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PRUDENT (Prioritization, incentives and Resource use for sUstainable DENTistry) is a multinational project funded under the European Union’s (EU’s) Horizon Europe program. Our team includes partners from Denmark, Estonia, France, Germany, Hungary, Ireland, Malta, the Netherlands, Norway, Portugal, and the United Kingdom; we aim to develop and implement an innovative and context-adaptive framework for optimal financing of oral health care that enables access to essential oral health care for everyone without causing financial hardship. PRUDENT will leverage health economics and implementation science methods to convert novel evidence on oral health financing into meaningful improvements of oral care. PRUDENT will harness behavioral experiments, system dynamics modeling, implementation trials, deliberative processes, and a multicountry monitoring framework on oral health care financing in the EU. Using a mixed-methods research design, PRUDENT addresses 3 objectives: (1) to develop a harmonized core set of oral health system indicators, implement them in a novel EU-wide monitoring system, and integrate them in deliberative processes to set priorities for oral care financing; (2) to identify optimization strategies for oral health care financing, in which real-world and lab experiments on provider payment and oral care insurance coverage, needs-adaptive resource planning, regulatory learning, and digital decision aid tools are leveraged to help accelerate transformations in oral care financing; and (3) to harness innovative knowledge transfer strategies for the co-development and co-production of sustainable implementation strategies for oral and general health care financing. Through improving access to essential oral care for everyone without causing financial hardship, PRUDENT is expected to help achieve universal health coverage for oral health.Knowledge Transfer Statement: The EU PRUDENT project aims to enhance the financing of oral health systems through novel evidence and implementation of better financing solutions together with citizens, patients, providers, and policy makers. The multicountry nature of the project offers unique windows of opportunity for rapid learning and improving within and across various contexts. PRUDENT is anticipated to strengthen capacities for better oral care financing in the EU and worldwide.

Zusammenfassung: Die minimal-invasive Chirurgie hat die Behandlung der Achalasie mehr als die jeder anderen gastrointestinalen Erkrankung beeinflusst. Die laparoskopische Heller-Myotomie hat sich dabei zur „First-line-Therapie“ bei Patienten mit Achalasie entwickelt und zu einer signifikanten Änderung im Behandlungsalgorithmus bei der Achalasie geführt. Ziel unserer Arbeit ist die Darstellung der technischen Aspekte der Heller-Myotomie mit kombinierter Antirefluxplastik sowie der „Fallstricke“ der operativen Prozedur. Nach Injektion von NaCl 0,9% in die Muskularis und Submukosa des distalen Ösophagus bzw. Fundus, wobei sich die submuköse Ebene sehr gut von der Mukosa abhebt, erfolgt die Myotomie der Längs- und Ringmuskulatur des distalen Ösophagus vom ösophagokardialen Übergang aus nach kranial über eine Distanz von 6–7 cm und wird über 1,5–2 cm auf den proximalen Magenfundus fortgesetzt. Als Antirefluxplastik präferieren wir eine 180° anteriore Semifundoplikatio nach Dor, die zweireihig in die beiden Schenkel der Myotomie eingenäht wird. „Fallstricke“ sind eine inkomplette Myotomie, insbesondere im distalen, fundusseitigen Anteil mit konsekutiver Persistenz/Rezidiv von Symptomen sowie okkulte Mukosaperforationen, die durch intraoperative Endoskopie detektiert werden können.

Introduction: Minimally invasive esophagectomy (MIE) for esophageal cancer is a complex procedure that reduces postoperative morbidity in comparison to open approach. In this study, thoracic cage width as a factor to predict surgical difficulty in MIE was evaluated. Methods: All patients of our institution receiving either total MIE or robotic-assisted MIE (RAMIE) with intrathoracic anastomosis between February 2016 and April 2021 for esophageal cancer were included in this study. Right unilateral thoracic cage width on the level of vena azygos crossing the esophagus was measured by the horizontal distance between the esophagus and parietal pleura on preoperative computer tomography. Patients’ data as well as operative and postoperative details were collected in a prospective database. Correlation between thoracic cage width with duration of the thoracic procedure and postoperative complication rates was analyzed. Results: Overall, 313 patients were eligible for this study. Thoracic width on vena azygos level ranged from 85 to 149 mm with a mean of 116.5 mm. In univariate analysis, a small thoracic width significantly correlated with longer duration of the thoracic procedure (p= 0.014). In multivariate analysis, small thoracic width and neoadjuvant therapy were identified as independent factors for long duration of the thoracic procedure (p= 0.006). Regarding postoperative complications, thoracic cage width was a significant risk factor for occurrence of postoperative pneumonia in the multivariate analysis (p= 0.045). Dividing the cohort into two groups of patients with narrow (≤ 107 mm, 19.5%) and wide thoraces (≥ 108 mm, 80.5%), the thoracic procedure was significantly prolonged by 17 min (204 min vs. 221 min, p= 0.014). Conclusion: A small thoracic cage width is significantly correlated with longer operation time during thoracic phase of a MIE in Europe, which suggests increased surgical difficulty. Patients with small thoracic cage width may preferably be operated by MIE-experienced surgeons. Graphical abstract:

