[eHealth applications for promotion of physical activity after visceral surgery : A systematic review]. / eHealth-Anwendungen zur Förderung körperlicher Aktivität nach viszeralen Operationen : Eine systematische Übersichtsarbeit.

BACKGROUND: eHealth applications can support early mobilization and physical activity (PA) after surgery. This systematic review provides an overview of eHealth services to enhance or record PA after visceral surgery interventions. METHODS: Two electronic databases (MEDLINE PubMed and Web of Science) were systematically searched (November 2023). Articles were considered eligible if they were controlled trials and described digital devices used to promote PA after visceral surgery. The Cochrane risk of bias (RoB-2) tool was used to determine the methodological quality of studies. RESULTS: A total of nine randomized controlled studies (RCT) were included in this systematic review. The studies differed with respect to the interventions, surgical indications and evaluation variables. The risk of bias of the individual studies was moderate. The six studies using activity trackers (AT) predominantly showed insignificant improvements in the postoperative step count. The more complex fitness applications could partially reveal significant advantages compared to the control groups and the home-based online training also showed a significant increase in functional capacity. CONCLUSION: Activity tracking alone has so far failed to show clinically relevant effects. In contrast, the more complex eHealth applications revealed advantages compared to usual postoperative care. More high-quality studies are needed for evidence-based recommendations for eHealth services in conjunction with visceral surgery.

Perforation of Abdominal Viscera Following Liposuction: A Systemic Literature Review.

BACKGROUND: Liposuction is among the most popular esthetic procedures worldwide. With growing demand and popularity, reports of serious complications accumulate. Despite being a rare complication of the procedure, visceral perforation is associated with morbidity and severe debilitation. METHODS: The authors conducted a literature search for reported cases of perforation of abdominal viscera following liposuction procedures in the electronic databases of PubMed, Scopus and Cochrane Library databases. RESULTS: The authors found 22 publications; 19 cases case reports and three studies, reporting a total of 49 cases of visceral perforation following abdominal liposuction procedures. Average age of patients was 50 years (range 24-72). Twenty-seven patients (73%) were female, and 10 were male (27%). Forty (81%) patients underwent isolated liposuction, and nine (19%) had multiple procedures carried out in a single surgery. Twenty patients (42%) had undergone previous abdominal surgery, 13 (27%) suffered abdominal wall weakness or deformities, and 7 (14%) suffered from obesity. 25 (52%) ileal perforations occurred, 6 jejunal (12.5%), 5 colic (10%) and 2 (4%) each of splenic and hepatic. Seven patients (14%) died during their hospitalization, 20 (41%) were discharged with no sequelae complications, and 22 (45%) developed complications after discharge. CONCLUSIONS: Liposuction is a popular esthetic procedure that underwent numerous changes over the past century since its introduction. Despite its widely accepted reputation of a safe procedure with minimal complications, a growing number of reports on visceral perforation following liposuction have emerged. Scrupulous pre-operative evaluation and high index of suspicion are crucial for avoiding complications and unfavorable outcomes. LEVEL OF EVIDENCE III: This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266 .

Management and outcome of true visceral and renal artery aneurysm repair.

PURPOSE: Visceral and renal artery aneurysms (VAA, RAA) are very rare pathologies. Both surgical and endovascular therapies are discussed as therapeutic options for ruptured and non-ruptured aneurysm repair; we describe our experience in the open and endovascular management of these entities. METHODS: Retrospective database analysis of 60 treated VAA and RAA in 59 patients between 1994 and 2020. Outcome data was descriptively analyzed. RESULTS: Thirty-seven aneurysms were surgically treated and 23 interventionally. In the total study cohort, we observed a mortality of 1.7% and a morbidity of 18.6%. One major complication occurred. The morbidity was higher after surgical repair in ruptured and non-ruptured cases. The mean aneurysm diameter was 30.5 ± 15.6 mm. Patients with hepatic or pancreaticoduodenal artery aneurysms presented more often in the stage of rupture, without differences in aneurysm size. The length of hospital stay after endovascular repair was significantly shorter compared to open surgical treatment (7.2 ± 6.9 days versus 11.8 ± 6.7 days, p = 0.014), but only in elective cases. Primary technical success was significantly better in patients that underwent surgical repair in an intention to treat analysis (100% versus 79.3%). The mean follow-up of the cohort was 53.5 months (range 3-207 months). CONCLUSION: Elective endovascular therapy and open surgery of VAA and RAA are safe procedures with a good periprocedural and long-term outcome. Surgical revascularization showed a better primary technical success but was associated with longer length of hospital stays.

