Annali Italiani Di Chirurgia[JOURNAL]
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200 papers
Three-Port Transoral Robotic Thyroidectomy: Technical Description and Early Outcomes.
Brucchi F, Colombo C, Kim HY … +1 more , Dionigi G
Ann Ital Chir · 2026 May · PMID 42136163 · Publisher ↗
AIM: Transoral robotic thyroidectomy has emerged as a scarless alternative to conventional and remote-access approaches; however, technical standardization and outcome data for truly scarless three-port configurations re...
AIM: Transoral robotic thyroidectomy has emerged as a scarless alternative to conventional and remote-access approaches; however, technical standardization and outcome data for truly scarless three-port configurations remain limited. The aim of this study was to describe the surgical technique and early clinical outcomes of three-port transoral robotic thyroidectomy (TORT) as a truly scarless remote-access approach to the thyroid gland. METHODS: This technical note reports a consecutive series of 25 patients who underwent three-port transoral robotic thyroidectomy between June 2017 and May 2019 at Korea University Hospital. Surgical steps, including vestibular port placement, working-space creation, robotic docking, and lobectomy procedures, are detailed. Perioperative data, postoperative outcomes, and complications were retrospectively analyzed. RESULTS: The median age was 41.0 years, and 76.0% of patients were female. Unilateral thyroidectomy was performed in 80.0% of cases, and central neck dissection in 52.0%. The median operative time was 308.0 minutes, with minimal blood loss (3.0 mL). No intraoperative complications occurred. Transient hypoparathyroidism and recurrent laryngeal nerve palsy were observed in 4.0% of patients each, while one permanent recurrent laryngeal nerve injury (4.0%) was recorded. No cases of mental nerve injury or surgical site infection were observed. Postoperative pain was low, and the median hospital stay was 3 days. CONCLUSIONS: Three-port transoral robotic thyroidectomy is a feasible and safe technique in carefully selected patients when performed in experienced centers. Despite a prolonged operative time during the initial learning phase, complication rates were acceptable and cosmetic outcomes were excellent. This approach should currently be reserved for high-volume endocrine robotic units under strict indication criteria and structured training pathways.
Minimally Invasive Nipple Sparing Mastectomy: Exercise in Style or Proof of Concept.
Barellini L, Coli V, Marcaccini G
Ann Ital Chir · 2026 Apr · PMID 41987635 · Publisher ↗
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Neurosurgery and Artificial Intelligence: Considerations About Defensive Medicine.
Zaed I, Cardia A
Ann Ital Chir · 2026 Apr · PMID 41987634 · Publisher ↗
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Radiomics and Radiogenomics in Prognostic Assessment of Head and Neck Cancer: A Systematic Review of Cutting-Edge Approaches.
Qamar Z, Abdul NS, Shenoy M … +5 more , Soman C, Shivakumar S, Cervino G, Marrapodi MM, Minervini G
Ann Ital Chir · 2026 Apr · PMID 41987633 · Publisher ↗
AIM: The integration of radiomics and radiogenomics in the prognostication of head and neck cancer represents a rapidly evolving field within precision oncology. This systematic review aims to appraise advanced methods i...
AIM: The integration of radiomics and radiogenomics in the prognostication of head and neck cancer represents a rapidly evolving field within precision oncology. This systematic review aims to appraise advanced methods in radiomics and radiogenomics concerning prognostication in head and neck cancer, with a particular focus on methodological developments and clinical applications. METHODS: A systematic literature search was conducted across seven major electronic databases: PubMed/MEDLINE, Embase, Web of Science, Scopus, Cochrane Library, CINAHL, and Google Scholar from January 2013 to December 2023. The search strategy incorporated database-specific syntax, controlled vocabulary such as Medical Subject Headings (MeSH) and Emtree terms, and supplementary free-text terms. RESULTS: Twelve studies were included in the review, and the qualitative analysis revealed three distinct research clusters: prognostic applications, development of predictive models, and molecular-immunological characterization. In all scenarios, studies employing multi-modality modelling were significantly more competent than those relying on single-modality analyses. The area under the curve values of machine learning ranged across 0.71-0.86, outperforming traditional statistical approaches. Larger cohort studies exhibited superior validation metrics. While predictions of molecular characteristics varied, the prediction of immune phenotypes was superior to that of specific genetic alterations. Studies incorporating external validation provided stronger evidence supporting clinical usability. Although some studies presented moderate risk due to early-phase methodological variability, nearly half demonstrated low overall bias. CONCLUSIONS: Our findings indicate significant advances in the prognostication of head and neck cancer through radiomics and radiogenomics approaches. Combined modelling strategies that integrate clinical, radiomic, and genomic features yielded enhanced performance. Despite the development of newer studies with greater methodological rigor and robust validation, variability in feature extraction, processing pipelines, and reporting metrics necessitates further consolidation of methodologies in this field.
Chest Tube Management After Lung Resection: A "Real-Life" Scenario.
