Conventional Surgery Research Articles

A new perspective on macrophage-targeted drug research: the potential of KDELR2 in bladder cancer immunotherapy

IntroductionBladder cancer was recognized as one of the most common malignant tumors in the urinary system, and treatment options remained largely limited to conventional surgery, radiotherapy, and chemotherapy, which limited patient benefits.MethodsResearchers constructed an RNA transcriptome map of bladder cancer by integrating single-cell RNA sequencing and clinical data, identifying potential molecular targets for diagnosis and treatment. We also verified the antitumor activity of the target through in vitro experiment.ResultsA distinct tumor cell subpopulation characterized by elevated S100A8 expression exhibited high copy number variation, high stemness, and low differentiation. It interacted with myeloid cells via the MIF-(CD74+CD44) and MIF-(CD74+CXCR4) signaling pathways. This study underscored KDELR2’s role in promoting cell proliferation, invasion, and migration, providing new therapeutic insights. Prognostic analysis revealed that KDELR2 correlated with poor survival, higher immune scores, and increased macrophage infiltration.DiscussionThe findings suggested that patients with high KDELR2 expression might benefit from immune checkpoint therapy. KDELR2 was also shown to enhance bladder cancer cell proliferation, invasion, and migration, highlighting it as a promising target for macrophage-focused drug development.

A systematic review and meta-analysis comparing robotic-assisted percutaneous screw fixation and conventional surgical techniques for acetabular fractures.

The objective of this comprehensive review and meta-analysis was to evaluate the effectiveness of robot-aided percutaneous screw fixation versus traditional surgical techniques in managing acetabular fractures. We plan to carry out an exhaustive exploration of certain databases (PubMed, CNKI, Embase, and Cochrane Library) to find studies that have been published since the beginning of these databases until August 2024, focusing on patients with acetabular fractures. These studies will compare the efficacy of robot-assisted percutaneous screw fixation with conventional surgical methods. Both English and Chinese literature will be included. We will adhere strictly to the predefined inclusion and exclusion criteria, with a focus on randomized controlled trials and cohort studies. Review Manager 5.4.1 will be utilized for the execution of data analysis. The ROBINS-I instrument will be used to evaluate the bias risk in Not-RCTs. The final analysis included 6 retrospective cohort studies, encompassing a total of 168 patients, with 83 undergoing robot-assisted percutaneous screw fixation and 85 receiving conventional surgery. The results indicated that patients treated with robot-assisted percutaneous screw fixation had shorter OT, fewer intraoperative fluoroscopy instances, and fewer adjustments of guide pins compared to those receiving conventional surgery. However, no significant differences were observed between the two treatment methods in terms of Modified Postel Merle D'Aubigne scores and EBL. The use of robots in percutaneous screw fixation has been demonstrated to be a secure and efficient method for managing acetabular fractures. Compared to conventional ORIF or free-hand screw fixation, this robotic-assisted technique offers significant advantages, including reduced operation time, lower IFF, and fewer guide wire adjustments.

Comparison of modified tumescent and conventional laparoscopic transabdominal pre-peritoneal repair in the patients of inguinal hernia: A randomised control trial.

Inguinal hernia surgery, a common procedure worldwide, continues to develop to achieve minimal access and tension-free repairs. However, a universally accepted technique has yet to be developed. Our study introduces a new approach, a modified tumescent transabdominal pre-peritoneal (TAPP), to a low-cost setting. We then compare its safety and efficacy with the conventional TAPP, providing a new perspective on hernia repair methods. The study was conducted between April 2016 and September 2017 at the department of surgery in a medical college in Jammu. Sixty patients were randomly assigned to either the conventional TAPP group or the tumescent TAPP group using computer-generated randomisation. In the tumescent group, we carefully administered a tumescent solution into the pre-peritoneal space after creating pneumoperitoneum and then compared the effectiveness and safety of the two procedures. Our study revealed significant differences in various aspects between the two groups. In the conventional group, 16.7% of patients experienced challenging peritoneal flap dissection, while none in the tumescent group faced this issue. In addition, none of the patients in the tumescent group had an intraoperative haemorrhage. The conventional group had a mean operating time of 100.4 ± 11.21 min. On the other hand, the tumescent group had a significantly shorter mean operating time of 84 ± 13.47 min. The complication rates were 16.7% in the tumescent group and 30% in the conventional group. After the surgery, 13.3% of patients in the conventional group reported persistent pain, compared to only one patient in the tumescent group, which was statistically significant. Our study demonstrates that tumescent TAPP can overcome the challenges of conventional TAPP surgery, offering practical benefits such as reduced bleeding, easier dissection, decreased post-operative pain and shorter operating time. Administering tumescent solution before TAPP repair of inguinal hernia provides technical and clinical advantages, suggesting the potential for shorter surgeries and a quicker learning curve.

