Pub Date : 2025-08-05DOI: 10.1016/j.sipas.2025.100299
Frank Davis, Oscar Atkinson, Marwan El-Sayed, Abdel Rahman Saad, Riem Johnson
Background
Historically, there have been concerns that reusable gowns may increase post operative infection rate, though more recent literature does not support this. The Sussex Orthopaedic Treatment Centre’s (SOTC) hand unit introduced reusable gowns in hand surgery and evaluated infection rates before and after implementation. Their adoption could provide economic and environmental benefits for the NHS.
Methods
A retrospective analysis compared infection rates in 396 hand surgeries. A two month period of disposable gowns was compared with a two month period of reusable gowns.
Results
Infection rates were 1.58 % (3/190) pre-intervention and 1.94 % (4/206) post-intervention. All cases were managed with oral antibiotics, with no reoperations.
Discussion
This small study shows that our infection rates align with that of current literature that reusable gowns do not increase infection rates. Their environmental benefits support adoption, and addressing misconceptions is key to implementation.
{"title":"Evaluating the impact of reusable gowns on postoperative infection rates in hand surgery","authors":"Frank Davis, Oscar Atkinson, Marwan El-Sayed, Abdel Rahman Saad, Riem Johnson","doi":"10.1016/j.sipas.2025.100299","DOIUrl":"10.1016/j.sipas.2025.100299","url":null,"abstract":"<div><h3>Background</h3><div>Historically, there have been concerns that reusable gowns may increase post operative infection rate, though more recent literature does not support this. The Sussex Orthopaedic Treatment Centre’s (SOTC) hand unit introduced reusable gowns in hand surgery and evaluated infection rates before and after implementation. Their adoption could provide economic and environmental benefits for the NHS.</div></div><div><h3>Methods</h3><div>A retrospective analysis compared infection rates in 396 hand surgeries. A two month period of disposable gowns was compared with a two month period of reusable gowns.</div></div><div><h3>Results</h3><div>Infection rates were 1.58 % (3/190) pre-intervention and 1.94 % (4/206) post-intervention. All cases were managed with oral antibiotics, with no reoperations.</div></div><div><h3>Discussion</h3><div>This small study shows that our infection rates align with that of current literature that reusable gowns do not increase infection rates. Their environmental benefits support adoption, and addressing misconceptions is key to implementation.</div></div><div><h3>Evidence level</h3><div>2b (Retrospective Cohort).</div></div>","PeriodicalId":74890,"journal":{"name":"Surgery in practice and science","volume":"24 ","pages":"Article 100299"},"PeriodicalIF":0.8,"publicationDate":"2025-08-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146173542","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-08-05eCollection Date: 2025-09-01DOI: 10.1016/j.sipas.2025.100301
Jiajie Yan, Shuangshuang Deng, Qiuyan Chen, Ning Liu, Songwei Huan, Min Zheng, Jiamin Zhang, Yanyan Gao
Background and objective: Anterior knee pain (AKP) remains a prevalent complication following total knee arthroplasty (TKA), affecting 4-60 % of patients. While robot-assisted TKA (RA-TKA) has demonstrated superior precision in prosthesis alignment compared to conventional manual TKA in the medium- and long-term, its impact on postoperative AKP remains underexplored. This study aimed to evaluate the medium- and long-term effects of RA-TKA on AKP intensity, functional outcomes, and knee mobility compared to CM-TKA.
Methods: In this retrospective cohort study, obese patients undergoing primary TKA for Kellgren-Lawrence grade 4 osteoarthritis between 2020 and 2023 were included. Propensity score matching balanced preoperative confounders, yielding 88 matched pairs (RA-TKA vs. CM-TKA). Outcomes included AKP intensity (Numeric Rating Scale, NRS), Knee Society Score (KSS), and active knee flexion/extension measured at 3, 6, 9, and 12 months postoperatively.
Results: The RA-TKA group exhibited significantly lower AKP intensity at 3 months (17.5 ± 8.1 vs. 24.6 ± 10.7, p = 0.034), with no between-group differences thereafter. At 12 months, RA-TKA demonstrated superior KSS (41.5 ± 6.2 vs. 34.4 ± 5.6, p = 0.042), and knee flexion (110.3 ± 11.8° vs. 107.5 ± 12.5°, p = 0.044) and extension (3.6 ± 1.4° vs. 4.1 ± 1.5°, p = 0.020). AKP peaked at 3 months in both groups, with similar temporal trends postoperatively after surgery 6 months.
Conclusion: RA-TKA demonstrated better short-term improvement in both AKP and knee functional capacity compared to standard total knee arthroplasty, and the improvements of knee flexion and extension are significant advantages. Although RA-TKA showed comparable long-term outcomes in knee function and AKP risk assessment to conventional surgery, its clinical significance lies in the critical early postoperative period when over 80 % of AKP events occur within the first 3 months.
