Conventional Surgical Approaches Research Articles

Comparative Evaluation of Laser System to Conventional Surgical Approaches in Periodontal Healing Using Optical Coherence Tomography

Background: Optical coherence tomography (OCT) is an emerging, radiation-free diagnostic tool in dentistry, providing high-resolution, real-time imaging of both hard and soft tissues, including periodontal areas, for more accurate postoperative evaluations. This study aims to investigate the efficacy of OCT on periodontal tissues in animals by comparing the healing effects of laser therapy with those of conventional surgical instruments. Methods: Six rabbits underwent periodontal surgery using a laser, scalpel, and punch to perform an apically positioned flap on the mandibular anterior incisors and to create a tongue ulcer on the dorsal surface of the tongue. Visual and OCT evaluations were conducted on days 1, 2, 3, 7, and 14. Results: In periodontal surgery, the laser exhibited slightly faster healing compared to other methods. In tongue ulcer formation, the scalpel and punch groups demonstrated slightly faster healing than that of the laser. However, both methods ultimately showed similar healing outcomes. Conclusions: In the dental field, OCT is emerging as a valuable tool for assessing healing, including early stages of healing, in periodontal therapy.

Comparison of the Efficacy and Safety of Thoracoscopic Surgery and Conventional Open Surgery for Congenital Diaphragmatic Hernia in Neonates: A Meta-analysis.

Thoracoscopic surgery is an increasingly popular surgical technique for the repair of congenital diaphragmatic hernias. We performed a meta-analysis to compare the efficacy, safety of thoracoscopic surgery and the conventional open surgical approach for congenital diaphragmatic hernia in neonates. A systematic search of electronic databases such as PubMed, Google, and Web of Science was performed to identify studies comparing thoracoscopic surgery and open surgery for congenital diaphragmatic hernia. A total of 6 studies with 3348 patients were found. Parameters such as operation time, hospital stay, recurrence rate, postoperative mortality, and postoperative complications were pooled and compared by meta-analysis. Of the 3348 children with congenital diaphragmatic hernia included in the 6 studies, 615 underwent thoracoscopic surgery and 2733 underwent open surgery. All studies were nonrandomized controlled trials. The operation times were shorter for thoracoscopic surgery than for open surgery in three studies, but there was no significant difference (standard mean difference = 1.25, confidence interval [CI] = [-0.48-2.98], P = 0.16). In the thoracoscopic surgery group, the rate of postoperative deaths was significantly lower (95% CI = 1.24-2.75), but the occurrence of recurrences was more frequent (95% CI = 0.08-0.23). The hospital stay varied significantly across studies. There was a statistically significant difference (standard mean difference = -1.47, CI = [-2.24--0.70], P < 0.001) in the overall effect between the groups. The complication rate was significantly lower with thoracoscopic surgery compared to open surgery (odds ratio = 0.26, CI = [0.10-0.66], P = 0.004) for the overall effect between the groups. The thoracoscopic procedure, however, was planned for milder and stable cases. Thoracoscopic repair of congenital diaphragmatic hernia in neonates is associated with a shorter length of hospital stay, fewer complications, and less postoperative mortality than traditional open repair. However, the rate of recurrence was found to be higher in those who underwent thoracoscopic surgery.

Targeted and Therapeutic Efficacy of 5-Fluorouracil-Loaded Polylactic Acid Nanocomplexes in Gastric Cancer

