1. Postoperative pneumonia after lung resection : a prospective double-blind comparative study of bronchial colonization and antibiotic prophylaxisSabrina Petrovič, Bojana Beović, Viktorija Tomič, Marko Bitenc, Mateja Marc-Malovrh, Vladimir Dimitrić, Martina Miklavčič, Aleksander Sadikov, Aleš Rozman, 2026, original scientific article Abstract: Background: Postoperative pneumonia (POP) remains a major cause of morbidity after lung cancer surgery. The role of perioperative antibiotic prophylaxis (PAP), particularly the choice of antibiotics and their adjustment to bronchial colonization, is still debated. Methods: We conducted a prospective, double-blind, comparative study including 200 patients with primary lung malignancy undergoing lung resection. Patients received either cefazolin or amoxicillin–clavulanic acid as PAP. Preoperative bronchial colonization was assessed before surgery. The primary outcomes were the incidence of POP according to the antibiotic regimen and colonization status. Results: The cohort comprised 200 patients (median age 68 years, range 44–83; 48.5% women). POP occurred in 47 patients (23.5%). Of these, 23 (21.5%) had received cefazolin and 24 (25.8%) amoxicillin–clavulanic acid, with no significant difference between regimens. Colonization was detected in 178 patients (89.0%), including 36 (20.2%) with potentially pathogenic microorganisms (PPMs). POP incidence was similar in non-colonized (22.7%), colonized (23.6%), and PPM-colonized patients (25.0%) (all P ≥ 0.51). Only one patient (0.5%) died within 30 days, unrelated to pneumonia. Conclusions: In this prospective comparative study, POP after lung cancer surgery did not significantly differ according to the prophylactic antibiotic regimen or colonization status. However, given the relatively small number of patients with PPM colonization and the single-center design, these findings should be interpreted cautiously. Standard perioperative prophylaxis with cefazolin appears appropriate, while routine preoperative colonization screening may not be necessary. Further studies are needed to better define risk-adapted preventive strategies.
Keywords: postoperative complications, bronchial colonization, cefazolin, amoxicillin-clavulanic acid
Published in DiRROS: 19.08.2026; Views: 157; Downloads: 83
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2. A higher amount of nutritional intake as a possible cause of hyperglycemia in extremely premature infants in parenteral and enteral nutrition at the tertiary neonatal intensive care unitIza Predanič Drobne, Lilijana Kornhauser-Cerar, Vanja Erčulj, Štefan Grosek, 2023, original scientific article Abstract: Background: This study aimed to find an association between infants who had hyperglycemia and those who did not, those treated with insulin or not and several prenatal and postnatal variables or the suboptimal prescription of parenteral nutrition. Methods: We conducted a retrospective study, which included extremely premature infants (<28 weeks of gestation) admitted to the tertiary NICU, University Medical Centre Ljubljana, between 1 January 2021 and 31 December 2021. Blood glucose measurements, insulin treatment, general characteristics, nutritional data and complications of prematurity were obtained retrospectively from hospital data. Results: There were 21 infants included in the study who did not receive insulin and 17 who were treated with insulin. Infants receiving insulin were younger and lighter compared to the non-insulin treatment group (mean gestational age 178 vs. 188 days; median birth weight 680 g vs. 990 g). The younger insulin group of infants received the same daily number of total macronutrients per kg per day compared to the older non-insulin group, i.e., glucose, lipids and amino acids, as recommended for the gestational age and birth weight. After adjusting for gestational age, no significant association with complications of prematurity was found. Conclusions: The postulated explanation (with the prescription of a higher amount of macronutrients during the first seven days) for hyperglycemia and treatment with insulin in the less mature and lighter infants cannot be supported by the data given.