Laparoscopic cytoreductive surgery and HIPEC: a comparative matched analysis.

BACKGROUND: Cytoreductive surgery (CRS) plus hyperthermic intraperitoneal chemotherapy (HIPEC) is a procedure that has had encouraging results for peritoneal metastases (PM) from diverse tumour origins, but it is not exempt from high morbidity. Recently, the important role of laparoscopy in oncologic surgeries and its benefits have been evaluated for CRS + HIPEC in selected patients, which has yielded promising results. The aim of our study is to analyse the use of laparoscopy for CRS + HIPEC in patients with limited peritoneal disease. METHODS: We have conducted a retrospective study from a prospective database in our tertiary referral hospital within the period of January 2009 to July 2019, which includes 825 patients who had PM from varying tumour origins. We have compared the patients treated with the laparoscopic approach (L-CRS-HIPEC) to a matched population who have undergone the open approach (O-CRS-HIPEC) and fulfil the same selection criteria. We have analysed the postoperative outcomes and survival results. RESULTS: We have confirmed the homogeneity between the sample of the O-CRS + HIPEC (n = 42) and the L-CRS + HIPEC (n = 18) regarding preoperative and intraoperative features. The L-CRS + HIPEC group had shorter hospital stays, (median of 4 [2-10] days versus 9 [2-19] days) and reduced wait time to return to chemotherapy (median of 4 [3-7] weeks and a median of 8 [4-36] weeks) than the O-CRS + HIPEC group. No differences were found regarding the need for perioperative blood transfusion, surgery time or postoperative morbi-mortality. No early locoregional relapse occurred in the L-CRS + HIPEC group and short term disease-free survival did not differ between groups. CONCLUSIONS: Laparoscopy for CRS + HIPEC is feasible and safe in highly selected patients, with no significant differences concerning postoperative morbi-mortality or early oncological results. We have found that patients who have undergone laparoscopic operations have shorter hospital stays and that they return to adjuvant chemotherapy sooner. Further investigation is required to confirm the benefits of minimally invasive procedures for the management of PM.

Reconstrucción del defecto de exenteración pélvico/perineal extendida con colgajo libre compuesto dorsal ancho-escapular-paraescapular y malla. La lógica en la elección / Reconstruction of extended pelvic/perineal exenteration defect with a composite latissimus dorsi-scapular-parascapular free flap and a mesh. The rationale behind the technique

Presentamos los fundamentos funcionales y reconstructivos en un caso de exenteración pélvica extendida. El propósito es analizar el defecto quirúrgico y los requerimientos reconstructivos, aspectos no suficientemente descritos en la literatura. Se trata de un varón de 62 años, con carcinoma epidermoide perineal de origen uretral (82x117x108 mm) que invadía vejiga, pelvis y fosa pararrectal. El defecto escisional fue reconstruido con un colgajo compuesto dorsal ancho-escapular-paraescapular y una malla bicapa (polipropileno y politetrafluoroetileno extendido). Describimos una reconstrucción multiplanar orientada a 3 requerimientos funcionales definidos: 1.- soporte visceral para evitar la herniación perineal; 2.- colapso del espacio muerto para minimizar el riesgo de infección; y 3.- cobertura cutánea estable en una región exigente. Sin complicaciones postoperatorias en el corto o largo plazo, el paciente puede deambular adecuadamente y se encuentra libre de enfermedad 1 año después de la intervención. Hasta donde hemos podido conocer, este caso presenta por primera vez el uso del colgajo compuesto descrito en la reconstrucción del defecto de exenteración pélvica