Gastric cancer (GC), arising from gastric mucosal cells, necessitates innovative treatment strategies beyond conventional surgical approaches. While 5-fluorouracil (5-FU) has demonstrated efficacy in various cancers, its lack of selectivity for cancer cells and limited half-life pose challenges. This study focuses on assessing the therapeutic potential of 5-FU-loaded L-polylactic acid (PLLA) nanofibers (NFs) for targeted GC treatment. The preparation of 5-FU/PLLA NFs involved refining the drug delivery approach to enhance drug impact on GC cell proliferation and apoptosis. Utilizing an organic phase separation methodology, 5-FU was incorporated into PLLA NFs, and the NF morphology was examined using scanning electron microscopy, with optical microscopy used for diameter measurement. Fourier-transform infrared spectroscopy (FTIR) and differential scanning calorimetry (DSC) explored binding state and PLLA crystallinity. Drug loading (DL) capacity and in vitro release characteristics were evaluated by UV-visible spectrophotometry, while NF degradation and stability were assessed. The human gastric adenocarcinoma (AGS) cell line was employed in cell experiments, with three groups: normal culture (Normal group), single drug treatment with 5-FU (5 μmol/L, 5-FU group), and 5-FU-loaded PLLA group (5-FU/PLLA group) containing 5 μmol/L 5-FU. Cell Counting Kit-8 gauged cell proliferation and viability, and Annexin V-FITC/PI assay determined cell apoptosis. Results revealed a (1,230.8±18.9) nm diameter for 5-FU/PLLA NFs with 18.3% crystallinity. FTIR and DSC analyses indicated a simple physical mixture of 5-FU and PLLA in 5-FU/PLLA. DL capacity was (18.1±2.3)%, with a DL efficiency of (92.5±9.4)%. in vitro release performance of 5-FU/PLLA surpassed that of raw 5-FU. The mass loss rate of 5-FU/PLLA was consistent across different pH buffer solutions, with a stable drug release (DR) rate over various storage times. In cell experiments, both 5-FU and 5-FU/PLLA groups exhibited reduced proliferation and viability compared to the Normal group, with higher apoptosis rates (P &lt; 0.05). Furthermore, the 5-FU/PLLA group showed decreased proliferation and viability compared to the 5-FU group, accompanied by higher apoptosis rates (P &lt; 0.05). In conclusion, 5-FU-loaded PLLA NFs, with excellent DR properties, demonstrated significant inhibitory and cytotoxic effects on GC cells.

HYDATID CYST IN CAUDATE LOBE OF LIVER- A THERAPEUTIC CHALLENGE

Background: Treatment of Echinococcal disease depends on the type, size, and location of the cyst, presence of complications, and the experience of the team. Treatment options include percutaneous treatments, surgery, anti-parasitic drugs, and follow-up without intervention. Objectives: To report a case of hydatid cyst located in caudate lobe of liver. Materials and Methods: A 32-year-female, presented with c/o of Pain in abdomen since 1 week localized to right hypochondrium. USG (A+P) was suggestive of hydatid cyst in caudate lobe of liver. MRI was suggestive of hydatid cyst of liver with abutment of left portal vein and IVC. Patient was first started on medical treatment for 6 weeks and then planned for laparoscopic hydatid cyst excision. Cyst was approached laproscopically and fluid aspirated followed by injection of 10% betadine solution (scolicidal) and then reaspirated. Endocyst was removed. The resultant cavity was plugged with omentum. Results: Patient was discharged on POD-3 on T. Albendazole 400 mg BD for 3 months and T. Praziquantal 600 mg once a week for 3 months. After 6 months, patient is symptomatically well and has no complaints or signs of recurrence at present. Conclusion: Minimally invasive laproscopic sugery has more or less replaced the conventional open surgical approach for cystic hydatidosis. Our case is unique due to its location in the caudate lobe of liver alongwith abutment and mild compression of IVC and portal vein which poses a therapeutic challenge to the surgeon. The caudate lobe of the liver is an anatomically complex liver segment. Its unique and intimate location with the hepatic hilum and inferior vena cava (IVC) coupled with its dual supply from both portal pedicles and direct venous drainage into the IVC make vascular control a particular challenge. Technically challenging cyst excision can be performed laparoscopically with its benefits of improved perioperative outcomes.