Keywords: hyperglycemia, extremely premature infants, nutritional intake, parenteral nutrition, complications of prematurity
Published in DiRROS: 06.08.2026; Views: 180; Downloads: 117
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4. Fifteen years of pediatric immune thrombocytopenia in a national cohort : chronicity, diagnostic challenges, and treatment patterns – single center experienceKatja Pregeljc, Elena Favaretto, Federico Verzegnassi, Barbara Faganel Kotnik, 2026, original scientific article Abstract: Background The majority of children with primary immune thrombocytopenia (ITP) follow a benign, self-limiting course. However, early identification of children at risk for chronic disease, timely recognition of alternative diagnoses that may mimic ITP at onset, and selection of patients for observation alone remain important clinical challenges. Methods This retrospective single-center study included patients aged ≤18 years who were evaluated for ITP between 2009 and 2024. Demographic, clinical, laboratory, and therapeutic data were collected at diagnosis and during follow-up. Factors associated with chronic ITP were assessed using logistic regression, providing odds ratios with 95% confidence intervals. Kaplan-Meier analysis was used to describe time to first bleeding complication according to initial management. Results A total of 271 patients were included (43.5% female; median age 4 years). Of these, 240 were ultimately diagnosed with ITP, while 31 received an alternative final diagnosis. In multivariate logistic regression, chronic ITP was independently associated with older age (OR 1.08; p=0.017), absence of a preceding infection or vaccination (OR 0.45; p=0.029), and higher platelet count at diagnosis (OR 1.03, p<0.0001). Compared with patients with final ITP, those with alternative causes of thrombocytopenia were older (p=0.034), had lower bleeding grades (p=0.037), higher MCV, and lower total leukocyte, lymphocyte, monocyte, and eosinophil counts at onset (all p<0.05). Patients receiving upfront pharmacological therapy were younger and presented with higher bleeding grades and lower platelet counts than those managed with observation. Bleeding complications were more frequent with upfront pharmacological therapy, whereas those in the watch-and-wait group tended to be more severe. Conclusion Our results suggest that readily available data may help identify children at risk for chronic disease and those whose thrombocytopenia is attributable to a cause other than ITP. Initial treatment decisions appeared to be driven primarily by clinical presentation.
Keywords: Alternative diagnoses, chronicity, complications, immune thrombocytopenia, pediatrics, watch- and-wait management
Published in DiRROS: 23.07.2026; Views: 276; Downloads: 155
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5. Safe implementation of robotic colorectal surgery : balancing surgical training and patient safety with the dual-console systemJurij Aleš Košir, Miha Petrič, Blaž Trotovšek, Gregor Norčič, Jan Grosek, 2026, original scientific article Abstract: Background: Robotic platforms expand minimally invasive options in colorectal surgery but raise concerns about training and patient safety. Dual-console systems may enable realtime coaching while preserving outcomes. Methods: We implemented a structured framework for safe implementation of robotic colorectal surgery that balances trainee autonomy with patient safety using a dual-console model. Early cases emphasized low-complexity pathology with escalation by predefined benchmarks. We prospectively gathered data and evaluated early program outcomes with primary endpoints including intraoperative adverse events, conversion to open surgery, 30-day morbidity, anastomotic integrity, and oncologic quality metrics. Secondary endpoints included operative time. Results: We included the analysis of 17 patients operated by one surgeon under supervision and compared the results to other senior colorectal surgeons. Out of the 17 patients, there were no conversions or anastomotic leaks. Overall complications were comparable to baseline robotic cases. Resection margins and lymph node yields met oncologic standards. Operative times were longer during early adoption but approached baseline with progression. Operative times were significantly reduced after eight cases and approached the times of senior surgeons after 13 cases. Conclusions: A dual-console strategy enables safe, scalable training in robotic colorectal surgery without compromising short-term patient outcomes or oncologic quality. Key elements include rigorous case selection, proficiency-based progression, real-time coaching, standardized protocols, and continuous data surveillance. This framework can guide institutions seeking to expand robotic colorectal programs while safeguarding patients and accelerating the learning curve.
