This article compiles the summaries of the presentations during the session “Joining Forces – What Can We Learn From Others?” at the SCS Congress.
What can we learn from each other: inborn malformations and pediatric surgery
Author: Stefan Holland-Cunz, Basel
From a purely surgical perspective, pediatric surgery is characterized by expertise in the reconstruction of congenital malformations, such as esophageal atresia or hypospadias. This requires organ-preserving and tissue-sparing dissection techniques within extremely confined anatomical spaces. Whether performed open or via laparoscopic and thoracoscopic approaches, fundamental manual skills are of paramount importance.
In surgical training across all specialties, pediatric surgery offers not only the acquisition of these technical skills and standards, but also fosters an understanding of the lifelong consequences of our surgical interventions on patients’ daily quality of life. The medical care of neonates, children, and their families demands tailored communication, adapted examination techniques, and dedicated follow-up care. Within these interactive domains, every surgeon can gain valuable experience that enriches their professional practice.
Iatrogenic vascular injuries, I need your help
Author: Sabine Richarz, Zürich
Over recent years, iatrogenic vascular injuries have become an increasing challenge, now accounting for 41–56% of all vascular trauma cases. This rise is driven by the growing use of minimally invasive and percutaneous procedures. High-risk settings include spinal surgery, vascular access procedures, ECMO, cardiac catheterization, nephrectomy, prostatectomy, and orthopedic surgery. Patients are typically elderly, often female, and frequently have significant comorbidities.
Vascular injuries do not always present with obvious bleeding. Manifestations range from acute hemorrhage and shock to delayed complications such as ischemia, compartment syndrome, arterial dissection, pseudoaneurysm, arteriovenous fistula, and catheter displacement, appearing days to years after the procedure.
Initial management requires remaining calm, calling for help, avoiding catheter removal, applying direct pressure or tamponade, and coordinating with the team. Definitive treatment includes open or endovascular repair. Prevention remains crucial through careful planning, imaging, ultrasound-guided access, anticipation of complications, and vigilant postoperative monitoring.
Iatrogenic ureteral injury, what now?
Author: Beat Roth, Bern
Iatrogenic ureteral injury remains one of the most challenging complications in pelvic and retroperitoneal surgery. Successful prevention and reconstruction depend not only on recognizing the anatomy of the ureter but, above all, on preserving its delicate vascular supply. Because ureteral viability is entirely dependent on its peri-ureteral tissue, excessive dissection, denudation, traction, or thermal damage can compromise blood flow and lead to ischemia, stricture formation, or reconstruction failure.
A wide range of reconstructive options is available, from uretero-ureterostomy and ureteroneocystostomy to Boari flap reconstruction, transuretero-ureterostomy, and ileal ureter substitution. However, successful management is not determined by the choice of technique alone. The optimal strategy must be tailored to the location and extent of injury, tissue quality, vascular integrity, previous treatments, and the overall clinical situation. In complex cases, surgical judgment and experience are essential to balance the risks and benefits of immediate versus delayed reconstruction. While primary repair is often desirable, a staged approach with temporary urinary diversion may provide superior long-term outcomes when local conditions are unfavorable due to inflammation, ischemia, or tissue loss. Ultimately, durable success relies on selecting the right reconstruction for the right patient at the right time.
The pregnant patient: Tocolysis? What medication to give?
Author: Katharina Redling, Basel
Non-obstetric surgery in pregnancy requires careful interdisciplinary decision-making, but medically necessary surgery should not be denied or delayed because of pregnancy. Evidence is limited, with no randomized trials and mainly case series or cohort studies. Appendicitis is the most common cause of non-obstetric emergency surgery in pregnancy and appendectomy is the treatment of choice. Cholecystectomy is the second most commonly performed non-obstetric surgery in pregnancy and is recommended in acute cholecystitis without delay.
If surgery is required, timing depends on the clinical situation. Appendicitis requires no delay in diagnostics or treatment, while biliary colic should, if possible, be treated in the second trimester. Laparoscopy is generally the method of choice, with a pneumoperitoneum of 8–12 mmHg and slight left tilt from 20 weeks of gestation. Tocolysis is not routine but should be considered in patients with preterm contractions, especially when the fetus is viable. Obstetrics should always be contacted first. For fetal monitoring, ultrasound before and after surgery is used if the fetus is non-viable; from approximately 23/24 weeks, CTG before and after surgery is recommended. For medication in pregnancy, package leaflets are not sufficient; evidence-based sources and obstetric expertise are essential.
What We Can Learn From a Senior Surgeon
Author: Raffaele Rosso, Lugano
This presentation reflects on the key lessons learned throughout a surgical career, emphasizing both technical excellence and personal integrity. A surgeon’s behavior—marked by respect, honesty, self-control, and teamwork—is as important as clinical skill. Sound judgment begins with proper patient selection, timing, and proactive management of complications, alongside awareness of one’s limits. Responsibility includes protecting and educating the team, fostering a no-blame culture, and leading by example. Humility is essential: knowing when to pause, seek help, and prioritize quality over speed. Trust with patients is built through clarity, honesty, and empathy, without giving false promises but never removing hope. Mentoring shapes future surgeons by encouraging independence and critical thinking. Professional engagement and gratitude toward mentors and institutions strengthen the community. Ultimately, a balanced life – valuing time, family, and personal well-being—is what truly endures beyond a surgical career.
