Author(s):  Anton Krige, Sarah G. Brearley, Céu Mateus, Gordon L. Carlson, Steven Lane
Source: BJS Open, Volume 6, Issue 3, June 2022, zrac055,
Abstract: Rectus sheath catheter analgesia (RSCA) and thoracic epidural analgesia (TEA) are both used for analgesia following laparotomy. The aim was to compare the analgesic effectiveness of RSCA with TEA after laparotomy for elective colorectal and urological surgery. METHOD: Patients undergoing elective midline laparotomy were randomized in a non-blinded fashion to receive RSCA or TEA for postoperative analgesia at a single UK teaching hospital. The primary quantitative outcome measure was dynamic pain score at 24 h after surgery. A nested qualitative study (reported elsewhere) explored the dual primary outcome of patient experience and acceptability. Secondary outcome measures included rest and movement pain scores over 72 h, functional analgesia, analgesia satisfaction, opiate consumption, functional recovery, morbidity, safety, and cost-effectiveness. RESULTS:  A total of 131 patients were randomized: 66 in the RSCA group and 65 in the TEA group. The median (interquartile range; i.q.r.) dynamic pain score at 24 h was significantly lower after TEA than RSCA (33 (11–60) versus 50.5 (24.50–77.25); P = 0.018). Resting pain score at 72 h was significantly lower after RSCA (4.5 (0.25–13.75) versus 12.5 (2–13); P = 0.019). Opiate consumption on postoperative day 3 (median (i.q.r.) morphine equivalent 17 (10–30) mg versus 40 (13.25–88.50) mg; P = 0.038), hypotension, or vasopressor dependency (29.7 versus 49.2 per cent; P = 0.023) and weight gain to day 3 (median (i.q.r.) 0 (−1–2) kg versus 1 (0–3) kg; P = 0.046) were all significantly greater after TEA, compared with RSCA. There were no significant differences between groups in other secondary outcomes, although more participants experienced serious adverse events after TEA compared with RSCA, which was also the more cost-effective. CONCLUSIONS:  TEA provided superior initial postoperative analgesia but only for the first 24 h. By 72 hours RSCA provides superior analgesia, is associated with a lower incidence of unwanted effects, and may be more cost-effective.

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Author(s) Lewis J.A.; Kinross J.M.; Souvatzi M.; Khan S.; Singh B.; Tilney H.S.; Wilson J.M.; Vitone L.J.
Institution(s) (Lewis, Kinross) Department of Surgery and Cancer, Imperial College London, London, United Kingdom
(Lewis, Souvatzi, Kinross) Imperial College Healthcare National Health Service Trust, London, United Kingdom
(Khan, Singh) University Hospitals of Leicester National Health Service Trust, Leicestershire, United Kingdom
(Tilney) Frimley Health National Health Service Foundation Trust, Frimley, United Kingdom
(Wilson) Whittington Health National Health Service Trust, Whittington, United Kingdom
(Vitone) East Lancashire Hospitals National Health Service Trust, Blackburn, United Kingdom
Source Diseases of the colon and rectum; Dec 2021; vol. 64 (no. 12)
Language English
Publication Date Dec 2021
Database EMBASE
AbstractBACKGROUND: This is an analysis of the first 50 in-human uses of a novel digital rigid sigmoidoscope. The technology provides digital image capture, telemedicine capabilities, improved ergonomics, and the ability to biopsy under pneumorectum while maintaining the low cost of conventional rigid sigmoidoscopy. The primary outcome was adverse events, and the secondary outcome was diagnostic view. PRELIMINARY RESULTS: Fifty patients underwent outpatient (n = 25) and surgical rectal assessment (n = 25), with a mean age of 60 years. This included 31 men and 19 women with 12 different clinical use indications. No adverse events were reported, and no defects were reported with the instrumentation. Satisfactory diagnoses were obtained in 48 (96%) of 50 uses, images were captured in 48 (96%) of 50 uses, and biopsies were successfully taken in 13 uses (26%). No adverse events were recorded. Independent reviewers of recorded videos agreed on the quality and diagnostic value of the images with a kappa of 0.225 (95% CI, 0.144-0.305) when assessing whether the target pathology was adequately visualized. IMPACT OF INNOVATION: The improved views afforded by digital rectoscopy facilitated a satisfactory clinical diagnosis in 96% of uses. The device was successfully deployed in the operating room and outpatients irrespective of bowel preparation method, where it has the potential to replace flexible sigmoidoscopy for specific use cases. The technology provides a high-quality image and video that can be securely recorded for documentation and medicolegal purposes with agreement between blinded users despite a lack of standardized training and heterogenous pathology. We perceive significant impact of this technology for the assessment of colorectal anastomoses, the office management of colitis, "watch and wait," and for diagnostic support in rectal cancer diagnosis. The technology has significant potential to facilitate proctoring and training, and it now requires prospective trials to validate its diagnostic accuracy against more costly flexible sigmoidoscopy systems.Copyright © The ASCRS 2021.

