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

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.

Variation of the main branches of the abdominal aorta is not uncommon and its spectrum is broad. However, here we present the supradiaphragmatic origin of the coeliac artery, superior mesenteric artery, and bilateral renal arteries - a variation that has not been reported previously in the literature.

Introduction: Four-dimensional computed tomography (4DCT) has emerged as an effective imaging modality to aid parathyroid localisation before surgery. Following a service change in 2018, we evaluated the accuracy of 4DCT to lateralise culprit parathyroid glands causing primary hyperparathyroidism (PHPT) in patients undergoing parathyroid surgery in our centre.

Methods: A total of 117 patients underwent 4DCT before parathyroidectomy for PHPT in NHS Grampian between March 2018 and January 2023, of whom 112 underwent first-time operations. Results of imaging, histopathology and surgery type along with biochemical follow-up were evaluated retrospectively to assess the sensitivity and specificity of 4DCT imaging.

Results: In our centre, 4DCT imaging showed results comparable with those reported previously, with 77.6% sensitivity to lateralise to one side of the neck, 89.1% specificity and an overall accuracy of 83.5%. A total of 58% of patients underwent targeted parathyroidectomy. At three- to six-month follow-up, 94.5% had achieved biochemical cure; 4DCT identified culprit lesions in four out of five patients undergoing reoperation. Age and corrected calcium did not affect accuracy of 4DCT.

Conclusions: 4DCT is an effective first-line imaging modality before first-time parathyroidectomy for PHPT in patients aged >60 years as well as in cases of reoperation. Use as the first-line imaging modality in younger patients may reduce overall radiation exposure by minimising the need for additional imaging, but further study is needed in this age group.

The US National Aeronautics and Space Administration (NASA) will be familiar to most across the world. Leading highly dangerous and innovative space travel, NASA has gone from a blame culture in the 1960s to an environment that keeps safety at the forefront and a top priority. NASA culture aims to ensure that staff work safely through balancing challenges and risks, feel comfortable communicating safety issues and learn from both successes and error. Surgery, and healthcare in general, still has a long way to go to embed a safety culture that values staff and looks at why incidents and errors have happened, and what can be learnt from them, instead of who was to blame. NASA's safety journey is a powerful study in learning from failure, evolving culture and leading with humility. From the Apollo 1, Challenger and Columbia disasters, NASA built a more transparent, accountable and resilient safety system and one that continues to evolve with the frontiers of space exploration. In many ways, surgeons can learn a lot from NASA to improve both patient safety and culture.

Introduction: Right hemicolectomy has evolved from open to minimally invasive approaches. Laparoscopic right hemicolectomy (LRH) is widely adopted, yet challenges persist, particularly in complex dissections. Robotic right hemicolectomy (RRH) offers enhanced precision and ergonomics but remains under scrutiny for its comparative advantages. This study critically evaluates the perioperative outcomes of LRH vs RRH within a single-centre framework.

Methods: A retrospective cohort analysis was carried out at a single tertiary institution, reviewing all RRH cases from January 2021 to December 2024 and comparing them with the most recent LRH cases. Inclusion criteria encompassed adults undergoing elective right hemicolectomy for confirmed malignancy; patients with recurrent disease or emergency indications were excluded. Demographics, tumour characteristics, operative details and short-term outcomes were compared using appropriate statistical tests.

Results: The baseline demographics were comparable between the groups. Transverse colon tumours were more frequent in the RRH group (n = 15, 37.5%) than in the LRH group (n = 2, 5%) (p = 0.003). The mean operative time was comparable in both groups (219.9mi in RRH vs 206.8min in LRH; p = 0.277). RRH demonstrated significantly reduced blood loss (24 vs 50.1 m; p < 0.001), earlier return of bowel function (1.9 vs 2.6 days; p = 0.004), and a reduced hospital stay (3.5 vs 6.1 days; p = 0.001). Lymph node yield was comparable.

Conclusion: RRH offers measurable benefits in recovery and haemostasis as compared with LRH. It offers equivalent short-term oncological outcomes without prolonging the operative time. Our findings suggest RRH may be preferable for anatomically complex cases. Larger, prospective studies with a long-term follow-up period are therefore indicated.