Reducing the environmental impact of surgery on a global scale: systematic review and co-prioritization with healthcare workers in 132 countries

Background Healthcare cannot achieve net-zero carbon without addressing operating theatres. The aim of this study was to prioritize feasible interventions to reduce the environmental impact of operating theatres. Methods This study adopted a four-phase Delphi consensus co-prioritization methodology. In phase 1, a systematic review of published interventions and global consultation of perioperative healthcare professionals were used to longlist interventions. In phase 2, iterative thematic analysis consolidated comparable interventions into a shortlist. In phase 3, the shortlist was co-prioritized based on patient and clinician views on acceptability, feasibility, and safety. In phase 4, ranked lists of interventions were presented by their relevance to high-income countries and low–middle-income countries. Results In phase 1, 43 interventions were identified, which had low uptake in practice according to 3042 professionals globally. In phase 2, a shortlist of 15 intervention domains was generated. In phase 3, interventions were deemed acceptable for more than 90 per cent of patients except for reducing general anaesthesia (84 per cent) and re-sterilization of ‘single-use’ consumables (86 per cent). In phase 4, the top three shortlisted interventions for high-income countries were: introducing recycling; reducing use of anaesthetic gases; and appropriate clinical waste processing. In phase 4, the top three shortlisted interventions for low–middle-income countries were: introducing reusable surgical devices; reducing use of consumables; and reducing the use of general anaesthesia. Conclusion This is a step toward environmentally sustainable operating environments with actionable interventions applicable to both high– and low–middle–income countries

Reducing the environmental impact of surgery on a global scale: systematic review and co-prioritization with healthcare workers in 132 countries

Abstract Background Healthcare cannot achieve net-zero carbon without addressing operating theatres. The aim of this study was to prioritize feasible interventions to reduce the environmental impact of operating theatres. Methods This study adopted a four-phase Delphi consensus co-prioritization methodology. In phase 1, a systematic review of published interventions and global consultation of perioperative healthcare professionals were used to longlist interventions. In phase 2, iterative thematic analysis consolidated comparable interventions into a shortlist. In phase 3, the shortlist was co-prioritized based on patient and clinician views on acceptability, feasibility, and safety. In phase 4, ranked lists of interventions were presented by their relevance to high-income countries and low–middle-income countries. Results In phase 1, 43 interventions were identified, which had low uptake in practice according to 3042 professionals globally. In phase 2, a shortlist of 15 intervention domains was generated. In phase 3, interventions were deemed acceptable for more than 90 per cent of patients except for reducing general anaesthesia (84 per cent) and re-sterilization of ‘single-use’ consumables (86 per cent). In phase 4, the top three shortlisted interventions for high-income countries were: introducing recycling; reducing use of anaesthetic gases; and appropriate clinical waste processing. In phase 4, the top three shortlisted interventions for low–middle-income countries were: introducing reusable surgical devices; reducing use of consumables; and reducing the use of general anaesthesia. Conclusion This is a step toward environmentally sustainable operating environments with actionable interventions applicable to both high– and low–middle–income countries

Cheek-midface lift for revision following failed excessive lower eyelid blepharoplasty

Iatrogenic ectropion with sagging of the lower eyelid after failed excessive lower eyelid blepharoplasty is asevere complication in aesthetic surgery. Traditionally, free skin grafting is the method of choice for correction. This overview presents the cheek-midface lift as auseful and powerful method for the correction of ectropion following excessive lower eyelid blepharoplasty. This technique, which can be performed with the patient under local anesthesia, enables good functional as well as aesthetic outcomes

Clinical approach for periocular lymphoma

Background Lymphomas occur very frequently in the periocular region, predominantly in adulthood. This malignant tumor shows a heterogeneous clinical pattern. Aim The aim of this article is to provide an overview of the symptoms, diagnostic procedures and treatment options for lymphomas of the periocular region. Symptoms The symptoms of periocular lymphomas are mostly nonspecific. The growth is usually painless and slowly progressive. A salmon-colored swelling is typical for conjunctival lymphoma. Diagnostics The basis of a precise diagnostic process is a detailed anamnesis. Contrast-enhanced magnetic resonance imaging (MRI) is considered the gold standard for imaging of lymphoproliferative lesions. A histopathological examination should be carried out to confirm the exact diagnosis. Subsequently, staging should be performed as periocular lymphomas can be the manifestation of a systemic involvement. Treatment The treatment procedure should be coordinated by an interdisciplinary tumor board. The treatment of periocular lymphomas can include percutaneous stereotactic irradiation as well as chemotherapeutic or new immunotherapeutic strategies

