Conventional Surgery Research Articles

Pediatric endoscopic pilonidal sinus treatment: lessons learned after 100 consecutive cases.

Pediatric endoscopic pilonidal sinus treatment (PEPSiT) has favorable short-term-outcomes, but there is a lack of reliable data on medium and long-term follow-up. The objective of our study was to evaluate the effectiveness and advantages of PEPSiT versus conventional surgery of pilonidal sinus in the pediatric population. A quasi-experimental study was carried out in pediatric patients undergoing pilonidal sinus surgery at a single institution from 2019 to 2022. Excision and healing by secondary intention (EHSI), excision and primary closure (EPC), and PEPSiT were compared. The surgical technique chosen was surgeon-dependent. In total, 149 patients were studied-100 undergoing PEPSiT, 28 undergoing EHSI, and 21 undergoing EPC. Median full healing process was 4weeks [interquartile range (IQR): 3-8] in PEPSiT, 16weeks in EHSI (IQR: 12-26.5), and 7weeks (IQR: 4-10) in ECP (p < 0.01). Pain on the visual analogue scale (VAS) and need for analgesics were lower in the PEPSiT group (p < 0.01). Mean time to return to normal life was shorter with PEPSiT-177days earlier than EHSI (95% CI 124.7-230.2; p < 0,01) and 7.2days earlier tan EPC (95% CI 20.2-138.6; p < 0,009). Complications with PEPSiT were 9.3 times lower tan EHSI [odds ratio (OR) 9.3; 95% confidence interval (CI) 3.5-24.7] and 8.5 times lower than ECP (OR = 8.5; 95% CI 2.9-24.4). EHSI had 5.3 times more probability of recurrence than PEPSiT (OR = 5.3; 95% CI 1.3-22.7), and ECP 15.2 times more (OR = 15.2; 95% CI 3.2-71.7). Endoscopic pilonidal sinus treatment is effective in medium-term follow-up, with fewer complications than classic techniques. It allows for an early return to normal life without restrictions.

Minimally invasive glaucoma surgery: A comprehensive review

Minimally Invasive Glaucoma Surgery (MIGS) has emerged as a major advancement in the management of glaucoma, providing a less invasive and safer alternative to traditional surgeries. Conventional glaucoma surgeries are typically reserved for patients with advanced glaucoma who are on “maximally tolerated medical therapy” or those with advanced disease. However, there is often a tendency to delay surgery because of the risk of potential complications of these invasive surgeries. MIGS is characterized by a high safety profile, with a lower risk of severe complications compared to traditional glaucoma surgeries. It is particularly suitable for patients with mild-to-moderate open-angle glaucoma. MIGS tends to bridge the therapeutic gap between medical management and traditional invasive surgeries. MIGS encompasses a variety of techniques and devices, such as Trabectome, iStent, Kahook Dual Blade, Gonioscopy-Assisted Transluminal Trabeculotomy (GATT), Hydrus, and minimally invasive bleb surgeries like PreserFlo Microshunt and Xen Implant. Post-operative recovery is generally quicker, with many patients experiencing improvements in their quality of life due to reduced medication dependence and faster healing.However, like all other interventions, MIGS is not without potential complications. Transient hyphema, IOP spikes, and device-related issues can occur. This review classifies MIGS procedures based on their anatomical targets, which include trabecular meshwork bypass, suprachoroidal space, and subconjunctival filtration.It explores the mechanisms, approaches, and clinical outcomes associated with different types of MIGS. A comprehensive literature search using PubMed was conducted, studies published between January 2000 and March 2023 were thoroughly read to gather insights into the evolving terminology, indications, contraindications, and classification of MIGS procedures. In conclusion, MIGS offers a promising alternative for glaucoma management, especially for patients with mild-to-moderate disease. Its safety, rapid recovery, and ability to reduce medication burdens make it a valuable addition to glaucoma armamentarium. However, further research and long-term studies are needed to fully establish the efficacy and safety of these innovative techniques.

