Conventional Surgery Research Articles

Exoscope-assisted surgery in otology and neurotology.

This review addresses the pressing need for an updated understanding of high-definition 3D exoscope role in contemporary otologic and neurotologic practice. With technological advancements driving innovations in surgical visualization, it is crucial to evaluate the efficacy of exoscope-assisted surgery compared to traditional microscopic approaches. By synthesizing recent literature, this review offers insights into the current state of exoscopic ear and lateral skull base surgery and its implications for clinical practice and research. Recent literature has focused on several key themes. Firstly, studies have demonstrated the feasibility and safety of exoscopic approaches for various otologic and neurotologic procedures. Secondly, comparative studies have highlighted similar outcomes with exoscopic techniques compared to conventional microscopic surgery, particularly in terms of operative time and complication rates. Thirdly, the exoscope can be a valuable tool for the education and training of surgeons. The findings from recent literature underscore the growing significance of exoscope-assisted surgery in otology and lateral skull base practice. However, challenges such as high magnification image quality and learning curve must be addressed to optimize its widespread adoption. Overall, this review highlights the importance of continued research and innovation in this rapidly evolving field.

Robot-assisted versus conventional laparoscopic surgery for rectal cancer.

This is a protocol for a Cochrane Review (intervention). The objectives are as follows: To assess the benefits and harms of robot-assisted surgery for rectal cancer resection.

Comparing the efficacy and safety between femtosecond laser-assisted cataract surgery and conventional phacoemulsification cataract surgery: systematic review and meta-analysis

To investigate the efficacy and safety of femtosecond laser-assisted cataract surgery (FLACS) compared with conventional phacoemulsification cataract surgery (CPCS). Randomized controlled trials (RCTs) were systematically searched in PubMed, Embase, Cochrane Library, ClinicalTrials.gov, CNKI, and Wanfang. Main outcomes were visual acuity, capsulotomy parameters, effective lens position, and complications. Secondary outcomes included refractive outcomes, intraoperative parameters, and corneal parameters. In total, 41 RCTs involving 9310 eyes were included. There was a statistically significant difference in favour of FLACS over CPCS for uncorrected distance visual acuity at 12 months (mean difference [MD] -0.03; 95% CI -0.05 to -0.01); corrected distance visual acuity at 1 week (MD -0.05; 95% CI -0.07 to -0.02) and 12 months (MD -0.02; 95% CI -0.04 to -0.00); area of capsulotomy at 1 month (MD 4.04 mm2; 95% CI 3.45-4.64) and 6 months (MD 5.02 mm2; 95% CI 3.28-6.77); and intraocular lens centroid-pupil centroid distance at 1 week (MD -0.06 mm; 95% CI -0.08 to -0.05), 1 month (MD -0.07 mm; 95% CI -0.09 to -0.06), and 6 months (MD -0.06 mm; 95% CI -0.07 to -0.04). With regard to surgical complications, FLACS was less than CPCS for the incidence of decentred IOL (odds ratio 0.06; 95% CI 0.01-0.24). However, FLACS did not increase the incidence of other intraoperative or postoperative complications except subconjunctival hemorrhage. Both FLACS and CPCS are effective and safe. FLACS achieves better visual outcomes in the early postoperative period and long-term follow-up, accompanied by more accurate capsulotomy and more optimized effective lens position than CPCS. However, no difference of visual outcomes was found after middle-term follow-up.

Could Abdominoplasty with Diastasis Recti Abdominis Correction Improve Stress Urinary Symptoms? A 1-Year Follow-up Prospective Study.

