Chirurgie (Heidelberg, Germany)最新文献

Introduction: The prehospital care of injured children is challenging. Immobilization and pharmacological pain management are in the foreground; however, the expectations of pediatric surgeons and trauma surgeons regarding emergency medical services and emergency physicians can vary. This study aims to identify similarities and differences.

Methods: In this study 186 members of the Pediatric Traumatology Section of the German Society for Trauma Surgery were surveyed on the necessity of 9 emergency medical interventions using 10 routine case studies.

Results: A total of 26 pediatric surgeons and 31 trauma surgeons provided their assessments. There were significant differences in assessment regarding the use of pharmacological pain management, the need for neurological assessment and reduction maneuvers with analgesia. There was high agreement regarding immobilization of the injured body region, the establishment of an intravenous approach and sterile closure of open fractures.

Discussion: Pediatric traumatologists with trauma surgery and pediatric surgery training have different priorities in their requirements for the prehospital care of injured children. Joint interdisciplinary recommendations for action should be formulated to provide widely accepted guidelines for emergency medical personnel, who often do not specialize in pediatric traumatology.

Background: Minimally invasive liver surgery has rapidly evolved in recent years. In addition to the laparoscopic liver resection (LLR), robot-assisted liver resection (RLR) is increasingly gaining in importance; however, although the robotic-assisted approach offers clinical benefits, particularly in complex procedures, it remains a matter of debate.

Objective: The aim of this study was to present the development, perioperative outcomes, key challenges, and insights from over 500 minimally invasive liver resections performed at a specialized high-volume center. It focused on the comparison between LLR and RLR based on the IWATE difficulty score.

Material and methods: A retrospective single-center analysis of 526 consecutive elective minimally invasive liver resections (2018-2024) was conducted. All cases were stratified using the IWATE score. The LLR and RLR were compared in terms of operative parameters, conversion rate and postoperative complications. Additionally, the annual procedural development was analyzed.

Results: The RLR was established in 2021 and accounted for over 50% of all minimally invasive liver resections by 2024. Compared to LLR, RLR was associated with significantly reduced intraoperative blood loss as well as lower conversion and complication rates, particularly in technically demanding resections. Despite an increasing proportion of advanced/expert resections, the rate of major complications could be reduced over time.

Conclusion: Minimally invasive liver resections can be safely performed at high-volume centers. The robotic-assisted technique offers specific advantages especially in complex resections, with respect to complication rates, reduced conversion rates and decreased blood loss. A key success factor in the implementation of robotic liver surgery is the pre-existing expertise in laparoscopic techniques, which significantly shortened the learning curve. The use of standardized techniques such as the scissor hepatectomy may have contributed to the comparatively low rate of bile leaks observed in RLR.

Brain metastases are the most frequent intracranial tumor entity and in most cases are a sign of advanced systemic cancer. Advances in neurosurgery, pathology, radiotherapy and oncology, especially with the introduction of immune and targeted systemic treatment, have significantly improved the prognosis for patients with brain metastases in recent years. Neurosurgical treatment plays a key role in symptom relief, reduction of the tumor burden and tissue acquisition for molecular analysis to enable patients to undergo postoperative radiotherapy and systemic therapy. The creation of an optimal patient-oriented treatment concept requires close interdisciplinary coordination and structured follow-up to make individualized and evidence-based treatment decisions.

Oligometastasis describes an intermediate stage between localized and systemic tumor disease, in which a limited number of metastases with restricted organ involvement still appear amenable to local treatment. Despite its growing relevance and numerous publications, a unified definition for gastrointestinal (GI) tumors is lacking. The aim of this work was to summarize the existing definitions and current therapeutic standards for oligometastasis in the GI tract. Based on current studies and guidelines it becomes evident that local treatment is currently being investigated for gastric, esophageal, colorectal, pancreatic, hepatocellular and cholangiocellular carcinomas. Initial data suggest a possible improvement in survival through combined systemic and local treatment approaches. The results of most prospective studies are still pending. In the future, molecular markers and biological tumor characteristics are expected to contribute to better patient selection and further improve the integration of local treatment.