•Educational Team Time Out leads to improved intraoperative communication, more prepared residents, improved understanding of the whole surgical team and more effective surgical education•Increases in performed substeps of complex oncologic procedures•The concept is applicable for all surgical specialties

Selon les dernières recommandations européennes, les ponctions biopsies prostatiques par voie transpérinéale (PBP-TP) sont le nouveau gold standard dans le diagnostic du cancer de prostate (CaP). Entre avril 2016 et mars 2022, 90 patients ont été inclus dans un essai clinique randomisé prospectif monocentrique (NCT: 02651948), évaluant la qualité de vie des patients ayant bénéficié de PBP par voie transrectale (TR) ou de PBP-TP sous contrôle IRM (in-bore) de réévaluation dans le cadre de la surveillance active (SA) du CaP ou après une première série de PBP TR négative avec lésion cible PIRADS≥3.

La localisation hilaire des masses rénales est parfois considérée comme un facteur limitant pour réaliser une néphrectomie partielle en toute sécurité. L’objectif de l’étude est de comparer les résultats périopératoires, oncologiques et fonctionnels de la néphrectomie partielle robot-assistée (NPRA) pour les tumeurs hilaires (NPRA-H) et extra-hilaires (NPRA-EH).

Le but de cette étude est d’évaluer de manière prospective la technique d’ultrasons endo-urétraux IRM-guidée (MRI-TULSA).

Byline: H. Lang, B. Lefebvre Quality assurance was once the domain of a small group of specialists who checked every product to ensure that it conformed to the given requirements. Today, there is an increasing awareness that economic quality assurance must be based on teamwork between all those involved in production, using the idea of a 'total quality concept'. This requires a change in a company's 'culture' to one in which employees at all levels have some responsibility for quality.

Aujourd’hui, la cryothérapie fait partie de l’arsenal thérapeutique face au cancer de la prostate localisé. Nous nous sommes intéressés aux traitements globaux, de première ou de seconde ligne. Notre travail visait à identifier des facteurs de risques de mauvaise réponse au traitement du cancer de la prostate par cryothérapie.

Immune checkpoint inhibitor (ICI)-based combinations have revolutionized the management of first-line metastatic renal cell carcinoma (mRCC) by improving patient survival. Large phase 3 randomized trials assessing ICI-based combinations have reported complete response (CR) rates of 10% to 18% in the first-line setting. However, there is a scarcity of data about the effect of treatment of residual disease regarding CR rates improvement.

Tools are needed to assess laparoscopic camera navigation (LCN) in the operating room. Here, we aimed to develop an objective rating scale for LCN. We defined the following key aspects of LCN: operational field centering, correct angle of the horizon, correct instrument visualization, verbal commands from the operating surgeon, and manual corrections from the operating surgeon. We then developed a score based on intraoperative error evaluation from intraoperative recordings of 80 procedures. Finally, the newly developed score was validated by four different raters using video-based analysis of 20 elective laparoscopic cholecystectomies. We developed and validated a tool for the structured assessment of laparoscopic assistant skills (SALAS). This score showed good internal consistency, with a Cronbach’s alpha of > 0.7. Intraclass correlation revealed a low interrater variability (ICC 0.866) for the total score. Comparison of experienced and inexperienced camera assistants revealed significantly better SALAS scores for experienced assistants (p< 0.05). Our present results show that SALAS score is valid, reliable, and practicable. This score can be used for future investigations of camera navigation efficiency and training.

Supplemental Digital Content is available in the text.

