[The suffering surgeon-How do German surgeons protect themselves? : Survey of the German Society of General and Visceral Surgery on the extent of occupational safety measures and health burden among German surgeons]. / Der leidende Chirurg ­ Wie schützen Chirurgen sich selbst? : DGAV-Umfrage zur Verbreitung von Arbeitssicherheitsmaßnahmen und Gesundheitsbelastung bei deutschen Chirurgen.

BACKGROUND: There are few data on how surgeons implement occupational safety measures to protect their own health and how they assess their subjective health burden. OBJECTIVE: In times of a shortage of surgeons it makes sense to examine these relationships in order to evaluate future-oriented adjustments to increase the attractiveness of the profession of "surgeon". MATERIAL AND METHODS: An online questionnaire was sent to the registered members of the German Society for General and Visceral Surgery (DGAV) in October 2016. The members were asked about the application of occupational safety measures, individual living conditions, working conditions and the subjective health burden depending on the level of training and type of hospital (basic, standard, maximum care). RESULTS: The response rate was 21% (1065/5011). Occupational safety measures were not strictly implemented: routine use of dosimeters, thyroid radiation protection, smoke extraction and protective goggles only took place in 40% (427/1065), 39% (411/1065), 10% (104/1065) and 5% (55/1065), respectively. The majority of surgeons (51%, 548/1065) rated their lifestyle as unhealthy. The majority of them are senior physicians, 46% (250/548) consider their job to be a health hazard. The proportion of chief physicians and assistant physicians is only 21% (115/548) and 18% (98/548). CONCLUSION: Guidelines for standardizing the perioperative protection of German surgeons are desirable. Health-promoting behavior could have a positive effect on the occupational safety of surgeons and ultimately also on patient safety. This can contribute to increasing the attractiveness of the profession "surgeon" in the long term.

Robot-Assisted Oesophagectomy: Recommendations Towards a Standardised Ivor Lewis Procedure.

A considerable number of reports have been published on the feasibility, techniques, and early postoperative results of robotic-assisted oesophageal surgery. However, these are mostly smaller case series, suggesting that the robot-assisted Ivor Lewis procedure is still in the implementation phase and far from being standardised. Oesophageal surgeons from seven robotic university centres in Germany, experienced in both minimally invasive and robot-assisted minimally invasive surgery, took part in a workshop on robot-assisted surgery. An intensive exchange of opinions and experiences, followed by a step-by-step re-enactment of the operation in a cadaver lab, enabled us to develop a standardised robot-assisted Ivor Lewis surgical workflow, which is presented here. Systematic and objective comparison of experiences and results using a robot-assisted Ivor Lewis procedure has made it possible to develop a standardised surgical workflow that is now clinically applied in our centres. It is hoped that standardisation of this procedure will help to maintain patient safety, prevent medical errors, and facilitate the learning curve, while introducing robotic surgery into a centre.

[Surgical Training in Germany: Desire and Reality]. / Chirurgische Weiterbildung an deutschen Kliniken - Wunsch und Realität.

BACKGROUND: In-house surgical education and practical training of surgical skills are inhomogeneous in German hospitals and vary greatly in terms of teaching content and forms. The present survey provides an overview of the currently practiced surgical education and practical training of surgical skills in German hospitals. MATERIAL AND METHODS: An online survey was performed among members of the "Deutsche Gesellschaft für Allgemein- und Viszeralchirurgie" (DGAV). It was a prospective data collection, divided into the following two groups: "junior physicians/consultants/senior physicians" and "chief physicians". The questionnaire consisted of 30 questions concerning the frequency, type and quality of in-house surgical education and practical training of surgical skills in German hospitals. RESULTS: A total of 325 physicians participated in the survey, including 61 chief physicians and 264 junior physicians/consultants/senior physicians. Amongst the participants, 107 (33 %) worked in university hospitals, 57 (18 %) in maximum care clinics, 73 (22 %) in major regional hospitals with specialised medical services and 88 (27 %) in basic care facilities. 199 (75.4 %) of the junior physicians/consultants/senior physicians reported a regular, 57 (21.6 %) an irregular and 8 (3.0 %) no formal surgical education or practical training of surgical skills in their hospitals. Assistance in substeps of an operation was considered to be very important by 72 % of the survey participants. Similarly, 71 % rated the practical teaching of basic surgical skills as very important. Furthermore, we investigated the availability of theoretical and practical training offerings as well as satisfaction with educational measures and their importance as assessed by the respondents. SUMMARY: The present survey illustrates the current state of surgical education and training in German hospitals. An implementation of pragmatic approaches such as the assistance in substeps of an operation and guided practical training of surgical skills might help to improve the satisfaction of physicians undergoing surgical training.