The article reports the functional, reconstructive rationale behind a case of extended pelvic exenteration. Our aim is to analyze the surgical defect and consequent reconstructive requirements, aspects which have not been adequately addressed in the literature. A case is presented of a 62-year-old man presenting with an 82x117x108 mm perineal squamous cell carcinoma of urethral origin invading bladder, pelvic bone and pararectal fossa. The resection defect was reconstructed with a composite latissimus dorsi-scapular-parascapular flap and a bilayer mesh (polypropylene and extended polytetrafluoroethylene). A multiplanar reconstruction is shown that addresses 3 distinct functional requirements: 1.- visceral support to prevent perineal herniation; 2.- collapse of dead space to minimize the risk of infection; and 3.- a stable skin cover for a demanding area. With no postoperative short or long-term complications, the patient is ambulating and free of disease at one-year follow-up. To the best of the authors' knowledge, this is the first report of the described composite flap in the reconstruction of the pelvic exenteration defect

Optimizing quantitative fluorescence angiography for visceral perfusion assessment.

BACKGROUND: Compromised tissue perfusion is a significant risk factor for anastomotic leakage after intestinal resection, leading to prolonged hospitalization, risk of recurrence after oncologic resection, and reduced survival. Thus, a tool reducing the risk of leakage is highly warranted. Quantitative indocyanine green angiography (Q-ICG) is a new method that provides surgeons with an objective evaluation of tissue perfusion. In this systematic review, we aimed to determine the optimal methodology for performing Q-ICG. METHOD: A comprehensive search of the literature was performed following the PRISMA guidelines. The following databases were searched: PubMed, Embase, Scopus, and Cochrane. We included all clinical studies that performed Q-ICG to assess visceral perfusion during gastrointestinal surgery. Bias assessment was performed with the Newcastle Ottawa Scale. RESULTS: A total of 1216 studies were screened, and finally, 13 studies were included. The studies found that intensity parameters (maximum intensity and relative maximum intensity) could not identify patients with anastomotic leakage. In contrast, the inflow parameters (time-to-peak, slope, and t1/2max) were significantly associated with anastomotic leakage. Only two studies performed intraoperative Q-ICG while the rest performed Q-ICG retrospectively based on video recordings. Studies were heterogeneous in design, Q-ICG parameters, and patient populations. No randomized studies were found, and the level of evidence was generally found to be low to moderate. CONCLUSION: The results, while heterogenous, all seem to point in the same direction. Fluorescence intensity parameters are unstable and do not reflect clinical endpoints. Instead, inflow parameters are resilient in a clinical setting and superior at reflecting clinical endpoints.

Multivisceral resection of locally advanced colorectal cancer in an African referral centre.

BACKGROUND: Colorectal cancer (CRC) is common and often presents with advanced disease in Africa. Multivisceral resection (MVR) improves survival in locally advanced (T4b) CRC. The aim was to describe the management and outcomes of patients with clinical T4b CRC without metastatic disease who underwent MVR. METHODS: A retrospective review of patients with T4 CRC who underwent MVR between January 2008 and December 2013. RESULTS: Four hundred and ninety-four patients were included. Of the 158 with suspected T4 cancer, 44 had MVR, of which one was excluded due to metastases. The mean age was 64 years. The male to female ratio was 1:1. The most commonly resected extra-colorectal structure was the abdominal wall (21%). The median survival was 68 months (SD 13.9). The 5-year disease free (DFS) and overall survival (OS) were 46% and 55%, respectively. Survival of patients with colon and rectum cancer was similar. Intraoperative tumour spillage, vascular/perineural invasion, and anastomotic leakage were independent predictors of survival. CONCLUSION: Multivisceral resection of locally advanced (T4b) CRC is feasible in the African context. Complete resection improves survival and should be the goal.

Total retroperitoneal en bloc resection of multivisceral-peritoneal packet (TROMP operation): a novel surgical technique for advanced ovarian cancer.