La néphrectomie différée est aujourd’hui de plus en plus souvent discutée chez des patients en réponse complète ou très bonne réponse partielle sur les sites métastatiques. Dans certains cas, des difficultés chirurgicales majeures ont été décrites en rapport avec des remaniements inflammatoires ou fibrotiques. L’objectif de cette étude est d’évaluer les facteurs préopératoires prédictifs de difficultés chirurgicales.

La néphrectomie partielle (NP) est actuellement le traitement de référence des cancers du rein localisés. La NP est réputée offrir un contrôle carcinologique équivalent à celui de la néphrectomie totale élargie (NTE), néanmoins, très peu de données sont disponibles dans ce contexte précis. Notre objectif était de comparer les survies sans progressions (DFS) dans ce contexte en fonction du type de chirurgie : NP versus NTE.

Les thérapies ablatives (TA) dans le cancer du rein se développent. Il paraît important de faire un point dans cette évolution pour des techniques en cours d’évaluation. L’objectif de cet article est d’identifier les indications actuelles des TA dans le cancer du rein.

Décrire les modalités spécifiques de prise en charge des traitements ablatifs dans le cancer de la prostate.

Les techniques ablatives permettant la destruction in situ d’un processus tumoral cherchent à obtenir la nécrose tissulaire par application de différent processus physiques.

Établir un état des lieux des indications et des limites actuelles des traitements ablatifs in situ dans le cancer de la prostate localisé.

Présenter les principaux éléments de débat des pratiques à partir des recommandations actuelles et proposer des perspectives pour les traitements ablatifs.

L’orientation vers une thérapie ablative (TA) étant pressentie, il conviendra de valider certaines étapes pour assurer le bon déroulement de cette prise en charge transversale. Selon le schéma du parcours patient, le but de cet article est d’aborder les exigences et les choix dans chacune des phases pré-, per- et post-interventions.

Établir un état des lieux des modalités d’évaluation et des résultats actuels des traitements ablatifs in situ dans le cancer de la prostate localisé.

L’incidence du cancer du rein est en augmentation ces dernières décennies du fait d’une plus grande fréquence des découvertes fortuites de petites tumeurs par imagerie. Le but de cet article est de décrire les résultats actuels des traitements ablatifs (TA) et les comparer aux autres modalités de traitement des petites tumeurs du rein en termes d’efficacité oncologique, préservation néphronique, morbidité et coût.

Presents letters to the editors referencing articles and topics about politics and administration discussed in previous issues of this periodical. Troubles in the administration of antiquities in Greece; Stereopticon talks on the subject of taxation in Cleveland, Ohio; Discussion about Castilian language.

After low anterior resection for rectal cancer, visual assessment of pelvic autonomic nerve preservation can be difficult due to the complexity of neuroanatomy, as well as surgery- and patient-related factors. The present study aimed to evaluate nerve-sparing quality assurance using the laparoscopic neuromapping (LNM) technique. We prospectively investigated a series of 30 patients undergoing laparoscopic low anterior resection. Nerve-sparing was evaluated both visually and electrophysiologically. LNM was performed using stimulation of pelvic autonomic nerves under simultaneous cystomanometry and processed electromyography of the internal anal sphincter. Urogenital and anorectal functions were evaluated using validated and standardized questionnaires preoperatively, at short-term follow-up, and at mid-term follow-up at a median of 9 months (range 6–12 months) after surgery. One patient reported new onset of urinary dysfunction, and another patient reported new onset of anorectal dysfunction. Of the 20 sexually active patients, five reported sexual dysfunction. Visual assessment by laparoscopy confirmed complete nerve preservation in 28 of 30 cases. For prediction of urinary and anorectal function, LNM sensitivity, specificity, positive and negative predictive value, and overall accuracy were each 100 %. LNM with combined assessment for prediction of sexual function yielded a sensitivity of 80 %, specificity of 93 %, positive predictive value of 80 %, negative predictive value of 93 %, and overall accuracy of 90 %. LNM is an appropriate method for reliable quality assurance of laparoscopic nerve-sparing.

Évaluer la morbidité et les suites fonctionnelles des cystectomies laparoscopiques avec dérivation urinaire non continente chez les sujets neurologiques.

Rapporter les résultats oncologiques des patients surveillés dans notre centre après le diagnostic de séminome testiculaire de stade I (ST1) (survie globale, spécifique et sans évolution à 2, 5 et 8ans) et rechercher les facteurs de risque d’évolution.