{"title":"Postoperative anterior knee pain in robot assisted total knee arthroplasty: a propensity score matching analysis.","authors":"Jiajie Yan, Shuangshuang Deng, Qiuyan Chen, Ning Liu, Songwei Huan, Min Zheng, Jiamin Zhang, Yanyan Gao","doi":"10.1016/j.sipas.2025.100301","DOIUrl":"10.1016/j.sipas.2025.100301","url":null,"abstract":"<p><strong>Background and objective: </strong>Anterior knee pain (AKP) remains a prevalent complication following total knee arthroplasty (TKA), affecting 4-60 % of patients. While robot-assisted TKA (RA-TKA) has demonstrated superior precision in prosthesis alignment compared to conventional manual TKA in the medium- and long-term, its impact on postoperative AKP remains underexplored. This study aimed to evaluate the medium- and long-term effects of RA-TKA on AKP intensity, functional outcomes, and knee mobility compared to CM-TKA.</p><p><strong>Methods: </strong>In this retrospective cohort study, obese patients undergoing primary TKA for Kellgren-Lawrence grade 4 osteoarthritis between 2020 and 2023 were included. Propensity score matching balanced preoperative confounders, yielding 88 matched pairs (RA-TKA vs. CM-TKA). Outcomes included AKP intensity (Numeric Rating Scale, NRS), Knee Society Score (KSS), and active knee flexion/extension measured at 3, 6, 9, and 12 months postoperatively.</p><p><strong>Results: </strong>The RA-TKA group exhibited significantly lower AKP intensity at 3 months (17.5 ± 8.1 vs. 24.6 ± 10.7, <i>p</i> = 0.034), with no between-group differences thereafter. At 12 months, RA-TKA demonstrated superior KSS (41.5 ± 6.2 vs. 34.4 ± 5.6, <i>p</i> = 0.042), and knee flexion (110.3 ± 11.8° vs. 107.5 ± 12.5°, <i>p</i> = 0.044) and extension (3.6 ± 1.4° vs. 4.1 ± 1.5°, <i>p</i> = 0.020). AKP peaked at 3 months in both groups, with similar temporal trends postoperatively after surgery 6 months.</p><p><strong>Conclusion: </strong>RA-TKA demonstrated better short-term improvement in both AKP and knee functional capacity compared to standard total knee arthroplasty, and the improvements of knee flexion and extension are significant advantages. Although RA-TKA showed comparable long-term outcomes in knee function and AKP risk assessment to conventional surgery, its clinical significance lies in the critical early postoperative period when over 80 % of AKP events occur within the first 3 months.</p>","PeriodicalId":74890,"journal":{"name":"Surgery in practice and science","volume":"22 ","pages":"100301"},"PeriodicalIF":0.8,"publicationDate":"2025-08-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12357315/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144877132","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-07-24DOI: 10.1016/j.sipas.2025.100298
Lana Othman Mahmmud , Vilhelmas Bartusevicius , Åke Norberg , Poya Ghorbani , Jonathan Grip
Background
Lactate is often elevated following major pancreatic surgery but the clinical relevance of this it not known.
Methods
A retrospective study including 491 consecutive patients undergoing major pancreatic surgery. Lactate upon arrival to post anaesthesia unit (L0), the morning following surgery (LPOD1) and the highest value within those two time points (LHigh) were examined. The primary outcome was postoperative complications (Clavien-Dindo IIIa-V) and the secondary outcomes were surgery specific complications and hospital length of stay.
Results
Median lactate values were: L01.7 mmol/L (IQR: 1.2 –2.6), LPOD11.3 mmol/L (IQR: 0.9 –1.9) and LHigh 2.3 mmol/L (IQR 1.7 –3.1). There were no differences in lactate values at any measuring point between those developing complications and those that didn´t. AUROC analysis (0.531–0.581) and Youden´s index (0.08–0.17) indicated poor diagnostic performance. LHigh > 2.65 mmol/L was associated with Odds ratio 2.05 (1.34 –3.14) for developing postoperative complications. Plasma lactate was higher following total pancreatectomy compared to partial resection at all three time points.
Discussion
Plasma lactate elevation in common following pancreatic surgery; however, this is of limited clinical use to predict complications. The relatively higher lactate following total pancreatectomy might be due to hormonal deficits inherent to this procedure.