BACKGROUND: A Total Retroperitoneal en bloc resection Of Multivisceral-Peritoneal packet (TROMP operation) is a no-touch isolation technique in a retroperitoneal space to resect the parietal peritoneum and the affected organs in advanced ovarian cancer. The study prescribed and analysed the results of this novel technique for primary cytoreductive surgery. METHODS: The study included 208 patients operated between January 2015 and December 2017 in Charité, Berlin. The TROMP operation was performed in 58 patients, whereas the other 150 patients were operated with the conventional cytoreductive method. RESULTS: The complete tumor resection rate accounts for 87.9% in TROMP group and 61.3% in the conventional surgery group. (p=0.001). This difference was even stronger in the sub-group of very advanced stages (T3c+T4) (85.1% of TROMP group and in only 53.1% in the conventional surgery group, p=0.001). The duration of the primary cytoreductive surgery was about 33 minutes shorter in TROMP group (median: 335 minutes vs 368 minutes; TROMP vs conventional, respectively) in spite of the fact that the most advanced cytoreductive procedures were performed statically significant more in TROMP operation arm in comparison with the conventional surgery arm. There was no statistically significant difference between the groups regarding the postoperative complication, blood loss or the length of stay in intensive care unit. CONCLUSION: Total retroperitoneal en bloc resection of multivisceral-peritoneal packet (TROMP operation) is a feasible and very effective technique of surgical therapy in advanced ovarian cancer. This technique increased the complete tumor resection rate to 87.9% without increasing the blood loss, postoperative complications or the duration of surgery. A prospective randomized study is advised to validate these results.

Noise patterns in visceral surgical procedures: Analysis of second-by-second dBA data of 599 procedures over the course of one year.

The objective of this study is to analyze noise patterns during 599 visceral surgical procedures. Considering work-safety regulations, we will identify immanent noise patterns during major visceral surgeries. Increased levels of noise are known to have negative health impacts. Based on a very fine-grained data collection over a year, this study will introduce a new procedure for visual representation of intra-surgery noise progression and pave new paths for future research on noise reduction in visceral surgery. Digital decibel sound-level meters were used to record the total noise in three operating theatres in one-second cycles over a year. These data were matched to archival data on surgery characteristics. Because surgeries inherently vary in length, we developed a new procedure to normalize surgery times to run cross-surgery comparisons. Based on this procedure, dBA values were adjusted to each normalized time point. Noise-level patterns are presented for surgeries contingent on important surgery characteristics: 16 different surgery types, operation method, day/night time point and operation complexity (complexity levels 1-3). This serves to cover a wide spectrum of day-to-day surgeries. The noise patterns reveal significant sound level differences of about 1 dBA, with the most-common noise level being spread between 55 and 60 dBA. This indicates a sound situation in many of the surgeries studied likely to cause stress in patients and staff. Absolute and relative risks of meeting or exceeding 60 dBA differ considerably across operation types. In conclusion, the study reveals that maximum noise levels of 55 dBA are frequently exceeded during visceral surgical procedures. Especially complex surgeries show, on average, a higher noise exposure. Our findings warrant active noise management for visceral surgery to reduce potential negative impacts of noise on surgical performance and outcome.

Robotic-Assisted Total Laparoscopic Supralevator Pelvic Exenteration: Steps in Excising the Pelvic Viscera.

STUDY OBJECTIVE: To illustrate the key steps involved in performing a supralevator pelvic exenteration robotically. DESIGN: Presentation of the steps involved in excising the pelvic viscera during robotic-assisted supralevator pelvic exenteration. SETTING: Tertiary care academic center. PATIENTS: A patient undergoing pelvic exenteration for uterine leiomyosarcoma. INTERVENTIONS: Robotic total supralevator pelvic exenteration. MEASUREMENTS AND MAIN RESULTS: In this woman undergoing pelvic exenteration for uterine leiomyosarcoma, the paravesical and pararectal spaces are shown, along with important pelvic landmarks, such as the major vessels and the ureters. Once the pararectal and paravesical spaces are identified, the parametrium in between is resected. The posterior dissection is then performed along the filmy presacral space to the level of the coccyx and levator muscles. Anteriorly, the bladder is dissected along the space of Retzius, and the urethra is transected. Once the pelvic organs are separated, the specimen is removed, and reconstruction of the pelvic floor is performed. The ileal conduit is created from a segment of small bowel approximately 20 cm from the terminal ileum measuring 15 cm long. The 2 ureters are spatulated and attached to the ileal conduit, and a stoma is created. The descending segment of colon is brought up through a separate stoma site on the other side of the abdomen to create the colostomy. The total operating time, including reconstruction with the ileal conduit, was 480 minutes, and the estimated blood loss was 250 mL. CONCLUSION: Total pelvic exenteration can be safely performed robotically with appropriate understanding of the key steps and anatomic landmarks.