À l’ère des inhibiteurs de points de contrôle immunitaires (ICI), la place de la néphrectomie différée reste inconnue. L’objectif de cette étude était d’évaluer les Résultats oncologiques à moyen terme des patients pris en charge pour un cancer du rein métastatique (mRCC) et opérés d’une néphrectomie différée post-immunothérapie après réponse complète (RC) ou réponse partielle majeure (mRP définie comme>80 %) sur les sites métastatiques.

L’obésité pourrait avoir un impact sur la période péri-opératoire des tumeurs du rein, en termes de morbidité, de résultats opératoires, mais également une influence sur les choix thérapeutiques notamment chirurgicaux. Les modifications morphologiques liées à l’obésité, la morbidité propre s’y rapportant et les comorbidités liées à celle-ci pourraient impacter les résultats péri-opératoires d’une chirurgie rénale et influencer le choix de la stratégie thérapeutique.

Notre objectif était d’évaluer la capacité des scores morphométriques à prédire les résultats oncologiques de la néphrectomie partielle (NP)

Le délai moyen d’hospitalisation après une néphrectomie partielle assistée par robot (RAPN) est de 3jours avec une tendance actuelle à la réalisation de cas ambulatoires sans qu’aucune population n’ait été identifiée. Nous avons réalisé une analyse descriptive du délai de survenue des complications postopératoires, identifié les facteurs de risque de survenue précoce et défini une population éligible à l’ambulatoire.

Laparoscopic novices begin at different performance levels, and studies on tailored training concepts are warranted. The effect of verbal instructor feedback has been investigated with varying results, and its effectiveness in virtual-reality laparoscopic (VRL) simulations still is unclear. This study aimed to determine whether laparoscopic novices with lower initial performance statuses may profit from training with intensive instructor feedback. A prospective, single-blinded study was performed within a week-long curricular course. In this study, 20 medical students performed a complex bimanual maneuver on a VRL simulator. There was a division in performance levels, with a high-performer group (HPG) that received a better median score and a low-performer group (LPG). During the training phase, only the initial LPG received standardized instructor feedback in a one-to-one setting. The final assessment of skills for both groups involved performing the task without feedback at the end of the course. The HPG and LPG showed significantly different initial performance levels according global and categorized (time, economics, error) scores (p< 0.005). This difference disappeared quickly throughout the instructor feedback phase. The final assessment demonstrated that both groups were at the same level of performance. This is the first study to use a tailored training concept with instructor feedback limited to the LPG. The tailored training was effective and economic for the laparoscopic novices and their teachers.

•T2w-MRU with multiple orientations and diuretic is sufficient to identify non-dilated ureter.•T2w-MRU offers information on ureteral contractions and could be proposed to detect initial obstruction before hydronephrosis occurs (for instance in cases of endometriosis).•T2w-MRU could also be used to evaluate potential renal donors or in patients unable to receive gadolinium.•CE-MRU rapidly produces an overdistended bladder with a risk of false positive diagnosis of mild obstruction.•CE-MRU is less convenient for patients.

Abstract: Purpose: Minimally invasive surgery requires technical skills distinct from those used in conventional surgery. The aim of this prospective study was to identify personal characteristics that may predict the attainable proficiency level of first-time virtual reality laparoscopy (VRL) trainees. Methods: Two hundred and seventy-nine consecutive undergraduate medical students without experience attended a standardized VRL training. Performance data of an abstract and a procedural task were correlated with possible predictive factors providing potential competence in VRL. Results: Median global score requirement status was 86.7% (interquartile range (IQR) 75–93) for the abstract task and 74.4% (IQR 67–88) for the procedural task. Unadjusted analysis showed significant increase in the global score in both tasks for trainees who had a gaming console at home and frequently used it as well as for trainees who felt self-confident to assist in a laparoscopic operation. Multiple logistic regression analysis identified frequency of video gaming (often/frequently vs. rarely/not at all, odds ratio: abstract model 2.1 (95% confidence interval 1.2; 3.6), P = 0.009; virtual reality operation procedure 2.4 (95% confidence interval 1.3; 4.2), P = 0.003) as a predictive factor for VRL performance. Conclusion: Frequency of video gaming is associated with quality of first-time VRL performance. Video game experience may be used as trainee selection criteria for tailored concepts of VRL training programs.