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Author(s) Papamichail M. (mp1977gr@googlemail.com); M P.; ND H.; Pizanias M.; Heaton N.D.
Institution(s) (Papamichail, M, M, ND) Department of Hepato-Pancreato-Biliary Surgery, Royal Blackburn Hospital, Blackburn, UK BB2 3HH, United Kingdom
(Pizanias, M, M, ND) Department of General Surgery, Whittington Hospital, London, UK N19 5NF, United Kingdom
(Heaton, M, M, ND) Department of Liver Transplant and Hepato-Pancreato-Biliary Surgery, Institute of Liver Studies, Kings Health Partners at King's College Hospital NHS Trust, London, UK SE5 9RS, United Kingdom
Source Hepatobiliary and Pancreatic Diseases International; 2021
Publication Type(s) Review
Database EMBASE
AbstractBackground: Primary and secondary liver tumors are not always amenable to resection due to location and size. Inadequate future liver remnant (FLR) may prevent patients from having a curative resection or may result in increased postoperative morbidity and mortality from complications related to small-for-size syndrome (SFSS). Data sources: This comprehensive review analyzed the principles, mechanism and risk factors associated with SFSS and presented current available options in the evaluation of FLR when planning liver surgery. In addition, it provided a detailed description of specific modalities that can be used before, during or after surgery, in order to optimize the conditions for a safe resection and minimize the risk of SFSS. Result(s): Several methods which aim to reduce tumor burden, preserve healthy liver parenchyma, induce hypertrophy of FLR or prevent postoperative complications help minimize the risk of SFSS. Conclusion(s): With those techniques the indications of radical treatment for patients with liver tumors have significantly expanded. The successful outcome depends on appropriate patient selection, the individualization and modification of interventions and the right timing of surgery.Copyright © 2021

