Annals of the Royal College of Surgeons of England最新文献

Introduction: Patients with recurrent respiratory papillomatosis (RRP) require frequent surgical removal of benign growths in the airway to maintain patency. This study aimed to investigate the impact of the COVID-19 pandemic on these patients, by monitoring their care and outcomes before and after the pandemic.

Methods: Participants were children or adults diagnosed with RRP, receiving treatment within an acute National Health Service hospital in the United Kingdom, registered with the Airway Intervention Registry. Data were captured between 1 April 2018 and 31 March 2022 (2 years pre- and post-COVID-19). Records for a subgroup of patients treated in England were linked to routine administrative data (Hospital Episode Statistics) for additional follow-up. Frequency of hospital visits, method of admission, type of surgical intervention, complications, disease severity (Derkay score) and voice quality were monitored.

Results: There was a reduction in RRP surgery frequency post COVID-19. The reporting clinician noted an intervention delay caused by COVID-19 in 11.8% of cases, and in half of those the treating clinician noted that the delay had resulted in worse symptoms. Despite this, disease severity remained relatively stable in both children and adults, as demonstrated by the Derkay and voice quality scores.

Conclusions: Patients with RRP experienced a reduction in surgical intervention post COVID-19. Although disease severity appeared overall stable within the study period, the long-term impact of changing surgical management of RRP patients in terms of voice quality and quality of life remain uncertain.

Introduction: Informed consent is fundamental to oncological surgery, but communication is often hindered by medical terminology, inconsistent explanations and variation in patient understanding. Large language models may improve accessibility by generating simplified consent information. This study assessed whether four leading artificial intelligence (AI) chatbots, ChatGPT (GPT-4), Gemini (2.5 Flash), DeepSeek (R1) and Grok (3) could generate information understandable to patients and comprehensive enough to support informed consent for six common oncological operations.

Methods: Standardised patient-style prompts were applied, and chatbot outputs were evaluated for readability using the Flesch Reading Ease Score (FRES), Flesch-Kincaid Grade Level (FKGL) and Gunning Fog Index (GF). Quality and completeness, including coverage of procedure details, risks, benefits, alternatives and consequences of no treatment, were assessed by three consultant surgeons using a modified DISCERN instrument.

Results: Gemini produced the highest quality information (mean DISCERN 72.3 ± 3.0), followed by Grok (63.0 ± 1.8), whereas ChatGPT (48.0 ± 4.7) and DeepSeek (47.1 ± 1.8) performed less well. DeepSeek generated the most readable content (FKGL 9.7; GF 10.8), although no model achieved the recommended sixth-grade level. Common limitations included the lack of systematic referencing (except Gemini), occasional factual inaccuracies, reliance on predominantly US-based resources, and failure to assess patient understanding.

Conclusion: Overall, AI chatbots can provide structured, accessible information to support surgical consent, but current limitations restrict their use as standalone tools. Gemini demonstrated the strongest balance of readability and quality, yet all models require refinement to improve reliability, equity, and patient safety. At present, AI should complement, rather than replace, clinician-led consent discussions.

Introduction: This study evaluated the efficacy and safety of Foley catheter balloon tamponade (FCBT) for actively bleeding penetrating neck injuries (PNI), focusing on rates of haemostatic success, subsequent surgical exploration, morbidity and mortality associated with FCBT in PNI.

Methods: A systematic search of Medline/PubMed, Embase, CINAHL and the Cochrane Library was conducted to 29 May 2025. Observational studies reporting FCBT outcomes in actively bleeding PNI were included. Pooled proportions were calculated with random effects models using Freeman-Tukey double-arcsine transformation; heterogeneity was explored with subgroup analysis and meta-regression. Study quality was assessed using the ROBINS-I tool.

Findings: Nine studies (1,658 participants) were included. FCBT was deployed in 236 cases, yielding a pooled rate of use of 27.85% (95% confidence interval [CI] 2.27 to 64.60, I² = 97%, p < 0.01). Primary haemostasis was achieved in 62.50% to 100% across studies, with most series reporting success rates exceeding 80.00%. In total, 53.47% (95% CI 16.97 to 88.27, I² = 61%, p = 0.0360) underwent surgical exploration, most often for major vascular injury or rebleeding at removal. Pooled morbidity and mortality were 11.70% (95% CI 0.00 to 50.47) and 6.30% (95% CI 0.00 to 19.97), respectively.

Conclusions: FCBT is a simple, rapid technique that achieves temporary haemorrhage control in PNI, providing a bridge to definitive surgical control, and may be effective as definitive treatment in selected venous injuries. However, pooled data are limited by heterogeneity in catheter size, balloon inflation and dwell time, restricting interpretability. Standardised multicentre prospective studies are needed to refine indications, optimise technique, and quantify complications.

