Surgeries

Background: Oesophageal cancer is a diagnosis carrying significant morbidity and mortality. Gold standard treatment is resection; however, this requires a complex operation. Despite progression to minimally invasive approaches, post-operative pain is a significant issue. Methadone is emerging as an additive intraoperative analgesic across specialities, with a single intra-operative dose seen to improve post-operative pain and reduce post-operative opioid use. This is promising for oesophagectomy patients, where pain is a significant issue; however, it remains poorly characterised. Aim: This paper aimed to assess the literature surrounding intra-operative methadone (IOM) in oesophagectomy, then broadly consider related evidence to consider how it may be applicable to patients undergoing oesophagectomy for oesophageal cancer. Methods: The search assessed existing evidence for efficacy and safety of IOM for patients undergoing oesophagectomy for oesophageal cancer. Of 1856 studies, only one fit inclusion criteria. Following this, the search was broadened to assess IOM use in related surgical contexts, deriving applicability to oesophagectomy. Results: There is very limited evidence for IOM use in oesophagectomy. Several papers explore its use in other intraabdominal and intrathoracic procedures. This evidence may be leveraged for oesophagectomy patients. There remain several safety concerns, most notably respiratory and cardiac risks. Further, several knowledge gaps remain. Conclusions: Overall, IOM represents a promising analgesic option. Unfortunately, current evidence is limited, predominantly derived from non-generalisable studies. This paper provides an up-to-date review of evidence, highlighting clear gaps. It is clear oesophagectomy patients are a vulnerable group who would benefit from improved pain and post-operative quality of life. As such, further focused research should be done to evaluate the role of IOM in oesophagectomy for oesophageal cancer.

Prehabilitation represents a proactive, multimodal strategy to enhance patient resilience prior to plastic and reconstructive surgery, building on the success of Enhanced Recovery After Surgery (ERAS) pathways. This narrative review synthesizes the conceptual framework of prehabilitation—encompassing exercise training, nutritional optimization, risk factor modification, and psychological preparation—and examines its current application within plastic surgery. While evidence from selected randomized trials and systematic reviews in orthopedic and colorectal surgery suggests potential reductions in complications (often in the range of 20–40% in higher-risk populations), the results remain heterogeneous and context-dependent. To date, there have been no randomized controlled trials on plastic surgery, despite unique patient populations facing modifiable risks, including smoking, obesity, and malnutrition. This review proposes a risk-stratified prehabilitation framework tailored to key plastic surgery domains: breast reconstruction, head-and-neck microsurgery, post-bariatric body contouring, and major esthetic procedures. Practical implementation strategies address timelines, multidisciplinary teams, and digital delivery tools. By positioning prehabilitation as a structured preoperative component within ERAS pathways, plastic surgeons may support better perioperative readiness, potentially influencing complications, recovery, and patient experience. This review proposes conceptual frameworks intended to guide structured evaluation and future clinical research in plastic surgery.

Background/Objectives: Intraoperative neuromonitoring (IONM) has improved safety in thyroid and parathyroid surgery, yet intermittent IONM (I-IONM) may miss traction injuries developing between stimulations. We evaluated the feasibility and clinical utility of a trend-based intermittent monitoring mode (NIM Vital NerveTrend®) that records closely spaced stimulations and plots amplitude and latency over time. Methods: We conducted a prospective observational study at a high-volume endocrine surgery unit (January–September 2025). Forty-four consecutive patients undergoing thyroidectomy and/or parathyroidectomy with NerveTrend® were enrolled. Electromyography (EMG) responses were categorized as Green (amplitude > 50% of baseline and latency < 110%), Yellow (amplitude < 50% or latency > 110%), Red (amplitude < 50% and latency > 110%), and Loss of Signal (LOS: amplitude <100 µV). Primary outcomes included LOS prevalence and the association between stimulation frequency and the appearance of Yellow trends. Ethical approval: AVEN protocol 486/2024/OSS/AOUPR; informed consent obtained. Results: Of 71 nerves at risk (NAR), 55 had a valid baseline and were analyzed; LOS occurred in 3/55 NAR (5.5%). The mean number of stimulations per NAR was 4.5 (range 1–9). Cases with both Green and Yellow points had a significantly higher mean number of stimulations than cases with only Green points (5.1 vs. 3.8; Student’s t-test p = 0.0059). One Red measurement occurred in a case that progressed to LOS. Conclusions: NerveTrend® provided near real-time functional feedback while maintaining the simplicity of I-IONM. Increased stimulation frequency was associated with early Yellow trend alerts, potentially signaling traction stress and enabling timely surgical adjustments. Larger multicenter studies and protocol standardization are warranted.