Learning curve of robotic mitral repair: prospective two-center study of proficiency and clinical outcomes.

Robotic-assisted mitral valve repair surgery has a steep learning curve, and it is not clear whether previous experience in minimally-invasive mitral valve surgery (MIMVS) facilitates this process. We aimed to investigate the initial experience of two cardiac centers starting their robotic programs, evaluating the impact of previous MIMVS experience. Retrospective analysis was performed for the first consecutive cases operated due to severe degenerative mitral valve regurgitation using the robotic surgical platform in two European centers, one transitioning from conventional surgery (Center1) and the other from mini-thoracotomy (MT) MIMVS (Center2). Cumulative sum analysis was used to evaluate the learning process using both surgical times and a combined primary outcome including relevant intra- and postoperative results. First 62 patients in each center were included. All median surgical times were shorter in Center 2: cardiopulmonary bypass (CPB): 238vs.115min,p<0.001; cross-clamp: 143vs.82min,p<0.001; and total intervention: 313vs.228min,p<0.001. The combined primary outcome showed no significant differences (9.7%vs.8%;p=1). However, the turning point making the end of the learning phase was detected at the 60th case in Center 1 and at the 50th in Center 2. Regarding surgical time, the learning curve was steeper in Center 1 with both CPB and cross-clamp overcoming the learning phase after 32 cases, as compared to 16 cases in Center 2. A successful robotic-assisted mitral repair program can be safely started coming from either conventional open approach or MT-MIMVS. However, previous MT-MIMVS experience had positive impact on the initial learning curve.

Application of 3D printing technology in preoperative planning and treatment of proximal humerus fractures: a retrospective study

BackgroundThe application of 3D printing technology in preoperative planning and treatment of these fractures has shown promise in improving surgical efficiency, trauma, and patient outcomes. This study aims to demonstrate the advantages of applying 3D printing technology to the treatment of proximal humeral fractures by comparing cases selected for 3D printing with a control group (conventional surgery group), in order to further promote the application of 3D technology in a broader range of trauma treatments.MethodsThis study conducted the clinical data of 51 patients with proximal humeral fractures. Inclusion criteria encompassed patients diagnosed with Neer II and III type proximal humerus fractures. Among them, 24 patients underwent traditional surgery, while 27 patients underwent surgery with 3D printing technology support. Intraoperative parameters, functional outcomes, radiographic results at 6 months, and pain scores were collected and analyzed.ResultsThe 3D printing group demonstrated significantly reduced total surgery time compared to the traditional surgery group (P < 0.05). Implant placement accuracy was significantly higher in the 3D printing group compared to the traditional surgery group (P < 0.05). Functional outcomes at 6 months favored the 3D printing group, with higher Constant-Murley Score and lower Disability of the Arm, Shoulder, and Hand (DASH) Score compared to the traditional surgery group (P < 0.05). Additionally, the 3D printing group showed a significantly lower prevalence of heterotopic ossification compared to the traditional surgery group (P < 0.05). Preoperative and early postoperative pain scores were significantly lower in the 3D printing group compared to the traditional surgery group (P < 0.05).ConclusionThe integration of 3D printing technology into the preoperative planning and treatment of complex proximal humerus fractures demonstrated significant advantages in surgical efficiency, functional outcomes, radiographic prognosis, and pain management.