{"title":"Frequency of lactate elevation following pancreatic surgery and its relationship to postoperative complications","authors":"Lana Othman Mahmmud , Vilhelmas Bartusevicius , Åke Norberg , Poya Ghorbani , Jonathan Grip","doi":"10.1016/j.sipas.2025.100298","DOIUrl":"10.1016/j.sipas.2025.100298","url":null,"abstract":"<div><h3>Background</h3><div>Lactate is often elevated following major pancreatic surgery but the clinical relevance of this it not known.</div></div><div><h3>Methods</h3><div>A retrospective study including 491 consecutive patients undergoing major pancreatic surgery. Lactate upon arrival to post anaesthesia unit (L<sub>0</sub>), the morning following surgery (L<sub>POD1</sub>) and the highest value within those two time points (L<sub>High</sub>) were examined. The primary outcome was postoperative complications (Clavien-Dindo IIIa-V) and the secondary outcomes were surgery specific complications and hospital length of stay.</div></div><div><h3>Results</h3><div>Median lactate values were: L01.7 mmol/L (IQR: 1.2 –2.6), LPOD11.3 mmol/L (IQR: 0.9 –1.9) and L<sub>High</sub> 2.3 mmol/L (IQR 1.7 –3.1). There were no differences in lactate values at any measuring point between those developing complications and those that didn´t. AUROC analysis (0.531–0.581) and Youden´s index (0.08–0.17) indicated poor diagnostic performance. L<sub>High</sub> > 2.65 mmol/L was associated with Odds ratio 2.05 (1.34 –3.14) for developing postoperative complications. Plasma lactate was higher following total pancreatectomy compared to partial resection at all three time points.</div></div><div><h3>Discussion</h3><div>Plasma lactate elevation in common following pancreatic surgery; however, this is of limited clinical use to predict complications. The relatively higher lactate following total pancreatectomy might be due to hormonal deficits inherent to this procedure.</div></div>","PeriodicalId":74890,"journal":{"name":"Surgery in practice and science","volume":"22 ","pages":"Article 100298"},"PeriodicalIF":0.8,"publicationDate":"2025-07-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144750562","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-07-23DOI: 10.1016/j.sipas.2025.100297
QingDa Wang, LouZong Sun, GuiGang Qiu, Nan Yang
Background
Laparoscopic cholecystectomy (LC) has been established as the gold standard for gallstone treatment due to its minimal invasiveness and rapid recovery. Despite the low incidence of complications after LC, postoperative incisional infections have received widespread attention from surgeons. This study aimed to evaluate whether pressurized incision dressing could reduce the occurrence of incisional infections.
Methods
This study retrospectively analyzed 396 patients diagnosed with gallbladder stones who underwent LC at our institution between January 2022 and December 2023. Patients were divided into standard dressing group A (n=200) and pressurized dressing group B (n=196) based on different postoperative incisional treatments. Clinical outcomes were compared between the two groups. Additionally, subset analyses were conducted on patients with BMI ≥30 kg/m2 and acute cholecystitis (AC) to further evaluate the differences in clinical outcomes with or without pressurized incision dressing.
Results
The incisional infection rate was 8.0 % (16/200) in the standard dressing group A and 6.1 % (12/196) in the pressurized dressing group B, with no significant difference. Among patients with BMI ≥30 kg/m2, no significant difference in incisional infection rate was observed between standard dressing group A1 and pressurized dressing group B1 (P=0.52). However, in patients with AC, pressurized incision dressing significantly reduced the incisional infection rate (23.7 % in the standard dressing group A2 vs. 9.8 % in the pressurized dressing group B2, P=0.04).
Conclusions
Pressurized incision dressing can reduce the incidence of incisional infection after LC in patients with AC.
{"title":"A retrospective study to investigate the effect of pressurized incision dressing on the occurrence of incisional infection after laparoscopic cholecystectomy","authors":"QingDa Wang, LouZong Sun, GuiGang Qiu, Nan Yang","doi":"10.1016/j.sipas.2025.100297","DOIUrl":"10.1016/j.sipas.2025.100297","url":null,"abstract":"<div><h3>Background</h3><div>Laparoscopic cholecystectomy (LC) has been established as the gold standard for gallstone treatment due to its minimal invasiveness and rapid recovery. Despite the low incidence of complications after LC, postoperative incisional infections have received widespread attention from surgeons. This study aimed to evaluate whether pressurized incision dressing could reduce the occurrence of incisional infections.</div></div><div><h3>Methods</h3><div>This study retrospectively analyzed 396 patients diagnosed with gallbladder stones who underwent LC at our institution between January 2022 and December 2023. Patients were divided into standard dressing group A (n=200) and pressurized dressing group B (n=196) based on different postoperative incisional treatments. Clinical outcomes were compared between the two groups. Additionally, subset analyses were conducted on patients with BMI ≥30 kg/m<sup>2</sup> and acute cholecystitis (AC) to further evaluate the differences in clinical outcomes with or without pressurized incision dressing.</div></div><div><h3>Results</h3><div>The incisional infection rate was 8.0 % (16/200) in the standard dressing group A and 6.1 % (12/196) in the pressurized dressing group B, with no significant difference. Among patients with BMI ≥30 kg/m<sup>2</sup>, no significant difference in incisional infection rate was observed between standard dressing group A<sub>1</sub> and pressurized dressing group B<sub>1</sub> (<em>P</em>=0.52). However, in patients with AC, pressurized incision dressing significantly reduced the incisional infection rate (23.7 % in the standard dressing group A<sub>2</sub> vs. 9.8 % in the pressurized dressing group B<sub>2</sub>, <em>P</em>=0.04).</div></div><div><h3>Conclusions</h3><div>Pressurized incision dressing can reduce the incidence of incisional infection after LC in patients with AC.</div></div>","PeriodicalId":74890,"journal":{"name":"Surgery in practice and science","volume":"22 ","pages":"Article 100297"},"PeriodicalIF":0.8,"publicationDate":"2025-07-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144750674","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-07-06DOI: 10.1016/j.sipas.2025.100294
Abdullah Riad , Majed Hadid , Adel Elomri , Ahmad Al-Ansari , Mohamed Amine Rejeb , Marwa Qaraqe , Sarada Parsad Dakua , Abdel Rahman Jaber , Abdulla Al-Ansari , Omar M. Aboumarzouk , Abdelfatteh EL Omri
Background
In recent years, Robot-Assisted Surgeries (RAS) have advanced significantly, revolutionizing healthcare with better patient outcomes, faster recovery times, and greater surgical accuracy. However, challenges such as restricted maneuverability and communication issues persist, along with the need to evaluate surgeons' proficiency in RAS. Healthcare 5.0 seeks to enhance RAS by integrating technologies like advanced imaging, haptic feedback, and artificial intelligence.