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Authors:
Taylor AK; School of Medicine, Leeds Institute of Health Sciences, University of Leeds, Leeds, UK annaktaylor@doctors.org.uk.
Chang D; Department of General Surgery, Royal Blackburn Hospital, East Lancashire Hospitals NHS Trust, Blackburn, UK.
Chew-Graham C; School of Medicine, Keele University, Keele, UK.
Rimmer L; Department of General Surgery, Blackpool Victoria Hospital, Blackpool Teaching Hospitals NHS Foundation Trust, Blackpool, UK.
Kausar A; Department of General Surgery, Blackpool Victoria Hospital, Blackpool Teaching Hospitals NHS Foundation Trust, Blackpool, UK.
Source: BMJ open 2021 Dec 16; Vol. 11 (12), pp. e050016. Date of E-Publication: 2021 Dec 16.
Publication Type: Journal Article
Abstract:
Objectives: Ten per cent of patients diagnosed with pancreatic cancer undergo pancreaticoduodenectomy. There is limited previous research focusing on psychological well-being; unmet support needs impact negatively on quality of life. This paper reports the psychological impact of a pancreatic cancer diagnosis and subsequent pancreaticoduodenectomy, exploring how patients' lives alter following surgery and how they seek support.
Design: Inductive qualitative study involving in-depth semistructured interviews with 20 participants who had undergone pancreaticoduodenectomy for pancreatic or distal biliary duct cancer. Interviews were audiorecorded, transcribed and anonymised, and thematic analysis used principles of constant comparison.
Setting: Single National Health Service Trust in Northwest England.
Participants: Patients were eligible for inclusion if they had had pancreaticoduodenectomy for head of pancreas cancer, periampullary cancer or distal cholangiocarcinoma between 6 months and 6 years previously, and had completed adjuvant chemotherapy.
Results: Analysis identified the following main themes: diagnosis and decision making around surgery; recovery from surgery and chemotherapy; burden of monitoring and ongoing symptoms; adjusting to 'a new normal'; understanding around prognosis; support-seeking. Participants seized the chance to have surgery, often without seeming to absorb the risks or their prognosis. They perceived that they were unable to control their life trajectory and, although they valued close monitoring, experienced anxiety around their appointments. Participants expressed uncertainty about whether they would be able to return to their former activities. There were tensions in their comments about support-seeking, but most felt that emotional support should be offered proactively.
Conclusions: Patients should be made aware of potential psychological sequelae, and that treatment completion may trigger the need for more support. Clinical nurse specialists (CNSs) were identified as key members of the team in proactively offering support; further training for CNSs should be encouraged. Understanding patients' experience of living with cancer and the impact of treatment is crucial in enabling the development of improved support interventions.

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Author(s) Ahmed N.; Obeidallah R.; Subar D.
Institution(s) (Ahmed, Obeidallah, Subar) Royal Blackburn Hospital, Blackburn, United Kingdom
Source British Journal of Surgery; Oct 2021; vol. 108
Language English
Database EMBASE
AbstractAims: To ascertain the impact of ''Cost effective home-based pre-rehabilitation'' on post-operative outcomes in patients undergoing major hepatic and pancreatic oncological surgery. Method(s): In this non-randomized comparative study (2019-2021), we included 36 patients having pancreatic or hepatic malignancy. In group I, patients were signed up for home-based pre-rehabilitation program and dietary modification. Group II; included patients who did not have rehabilitation. The two groups were compared for post-operative outcomes (post-operative complications, length of ITU and hospital stay) Results: Mean age was 69.05+/-9.68 years in group I and 67.50+/-8.75 years in group II (p-value 0.61). Open approach was used in 02 (11.0%) patients in group I and in 09 (50%) patients in group II (p-value 0.01). More patients in group II needed admission in intensive care unit (ICU); 18 (100%) versus 11 (61.1%) in group II (p-value 0.0003). The group I had shorter length of hospital stay as compared to Group II (p-value 0.0001). There was no significant difference in post-operative complications between the groups. Conclusion(s): Home based pre-rehabilitation, has shown beneficial outcomes in terms of less requirement for ITU admission post operatively, shorter length of hospital stay and cost effective method of pre rehabilitation.

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Author(s) Sawhney R.; Seite E.; Fedder A.
Institution(s) (Sawhney, Seite, Fedder) East Lancashire Hospitals NHS Trust
Source British Journal of Surgery; Oct 2021; vol. 108
Database EMBASE
AbstractAims: The quality of junior clerking is essential to patient safety and care; it provides information vital to the management of surgical patients. This audit aimed to evaluate the completion of the General Admission Document (GAD) on the Surgical Admissions Unit to identify the impact of staff absences secondary to CoViD-19. Method(s): Admissions to the unit over a 5-day period (n=92) were evaluated against a checklist of the 26 items included on the GAD utilised by the trust, and daily handover sheets were used to identify staff absences. Mean completion was measured alongside thematic analysis of free-text remarks. Result(s): Handover sheets identified staff absences on 3 days. The overall mean completion of the GAD was 50.88% (95%CI: 46.65, 55.11, p<0.05). This was not significantly (p=0.074) impacted by staffing; mean completion was 48.47% (95%CI: 42.75, 54.20, p<0.05) on days with junior doctor absences, and 54.98% (95%CI: 49.14, 60.82, p<0.05) without. The major theme identified was deferring to the 'senior review' section of the GAD, suggesting a lack of awareness among juniors regarding the importance of a full junior clerking. Conclusion(s): Staff shortages secondary to CoViD-19 absences did not significantly impact the quality of junior clerking. However, the baseline completion of the GAD was noted to be poor regardless. Therefore, a teaching session during induction of the next cohort of doctors could be a sensible intervention to reiterate the importance of a full clerking.