Tissue-Engineered Skin Substitutes for Use in Clinical Dermatological Practice

Skin replacements are essential in dermatology as they serve to connect the gap between conventional wound care and surgical procedures. Due to pioneering innovations from the last century, tissue-engineered skin substitutes have significantly advanced in the field of dermatology, offering new hope for patients with complex wound healing needs. Whilst before, skin grafting was performed to act as an intermediary to promote skin healing, it has now evolved to also mimic skin structure and function. To our knowledge, there have not been any summaries on the use of tissue-engineered in dermatology. Therefore, we conducted a scoping review to summarize research papers which performed human clinical trials and follow-up work using synthetic lab-made skin with a clear clinical application from the last 30 years.

Defining the ideal trajectory into the inner ear in image-guided cochlear implant surgery

The aim of robot-assisted cochlear implant surgery (RACIS) is to access the inner ear with minimal trauma. High-resolution imaging, empowered with a highly accurate navigation system can enable the planning of a direct keyhole drilling trajectory toward the inner ear. The time has come to (re)define the ideal trajectory into the inner ear with robot-assisted tools that can drill with the highest accuracy. The trajectories of past RACIS procedures were analysed to gain insight into how to calculate the most ideal trajectory and to determine which trajectory parameters influence the course of the procedure. Data-analysis was performed on three groups of previously performed RACIS-procedures. Group 1 included the RACIS-procedures with a round window (RW) approach. Group 2 included the RACIS-procedures with difficulty entering the inner ear. Group 3 included the converted cases to conventional CI surgery due to inadequate intra-operative safety margins. The RW diameter was significantly smaller and its orientation significantly less favourable in group 2 compared to group 1. A smaller surface size and an unfavourable orientation of the RW in relation to the drilling trajectory are thus associated with a more difficult electrode array insertion in RACIS. Both must be taken into account when planning a drilling trajectory into the inner ear.

The Comparison of The Quality of Life Between Conventional Orthognathic Surgery and Surgery-first Orthognathic Surgery in Skeletal Class III Deformity Patients

Objectives: This prospective cohort study aimed to compare the quality of life (QoL) of patients with skeletal Class III deformities undergoing either conventional orthognathic surgery (CS) or surgery-first orthognathic surgery (SF) using the Orthognathic Quality of Life Questionnaire (OQLQ) and the Oral health Impact (OHIP-14) tools. Methods: The OQLQ was translated into Thai. Thirty-four patients were enrolled, with 17 in each group according to their orthodontic treatment plans. Patients completed the OQLQ and OHIP-14 assessments on the day before surgery (T1) and at 1 month (T2), 3 months (T3), and 6 months (T4) post-surgery. Data collection occurred from October 2021 to April 2022. Independent sample T-tests and one-way repeated measures ANOVA were used for statistical analysis (p&lt;0.05). Results: At T1, the QoL was significantly lower in the CS group compared to the SF group. The CS group exhibited significant QoL improvements at T2 (OQLQ) and T3 (OHIP-14) compared to T1. The SF group had a lower QoL at T2 but showed significant improvement at T4 (OQLQ and OHIP-14). Conclusions: There was no significant difference in QoL between the two groups after surgery. Both surgical approaches led to improvements in patients' QoL. Thus, the choice of surgical method should be based on appropriate indications and patient-doctor agreement.

Energy-based surgery generated carbonized particles promote the development of ovarian cancer

Cancer patients face a high risk of tumor recurrence and metastasis after surgery. Surgical stress has been reported to be an important trigger for cancer recurrence and metastasis. Energy-based surgical devices have become the most commonly used surgical tool in recent years. However, there is a lack of studies investigating whether using energy-based surgical devices promotes the development of residual tumors. This study aimed to examine the impact of energy-based surgery on tumor growth in comparison to conventional surgery. Results indicated that energy-based surgery is more likely to promote tumor growth than conventional surgery. Further investigation revealed that the carbonized particles produced by energy-based surgical devices during tissue combustion are robust inducers, strongly inducing the polarization of M2-like macrophages in vivo and in vitro. Additionally, carbonized particles induced an immunosuppressive tumor microenvironment in vivo, promoting tumor growth similarly to energy-based surgery. These findings suggested that the production of carbonized particles during energy-based surgery contributed to the development of residual tumor cells. Therefore, it is advisable to implement measures to either eliminate or prevent the production of carbonized particles during energy-based surgery procedures.