Diastasis recti abdominis (DRA) indicates an abnormal separation of the rectus abdominal muscles from the midline, resulting in abdominal bulging. Recent literature shows a correlation between DRA and back pain, stress urinary incontinence. Primary goal of this study is to check the correlation between DRA correction in abdominoplasty and improvement of urinary symptoms. This is a prospective study on patients with post-pregnancy rectus diastasis who underwent surgical correction of diastasis through conventional abdominoplasty. All patients were asked to complete the ICIQ-FLUTS questionnaire, which assesses urinary disorders, and the SF-36 questionnaire, aimed at quantifying health-related quality of life. The questionnaires were administered to patients the day before surgery and one year after surgery. The recruited patients (n = 51) were then stratified on the presence or absence of stress urinary incontinence. Of the 39 patients with preoperative incontinence, the average scores of the ICIQ-FLUTS were analyzed. In particular, for the questions relating to stress urinary incontinence a statistically significant difference was reported between the preoperative mean and the 1-year mean for all questions (p value<0.05). As regards quality of life, comparing the average scores of each question of SF-36 there is an improvement in the values of all the variables of the questionnaire. The strength of this study, which distinguishes it from other literature, is that the changes in abdominal pressure post-abdominoplasty which should lead to a worsening of stress incontinence, do not cause it. On the contrary, we have demonstrated the improvement of this symptom after conventional abdominoplasty surgery in most patients. This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266.

Laparoscopic complete mesocolic excision in colon cancer: a prospective cohort study

Introduction: Compared to conventional colon cancer surgery, laparoscopic complete mesocolic excision (CME) increases the likelihood of lymph node dissection. However, this surgery is not yet considered a safe strategy. The authors study this topic to evaluate the safety and feasibility of this surgery. Methods: A prospective cohort study was performed on patients undergoing laparoscopic CME surgery at the Hue University of Medicine and Pharmacy Hospital and Hue Central Hospital. Results: Demographic data, surgical features, and postoperative complications. Evaluate different clinicopathological factors determining the number and distribution of lymph nodes; and the rate of lymph node metastasis by tumor location and lymph node groups. Three-year overall survival and disease-free survival follow-up after surgery. Conclusion: The results of laparoscopic CME colectomy surgery are safe, with a reliable maximum number of harvested nodes.

Assessing the suitability of video-assisted anal fistula treatment for obese patients compared to conventional surgery: a question worth investigating

Background and aimsVideo-assisted anal fistula treatment (VAAFT) is an innovative surgical approach enabling the direct visualization of the fistula tract structure. This study aims to assess the efficacy of VAAFT in comparison with that of traditional surgical methods and explore potential risk factors contributing to fistula recurrence to provide new recommendations for surgical selection.Materials and methodsInformation was collected from 100 patients with complex anal fistula (CAF) in our hospital who underwent surgical treatment from January 2021 to January 2023. We compared the baseline information and surgical outcomes of two groups, analyzed the risk factors for fistula recurrence by using logistic regression analysis, and conducted further exploration by using the body mass index.ResultsEqual numbers of patients underwent VAAFT and traditional surgeries, and no significant differences in baseline information were observed. Patients who received VAAFT experienced less intraoperative bleeding (15.5 (14.0–20.0) vs. 32.0 (25.0–36.0)), shorter hospital stays (2.0 (2.0–2.5) vs. 3.0 (3.0–3.5)), reduced postoperative pain and wound discharge, but longer operative times (43.3 ± 6.9 vs. 35.0 (31.5–40.0)) compared with patients who underwent traditional surgeries. No significant differences in recurrence rates were found three and six months after operation (the p-values were 0.790 and 0.806, respectively). However, the Wexner scores of the VAAFT group were significantly low in the first follow-up (0 (0–1.0) vs. 2.0 (1.0–2.0)). Postoperative recurrence of fistulas may be associated with obesity (p-value = 0.040), especially in patients undergoing traditional surgeries (p-value = 0.036).ConclusionVAAFT offers advantages, such as less pain, less trauma, and faster recovery, compared with traditional surgical treatment. Obese patients with CAF are prone to recurrence, and we recommend that they undergo VAAFT treatment rather than traditional surgeries.