Tassi V, Cirocchi R, Ragusa M
Ann Ital Chir · 2026 Apr · PMID 41987632 · Publisher ↗
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Multistage Management of Splenic Flexure Adenocarcinoma in Suspected -Associated Polyposis: A Case Report.
Costanzi A, Tapia Gomez H, Schievano G … +11 more , Chiarelli M, Olmetti S, Scaini A, Bernasconi D, Bonfanti G, Canfora I, Bicelli N, Carissimi F, Fazzini N, Bonfanti G, Sassun R
Ann Ital Chir · 2026 Apr · PMID 41987631 · Publisher ↗
AIM: Colorectal adenocarcinoma in young adults should prompt evaluation for hereditary syndromes such as familial adenomatous polyposis (FAP), attenuated FAP, -associated polyposis (MAP) and other inherited cancer predis...
AIM: Colorectal adenocarcinoma in young adults should prompt evaluation for hereditary syndromes such as familial adenomatous polyposis (FAP), attenuated FAP, -associated polyposis (MAP) and other inherited cancer predisposition syndromes. The purpose of this case report is to highlight management options of incidental MAP diagnosis. CASE PRESENTATION: We report the case of a 41-year-old man presenting to the emergency department with intestinal obstruction due to adenocarcinoma of the splenic flexure, colonic polyposis with rectal sparing, and a significant family history of cancer. RESULTS: After successful endoscopic stenting, a multidisciplinary approach including surgical resection, adjuvant treatment and genetic counseling was carried out. CONCLUSIONS: A minimally invasive subtotal colectomy was proposed to a 41-year-old man whose genetic testing for polyposis and hereditary cancer syndromes revealed a rare homozygotic variation of uncertain significance (VUS)+ in the gene. Absence of rectal involvement made rectal sparing possible in association with close endoscopic follow-up.
Bailout Maneuvers to Avoid Brain Infarct During Aneurysm Exclusion Using the Nexus™ Endograft: A Case Report.
Colacchio EC, Piazza M, Abruzzino G … +3 more , D'Onofrio A, Grego F, Antonello M
Ann Ital Chir · 2026 Apr · PMID 41987630 · Publisher ↗
The aim of this study is to report our experience with a complication that occurred during a single-branch aortic arch endograft deployment for a symptomatic aortic aneurysm exclusion. An 85-year-old patient was diagnose...
The aim of this study is to report our experience with a complication that occurred during a single-branch aortic arch endograft deployment for a symptomatic aortic aneurysm exclusion. An 85-year-old patient was diagnosed with an aortic arch and descending aortic aneurysm associated with chest pain and dyspnea. After a multidisciplinary discussion, we selected an endovascular approach using an off-the-shelf device for the arch (Nexus™ endograft; Endospan) with a single branch for the brachiocephalic trunk (BCT). Supra-aortic trunks debranching (right common carotid-left subclavian bypass and left common carotid artery reimplantation) was planned in the same procedure. After an uneventful main module deployment, the release of the ascending graft was followed by the sudden occlusion of the endograft branch. Suspecting the branch coverage by the ascending module, a relining of the branch using the through-and-through guide wire was performed restoring brain perfusion. The post-operative course was uneventful as well during the follow-up (6 months). In our experience, the Nexus™ endograft (Endospan) presents peculiar technical features that provide great main module deployment stability and allow for rapid bailout maneuvers if complications occur.
Clinical Decision-Making in Laparoscopic Common Bile Duct Exploration: Choosing Between Primary Closure and T-Tube Drainage.
Liu K, Liu Z, Gao J … +2 more , Liu Z, Liu Y
Ann Ital Chir · 2026 Apr · PMID 41987629 · Publisher ↗
AIM: Choledocholithiasis, or common bile duct (CBD) stones, is increasingly prevalent in aging populations worldwide. Laparoscopic common bile duct exploration (LCBDE) is a well-established minimally invasive procedure;...
AIM: Choledocholithiasis, or common bile duct (CBD) stones, is increasingly prevalent in aging populations worldwide. Laparoscopic common bile duct exploration (LCBDE) is a well-established minimally invasive procedure; however, the optimal method for choledochotomy closure-primary closure (PC) versus T-tube drainage (TTD)-remains controversial. METHODS: This narrative review summarizes the available evidence from randomized controlled trials, meta-analyses, and observational studies to compare perioperative practices, clinical outcomes, and patient-specific variables associated with PC and TTD following LCBDE. RESULTS: Quantitative data from meta-analyses and recent clinical studies indicate that when complete stone clearance is achieved and patient conditions permit, PC is associated with significantly shorter operative time (by approximately 20 minutes), reduced hospital stay (by 1-2 days), and lower overall complication rates (e.g., 5.2% vs. 12.1% in selected series), without increasing the risks of bile leakage or biliary stricture. TTD remains valuable in scenarios involving residual stone risk, biliary tract inflammation, uncertain ductal anatomy, or limited institutional resources. Key determining factors include CBD diameter, infection status, choledochoscopic visualization quality, and operator expertise. CONCLUSIONS: Both PC and TTD are valid therapeutic options following LCBDE, with PC preferred in uncomplicated cases and TTD indicated for high-risk scenarios. An individualized, patient-centered strategy based on intraoperative findings and institutional resources is essential to optimize clinical outcomes.
