Annals of the Royal College of Surgeons of England
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Owing to the COVID-19 pandemic, there has been significant disruption to all surgical specialties. In the UK, units have cancelled elective surgery and a decrease in aerosol generating procedures (AGPs) was favoured. Centres around the world advocate the use of negative pressure environments for AGPs in reducing the spread of infectious airborne particles. We present an overview of operating theatre ventilation systems and the respective evidence with relation to surgical site infection (SSI) and airborne pathogen transmission in light of COVID-19. ⋯ Evidence for laminar flow ventilation in reducing the rate of SSI in orthopaedic surgery is widely documented. There is little evidence to support its use in general surgery. Following previous viral outbreaks, some centres have introduced negative pressure ventilation in an attempt to decrease exposure of airborne pathogens to staff and surrounding areas. This has again been suggested during the COVID-19 pandemic. A limited number of studies show some positive results for the use of negative pressure ventilation systems and reduction in spread of pathogens; however, cost, accessibility and duration of conversion remain an unexplored issue. Overall, there is insufficient evidence to advocate large scale conversion at this time. Nevertheless, it may be useful for each centre to have its own negative pressure room available for AGPs and high risk patients.
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Ann R Coll Surg Engl · Oct 2020
ReviewArtificial Intelligence in plastic surgery: What is it? Where are we now? What is on the horizon?
An increasing quantity of data is required to guide precision medicine and advance future healthcare practices, but current analytical methods often become overwhelmed. Artificial intelligence (AI) provides a promising solution. Plastic surgery is an innovative surgical specialty expected to implement AI into current and future practices. It is important for all plastic surgeons to understand how AI may affect current and future practice, and to recognise its potential limitations. ⋯ Current machine learning models using convolutional neural networks can evaluate breast mammography and differentiate benign and malignant tumours as accurately as specialist doctors, and motion sensor surgical instruments can collate real-time data to advise intraoperative technical adjustments. Centralised big data portals are expected to collate large datasets to accelerate understanding of disease pathogeneses and best practices. Information obtained using computer vision could guide intraoperative surgical decisions in unprecedented detail and semi-autonomous surgical systems guided by AI algorithms may enable improved surgical outcomes in low- and middle-income countries. Surgeons must collaborate with computer scientists to ensure that AI algorithms inform clinically relevant health objectives and are interpretable. Ethical concerns such as systematic biases causing non-representative conclusions for under-represented patient groups, patient confidentiality and the limitations of AI based on the quality of data input suggests that AI will accompany the plastic surgeon, rather than replace them.
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Ann R Coll Surg Engl · May 2020
ReviewEmergency surgery during the COVID-19 pandemic: what you need to know for practice.
Several articles have been published about the reorganisation of surgical activity during the COVID-19 pandemic but few, if any, have focused on the impact that this has had on emergency and trauma surgery. Our aim was to review the most current data on COVID-19 to provide essential suggestions on how to manage the acute abdomen during the pandemic. ⋯ During the COVID-19 pandemic, all efforts should be deployed in order to evaluate the feasibility of postponing surgery until the patient is no longer considered potentially infectious or at risk of perioperative complications. If surgery is deemed necessary, the emergency surgeon must minimise the risk of exposure to the virus by involving a minimal number of healthcare staff and shortening the occupation of the operating theatre. In case of a lack of security measures to enable safe laparoscopy, open surgery should be considered.
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Ann R Coll Surg Engl · Mar 2019
ReviewSolitary ulnar shortening osteotomy for malunion of distal radius fractures: experience of a centre in the UK and review of the literature.
Isolated ulnar shortening osteotomies can be used to treat ulnocarpal abutment secondary to radial shortening following distal radius fractures. Given the increase of fragility distal radius fractures awareness of treating the sequelae of distal radius fractures is important. We present the largest reported case series in the UK of ulnar shortening osteotomies for this indication. ⋯ The ulnar shortening osteotomy is a relatively simple procedure compared with corrective radial osteotomy, with a lower complication profile. In our series, patients showed significant improvement in pain and function by correcting the ulnar variance thus preventing ulna-carpal impaction.
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Ann R Coll Surg Engl · Mar 2019
Suture choice to reduce occurrence of surgical site infection, hernia, wound dehiscence and sinus/fistula: a network meta-analysis.
There are many options and little guiding evidence when choosing suture types with which to close the abdominal wall fascia. This network meta-analysis investigated the effect of suture materials on surgical site infection, hernia, wound dehiscence and sinus/fistula occurrence after abdominal surgery. The aim was to provide clarity on whether previous recommendations on suture choice could be followed with confidence. ⋯ No suture type can be considered the 'best treatment' for the prevention of surgical site infection, hernia, wound dehiscence and sinus/fistula occurrence.