Basic Surgical Techniques Research Articles

Lateral rectus resection versus lateral rectus plication in patients with residual esotropia

Background Muscle resection or plication is a common treatment for strabismus by strengthening the muscle. Lateral rectus muscle resection is a basic surgical technique for correcting residual esotropia. Plication approach is an alternative surgical technique to resection. Aim Is to compare the result of lateral rectus plication versus lateral rectus resection in patients with residual esotropia. Patients and methods This is a prospective, comparative, randomized interventional study which was carried on 40 eyes of 20 patients with residual esotropia All the patients underwent surgery to both eyes, they were divided into two groups according to surgical technique. Group A: 20 eyes of 10 patients underwent lateral rectus resection surgery. Group B: 20 eyes of 10 patients underwent lateral rectus plication. Results Postoperative success rate in two groups was 80% with main postoperative angle of deviation higher on group B. Conclusion Lateral rectus muscle plication technique is an alternative to resection that has the same effect as resection as obvious by the similar success rate that can be used on horizontal muscles especially when anterior ciliary vessel sparing is needed.

From Ancient Remedies to Robotic Precision: An Otolaryngology Journey.

This review traces the historical development of otolaryngology, a medical specialty focused on diagnosing and treating ear, nose, and throat (ENT) disorders. The paper highlights key milestones and innovations shaping the field from ancient times to the modern era. The study involves a comprehensive review of historical texts and medical literature, examining advancements in otolaryngology. The analysis covers the early use of herbal remedies and rudimentary instruments, developments in surgical techniques and medical knowledge during the Renaissance, and innovations in anaesthesia and antisepsis in the 19th century. Additionally, it explores the impact of endoscopy, microsurgery, and the advent of robotic surgery on the field. The review identifies several important stages in the evolution of otolaryngology. Early practices in ancient Egypt, Greece, China, and India focused on herbal remedies and basic surgical techniques. During the medieval period, Arabic scholars preserved and enhanced medical knowledge. The Renaissance era saw significant progress through advances in anatomical studies and surgical techniques. The 19th century marked the formalization of otolaryngology with the introduction of anaesthesia, antisepsis, and specialized instruments. The mid-20th century brought a revolutionary impact with endoscopy and microsurgery, enabling minimally invasive procedures. The early 21st century saw the advent of robotic surgery, enhancing surgical precision and outcomes. Emerging technologies such as artificial intelligence, augmented reality, virtual reality, nanotechnology, and bioprinting hold potential to further advance the field, enhancing patient care and treatment efficacy. Otolaryngology has evolved significantly, with ongoing technological advancements promising further improvements in patient care and treatment outcomes.

Convexity Meningioma, Parasagittal Meningioma, Falx Meningioma

During surgery for meningioma, basic surgical techniques and strategies required for the removal of the tumor are common, particularly for tumors located superficially, such as convexity, parasagittal, and falx meningiomas. Four basic surgical techniques, including detachment; devascularization; debulking; and dissection should be combined and repeated in appropriate sequence, tailored to the specific conditions of each tumor. This eventually enables the total circumferential dissection of the tumor from the surrounding tissues. It is essential to retract the tumor towards the space created at the tumor center through internal debulking, rather than retracting the normal brain, to avoid damage to the surrounding brain tissue. During surgery for parasagittal meningioma with venous sinus occlusion, it is crucial to preserve the cortical veins that have developed as collateral pathways to prevent venous complications. During surgery for falx meningioma, the selection of a surgical approach including a contralateral approach based on factors such as the development of bridging veins and significant peritumoral brain edema is required. In this article, detailed surgical procedures for convexity meningioma, parasagittal meningioma, and falx meningioma were described focusing on the application of fundamental surgical techniques tailored to each tumor type.

Successful robotic kidney transplantation for surgeons with no experience in minimally invasive surgery: a single institution experience.