Research Advances in Cell-Assisted Lipotransfer for Facial and Breast Surgery.
Du M, Qin H, Zhang L
Ann Ital Chir · 2026 Apr · PMID 41987628 · Publisher ↗
Cell-assisted lipotransfer (CAL) is an advanced fat grafting technique in which adipose tissue is enriched with regenerative cellular components, most frequently stromal vascular fraction (SVF) or adipose-derived stem ce...
Cell-assisted lipotransfer (CAL) is an advanced fat grafting technique in which adipose tissue is enriched with regenerative cellular components, most frequently stromal vascular fraction (SVF) or adipose-derived stem cells (ADSCs). This approach is intended to enhance the survival and structural stability of conventional fat grafts, thereby improving outcomes in soft-tissue augmentation and regeneration. By supporting early vascularization, reducing postoperative resorption, and enhancing long-term volume retention, CAL may also improve skin quality and local tissue remodeling. Nevertheless, key challenges remain, including the lack of standardized processing protocols, uncertainty about long-term safety, inadequate consensus on optimal cell dosing, and the need for clear regulatory guidelines. This review outlines the technical basis of CAL, presents the preparation and proposed mechanisms of its key bioactive components, including SVF, ADSCs, and platelet-rich plasma (PRP), and systematically examines recent clinical evidence for its application in facial rejuvenation and contour enhancement, as well as breast reconstruction and augmentation. Overall, the aim is to provide a foundation for developing standardized clinical protocols for CAL.
Clinical Efficacy of UBE-ULBD in Patients With Severe Lumbar Spinal Stenosis and Its Impact on Imaging Manifestations.
Zhang Y, Wang L, Hu X … +1 more , Shen M
Ann Ital Chir · 2026 Apr · PMID 41987627 · Publisher ↗
AIM: This research seeks to evaluate the clinical efficacy of unilateral bilateral endoscopy-unilateral laminotomy for bilateral decompression (UBE-ULBD) in patients with severe lumbar spinal stenosis (LSS) and explore i...
AIM: This research seeks to evaluate the clinical efficacy of unilateral bilateral endoscopy-unilateral laminotomy for bilateral decompression (UBE-ULBD) in patients with severe lumbar spinal stenosis (LSS) and explore its impact on imaging manifestations. METHODS: Fifty patients with severe LSS receiving treatment from January 2023 to June 2024 were included in this study and retrospectively examined. The participants were divided into the experimental group ( 27) and the control group ( 23). The control group underwent conventional open surgery, while the experimental group adopted the UBE-ULBD technique. Primary endpoints included perioperative metrics, such as surgical duration, intraoperative blood loss, postoperative drainage, time to first ambulation, and length of hospital stay. Secondary endpoints included visual analogue scale (VAS), Japanese Orthopaedic Association (JOA) scores, Oswestry Disability Index (ODI) scores, Macnab scores, disc height, dural sac area, and complications. All outcomes were assessed at baseline, 1 month, 6 months, and 1 year postoperatively. Additionally, surgical segment fusion, Macnab scores, intervertebral disc height, and dural sac area were assessed at 6 months and 1 year postoperatively, and complications occurring within 1 year postoperatively were documented. RESULTS: In the experimental group, patients experienced shorter surgery duration, reduced intraoperative amount of bleeding, decreased 24-hour wound drainage, shorter antibiotic administration time, earlier ambulation time, and shorter length of hospital stay compared with the control group ( 0.001). At 6 months and 1 year post-surgery, the intervertebral disc height and dural sac area in the experimental group were significantly higher than those in the control group ( < 0.001). There was no statistically significant difference in the number of non-fused cases postoperatively between the groups ( > 0.05), but the experimental group showed a better distribution of Macnab scores ( < 0.05). The VAS scores for low back pain in the experimental group were significantly lower than those in the control group at 1 month and 6 months postoperatively ( < 0.05), while the VAS scores for leg pain were significantly lower only at 1 month postoperatively ( < 0.05), but there was no significant difference between the two groups at 1 year after surgery ( > 0.05). The JOA score of the experimental group was significantly higher than that of the control group at 1 month postoperatively ( < 0.05); the ODI score of the experimental group was significantly lower than that of the control group at 1 month, 6 months and 1 year postoperatively ( < 0.05). Besides, there was no statistically significant difference in the incidence of complications between the two groups ( > 0.05). CONCLUSIONS: Compared with open surgery, UBE-ULBD demonstrated superior perioperative outcomes, greater early decompression, and improved early Macnab efficacy in patients with severe LSS, supporting its potential as a minimally invasive treatment option.
Application of Worry-Free Nursing Concept in Operating Room Nursing Care for Myomectomy: Effects on Perioperative Anxiety and Patient Satisfaction.