Validation study of synthetic models for esophageal atresia with tracheoesophageal fistula (EA/TEF): A simulation-based training in pediatric surgery

BackgroundPediatric surgery is a highly specialised field, with minimally invasive surgery (MIS) posing greater technical challenges than conventional open surgery. Proficiency requires both in and out-of-operating-room training, with simulation playing a crucial role. The purpose of this study was to explore MIS perceptions, training experiences, and preferences regarding laparoscopic simulation training. Furthermore, we aimed to validate two synthetic EA/TEF models. MethodA questionnaire focused on the degree of adoption of MIS among paediatric surgeons was proposed online to participants at the 68th Czech and Slovak Pediatric Surgery Congress in Slovakia in 2024. All participants also had scheduled sessions to practice advanced laparoscopic skills on two synthetic EA/TEF models. The purpose of this study was to analyse experiences with paediatric MIS, the implementation of simulation training, and personal stances on integrating simulation training into training curricula. EA/TEF models were validated with a 5-point Likert scale. ResultsThirty-three paediatric surgeons from 14 centres in two countries completed the questionnaire. Six (18 %) were novices, 12 (36 %) intermediate trainees, and 15 (45 %) specialists with over 11 years of practice. Eight participants (18 %) declared weekly access to simulation training, while 49 % had none. Additionally, 15 individuals (45.5 %) strongly agree and 48.5 % agree that regular training on simulators enhances surgical skills in MIS procedures in the operating room. Twenty-six respondents (76 %) believe that simulator training should be part of the requirements for pediatric surgical trainees, with no significant difference according to the surgeons' experience (p = 0.290). Thirty surgeons validated the EA/TEF models. Highest ratings were for overall impression and tool usefulness in experienced surgeons' training (mean scores: 4.5 and 4.6). The working space received the lowest score (mean: 3.6 ± 0.8), with experienced surgeons rating it significantly lower (3.4) than the inexperienced group (4.1, p = 0.030). No significant differences were observed between models in Likert scale parameters. ConclusionSimulation training is essential for teaching MIS in paediatric surgery, improving skills, and should be part of specialisation preparation. Synthetic EA/TEF models received high ratings as effective training tools for thoracoscopic EA/TEF training. Further studies are needed to prove construct validity.

Comparative Analysis of Acute-Phase Protein Profiles in Cats Undergoing Ovariectomy: Laparoscopic vs. Conventional Surgery in Short Time After Procedure.

Acute-phase proteins (APPs) are biomarkers of systemic inflammation, which allow monitoring the response to surgery and post-operative complications. Ovariectomy (OVE) can be a useful model to evaluate surgical trauma and inflammation in feline species. The objective of this study was to evaluate and compare the acute-phase response (APR) after applying two different OVE techniques by measuring serum levels of serum amyloid A (SAA), haptoglobin (Hp), total serum proteins (TSPs), albumin (ALB), and paraoxonase-1 (PON-1) during the first 48 h post-surgery (hospital stay). Forty-two female cats were selected for elective spaying. The animals were randomly distributed into two groups: laparoscopic OVE (L-OVE) and midline OVE (M-OVE). Serum SAA, Hp, TSPs, ALB, and PON-1 were measured before surgery and 1, 6, 12, 24, and 48 h post-surgery. Unlike negative APPs such as PON-1 and ALB, SAA is the most sensitive positive APP for monitoring the inflammatory response in cats undergoing OVE following laparoscopic and conventional surgery. OVE performed in cats via both laparoscopic and midline techniques results in a significative increase in SAA levels, with early recovery, minor variations in serum total protein, and no significant changes in albumin, haptoglobin, or PON-1 over a 48-h period post-procedure. Based on SAA concentrations, the response to surgical trauma does not differ between surgical techniques.

