Chirurgie (Heidelberg, Germany)最新文献

Anatomical structures of the liver could be reconstructed three dimensionally from preoperative cross-sectional imaging for over 20 years. This three-dimensional (3D) representation not only optimizes the preoperative planning options but also the communication of specific operation-relevant structures can be improved using 3D models. In addition to a plastic and interactive visualization of 3D organ models, the disruptive technology of virtual reality (VR) can also provide a possibility for structured training and further education regarding surgical anatomy of the liver and operation planning. This makes examinations in virtual reality also seem tangible. The latest prototypes even enable patient-specific simulation of intraoperative sonography. This review article provides an overview of the current status of available technologies for training and further education using VR exemplified by liver surgery.

Introduction: Early postoperative reflux (PR) can compromise anastomotic healing after Ivor Lewis esophagectomy (ILE) and poses a risk for aspiration. Anastomotic insufficiency is the most threatening surgical complication. We present the protective method of pre-emptive active reflux drainage (PARD) with simultaneous enteral feeding. We report our experience with this new safety concept in esophageal surgery in a cohort of 43 patients.

Materials and methods: For PARD we use a double lumen open porous film drainage (dOFD). To create the dOFD, the gastric tube of a Trelumina probe (Freka®Trelumina, Fresenius) is coated with a double-layered open-pore drainage film (Suprasorb®CNP drainage film, Lohmann & Rauscher) over a length of 25 cm. The dOFD is endoscopically inserted into the tubular stomach intraoperatively after completion of the anastomosis. Continuous negative pressure is applied with an electronic pump (-125 mm Hg). The PR is continuously aspirated completely and the stomach and anastomotic region are decompressed. At the same time, nutrition is delivered via an integrated intestinal tube. Depending on the results of the endoscopic control after 5 days, PARD is either continued or terminated.

Results: During the observation period (2017-2023), PARD was used in all patients (n = 43) with ILE. The healing rate under PARD was 100% and healing was observed in all anastomoses. No additional endoscopic procedures or surgical revisions of the anastomoses were required. The median duration of PARD was 8 days (range 4-21). We observed problems in the healing of the anastomosis in 20 of 43 patients (47%) for whom we defined endoscopic criteria for at-risk anastomosis.

Conclusions: Our results suggest that PARD has a strong protective effect on anastomotic healing and may reduce the risk of anastomotic insufficiency. The integrated feeding tube of the dOFD allows early postoperative enteral feeding while simultaneously applying negative pressure. PARD appears to prevent the negative consequences of impaired anastomotic healing.

Advances in telemedicine, exemplified by augmented reality (AR) and virtual reality (VR), are rapidly progressing. For instance, AR available over long distances has already been successfully utilized in crisis intervention, such as in war zones. The potential of telemedicine also appears promising in structurally weak areas or in the involvement of experts in emergency situations. Further research and development are needed on the avatars used in such telemedicine approaches to improve the sense of presence and thereby increase acceptance. Artificial intelligence (AI) in endoscopy, particularly in colonoscopy, is already a routine practice in many gastroenterology departments. The benefits are clearly evidenced by an increased adenoma detection rate (ADR). Studies have also shown a higher detection rate for sessile serrated adenomas (SSA) compared to the control group as well as a significantly increased rate of dysplastic Barrett's areas in the upper gastrointestinal (GI) tract (potential Barrett's carcinomas).

The term cholangiocarcinoma (CCA) includes a group of malignant tumors that develop in the efferent bile ducts and are characterized by a high degree of heterogeneity. These differences between intrahepatic, perihilar and distal CCAs run through all aspects of the disease including the etiology, pathogenesis, symptoms, diagnostics and treatment. This review article presents the current developments in this field of diseases. We highlight surgical innovations in the clinical routine and the application of new systemic forms of treatment to augment the oncological radicality of surgery.

University teaching is undergoing radical changes. Rising student numbers and the progressive digitalization of routine daily life are also leading to the testing of various new teaching and learning formats. This article provides an overview of the reasons for and approaches used to effectively and efficiently organize teaching of anatomy using digital learning methods and to fulfil the expectations of students.

The oncological standard for curative treatment of non-metastasized gastric cancer is surgical resection with systematic D2 lymphadenectomy. Early stage carcinomas (pT1a) with circumscribed prerequisites are an exception as they can be endoscopically resected; however, by infiltration of invasive gastric cancer into submucosal layers (pT1b) the risk for lymph node metastases is up to 25-28%. Due to the lack of screening programs in the western world, most gastric cancers are diagnosed in an advanced stage and the treatment is multimodal with perioperative multiple chemotherapy and increasingly more also with immunotherapy. Nevertheless, despite multidisciplinary treatment strategies, the benefits of surgical resection and an adequate systematic lymphadenectomy are still independent prognostic factors for long-term survival; however, the classification and extent of the lymphadenectomy are regularly updated, especially as a result of the spread of minimally invasive operations, and in addition are internationally evaluated differently. In the context of perioperative morbidity and oncological outcome this includes the approach with respect to individual lymph node stations, especially lymph node stations 10 and 12a and in addition the classification D1-D3. Furthermore, continuous modifications, particularly from Asia, such as sentinel lymph node resection underline the pursuit of improvements. The multitude of alterations in the context of multidisciplinary treatment concepts and the international heterogeneity make the evaluation of the value of individual surgical aspects noticeably more difficult.