Introduction: The UK Foundation Programme bridges the gap between medical school and specialty training and should be designed to provide opportunities that make Foundation Doctors (FDs) competitive. These opportunities are afforded in part through study leave. Health Education England (HEE) guidelines detail study leave allowances, but the specifics of what study leave can be used for differs regionally. We investigated differences in study leave across Foundation Schools by comparing individually published guidelines.

Methods: FDs in each Foundation School were used to identify the 2024-2025 study leave guidelines in their respective Foundation School and completed a survey. These data were then independently verified by two authors.

Results: Every Foundation School was compliant with minimum HEE guidelines on study leave. Some Schools allowed twice as many taster days (five versus ten). Every School allowed leave for specialty exams, conferences and courses in Foundation Year 2 (FY2), but limited Schools allowed this in FY1. Most Schools had an undefined study budget, but London allowed up to £1,000, whereas Yorkshire and Humber provided funding only in exceptional circumstances.

Conclusions: Every Foundation School complies with HEE outline guidance for study leave utilisation. However, large geographical discrepancies remain in the level of funding provided to FDs and the majority of leave is limited to FY2, leaving only 106 days for this to be useful towards specialty applications. This highlights a shortfall in the opportunities provided to early career doctors and may impact their ability to make successful applications postfoundation training.

Optilume is a novel drug-coated balloon (DCB) that combines mechanical urethral dilatation with localised delivery of paclitaxel, an anti-proliferative agent aimed at reducing stricture recurrence. We report a rare complication in a 49-year-old man who had a urethral stricture treated with buccal mucosal graft urethroplasty abroad 6 years ago, followed by recurrence of ∼3cm mid-bulbar urethral stricture managed at another hospital with Optilume balloon dilatation. Post-procedure, he developed recurrent episodes of significant urethral bleeding needing multiple visits to the emergency unit. Subsequently, a computed tomography angiogram revealed an active arterial haemorrhage in the base of the penis, most likely arising from the left internal pudendal artery. The bleeding was successfully managed with super-selective embolisation using microcoils, preserving surrounding vascular structures. This case highlights the potential for serious vascular injury with DCB use and underscores the importance of preoperative counselling, careful technique and close postoperative monitoring. It further emphasises the role of microcoil embolisation as a targeted and effective approach for controlling complex urethral bleeding.

Introduction: Artificial urinary sphincter (AUS) is a guideline-recommended treatment for male stress urinary incontinence. Despite its widespread use, it is thought that there is no standardisation in AUS practice. This study aims to report current AUS insertion practices in the UK and highlight any discrepancies.

Methods: A REDCap survey was conducted under the British Association of Urological Surgeons (BAUS) Section of Female, Neurological, and Urodynamic Urology, and reported using the CHERRIES checklist. Outcomes were framed using the International Continence Society (ICS) document and recent BAUS consensus document.

Results: The survey received 34 responses (response rate: 44-94%). Most respondents (80%) used video-urodynamics and patient-reported outcomes in patient workup. Loss of compliance on urodynamics was the most common contraindication, and detrusor overactivity was often treated before AUS surgery. Perioperative preparation and implantation techniques varied significantly from the ICS document, as did complication management.

Conclusions: The reported variation may result from local or national influences, a lack of high-quality evidence and divergent surgical training. This variability impacts the heterogeneity of outcomes and their reporting. Future efforts should focus on adopting the new national consensus to standardise practice, improving training curricula, researching the effects of variability on surgical outcomes and enhancing the quality of evidence in this field.

Introduction: Nasal obstruction secondary to septal deformity is a common problem, for which surgery is the gold-standard treatment. Long waiting times for surgery, however, leave patients in need of effective, patient-led strategies in the interim. Many wearable nasal devices are commercially available for patients to help relieve nasal obstruction while waiting for surgery; however, the literature around their efficacy is limited.

Methods: A scoping review of the literature was conducted using Medline, Embase, PubMed and Cochrane Library. This was in accordance with the 2018 PRISMA (Preferred Reporting Items for Systematic reviews and Meta Analyses) extension for scoping reviews (PRISMA-ScR).

Results: A total of 186 records were identified from the search, of which 13 met the inclusion criteria. Most studies assessed external nasal devices, in particular the Breathe Right nasal strips, with fewer assessing internal nasal devices. Both devices appear to relieve nasal obstruction; however, objective and subjective outcomes demonstrated greater relief with internal nasal devices. Data on long-term effects were limited.

Conclusions: Nasal valve devices, in particular internal nasal devices, appear to be an effective and accessible method of relieving nasal obstruction. In patients struggling with symptoms and awaiting surgery, these devices could be recommended by clinicians to offer relief in the interim. Further studies on emerging devices such as magnetic nasal strips, which theoretically could be more comfortable to wear, are needed to allow clinicians to fully counsel patients on potential options for treatment.