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Author(s) Yang N.P.C.; Nijjar P.S.; Phyu S.; Barkeji M.; Butt M.A.J.
Institution(s) (Yang, Nijjar, Phyu, Barkeji) West Middlesex University Hospital, Chelsea and Westminster Hospital NHS Foundation Trust
(Butt) Royal Blackburn Hospital
Source British Journal of Surgery; Oct 2021; vol. 108
Database EMBASE
AbstractAims: Nipple discharge is a presentation commonly seen at breast clinics. It is conventionally evaluated with physical examination and sonography( or mammography). The aim of this study is to investigate the diagnostic value of magnetic resonance imaging (MRI) as an additional imaging tool in the evaluation of potential malignancy in patients presented with nipple discharge. Method(s): A retrospective evaluation of 85 patients with nipple discharge who underwent breast ultrasound (USS) and MRI between 04/ 06/2008 and 25/10/2019 was conducted. Clinical notes, radiographic reports and biopsy results were reviewed. Sensitivity, specificity, positive predictive value and negative predictive value of USS and MRI were calculated. Result(s): Out of the 85 patients (all female; mean age 45.33 +/- 12.93 years old) with nipple discharge, 11 were found to have biopsy-proven malignancy (invasive ductal carcinoma/ ductal carcinoma in situ; 12.94% risk). USS failed to identify seven malignancies (27.27% sensitivity) while MRI missed three malignancies (72.72% sensitivity). USS falsely identified four malignancies from 74 patients with no malignancy (94.59% specificity) while MRI only falsely identified one case (98.65% specificity). For patients with negative USS results (U1/U2/U3) or negative MRI results (BI-RADS category 1,2 or 3), the negative predictive values of USS is 89.74% while that of MRI is 96.05%. The positive predictive values of USS and MRI are 42.86% and 88.88% respectively. Conclusion(s): Compared to USS, MRI has a higher sensitivity, specificity, positive predictive value and predictive value. It will be a valuable addition to the standard nipple discharge evaluation workup to help rule out malignancy.

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Author(s) Taib A.; Hammill C.; Abraham A.; Subar D.; Fakim B.; Garstang P.
Institution(s) (Taib, Hammill, Abraham, Subar) Blackburn Research Innovation, Development Group in General Surgery (BRIDGES), Blackburn, United Kingdom
(Taib, Hammill, Abraham, Fakim, Subar) Department of General Surgery, East Lancashire Hospitals NHS Trusts, Blackburn, United Kingdom
(Garstang) Women's and Children's Division, Lancashire Teaching Hospitals NHS Foundation Trust, Preston, United Kingdom
Source British Journal of Surgery; Oct 2021; vol. 108
Database EMBASE
AbstractAims: Surgical Advanced Clinical Practitioners (SACP) form part of the extended surgical workforce and are drawn from allied health care backgrounds. The primary aim of this study was to determine if there is a financial benefit performing minor surgical procedures on dedicated SACP lists compared to consultant surgeon lists. Method(s): This was a retrospective cohort study including all patients who had a minor 'lumps and bumps' procedure undertaken between April 2014 and August 2019 at Anonymous Hospitals NHS Trust (AHT) under local anaesthetic by the general surgery team. Data such as lesion type, theatre staffing levels and operating time was collected. The cost of the procedure was calculated by operating time multiplied by cost of staff of per minute according to local banding. Result(s): A total of 1399 patients had a lesion excised; the majority were carried out by a doctor n=907, the rest independently by a SACP. The majority of lesions excised were lipomas and cysts. There was no difference in the median surgical time (20 minutes, IQR 14) taken to operate on each patient by SACPs and doctors. Minor procedures carried out on consultant surgeon lists cost 62.4% (21.72) more on average than those on SACP lists (56.55 vs 34.83 median respectively, p<0.001) due to excess staff for these cases. Conclusion(s): A dedicated and independent SACP 'lumps and bumps' list has shown to be a financially beneficial service. Operative times are similar to doctors. These lists free staff for consultant lists, potentially permitting more major cases.

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Author(s) Parmar K.; Badrick E.; Malcomson L.; Renehan A.; Sharma A.; Heywood N.
Institution(s) (Parmar, Badrick, Malcomson, Renehan) Manchester Cancer Research Centre, University of Manchester
(Parmar) General Surgery Training Programme, Health Education North West England
(Renehan) Christie NHS Foundation Trust
(Sharma) Manchester University NHS Foundation Trust
(Heywood) East Lancashire Hospitals Trust
Source British Journal of Surgery; Oct 2021; vol. 108
Language English
Database EMBASE
AbstractIntroduction: Guidelines suggest the laparoscopic approach may be safe and feasible in emergency general surgery. Despite this, the UK National Emergency Laparotomy Audit (NELA) rate of laparoscopic surgery remains low. Our earlier analysis of the NELA database identified factors associated with use of laparoscopy, then recommended further analysis to compare outcomes between laparoscopic and open surgery. Method(s): We obtained information from the NELA database (2013- 2017) and performed logistic regression on all first operations during the hospital admission. Outcomes were compared between open and laparoscopic approach (fully laparoscopic, laparoscopic assisted and laparoscopic converted). The primary outcome was death during hospital admission; secondary outcomes were admission to intensive care unit (ICU), length of ICU stay and return to theatre. Result(s): The cohort comprised 68,928 open (52% men, mean age 65) and 12,144 laparoscopic (51% men, mean age 58). In a model adjusted for all factors influencing primary or secondary outcomes (age, gender, p-possum, weekday versus weekend, operative time of day, malignancy, peritoneal soiling, CEPOD urgency, surgical grade and anaesthetist grade), death rates were significantly lower in the laparoscopic group (OR 0.65, 95% CI 0.59-0.71). Post-operative admission to ICU and ICU stay > 3 days were both significantly lower in the laparoscopic group (OR 0.59, 95% CI 0.56-0.62; OR 0.82, CI 0.75-0.89). There was no difference in return to theatre. Conclusion(s): Outcomes for laparoscopy in emergency general surgery appear superior to open surgery, although there may be residual unmeasured confounding factors. Further analysis will compare outcomes between pathologies.

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Author(s) Eden J.K.; Gawne S.; Dobrashian R.
Source Breast Cancer Research; 2021; vol. 23
The injectable breast filler Polyacrylamide hydrogel (PAAG) was widely used in China since the 1980s with as many as 300,000 women subjected for cosmesis and reconstruction following cancer.[1] The procedure requires no anaesthesia, often injected by nonmedical professionals. No safety clinical trials were conducted and in 2006 the Chinese State Food and Drug Administration prohibited the clinical application following significant evidence of neurotoxic and teratogenic monomers residual in the synthesis of PAAG.[2] Although now withdrawn, many patients are developing on-going associated complications of PAAG and presenting worldwide to surgeons unfamiliar with the treatment, necessitating complex surgery. Management of PAAG is not standardised and often directed by the radiological appearances. A case study is reported discussing the associated challenges of PAAG with recommendations gathered from the literature. Radiological imaging can mimic malignancy with inflammatory appearances, whilst simulating silicone implants and the features of Breast Implant Associated-Anaplastic Large Cell Lymphoma. Glandular atrophy and encapsulation can develop potentially delaying cancer diagnosis.[3] Surgically, migration of the gel almost always prevents complete removal and often requires extensive reconstructive techniques. Considering PAAG may have potential toxicity and radiological interpretation is significantly compromised, careful assessment is required to understand how best to manage this group of patients often presenting with multiple complications; the long term implications are yet unknown.