Optimizing Osteotomy Techniques: Comparison of Conventional Rotary Instruments Versus Other Bone Cutting Devices.

Osteotomy procedures can be performed using conventional rotary instruments or piezoelectric surgery. Each technique has distinct advantages and disadvantages regarding surgical precision, patient outcomes, and recovery. To systematically review the literature comparing conventional rotary instruments and piezoelectric surgery in osteotomy procedures. PubMed, Cochrane Library, and Embase were systematically searched. Studies were included if they compared outcomes of conventional rotary instruments and piezoelectric surgery in osteotomy. Data on postoperative pain, swelling, surgical time, and other relevant outcomes were extracted. Thirteen studies met the inclusion criteria. Findings indicated no significant difference in postoperative swelling between the 2 techniques, whereas piezoelectric surgery was associated with reduced postoperative pain and improved tissue integration but required longer surgical times. Piezoelectric surgery shows potential benefits over conventional rotary instruments in specific contexts but requires longer operative times.

A randomized phase 3 trial of total neoadjuvant therapy (induction chemotherapy, neoadjuvant chemoradiation, neoadjuvant chemotherapy, and surgery) vs. standard long-term chemoradiation therapy (neoadjuvant chemoradiation, surgery, and adjuvant chemotherapy) in locally advanced rectal cancer

PurposeThe management of rectal adenocarcinoma has evolved during the last decade, shifting from a conventional neoadjuvant chemoradiotherapy, surgery, and adjuvant chemotherapy in all cases to a total neoadjuvant approach, especially in locally advanced tumors when a sphincter-sparing surgery has been planned. However, the exact indications and the neoadjuvant regimen with the highest response remain unresolved. We aimed to assess whether administering neoadjuvant chemotherapy before and after preoperative chemoradiotherapy could increase the pathological complete response (pCR) rates.MethodsWe conducted a phase 3, multicenter, randomized trial at four hospitals in Iran. Adult patients with a newly diagnosed, biopsy-proven, locally advanced non-metastatic rectal adenocarcinoma with an ECOG performance status of 0–2 were randomly assigned (2:2) to either the total neoadjuvant treatment (TNT) or the standard-of-care groups using a block randomized design. Investigators and participants were not masked to treatment allocation and groups. The TNT group received neoadjuvant chemotherapy with FOLFOX6 (intravenous 85 mg/m2 oxaliplatin and 400 mg/m2 leucovorin, followed by intravenous 400 mg/m2 fluorouracil bolus and then continuous infusion at a dose of 2,400 mg/m2 over 46 h every 14 days for four cycles before and four cycles after chemoradiotherapy), chemoradiotherapy (50.4 Gy during 28 fractions and 800 mg/m2 concurrent oral capecitabine twice daily 5 days per week), and total mesorectal excision. The standard-of-care group received neoadjuvant chemoradiotherapy, total mesorectal excision, and adjuvant chemotherapy (eight cycles). The primary endpoint was the pathological complete response. Safety analyses were conducted on treated patients.ResultsOverall, 25 and 27 patients were enrolled in the TNT and standard-of-care groups, respectively. Both groups were similar in terms of gender, age, and tumor differentiation. The tumors in the standard-of-care group were significantly located closer to the anal verge compared with those in the TNT group (9.4 ± 3.7 cm in TNT vs. 6.8 ± 4 cm in standard, p = 0.02). A pCR was reached in 48% (12/25) and 25.9% (7/27) of patients in the TNT and standard-of-care groups, respectively (p = 0.4). The R0 resection rates were identical between the two groups (92% vs. 88.9%, p = 0.3). Moreover, the toxicity rates were similar between the two groups.ConclusionOur results showed that TNT is a safe and feasible treatment approach in patients with rectal cancer and may improve the overall pCR rate compared with standard treatment.Clinical trial registrationhttps://irct.behdasht.gov.ir/trial/65666, identifier IRCT20220723055527N1.

