Essential Surgical Techniques Research Articles

Sensorless Based Haptic Feedback Integration In Robot-assisted Pedicle Screw Insertion For Lumbar Spine Surgery: A preliminary cadaveric study

Pedicle screw fixation is an essential surgical technique for addressing various spinal pathologies, including degenerative diseases, trauma, tumors, neoplasms, and infections. Despite its efficacy, the procedure poses significant challenges, notably the limited visibility of spinal anatomical landmarks and the consequent reliance on surgeon's hand-eye coordination. These challenges often result in inaccuracies and high radiation exposure due to the frequent use of fluoroscopy X-ray guidance. Addressing these concerns, this study introduces a novel approach to pedicle screw insertion by utilizing a robot-assisted system that incorporates sensorless based haptics incorporated 5-DOF surgical manipulation. This innovative system aims to minimize radiation exposure and reduce operating time while improving the surgeon's hand posture capabilities. The developed prototype, expected to be implemented using bilateral control, was tested through preliminary cadaveric experiments focused on the insertion of both percutaneous and open pedicle screws at the L4-L5 level of the lumbar spine. Validation of the Sensorless Haptic Feedback feature was an integral part of this study, aiming to enhance precision and safety. The results, confirmed by fluoroscopic x-ray images, demonstrated the successful placement of two percutaneous and two open pedicle screws, with average position and torque errors of 0.011 radians and 0.054 Nm for percutaneous screws, and 0.0116 radians and 0.0057 Nm for open screws, respectively. These findings underscore the potential of the sensorless haptic feedback in a robot-assisted pedicle screw insertion system to significantly reduce radiation exposure and improve surgical outcomes, marking a significant advancement in spinal surgery technology.

Hybrid Bioactive Hydrogel Promotes Liver Regeneration through the Activation of Kupffer Cells and ECM Remodeling After Partial Hepatectomy.

Partial hepatectomy is an essential surgical technique used to treat advanced liver diseases such as liver tumors, as well as for performing liver transplants from living donors. However, postoperative complications such as bleeding, abdominal adhesions, wound infections, and inadequate liver regeneration pose significant challenges and increase morbidity and mortality rates. A self-repairing mixed hydrogel (O5H2/Cu2+/SCCK), containing stem cell derived cytokine (SCCK) derived from human umbilical cord mesenchymal stem cells (HUMSCs) treated with the traditional Chinese remedy Tanshinone IIA (TSA), is developed. This SCCK, in conjunction with O5H2, demonstrates remarkable effects on Kupffer cell activation and extracellular matrix (ECM) remodeling. This leads to the secretion of critical growth factors promoting enhanced proliferation of hepatocytes and endothelial cells, thereby facilitating liver regeneration and repair after partial hepatectomy. Furthermore, the hydrogel, featuring macrophage-regulating properties, effectively mitigates inflammation and oxidative stress damage in the incision area, creating an optimal environment for postoperative liver regeneration. The injectability and strong adhesion of the hydrogel enables rapid hemostasis at the incision site, while its physical barrier function prevents postoperative abdominal adhesions. Furthermore, the hydrogel's incorporation of Cu2+ provides comprehensive antibacterial effects, protecting against a wide range of bacteria types and reducing the chances of infections after surgery.

In-vitro external fixation pin-site model proof of concept: A novel approach to studying wound healing in transcutaneous implants.

External fixation is an essential surgical technique for treating trauma, limb lengthening and deformity correction, however infection is common, with infection rates ranging from 4.5 to 100% of cases. