article describes Baum's education as well as his professional career and private background.

The treatment of inguinal hernias with open and minimally invasive procedures has reached a high standard in terms of outcome over the past 30 years. However, there is still need for further improvement, mainly in terms of reduction of postoperative seroma, chronic pain, and recurrence. This video article presents the endoscopic anatomy of the groin with regard to robotic transabdominal preperitoneal patch plasty (r‑TAPP) and illustrates the surgical steps of r‑TAPP with respective video sequences. The results of a cohort study of 302 consecutive hernias operated by r‑TAPP are presented and discussed in light of the added value of the robotic technique, including advantages for surgical training. r‑TAPP is the natural evolution of conventional TAPP and has the potential to become a new standard as equipment availability increases and material costs decrease. Future studies will also have to refine the multifaceted added value of r‑TAPP with new parameters.

Background: Robotic assistance has become established in surgery but is not yet a standard procedure. The current status of clinical dissemination in Germany remains unclear. Industry independent sources are scarce.

Aim of the work: The aim of this survey was to investigate the current status of robotic-assisted surgery (RAS) across specialties in Germany from 2014 to 2018.

Material and methods: An internet search was used to identify hospitals and departments (DP) with access to RAS. The DPs were asked to share their data from 2014-2018. In addition to clinical data, data on utilization, implementation, training, and funding were requested.

Results: As of 31 December 2018 RAS was offered at 121 hospitals in Germany, 383 DPs with access to RAS were identified and 26% (n = 98) of DPs responded. On average each DP had two consultant surgeons, 10% of DPs had more than one RAS system and 100% of the RAS systems recorded were from Intuitive Surgical Inc., CA, USA. RAS was implemented in 65% in urology and in 12% in visceral surgery (VS). 21% of programs were interdisciplinary and 4% multidisciplinary (> 3). 83% of systems were purchased and 17% otherwise funded. For additional operating room costs, 74% of hospitals reported paying for them themselves. 14% chose pay as you go. Since 2014, procedures increased by a factor of 4 to approximately 8000. The proportion of VS increased by a factor of 5 since 2016.

Conclusion: RAS in Germany experienced strong growth through 2018. The range of procedures is similar to that of laparoscopy. With a current lack of reimbursement for the additional technical effort, RAS is predominantly used in the medium and high complexity range. The online survey is a good method to collect independent data without high administrative effort.

Background: There are few data on how surgeons implement occupational safety measures to protect their own health and how they assess their subjective health burden.

Objective: In times of a shortage of surgeons it makes sense to examine these relationships in order to evaluate future-oriented adjustments to increase the attractiveness of the profession of "surgeon".

Material and methods: An online questionnaire was sent to the registered members of the German Society for General and Visceral Surgery (DGAV) in October 2016. The members were asked about the application of occupational safety measures, individual living conditions, working conditions and the subjective health burden depending on the level of training and type of hospital (basic, standard, maximum care).

Results: The response rate was 21% (1065/5011). Occupational safety measures were not strictly implemented: routine use of dosimeters, thyroid radiation protection, smoke extraction and protective goggles only took place in 40% (427/1065), 39% (411/1065), 10% (104/1065) and 5% (55/1065), respectively. The majority of surgeons (51%, 548/1065) rated their lifestyle as unhealthy. The majority of them are senior physicians, 46% (250/548) consider their job to be a health hazard. The proportion of chief physicians and assistant physicians is only 21% (115/548) and 18% (98/548).

Conclusion: Guidelines for standardizing the perioperative protection of German surgeons are desirable. Health-promoting behavior could have a positive effect on the occupational safety of surgeons and ultimately also on patient safety. This can contribute to increasing the attractiveness of the profession "surgeon" in the long term.