Koscielny Arne, Schmidt Valeri, Branchi Vittorio, Verrel Frauke, Kalff Jörg C, Matthaei Hanno
Klinik und Poliklinik für Allgemein-, Viszeral-, Thorax- und Gefäßchirurgie, Universitätsklinikum Bonn, Deutschland.
Zentralbl Chir. 2018 Oct;143(5):494-502. doi: 10.1055/a-0731-0499. Epub 2018 Oct 24.
Due to improved surgical techniques and safer perioperative management, there has been an increase in radical abdominal and oncological operations. Simultaneous vascular interventions are increasingly necessary - either after preoperative planning or after an intraoperative vascular emergency. It is unclear whether German visceral surgeons have the required vascular surgical skills. An assessment of the current and future status of vascular techniques within visceral surgery is therefore the issue of the present survey.
A questionnaire was sent to the chairs of visceral surgery of German university hospitals and to the directors of non-academic surgical departments in 2017. Thus, we sought to assess the current and future status of vascular surgery within abdominal and oncological operations. There were person-, hospital-, system-, and intervention-related questions to be answered.
Compared to non-academic hospitals, significantly more vascular interventions were performed within abdominal surgery at university hospitals (p < 0.001), where generally more such expertise is available. Surgical support from vascular surgeons is present in a majority of both academic and non-academic institutions (72.8%). However, almost one third of respondents expressed a desire for more vascular surgery expertise at their departments. An optional rotation in vascular surgery exists predominantly at university hospitals (92.9 vs. 73.8%; p = 0.031). A slim majority of all surgical managers assumes that vascular surgery will play an increasing role in the future of visceral and oncological surgery (51.6%) and favours obligatory rotation for visceral surgery residents of at least six months (54.1%). Necessary skills to be taught include thrombectomy and embolectomy (95.6%), vascular suture (98.6%) and patch (89.1%) as well as vascular bypass surgery (45.5%).
There is an expert consensus that vascular surgery is of increasing significance for visceral surgeons. In spite of the possibility of optional rotations for residents at most hospitals, there seems to be a demand for more expertise in vascular surgery at several departments. Obligatory rotation in vascular surgery should be discussed within training programs for visceral surgery.