Chen Y, You X, Liu C … +3 more , Ouyang Y, Qiang S, Tong W
Ann Ital Chir · 2026 Apr · PMID 41987626 · Publisher ↗
AIM: This retrospective study aimed to investigate the effects of the "worry-free nursing" concept on perioperative anxiety and nursing satisfaction in patients undergoing myomectomy. METHODS: This retrospective study en...
AIM: This retrospective study aimed to investigate the effects of the "worry-free nursing" concept on perioperative anxiety and nursing satisfaction in patients undergoing myomectomy. METHODS: This retrospective study enrolled 200 patients who underwent myomectomy at Shanghai East Hospital (South Branch) between January 2023 and January 2025. Participants were divided into two groups based on the nursing care they received: the control group (n = 107) receiving conventional nursing care, and the observation group (n = 93) receiving "worry-free nursing" care. Patient satisfaction with nursing care, depression and anxiety levels, surgery-related indicators, and postoperative pain intensity were compared between the two groups. RESULTS: The depression and anxiety scores were significantly lower in the observation group than those in the control group ( < 0.001). Compared with the control group, the time to first flatus, time to first ambulation, and average length of hospitalization were significantly lower in the observation group ( < 0.001). Furthermore, the observation group reported significantly lower postoperative pain at 24, 48, and 72 hours than in the control group ( < 0.001). Patient satisfaction with nursing care was significantly higher in the observation group than in the control group, as reflected by the Newcastle Satisfaction with Nursing Scale (NSNS) scores and satisfaction distribution. CONCLUSIONS: The nursing intervention guided by the worry-free concept can alleviate anxiety and depression, and improve emotional well-being in patients undergoing myomectomy, ultimately increasing patient satisfaction, promoting postoperative recovery, and decreasing hospitalization duration.
Predictive Value of C-reactive Protein/Albumin Ratio and Neutrophil/Lymphocyte Ratio in Elderly Patients With Acute Kidney Injury Following On-pump Coronary Artery Bypass Graft.
Wang Z, Fan J, Yuan G … +2 more , Li W, Pan X
Ann Ital Chir · 2026 Apr · PMID 41987625 · Publisher ↗
AIM: This study intended to investigate the predictive value of C-reactive protein (CRP)/albumin ratio (CAR) and neutrophil/lymphocyte ratio (NLR) in elderly patients with acute kidney injury (AKI) following on-pump coro...
AIM: This study intended to investigate the predictive value of C-reactive protein (CRP)/albumin ratio (CAR) and neutrophil/lymphocyte ratio (NLR) in elderly patients with acute kidney injury (AKI) following on-pump coronary artery bypass graft (CABG). METHODS: The clinical information of elderly patients undergoing on-pump CABG admitted to Taizhou People's Hospital was collected for retrospective analysis ( = 150). The patients were divided into two groups based on their postoperative AKI status: injury group ( = 58, with AKI) and non-injury group ( = 92, without AKI). All patients with postoperative AKI were further divided into three groups based on AKI stage: stage 1 group ( = 40), stage 2 group ( = 12), and stage 3 group ( = 6). The CAR and NLR were calculated. Multivariate logistic regression analysis was utilized to explore the risk factors for AKI after on-pump CABG in elderly patients. Receiver operating characteristic (ROC) curve analysis was conducted to predict their diagnostic utility in AKI. RESULTS: Compared with the non-injury group, the injury group exhibited reduced lymphocyte count ( < 0.001) and higher European System for Cardiac Operative Risk Evaluation II (EuroSCORE II) score, cardiopulmonary bypass (CPB) time, NLR, CRP, and CAR ( = 0.006, 0.002, <0.001, <0.001, and <0.001, respectively). Multivariate logistic regression analysis showed that CPB time ( = 0.005, odds ratio [OR] = 1.034, 95% confidence interval [CI] = 1.010-1.058), NLR ( = 0.003, OR = 1.476, 95% CI = 1.139-1.911), and CAR ( < 0.001, OR = 4.460, 95% CI = 2.237-8.890) were the independent influencing factors of AKI in elderly patients after on-pump CABG. The area under the curve (AUC) of CPB time, NLR, CAR, and the combination of NLR and CAR were 0.650, 0.787, 0.790, and 0.838, respectively. DeLong test demonstrated that the combined model incorporating NLR and CAR had significantly greater predictive performance than models using CAR alone ( = 0.011), NLR alone ( = 0.008), and CPB time alone ( = 0.001). Compared to stages 1 and 2, stage 3 patients had significantly higher EuroSCORE II scores ( < 0.05). CRP and CAR levels and age of patients were significantly higher in stage 3 than in stage 1 ( < 0.05), but the difference was not statistically significant compared to stage 2. CONCLUSIONS: NLR, CAR, and CPB time are identified as independent predictors of AKI in elderly patients undergoing on-pump CABG. The combined use of NLR and CAR demonstrates superior predictive performance for postoperative AKI compared with either indicator alone.
Effects of Preoperative Mindfulness Training Combined With Active Breathing and Circulation Exercises on Pulmonary Function Recovery in Lung Cancer Patients After Lobectomy.
