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At least 19 recordsLinked to original sources
PubMed2026

Delphi study robot consenso: Strategies for the implementation of robotic surgery in general surgery in the Spanish hospital network.

INTRODUCTION: The implementation of robotic surgery in public hospitals presents multiple logistical, educational, and organizational challenges. In the absence of unified guidelines, a national consensus is required to optimize its safe and efficient adoption. This study aimed to establish a set of consensus-based and measurable recommendations for the implementation of robotic surgery programs in hospitals within the Spanish National Health System, based on the experience of centres with established robotic programs and intended to serve as guidance for hospitals that are initiating or planning their implementation. METHODS: A national Delphi study was conducted with the participation of robotic surgery experts from 26 public hospitals. The expert panel was composed exclusively of digestive surgeons with experience in robotic surgery. Three iterative rounds of expert panel evaluation were conducted between March 2024 and March 2025. The questions were grouped into five thematic blocks. Consensus was defined as an agreement level of ≥66.7%. Kendall's W coefficient was used to assess concordance. RESULTS: High levels of consensus were achieved on key aspects related to infrastructure, structured training, cost evaluation, and quality assurance mechanisms. Areas of disagreement were also identified, such as the need for a dedicated anaesthesiologist, purchase of accessory instruments during the initial phase, and official accreditation pathways. CONCLUSIONS: This study provides a guideline for developing a national robotic surgery strategy focused on patient safety, program sustainability, and standardized training of surgical teams. These recommendations can guide hospitals at different stages of robotic technology adoption. Given that the consensus was reached from an exclusively surgical perspective, the recommendations focus on patient safety, program sustainability, and standardized training of the surgical team, and should be interpreted in an adaptable manner according to each centre's context, case volume, and available resources.

Cirugía Asistida por Robot↗
PubMed1977

Recent advances in general surgery.

In order to give an overview of recent advances in general surgery, it is necessary to define: (i) what is general surgery; (ii) what is recent; and (iii) what constitutes an advance. General surgery appears to have entered an era of conservatism. This is particularly evident in the surgery of breast cancer, peptic ulceration, varicose veins, liver trauma, portal hypertension, upper gastrointestinal bleeding, and hiatal hernia. Controlled clinical trials in surgery have become popular. The following are considered to be advances: parenteral nutrition, suction drainage, control of Gram-negative sepsis, bypass surgery for pathological obesity, and a discriminatory approach to transplant surgery.

Anti-Bacterial Agents↗
PubMed1977

[Recording of the surgical procedures and postoperative complications in general surgery].

With selected examples from general surgery, a better statistical elaboration of patient's data by means of operation and complication classification is demonstrated. The use of an operation and a complication key is presented. The advantage of such a classification key in documentation is the possibility of maintaining an accurate yearly review of all therapeutical methods in surgery.

Computers↗
PubMed1978

The high-risk cardiac patient undergoing general surgery.

The challenge of the high-risk cardiac patient undergoing general surgery will be met only when an aggressive approach is taken to avoid an unfavourable balance between the oxygen supply and demand of the myocardium. In the past this challenge has been accepted in the operating room but postoperative care has been less than adequate. The intelligent use of potent, effective pharmacologic agents and intensive monitoring of myocardial performance intra- and postoperatively have greatly reduced morbidity and mortality in patients with ischemic heart disease undergoing aortocoronary bypass procedures; they can achieve similar results in such patients who must undergo general surgery.

Anesthesia, General↗
PubMed1977

A 14-month study of severe non-wound infectious complications in general surgery.

A retrospective study of serious non-wound infectious complications in general surgery during at 14-month period is reported. A prospective study on wound infections in available from the same institution and period. Septicemia, intraabdominal and intrathoracal abscesses and rare cases of osteomyelitis occurred in 1.3% of all treated patients, whereas postoperative wound infection developed in 7.5% of primarily non-infected patients. Mortality was significantly higher among patients with serious infections than in all patients nursed during the same period. Severe postoperative infectious complications was in fact the third most common cause of death and accounted for 14% of the mortality of the clinic. This rate rises to close to 50% when death from incurable disease is excluded. Septicemia carried a significantly higher mortality rate than intraabdominal abscesses. The risk of a serious infection developing was significantly higher in operations on the small or large intestine than after appendectomies or biliary operations. Gram negative bacteria dominated, especially in cases with a fatal outcome. Contributing factors such as malignancy, preoperative infection or macroscopic peroperative wound soiling, were more common in patients where a serious infectious complication developed postoperatively.

Abscess↗
PubMed1977

The value of laparoscopy in general surgery.

Fifty-six general surgical patients were evaluated by laparoscopy, primarily for diagnostic problems, ascites or liver assessment for potential metastatic disease. There was minimal morbidity and no mortality from the procedure. Overall laparoscopic accuracy was 87%. In properly selected cases, laparoscopy can often resolve a diagnostic problem, determine the extent of disease and permit initiation of appropriate therapy.

Adenocarcinoma↗
PubMed1976

Laparoscopy in general surgery.

In the last seven years laparoscopy has become increasingly popular in North America. The procedure has been mainly embraced by the gynecologist. Other specialities have been relatively slow in recognizing its value. Laparoscopy has wide applications in general surgery. It is a useful tool in blunt abdominal trauma and often prevents laparotomy. In patients with acute abdominal conditions, when findings are atypical, uncertainty in diagnosis may be resolved by laparoscopy. In patients with malignant disease it permits assessment of the extent of the lesion and enables accurate selection of the mode of therapy. Numerous procedures per laparoscopy, including biopsies, division of adhesions, cholangiography and collection of samples for bacteriologic studies, may be carried out simultaneously. Complication associated with the procedure are few but may be severe. These can be avoided by careful adherence to proper technic.