Laparotomy for organ evisceration from abdominal stab wounds: A South African experience.

INTRODUCTION: Organ evisceration following abdominal stab wound (SW) is currently considered as an absolute indication for mandatory laparotomy due to the high incidence of associated intra-abdominal injuries, but literature describing the spectrum of organ injury encountered is limited. MATERIALS AND METHODS: We reviewed our experience of 301 consecutive patients who were subjected to mandatory laparotomy over an eight-year period at a major trauma centre in South Africa. RESULTS: Of the 301 patients with organ evisceration, 92% were male (mean age: 28 years). Ninety per cent (270/301) of the laparotomies were positive (85% (229/270) therapeutic, 15% (41/270) non-therapeutic). The frequencies of eviscerated organs were small bowel (70%), large bowel (26%), and stomach 3%. Three (1%) patients had combined evisceration of more than one of the above organs. The most commonly injured organs were small bowel and large bowel. The mean length of hospital stay was nine days. Seven patients required intensive care admission. The morbidity rate was 21% and mortality was 2%. CONCLUSIONS: The spectrum of injury associated with abdominal SW with organ evisceration is similar to smaller published series. Multiple organ injuries are common. The most commonly eviscerated organs were small bowel, large bowel and stomach, while the most commonly injured organs were small bowel and large bowel.

The spectrum of injuries resulting from abdominal stab wounds with isolated omental evisceration: A South African experience.

INTRODUCTION: The spectrum of injury associated with anterior abdominal stab wounds (SWs) is well established. The literature in the specific setting of isolated omental evisceration is limited. MATERIALS AND METHODS: We reviewed our experience of 244 consecutive patients with established indications for laparotomy over an eight year period at a major trauma centre in South Africa. RESULTS: Of the 244 patients (93% male, mean age: 27 years), 224 (92) underwent immediate laparotomy (IL). Twenty were initially observed and eventually required a laparotomy (delayed laparotomy, DL). The mean time from injury to decision for laparotomy was <3 h in 92% (224/244), <6 h in 6% (14/244), <12 h 2% (4/244) and <18 h in 1% (2/244). Ninety-eight per cent (238/244) of laparotomies were positive and 96% of the positive laparotomies (229/238) were considered therapeutic. The mostly commonly injured organ encountered on laparotomy were small bowel, stomach and colon. CONCLUSIONS: The most commonly injures encountered are intestinal and gastric. Clinicians must remain vigilant as injuries may be subtle.

Real world usability analysis of two augmented reality headsets in visceral surgery.

Recent developments in the field of augmented reality (AR) have enabled new use cases in surgery. Initial set-up of an appropriate infrastructure for maintaining an AR surgical workflow requires investment in appropriate hardware. We compared the usability of the Microsoft HoloLens and Meta 2 head mounted displays (HMDs). Fifteen medicine students tested each device and were questioned with a variant of the System Usability Scale (SUS). Two surgeons independently tested the devices in an intraoperative setting. In our adapted SUS, ergonomics, ease of use, and visual clarity of the display did not differ significantly between HMD groups. The field of view (FOV) was smaller in the Microsoft HoloLens than the Meta 2 and significantly more study subjects (80% vs. 13.3%; P < 0.001) felt limited through the FOV. Intraoperatively, decreased mobility due to the necessity of an AC adapter and additional computing device for the Meta 2 proved to be limiting. Object stability was rated superior in the Microsoft HoloLens than the Meta 2 by our surgeons and lead to increased use. In summary, after examination of the Meta 2 and the Microsoft HoloLens, we found key advantages in the Microsoft HoloLens which provided palpable benefits in a surgical setting.