Indocyanine green fluorescence imaging for lymph node detection and long-term clinical outcomes in colorectal cancer surgery: A systematic review and meta-analysis.

The indocyanine green fluorescence imaging (ICG-FI) technique is increasingly being used in laparoscopic colorectal surgery for lymph node mapping. However, there is no definitive standard regarding whether the application of this technique can significantly increase the detection rate of metastatic lymph nodes and improve long-term prognosis. PubMed, Embase, Web of Science, and Cochrane Library databases were searched to include studies including ICG-FI in laparoscopic colorectal surgery. Data on the detection rate of lymph nodes, metastatic rate of ICG-positive nodes, and long-term clinical outcomes were extracted following inclusion criteria. Eighteen studies with a total of 1552 patients 922 with ICG-guided laparoscopic and 630 without ICG technique were finally included. Clinical stage II/III colorectal tumors were the most commonly studies types. The patients using the ICG-FI technique had more harvested lymph nodes (weighted mean: 23.5 vs. 18.9; WMD=4.6; p<0.00001) during dissection but a lower metastasis rate of ICG-positive nodes (61/218 [28%] vs. 96/333 [28.9%]; OR=1.45; p=0.08). Compared with conventional laparoscopic colorectal surgery, additional ICG-FI technique did not improve the 3year overall survival rate (272/289 [94.1%] vs. 269/289 [93.1%]; OR=1.19; p=0.61), relapse-free survival (246/289 [85.1%] vs. 249/289 [86.2%]; OR=0.92; p=0.72), and local recurrence rate (22/289 [7.6%] vs. 28/289 [9.7%]; OR=0.77; p=0.38). The overall detection rate of sentinel lymph nodes, lymph flow, and metastatic rate of ICG-positive nodes with the help of ICG-FI were 86.8%, 89.9%, and 22.8%, respectively. No patients experienced major adverse events during ICG injection preoperatively or postoperatively. Indocyanine green fluorescence imaging-guided procedure, compared to conventional laparoscopic dissection, can assist in obtaining a greater number of harvested lymph nodes and metastatic lymph nodes, however, it did not significantly improve the long-term clinical outcomes. Level III systematic review of randomized control and nonrandomized studies.

ArtiSentialⓇ versus conventional laparoscopic colorectal cancer surgery: a multicenter retrospective matched cohort study

Background: This study aims to compare outcomes of colorectal cancer surgeries performed using the newly developed articulating laparoscopic instrument, ArtiSential®, with those using conventional non-articulating or rigid laparoscopic instruments. Methods: This multicenter, retrospective, matched cohort study enrolled patients with colorectal cancer undergoing laparoscopic surgery in seven tertiary referral hospitals from January 2021 to October 2022. A 1:1 propensity score matching was performed between the articulating (Arti-LAP) and conventional (Rigid-LAP) laparoscopic groups. The primary outcome was the overall incidence of short-term complications. Results: The study initially comprised 694 and 2008 patients in the Arti-LAP and Rigid-LAP groups, respectively. After matching, each group consisted of 694 patients, with no significant differences in baseline clinical characteristics. Mean operation time was 161 ± 32 min in Arti-LAP and 152 ± 25 min in Rigid-LAP groups (P=0.105). Open conversion rates were 0% (0/694) in Arti-LAP and 1.0% (7/694) in Rigid-LAP groups (P=0.024). Overall morbidity rates were 9.5% (66/694) in Arti-LAP and 12.8% (89/694) in Rigid-LAP (P=0.061), with similar rates of severe morbidities. Specimen quality was acceptable in both groups. Multivariable regression analysis showed that the choice of instrument type (articulating or rigid) was not associated with perioperative morbidity. Despite a short median follow-up period of 19.5 months, no significant difference in disease-free survival was observed between the groups. Conclusion: Laparoscopic surgery using ArtiSential® was performed safely and effectively for patients with colorectal cancer. Articulating laparoscopic instruments may offer an advantage in reducing open conversion rates.