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Author(s) Hedayat F. (Fatemehhedayat97@gmail.com); Kyzas P. (Panayiotis.Kyzas@elht.nhs.uk); Vassiliou L.V. (Leandros.Vassiliou@elht.nhs.uk); Lauder J.J. (Joshua.Lauder@elht.nhs.uk)
Source Journal of Surgical Case Reports; Jul 2021; vol. 2021 (no. 7)
AbstractWe present the case of a 75-year-old patient with a T2N0Mo oral cancer, who underwent surgery for cancer ablation and reconstruction. Intraoperatively, a duplicate internal jugular vein (IJV) was identified. Both segments were preserved. The veins of the free radial forearm flap that was used to reconstruct the defect were anastomosed to tributaries of the anterior IJV segment. In this rare anatomical variation, the anterior segment of IJV lies medially/anteriorly to the sternocleidomastoid muscle which poses a risk of inadvertent injury during the early steps of the neck dissection (ND). The posterior segment is at risk of injury during developing levels II-III-IV of ND. It is important to preserve the anterior IJV segment as this receives all tributaries that can be used for end-to-end anastomosis for the free flap. Preoperative contrast computed tomography scan can aid in recognition of IJV duplication and help prepare the surgeon to adjust certain operative steps. Copyright © 2021 Published by Oxford University Press and JSCR Publishing Ltd. All rights reserved.

• Available at Journal of surgical case reports from Europe PubMed Central - Open Access

Author(s) Taib, A; Hammill, C; Abraham, A; Fakim, B; Garstang, P; Carney, J; Natarajan, V; Subar, D
Institution(s) (Taib, A) Department of General Surgery, East Lancashire Hospitals NHS Trusts, Blackburn, UK.
(Hammill, C) Department of General Surgery, East Lancashire Hospitals NHS Trusts, Blackburn, UK.
(Abraham, A) Department of General Surgery, East Lancashire Hospitals NHS Trusts, Blackburn, UK.
(Fakim, B) Department of General Surgery, East Lancashire Hospitals NHS Trusts, Blackburn, UK.
(Garstang, P) Women's and Children's Division, Lancashire Teaching Hospitals NHS Foundation Trust, Preston, UK.
(Carney, J) Department of General Surgery, East Lancashire Hospitals NHS Trusts, Blackburn, UK.
(Natarajan, V) Department of General Surgery, East Lancashire Hospitals NHS Trusts, Blackburn, UK.
(Subar, D) Department of General Surgery, East Lancashire Hospitals NHS Trusts, Blackburn, UK.
Source BJS open; Jul 2021; vol. 5 (no. 5)
Database Medline
AbstractBACKGROUNDSurgical advanced clinical practitioners (SACPs) form part of the extended surgical workforce drawn from a variety of allied healthcare backgrounds. The primary aim of this study was to determine whether there was a financial benefit in having minor surgical procedures undertaken by dedicated SACPs compared with operating lists assigned to consultant surgeons.METHODSThis was a retrospective cohort study including all patients who had minor 'lumps and bumps' procedures undertaken between April 2014 and August 2019 at East Lancashire Hospitals NHS Trust under local anaesthetic by the general surgery team. Clinical patient information, including lesion type, was collected along with operating room staffing levels and duration of operation. The cost of the procedure was calculated as operating time multiplied by cost of staff per minute according to local banding.RESULTSA total of 1399 patients had a lesion excised; 907 procedures were carried out by a doctor, and the rest independently by a SACP. The majority of lesions excised were lipomas and cysts. There was no difference in the median surgical time taken between SACPs and doctors (20 (i.q.r. 14-28) min). Minor procedures carried out on consultant surgeon lists cost 62.3 per cent (€25.33) more on average than those on SACP lists (median €65.96 versus 40.63 respectively; P < 0.001).CONCLUSIONA dedicated and independent SACP 'lumps and bumps' list was financially beneficial. Operating times were similar to those of doctors. These lists safely free trainee and consultant surgeons to undertake more complex work.