Yang L, Chen A, Li L
Ann Ital Chir · 2026 Apr · PMID 41987624 · Publisher ↗
AIM: Diminished pulmonary function and psychological distress, which are common following lobectomy in lung cancer patients, represent a hindrance to the overall recovery. This study aimed to retrospectively explore the...
AIM: Diminished pulmonary function and psychological distress, which are common following lobectomy in lung cancer patients, represent a hindrance to the overall recovery. This study aimed to retrospectively explore the effects of preoperative mindfulness training combined with active breathing and circulation exercises on postoperative pulmonary function recovery in lung cancer patients undergoing lobectomy. METHODS: A retrospective study was conducted on 160 patients who underwent lobectomy at Shaoxing People's Hospital. The samples were divided into two groups based on the type of nursing care received: the control group received standard care, whilst the experimental group received preoperative mindfulness training combined with active breathing and circulation exercises. Evaluation indicators included anxiety and depression levels, physiological parameters (peripheral capillary oxygen saturation [SpO], forced vital capacity [FVC], forced expiratory volume in one second [FEV], maximum voluntary ventilation [MVV], forced expiratory volume in one second, percent of predicted [FEV%pred], forced vital capacity, percent of predicted [FVC%pred], FEV/FVC, arterial oxygen pressure [PaO], and arterial carbon dioxide pressure [PaCO]), exercise tolerance, medication adherence and health-related quality of life (HRQoL). RESULTS: The depression score (2.00 [1.00, 3.00]) and anxiety score (2.00 [1.00, 4.00]) in the experimental group were significantly lower than those in the control group ( < 0.001). Compared with the control group, several physiological indicators showed significant improvement in lung function in the experimental group ( < 0.05), and the Borg scale score (1.00 [0.00, 2.00]) was significantly lower in the experimental group than in the control group ( < 0.001). Regarding exercise tolerance, the post-intervention six-minute walk distance (6MWD) was significantly higher in the experimental group than in the control group (382.10 ± 68.17 vs. 356.24 ± 87.46, < 0.05). In the experimental group, the proportions of patients with poor, moderate, and good medication adherence after surgery were 5.95%, 26.19%, and 67.86%, respectively. In contrast, the corresponding proportions in the control group were 7.89%, 47.37%, and 44.74%. Medication adherence was significantly higher in the experimental group than in the control group ( < 0.05). Regarding quality of life, the experimental group showed significantly higher scores in the five functional dimensions and the overall healthy quality of life dimension compared to the control group ( < 0.05). CONCLUSIONS: Preoperative mindfulness training combined with active breathing and circulation exercises significantly improves the postoperative psychological well-being of patients undergoing lobectomy, enhances medication adherence and lung function recovery, and ultimately improves overall health-related quality of life.
Comparative Efficacy of Uterine Suturing Techniques on Postoperative Recovery Following Repeat Caesarean Section: A Retrospective Cohort Study in Patients With Scarred Uteri.
Chen X, Lu J
Ann Ital Chir · 2026 Apr · PMID 41987623 · Publisher ↗
AIM: The optimal uterine suturing technique for repeat caesarean section in women with a scarred uterus remains controversial, and evidence comparing novel techniques, such as the breakwater suture, with conventional met...
AIM: The optimal uterine suturing technique for repeat caesarean section in women with a scarred uterus remains controversial, and evidence comparing novel techniques, such as the breakwater suture, with conventional methods in terms of comprehensive recovery is limited. The objective of this study is to investigate the combined effects of single-layer suturing, double-layer suturing, and breakwater suture techniques on postoperative recovery in patients with scarred uteri undergoing repeat caesarean section. METHODS: In this retrospective cohort study, 300 pregnant women with scarred uteri undergoing repeat caesarean section at The Maternal and Child Health Care Hospital of Tong Xiang between January 2022 and December 2024 were included. The sample was divided into three groups based on the type of suture used: single-layer suture group ( = 108), double-layer suture group ( = 103), and breakwater suture group ( = 89). Primary outcomes comprised postoperative recovery time, complications, uterine healing status, psychological state, and sleep quality. RESULTS: There were no significant differences in baseline characteristics among the three groups ( > 0.05). Regarding postoperative recovery, the breakwater suture group demonstrated significantly shorter time to anal flatus, time to first ambulation, and postoperative hospital stay compared with both the single-layer and the double-layer suture groups ( < 0.05). Postoperative ultrasound revealed significantly greater uterine segment myometrial thickness in the breakwater suture group compared to the other two groups ( < 0.001). At six months postoperatively, the incidence of uterine diverticulum in the breakwater suture group (4.5%) was significantly lower than that in the single-layer suture group (15.7%); the overall difference among the three groups was statistically significant ( = 0.041). Furthermore, patients in the breakwater suture group demonstrated significantly better postoperative outcomes on the Self-Rating Anxiety Scale (SAS), Self-Rating Depression Scale (SDS), Edinburgh Postnatal Depression Scale (EPDS), and Pittsburgh Sleep Quality Index (PSQI) compared with the other groups ( < 0.001). CONCLUSIONS: In repeat caesarean sections in women with scarred uteri, the breakwater suture technique comprehensively promotes postoperative recovery and may be recommended as a suturing method.