Robotic kidney transplantation (RKT) is a novel and welcomed innovation yielding good surgical outcomes. However, data on the feasibility and safety of performing RKT by surgeons with a lack of prior minimally invasive surgery (MIS) experience are limited. The authors aimed to evaluate the surgical and functional results of RKT and present the learning curves (LC) of RKT by a single surgeon with no prior experience in MIS. This was a retrospective study of all RKT performed between November 2019 and April 2023 at Severance Hospital in Seoul, South Korea. The authors analyzed surgical and functional outcomes, as well as complication rates of RKT in comparison to open kidney transplantation (OKT). The authors evaluated LCs using the cumulative summation method to describe the number of cases associated with the competency of a single surgeon. A total of 50 patients who underwent RKT and 104 patients who underwent OKT were included in this study. In RKT group, the median surgical console time was 193min (interquartile range, 172-222) and the median vascular anastomoses time was 38min (35-44). Total operation time was 323min (290-371) and rewarming time was 62.5min (56.0-70.0) in RKT group compared to 210min (190-239) and 25min (21-30), respectively, in OKT group. Despite extended surgical durations with a robotic technique, both groups had comparable intraoperative and postoperative outcomes, as well as renal function. Estimated blood loss and post-transplant hospital stays were significantly lower in RKT group than in OKT group. LC analysis of RKT by the single surgeon revealed that surgical competence was achieved after 15 cases. Even if surgeons do not have prior experience with MIS, they can rapidly overcome the LC and safely perform RKT with adequate preparation and acquisition of basic robotic surgical techniques.

"Self-Designed Simulation-Based Laparoscopic Training Program for Urology Residents: Results After 6 Years of Experience".

Learning laparoscopy (LAP) is challenging and requires different skills to conventional open surgery. There is a recognized need for a standardized laparoscopic training framework within urology to overcome these difficulties and to shift learning curve from patient to skills laboratory. Simulation-based training has been widely commented, but implementation in real day practice is lacking. We present our "LAP training program for residents". Between 2017 and 2022, 11 residents participated in our self-designed program: Theoretical: (Moodle platform) basic knowledge and multimedia content for initiation into LAP. Evaluated through online exam. Practical: exercises for LAP skills acquisition were proposed and encouraged residents' practice in a box trainer available and experimental surgery sessions on a porcine model. On-site E-BLUS (European Basic Laparoscopic Urologic Skills) examination was performed annually. Feedback was obtained through an anonymous online survey. All residents positively evaluated the program. Theoretical: 82% passed the online exam. The most valued topics: LAP in special clinical situations, complications, instruments, and configuration of the operating room (OR). Practical: all residents increased dry-lab box practices. A total of 23 experimental surgical sessions were carried out. For 64%, simulation in the experimental OR was a necessary complement to achieve laparoscopic skills and allowed them to feel more confident. Forty-five percent considered it essential to improve their surgical technique. E-BLUS evaluation was valued as a means to achieve dexterity and safer surgery by 90%. Reduction in time and errors were observed through time, although only 2 passed the E-BLUS. Our program for learning LAP includes the acquisition of knowledge, training of basic skills and surgical technique in a safe environment, as well as an objective evaluation. Encouraged practice of basic skills and surgical technique simulation and improved objective evaluation. It is structured, reproducible, systematic and has been positively valued, although it requires commitment for success.

Evaluation of Self-Perceived Confidence and Competence in Oral Surgery among Final Year Undergraduate Students in Greece.

Oral surgery is an integral part of dentistry that deals with the diagnosis and management of pathology of the mouth and jaws that requires surgical intervention. The aim of undergraduate studies in oral surgery is, upon graduation, to be confident and competent to treat without assistance surgical cases in the spectrum of general dentistry. This study evaluates the senior Greek dental students' self-confidence and self-perceived competence to undertake cases within the scope of oral surgery. Evaluation of clinical experience gathered during training and self-perceived confidence and competence in generic oral surgery skills is included. The present study was a questionnaire survey conducted during the academic year 2018-2019. The questionnaire comprised three sections. Section 1 included demographic data and four closed-ended questions concerning numerical data about procedures that they had already performed or observed, section 2 included four questions concerning their self-perceived competence to perform basic surgical techniques, and section 3 included 10 clinical case scenarios. One hundred and twenty-seven students participated in the study. Among the basic surgical skills, students were most confident with suturing, and they were least confident with bone removal. Students from the Aristotle University of Thessaloniki (AUTH) tend to show higher level of confidence compared with students from the National and Kapodistrian University of Athens (NKUA) in most questions. Greek graduate dental students report moderate levels of self-confidence in oral surgery. A realistic approach in increasing self-confidence and competence in oral surgery would be the focus on preclinical training in generic elementary surgical skills, in combination with increased observational sessions of oral surgery procedures or outreach training.