• Available at BJS open from Oxford Journals - Open Access

Author(s) Lambert J.E.; Keegan T.J.; Gaffney C.J.; Subar D.A.; Hayes L.D.
Source Annals of surgery; Jul 2021; vol. 274 (no. 1); p. 70-77
OBJECTIVE: To determine the impact of prehabilitation on hospital length of stay, functional capacity, complications, and mortality after surgery in patients with hepatobiliary, colorectal, and upper gastrointestinal cancer. BACKGROUND: "Prehabilitation" encompasses exercise, nutrition, and psychosocial interventions to optimize health before surgery. The benefits of prehabilitation are ill-defined. 

• Available in full text at Annals of surgery from Ovid (Journals @ Ovid)

​Author(s) Rimmer L.; Bashir M.; Howard C.; Picca L.
Source European journal of trauma and emergency surgery : official publication of the European Trauma Society; Jun 2021; vol. 47 (no. 3); p. 757-762
BACKGROUND: Artificial intelligence (AI) is a field involving computational simulation of human intelligence processes; these applications of deep learning could have implications in the specialty of emergency surgery (ES). ES is a rapidly advancing area, and this review will outline the most recent advances. METHOD(S): A literature search encompassing the uses of AI in surgery was conducted across large databases (Pubmed, OVID, SCOPUS). Two doctors (LR, CH) both collated relevant papers and appraised them. Papers included were published within the last 5 years, and a "snowball effect" used to collate further relevant literature. RESULT(S): AI has been shown to provide value in predicting surgical outcomes and giving personalised patient risks based on inputted data. Further to this, image recognition technology within AI has showed success in fracture identification and breast cancer diagnosis. Regarding theatre presence, supervised robots have carried out suturing and anastomosis of bowel in controlled environments to a high standard. CONCLUSION(S): AI has potential for integration across surgical services, from diagnosis to treatment, and aiding the surgeon in key decision-making for risks per patient. Fully automated surgery may be the future, but at present, AI needs human supervision.

Author(s) Tebbutt J.E.; Markose G.; Graham R.M.
Source Annals of the Royal College of Surgeons of England; May 2021; vol. 103 (no. 5); p. 381-382

• Available at Annals of the Royal College of Surgeons of England from EBSCO (MEDLINE Complete)

Author(s) Sharrock M.; Whelton C.; Paton R.
Source British Journal of Surgery; May 2021; vol. 108
Introduction: Controversy exists surrounding the efficacy of the UK screening programme for developmental dysplasia of the hip (DDH). Method(s): Clinical records were reviewed in children who were treated surgically for DDH. Demographic data, age and mode of presentation, and surgical treatments were analysed, as well as outcomes, re-operation rate and AVN incidence. Late diagnosis was defined as greater than 4 months. 

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Author(s) Sharrock M.; Whelton C.; Paton R.
Source British Journal of Surgery; May 2021; vol. 108

Aim:: To assess the accuracy of clinical coding of developmental dysplasia of the hip (DDH) operations Method: 106 children underwent surgery for DDH at our turst from 1997 to 2018. Our coding department was sent a list of patients and operation dates and asked to tabulate data on what each operation had been coded as. We compared what each operation was coded as with the procedure actually performed (as per operation notes, clinic letters and intra-operative fluoroscopy images). 

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Author(s) Holmes B.; Mirza U.; Manning C.; Cooke R.; Jugdey R.
Source British Journal of Surgery; May 2021; vol. 108
Introduction: COVID-19 has placed unprecedented demand on services at ELHT and it has become necessary to have telephone clinics to reduce the number of face-to-face clinics. A 'telephone triage clinic' was set up for referrals from A&E. Our project evaluated patient and clinician satisfaction on this. 
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Author(s) Leiberman D.; Trivedy M.; Kausar A.
Source British Journal of Surgery; May 2021; vol. 108
Introduction: The 2020 ST3 recruitment year for Higher Surgical Training (HST) did not have a face-to-face interview due to COVID-19. Candidates were solely scored on portfolio self-assessment alone. We have assessed the impact on Core Surgical Trainee progression into ST3 by comparing the 2020 recruitment year with 2019. 