Efficacy of Ksharasutra Therapy in the Management of Bhagandara (Fistula-in-ano): A Case Study

Bhagandara, or Fistula-in-Ano as it is termed in modern medical parlance, is a persistent and distressing condition that gives rise to an abnormal connection between the anorectal canal and the perianal skin. While conventional surgical approaches to the condition prove adequately effective, they tend to produce high rates of complications and recurrences. Hence, this study. which sets out to explore the effectiveness of Ksharasutra, an Ayurvedic para-surgical intervention, regarding the management and treatment of Bhagandara. Ksharasutra treatment is performed by inserting a medicated thread, prepared specifically for the purpose, along the fistulous tract, where the thread slowly cuts through the tract and healing it over a period. The patient chosen for inclusion in the case study is a 35-year-old male who displayed the classic characteristic signs of suffering from a low trans-sphincteric fistula on initial presentation, i.e. recurring secretion of blood, pus, and other discharge from a swelling in the perianal region as well as severe pain. The treatment was performed over 8 weeks, with regular weekly changes of the thread and visits to the clinic. Significant improvement was observed, including the complete healing of the fistulous tract, with no complications or relapses noted post-treatment. The study concludes the potential of Ksharasutra treatment as a viable alternative to conventional approaches to the treatment of Bhagandara, as it is not only safer a significantly lower rate of complications and recurrence but also promotes quicker healing and a higher quality of life for patients. The study underscores the need to develop the standardized protocol for treatment and test the long-term effects of Ksharasutra therapy for Fistula-in-Ano on broader sample sizes.

Research progress in the anatomy and surgical approach of the parapharyngeal space

The parapharyngeal space, a complex fascial compartment within the head and neck region, encompasses crucial anatomical structures including blood vessels and nerves. Tumors occurring within this space are rare, with the majority being benign in nature. Surgical intervention remains the primary treatment modality; however, managing parapharyngeal space tumors poses significant challenges due to their intricate anatomical configuration. Conventional open surgical approaches have been associated with significant tissue damage and a high prevalence of postoperative complications. Recently, advancements in anatomical studies and surgical techniques have led to significant progress in understanding parapharyngeal space anatomy and improving surgical management. This article aims to provide a comprehensive overview of these developments.

Trends in the Management of Anterior Mitral Leaflet Regurgitation

The overall prevalence of mitral valve replacement (MVR) or MV repair at the time of cardiac surgery in the setting of isolated anterior mitral leaflet degenerative pathologic status in the US population is unknown. To investigate the prevalence of MVR and MV repair using the Society of Thoracic Surgeons' Adult Cardiac Surgery Database. In a cross-sectional study, all patients diagnosed with isolated anterior mitral leaflet degenerative regurgitation who underwent either surgical MVR or MV repair between July 1, 2011, and June 30, 2022, were identified. Linear regression analysis was used to assess trends over time. Assessment of the trends in MV repair and MVR over time. A total of 16 259 patients (9624 [59.2%] men) were identified, and the median age was 68 (IQR, 58-74) years. A total of 7214 patients (44.4%) had MVR, and 9045 (55.6%) had MV repair. There was a declining trend of MV repair from 58.0% in 2011 to 51.6% in 2022 (P = .05). The MVR group was older (median [IQR] age, 70 [62-77] vs 67 [58-74] years; P < .001) and had more comorbidities. A total of 85.1% of all patients underwent concomitant procedures. In 81.7% of MVR cases, no attempt at MV repair was made. The median (IQR) annual hospital volume was lower with MVR vs MV repair (2.50 [1.50-5.00] vs 4.00 [2.00-7.00]; P < .001). Conventional surgical approaches were most common (91.5%) but with a declining trend (P < .001). Minimally invasive approaches were used in 13.1% (robotic, 4.6%), and with an inclining trend from 5.0% in 2011 to 12.0% in 2022 (P < .001). Annuloplasty was performed in 88.8% of MV repair cases. Its use as a sole mean of MV repair decreased from 48.0% in 2011 to 13.9% in 2022 (P < .001). Repair maneuvers in addition to annuloplasty were neochordae (overall 40.1%, increasing from 22.5% in 2011 to 62.3% in 2022; P < .001), leaflet resection (overall 10.2%, decreasing from 13.1% in 2011 to 7.9% in 2022, P = .002), edge-to-edge MV repair (overall 5.3%, decreasing from 6.9% in 2011 to 4.5% in 2022; P = 0.04), and chordal transfer (overall 2.4%, decreasing from 2.7% in 2011 to 0.7% in 2022; P = .004). In this cross-sectional study, MV repair was the preferred option for degenerative mitral valve disease but was only slightly more commonly performed than MVR for isolated anterior leaflet pathologic status. A large proportion of MVR was performed without an MV repair attempt, suggesting reluctance to repair this pathologic condition.