Objective
This paper explores the Operational Management of Robotic-Assisted Surgeries (OM-RAS) by analyzing recent research. It assesses surgical robotics operations, workflow optimization, performance enhancement, and skill assessment. Additionally, it examines challenges and gaps in the RAS domain, providing a comprehensive research overview.
Methods
A comprehensive literature search was conducted across databases such as Scopus, Web of Science, and Google Scholar, covering publications up to the third quarter of 2023. Search terms were selected using scientific criteria and validated by experts, resulting in a substantial document collection. A rigorous screening process, aligned with PRISMA 2020 standards, filtered the selection to 50 research papers, forming the foundation for detailed investigation.
Findings
OM-RAS is a multidimensional field influenced by emerging technologies that optimize workflows, enhance performance, and improve skill assessment in RAS. Despite superior outcomes, challenges such as implementation costs and seamless technology integration persist. Additionally, research gaps exist regarding RAS benefits, creating opportunities for efficiency enhancement in patient care. Further exploration of RAS procedure scheduling across different surgery types is essential.
Conclusion
Integrating advanced technologies into RAS has improved surgical outcomes, shortened hospital stays, and enhanced working environments. This study advocates for a holistic multi-criteria decision-making approach, considering factors like kinematics, imaging, Internet of Things/Tactile Internet (IoT/TI), and AI. It provides valuable insights, guiding future research and shaping OM-RAS studies.
近年来，机器人辅助手术（RAS）取得了显著进展，以更好的患者治疗效果、更快的恢复时间和更高的手术准确性彻底改变了医疗保健。然而，诸如受限的可操作性和沟通问题等挑战仍然存在，同时还需要评估外科医生对RAS的熟练程度。医疗保健5.0试图通过集成先进成像、触觉反馈和人工智能等技术来增强RAS。目的对机器人辅助手术（OM-RAS）的操作管理进行分析。它评估外科机器人操作，工作流程优化，性能增强和技能评估。此外，它还研究了RAS领域的挑战和差距，提供了一个全面的研究概述。方法对Scopus、Web of Science、b谷歌Scholar等数据库进行综合文献检索，检索截止到2023年第三季度的出版物。使用科学标准选择搜索词并由专家验证，从而产生大量文档集合。经过严格的筛选过程，符合PRISMA 2020标准，筛选出50篇研究论文，为详细调查奠定了基础。发现som -RAS是一个受新兴技术影响的多维领域，这些技术优化了RAS的工作流程，提高了性能，并改进了技能评估。尽管取得了优异的成果，但实施成本和无缝技术集成等挑战仍然存在。此外，关于RAS效益的研究存在差距，为提高患者护理效率创造了机会。进一步探索不同手术类型的RAS手术安排是必要的。结论将先进技术应用于RAS可改善手术效果，缩短住院时间，改善工作环境。本研究提倡一种整体的多标准决策方法，考虑运动学、成像、物联网/触觉互联网（IoT/TI）和人工智能等因素。它提供了有价值的见解，指导未来的研究和塑造OM-RAS研究。
{"title":"Advancements and challenges in robotic surgery: A holistic examination of operational dynamics and future directions","authors":"Abdullah Riad , Majed Hadid , Adel Elomri , Ahmad Al-Ansari , Mohamed Amine Rejeb , Marwa Qaraqe , Sarada Parsad Dakua , Abdel Rahman Jaber , Abdulla Al-Ansari , Omar M. Aboumarzouk , Abdelfatteh EL Omri","doi":"10.1016/j.sipas.2025.100294","DOIUrl":"10.1016/j.sipas.2025.100294","url":null,"abstract":"<div><h3>Background</h3><div>In recent years, Robot-Assisted Surgeries (RAS) have advanced significantly, revolutionizing healthcare with better patient outcomes, faster recovery times, and greater surgical accuracy. However, challenges such as restricted maneuverability and communication issues persist, along with the need to evaluate surgeons' proficiency in RAS. Healthcare 5.0 seeks to enhance RAS by integrating technologies like advanced imaging, haptic feedback, and artificial intelligence.</div></div><div><h3>Objective</h3><div>This paper explores the Operational Management of Robotic-Assisted Surgeries (OM-RAS) by analyzing recent research. It assesses surgical robotics operations, workflow optimization, performance enhancement, and skill assessment. Additionally, it examines challenges and gaps in the RAS domain, providing a comprehensive research overview.</div></div><div><h3>Methods</h3><div>A comprehensive literature search was conducted across databases such as Scopus, Web of Science, and Google Scholar, covering publications up to the third quarter of 2023. Search terms were selected using scientific criteria and validated by experts, resulting in a substantial document collection. A rigorous screening process, aligned with PRISMA 2020 standards, filtered the selection to 50 research papers, forming the foundation for detailed investigation.</div></div><div><h3>Findings</h3><div>OM-RAS is a multidimensional field influenced by emerging technologies that optimize workflows, enhance performance, and improve skill assessment in RAS. Despite superior outcomes, challenges such as implementation costs and seamless technology integration persist. Additionally, research gaps exist regarding RAS benefits, creating opportunities for efficiency enhancement in patient care. Further exploration of RAS procedure scheduling across different surgery types is essential.</div></div><div><h3>Conclusion</h3><div>Integrating advanced technologies into RAS has improved surgical outcomes, shortened hospital stays, and enhanced working environments. This study advocates for a holistic multi-criteria decision-making approach, considering factors like kinematics, imaging, Internet of Things/Tactile Internet (IoT/TI), and AI. It provides valuable insights, guiding future research and shaping OM-RAS studies.</div></div>","PeriodicalId":74890,"journal":{"name":"Surgery in practice and science","volume":"22 ","pages":"Article 100294"},"PeriodicalIF":0.6,"publicationDate":"2025-07-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144605310","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Radical cystectomy is the standard treatment for muscle-invasive bladder cancer (MIBC). This study presents the first analysis of open radical cystectomy (ORC) outcomes in Azerbaijan, where robotic surgery is unavailable.