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Author(s) Ansari S.A.; Al-Jader B.; Khan N.; Younis F.
Source British Journal of Surgery; May 2021; vol. 108
Introduction: Higher number of cycling injuries were observed during the COVID-19 period in the United Kingdom at our institution. Many were serious injuries requiring hospitalisation and some requiring surgery. We investigated whether the lockdown led to a legitimate increase in incidence of cycling related injuries, resulting in a higher number of aerosol generating procedures (AGPs). This would assess whether the guidance on exercise during lockdown was appropriate, shaping future regulation in the case of cyclical lockdowns.

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Author(s) Sadozai Z.; Bokhari S.A.; Mannan K.
Source British Journal of Surgery; May 2021; vol. 108
Introduction: Effective communication skills are an extremely important aspect of good medical practice. Fractures are common with over 1 million fractures occurring each year in the UK; of which 5-10% may have problems with healing. Patient perceptions of factors harmful to the fracture healing process are unknown and our study investigates this. 

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Author(s) Chan V.W.-S.; Tan W.S.; Chiu P.K.-F.; Teoh J.Y.-C.; Leow J.J. et al.
Source World journal of urology; May 2021
PURPOSE: The COVID-19 pandemic has led to the cancellation or deferment of many elective cancer surgeries. We performed a systematic review on the oncological effects of delayed surgery for patients with localised or metastatic renal cell carcinoma (RCC) in the targeted therapy (TT) era. 

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Author(s) Tan S.; Hoggett L.; Choudry Q.; Aithal S.; Bokhari A.
Source British Journal of Surgery; Mar 2021; vol. 108
Introduction: According to NICE CG124, the gold standard of treatment for neck of femur (NOF) fractures is operative management on the day or day after admission. In practice, this is not always achievable depending on various factors, e.g. patient preference, clinical condition and theatre availability, with a further subset of patients undergoing conservative management. 

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Author(s) Cousin G.; Markose G.
Source Annals of the Royal College of Surgeons of England; Jul 2020; vol. 102 (no. 6)

A postoperative radiograph demonstrated a folded radio-opaque structure in the nasopharynx, resembling a retained throat pack, despite her not having any respiratory symptoms. Retention of a throat pack is a never event.

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Author(s) Nevins E.J.; Strong C.; Al-Zubaidi S.; Wayman J.; Karat D. et al.
Source Journal of patient safety; Dec 2019; vol. 15 (no. 4)
OBJECTIVES: Expert opinion remains divided regarding whether routine urethral catheterization is required before nononcological laparoscopic pelvic surgery. Catheterization is thought to reduce the incidence of bladder injury when inserting a suprapubic laparoscopic port and prevent obstruction of the view of the pelvis because of bladder filling. However, catheterization comes with a risk of nosocomial infection and harbors financial cost. Moreover, indwelling catheters inhibit early mobilization and increase postoperative discomfort.

METHOD(S): A systematic review was undertaken using the Meta-Analysis of Observational Studies guidelines to identify eligible publications. End points included bladder injury, positive postoperative urinary microbiology, and postoperative urinary symptoms.

RESULT(S): The reported incidence rates of laparoscopic bladder injury in included publications ranges from 0% to 1.3%. Importantly, bladder injury has occurred during both catheterized and noncatheterized operations. Our meta-analysis also shows that patients who are catheterized have a 2.33 times relative risk of developing postoperative positive microbiology in their urine (P = 0.01) and a 2.41 times relative risk of postoperative urinary symptoms (P = 0.005), when compared with noncatheterized patients.

​CONCLUSION(S): This meta-analysis indicates that omitting a catheter in emergency and elective nononcological laparoscopic pelvic surgery may be a safe option. Catheterization does not remove the risk of bladder injury but results in more urinary tract infections and symptoms. It may be reasonable to ask a patient to void immediately before anesthesia, after which an on-table bladder scan should be performed. If there is minimal residual volume, a urinary catheter may not be necessary, unless operative time is estimated to be greater than 90 minutes.