Importance of interdisciplinary collaboration for optimal treatment of orbital tumors

Optimal treatment of tumors with orbital invasion may exceed the competences of an individual medical specialty and require interdisciplinary cooperation. The aim of this article is to present an interdisciplinary treatment concept based on the examples of intraorbital hemangioma and squamous cell carcinoma of the paranasal sinuses infiltrating the orbit. In addition to adetailed medical history and acomplete ophthalmological examination, adetailed imaging technique with standardized echography and tomography methods such as orbital thin-slice CT and/or in many cases MRI is essential for the primary classification of an intraorbital pathology. Depending on the type of pathology, apurely surgical procedure involving various disciplines such as ophthalmology, otorhinolaryngology, maxillofacial surgery, neurosurgery, and pathology, or an interdisciplinary treatment regimen including (neo)adjuvant radiotherapy or chemotherapy is necessary. Orbital tumors have awide range of potential pathologies, requiring complex surgical procedures and multimodal therapies. In case of infiltration of the paranasal sinuses or intracranial structures, an interdisciplinary team including neuroradiologists, oral-maxillofacial surgeons, otorhinolaryngologists, neurosurgeons, radiation therapists, ophthalmologists, pathologists, oncologists, and psycho-oncologists is essential for successful treatment

Diagnostics of benign and malignant tumors of the orbit

Background Orbital space-occupying lesions can have a significant impact on the quality of life. Depending on the dignity and etiology of the mass, they can even represent a life-threatening process, which must be timely treated in an interdisciplinary cooperation. Objective To achieve a comprehensive overview about the diagnostics and frequency of malignant and benign masses of the orbit. Material and methods A literature search was carried out in PubMed and Google scholar. Results and discussion Clinically, orbital lesions can show symptoms, such as exophthalmos with an increase in the vertical lid fissure, visual impairment and motility dysfunction with diplopia. Depending on the extent, an exposure keratopathy can occur due to failure to close the eyelids. For the diagnostics several tests should be carried out. Following a thorough anamnesis and clinical examination, these should include a blood sample to test for various parameters, an ultrasound examination with subsequent computed tomography (CT) in cases of bone involvement or thin slice magnetic resonance imaging (MRI) of the orbit for assessment of soft tissues. In adults an endocrine orbitopathy is the most frequent cause of an inflammatory orbital process, where lymphomas are the most frequent entity among malignant tumors and vascular space-occupying lesions are the most frequent benign tumors. In children the most frequent benign masses are dermoid cysts and rhabdomyosarcoma is the most frequent primary malignant orbital tumor. The multimodal interdisciplinary treatment can include surgical excision and adjuvant radiotherapy or chemotherapy, depending on the entity

Clinico-echographic diagnostics of iris tumors

Background. The differentiation of iridic space-occupying lesions represents a regularly reoccurring diagnostic challenge. Objective. This article presents an overview of the epidemiological data and describes the diagnostic procedure for iris tumors. Material and methods. The article provides a review of the literature from PubMed and own clinical results. Results. Melanocytic lesions comprise the vast majority of all iris tumors and include nevi and melanomas. Slit lamp biomicroscopy with standardized photography reveals two-dimensional planar tumor growth over time, which is the only recognized clinical surrogate finding for a malignant event. Ultrasound biomicroscopy (UBM) is additionally obligatory because it is the only method which enables documentation of the extent of tumor penetration, ciliary body involvement and internal structure of iris tumors. Conclusion. Serial slit lamp and UBM examinations with reproducible pupillary diameters are indispensable for the differentiation of cystic, solid and tumor-simulating lesions and for the detection of malignant transformation in iris tumors