Impact of Simulation Training Combined With Video Debriefing on Surgical Skill Acquisition and Perioperative Outcomes in Laparoscopic Adrenalectomy.
Zuo Y, Zhao Y, Wu X
Ann Ital Chir · 2026 Apr · PMID 41987622 · Publisher ↗
AIM: To investigate the effect of a comprehensive training model combining simulation training and video debriefing on improving the surgical skills of surgeons performing laparoscopic adrenalectomy and to evaluate its i...
AIM: To investigate the effect of a comprehensive training model combining simulation training and video debriefing on improving the surgical skills of surgeons performing laparoscopic adrenalectomy and to evaluate its influence on perioperative outcomes in clinical practice. METHODS: This retrospective study included nine surgeons who completed training between January 2021 and December 2024 and 182 laparoscopic adrenalectomies performed by them. All surgeons underwent both a traditional and a comprehensive training phase, combining simulation training with video debriefing. Accordingly, a total of 79 cases were completed during the traditional training phase, and 103 cases were completed during the comprehensive training phase. The theoretical knowledge scores of the surgeons, Objective Structured Assessment of Technical Skills (OSATS) scores, surgical confidence scores, and corresponding perioperative indicators (operation time, intraoperative blood loss, conversion to open surgery, and postoperative recovery indicators) were compared between the two phases. RESULTS: Compared with the traditional training phase, the comprehensive training phase significantly improved the theoretical knowledge scores of the surgeons [43.00 (42.00, 43.00) vs. 41.00 (38.00, 43.00), = 0.028] and significantly enhanced all dimensions and the total OSATS scores (all < 0.05). The confidence of the surgeons in "independently performing surgery", "understanding the operation steps" and "intraoperative decision-making" was also significantly increased (all < 0.05). Regarding clinical outcomes, patients treated during the comprehensive training phase had significantly shorter operation times [82.00 min vs. 107.00 min, < 0.001], reduced blood loss [64.00 mL vs. 104.00 mL, < 0.001], and significantly shorter times to first postoperative oral intake [13.00 h vs. 31.00 h, < 0.001], ambulation [13.00 h vs. 16.00 h, = 0.002], and postoperative hospital stay [4.00 days vs. 5.00 days, < 0.001]. No statistically significant difference in the conversion rate to open surgery was observed between the two groups ( = 0.816). CONCLUSIONS: The integrated training model combining simulation training and video debriefing effectively improves the theoretical knowledge of surgeons, technical skills, and surgical confidence in laparoscopic adrenalectomy. Notably, these educational improvements were associated with measurable enhancements in real-world surgical performance and improved perioperative patient outcomes. This model represents an efficient surgical training strategy with significant clinical translational value.
Impact of Preoperative Frailty on Postoperative Functional Recovery and Quality of Life in Elderly Patients With Gastrointestinal Tumors.
Xie F, Xi C, Bao G … +4 more , Yang B, Zheng X, Fu B, Zheng Z
Ann Ital Chir · 2026 Apr · PMID 41987621 · Publisher ↗
AIM: To examine the impact of preoperative frailty levels on postoperative functional recovery and quality of life in elderly individuals with gastrointestinal tumors, thereby providing evidence to inform perioperative c...
AIM: To examine the impact of preoperative frailty levels on postoperative functional recovery and quality of life in elderly individuals with gastrointestinal tumors, thereby providing evidence to inform perioperative clinical management. METHODS: A total of 198 individuals aged ≥60 years who underwent radical resection of gastrointestinal tumors in the Department of General Surgery, The First Affiliated Hospital of Kunming Medical University from January 2019 to January 2024 were retrospectively analyzed. The Tilburg Frailty Indicator (TFI) was utilized to assess preoperative frailty; the Barthel Index was used to evaluate functional recovery at 30 and 90 days postoperatively; and the 12-Item Short-Form Health Survey (SF-12) was adopted to assess quality of life at 90 days postoperatively. Statistical analyses, such as chi-square test, logistic regression, and repeated measures analysis of variance, were performed. RESULTS: The incidence of preoperative frailty was 19.2%, mainly manifested in the physical domain. Age, severe comorbidity (Charlson Comorbidity Index ≥6 points), operative duration ≥180 minutes, and preoperative depression were identified as independent risk factors for preoperative frailty, while habit of regular exercise was a protective factor ( < 0.05). Postoperatively, both the Barthel Index and SF-12 scores in the frailty group were significantly lower compared to the non-frailty group ( < 0.001). CONCLUSIONS: Preoperative frailty delays postoperative functional recovery and reduces quality of life in elderly individuals with gastrointestinal tumors. Our findings support the inclusion of TFI in routine preoperative assessment, coupled with the implementation of targeted interventions.
Comparison and Threshold Analysis of the ODET/GTD Ratio Between Patients With and Without Postoperative Sore Throat: A Retrospective Study.