INTELLECTUAL PROPERTY APPLIED TO MEDICAL IMAGING SYSTEMS IN PRESENT CONTEXT

The present work discusses the imaging technologies used in the past and present, with utility in neurosurgery. It represents a brief overview of conventional (equipment that use X-rays) and unconventional (equipment that used electromagnetic radiation and ultrasound) technologies, used in current practice. Radiology as a stand-alone specialty has undergone remarkable development in recent years, helping neurosurgery as a specialty to develop, having the devices necessary for a better diagnosis of lesions of the central and peripheral nervous system, helping to a more efficient surgical planning and an adapted surgical treatment. Both conventional and unconventional radiological techniques represent an essential pillar in the application of basic surgical techniques in neurosurgery. As imaging techniques have undergone exponential development, so has the equipment used undergone improvement and upgrading. At the same time, the accumulation and storage of medical data represents an increasingly greater challenge in recent years. With technological evolution, intellectual property applied to databases containing patient information is becoming increasingly important. The need for centralization and maintaining the security of such information is a field of research.

The LazyBox Educational Intervention Trial: Can Longitudinal Practice on a Low-Fidelity Microsurgery Simulator Improve Microsurgical Skills?

Introduction Every surgical trainee must acquire microsurgical skills within a limited timeframe. Therefore, identifying effective educational strategies to help learners attain these skills is crucial. Objective Establish the effectiveness of a low-fidelity microsurgery simulator to improve the execution and one's perception of the difficulty of basic surgical techniques. Methods From 2021 to 2022, 24 medical students were randomized to either (1) a treatment group (n=12) that engaged in longitudinal practice on a low-fidelity microsurgery simulator (the LazyBox) or (2) a control group (n=12) that did not practice. Students performed vessel loop ligation, catheter macroanastomosis, and synthetic vessel microanastomosis prior to and six weeks after intervention. Both objective metrics and subjective metrics (Swedish Occupational Fatigue Inventory (SOFI) and Surgery Task Load Index (SURG-TLX)) were obtained. Results The treatment and control arms had 1.2 (SD = 2.6) and 2.1 (SD = 2.4) points increase in the vessel loop ligation, respectively (p = 0.39). The treatment and control arms had a 3.4 (SD = 4.1) and 2.9 (SD = 3.6) points increase in the macroanastomosis task, respectively (p = 0.74). In the synthetic vessel microanastomosis task training, the experimental and control arms showed a 5.4 (SD = 8.3) and a 2.9 (SD = 5.6) points increase, respectively (p = 0.30). No differences were found between the groups regarding survey metrics of mental (p = 0.82), temporal (p = 0.23), and physical demands (p = 0.48). Conclusion In our randomized educational intervention, we found no significant difference in objective and subjective metrics of microsurgical task performance between learners who did and did not use the LazyBox simulator.

A Simplified Three-Layered Suturing Training Pad for Undergraduate Medical Students: A Technical Note.

Surgical training is a long process that requires a lot of commitment and effort. Basic surgical techniques are the foundation of every procedure, with suturing being one of them. Hence, it is of great importance for aspiring young surgeons to practice and develop their suturing skills. Quite many kinds of suturing training models have been used and proposed worldwide, ranging from commercial silicone pads to meat leftovers and various fruits. We have developed our own, simplified, and low-cost suturing training pad that consists of three layers and is based on the combined use of silicone sponge sheet and polyurethane foam. It is quite durable and elastic and has been applied in three suturing training workshops so far. For this reason, we would like to present our experience of a low-cost but effective way of promoting and achieving further surgical excellence.

