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Background: Transanal endoscopic microsurgery (TEM) is an established technique for the resection of rectal adenomas and selected malignant tumours. It avoids the morbidity of radical resection for tumours not amenable to endoscopic resection. An important marker of quality is the local recurrence rate. The primary objective was to determine local recurrence rates for benign and malignant rectal tumours. Methods: We identified index TEM excisions of rectal adenomas and adenocarcinomas in patients age 18 and over at Dunedin Hospital, New Zealand, between 2000 and 2020, from a prospective database. Surveillance data were collected via chart review. The primary outcome was recurrence rate for adenomas and adenocarcinomas. Secondary outcomes included time to recurrence, association of recurrence with recognized risk factors, and adverse event rates. Results: We identified 100 patients for analysis. Of 75 benign cases, 11 (14.7%) developed local recurrence, with 63.6% identified within 1 year. Of the 25 malignant cases (19 T1, 5 T2, 1 T3), 9 (36%) developed recurrence, with 77.8% identified within 2 years. Adverse events occurred in 26% of patients, with no reoperations or deaths. Conclusion: Our adenoma recurrence rate was at the higher end of the reported range of 2.4–16%. Minor complications were common, but not major morbidity. The propensity for rectal tumours to recur commonly and early reinforces the importance of regular standardized endoscopic surveillance. [ABSTRACT FROM AUTHOR]

Introduction: Ultrasound measurements of the aorta are typically taken in the axial plane, with the transducer perpendicular to the aorta, and diameter measurements are obtained by placing the callipers from the anterior to the posterior wall and the transverse right to the left side of the aorta. While the 'conventional' anteroposterior walls in both sagittal and transverse plains may be suitable for aneurysms with less complicated geometry, there is controversy regarding the suitability of this approach for complicated, particularly tortuous aneurysms, as they may offer a more challenging situation. Previous work undertaken within our research group found that when training inexperienced users of ultrasound, they demonstrated more optimal calliper placement to the abdominal aorta when approached from a decubitus window to obtain a coronal image compared to the traditional ultrasound approach. Purpose: To observe the level of agreement in real‐world reporting between computed tomography (CT) and ultrasound measurements in three standard planes; transverse AP, sagittal AP and coronal (left to right) infra‐renal abdominal aortic aneurysm (AAA) diameter. Methodology: This is a retrospective review of the Otago Vascular Diagnostics database for AAA, where ultrasound and CT diameter data, available within 90 days of each other, were compared. In addition to patient demographics, the infrarenal aorta ultrasound diameter measurements in transverse AP and sagittal AP, along with a coronal decubitus image of the aorta was collected. No transverse measurement was performed from the left to the right of the aorta. Results: Three hundred twenty‐five participants (238 males, mean age 76.4 ± 7.5) were included. Mean ultrasound outer to the outer wall, transverse AP and sagittal AP diameters were 48.7 ± 10.5 mm and 48.9 ± 9.9 mm, respectively. The coronal diameter measurement of the aorta from left to right was 53.9 ± 12.8 mm in the left decubitus window. The mean ultrasound max was 54.3 ± 12.6 mm. The mean CT diameter measurement was 55.6 ± 12.7 mm. Correlation between the CT max and ultrasound max was r2 = 0.90, and CT with the coronal measurement r2 = 0.90, CT and AP transverse was r2=0.80, and CT with AP sagittal measurement was r2 = 0.77. Conclusion: The decubitus ultrasound window of the abdominal aorta, with measurement of the coronal plane, is highly correlated and in agreement with CT scanning. This window may offer an alternative approach to measuring the infrarenal abdominal aortic aneurysm and should be considered when performing surveillance of all infra‐renal AAA. [ABSTRACT FROM AUTHOR]

Background: In our unit, we routinely use negative pressure wound therapy (NPWT) with either gauze or sponge as the interface and have observed that slough can build up over time, in specific wounds, with use of NPWT. Slough and biofilm build-up can slow healing of diabetic foot ulcerations, postoperative femoral bypass infections, leg ulcers and wound dehiscence. Aim: Our aim was to determine the impact of NPWTi-d on wounds which failed to respond to standard treatment and those who could not have surgical debridement in theatre because of their comorbidities. Method: We assessed the wound bed response, length of hospital stay and pain, in vascular patients with a range of wound types. The NPWTi-d and V.A.C. VeraFlo Cleanse Choice dressing were used to treat wounds for an average of seven days. Wound size and wound beds well as pain were assessed daily by a wound care specialist. Pain was recorded on a validated pain scale 1-10 visual analogue scale (VAS). Results: Improved wound bed preparation was shown using the silhouette photography system in all five patients in the evaluation. Theatre and surgical debridement was avoided in all cases. There was a significant pain reduction associated with treatment in 4/5 patients. Dressing were changed on average three times with digital photography taken before and after. Conclusion: NPWTi-d improves wound bed preparation, healing and pain in wounds that fail to improve with standard treatment. This case series demonstrates the benefit in adopting this as an option in the treatment of complex vascular wounds. It also highlighted a need for more research for example; type of instillation fluid, plus optimal volume and dwell times. [ABSTRACT FROM AUTHOR]

Background: To identify whether compliance with Enhanced Recovery After Surgery (ERAS) Society recommendations is associated with length of stay (LOS) in a New Zealand hospital for patients undergoing segmental colectomy in mixed acute and elective general surgery wards.Methods: Consecutive elective colorectal surgeries (n = 770) between October 2012 and February 2019 were audited. Patients with non-segmental colectomies, multi-organ surgeries, LOS > 14 days, and those who died were excluded. Logistic regression was used to determine the relationship between patient demographics, compliance with ERAS guidelines, and suboptimal LOS (> 4 days).Results: Analysis included 376 patients. Age, surgery prior to 2014, surgical approach, non-colorectal surgical team, operation type, and complications were significantly associated with suboptimal LOS. Non-compliance with ERAS recommendations for laparoscopy [OR 8.9, 95% CI (4.52, 19.67)], removal of indwelling catheters (IDC) [OR 3.14, 95% CI (1.85, 5.51)], use of abdominal drains [OR 4.27, 95% CI (0.99, 18.35)], and removal of PCA [OR 8.71, 95% CI (1.78, 157.27)], were associated with suboptimal LOS (univariable analysis). Multivariable analysis showed that age, surgical team, late removal of IDC, and open approach were independent predictors of suboptimal LOS.Conclusions: Non-compliance with ERAS guidelines for laparoscopic approach and early removal of IDC was higher among procedures performed by non-colorectal surgery teams, and was also associated with adverse postoperative events and suboptimal LOS. This study demonstrates the importance of the surgical team's expertise in affecting surgical outcomes, and did not find significant independent associations between most individual ERAS guidelines and suboptimal LOS once adjusting for other factors. [ABSTRACT FROM AUTHOR]

BackgroundPurposeCase presentationOutcomesConclusionLow cardiorespiratory fitness predicts worse postoperative outcomes, exacerbated by age and frailty. Preoperative High-Intensity Interval Training (HIIT) improves cardiorespiratory fitness and postoperative outcomes but is challenging to implement in frailty due to perceived risks.The aim of this case report was to demonstrate feasibility of HIIT in a patient with frailty and multimorbidity.An 83-year-old frail male with atrial fibrillation and limited mobility presenting with locally advanced rectal cancer was assessed as unfit for major surgery unless his cardiorespiratory fitness improved. Initial cardiopulmonary exercise testing demonstrated low cardiorespiratory fitness (peak oxygen consumption ($\dot V$V˙O2peak) of 11.45 mL·min−1·kg−1). He subsequently underwent 15 supervised HIIT sessions targeting a Rating of Perceived Exertion ≥ 15.The patient demonstrated initial substantial improvements in his physical condition, increasing maximal work rate from 27.5 W to 55 W. However, there was no additional progress following session eight. At his post-exercise CPET he rapidly fatigued, resulting in a $\dot V$V˙O2peak of 7.4 mL·min−1kg−1. Clinical investigations revealed a worsening anemia with a hemoglobin of 92 g/L caused by an undiagnosed synchronous cecal tumor which was corrected preoperatively. Postoperatively, the patient recovered without complications and was successfully discharged home.Personalized HIIT improved exercise duration and work rate and was associated with positive postoperative outcomes in this patient with frailty and multimorbidity. A unique feature of this case was the unexpected loss of training progress and $\dot V$V˙O2peak deterioration post-HIIT, which prompted further clinical investigations. These identified a worsening anemia and resulted in important changes in both the preoperative and intraoperative treatment. [ABSTRACT FROM AUTHOR]