Methods
We retrospectively analyzed 106 patients with non-metastatic MIBC who underwent ORC with bilateral pelvic lymph node dissection and Bricker ileal conduit reconstruction, performed by a single surgeon between 2014 and 2024. Demographic data, comorbidities, operative metrics (duration, blood loss), complications, length of stay, and follow-up data were analyzed.
Results
The cohort's mean age was 64.2 years (72.6 % male), with common comorbidities including hypertension (33 %), diabetes (33 %), and coronary artery disease (24.5 %). The median operative time was 300 min and blood loss was 450 mL. Postoperative complications occurred in 9.4 %, primarily urinary tract infections. No intraoperative complications or in-hospital mortalities occurred. Longer hospital stays were associated with advanced age (p < 0.001), higher body mass index (p = 0.042), longer operative time (p < 0.001), and increased blood loss (p = 0.008). Of all patients, 58.5 % were followed for a median of 71.3 months with no observed recurrences. There were three non-cancer related deaths.
Conclusion
This initial report from Azerbaijan demonstrates acceptable perioperative outcomes for ORC in MIBC, despite the absence of robotic surgery. Our findings emphasize optimizing surgical efficiency, comorbidity management, and strengthening follow-up to enhance patient outcomes in resource-limited settings.
{"title":"Single-surgeon outcomes of open radical cystectomy for muscle-invasive bladder cancer: Experience from a tertiary center in Azerbaijan","authors":"Rashad Sholan , Rufat Aliyev , Seymur Karimov , Jamal Musayev , Anar Almazkhanli , Rahman Ismayilov","doi":"10.1016/j.sipas.2025.100296","DOIUrl":"10.1016/j.sipas.2025.100296","url":null,"abstract":"<div><h3>Objective</h3><div>Radical cystectomy is the standard treatment for muscle-invasive bladder cancer (MIBC). This study presents the first analysis of open radical cystectomy (ORC) outcomes in Azerbaijan, where robotic surgery is unavailable.</div></div><div><h3>Methods</h3><div>We retrospectively analyzed 106 patients with non-metastatic MIBC who underwent ORC with bilateral pelvic lymph node dissection and Bricker ileal conduit reconstruction, performed by a single surgeon between 2014 and 2024. Demographic data, comorbidities, operative metrics (duration, blood loss), complications, length of stay, and follow-up data were analyzed.</div></div><div><h3>Results</h3><div>The cohort's mean age was 64.2 years (72.6 % male), with common comorbidities including hypertension (33 %), diabetes (33 %), and coronary artery disease (24.5 %). The median operative time was 300 min and blood loss was 450 mL. Postoperative complications occurred in 9.4 %, primarily urinary tract infections. No intraoperative complications or in-hospital mortalities occurred. Longer hospital stays were associated with advanced age (<em>p</em> < 0.001), higher body mass index (<em>p</em> = 0.042), longer operative time (<em>p</em> < 0.001), and increased blood loss (<em>p</em> = 0.008). Of all patients, 58.5 % were followed for a median of 71.3 months with no observed recurrences. There were three non-cancer related deaths.</div></div><div><h3>Conclusion</h3><div>This initial report from Azerbaijan demonstrates acceptable perioperative outcomes for ORC in MIBC, despite the absence of robotic surgery. Our findings emphasize optimizing surgical efficiency, comorbidity management, and strengthening follow-up to enhance patient outcomes in resource-limited settings.</div></div>","PeriodicalId":74890,"journal":{"name":"Surgery in practice and science","volume":"22 ","pages":"Article 100296"},"PeriodicalIF":0.6,"publicationDate":"2025-07-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144588485","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-07-02DOI: 10.1016/j.sipas.2025.100295
Nisha Narula , Shanen M. Mulles , Aziz M. Merchant , Kenechi Onwubalili , Lauren Cue , Michele Fiorentino , Nina Awan , Joseph B. Oliver , Dustin Cummings , Michael E. Shapiro , Anne C. Mosenthal , David H. Livingston , Nina E. Glass
Introduction
An emergency general surgery (EGS) service is a crucial component of care in a hospital. Current reviews of EGS focus on procedural-based or diagnosis-driven reviews of administrative data. However, patients evaluated by an EGS service may or may not undergo surgery. Therefore, we sought to determine the feasibility of maintaining an EGS registry to include those who do and do not undergo surgery and determine the contribution of nonoperative care to the service.