Abdomen, Acute↗
PubMed1976

[Total endoprosthesis of the hip joint. Experience with 931 cases (April 1969-April 1976) in a general surgery department (author's transl)].

The total artificial replacement of the hip joint in dislocated medial fracture of the neck of the femur in elderly people and in coxarthrosis is the standard method today. While there is no better method at the present time for the older patient, loosening and infections in particular compel strict indication and a search for other solutions for younger persons. Taking these criteria into consideration, the operation has proved thoroughly reliable up to the present and it is also worth recommending for use in a suitably experienced general surgery department. In the 6 years, 193 medial fractures of the neck of the femur with sequelae and 704 coxarthroses were operated on and 34 prosthesis exchanges were also undertaken. In medial fracture of the neck of the femur in the elderly as an acute and life-threatening disturbance of function, the mortality was 15%, whereas in coxarthrosis patients it was 0,3%. The early and late complications lie within justifiable limits.

Age Factors↗
PubMed1975

[The value of dextran 70 in the prevention of thromboembolism in general surgery, orthopedics, urology and gynecology. A review of the literature].

28 prospective, controlled, randomised studies on the incidence of deep vein thrombosis (DVT) and pulmonary embolism (PE) in surgical patients on dextran 70 prophylaxis are analysed. In all patients the diagnosis had been established by objective methods (fibrinogen test, phlebography, autopsy). In patients undergoing hip surgery (11 studies, mainly fractures of the upper end of the femur) the reduction in the number of DVT under dextran prophylaxis is the more evident the longer after operation phlebography is carried out. Coumarin and dextran prevention are equally effective. In 3 studies where diagnosis by the fibrinogen test was established during the first postoperative week only, no significant effect of dextran can be shown; there is no difference between the effect of dextran, coumarin or small doses of subcutaneous heparin. The effectiveness of dextran prophylaxis in reducing the DVT rate in general surgery (4 papers) is not clear, though 7 studies show that the number of fatal PE is reduced more than fivefold (p less than 0.0005). In patients on dextran prophylaxis, the incidence of DVT is equal to that in patients on coumarin prophylaxis before major gynecological surgery (4 papers). On postoperative initiation coumarin is significantly less effective than dextran. 2 further studies show that dextran is significantly effective as compared to controls and that there is no difference between dextran and heparin prophylaxis. Out of 1932 control patients 36 died of fatal PE verified at autopsy. Only 8 PE were seen in the group of 2011 patients receiving dextran prophylaxis (p less than 0.005). The effectiveness of dextran 70 corresponds to that of small doses of subcutaneous heparin. Dextran prevention is more effective in women than in men. Dextran prophylaxis is simple to carry out, has few contraindications, only rarely causes complications and is already effective during operation.

Amputation, Surgical↗
PubMed1978

[Urination disorders following general surgery].

The disturbance of miction after general surgical operations has three causes. They exist individually and combined. The first cause is a relative trauma of anaesthesiological remedies. They have a central site of action in the brain stem and a peripheral one in the parasympathetic and sympathetic ganglian of the urinary bladder. The second cause is an operative trauma of the abdomino-pelvic initial reflex of the miction. The two traumata, the vegetative and the mechanical one, decompensate an imminent neuropathic or obstructive reduction of the urinary bladder. The two traumata are prolonged by abdominal, pulmonary and cerebral insufficiency. The third cause is a direct lesion of the sacral plexus pelvicus. - The postoperative disturbance of miction concerns about 25% of all operated persons. Children are specifically rarely concerned. Operations on the lower half of the body cause the disturbance of miction by far more frequently than operations on the upper half of the body or on extremities. The therapy consists of a rational, liberal and differentiated use of the catheter, further in parasympathomimetic and sympatholytic medication, in the obstructively or neuropathically decompensated cases in transurethral operative correction of the outlet of the urinary bladder.

Anesthesia, General↗
PubMed2026

Interhospital transfer and outcomes after robotic emergency general surgery: a national analysis.

The outcomes of patients transferred to receiving centers who subsequently undergo robotic EGS remain uncharacterized at a national level. We aimed to quantify the association between transfer and outcomes among adults undergoing robotic EGS. We performed a retrospective cohort study of the Nationwide Readmissions Database (2016-2019) including adult nonelective admissions undergoing robotic EGS. Interhospital transfer versus direct admission was the exposure. Survey-weighted logistic regression estimated adjusted odds ratios (aOR) for clinical outcomes; generalized linear models with gamma family and log link estimated adjusted mean ratios (aMR) for length of stay (LOS) and cost. Average marginal effects provided adjusted risks/means and absolute differences. Among 26,869 unweighted robotic EGS admissions, representing an estimated 46,517 admissions nationally, 246 unweighted admissions were interhospital transfers, representing an estimated 444 transfers (1.0%) nationally. Transfers were older, more comorbid, and more severely ill and were treated predominantly at large, teaching hospitals. After adjustment, transfer was associated with a higher risk of postprocedural complications (8.0% vs. 3.5%; aRR 2.26, 95% CI 1.25-3.27), non-home discharge (31.2% vs. 18.9%; aRR 1.65, 95% CI 1.38-1.92), longer LOS (11.49 vs. 5.53 days; AMR 2.08, 95% CI 1.78-2.42), and higher cost ($43,340 vs. $21,821; AMR 1.99, 95% CI 1.68-2.35). The association with postprocedural complications was attenuated after additional adjustment for APR-DRG Severity of Illness, whereas associations with non-home discharge, LOS, and cost persisted. Among patients undergoing robotic EGS, interhospital transfer is independently associated with higher complication burden and greater resource use. Transferred patients represent a small but distinctly high-risk subgroup whose worse outcomes may reflect drivers that extend beyond the choice of surgical approach.

Humans↗