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Near-infrared fluorescence imaging improves resection outcomes in liver surgery

Post author By STITCHES Newsletter
Post date 12/12/2024
Categories In General Surgery, HPB & Spleen

Laparoscopic hepatectomy utilizing near-infrared fluorescence imaging significantly enhanced tumor identification, identifying over 59% of tumors on the liver surface. The technique yielded a remarkable 96.6% clear resection margins among patients with colorectal liver metastases. Furthermore, no tumor cells were found in 21.3% of cases analyzed, with a median continuous fluorescent signal distance from the tumor margin measuring 1.074 mm. These findings suggest improved intraoperative tumor visibility and margin assurance, potentially reducing positive resection margins.

Journal Article by Kato T, Imamura M (…) Takemasa I et 6 al. in Surg Laparosc Endosc Percutan Tech

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Prehabilitation enhances recovery in surgical oncology patients.

Post author By STITCHES Newsletter
Post date 11/12/2024
Categories In General Surgery, Perspectives, Opinions and Curiosities

Prehabilitation significantly improves functional capacity and reduces postoperative complications in surgical oncology patients undergoing major abdominal surgery. An analysis of 27 studies involving 2532 patients found a mean difference of 28.32 meters in the 6-minute walk distance for those who underwent prehabilitation. It also showed lower odds of postoperative complications (OR 0.60). Multimodal prehabilitation was particularly effective, yielding greater functional capacity improvements (37.35m vs 13.38m) and reduced complication rates.

Review by Soh NH, Yau CRZ (…) Wong JSM et 11 al. in Ann Surg Oncol

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Early discharge after ostomy construction does not increase readmission rates.

Post author By STITCHES Newsletter
Post date 11/12/2024
Categories In General Surgery, Intestine and Lower Gastrointestinal Tract

A study analyzed 13,628 patients undergoing ostomy construction, revealing that early discharge within 1-2 days did not significantly increase 30-day readmission rates compared to discharges of 3-5 days. Readmission rates were 13.6% for expedited discharges versus 14.2% for nonexpedited, with no significant difference found after adjusting for various factors. These findings provide support for expedited discharge in selected patients, suggesting that careful patient selection mitigates risks associated with early discharge.

Journal Article by Burge KG, Sheffer HF (…) Hollis RH et 3 al. in BMC Surg

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Trained medical students can effectively assess surgical quality

Post author By STITCHES Newsletter
Post date 11/12/2024
Categories In General Surgery, Intestine and Lower Gastrointestinal Tract

Trained medical students demonstrated excellent reliability in evaluating minimally invasive right hemicolectomy videos, achieving an intraclass correlation coefficient of 0.885. When combined with expert colorectal surgeons’ scores, the inter-rater reliability increased to 0.945. These trained students accurately identified lower quality surgeries, while untrained students assigned higher scores to poorer quality surgeries. The findings suggest that medical students, after proper training, can contribute to objective assessments of surgical quality alongside professionals.

Journal Article by Grüter AAJ, Toorenvliet BR, Tanis PJ and Tuynman JB in BMC Surg

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Partial splenic embolization improves outcomes for cancer patients.

Post author By STITCHES Newsletter
Post date 11/12/2024
Categories In General Surgery, HPB & Spleen

Research indicates that partial splenic embolization (PSE) significantly enhances platelet counts and reduces complications for cancer patients suffering from hypersplenism. Optimal splenic infarction volumes of 388 to 540 ml are essential for achieving these benefits. In cases of massive splenomegaly, the noninfarcted spleen volume is crucial. Additionally, combining PSE with systemic chemotherapy shows promise in prolonging progression-free survival for those with hepatocellular carcinoma while also improving liver function and activating immune responses.

Review by Beppu T, Masuda T, Imai K and Hayashi H in Hepatol Res

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Indocyanine green significantly lowers anastomotic leak risk.

Post author By STITCHES Newsletter
Post date 11/12/2024
Categories In General Surgery, Intestine and Lower Gastrointestinal Tract

A systematic review and meta-analysis examining randomized controlled trials reveals that indocyanine green fluorescence angiography (ICG-FA) leads to a 45% reduction in overall anastomotic leaks during colorectal surgery. Specific findings indicate a 47% reduction for low anastomoses and a 69% reduction in grade A leaks. However, no significant differences were noted in secondary outcomes such as blood loss and surgery duration. The evidence supports ICG-FA’s effectiveness, necessitating further trials for confirmation.

Journal Article by Elmajdub A, Brebesh N (…) Darwich I et 3 al. in Updates Surg

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Negative-pressure wound therapy reduces surgical site infections

Post author By STITCHES Newsletter
Post date 10/12/2024
Categories In General Surgery, Perspectives, Opinions and Curiosities

A clinical trial demonstrated that negative-pressure wound therapy (NPWT) significantly reduces the incidence of surgical site infections and occurrences in laparotomy patients compared to conventional dressings. Among 275 participants, those using NPWT had a 13% lower absolute risk for infections and a 12% reduction in other complications, alongside a three-day shorter hospital stay. The findings suggest that incorporating NPWT for high-risk patients can enhance postoperative outcomes without severe adverse effects, warranting its broader adoption.

Journal Article by Moreno Gijón M, Suárez Sánchez A (…) Sanz Álvarez L et 7 al. in BMC Surg

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AI system significantly improves surgical case length predictions

Post author By STITCHES Newsletter
Post date 10/12/2024
Categories In Digital Surgery and Telemedicine, General Surgery, Perspectives, Opinions and Curiosities

An artificial intelligence system was developed for predicting surgical case lengths, significantly outperforming current electronic health record estimates. Analyzed data from 125,493 inpatient elective surgical cases revealed the categoricalboost regressor using clinical text embeddings achieved a mean absolute error of 46.4 minutes, compared to 120.0 minutes for existing records (p < 0.001). The AI model accurately estimated case lengths within ±20% in 48% of cases, drastically enhancing prediction accuracy and operational efficiency.

Journal Article by Ramamurthi A, Neupane B (…) Kothari AN et 5 al. in BMC Surg

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Increased frailty elevates postoperative complication rates in surgery

Post author By STITCHES Newsletter
Post date 10/12/2024
Categories In Appendix, Gallbladder and Surgical Emergencies, General Surgery

A study involving 733 patients undergoing major emergency abdominal surgery found that frailty significantly impacts postoperative complications. Patients with low frailty (CFS 1-3) experienced 140 complications per 100 patients, compared to 267 for moderate (CFS 4-6) and 297 for high frailty (CFS 7-9), revealing a strong correlation between higher frailty scores and increased complication severity, as indicated by Clavien-Dindo scores and median CCI scores. This highlights the importance of assessing frailty preoperatively.

Journal Article by Snitkjær C, Jensen TK, Kokotovic D and Burcharth J in World J Surg

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Modified apprenticeship models could enhance esophageal ESD training.

Post author By STITCHES Newsletter
Post date 10/12/2024
Categories In General Surgery, Surgical Endoscopy, Upper Gastrointestinal Tract

Endoscopic resection techniques, like ESD, offer safer alternatives to esophagectomy for esophageal cancer. While ESD provides complete histopathological assessment, a consensus on training models remains elusive. The effectiveness of Japan’s apprenticeship model contrasts with the West’s comprehensive methods that combine various training approaches. Researchers suggest adapting a modified apprenticeship model to optimize ESD training outcomes. Emerging technologies also support improvements in ESD training, aiming to enhance skill acquisition among clinicians globally.

Review by Qatomah A and Aihara H in Curr Gastroenterol Rep

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