Comparative analysis of changes in retinal layer thickness following femtosecond laser-assisted cataract surgery and conventional cataract surgery

BackgroundTo investigate the influence of femtosecond laser-assisted cataract surgery (FLACS) on macula by examining changes in retinal layers after FLACS and to compare these changes with those after conventional cataract surgery (CCS).MethodsThis study included 113 unrelated Korean patients with age-related cataract who underwent CCS or FLACS in Severance Hospital between September 2019 and July 2021. Optical coherence tomography was performed before and 1 month after surgery. The total retinal layer (TRL) was separated into the inner retinal layer (IRL) and outer retinal layer (ORL); moreover, the IRL was subdivided into the retinal nerve fiber layer, ganglion cell layer, inner plexiform layer, inner nuclear layer (INL), outer plexiform layer, and outer nuclear layer. We performed between-group comparisons of the postoperative thickness in each retinal layer and the postoperative differences in retinal thickness. The average retinal thickness of the four inner macular ring quadrants was used for comparative analysis.ResultsCompared with the CCS group, the FLACS group exhibited a thicker ORL (P = 0.004) and a thinner INL (P = 0.007) after surgery. All retinal layer thickness values showed significant postoperative changes regardless of the type of surgery (P < 0.05). The postoperative increase in TRL and IRL thickness was significantly smaller in the FLACS group than in the CCS group (P = 0.027, P = 0.012).ConclusionsThe 1-month postoperative retinal changes were less pronounced in the FLACS group than in the CCS group.

Clinical Outcomes, Predictors, and Surgical Management of Infracardiac Total Anomalous Pulmonary Venous Connection.

This study sought to find the risk factors of postoperative pulmonary venous obstruction (PVO), PVO-related reintervention, and postoperative mortality, determine the relationship between pulmonary venous confluence (PVC) morphology and the clinical outcomes, and provide the basis for the selection of the optimal surgical strategy for infracardiac total anomalous pulmonary venous connection (TAPVC). From December 2009 to December 2023, 101 patients with infracardiac TAPVC undergoing surgical repair in our institution were included [Conventional surgery (CS) group, n = 73; Sutureless technique (ST) group, n = 28]. The Kaplan-Meier curve was used to demonstrate the survival estimates. The Cox proportional hazard model was used to identify risk factors for primary endpoints. There were 8 in-hospital deaths and 4 late deaths. The survival rates at 1, 5, and 10years were 88.8%, 87.6%, and 87.6%, respectively, in the whole cohort. Multivariable analysis showed that prolonged cardiopulmonary bypass (CBP) time was associated with overall mortality and Y-shaped PVC has a trend for a higher mortality rate. Postoperative PVO occurred in 27 patients. Freedom from postoperative PVO at 1, 5, and 10years were 81.8%, 69.9%, and 69.9%, respectively. Y-shaped PVC and preoperative PVO were incremental risk factors for PVO, but ST repair was a protective factor. Sixteen patients underwent PVO-related reintervention. Y-shaped PVC was the only independent risk factors for PVO-related reintervention while ST repair was a protective factor. Sutureless technique can achieve satisfactory outcomes for infracardiac TAPVC repair. Compared with CS repair, ST repair is significantly associated with decreased postoperative PVO and PVO-related reintervention. Y-shaped PVC is associated with a higher risk of PVO, PVO-related reintervention, and mortality, respectively. Patients with preoperative PVO are more likely to develop postoperative PVO.

Biophysical stimuli for promoting bone repair and regeneration

Abstract Bone injuries and diseases are associated with profound changes in the biophysical properties of living bone tissues, particularly their electrical and mechanical properties. The biophysical properties of healthy bone are attributed to the complex network of interactions between its various cell types (i.e., osteocytes, osteoclast, immune cells and vascular endothelial cells) with the surrounding extracellular matrix (ECM) against the backdrop of a myriad of biomechanical and bioelectrical stimuli arising from daily physical activities. Understanding the pathophysiological changes in bone biophysical properties is critical to developing new therapeutic strategies and novel scaffold biomaterials for orthopedic surgery and tissue engineering, as well as provides a basis for the application of various biophysical stimuli as therapeutic agents to restore the physiological microenvironment of injured/diseased bone tissue, to facilitate its repair and regeneration. These include mechanical, electrical, magnetic, thermal and ultrasound stimuli, which will be critically examined in this review. A significant advantage of utilizing such biophysical stimuli to facilitate bone healing is that these may be applied non-invasively with minimal damage to surrounding tissues, unlike conventional orthopedic surgical procedures. Furthermore, the effects of such biophysical stimuli can be localized specifically at the bone defect site, unlike drugs or growth factors that tend to diffuse away after delivery, which may result in detrimental side effects at ectopic sites.

