Chirurgie (Heidelberg, Germany)最新文献

Neuroprosthetics represents a dynamic field at the interface of neurosciences, engineering and neurosurgery that is based on implanted devices for restoration or extension of neurological functions. Important advances involve brain-computer and brain-spine interfaces that enable communication, motor and sensory feedback in paralyzed or anarthric patients. Intracortical arrays, subdural electrocorticographic lattices and endovascular electrodes provide different access routes, supplemented by strategies, such as spinal neuromodulation and functional electrostimulation. Recent studies confirmed the restoration of grasping movements, standing and walking as well as fluid speech and text communication, sometimes via avatars. Bidirectional systems with sensory feedback enhance the naturalness and precision. There are challenges in signal stability, longevity and minimally invasive access routes. With interdisciplinary cooperation and technical maturity neuroprostheses can enrich the routine neurosurgical care in the future.

The shock room treatment of severely injured and polytraumatized patients has become established as a model for the treatment of non-traumatological critically ill patients. For the treatment of trauma patients the term trauma team is therefore used. This article presents the evidence-based requirements for the trauma shock room. In addition, the reasons why a trauma team improves the outcome are discussed. The composition of a trauma team depends partly on the organizational regulations of the individual hospitals but also on their level of care. This is relevant for certification as a trauma center. The criteria for trauma team activation is a decisive criterion for the quality of care and resource-saving use. For quality control and to reduce overtriage and undertriage, it is shown which parameters can be used to assess when trauma team activation has been appropriate.

Background: Advanced surgical training is essential for maintaining the quality of care; however, Germany still lacks validated quality indicators despite the legal requirements for quality-linked funding under §17b of the Hospital Funding Act.

Objective: The aim of this work is to develop practical and measurable quality indicators that enable an objective assessment of the structural, procedural and outcome quality of advanced surgical training.

Material and methods: To develop these indicators, legal frameworks were analyzed, a systematic literature search on quality assessment surgical training was conducted and international training models were analyzed as a comparison. Key quality domains were then identified and consolidated into a structured indicator set through expert consensus.

Results: A three-stage set of indicators is proposed: 1) Structural indicators cover aspects such as curriculum quality, supervisor-trainee ratio, network-based training and teaching qualifications. 2) Process indicators include structured training discussions, operational supervision including surgical and procedural keys (OPS) coding for training interventions and continuing education activities. 3) Outcome indicators relating to the duration of training, the success rate of the specialist medical examination and standardized satisfaction. Digital tools, such as e‑logbooks and training registers enable valid and comparable data to be collated for the first time.

Conclusion: Standardized quality indicators achieve transparency, enable benchmarking and foster a learning data-driven advanced training culture. Annual digital reporting and centralized anonymized assessments are essential for quality assurance and to support future quality-linked funding models.

Bone metastases are the most common malignant bone tumors and are often the first clinical sign of a malignant disease. Although the occurrence of bone metastases in a malignant disease usually means a palliative situation for patients, adequate treatment of the metastases can greatly improve the patient's prognosis and ensure that the quality of life is maintained. In addition to oncological and radiotherapeutic treatment options, there are many surgical treatment options available. For this reason, metastasis surgery is the most common oncological operation in musculoskeletal surgery. The indications for metastasis surgery should always be assessed in an interdisciplinary setting, taking the patient's life expectancy, physical limitations and wishes into account. This review article summarizes the various surgical treatment options for bone metastases depending on the region of the body.

Anorectal functional disorders following curative treatment for rectal cancer range from fecal incontinence to obstructed defecation and represent a symptom complex with tremendous impact on the quality of life in up to 70% of patients. Following resection, symptoms are defined as low anterior resection syndrome (LARS) and can be differentiated into minor LARS and major LARS. Independent factors predictive of LARS include total mesorectal excision, level of the anastomosis and neoadjuvant chemoradiotherapy. Therapeutic options include conservative management (dietary modification, stool regulation), pelvic floor rehabilitation and transanal irrigation. Sacral neuromodulation has been shown to be effective for major LARS. In general, multidisciplinary teams providing professional management according to patient-reported outcome measurements are mandatory. Based on the prevalence of anorectal functional disorders after resection and organ preservation, the description of symptoms restricted to LARS no longer seems appropriate and a new consensus-based definition should be developed.

Background: Surgical residency training stands in a field of tension between educational needs and patient safety. The aim of this review was to evaluate the impact of surgical training on patient safety.

Methods: A systematic PubMed search (2011-2025) was conducted, including original studies with an explicit focus on residency training. Out of 419 identified records 32 studies were analyzed and 30 were included in the meta-analysis based on complete datasets.

Results: Across most surgical specialties, interventions involving residents showed comparable morbidity and mortality rates to surgery guided by specialists, with a pooled odds ratio (OR) of 1.03 (95% confidence interval (CI) 0.88-1.21); however, the operative time was significantly longer by a mean of 15.04 min (95% CI 5.16-24.93, p = 0.0029). Structured curricula and direct supervision enabled safe performance even of complex procedures by residents.

Conclusion: Surgical training is largely safe when adequate structure and supervision are provided. Structured training programs and competency-based entrustment concepts can enhance both patient safety and operative autonomy.