WTP6.14 The Effectiveness of Mental Practice in Surgical Skills Practice and Acquisition: A Review

Abstract Aims Mental practice (MP) is an established method to enhance performance in other disciplines. The aim of this review is to assess whether the principles of MP are transferable to surgery and describe how it has been applied in our field so far. Methods A narrative review was conducted according to the four steps described by Demiris et. al. Results This review describes the different types of MP and their role on motor skill acquisition. The process of preparation, delivery and assessment of a MP session is described here in a reproducible manner; providing a ‘user guide’ to surgeons. MP has been shown in several reports to be an effective means in learning surgical skills, from basic surgical technique to the steps of a procedure. It has also been described as a technique applicable to both surgical trainees and established surgeons. Ten RCTs demonstrated a favourable effect of MP on technical skills and one trial showed that MP with MI is equivalent to additional physical practice. On the contrary two RCTs showed MP to be inferior or have no impact compared to other types of preparation. Reduced MP duration was identified as one of the possible reasons for a lack of positive results. Conclusion Mental practice is a feasible method for rehearsing surgical skills and procedures that has been demonstrated to enhance skills acquisition and surgical performance. Larger scale, randomised controlled trials are needed to standardise the duration, number of repetitions, and practical considerations for mental practice in surgery.

A Role for Live-Animal Models in Undergraduate Surgical Education During the Cadaver Shortage.

A Role for Live-Animal Models in Undergraduate Surgical Education During the Cadaver Shortage.

Training in vascular trauma surgery for non-vascular surgeons: Vascular trauma surgery skills course.

The experience of general and trauma surgeons in vascular trauma management has decreased with sub-specialization of surgery and working hours restrictions. We introduce avascular trauma surgery skills course established to train German military surgeons prior to their deployment to conflict areas. The intention and implementation of the vascular trauma course for non-vascular surgeons is described in detail. In hands-on courses, participants learn and train basic vascular surgical techniques on more realistic extremity, neck, and abdominal models with pulsatile vessels. Afundamental and an advanced course each provide military as well as civilian surgeons from different non-vascular specialties with asurgical skill set including direct vessel sutures, patch angioplasty, anastomosis, thrombectomy, and resuscitative endovascular balloon occlusion of the aorta (REBOA) in order to render them capable of managing major vascular injuries. The experiences of this vascular trauma surgical skills course, initially established for military surgeons, can also be of use to all civilian general, visceral, and trauma surgeons occasionally facing traumatic or iatrogenic vascular injuries. Thus, the introduced vascular trauma course is valuable for all surgeons working in trauma centers.

Complications after Cranioplasty: A Pictorial Narrative with Techniques to Manage and Avoid the Same

Abstract Background Cranioplasty following decompressive craniotomy is considered to be a “routine procedure” but several large series have documented a significant amount of both delayed and immediate complications and also a mortality rate of up to 3.6%. Materials and Methods We went through some of the salient complications (excluding seizures) needing resurgery following interval cranioplasty over the past 18 years at our institution in over 300 cases and analyzed the literature that mention these complications and their treatment. Results In addition to the commonly mentioned complications, we found some that had been rarely described or not mentioned hitherto in the literature which we have presented as a pictorial narrative. Based on our experience, we recommend some measures that may decrease the incidence or prevent the occurrence of the same. Conclusions Attention to small but basic surgical techniques will go a long way in preventing unwanted postoperative events.

The glymphatic system and biomarkers of the cerebrospinal fluid in idiopathic normotensive hydrocephalus