Questionnaire to Survey Cosmetic Outcomes in Laparoscopic Surgery for Colorectal Cancer.

There has been a steady increase in the use of minimally invasive surgery, including conventional multiport laparoscopic surgery (MLS) and single-site laparoscopic surgery (SLS) for colorectal cancer. We aimed to evaluate how important the cosmetic outcome, one of the advantages of SLS, is to patients and whether SLS reflects social needs. We used a web-based questionnaire to survey nonmedical and medical workers for what factors were considered on the assumption that respondents undergo colorectal cancer surgery and that the most important person for them undergoes. Five items (curability, safety, pain, length of hospital stay, and cosmetic outcomes) were compared. After paired photographs before and after SLS and MLS were shown, perceptions of body image and cosmesis were assessed using a visual analog scale. This study included a total of 1352 respondents (990 nonmedical and 362 medical). Curability had the highest score (49.9-53.7 points), followed by safety (23.8-24.7 points). The scores for cosmetic outcomes (6.2-7.1 points) were almost equal to those of the length of hospital stay (6.2-7.1 points), which was associated with medical costs and pain (10.0-11.1 points), one of the main reasons for fear of surgery. Participants who were female, younger, and in the nonmedical group placed great importance on cosmetic outcomes. For all questions regarding body image and cosmesis, SLS had superior scores compared with MLS. Understandably, curability, and safety were most important in colorectal cancer surgery. However, medical workers should consider cosmetic outcomes, even in malignant cases.

Comparative Study between Radiofrequency Ablation and Laser Ablation in Treatment of Varicose Vein

Abstract Background Varicose veins are avery common problem all over the world. Surgery has been the gold standard treatment for many years, however now other less invasive options are available and sometimes more efficient. Aim of the Work The purpose of this study was to evaluate the RFA technique in treatment of GSV varicosities and to compare the results, clinical outcome, complications and recurrence rate after RFA and CS of GSV. Patients and Methods In this study 25 patients with varicose vein were randomized to laser ablation of GSV and another 25 patients underwent RFA of the GSV in Nasser institute. Both techniques were done under local (tumescent) anesthesia helped by sedation (Deprivan) in some patients or spinal anethesia in the other patients. Operative time was nearly the same in both techniques. no statistically significant difference between both techniques Results This study proved that radiofrequency and laser ablation techniques are safe and efficient in treating varicose veins and there was no statistically significant difference between both groups regarding postoperative complications or recanalization and recurrence. Conclusion Duplex guided radiofrequency ablation and laser ablation are efficient and safe modalities in the treatment of great saphenous vein varicosities. Conventional surgery has been used for a long time for treatment of varicose veins with variable degrees of minor to major complications. R radiofrequency and laser ablation of GSV in treatment of varicose vein provides high ablation rates in conjunction with a very moderate side effect profile

Endoscopic decompression of severe post-tuberculosis kyphosis related ossification of the ligamentum flavum: case report and literature review.

Spinal tuberculosis, if not promptly treated, can lead to kyphotic deformity, causing persistent neurological abnormalities and discomfort. Spinal cord compression can occur due to ossification of the ligamentum flavum (OLF) at the apex of kyphosis. Traditional surgical interventions, including osteotomy and fixation, pose challenges and risks. We present a case of thoracic myelopathy in a patient with post-tuberculosis kyphosis, successfully treated with biportal endoscopic spinal surgery (BESS). A 73-year-old female with a history of untreated kyphosis presented with walking difficulties and lower limb pain. Imaging revealed a kyphotic deformity of 120° and OLF-induced cord compression at T8-9. UBE was performed under spinal anesthesia. Using the BESS technique, OLF was successfully removed with minimal damage to the stabilizing structures. The patient exhibited neurological improvement after surgery, walking on the first day without gait instability. Follow-up at 1year showed no kyphosis progression or recurrence of symptoms. BESS successfully resolved the cord compression lesion with minimal blood loss and damage. In spinal tuberculosis-related OLF, conventional open surgery poses challenges. BESS emerges as an excellent alternative, providing effective decompression with reduced instrumentation needs, minimal blood loss, and preservation of surrounding structures. Careful patient selection and surgical planning are crucial for optimal outcomes in endoscopic procedures.