GAMMA KNIFE AND QUALITY OF LIFE: A REVIEW ON THE USE OF RADIOSURGERY IN BRAIN TUMORS

INTRODUCTION: Considering the quality of life of patients with brain tumors, several treatment alternatives have been developed over time, aiming at a less invasive potential and providing a permanent functional capacity for the individual. In this regard, in recent decades there has been debate about radiosurgery for the treatment of brain tumors. OBJECTIVE: The objective of this study was to evaluate the feasibility of Gamma Knife radiosurgery, considering patient safety. METHODS: This article is characterized as an integrative literature review of an exploratory nature, in the PubMED and Cochrane databases, the search was restricted to observational studies and randomized clinical trials as primary data to contemplate the outcomes Quality of life, neurological preservation, recurrence, cerebral complications and overall survival. RESULTS: The analysis of the collected data demonstrated that, in general, radiosurgery by the Gamma Knife platform preserves quality of life in several cases, mainly in smaller benign brain tumors. The disease recurrence rate after 3 years of radiosurgery ranged from 20 to 40%, depending on the type of tumor and treatment, with the highest recurrence rate in grade III meningiomas and high-grade gliomas. The 5-year recurrence rate ranged from 60 to 80%, and was therefore higher than that of more invasive treatments. CONCLUSION: The qualitative synthesis of these data proves the efficacy of radiosurgery and may suggest to neurosurgeons the possibility of treating brain tumors in patients who are not eligible for conventional surgery or in patients with non-bulky tumors.

Evolution from laparoscopic to robotic radical resection for gallbladder cancer: a propensity score-matched comparative study.

The use of robotic or laparoscopic surgery for gallbladder cancer (GBC) is increasing, with reported advantages over conventional open surgery. The purpose of this study was to compare the perioperative outcomes and postoperative overall survival (OS) associated with robotic radical resection (RRR) and laparoscopic radical resection (LRR) for GBC. A total of 109 patients with GBC who underwent radical resection with the same surgical team between January 2015 and December 2023 were enrolled, with 21 patients in the RRR group and 88 cases in the LRR group. A 1:1 propensity score matching (PSM) algorithm was used to compare the surgical outcomes and postoperative prognosis between the RRR and LRR groups. Logistic regression analysis was used to identify the risk factors of postoperative overall survival (OS) and complications of Clavien-Dindo (C-D) Grades III-IV. The median follow-up time was 46 (inter-quartile range, IQR 29-70) months for the LRR group and 16 (IQR 12-34) months for the RRR group. After PSM, the baseline characteristics of the RRR and LRR groups were generally well balanced, with 21 patients in each group. RRR was associated with significantly decreased intraoperative bleeding [100.00 (50.00, 200.00) mL vs 200.00 (100.00, 300.00) mL] and higher number of lymph nodes (LNs) yield [12.00 (9.00, 15.50) vs 8.00 (6.00, 12.00)]. The two groups showed comparable outcomes in terms of the incidence of biliary reconstruction, the range of liver resection, the length of operation, the incidence of postoperative morbidity, the incidence of C-D Grades III-IV complications, number of the days of drainage tubes indwelling and postoperative hospital stay, and mortality by postoperative days 30 and 90. After PSM, the 1-, 2-, and 3-year overall survival rates were 78, 70, and 37%, respectively, in the RRR group, and 71, 59, and 48%, respectively, in the LRR group (P = 0.593). Multivariate analysis showed that the preoperative TB level ≥ 72µmol/L and biliary reconstruction were found to be the independent risk factors of C-D Grades III-IV complications. T3 stage was identified to be the risk factor for postoperative OS. Compared with LRR, RRR showed comparable perioperative outcomes in terms of length of operation, and postoperative complications, recovery, and OS. In our case series, RRR of GBC can be accomplished safely and tends to show less intraoperative bleeding and higher LNs yield.

Robotic surgery versus laparoscopic surgery for rectal cancer: a comparative study on surgical safety and functional outcomes.