Methods
Demographic and clinical data for operative and nonoperative general surgery consult patients extracted from the local medical record were entered into a registry over 12 months from 2018 to 2019. We used descriptive statistics to demonstrate differences in demographics and clinical presentation between operative and nonoperative groups.
Results
1065 EGS patients were captured into the registry, only 40 % of whom required an operation. Insurance status and race/ethnicity were different between operative and nonoperative groups. Reasons for consultation varied broadly with the largest group (20 %) being for hepatopancreaticobiliary disease.
Discussion
Providing insight into the important contribution of nonoperative care on EGS burden, we present data from an institutional EGS registry. EGS registries can provide direction for future studies to guide optimal management of EGS patients, especially in resource-limited settings.
Conclusion
Maintaining registries poses challenges but given its importance and the need to determine the contribution of patients who do not undergo procedures to the service load, resources are necessary to ensure they continue.
{"title":"Emergency general surgery: The prevalence of non-operative consultations and importance of a registry","authors":"Nisha Narula , Shanen M. Mulles , Aziz M. Merchant , Kenechi Onwubalili , Lauren Cue , Michele Fiorentino , Nina Awan , Joseph B. Oliver , Dustin Cummings , Michael E. Shapiro , Anne C. Mosenthal , David H. Livingston , Nina E. Glass","doi":"10.1016/j.sipas.2025.100295","DOIUrl":"10.1016/j.sipas.2025.100295","url":null,"abstract":"<div><h3>Introduction</h3><div>An emergency general surgery (EGS) service is a crucial component of care in a hospital. Current reviews of EGS focus on procedural-based or diagnosis-driven reviews of administrative data. However, patients evaluated by an EGS service may or may not undergo surgery. Therefore, we sought to determine the feasibility of maintaining an EGS registry to include those who do and do not undergo surgery and determine the contribution of nonoperative care to the service.</div></div><div><h3>Methods</h3><div>Demographic and clinical data for operative and nonoperative general surgery consult patients extracted from the local medical record were entered into a registry over 12 months from 2018 to 2019. We used descriptive statistics to demonstrate differences in demographics and clinical presentation between operative and nonoperative groups.</div></div><div><h3>Results</h3><div>1065 EGS patients were captured into the registry, only 40 % of whom required an operation. Insurance status and race/ethnicity were different between operative and nonoperative groups. Reasons for consultation varied broadly with the largest group (20 %) being for hepatopancreaticobiliary disease.</div></div><div><h3>Discussion</h3><div>Providing insight into the important contribution of nonoperative care on EGS burden, we present data from an institutional EGS registry. EGS registries can provide direction for future studies to guide optimal management of EGS patients, especially in resource-limited settings.</div></div><div><h3>Conclusion</h3><div>Maintaining registries poses challenges but given its importance and the need to determine the contribution of patients who do not undergo procedures to the service load, resources are necessary to ensure they continue.</div></div>","PeriodicalId":74890,"journal":{"name":"Surgery in practice and science","volume":"22 ","pages":"Article 100295"},"PeriodicalIF":0.6,"publicationDate":"2025-07-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144588484","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-06-30DOI: 10.1016/j.sipas.2025.100293
Grace EM Kennedy , Ramy Rashed , Joshua Lau , Maham Khan , Mohammad Abdelmonem , Sathya Lakpriya , Bryony Ford , Ahmed El-Bakoury
Background and Aims
Posterior pelvic ring disruption has been associated with high-energy trauma, and significant morbidity and mortality. We aimed to determine functional and radiological outcomes following sacroiliac screw fixation of posterior pelvic ring injuries at a major trauma centre.
Methods
Patients who underwent sacroiliac screw fixation at our institution, between 1st January 2013 – 1st April 2020 were identified from a database. Electronic systems were accessed to obtain information regarding patient demographics, injuries sustained, and interventions performed. Patients were contacted via telephone regarding clinical outcomes (EQ5D3L, EQVAS and Majeed scores). Radiographical outcomes were assessed using the Keshishyan cross-measure method.