Totally laparoscopic surgery for choledochal cysts with hand‑sewn Roux‑en‑Y reconstruction in a pediatric population.

Cyst excision and Roux-en-Y hepaticojejunostomy (RYHJ) is the standard treatment for choledochal cysts (CCs). In the present study, the results of totally laparoscopic surgery for CCs (TLCCs) in a pediatric population were evaluated. The clinical data of 28 children with CCs between June 2020 and June 2023 were retrospectively reviewed. All patients underwent TLCCs involving cyst excision and RYHJ. The jejunojejunal anastomosis was completed laparoscopically using manual sutures. Age at operation, operative time, postoperative recovery and complications were evaluated. The 28 patients comprised 8 boys and 20 girls who underwent TLCCs at a mean age of 4.2 years (range, 1 month-12.3 years) with a mean weight of 15.9 kg (range, 4.6-43 kg). All patients received ultrasound and magnetic resonance cholangiopancreatography examinations, which revealed a mean cyst diameter and length of 1.74±0.76 cm and 3.85±1.25 cm, respectively. The mean operative time was 214±43.8 min. The mean time until starting an oral diet after surgery was 2.89±1.23 days. Apart from bile leakage and wound infection, no other complications occurred during a median follow-up period of 18 months (range, 4-42 months). TLCCs can be performed safely by skilled surgeons in pediatric patients. TLCCs may be more physiologically compatible and accelerate recovery of intestinal function with reduced trauma and better esthetic outcomes than conventional laparoscopic surgery for CCs. Therefore, TLCCs with manual sutures may be considered as an option for minimally invasive surgery in pediatric patients with CCs.

The treatment of bacterial biofilms cultivated on knee arthroplasty implants using the bioelectric effect.

Introduction: The formation of bacterial biofilms on knee arthroplasty implants can have catastrophic consequences. The aim of this study was to analyze the effectiveness of the bioelectric effect in the elimination of bacterial biofilms on cultivated knee arthroplasty implants. Methods: A novel device was designed to deliver a bioelectric effect on the surface of knee arthroplasty implants. 4-femoral prosthetic implants were cultivated with a staphylococcus aureus inoculum for 15days. The components were divided into four different groups: A (not treated), B (normal saline 20-minutes), C (bioelectric effect 10-minutes), D (bioelectric effect 20-minutes). The implants were sonicated, and the detached colonies were quantified as the number of colony-forming unit (CFUs). The implants were sterilised and the process was repeated in a standardized manner four more times, to obtain a total of five samples per group. Results: The number of the CFUs after a 10-minute exposure to the bioelectric effect was of 208.2 ± 240.4, compared with 6,041.6 ± 2010.7 CFUs in group A, representing a decrease of 96.5% ± 4.3 (p = 0.004). And a diminution of 91.8% ± 7.9 compared with 2,051.0 ± 1,364.0 CFUs in group B (p = 0.109). The number of bacterial colonies after a 20-minute exposure to the bioelectric effect was 70 ± 126.7 CFUs, representing a decrease of 98.9% ± 1.9 (p = 0.000) compared with group A. And a decrease of 97.8% ± 3.0 (p = 0.019) compared with group B. Conclusions: The bioelectric effect was effective in the elimination of bacterial biofilm from knee arthroplasty implants. This method could be used in the future as part of conventional surgical procedures.

