GKT School of Medical Education

Abstract Aim Uniportal Video-Assisted Thoracoscopic Surgery (VATS) has become an important advancement in minimally invasive thoracic surgery, offering advantages over traditional multiportal approaches, including reduced postoperative pain, shorter hospital stay, and faster recovery. This study aimed to evaluate preoperative characteristics, surgical approaches, and perioperative outcomes among patients undergoing uniportal VATS at a tertiary care centre. Methods A retrospective cohort study was conducted including all patients who underwent uniportal VATS. Data were extracted from operative and clinical records. Quantitative variables were summarized using descriptive statistics, while categorical variables were reported as frequencies and percentages. Preoperative characteristics, intraoperative details, and postoperative outcomes were analysed to assess procedure’s safety and versatility. Results A total of 150 patients were included (mean age 59 ± 17 years; 69% male). The most common preoperative conditions were pleural effusion (31%) and pneumothorax (17%). Primary procedures included bronchoscopy (31%), pleural biopsy (29%), mediastinoscopy (18%), and talc pleurodesis (17%). The mean port size was 12.6 ± 4.3 mm, and mean ejection fraction was 61.2 ± 5.3%. Most patients were extubated in operating theatre and safely transferred to recovery. Common comorbidities included malignancy, autoimmune disease, and chronic pulmonary disorders. Substance exposure, including tobacco, alcohol, or opioids, was documented in 10% of patients. Conclusions Uniportal VATS is a safe, versatile, and minimally invasive option for managing a broad spectrum of thoracic conditions. Although limited by retrospective design and incomplete perioperative data, these findings highlight its favourable safety profile and support the need for prospective studies to evaluate long-term outcomes, functional recovery, and quality of life.

Abstract Background Diabetes mellitus is a well-recognised risk factor for impaired wound healing and sternal wound complications following coronary artery bypass graft (CABG) and Aortic Valve Replacement (AVR) Surgeries. Microvascular dysfunction is thought to play a central role, but objective intraoperative and postoperative assessment of sternal microcirculation remains limited. Methods Sternal microcirculatory blood flow was assessed using laser Doppler flowmetry in patients undergoing median sternotomy for CABG and AVR Surgeries. Diabetic and non-diabetic patients were prospectively compared. Measurements were obtained at baseline and at predefined postoperative intervals. Microcirculatory flow patterns and recovery profiles were analysed between groups. Results Diabetic patients demonstrated significantly reduced baseline sternal microcirculatory flow compared with non-diabetic patients. Following sternotomy, diabetics exhibited a greater reduction in microcirculatory perfusion and a delayed recovery trajectory. Persistent impairment in postoperative microvascular flow was observed in the diabetic cohort, suggesting sustained microvascular dysfunction. These changes correlated with known clinical risk factors for impaired wound healing. Conclusion Diabetes mellitus is associated with significant impairment of sternal microcirculation before and after cardiac surgery. Laser Doppler flowmetry provides a sensitive, real-time method for detecting microvascular dysfunction and offers mechanistic insight into the increased risk of sternal wound complications in diabetic patients. This technique may have a future role in perioperative risk stratification and targeted wound-protective strategies.

Objectives:This study aims to study the clinical features, pathological findings, and outcomes of BK virus-associated urothelial carcinoma (UC) in kidney transplant recipients (KTRs). Patients and Methods:The study was conducted in a retrospective cohort of KTRs with histologically confirmed UC managed at a UK supra-regional transplant urology centre from November 2006 to January 2026. BK virus status was determined using polymerase chain reaction (PCR) testing, and tumour samples were assessed for SV40 large T antigen. Patients were stratified by BKV and SV40 status to enable comparison of tumour grade, stage, and other clinicopathological features. Results:24 KTRs met the inclusion criteria; 11 of whom were BKV+. The mean follow-up time post-UC diagnosis was 7.3 ±  6.1 years. Mean age at UC diagnosis was 59.9  ±  14.6 years. 90.9% of BKV+ patients had high-risk UC compared to 30.8% of the BKV- group (p = 0.005). Tumour grade at diagnosis was higher in BKV+ patients (p = 0.013). SV40 Large T antigen was detected in 33.3% of cases, all with a previous history of BKV infection. These tumours were all high grade (G3) and had tended to be a higher stage at diagnosis than SV40- tumours (p = 0.050). UC in BKV+ patients was not diagnosed earlier post-transplant (p = 0.616). There was no difference in survival probability between the two cohorts (p = 0.639). Conclusion:BKV infection in KTRs was associated with aggressive, high-grade UC. Screening and timely adjustment of immunosuppression are essential to protect this at-risk population. Further studies are required to clarify the oncogenic potential of BKV and optimise management strategies.