This study aims to evaluate the clinical efficacy and functional outcomes of DA Vinci (Xi)-assisted surgery compared to conventional laparoscopic surgery for middle and low rectal cancer, focusing on oncologic cure and functional preservation. Between December 2020 and June 2021, 102 patients with middle and low rectal cancer (tumour lower margin ≤10 cm) were enrolled at the affiliated Hospital of Xuzhou Medical University. Participants were divided into two groups: robot-assisted (n = 51) and laparoscopy-assisted (n = 51). Each group underwent a radical resection using their assigned method. Clinical and functional outcomes were analysed post-surgery. Preoperative data did not differ significantly between groups (P > 0.05). All surgeries were successfully completed without conversion to open surgery. The robotic group experienced significantly less intraoperative blood loss (55.2 ± 29.8 mL vs. 109.5 ± 58.5 mL) and faster recovery in gastrointestinal function (35.1 ± 9.4 h vs. 40.7 ± 1.9 h), diet recovery (2.1 ± 0.8 days vs. 2.9 ± 0.4 days), and catheter removal (2.9 ± 2.7 days vs. 5.3 ± 2.1 days). The robotic group also dissected more lymph nodes (23 ± 6 vs. 15 ± 4). However, they had longer operative times (239.8 ± 29.6 min vs. 141.1 ± 18.5 min) and higher hospital costs. Satisfaction levels regarding defecation, voiding, and sexual functions were notably higher in the robotic group. No significant differences in surgical safety or immediate postoperative outcomes were observed between robotic and laparoscopic approaches. However, robotic surgery demonstrated superior lymph node dissection, anal function preservation, and gastrointestinal recovery, enhancing overall functional outcomes.

Advantages of the split-leg supine position single-port plus one laparoscopic surgery approach

The goal of this study was to compare the advantages of conventional laparoscopic surgery (CLS) and the split-leg supine position single-port plus one laparoscopic surgery (SSP SILS + 1) in esophageal surgery. This study enrolled 73 patients who previously underwent radical esophagectomy for esophageal cancer from August 2021 to February 2023. Among them, 36 patients underwent SSP SILS + 1, whereas the remaining 37 patients underwentCLS. Surgical time, bleeding volume, number of dissected lymph nodes, incision length, and postoperative abdominal pain score between the two groups of patients were compared using either the Student’s t-test or chi-square test. Time of abdominal incision (1.4 ± 0.2 min vs. 5.2 ± 0.7 min, p < 0.001) was shorter in patients in the SSP SILS + 1 group compared with those in the CLS group. However, the average incision length was shorter in the SSP SILS + 1 group compared with that in the CLS group (35.4 ± 4.0 cm vs. 4.6 ± 4.1 cm, p < 0.001). Notably, the pain score on postoperative day (POD) 1 was lower in the SSP SILS + 1 group compared with that in the CLS group (5.7 ± 0.7 vs.6.3 ± 0.7, p = 0.001). The SCAR score was also lower in the SSP SILS + 1 group compared with that in the CLS group (3.5 ± 0.9 vs. 8.3 ± 1.4, p = 0.019). There was no significant difference in the number of dissected abdominal lymph nodes and positive lymph nodes (p > 0.01) between the two groups. The SSP SILS + 1 intervention offers multiple benefits over conventional surgical procedures, encompassing shorter incision length and pain scores on POD 1. In accelerated rehabilitation surgery for esophageal cancer, this surgical procedure demonstrated high safety, feasibility.

Intraocular Lens Rotational Stability after Cataract Surgery with and without Primary Posterior Continuous Curvilinear Capsulorrhexis.