Results
115 patients were identified. The mean age at injury was 51.6 years (17–84 years). Most injuries resulted from falls and road traffic collisions (83.5 %). Eighty patients (69.6 %) sustained additional non-pelvic injuries and twenty-nine (25.2 %) underwent a non-pelvic procedure, most commonly limb or clavicle fracture fixation (N = 19). Thirty-day and 12-month all-cause mortality rates were 0.9 % and 1.7 %, respectively. Clinical outcomes were obtained for 82/105 possible patients (78.1 %). Regarding EQ5D3L, 36/82 patients (43.9 %) reported a full health status; only six patients reported severe problems. The mean Majeed score was 70.3. 49/59 patients (86.0 %) returned to their pre-injury employment. A significant association was found between the clinical outcomes (EQ5D3L index, EQVAS, Majeed score) and the pre-operative asymmetry value and deformity index but not the post-operative asymmetry value and deformity index. One patient (0.9 %) required revision for infection, 12 patients (10.4 %) reported post-operative lower limb paraesthesia, and one patient (0.9 %) experienced a post-operative deep vein thrombus.
Conclusions
Most patients with pelvic ring injuries experienced high-energy trauma, often resulting in multiple injuries and operative interventions. Nevertheless, mortality rates were low, and most patients experienced either mild or no functional difficulties. The magnitude of the pelvic deformity pre-operatively correlates with post-operative clinical scores.
{"title":"Functional and radiological outcomes following sacroiliac screw fixation of posterior pelvic ring injuries: A retrospective study","authors":"Grace EM Kennedy , Ramy Rashed , Joshua Lau , Maham Khan , Mohammad Abdelmonem , Sathya Lakpriya , Bryony Ford , Ahmed El-Bakoury","doi":"10.1016/j.sipas.2025.100293","DOIUrl":"10.1016/j.sipas.2025.100293","url":null,"abstract":"<div><h3>Background and Aims</h3><div>Posterior pelvic ring disruption has been associated with high-energy trauma, and significant morbidity and mortality. We aimed to determine functional and radiological outcomes following sacroiliac screw fixation of posterior pelvic ring injuries at a major trauma centre.</div></div><div><h3>Methods</h3><div>Patients who underwent sacroiliac screw fixation at our institution, between 1<sup>st</sup> January 2013 – 1<sup>st</sup> April 2020 were identified from a database. Electronic systems were accessed to obtain information regarding patient demographics, injuries sustained, and interventions performed. Patients were contacted via telephone regarding clinical outcomes (EQ5D3L, EQVAS and Majeed scores). Radiographical outcomes were assessed using the Keshishyan cross-measure method.</div></div><div><h3>Results</h3><div>115 patients were identified. The mean age at injury was 51.6 years (17–84 years). Most injuries resulted from falls and road traffic collisions (83.5 %). Eighty patients (69.6 %) sustained additional non-pelvic injuries and twenty-nine (25.2 %) underwent a non-pelvic procedure, most commonly limb or clavicle fracture fixation (<em>N</em> = 19). Thirty-day and 12-month all-cause mortality rates were 0.9 % and 1.7 %, respectively. Clinical outcomes were obtained for 82/105 possible patients (78.1 %). Regarding EQ5D3L, 36/82 patients (43.9 %) reported a full health status; only six patients reported severe problems. The mean Majeed score was 70.3. 49/59 patients (86.0 %) returned to their pre-injury employment. A significant association was found between the clinical outcomes (EQ5D3L index, EQVAS, Majeed score) and the pre-operative asymmetry value and deformity index but not the post-operative asymmetry value and deformity index. One patient (0.9 %) required revision for infection, 12 patients (10.4 %) reported post-operative lower limb paraesthesia, and one patient (0.9 %) experienced a post-operative deep vein thrombus.</div></div><div><h3>Conclusions</h3><div>Most patients with pelvic ring injuries experienced high-energy trauma, often resulting in multiple injuries and operative interventions. Nevertheless, mortality rates were low, and most patients experienced either mild or no functional difficulties. The magnitude of the pelvic deformity pre-operatively correlates with post-operative clinical scores.</div></div>","PeriodicalId":74890,"journal":{"name":"Surgery in practice and science","volume":"22 ","pages":"Article 100293"},"PeriodicalIF":0.6,"publicationDate":"2025-06-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144605309","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-06-15DOI: 10.1016/j.sipas.2025.100292
Sascha Vaghiri , Maria Chara Stylianidi , Laura Engelmann , Eslam Elmaghraby , Levent Dizdar , Wolfram Trudo Knoefel , Hermann Kessler , Dimitrios Prassas
Introduction
The optimal timing for Hartmann’s reversal remains a topic of ongoing debate. This study aimed to assess postoperative outcomes in patients undergoing early versus late Hartmann’s reversal at a tertiary academic center in Germany.
Methods
A single-center retrospective cohort study was conducted, including all patients who underwent Hartmann’s reversal between January 2008 and July 2020. Patients were stratified into early (ER) and late (LR) reversal groups using a median cut-off value of 159 days. Operative outcomes including major morbidity and overall postoperative complications were compared between both groups. Factors associated with major postoperative morbidity were detected using uni- and multivariate regression models.