Endoscopic Evacuation of Putaminal Hemorrhage Using the Trans-Middle Temporal Gyrus Approach: Technical Notes and Case Presentations.

The development of minimally invasive endoscopic neurosurgery has enabled widespread application of endoscopic surgery via the ipsilateral transfrontal approach for putaminal hematoma evacuation. However, this approach is unsuitable for putaminal hematomas that extend into the temporal lobe. We adopted the endoscopic trans-middle temporal gyrus approach, instead of the conventional surgical approach, for the management of these complicated cases and determined its safety and feasibility. Twenty patients with putaminal hemorrhage underwent surgical treatment at the Shinshu University Hospital between January 2016 and May 2021. Of these, two patients with left putaminal hemorrhage that extended into the temporal lobe underwent surgical treatment using the endoscopic trans-middle temporal gyrus approach. The procedure entailed the use of a thinner transparent sheath to reduce the technique's invasiveness, a navigation system to determine the location of the middle temporal gyrus and the sheath's trajectory, and an endoscope with a 4K camera for higher image quality and utility. The sylvian fissure was compressed superiorly using our novel "port retraction technique" (i.e., by tilting the transparent sheath superiorly) to avoid damage to the middle cerebral artery and Wernicke's area. The endoscopic trans-middle temporal gyrus approach allowed sufficient hematoma evacuation and hemostasis under endoscopic observation without any surgical complexities or complications. The postoperative course was uneventful in both patients. The endoscopic trans-middle temporal gyrus approach for putaminal hematoma evacuation helps avoid damage to normal brain tissue, which could result from the wide range of motion of the conventional technique, particularly when the hemorrhage extends to the temporal lobe.

Surreptitious Area of Middle Ear - the Sinus Tympani.

Sinus tympani is one of the hidden space in the retrotympanic area of middle ear which is commonly invaded by cholesteatoma and known for recidivism. Conventional surgical approaches sometimes fail to access deep sinuses and eradicate the disease. The aim of our study was to measure endoscopic depth of Sinus tympani in Indian Population. Total of 30 patients underwent mastoid exploration and intraoperatively depth of Sinus Tympani was measured using a 0.5mm calibrated probe with 30 degree rigid Hopkins endoscope. Endoscopic depth in the present study ranges between 2.5 and 5.5mm. It was higher in right ear in case of females however no significant difference were seen in males and females on left side. It is difficult to clear disease from Sinus Tympani because of its inaccessible location. Sinus Tympani can also show variations in terms of its depth further making difficult to clear disease.

Complications in Vascular and Endovascular Surgery: To Defeat Your Enemy, You Must Know Your Enemy

In recent decades, the field of vascular surgery has been revolutionized by the introduction and ever-rising growth of endovascular techniques for almost all arterial and venous diseases, mainly owing to their reduced morbidity and mortality rates as compared with conventional open surgical approaches [...]

