Abstract


Modern surgical methods are becoming increasingly sophisticated and the number of technical devices that are used during these interventions is increasing. However, the surgical operating room (OR) remains a mere conglomerate of unconnected medical devices. The increase in the complexity of device functionality, in addition to the demands of surgery, pushes human mental capacity to its limit. Hence, an “intelligent” collaborative support system would be more than welcome. We envision a “human-like” intelligent system, which could support the surgical team as a situation-aware consultant. This so-called “active collaborative support system” (ACSS) is based on four main pillars: real-time data inflow, a comprehensive knowledge-base, access to the Internet of Things (surgical devices), and an understanding of human language through natural language processing. Recent advances in the area of AI are bringing this ambitious goal within reach, but there is still a considerable amount of work to be done, including the establishment of a new way of thinking in the collaboration between surgeons and computer scientists/engineers, and possibly one day with intelligent machines–provided that AI systems can be sufficiently trusted.

Abstract


Purpose: Postoperative air leakage does not always originate from parenchymal defects. In some cases, it may arise from defects in the chest drainage unit itself or connections, or from reverse airflow in water seals. The aim of the present study was to test a new chest drainage unit in the clinic, where an integrated CO2-sensitive colour indicator helps to distinguish false air leakage from true air leakage.
Methods: Over a 3-week period, 14 consecutive patients were operated upon using either an open approach (for bilobectomies) or VATS (for diagnostic procedures or lobectomies). All patients received general anaesthesia with double-lumen intubation. All patients had a 24-Fr chest tube connected to a chest drainage unit with a built-in CO2-detector.
Results: In all patients with air leakage after surgery, we found a colour change in the CO2-sensitive colour indicator, confirming “true air leakage”. One patient had prolonged air leakage. None of the patients had pneumothorax after removal of the chest tube and no patients had wound infections or any other complications.
Conclusion: The chest drainage unit described here was easily implemented in the clinic and clearly confirmed true air leakage in all patients with air leakage after lung surgery. It allowed safe and appropriate timing for chest tube removal with no need for reinsertion in a broad cohort of patients referred for thoracic surgery.

Abstract


Purpose: The goal of this study was to assess the bacteriology of surgical site infections (SSIs) in patients undergoing complex abdominal wall reconstruction (CAWR) with biologic mesh.
Methods: This was a prospective cohort study of all patients who developed SSI following CAWR with biologic mesh between 2017-2020 at an academic tertiary/quaternary care center. The patients were subdivided into six overlapping groups: infections found during hospitalization vs. infections found after discharge, sensitive bacteria vs. resistant bacteria, and nosocomial bacteria vs. intestinal bacteria.
Results: Of the 194 patients who underwent CAWR during the study period, 33 (17%) developed SSI. SSI was more commonly discovered after discharge than during hospitalization. These SSIs were vancomycin-resistant Enterococcus (VRE) or methicillin-resistant Staphylococcus aureus (MRSA) rather than sensitive bacteria, and required re-operation, which were more frequently found following elective procedures. VRE and MRSA infections were more common with clean wounds than with clean/contaminated, contaminated, or dirty wounds, while SSIs with intestinal flora were more common following fistula and stoma takedown.
Conclusions: Surgical site infections with resistant bacteria manifest more frequently post-discharge and require more re-admissions and re-operations.