MiR-23a/-24-induced gene silencing results in mesothelial cell integration of pancreatic cancer.

BACKGROUND: Invasion of the surrounding tissue is part of the metastatic cascade. Here, we examined the invasion of pancreatic ductal adenocarcinoma (PDAC) cells into the mesothelial barrier and identified the related microRNA (miRNA) expression profiles. METHODS: The interactions between PDAC cells and mesothelial monolayers were characterised and quantified using a specific time-lapse videomicroscopy assay. Pancreatic ductal adenocarcinoma cells were further evaluated using the adhesion assay, and miRNA, mRNA and protein expressions were determined using microarray, q-RT-PCR and western blots, respectively. These data were correlated with in vivo dissemination scores. RESULTS: Two groups of PDAC cell lines were distinguished by their integration capacity into the mesothelial monolayer using mean elongation factors (MEFs). Adhesion assays showed a concordant relation between adhesive properties and integration capacity. The distant metastases scores were reverse correlated with MEFs. Microarray analysis of these groups revealed that miR-23a and/or miR-24 target for FZD5, HNF1B and/or TMEM92, respectively, and that they are significantly deregulated. CONCLUSIONS: MiR-23a and/or miR-24 overexpression leads to gene silencing of FZD5, TMEM92 and/or HNF1B. Their downregulation induces deregulated expression and degradation of E-cadherin and ß-catenin causing destabilisation of the cadherin/catenin complex, and altered the expression of Wnt-related genes. We propose a molecular (epi)genetic mechanism by which increased EMT-like cell shape transformation and integration into mesothelial monolayers of PDAC cells can be observed.

[Advances, limitations and prospects of oncological liver surgery]. / Fortschritt, Limitationen und Zukunft der onkologischen Leberchirurgie.

Modern oncological liver surgery continues to push the limits of resectability by incorporating an array of new developments in the fields of surgery, anaesthesia and intensive care, oncology, radiology and transplantation medicine. New criteria for determining the resectability of primary and secondary liver tumours have been developed and introduced into national consensus guidelines. Modern tools for improving oncological outcome include the rapid induction of liver hypertrophy prior to major liver resection, downstaging of tumours with advanced chemotherapy protocols, minimally invasive local therapies like radiofrequency ablation and chemo- or radioembolisation, and liver transplantation for non-resectable hepatocellular carcinoma.

In vivo quantification of metastatic tumor cell adhesion in the pulmonary microvasculature.

In vivo and ex vivo fluorescence video microscopy used to be a well-established method in life science with a variety of applications, such as in inflammation or cancer research. In this book chapter, we describe a model of in vivo fluorescence microscopy of the rat's lung with the exclusive advantage of qualitative and quantitative in vivo analysis of cell adhesion within the complex microenvironment of the ventilated and perfused lung. Observation can include real-time, time-lapse, or fast-motion analysis. In our laboratory, we have used the model for qualitative and quantitative real-time analyses of metastatic colon cancer cell adhesion within the rat's pulmonary microcirculation. Using some modifications in another series, we have also applied the model to analyze thrombocyte and leucocyte adhesion within the pulmonary capillaries in experimental sepsis. For interventional studies, injected cells or animals may be pretreated with various reagents or drugs for further analysis of adhesion molecules involved in tumor cell-endothelial cell interactions.

Expression of tight and adherens junction proteins in ulcerative colitis associated colorectal carcinoma: upregulation of claudin-1, claudin-3, claudin-4, and beta-catenin.

BACKGROUND: Tight junction (TJ) proteins play a critical role in cellular adhesion, glandular differentiation, and cellular proliferation. The function of these proteins is compromised in a number of intestinal diseases, including ulcerative colitis that has an increased incidence for colorectal carcinoma (CAC). The aim of this study was to determine the expression of TJ proteins, claudin-1-4, occludin, ZO-1, and the adherens junction (AJ) protein beta-catenin in CAC. METHODS: Sixteen colectomy specimens with CAC, adjoining intraepithelial neoplasia, and normal mucosa were studied by immunofluorescence. A semiquantitative evaluation of all investigated proteins was performed by scoring the staining intensity, and the TJ and AJ protein expression in neoplastic cells was compared to normal and intraepithelial neoplastic colonic mucosa. RESULTS: Using an intensity scoring system, mucosa of crypts and surfaces of CAC exhibited significantly elevated expression levels of claudin-1, claudin-3, claudin-4, and beta-catenin compared to intraepithelial neoplasia and normal mucosa (p<0.05). These data were confirmed by a comparative score. The expression of claudin-2, occludin, and ZO-1 showed no differences between the groups. CONCLUSION: TJ proteins claudin-1, claudin-3, claudin-4, and the AJ protein beta-catenin are overexpressed in CAC. This suggests that these proteins may become potential markers and targets in CAC.