Is Robotic Surgery the Future for Resectable Esophageal Cancer?: A Systematic Literature Review of Oncological and Clinical Outcomes

BackgroundRadical esophagectomy for resectable esophageal cancer is a major surgical intervention, associated with considerable postoperative morbidity. The introduction of robotic surgical platforms in esophagectomy may enhance advantages of minimally invasive surgery enabled by laparoscopy and thoracoscopy, including reduced postoperative pain and pulmonary complications. This systematic review aims to assess the clinical and oncological benefits of robot-assisted esophagectomy.MethodsA systematic literature search of the MEDLINE (PubMed), Embase and Cochrane databases was performed for studies published up to 1 August 2023. This review was conducted according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) protocols and was registered in the PROSPERO database (CRD42022370983). Clinical and oncological outcomes data were extracted following full-text review of eligible studies.ResultsA total of 113 studies (n = 14,701 patients, n = 2455 female) were included. The majority of the studies were retrospective in nature (n = 89, 79%), and cohort studies were the most common type of study design (n = 88, 79%). The median number of patients per study was 54. Sixty-three studies reported using a robotic surgical platform for both the abdominal and thoracic phases of the procedure. The weighted mean incidence of postoperative pneumonia was 11%, anastomotic leak 10%, total length of hospitalisation 15.2 days, and a resection margin clear of the tumour was achieved in 95% of cases.ConclusionsThere are numerous reported advantages of robot-assisted surgery for resectable esophageal cancer. A correlation between procedural volume and improvements in outcomes with robotic esophagectomy has also been identified. Multicentre comparative clinical studies are essential to identify the true objective benefit on outcomes compared with conventional surgical approaches before robotic surgery is accepted as standard of practice.

Long-term oncological outcomes for endoscopic endonasal versus open surgical approaches for anatomically matched, locally advanced stage T4 sinonasal malignancies with skull base involvement.

Expanded endoscopic approaches (EEAs) are increasingly used for the definitive management of sinonasal malignancies. EEAs, in appropriately selected cases, provide similar oncological outcomes but are associated with lower complication rates compared with open surgical approaches. Selection bias is a limitation reported in previous studies comparing EEAs and open surgical approaches for the management of sinonasal malignancies. To address this issue, in this study the authors compared the long-term oncological outcomes of an anatomically matched cohort of patients with locally advanced sinonasal malignancies with skull base involvement (T4 stage). The specific objective of this study was to investigate the extent of resection (EOR), overall survival (OS), and disease progression between the EEA and open surgical cohorts. A cohort of 42 patients with locally advanced sinonasal malignancies and skull base involvement (stage T4) and operated on via an EEA was matched anatomically with a cohort of 54 patients who had undergone open surgery. A retrospective chart review was conducted on these 96 patients who were treated between September 1993 and June 2020. All patients in the cohort were eligible for either an EEA or open surgery according to anatomical criteria. Patients of all ages were included, and the minimum follow-up required for eligibility was 4 months. Patients were excluded if surgery was not offered for curative intent and preoperative imaging did not demonstrate that gross-total resection was achievable. There were more complications in the conventional surgery cohort than in the EEA cohort (33.33% vs 14.29%, p = 0.033). There was no significant difference in the EOR between the EEA and conventional surgery cohorts, as demonstrated by comparable rates of positive margins in both groups (5.56% vs 2.38%, respectively). Disease progression (hazard ratio [HR] 0.47, 95% CI 0.17-1.27, p = 0.137) was lower and OS (HR 0.58, 95% CI 0.26-1.29, p = 0.183) was higher in the EEA cohort, but these findings did not reach statistical significance. The EEA was found to be associated with lower risks of complications than conventional craniofacial surgical approaches. There were no significant differences in OS and progression-free survival between the EEA and conventional surgical cohorts when comparing anatomically matched cohorts of patients with stage T4 sinonasal malignancies and skull base involvement.