Im Rahmen des wachsenden Interesses an der Betriebssicherheit von Fahrrädern und deren Komponenten wurden Gestaltfestigkeitsuntersuchungen an einem Fahrradbremshebel aus einer Aluminiumgusslegierung durchgeführt. Neben Materialuntersuchungen und einer FE‐Analyse wurde je eine Zeitfestigkeitsgerade für zwei Stichproben von Bremshebeln aus jeweils unterschiedlichen Herstellungszeiträumen experimentell ermittelt. Die gegenüber der ersten Stichprobe mit einem Neigungsexponent von 5,5 steiler verlaufende Zeitfestigkeitsgerade der zweiten Stichprobe liegt außerdem im Bereich größerer Schwingspielzahlen. Die Ursache hierfür ist in einer nachweisbar veränderten Gussqualität zu sehen. Im Bereich der Betriebsfestigkeit wurden 2‐Stufen‐Blockversuche durchgeführt. Unter Anwendung der Miner‐Regel ergaben sich aus den Versuchsergebnissen Schadenssummen größer eins. Die Versuchsergebnisse liegen somit im sicheren Bereich.

Background: Performing minimally invasive surgery requires training and visual-spatial intelligence. The aim of our study was to examine the impact of visual-spatial perception and additional mental training on the simulated laparoscopic knot-tying task performed by surgical novices.Methods: A total of 40 medical students randomly assigned to two groups underwent two sessions of laparoscopic basic training on a VR simulator (SimSurgery®, Oslo, Norway). The variables timeand tip trajectory(total path length of the instrument tip trajectory) were used to assess the performance of the intracorporeal knot-tying task using a laparoscopic Nissen fundoplication model. The experimental group completed additional mental practice during the interval between the two training sessions. All performed a cube subtest of a standard intelligence test (I-S-T 2000 R) to evaluate visual-spatial ability.Results: All participants achieved an improvement in time(t= 9.861; p< 0.001) and tip trajectory(t= 6.833; p< 0.001) in the second training session. High scores on the visual-spatial test correlated with a faster performance (r= −0.557; p< 0.001) and more precise movements (r= −0.377; p= 0.016). Comparison of the two groups did not show any statistical significant differences in the parameters timeand tip trajectory.Conclusions: Visual-spatial intelligence tested by a cube test correlated with simulated laparoscopic knot-tying skills in surgical novices. Additional mental practice did not improve the overall knot-tying performance. Further studies are therefore required to determine whether mental practice might be beneficial for experienced laparoscopic surgeons or for more complex tasks.

Minimally invasive Heller myotomy has evolved the “gold standard” procedure for achalasia in the spectrum of current treatment options. The laparoscopic technique has proved superior to the thoracoscopic approach due to improved visualization of the esophagogastric junction. Operative controversies most recently include the length of the myotomy, especially of its fundic part, with respect to the balance between postoperative persistent dysphagia and development of gastroesophageal reflux, as well as the type of the added antireflux procedure. Perioperative mortality should approach 0%, and favorable long-term results can be achieved in > 90%.

Hintergrund: Von der Sektion «Plasmatische Blutbestandteile» der DGTI wurde ein Ringversuch mit humanen Immunglobulinen zur intravenösen Anwendung (IVIG) und einem NIBSC-Serum, mit der Bezeichnung 67/98C, durchgeführt, da die IVIG-Monographie der Europäischen Pharmacopoeia (EP) keine Angaben zur IgG-Subklassenverteilung enthält. Ziel der Ringstudie der DGTI-Arbeitsgruppe war 1) die Bestimmung der IgG-Subklassenverteilung in IVIGs mit einer einheitlichen Methode und 2) die Bestimmung der IgG-Subklassenverteilung in dem Serum mit der Codierung 67/98C des NIBSC und zu prüfen, ob die NIBSC-Präparation mit dem Code 67/98C als Referenzserum zur IgG-Subklassenbestimmung geeignet ist. Material und Methodik:An dem Ringversuch nahmen zehn Labors aus Europa teil. Die Bestimmung der IgG-Subklassen erfolgte mit der radialen Immundiffusion (RID). Ergebnis:Der Ringversuch ergab gut übereinstimmende Ergebnisse für die teilneh-menden Labors und zeigte deutliche Unterschiede der IgG-Subklassenzusammen-setzung für die IVIGs auf. Die Reproduzierbarkeit der RID-Methode ergab Variationskoeffizienten (VK) von ca. 10%. Schluβfolgerung:Das NIBSC-Serum 67/98C ist als Referenzserum zur IgG-Subklassenbestimmung in Seren und IVIGs geeignet.