Audience:This simulation is intended for emergency medicine residents. Background:Lateral canthotomy and cantholysis (LCC) is a sight-saving procedure for orbital compartment syndrome (OCS).1 Due to the rarity of OCS, emergency-medicine trainees often have limited exposure and low procedural confidence. In a questionnaire we found that trainees have low confidence levels in performing the procedure attributed to the low incidence of OCS and the scarcity of training opportunities. Existing literature describes LCC task trainers with creation of simulation models, but few provide a reproducible multimodal package adaptable for multiple training centres.2,3 Our innovation combines presentation, instructional video, gamified quiz, and hands-on practicer with low fidelity models. Unlike previous studies referencing the use of pre-made or cadaveric-based models, this design offers detailed guidance on model assembly using commonly available and low-cost materials.2,3 We designed and tested a multimodal training approach to optimize trainee confidence and competence in recognizing OSC and performing the LCC procedure. This aligns with recent calls in medical education for innovative, cost-effective simulation that maintains clear guidance and instructions while overcoming financial and/or logistical barriers.4,5. Educational Objectives:By the end of this session, learners should be able to: 1) recognize the clinical features of OCS, 2) describe the indications and steps of performing LCC, 3) perform a lateral canthotomy and cantholysis procedure on a low-fidelity model, and 4) demonstrate improved confidence in recognizing and managing OCS. Educational Methods:The training uses a multimodal structure involving the following resources: 1) Instructor-led presentation on OCS and LCC with a step-by-step guide (Appendix A), 2) gamified quiz (Appendix B), 3) a procedural demonstration video, 4) a procedural handout containing a step-by-step guide (Appendix C), 5) a low-fidelity model of the orbit constructed from inexpensive materials, and 6) hands-on procedural practice with trainer feedback. Research Methods:Trainees' confidence and perceived competence in performing the procedure were assessed using a 10-point Likert scale before and after the training, in addition to collection of qualitative feedback via free-text comments. Trainees also rated all educational components of the course using a 10- point Likert scale. Statistical significance was calculated using paired t-tests. Results:A total of thirty-four emergency medicine trainees participated in this multi-national training simulation package across three centers within the UK, completing pre- and post-intervention feedback. We observed a significant improvement in participants' self-assessed confidence levels when comparing theoretical knowledge (5.0 ± 2.5 to 8.7 ± 1.7; p < 0.0001) and procedural competence (4.1 ± 2.8 to 8.9 ± 1.5; p < 0.0001). All educational components of the training package were rated highly, with mean scores ranging between 8.7 and 10 (measured on a 10-point Likert scale). All trainees involved supported the idea of annual delivery of the training package to emergency medicine trainees. Qualitative feedback further supported the value of practical simulation. Discussion:Given the severe clinical consequences of OCS, there is a need for diagnostic and procedural competence. This training package demonstrated significant improvement in trainees' confidence and competence for a rare but critical emergency department procedure. The low-fidelity model and simulation package is reproducible, cost-effective, and scalable across training centres. Topics:Simulation, emergency medicine, orbital compartment syndrome, lateral canthotomy, cantholysis, procedural skills, low-fidelity model.

To review the evidence for enteral feed modification after surgery for Necrotising Enterocolitis (NEC) and determine the optimal feeding regime for these babies. A systematic review of the Scopus and PubMed databases was carried out. Papers reporting feed regimes in babies following surgery for NEC and reporting at least one clinical outcome were included. The ROBINS-I tool was utilised to evaluate the risk of bias. The search strategy returned 2772 records. After deduplication and screening against the inclusion/exclusion criteria, 11 studies were included in the review. Three studies reported the implementation of a standardised feeding regime; one led to earlier introduction of enteral feed, two found no increase in NEC recurrence and all three saw a reduction in liver dysfunction. There is a paucity of high quality evidence to guide specific post-operative feeding strategies in infants following surgery for NEC. However, limited available data suggest that achieving early enteral nutrition is not associated with worse short-term outcomes and may be associated with reduced parenteral nutrition dependence, improved growth, and lower feed-related complications. Large prospective and multicentre studies are needed to define optimal feeding composition, timing and advancement strategies to improve post-operative outcomes in this vulnerable neonatal population.