Keywords: robotic colorectal surgery, learning curve, safe implementation, complications
Published in DiRROS: 20.07.2026; Views: 260; Downloads: 153
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6. Transition from laparoscopic to robot-assisted partial nephrectomy : perioperative outcomes during an institutional transition in a high-volume European centreJure Bizjak, Andraž Kondža, Kosta Cerović, Milan Medved, Simon Hawlina, 2026, original scientific article Abstract: Background/Objectives: Robot-assisted partial nephrectomy (RAPN) has increasingly replaced laparoscopic partial nephrectomy (LPN) in the management of localized renal tumours. This study aimed to evaluate perioperative, functional and surgical margin outcomes during an institutional transition from LPN to RAPN in a high-volume centre. Methods: We performed a retrospective single-centre analysis of 100 consecutive patients undergoing minimally invasive partial nephrectomy. The last 50 LPN cases (August 2014 May 2018) were compared with the rst 50 RAPN cases (June 2018February 2020). Baseline characteristics, perioperative outcomes, early functional parameters and surgical margin status were analysed. Complications were classied according to the Clavien Dindo system. Results: Tumours treated in the RAPN group were signicantly larger (3.4 vs. 2.5 cm) and more complex (RENAL score of 6 vs. 5; p < 0.001). Operative time was longer in the RAPN group (143 vs. 122 min; p < 0.01), while warm ischaemia time did not di er signicantly (16 vs. 15 min; p = 0.37). Estimated blood loss was lower (0 vs. 10 mL; p = 0.049) and the hospital stay was shorter (3 vs. 4 days; p < 0.001) in the RAPN group. Haemoglobin decrease and postoperative creatinine change were comparable between groups. Positive surgical margins were observed less frequently in the RAPN group (2.3% vs. 7.7%), but this di erence was not statistically signicant (p = 0.34). Complication rates were signicantly lower in the RAPN group (4% vs. 22%; p < 0.05), with no major complications observed in the robotic cohort. Conclusions: In this institutional experience, RAPN was associated with favourable perioperative outcomes during the transition period, despite the treatment of larger and more complex renal tumours. The slightly longer operative and warm ischaemia times likely reect a more comprehensive reconstruction strategy, which may contribute to improved haemostatic control and lower complication rates. Further studies with extended follow-up are required to evaluate oncological and renal functional outcomes.
Keywords: robot-assisted partial nephrectomy, laparoscopic partial nephrectomy, renal cell carcinoma, nephron-sparing surgery, minimally invasive surgery, warm ischaemia time, surgical outcomes, complications, renal function, enucleation
Published in DiRROS: 01.07.2026; Views: 255; Downloads: 179
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7. The initial results of MRI-TRUS fusion prostate biopsy in high volume tertiary centerTomaž Smrkolj, Milena Taskovska, Iztok Ditz, Klemen Černelč, Simon Hawlina, 2024, original scientific article Abstract: Background: Multiparametric magnetic resonance imaging (mpMRI) is a prerequisite for targeted prostate biopsy. The aim of our study was to evaluate the performance and learning curve of the mpMRI-transrectal ultrasound (TRUS) software image fusion (MRI-TRUS fusion) biopsy (BX) process in the first year after its introduction in our urology department. Patients and methods: MRI-TRUS fusion BX was performed in 293 patients with at least one Prostate Imaging-Reporting and Data System (PIRADS) ≥3 lesion. The proportion of patients and lesions with positive histopathologic result for prostate cancer (PCa) was analyzed. The learning curve for MRI-TRUS fusion BX was assessed at institutional and individual level. Positive BX lesions were further analyzed by PIRADS and Gleason scores. Results: The proportion of patients with positive histopathologic results for targeted BX, systematic BX, and combined BX was 53.9%, 47.9%, and 63.5%, respectively. The chi-square test for the proportion of PCa positive patients showed no significant difference between the time-based patient groups at the institutional level and no significant difference between individual urologists. PIRADS score (p < 0.001), total PSA concentration (p = 0.05), prostate volume (p < 0.001) and number of cores per lesion (p = 0.034) were significant predictors of a positive histopathologic result in a lesion-based analysis. Clinically significant PCa (csPCa) was confirmed in 34.7% of the 412 BX lesions and 76.4% of the 187 positive PCa lesions. Conclusions: MRI-TRUS fusion targeted BX significantly improves the overall rate of PCa detection compared with systematic BX alone. No steep learning curve was observed in our urologists. The proportion of lesions with clinically insignificant PCa was low, limiting overdiagnosis of PCa.