Results
A total of 133 patients classified into the ER (n = 67, 50.38%) and LR (n = 66, 49.62%) groups were analyzed. There were no significant differences in overall morbidity (ER 56.72% versus LR 39.39%, p = 0.057) and major morbidity rates (Clavien-Dindo ≥ IIIa) (ER 28.36% versus LR 21.21%, p = 0.423) between both groups. On multivariate analysis, smoking (p = 0.006), chronic renal disease (p = 0.003) and anastomotic configuration (p = 0.003) were identified as significant factors contributing to major morbidity after Hartmann’s reversal.
Conclusion
Hartmann’s reversal is still associated with an increased risk of postoperative complications. However, timing of Hartmann’s reversal does not seem to influence postoperative morbidity. Of note, patient-related modifiable factors as well as the anastomotic configuration are important determinants of major complication occurrence.
{"title":"Reversal of Hartmann’s procedure: The impact of timing – a single-tertiary-center experience","authors":"Sascha Vaghiri , Maria Chara Stylianidi , Laura Engelmann , Eslam Elmaghraby , Levent Dizdar , Wolfram Trudo Knoefel , Hermann Kessler , Dimitrios Prassas","doi":"10.1016/j.sipas.2025.100292","DOIUrl":"10.1016/j.sipas.2025.100292","url":null,"abstract":"<div><h3>Introduction</h3><div>The optimal timing for Hartmann’s reversal remains a topic of ongoing debate. This study aimed to assess postoperative outcomes in patients undergoing early versus late Hartmann’s reversal at a tertiary academic center in Germany.</div></div><div><h3>Methods</h3><div>A single-center retrospective cohort study was conducted, including all patients who underwent Hartmann’s reversal between January 2008 and July 2020. Patients were stratified into early (ER) and late (LR) reversal groups using a median cut-off value of 159 days. Operative outcomes including major morbidity and overall postoperative complications were compared between both groups. Factors associated with major postoperative morbidity were detected using uni- and multivariate regression models.</div></div><div><h3>Results</h3><div>A total of 133 patients classified into the ER (n = 67, 50.38%) and LR (n = 66, 49.62%) groups were analyzed. There were no significant differences in overall morbidity (ER 56.72% versus LR 39.39%, p = 0.057) and major morbidity rates (Clavien-Dindo ≥ IIIa) (ER 28.36% versus LR 21.21%, p = 0.423) between both groups. On multivariate analysis, smoking (p = 0.006), chronic renal disease (p = 0.003) and anastomotic configuration (p = 0.003) were identified as significant factors contributing to major morbidity after Hartmann’s reversal.</div></div><div><h3>Conclusion</h3><div>Hartmann’s reversal is still associated with an increased risk of postoperative complications. However, timing of Hartmann’s reversal does not seem to influence postoperative morbidity. Of note, patient-related modifiable factors as well as the anastomotic configuration are important determinants of major complication occurrence.</div></div>","PeriodicalId":74890,"journal":{"name":"Surgery in practice and science","volume":"22 ","pages":"Article 100292"},"PeriodicalIF":0.6,"publicationDate":"2025-06-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144321728","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-06-06DOI: 10.1016/j.sipas.2025.100290
William Nkenguye
The application of Artificial Intelligence (AI) and Machine Learning (ML) in surgical care has significantly advanced healthcare delivery in high-income countries (HICs), yet remains underutilized in lower- and middle-income countries (LMICs). With a growing burden of surgical diseases, limited surgical expertise, and constrained healthcare resources, AI and ML offer transformative potential in optimizing surgical workflows, improving patient outcomes, and expanding access to specialized care. This manuscript explores the current status, challenges, and future prospects of AI and ML in surgical care for LMICs, emphasizing the critical need for investment, capacity building, and policy development to bridge the healthcare gap.
{"title":"Artificial intelligence in surgical care for low- and middle-income countries: Challenges, opportunities, and the path forward","authors":"William Nkenguye","doi":"10.1016/j.sipas.2025.100290","DOIUrl":"10.1016/j.sipas.2025.100290","url":null,"abstract":"<div><div>The application of Artificial Intelligence (AI) and Machine Learning (ML) in surgical care has significantly advanced healthcare delivery in high-income countries (HICs), yet remains underutilized in lower- and middle-income countries (LMICs). With a growing burden of surgical diseases, limited surgical expertise, and constrained healthcare resources, AI and ML offer transformative potential in optimizing surgical workflows, improving patient outcomes, and expanding access to specialized care. This manuscript explores the current status, challenges, and future prospects of AI and ML in surgical care for LMICs, emphasizing the critical need for investment, capacity building, and policy development to bridge the healthcare gap.</div></div>","PeriodicalId":74890,"journal":{"name":"Surgery in practice and science","volume":"22 ","pages":"Article 100290"},"PeriodicalIF":0.6,"publicationDate":"2025-06-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144291439","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
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