Idiopathic normotensive hydrocephalus is one of the most common brain diseases in older people. The most urgent issue in the study of normotensive hydrocephalus is its differential diagnosis with other neurodegenerative and vascular pathologies of the brain. Currently, more studies have examined the concentration of biomarkers in the cerebrospinal fluid of patients with idiopathic normotensive hydrocephalus and other brain diseases to understand the pathophysiological processes in the pathogenesis of neurodegenerative diseases. The overwhelming majority of these studies have focused on the biomarkers of the cerebrospinal fluid in only one anatomical area: the ventricles of the brain or the lumbar subarachnoid space. However, only a few studies have conducted a comparative assessment of the composition and concentrations of biomarkers in ventricular and lumbar cerebrospinal fluid in the same patients. We believe that the difference in the content of biomarkers in different areas may be crucial in the choice of treatment methods for patients with idiopathic normotensive hydrocephalus. The lumbar cerebrospinal fluid is more pollutedthe content of nearly all biomarkers in the lumbar subarachnoid space is higher than that of the cerebrospinal fluid in the ventricles of the brain. Of the two most commonly used basic surgical techniques for the treatment of idiopathic normotensive hydrocephalus, ventriculoperitoneal and lumboperitoneal bypass surgery, preference is given to lumboperitoneal bypass surgery, which avoids complications associated with damage to the parenchyma of the brain and, most importantly, drains the dirtier cerebrospinal fluid with a higher concentration of proteins from the lumbar space. Instead of lumboperitoneal bypass surgery, we proposed a new combination of two surgical proceduresthe combination of endoscopic triventriculocysternostomy and ventriculoperitoneal bypass surgery. With such a combination, we believe that drainage of the cerebrospinal fluid from the ventricles and the subarachnoid space of the cisterns of the base of the brain will be more effective than the traditional ventriculoperitoneal shunting because the concentration of proteins involved in the progression of degenerative diseases of the brain will decrease more actively.

Reconsideration of Sharp Dissection in Gynecological Surgery.

In surgical fields, sharp dissection is a basic surgical technique, and the prognosis and oncological outcomes are known to be affected by the technique of dissection. Even in gynecologic surgery, we believe that the basic surgical technique is sharp dissection. We herein present our technique and discuss its significance. Sharp dissection should entail the removal of a single thin line between the residual tissue and the excised tissue. If this line becomes multiple or thicker, it is not sharp dissection but blunt dissection. The accumulation of this thin line of sharp dissection can form surgical layers. What is important is moderate tissue tension and how to use monopolar. One can sharply cut the loose connective tissue assisted by moderate tissue tension. With regard to the use of monopolar, it is essential that it not be applied directly to the tissue, but rather be used with or without touching the tissue. Inadvertent blunt dissection should be minimized, as most surgical procedures can be performed with sharp dissection. We usually perform sharp dissection for open surgery as well as minimally invasive surgery. We obstetricians and gynecologists should reconsider the significance of sharp dissection and practice it in gynecological surgery.

Super-microsurgery technique for lymphaticovenular anastomosis

BackgroundIn super-microsurgery, such as lymphaticovenular anastomosis (LVA), the diameter of the target vessel can be small and difficult to manage, and the basic surgical technique of microsurgery, such as inserting a forceps into the lumen and applying countertraction, can be difficult. In addition, it can be difficult to confirm the success or failure of the postoperative anastomosis, unlike with normal free-flap transfer, or to learn the technique by reviewing the results. MethodsWe have described a safe, quick, and accurate technique for LVA based on our experience performing several hundred such cases at our institution. ResultsBefore LVA, the location of the significant lymphatic vessels and veins proximal to the lymphatic vessels should be marked using indocyanine green fluorescence angiography and a vein viewer to help determine the skin incision site. We used super-microsurgical titanium needles and surgical scissors and an end-to-end anastomosis. The lymphatic vessels should be dissected as far as possible from the skin incision to the center, and the veins should be dissected as far as possible from the periphery. First, a stay suture should be applied to the upper and lower ends of the anastomosis at 180°. Next, the anterior wall should be sutured. In some cases, countertraction can be applied by inserting the tip of a forceps into the vascular vessel. However, because its insertion could damage the lymphatic vessel wall, it would be more appropriate to perform the anastomosis using the involved stitch technique. After anastomosis of the anterior wall, the vessel should be inverted and the posterior wall anastomosed using the same technique. ConclusionsWe have reported the key points necessary to perform LVA quickly and accurately and the precautions necessary to maintain long-term patency. This sophisticated LVA technique can be applied to improve the outcomes for patients with lymphedema.

Short-term outcomes of one-stage debridement and fusion for ankle joint tuberculosis.