Robotic-Assisted DIEP Flap Harvest for Autologous Breast Reconstruction: Case Report, Technical Aspects and Identification of Suitable Patients

Robotic-assisted harvest of the deep inferior epigastric perforator (DIEP) flap is an innovative modification of the traditional open preparation for autologous breast reconstruction. It is assumed that donor-site morbidity (herniae, bulging) is reduced by minimising the fascial incision length in robotic-assisted DIEP flap harvest. This is the first report of a robotic-assisted DIEP harvest in Germany, which was performed in April 2023 at the University Hospital of Freiburg in an interdisciplinary approach of the Departments of Plastic Surgery, Urology and Gynaecology. To determine the value of this novel technique, we assessed the demand by retrospectively performing an analysis of potential patients and conducted a cost analysis based on the breast reconstructions with DIEP flap harvest performed between April 2021 and May 2023 at the Department of Plastic Surgery at Freiburg University Hospital. To this end, we carried out a retrospective analysis of preoperative CT angiographies to determine the proportion of patients suitable for a robotic-assisted procedure in a post-hoc analysis. Furthermore, we describe the basic robotic-assisted techniques and discuss the TEP and TAPP laparoscopic approaches. In line with the previously published literature, a short intramuscular course (≤25 mm) and a perforator diameter of≥1.5 mm and≥2.7 mm (subgroup) were defined as a crucial condition for the robotic-assisted procedure. We analysed 65 DIEP flaps harvested in 51 patients, of which 26 DIEP flaps in 22 patients met both criteria, i. e.≤25 mm intramuscular course and≥1.5 mm diameter of the perforator, while 10 DIEP flaps in 10 patients additionally met the criteria of the subgroup (≥2.7 mm diameter). Based on the intramuscular course of the perforators in the CT angiographies of those 26 DIEP flaps, a potential reduction of the fascial incision of 96.8±25.21 mm (mean±standard deviation) compared with the conventional surgical approach was calculated. The additional material costs in our case were EUR 986.01. However, ischaemia time was 33,5 minutes longer than the median of the comparative cohort. The robotic-assisted procedure has already proven to be a feasible alternative in a suitable patient population. However, further studies are needed to confirm that robotic-assisted DIEP flap harvest actually reduces harvest site morbidity and thereby justifies the additional costs and complexity.

Comparison Between Conventional and Patch Carotid Endarterectomy: A Single-Center Retrospective Study

BackgroundCarotid endarterectomy (CEA) is most commonly performed via conventional (cCEA)or patch (pCEA) surgical approaches. Current guidelines recommend prioritizing pCEA, however, these recommendations are based on clinical practice of over a decade ago. Under current medical conditions, controversy remains on optimal choice for surgical techniques. ObjectiveTo compare perioperative and long-term safety and effectiveness between cCEA and pCEA. MethodsData on baseline characteristics as well as perioperative and long-term postoperative complications from patients who underwent cCEA or pCEA at the Department of Vascular Surgery, Xuanwu Hospital of Capital Medical University, from 2013 to 2022, were retrospectively collected and analyzed. ResultsA total of 248 CEA patients included in our study. The majority of patients (87.3%) were male, and mean age was 63.6±7.6 (range, 40-81) years; 104 patients (41.9%) underwent cCEA, while 144 (58.1%) underwent pCEA. Between the cCEA and pCEA groups, there were no significant differences in clinical baseline characteristics, occurrence of perioperative or long-term (median, 42.5 [range, 7 to 120] months) complications, and survival whether restenosis-free, asymptomatic or overall. ConclusionIn a single-center experience, conventional and patch CEA approaches appear similarly safe and effective.

The influence of laparoscopic and conventional surgical approaches on the development of surgical site infections in colon cancer

The influence of laparoscopic and conventional surgical approaches on the development of surgical site infections in colon cancer

The potential of cardiac xenotransplantation for management of infants with complex congenital heart disease.