Preliminary investigation of endoscopic surgery for tympanic membrane perforation: Regenerative treatment compared with conventional surgery

PurposeTo compare surgical outcomes of regenerative treatment (RT) including basic fibroblast growth factor (bFGF) (Group-R) with the conventional method (Group-C) for patients with tympanic membrane perforation (TMP), both of whom underwent transcanal endoscopic ear surgery. MethodsThe study population of Group-R included 61 ears of 59 patients treated with RT-TMP in which TMP edges were disrupted mechanically and a gelatin sponge immersed in bFGF was inserted into the TMP. Fibrin glue was then dripped over the sponge. Group-C consisted of 13 patients who underwent conventional surgery before adopting the RT-TMP. Patients' characteristics and outcomes including TMP closure rates, and change in hearing level were evaluated three or more weeks after the surgery. ResultsThe baseline characteristics including size of TMP were not significantly different between the two groups. Although Group-R had significantly shorter operating time than Group-C, the complete TMP closure rates were 69 % (9/13) and 85 % (52/61), respectively. Air-conduction hearing thresholds showed significant improvements, and analysis of variance showed that Group-R achieved significant interactions other than at 8 kHz, implying better improvement in cases with TMP closure. The air-bone gaps also improved at all frequencies in both groups. Specifically, at 4 kHz, there was a trend showing better improvement in Group-R. ConclusionRT-TMP had a high TMP closure rate and good hearing improvement, with no significant differences compared with those of conventional surgery. This new therapy is simple and safe, and requires less operating time, and it could help improve the quality of life of patients with TMP.

Comparison of conventional percutaneous nephrolithotomy versus endoscopic combined intrarenal surgery in complex renal calculus – Our institutional experience

Background: Complex renal calculi, characterized by their size, location, and composition, pose a significant challenge to urologists due to the potential for complications and the difficulty in achieving complete stone clearance. Conventional percutaneous nephrolithotomy (PCNL) and endoscopic combined intrarenal surgery (ECIRS) are two established techniques for managing these complex renal calculi. Aims and Objectives: The aims and objectives are to compare the effectiveness, safety, and outcomes of PCNL versus ECIRS in managing complex renal calculi in a cohort of 60 cases treated at GMKMCH-Salem. Materials and Methods: A retrospective analysis was conducted on 60 patients with complex renal calculi who underwent either conventional PCNL or ECIRS during a specified period at GMKMCH-Salem. Patient demographics, stone characteristics, procedural details, intraoperative and post-operative parameters, and complications were analyzed and compared between the two treatment groups. Results: The study found that both PCNL and ECIRS techniques were effective in treating complex renal calculi. However, significant differences were observed between the two groups in terms of outcomes. The ECIRS technique exhibited superior outcomes with higher stone clearance rates (P&lt;0.001), shorter operative times (P&lt;0.05), and reduced hospital stays (P&lt;0.05) compared to conventional PCNL. Conclusion: This study demonstrates that ECIRS is a promising alternative to conventional PCNL in the management of complex renal calculi. The ECIRS technique yielded higher stone clearance rates, shorter operative times, and reduced hospital stays, potentially improving patient outcomes and reducing health-care costs. Although our findings show favorable results for ECIRS, the decision between conventional PCNL and ECIRS should be based on individual patient characteristics, surgeon expertise, and resource availability.

New surgery technique combining robotics and laparoscopy using the Hugo™ RAS system.

Hybrid total laparoscopic hysterectomy combines conventional laparoscopic surgery and robot-assisted devices: the camera and assistant forceps are operated by a robotic device, whereas the surgeon performs laparoscopic procedures, enabling surgery with a completely fixed field of view and significantly reducing errors in forceps grasping and needle misalignment. Here, we examined whether using two arms of the Hugo™ robot-assisted surgery system, one for the camera and one for the assistant, would improve surgical accuracy compared with conventional total laparoscopic hysterectomy. The surgical system reduced surgeon errors in grasping the forceps during training and stabilized forceps operation. Compared with conventional laparoscopic surgery, the use of the surgical system did not result in different operative durations. The stable surgical procedure was considered a major advantage. This new technique involving new equipment can improve surgeon training and performance. In the future, we will develop new techniques to improve surgical performance.

The effect of narrow band imaging in CO2 laser therapy in early-stage glottic cancer

Objective:To explore efficacy of narrow band imaging（NBI） technique in CO2laser therapy in Early-Stage Glottic cancer. Methods:The clinical data of patients with Early-Stage Glottic cancer who underwent CO2laser vocal cord resection from June 2011 to August 2022 were retrospectively analyzed. Among these, 27 patients who underwent surgery assisted by NBI were assigned to the observation group, while 25 patients who underwent conventional CO2 laser microsurgery with a suspension laryngoscope were assigned to the control group. The differences between the two groups were analyzed in terms of intraoperative frozen pathology results, postoperative recurrence rates, 5-year cumulative disease-free survival rates, complications, and voice recovery. Results:All 52 patients were operated successfully. Temporary tracheostomy and serious complications did not occur during the operation. The postoperative patient's pronunciation was satisfactory. One patient experienced vocal cord adhesion, but there were no severe complications such as breathing difficulties or bleeding, with an overall complication rate of 1.92%. Postoperative follow-up was 1-5 years. The 5 years recurrence free survival in the general group was 77.90％, and the 5 years recurrence free survival in the NBI group was 100％, the difference was statistically significant（P<0.05）. NBI endoscopy is safer and more accurate than the general group in determining the safe margin of tumor mucosal resection（P<0.05）. Among the patients who accepted the voice analysis, the difference was no statistically significant（P>0.05）. Conclusion:Compared with conventional CO2laser surgery under microscope, NBI guided laser resection of Early-Stage Glottic cancer is more accurate. NBI guided laser resection could improve 5 years recurrence free survival rate. In a word, narrow-band imaging endoscopy can has very high value in clinical application.

Modified Ultrafiltration Technique in Valvular Heart Surgery: A Case Series

Abstract Application of cardiopulmonary bypass (CPB) in cardiac surgery may cause systemic inflammatory reactions, possibly causing clinical sequelae and multiple organ failures such as systolic or diastolic dysfunction, regional or global left ventricle or right ventricle low contractility, and the function of vascular tone. The use of drugs (i.e., corticosteroids) and the ultrafiltration method during the CPB application has been known to prevent or minimize the complication of CPB in cardiac surgery. One of the non-pharmacological approaches to minimize those inflammatory responses is the modified ultrafiltration (MUF) technique. Theoretically, this is due to ultrafiltration which may reduce the interstitial fluid and inflammatory mediator. MUF can be used to counteract inflammatory responses in pediatric cardiac surgery. This ultrafiltration method became a recommended procedure in minimally invasive surgery and conventional open-heart surgery. However, studies about effectiveness in adults are limited. In this case series, the MUF technique was used in three patients who underwent valvular heart surgery with a CPB machine. Following the application of the CPB, the MUF technique is performed for 10 min at a speed of no more than 10% full flow. Hemodynamic measurements and interleukin-6 (IL-6) levels were taken during surgery and 24 h post-CPB. At 24 h post-CPB, the vasoactive inotropic score and duration of mechanical support use were less than 20 and 18–24 h, respectively, and the IL-6 level ranged from 7.22 to 14.22 pg/mL. The cardiac index increased, ranging from 2.43 to 3.47 L/min/m2, and pulmonary vascular resistance decreased, ranging from 78 to 146 dyne s/cm5.

Repairing Exposed Tendon Wounds with Absorbable Gelatin Sponges and Autologous Split-Thickness Skin Grafts: A Case Series.

Conventional flap repair surgery has several drawbacks, including operational complexity, donor site damage, and high risk. In this case series, the authors explored an alternative approach for repairing exposed tendon wounds caused by trauma using absorbable gelatin sponges (AGSs) and autologous thigh skin grafts. This report presents two cases of lower-extremity skin necrosis with tendon exposure following wound debridement. The treatment approach involved early debridement, negative-pressure wound therapy, and wound irrigation with 0.9% sodium chloride. Upon achieving controlled wound infection, AGSs were applied to the exposed tendon to prevent degeneration and promote wound healing. Subsequently, areas where granulation tissue failed to cover the tendon were repaired using AGSs and 0.25-mm-thick autologous mesh skin grafts harvested from the thigh. Complete wound healing was achieved in both cases, on the 20th and 12th day after skin grafting, respectively. The proposed method proved successful in repairing exposed tendon wounds, effectively preventing infection and necrosis.