Zhu WP, Zhou N, Wang YN … +2 more , Zhang J, Lin W
Ann Ital Chir · 2026 Apr · PMID 41987620 · Publisher ↗
AIM: This study aimed to retrospectively compare the outer diameter of the endotracheal tube to glottic transverse diameter (ODET/GTD) ratio between patients with and without postoperative sore throat (POST). An optimal...
AIM: This study aimed to retrospectively compare the outer diameter of the endotracheal tube to glottic transverse diameter (ODET/GTD) ratio between patients with and without postoperative sore throat (POST). An optimal ODET/GTD ratio cut-point was explored to provide a reference for endotracheal tube (ETT) selection and potentially help manage the risk of POST. METHODS: We reviewed 150 patients in the Post Anesthesia Care Unit (PACU). Among these, 68 patients developed POST and 82 did not. The ODET/GTD ratio was calculated for each patient. This ratio was compared between the two patient groups. Receiver operating characteristic curve (ROC) analysis was performed, and the Youden index was used to identify the optimal ODET/GTD ratio cut-point for predicting POST. RESULTS: The overall incidence of POST was 45.33%. The mean ODET/GTD ratio was significantly lower in patients without POST (1.02 ± 0.06) than in those with POST (1.18 ± 0.08), < 0.01. ROC analysis identified an optimal ODET/GTD ratio cut-point of 1.10 (Youden index = 0.79) for predicting POST, with a sensitivity of 85% and a specificity of 79%. CONCLUSIONS: Our findings suggest that a higher ODET/GTD ratio may contribute to the development of POST. Based on the ROC curve analysis, the ODET/GTD ratio of 1.10 was determined as a potential reference cutoff value for stratifying the risk of POST. These findings suggest that the ODET/GTD ratio may be useful for perioperative risk assessment; however, before applying it to guide the selection of tracheal intubation, further prospective studies and external validation are still needed.
The Efficacy of Laparoscopic Suspension Combined With Vaginal Wall Repair in the Treatment of Pelvic Organ Prolapse: A Clinical Study.
Kuai X, Hua T
Ann Ital Chir · 2026 Apr · PMID 41987619 · Publisher ↗
AIM: To assess the efficacy and safety of combining laparoscopic suspension with vaginal wall repair for treating Pelvic Organ Prolapse (POP). METHODS: Clinical data from 112 patients with POP admitted to Taishun County...
AIM: To assess the efficacy and safety of combining laparoscopic suspension with vaginal wall repair for treating Pelvic Organ Prolapse (POP). METHODS: Clinical data from 112 patients with POP admitted to Taishun County People's Hospital between January 2022 and October 2024 were collected and analyzed retrospectively. Based on the surgical method, the subjects were categorized into two groups: 52 patients treated with conventional vaginal wall repair were assigned to the control group, and 60 patients treated with vaginal wall repair combined with laparoscopic suspension were assigned to the study group. General characteristics, perioperative indicators, pelvic floor function, postoperative complications, and quality of life were compared between the two groups. The pelvic floor function was assessed using the Colorectal-Anal Distress Inventory-8 (CRADI-8), Pelvic Organ Prolapse Distress Inventory-6 (POPDI-6), and Urogenital Distress Inventory-6 (UDI-6), whereas the quality of life was measured using the Pelvic Organ Prolapse/Urinary Incontinence Sexual Questionnaire-12 (PISQ-12), Pelvic Floor Distress Inventory-20 (PFDI-20), and Pelvic Floor Impact Questionnaire-7 (PFIQ-7). RESULTS: Baseline characteristics were comparable between the two groups ( > 0.05). The study group, however, experienced longer surgery, increased intraoperative blood loss, and extended catheterization compared with the control group, while length of hospital stay and postoperative residual urine volume showed no significant differences ( > 0.05). At three months postoperatively, patients in the study group showed significantly improved scores in CRADI-8, POPDI-6, and UDI-6 compared with the control group ( < 0.05). Postoperative complication rates were similar between the groups ( > 0.05). At 12 months postoperatively, the study group had higher PISQ-12 scores and lower PFDI-20 and PFIQ-7 scores compared with the control group ( < 0.001), suggesting more significant improvements in sexual function and quality of life. CONCLUSIONS: Compared with vaginal wall repair alone, the combined approach of laparoscopic suspension and vaginal wall repair improves postoperative pelvic floor function and quality-of-life outcomes without increasing the risk of complications, supporting its role as a valuable surgical option for selected patients with POP.
Effects of Ultrasound-Guided Pericapsular Nerve Group Block Combined With Lumbar Anesthesia on Analgesia and Cognitive Function in Elderly Patients After Hip Arthroplasty.
He Y, Zhuo H, Wang J
Ann Ital Chir · 2026 Apr · PMID 41987618 · Publisher ↗
AIM: With population aging, hip arthroplasty among elderly patients has become increasingly common. This study investigated the effects of ultrasound-guided pericapsular nerve group block (PENG) combined with lumbar anes...