Gene editing of the porcine genome has enabled the production of pigs that do not express the three known carbohydrate antigens that are associated with hyperacute rejection of a pig organ xenotransplant. In addition, it is now possible to insert a variety of human transgenes to protect against the human immune response, e.g., to protect from complement and coagulation activation. As a result, cardiac xenotransplantation of the gene-edited porcine heart is progressing towards clinical application. Many hope that it will definitively address the disparity between organ supply and demand. The role of cardiac xenotransplantation in pediatric care remains controversial but we believe there is an infant patient population with complex congenital heart disease (CHD) (not optimally managed by conventional surgical approaches) that is ideally suited to initial clinical application of this new technology. The most efficacious start would be to initiate clinical use as a short-term bridge to allotransplantation, particularly in infants with single ventricle pathology and significant risk factors for first stage Norwood palliation. Infants with end-stage heart failure after first stage palliation would represent a second target population. Infants experience unacceptably high mortality and morbidity when placed on mechanical circulatory support as a bridge to allotransplant. Effectively bridging these vulnerable populations could promote acceptance of cardiac xenotransplantation, allowing indications and use to expand, e.g., by (I) bridging patients with failed second and third stage single ventricle disease, or (II) with complex biventricular CHD, or (III) those with a restrictive or dilated cardiomyopathy. Finally, there is a reasonable expectation that the immunologic privilege of infants will allow porcine heart xenotransplantation to be destination therapy for some patients. In summary, heart allotransplantation in infants offers superior outcomes when compared to three-stage single ventricle palliation, but there is a continual shortage of deceased human donor organs. We should pursue research towards the application of xenotransplantation in patients with single ventricle pathology, in whom the results of staged palliation are likely to be suboptimal. There are many remaining issues to be resolved before cardiac xenotransplantation enters regular pediatric clinical use, but experience in this field is progressing rapidly.

Clinical study of modified INFIX combined with sacroiliac joint screws for pelvic instable injuries

ObjectiveThe INFIX technique is becoming one of the most commonly performed surgical procedures for anterior pelvic ring instability injuries. The purpose of this article is to compare the clinical outcomes of modified anterior subcutaneous internal fixation (M-INFIX) with conventional anterior subcutaneous internal fixation (C-INFIX) for anterior pelvic ring instability injuries.Patients and methodsA retrospective analysis of 36 cases of unstable pelvic injuries treated operatively at our institution, 20 of which were treated with C-INFIX and 16 with M-INFIX. Data collected included age, gender, ISS score, fracture typing, operative time, operative bleeding, postoperative complications, fracture healing time, Matta score, Majeed score, and follow-up time. Statistical sub-folding of each variable between the two groups was performed.ResultsThere was no statistical difference between the C-INFIX and M-INFIX groups in terms of age, gender, ISS (Injury Severity Score), follow-up time, fracture typing, fracture healing time, and Majeed score (P > 0.05). the M-INFIX had a significantly lower incidence of postoperative complications than the C-INFIX group, especially in the incidence of Lateral femoral cutaneous nerve (LFCN) injury (P < 0.05). In contrast, the M-INFIX group had statistically higher operative time, intraoperative bleeding, and Matta score than the C-INFIX group (P < 0.05).ConclusionThis study was based on a modified application of the surgical experience with C-INFIX and showed better clinical outcomes in terms of complication rates and quality of repositioning than the conventional surgical approach. These findings indicate that further analytical studies of this study would be valuable.

Effects of drug-induced sleep endoscopy in children with conventional obstructive sleep apnea–hypopnea syndrome: a systematic review and meta-analysis