Introduction Methods Findings Conclusion Compression stocking therapy is the gold standard of treatment for conditions associated with lower limb venous dysfunction. The benefits in symptom relief and preventing disease progression are well documented. Despite this, adherence to compression stocking therapy is poor. This project aimed to identify factors affecting compression stocking adherence in Aotearoa New Zealand through qualitative evaluation of interviews of patients with chronic venous insufficiency.In this mixed‐methods study, 25 participants were recruited, and semi‐structured interviews were carried out until thematic saturation was reached. All participants also took part in surveys recording characteristics and Quality of Life questionnaires. Common interview themes were summarized and quality of life scores were compared between respondents.Interview respondents were a median of 64 years old, and were prescribed compression therapy a median of 8 years prior. The cohort spent a median of 8 h a day standing. Qualitative interviews identified three main themes influencing compression stocking use: physical factors, psychological factors and external factors. Subthemes included the influence of age and sex on participant perceptions of the stockings' appearance, and how comorbidities contribute to donning difficulty.Understanding factors influencing patient adherence can enable clinicians to provide a multidimensional approach, mitigating barriers and emphasizing facilitators for the individual patient to improve adherence. [ABSTRACT FROM AUTHOR]

Background: Supracondylar humeral fractures (SCHF) are a common cause of orthopedic morbidity in pediatric populations across the world. The treatment of this fracture is likely one of the first procedures involving x-ray-guided wire insertion that trainee orthopedic surgeons will encounter in their career. Traditional surgical training methods of "see one, do one, teach one" are reliant on the presence of real-world cases and must be conducted within an operative environment. We have developed an augmented reality simulator that allows trainees to practice this procedure in a radiation-free environment at no extra risk to patients., Objective: This study aims to examine whether training on a simulator in addition to traditional surgical training improves the in-theater performance of trainees., Methods: This multicenter, interventional cohort study will involve orthopedic trainees from New Zealand in their first year of advanced training between 2019 and 2023. Advanced trainees with no simulator exposure who were in their first year in 2019-2021 will form the comparator cohort, while those in the years 2022-2023 will receive additional regular simulator training as the intervention cohort. The comparator cohort's performance in pediatric SCHF surgery will be retrospectively audited using routinely collected operative outcomes and parameters over a 6-month period. Data on the performance of the intervention cohorts will be collected in the same way over a comparable period. The data collected for both groups will be used to determine whether additional training with an augmented reality training shows improved real-world surgical outcomes compared to traditional surgical training., Results: As of February 2022, a total of 8 retrospective comparator trainees have been recruited by email. The study is financially supported through an external grant from the Wishbone Orthopaedic Research Foundation of New Zealand (September 2021) and an internal research grant from the University of Otago (July 2021)., Conclusions: This protocol has been approved by the University of Otago Health Ethics committee (reference HD21/087), and the study is due for completion in 2024. This protocol may assist other researchers conducting similar studies in the field., Trial Registration: Australian New Zealand Clinical Trials Registry ACTRN12623000816651; https://tinyurl.com/mtdkecwb., International Registered Report Identifier (irrid): DERR1-10.2196/38282., (©Joyce Guo, Phil Blyth, Kari Clifford, Nikki Hooper, Haemish Crawford. Originally published in JMIR Research Protocols (https://www.researchprotocols.org), 02.08.2023.)