AIM: With population aging, hip arthroplasty among elderly patients has become increasingly common. This study investigated the effects of ultrasound-guided pericapsular nerve group block (PENG) combined with lumbar anesthesia versus general anesthesia on circulatory and respiratory stability, analgesia, cognitive function, and safety in elderly patients after hip arthroplasty. METHODS: A total of 86 patients who underwent hip arthroplasty in our hospital between June 2022 and June 2024 were retrospectively selected and divided into a control group (n = 50, general anesthesia) and an observation group (n = 36, ultrasound-guided PENG combined with lumbar anesthesia) according to different anesthesia conditions. Circulatory and respiratory indices, including mean arterial pressure, systolic blood pressure (SBP), diastolic blood pressure (DBP), oxygenation index, and lung function, were compared between the two groups before and after surgery. Analgesia was evaluated using visual analogue scale (VAS). Cognitive function was assessed using the Mini-Mental State Examination (MMSE) score, and the incidence of postoperative delirium (POD) was compared between the two groups. Adverse reactions related to anesthesia were also recorded. RESULTS: Mean arterial pressure, SBP, and DBP showed no significant differences between the two groups at different perioperative time points (all > 0.05). The oxygenation index also remained stable postoperatively, with no statistically significant difference between groups. At 1, 6, and 24 hours after the operation, the incidence of adverse events in the observation group (2.78%, 8.33%, and 13.89%, respectively) was lower than in the control group (6%, 14%, and 26%). VAS scores decreased significantly over time, with a significant time effect ( < 0.001). In addition, a significant time × group interaction was observed ( < 0.001), suggesting a greater reduction in the observation group. The incidence of postoperative delirium in the observation group showed a lower trend (8.33% 14% at 6 hours; 16.67% 24% at 24 hours), though the difference was not statistically significant ( > 0.05). The overall incidence of adverse reactions was significantly lower in the observation group (13.89%) compared with the control group (26.00%, < 0.05). There was no significant difference in the preoperative MMSE scores between the two groups (control group: 27.50 ± 2.10 points, observation group: 27.80 ± 1.90 points, = 0.58, = 0.46). The postoperative MMSE score of the observation group (27.00 ± 2.50 points) was significantly higher than that of the control group (25.20 ± 2.99 points, = 3.13, = 0.01). CONCLUSIONS: Ultrasound-guided PENG combined with lumbar anesthesia is a safe and effective anesthesia method for elderly patients undergoing hip arthroplasty, providing better analgesia, preserving cognitive function, and reducing adverse reactions.
Comparison of MRI T2 Mapping and T2 Multi-Echo 3D Water Excitation in Assessing Cartilage Injury of Ankle Joint.
Chen S, Zang J, Guo L … +2 more , Zhao H, Wan X
Ann Ital Chir · 2026 Apr · PMID 41987617 · Publisher ↗
AIM: The ankle joint is vulnerable to injuries. However, utilizing conventional magnetic resonance imaging (MRI) to detect early compositional changes of cartilage injury in the ankle joint poses significant challenges,...
AIM: The ankle joint is vulnerable to injuries. However, utilizing conventional magnetic resonance imaging (MRI) to detect early compositional changes of cartilage injury in the ankle joint poses significant challenges, and the diagnostic value of T2 mapping and T2 multi-echo 3D water excitation (T2-me3d-we) versus conventional MRI remains unclear. To explore the clinical value of T2 mapping and T2-me3d-we quantitative parameters in MRI in the diagnosis of cartilage injury of the ankle joint based on the receiver operating characteristic (ROC) curve. METHODS: Clinical data of 182 patients with suspected cartilage injury of the ankle joint who underwent MRI examination in our hospital from November 2019 to November 2021 were retrospectively analyzed. T2 mapping and T2-me3d-we quantitative parameters were obtained from MRI examination performed on all included patients. T2 values, apparent diffusion coefficient (ADC) and fractional anisotropy (FA) were measured as key parameters. ROC curve analysis, paired -test, and intraclass correlation coefficient (ICC) were used for comparative analysis. RESULTS: T2 mapping demonstrated superior efficacy, as evidenced by a higher area under the curve (AUC) (0.879 vs. 0.868) and a higher Youden index (0.608 vs. 0.607) in the ROC analysis. The combination of T2 mapping-derived T2 values and diffusion tensor imaging ADC metrics using an integrated model achieved an AUC of 0.942 (95% confidence interval [CI]: 0.897-0.987). This result indicates that the model performed better than the performance of each individual parameter when used on its own. The diagnostic coincidence rate of T2 mapping was 97.80%, higher than the T2-me3d-we rate of 93.41% (p < 0.05). Compared with the normal group (NG), the injury group (IG) exhibited higher T2 values (p < 0.001) and ADC values, but lower FA values (p < 0.001). The ROC curve showed that the quantitative parameters of T2 mapping and T2-me3d-we demonstrated good diagnostic efficacy for cartilage injury of the ankle joint. CONCLUSIONS: T2 mapping demonstrated superior quantitative diagnostic performance compared to T2-me3d-we for detecting ankle chondral lesions and may therefore serve as a promising first-line imaging biomarker for routine clinical evaluation. Combined image assessment further enhanced discriminatory power, offering incremental value for surgical decision-making.
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