To evaluate intraocular lens (IOL) rotational stability and capsular fusion process after cataract surgery with and without primary posterior continuous curvilinear capsulorrhexis (PPCCC). Fujian Provincial Hospital, Fujian, China. Prospective, intraindividual, randomized clinical trial. This study included 56 adult patients (112 eyes) with bilateral cataract undergoing phacoemulsification cataract surgery with PPCCC in one eye (PPCCC group) and conventional cataract surgery in the contralateral eye (NPCCC group). IOL axis orientation and fusion footprint length were measured at 1 day, 1 week, 1 month, 3 months, and 1 year after surgery using OPD-Scan III, while capsular bend index (CBI) was assessed at the same time points using Pentacam AXL. No between-group difference was found in the absolute rotation from 1 day to 1 year (2.93 ± 1.72 vs 2.66 ± 1.61 degrees, P=0.54). The absolute rotation from 1 week to 1 month in NPCCC group was higher than that in PPCCC group (1.65 ± 0.68 vs 1.27 ± 0.32 degrees, P=0.01). At 1 month after surgery, both fusion footprint length (9.11 ± 2.74 vs. 10.67 ± 2.06 mm, P = 0.02) and CBI (2.92 ± 0.60 vs. 3.25 ± 0.59, P = 0.03) were lower in NPCCC group. Cataract surgery involving PPCCC demonstrates comparable outcomes to conventional procedures regarding long-term IOL rotational stability, therefore is a promising option for adult cataract patients scheduled for toric IOL implantation. PPCCC slightly reduces IOL rotation in the early postoperative period, which can be attributed to accelerated capsular fusion.

Is robot-assisted pedicle screw placement really superior to conventional surgery? An overview of systematic reviews and meta-analyses.

Over the past two decades, modern spine surgery has become increasingly intellectualized and minimally invasive. However, whether using robots in spine surgery results in more accurate pedicle screw placement remains a topic of debate. This study aimed to evaluate the certainty and quality of the available evidence on the efficacy of robot-assisted pedicle screw placement. We performed an overview of reviews including systematic reviews (SRs) and meta-analyses (MAs) regarding the accuracy of robot-assisted pedicle screw placement. Regarding the SRs/MAs, five electronic databases were searched from inception to 28 April 2023. There were no restrictions on the language or population. The quality and certainty of the evidence were evaluated with PRISMA, AMSTAR-2, ROBIS, Veritas plot, and GRADE tools. Fifteen SRs/MAs were analyzed. The findings indicated that the accuracy of pedicle screw placement in the robot-assisted group was not superior to that in the freehand group. All the SRs/MAs were of low or critically low quality. The main reasons for this include missing data, lack of transparency, lack of sensitivity analysis, and measurement of heterogeneity in the included studies, registration of reporting protocols, and deficiencies in the study inclusion methods and selection criteria. While there is potential for robot-assisted pedicle screw placement to offer superior accuracy compared to conventional surgery, the current evidence is limited by methodological shortcomings. The quality of the studies analyzed was insufficient to provide a robust basis for developing clinical guidelines. Further high-quality research is necessary to confirm the benefits and establish clearer recommendations.

Comprehensive interdisciplinary treatment of patient with unilateral cleft palate and oroantral fistula using archwise Interdental distraction osteogenesis: A case report with 1-year follow-up

A unilateral cleft palate with a wide oroantral fistula necessitates meticulous treatment planning and precise execution to mitigate the risk of relapse. It is arduous to address substantial gaps through conventional surgeries using buccal, labial mucosal flaps, or tongue flaps and is associated with heightened failure rates. In recent years, the introduction of interdental distraction osteogenesis (DO) has facilitated successful interventions in mending extensive cleft defects. In this case report, an adult patient with unilateral cleft palate and oronasal fistula has been successfully managed with orthodontic treatment and interdental DO using a custom-made device. The patient received successful treatment through orthodontic treatment and interdental DO utilizing a custom-made device abiding by Ilizarov’s principles. The size of the oroantral fistula was reduced significantly with a successful approximation of the segments. Subsequently, prosthetic replacement of the distracted segment was performed to restore esthetics. Follow-up images and radiographs showcase the stability and integrity of the arches. The epilogue of this case report is that the implementation of transport distraction can be accounted as an effective treatment approach when meticulously planned and followed through. By integrating early detection, multidisciplinary interventions, and ongoing support, healthcare professionals can significantly enhance outcomes and empower individuals to lead fulfilling lives despite their condition.