PurposeThis study aimed to conduct a meta-analysis and systematic review of drug-induced sleep endoscopy (DISE) in pediatric conventional obstructive sleep apnea–hypopnea syndrome (OSAHS) without previous upper airway surgery, or comorbidity, to evaluate the change in treatment strategies and to identify obstructive sites observed during DISE. This study aimed to explore the role of DISE in the management of pediatric conventional OSAHS.MethodsA comprehensive search was conducted using both computerized and manual methods to retrieve relevant case studies on DISE-guided treatment of pediatric conventional OSAHS from databases including PubMed, EMBASE, Cochrane Library, Web of Science, CNKI, WF, and VIP database. The search period extended from database inception to January 2023. Strict inclusion and exclusion criteria were applied to select relevant literature, and data extraction was performed accordingly. Meta-analysis was conducted using the Stata 16.0 software.ResultsA total of 761 patients from four studies were included in the meta-analysis. All pediatric patients had no history of upper airway surgery, craniofacial abnormalities, or syndromes other than OSAHS. The quality assessment revealed that the included studies were of low methodological quality and consisted of non-randomized case studies. Meta-analysis results indicated that in pediatric patients with OSAHS, the obstruction rates observed during DISE were as follows: nasopharyngeal (adenoid) obstruction 93%, soft palate obstruction 35%, oropharyngeal (tonsil) obstruction 76%, tongue base obstruction 32%, supraglottic obstruction 31%, and multi-level obstruction 60%. DISE led to a change in the conventional surgical approach in 45% (95% CI: 29–60%) of patients with OSAHS, providing individualized treatment plans. Postoperative symptoms and sleep-related parameters improved significantly compared to preoperative values, with DISE findings possibly enhancing surgical success rates and potentially avoiding unnecessary procedures.ConclusionIn some cases, DISE may potentially lead to alterations in conventional surgical approaches for children with OSAHS who had no history of upper airway surgery, craniofacial abnormalities, or other syndromes.. The results of our meta-analysis were in favor of DISE-directed approach for pediatric conventional OSAHS. However, further high-quality randomized controlled trials (RCTs) are warranted in future research to investigate the role of DISE in the management of pediatric OSAHS.

Performance of a multidisciplinary robotic surgery program at a university hospital (2012-2022).

Robotic-assisted surgery has become widely adopted for its ability to expand the indications for minimally invasive procedures. This technology aims to improve precision, accuracy, and outcomes while reducing complications, blood loss, and recovery time. Successful implementation of a robotic surgery program requires careful initial design and a focus on maintenance and expansion to maximize its benefits. This article presents a comprehensive study conducted at a University Hospital on the robotic surgery program from December 2012 to December 2022. Data from hospital databases, including patient demographics, surgical department, surgical time, operating room occupancy, and primary diagnosis, were analyzed. The analysis covered various time periods (surgical sessions, weeks, months, and years) to assess the program's evolution over time. Over the 10-year period, a total of 1847 robotic-assisted interventions were performed across five surgical services. Urology accounted for 57% of the cases, general surgery 17%, gynecology 16%, otorhinolaryngology 6%, and thoracic surgery 4%. The most frequently performed procedures included robotic prostatectomies (643 cases), hysterectomies (261 cases), and colposacropexies (210 cases). The weekly volume of interventions showed a notable increase, rising from 2 cases per week in 2013-2014 cases in 2022. Moreover, the average surgical duration per intervention exhibited a progressive decrease from 275min in 2013 to 184min in 2022. This study highlights the potential of a well-managed robotic surgery program as a viable alternative to conventional surgical approaches. Effective coordination and resource utilization contribute to the program's efficiency. The findings underscore the successful integration of robotic-assisted surgery in diverse surgical specialties.

Transglabellar resection of frontal sinus cholesterol granuloma extending cranially through cecum foramina: Technical note.

Cholesterol granuloma (CG) commonly occurs in the petrous apex; their occurrence in the anterior cranial fossa CGs is rare. Subfrontal approaches are the conventional surgical approaches for the resection of midline lesions of the anterior cranial fossa and frontal sinuses. In this article, we describe a successful minimally invasive approach for resection of a small midline anterior cranial fossa CG. We report a rare case of frontal air sinus CG extending intradurally through the foramen caecum. The surgical management of this patient involved the use of a minimally invasive transglabellar approach and a butterfly incision and the patient outcomes at 1 year after the surgery. The lesion was totally resected with no complications and the patient was discharged on the 3rd postoperative day. A 1-year follow-up scan showed neither residual nor recurrence of the lesion. The transglabellar approach through a butterfly incision offers a safe approach for the resection of a lesion extending from the frontal air sinuses to the anterior cranial fossa with no complications, shorter hospital stay, and good cosmetic results.