Tuberculosis remains a worldwide health problem, as well as its complications including arthritis in various joints. End-stage arthritis in weight-bearing joint would require surgery either arthroplasty or arthrodesis, in order to achieve painless and stable gait. In general, staged surgery consisted of debridement and subsequent definitive procedure is accepted. However, multiple surgery would be disadvantageous in terms of clinical and economic burdens. This study reported the short-term result of one-stage debridement and fusion for ankle joint tuberculosis. Retrospective evaluation of twenty-six patients with history of one-stage debridement and ankle fusion was conducted. Basic anthropometric measurement, local status, and surgical technique were recorded. Functional score using Foot and Ankle Ability Measures (FAAM) activities of daily living (ADL) was assessed pre-operatively and at two and half year post-surgery follow-up visit along with radiological fusion rate. Paired t test was used to analyse the improvement of the clinical scores. There was improvement in FAAM score from 43.38 ± 9.51 to 62.19 ± 6.63% (p < 0.001). All sinuses had been subsided, albeit at various time spans. Modified radiographic union score for tibia (RUST) revealed various fusion rate results, ranged from 5 to 11. One-stage debridement and fusion is proven efficacious for end-stage joint tuberculosis, with less surgery occasion compared with staged surgery. However, patient selection is important since any comorbidities or secondary infection may complicate the fusion.

The role of the lateral tarsal strip procedure in modern ophthalmic plastic surgery-A review.

The lateral tarsal strip is one of the basic surgical techniques in ophthalmic plastic surgery. It is used in many indications, predominantly in ectropion repair. Even though there are alternatives, it is probably one of the most popular techniques in ophthalmic plastic surgery. The lateral tarsal strip is also part of bigger surgical procedures (such as midface lifting, entropion surgery, reconstruction surgery, or a part of some surgical approaches to the orbit). The aim of this review is to assess the most common ways of usage of the lateral tarsal strip, to cover its alternatives, and to discuss the future of this technique. We have search PubMed and Web of Science and went through articles about lateral tarsal strip. We have also searched for other techniques that used the lateral tarsal strip and included these articles in our review. We have analyzed the major articles and made a review about the topic. As a natural part of many advanced surgical techniques and as a major surgical technique for lower eyelid ectropion repair, the lateral tarsal strip remains an important part of modern ophthalmic plastic surgery.

A Modified Tension Band Fixation Technique for the Management of Patellar Fractures Using Crossed Pins and a Lateral Parapatellar Approach.

The use of the tension band technique for patellar fracture fixation has been associated with a loss of the rigidity of the construct after cyclic loading. Biomechanical studies have shown the biomechanical superiority of the crossed pin configuration relative to the traditional parallel one. Here, we describe a modified tension band technique that involves the use of crossed pins and a figure-of-eight passed as close to the bone as possible through a lateral parapatellar approach. The basic surgical technique and our case series are reviewed.

A Retrospective Critique of the Various Sphincter-preserving Surgical Procedures for Ischiorectal Fistula.

In the 1950s, the cause of anal fistulas was identified as an infection of the anal gland (cryptoglandular infection theory). Thereafter, treatment for this disorder began in the 1960s with the lay-open procedure, which involved incising the sphincter and the fistula tract. However, it was found that too much invasion into the sphincter could result in postoperative fecal incontinence. Thus, to reduce such risk, sphincter-preserving surgery was applied for superficial anal fistula in 1961 and for deep anal fistula (ischiorectal fistula) in 1965. Over the years, more effective sphincter-preserving procedures for ischiorectal fistula have been developed to improve the quality of life of the patient. In this review article, we aim to first introduce the basic surgical techniques for ischiorectal fistula. We will discuss the anatomy of the anus and the pathogenesis of ischiorectal fistula and will provide some diagnostic methods. Representative sphincter-preserving procedures that have been performed for ischiorectal fistula since 1965 will also be categorized and outlined chronologically. The discussion will look at the following techniques for ischiorectal fistula and outline the advantages and disadvantages of each procedure so that they can be used as a reference for ischiorectal fistula surgery in the future: the lay-open procedure (fistulotomy and fistulectomy), the Hanley procedure (first partial sphincter-preserving procedure), the muscle-filling procedure, the Moriya method and Ui method (modified partial sphincter-preserving procedure), the Takano method and the sphincter-preserving lateral procedure (complete sphincter-preserving procedure), the seton method (a cross between the lay-open procedure and sphincter-preserving procedure), and the overseas sphincter-preserving procedure.