Short-term outcome and survival after multiorgan resection for locally advanced colo-rectal cancer. Identification of risk factors.

INTRODUCTION: Although multi-organ resections (MOR) are recommended by international guidelines for advanced colorectal cancer, the literature shows that the morbidity and mortality that accompanies these complex interventions limits the number of patients receiving this treatment. The purpose of our study was to analyse the immediate and remote results obtained after MOR and to identify potential factors that might influence the outcome. MATERIAL AND METHOD: Our study is a retrospective cohort which included patients surgically treated in our service for locally advanced colorectal cancer. We excluded patients with hepatic metastatic tumors and those who needed pelvic exenteration. Between 2006 and 2010, in our service, have been treated with MOR 146 patients, 107 being included in our study. We analysed morbidity, mortality and survival after MOR and the factors that could have influenced the postoperative course. RESULTS: Identified risk factors that negatively influenced the postoperative outcome were: diabetes, personal neoplastic pathologies, associated cardiovascular disease, history of major surgeries, intraoperative blood loss, number of resected organs. Survival was negatively influenced by positive resection margins, the presence of lymph node metastases and the presence of complications in the postoperative period. CONCLUSIONS: The data of this study support the indication for routine MOR for patients diagnosed with locally advanced colorectal cancer with the condition that R0 resection margins are achieved. All mentioned above underline the importance of the experience that the surgical team has in this type of surgeries, in order to achieve optimum results. This experience must concern the preoperative management, surgical technique and postoperative care. KEY WORDS: Colo-rectal cancer, Multi-organ resections, Risk factors.

Teaching courses in the management of visceral trauma. / Docencia en el manejo del traumatismo visceral.

Several changes introduced in the management of trauma during the last two decades have considerably decreased the practical exposure to bleeding trauma patients by residents and young surgeons. Hemorrhage still represents the second cause of death from trauma worldwide, and the surgical maneuvers required for its control must be learned and practised in specific courses. These courses address the "second hour" of trauma, beyond ATLS©, and also emphasize the decision-making process, communication among team members, and discussion of clinical scenarios. The significant progress made in simulation technologies and virtual reality systems have yet to replace living tissue models to train surgeons in the rapid control of active bleeding, although that replacement is probably not far away.

Docencia en el manejo del traumatismo visceral / Teaching courses in the management of visceral trauma

Diversos cambios introducidos en la atención al paciente traumatizado en las dos últimas décadas han hecho disminuir considerablemente la exposición práctica al manejo de las lesiones viscerales y hemorrágicas por parte de los MIR y cirujanos jóvenes. Esta hemorragia sigue siendo la segunda causa de muerte por trauma a nivel mundial, y determinadas maniobras quirúrgicas necesarias para su control adquieren a menudo una importancia crítica, debiendo ser aprendidas y ensayadas en cursos específicos. Son cursos dirigidos a la «segunda hora», más allá del ATLS(C), y enfatizan también el proceso de toma de decisiones, discusión de casos clínicos y comunicación entre los miembros del equipo multidisciplinar. Los avances significativos experimentados en las tecnologías de simulación y los sistemas de realidad virtual no han logrado aún reemplazar a los modelos tisulares vivos para entrenar al cirujano en el control del sangrado activo de una manera rápida, aunque sin duda lo harán en un futuro no lejano

Several changes introduced in the management of trauma during the last two decades have considerably decreased the practical exposure to bleeding trauma patients by residents and young surgeons. Hemorrhage still represents the second cause of death from trauma worldwide, and the surgical maneuvers required for its control must be learned and practised in specific courses. These courses address the "second hour" of trauma, beyond ATLS(c), and also emphasize the decision-making process, communication among team members, and discussion of clinical scenarios. The significant progress made in simulation technologies and virtual reality systems have yet to replace living tissue models to train surgeons in the rapid control of active bleeding, although that replacement is probably not far away