Keywords: complications, learning curve, prostate cancer, targeted prostate biopsy
Published in DiRROS: 26.06.2026; Views: 257; Downloads: 168
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8. Do laparoscopic colorectal procedures need fluid optimization?Matej Jenko, Jasmina Markovič Božič, Alenka Spindler-Vesel, 2024, original scientific article Abstract: BACKGROUND: Goal-directed fluid therapy (GDFT) with hemodynamic monitoring may not be of benefit to all elective patients undergoing major abdominal surgery, particularly those managed in enhanced recovery after surgery protocols (ERAS) setting. AIMS: We predicted different fluid and vasoactive drug consumption during the procedure and less complications in the group of patients, where invasive hemodynamic monitoring was used. METHODS: Two groups of patients undergoing elective laparoscopic colorectal surgery were compared: A control group (CG), with standard hemodynamic monitoring, and a study group, (SG) with invasive hemodynamic monitoring and appropriate intraoperative interventions. We compared differences in intraoperative fluid consumption, length of hospital stay (LOS) and post-operative morbidity. RESULTS: A group of 29 patients in SG had similar average intraoperative fluid balance (+438 mL) as 27 patients in CG (+345 mL) p = 0.432. Average LOS was 8 days (±4) in SG and 6 days (±1) in CG (p = 0.124). Acute renal failure, anastomotic dehiscence, and indication for antibiotic treatment were predictors of statistically significant prolongation of hospital stay 3rd day after surgery, but independent of SG. CONCLUSION: Since no differences between the groups were shown in overall fluid and vasoactive drug consumption, we conclude that GDFT is not needed in laparoscopic colorectal surgery, when ERAS is followed.
Keywords: laparoscopic abdominal surgery, Hemodynamic monitoring, post-operative complications
Published in DiRROS: 15.06.2026; Views: 299; Downloads: 185
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9. Prevention of air embolism in extracorporeal membrane oxygenation systems : an in vitro study on protection of central venous catheter lumenDanilo Franco, Nejc Krašna, Robert Novak, Giovanni Esposito, Raffaele Izzo, Jan Bělohlávek, Marko Noč, Tomaž Goslar, 2024, original scientific article Abstract: Background and Objectives: This study aimed to investigate the risk and mechanisms of air entry into the extracorporeal membrane oxygenation (ECMO) circuit through the central venous catheter (CVC) in a veno-venous configuration. The primary goal was to assess the impact of different air volumes on ECMO circuit performance at varying pump speeds. Material and Methods: The study utilized a circuit model to simulate ECMO conditions and evaluate the potential entry points of air, specifically through the unprotected lumen of the CVC. Various interventions, such as the use of a closed three-way stopcock or clave, were implemented to assess their efficacy in preventing air entry. Results: The unprotected lumen of the central venous catheter posed a significant risk for air entry into the ECMO circuit. The introduction of a closed three-way stopcock or clave proved effective in preventing air ingress through the central venous catheter. Auditory cues, such as a distinct hissing sound, served as an early warning sign of air presence in the circuit. The study demonstrated that even small volumes of air, as minimal as 1 mL, could pass through the oxygenator at specific pump speeds, and larger volumes could lead to pump dysfunction. Conclusions: The study identified the unprotected lumen of the central venous catheter as a potential entry point for air into the ECMO circuit. The use of a closed three-way stopcock or one-way valve was found to be a reliable protective measure against air infiltration. Early detection through the observation of a hissing sound in the circuit provided a valuable warning sign. These findings contribute to enhancing the safety and performance of ECMO systems by minimizing the risk of air embolism.
Keywords: air embolism, complications, extracorporeal membrane oxygenation, simulation
Published in DiRROS: 12.06.2026; Views: 293; Downloads: 207
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