Für die Auslegung von Schraubenverbindungen und deren Zuverlässigkeit sind Reibwerte von wesentlicher Bedeutung. Eine fehlerhafte Bewertung der vorhandenen Reibbedingungen kann zum Versagen der Schraubenverbindung führen. Mögliche Versagensursachen werden unter Nutzung der Fehlerbaumanalyse (FTA – Fault Tree Analysis) diskutiert. Mittels experimenteller Reibkraftmessungen bei tangentialer Schubbeanspruchung wurden Reibwerte für unterschiedliche Oberflächenmerkmale (Rauheiten, Welligkeiten) und Fertigungsbedingungen am Beispiel der Aluminiumlegierung EN AW6082 T6 untersucht. Es werden Empfehlungen für die Festlegung von Reibwerten angegeben.

Es werden Ergebnisse von Festigkeits und Bruchuntersuchungen an Aluminiumschrauben mit gewalztem Gewinde aus EN AW7075, Nenngröße M6 bei quasistatischer und Schwingbeanspruchung mit vergleichsweise hohen Mittelspannungen vorgestellt. Den Untersuchungen lagen Schrauben mit gewöhnlicher Korngröße und Schrauben aus ultrafeinkörnigem, durch Equal Channel Angular Extrusion ECAE erzeugtem Werkstoff, zugrunde. Obwohl die Zugfestigkeit bei beiden Korngrößen ähnliche ist, erreicht die Schwingfestigkeit des ultrafeinkörnigen Werkstoffs nach den vorliegenden Untersuchungen nicht die Schwingfestigkeit des Werkstoffes mit gewöhnlicher Korngröße. Mittels eines modifizierten Treppenstufenverfahrens wurde für die Schrauben mit gewöhnlicher Korngröße eine Dauerfestigkeitsamplitude von 23 MPa ermittelt. Weiterhin wird das Bruchverhalten der Aluminiumschrauben diskutiert.

Indenyl‐Titaniumchlorides: Ethene‐Polymerization and Structure‐Reactivity Studies

Ungefähr die Hälfte aller Patienten mit kolorektalem Karzinom (KRK) entwickeln Lebermetastasen. Die Therapiemöglichkeiten bei Betroffenen mit metastasiertem KRK haben sich jedoch in den letzten Jahren erfreulicherweise positiv weiterentwickelt. Der Anteil resektabler Metastasen konnte gesteigert werden – einerseits durch optimierte chirurgische Techniken, andererseits durch die Erweiterung des Armentariums der systemischen Therapieoptionen. So sind oft eine Lebensverlängerung und z. T. eine Heilung möglich.

Accurate preoperative prediction of functional donor and remnant hemiliver volumes in live donor liver transplantation is essential in preventing postoperative liver failure and optimizing safety. Our aim was (1) to evaluate volume variability associated with multiphasic CT imaging and (2) to determine over- or under-estimations of 3-D CT graft-volume assessments based on ‘largest’ versus ‘smallest’ CT phases with respect to intraoperative findings. Native, arterial and venous phase CT images from 83 potential live liver donors were subject to 3-D CT liver volume calculations and virtual 3-D liver partitioning. Estimates were compared to intraoperative volumes obtained in 43 cases. Calculated (preoperative) graft-volume-body-weight-ratios (GVBWR) versus measured (intraoperative) graft-weight-body-weight-ratios (GWBWR) were analyzed. Significant differences in total liver volume- and in graft-liver volume calculations were found among the largest (venous) and smallest (native) CT phases. High significant overestimations were observed in graft-volume determinations and in GVBWR-calculations based on the ‘largest’ CT phase when compared to intraoperatively obtained graft-weight and -GWBWR values. In contrast, differences among intraoperative measurements and preoperative calculations based on the ‘smallest’ CT phase yielded less significant overestimations. While 3-D CT volumetry based on the ‘largest’ (venous) CT phase is associated with considerable overestimation, 3-D volumetry based on the ‘smallest’ (native) CT phase accurately matches the intraoperative findings.