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

Bladder 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. Researchers 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. A 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. The 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.

Efficacy and safety of intraoperative MRI in glioma surgery: a systematic review and meta-analysis of prospective randomized controlled trials.

Maximum extent of resection in glioma yields enhanced survival outcomes. The contemporary literature presents contradictory results regarding the benefit of intraoperative MRI (iMRI). This meta-analysis aimed to investigate the efficacy and safety of iMRI-guided surgery. The authors searched the PubMed, Embase, and Cochrane Reviews databases for eligible prospective randomized controlled trials through the end of February 2024. Endpoints were extent of resection, progression-free survival (PFS), overall survival, neurological functioning, and surgical complications. Individual patient data regarding PFS were reconstructed using the R package IPDfromKM. From 1923 identified results, 3 randomized controlled trials with 384 patients met the inclusion criteria. Extended resections after iMRI were performed in 29.2% of the iMRI cases. Intraoperative MRI-guided glioma surgery (OR 5.40, 95% CI 3.25-8.98; p < 0.00001) outperformed conventional navigation-guided surgery in attaining gross-total resection (GTR). In patients in whom a GTR was achieved, the median time to progression was 16.0 months (95% CI 12.3-19.7 months), while the median PFS in patients with a subtotal resection was 9.7 months (95% CI 6.9-12.5 months) (p < 0.001). Despite increased GTR rates, postoperative neurological deterioration was equal among the iMRI and control groups (OR 1.0, 95% CI 0.6-1.7; p = 0.91, I2 = 0%). Intraoperative MRI use prolongs surgery by 42 minutes on average (95% CI 3.3-80.7 minutes; p = 0.03, I2 = 56%). The risk of postoperative intracranial hemorrhage (OR 1.9, 95% CI 0.2-16.9; p = 0.55, I2 = 0%) was not increased, while in one study significantly increased infections were observed in the iMRI arm. Intraoperative MRI outperforms conventional surgery in achieving complete glioma resections of all contrast-enhancing tumor portions, enhancing PFS without added risk. Intraoperative MRI is a tool that facilitates these aims without reducing safety in terms of neurological deficits and surgical complications.

Generation of Shape Models of Calcified TAVR populations for Solid Mechanics Simulations by means of Deep Learning

Abstract Minimally invasive transcatheter aortic valve replacement (TAVR) procedure has become the preferred procedure for patients with aortic valve stenosis or insufficiency with high risk for conventional open surgery. The favorable clinical outcomes of high-risk patients led to an expansion of the cohort including intermediate and low-risk patients. A critical aspect of advancing TAVR procedures lies in preoperative planning, integrating patient-specific in-silico deployment simulation and post-deployment fluid mechanics assessments. This study introduces a novel approach to calcified TAVR patient shape modeling, addressing this problems. The model integrates an extended mesh generated by DeepCarve, encompassing the aortic arch, and a novel deep learning-based volumetric shape model of calcifications. The key innovation lies in the utilization of a conditional Convolutional Variational Autoencoder (cCVAE) to generate realistic calcification patterns, demonstrating promising preliminary results in matching actual cohort data. Future investigations should focus on data collection from diverse medical centers to validate and refine the proposed methodology. This study showcases significant progress in generating synthetic TAVR patient geometries, incorporating detailed anatomical structures such as the aortic root, valve, and arch, along with volumetric calcification patterns. These findings represent a crucial step towards enabling real-time preoperative TAVR planning, inclusive of patient- specific in-silico deployment simulation and comprehensive fluid mechanics assessments.

Embolization of persistent type 2 endoleaks after endovascular treatment of abdominal aortic aneurysms: a study of long-term success

Endovascular treatment of abdominal aortic aneurysms (EVAR) has been shown to be effective, with lower perioperative mortality and morbidity than open surgical treatment in patients with compatible anatomy. This benefit is lost after three years of follow-up. This could be explained by the higher rate of reintervention in EVAR patients due to endoleaks. Around half of patients with a persistent type 2 endoleak have an increase in aneurysm size. Either endovascular or by conventional surgery techniques have been described to treat this type of endoleak. The aim of this study was to measure the long-term success rate of embolization of type 2 endoleaks (T2EL) in a pragmatic retrospective series.A total of 592 patients underwent stent-graft surgery at CHU Amiens Picardie during the study period. During follow-up, endoleaks were observed in 140 patients (25 type 1, 122 T2EL, 8 type 3, 1 type 4 and 4 type 5 endoleaks). Concerning T2EL type, 53 were not persistent. Treatment decision was ordered for 30 patients. Among them, 22 patients underwent primary embolization (73%), 7 patients underwent primary surgical treatment (23%) and 1 patient underwent emergency endovascular extension for aortic rupture. The technical success were achieved in all procedures (n=22) , after embolization, the median follow up was 51 months [29.25 – 59.75]. At the end oft he study 8 patients (36%) were considered in „clinical success“ with no difference among embolization procedure, embolization agent used or initial clinical characteristics.We report that embolization procedures have a low clinical sucess rate durign follow-up. Further studies should investigate the etiologies of sac enlargement after embolization, that could be related with of a wrong categorization of initial endoleak.

Clinical Application of 3D-Assisted Surgery Techniques in Treatment of Intra-Articular Distal Radius Fractures: A Systematic Review in 718 Patients.

Objectives: Three-dimensional (3D) technology is increasingly applied in the surgical treatment of distal radial fractures and may optimize surgical planning, improve fracture reduction, facilitate implant and screw positioning, and thus prevent surgical complications. The main research questions of this review were as follows: (1) "How do 3D-assisted versus 2D-assisted distal radius fracture surgery compare in terms of intraoperative metrics (i.e., operation time and fluoroscopy frequency)?", and (2) "What are the effects of 3D-assisted versus 2D-assisted surgery on postoperative outcomes (patient-reported outcome measures (PROMs), range of motion (ROM), fracture reduction, complication rate, and screw placement accuracy)?" Methods: This review was performed according to the Preferred Reporting Items for Systematic Reviews (PRISMA) guidelines. In total, 873 articles were found between 1 January 2010 and 1 April 2024, of which 12 (718 patients) were suitable for inclusion. The quality of the studies, assessed using the McMaster quality assessment, ranged from moderate to excellent, although the surgical techniques and outcome measures varied widely. Articles comparing a 3D group to a 2D group (conventional imaging) and reporting on primary or secondary outcomes were included in the analysis, for which weighted means and ranges were calculated. Results: Three different concepts of 3D-assisted surgery techniques were identified: (1) 3D virtual surgical planning (VSP), (2) 3D-printed handheld models, and (3) 3D intraoperative guides. Differences between 3D-assisted and conventional 2D-assisted surgery were evaluated. Regarding intraoperative metrics, 3D-assisted surgery significantly reduced operation time by 6 min (weighted mean 66.9 versus 73.2 min) and reduced the fluoroscopy frequency by 1.1 images (5.8 versus 4.7 times). Regarding postoperative outcomes, the weighted mean of the DASH score differed between the 3D- and 2D-assisted groups (17.8 versus 23.9 points), and no differences in PRWE or VAS score were found. Furthermore, our results showed no significant differences in the ROM and fracture reduction parameters. In terms of complications, the application of 3D-assisted surgery decreased the complication rate from 10.7% to 3.6%, and the use of screws with appropriate lengths improved from 75% to 86%. Conclusions: Applications of 3D-assisted surgery in distal radial fracture surgery can slightly reduce the operation time and fluoroscopy frequency. Evidence for the improvement of fracture reduction and functional outcomes is still lacking, although it likely reduces the complication rate and improves the use of appropriate screw lengths.

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.

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.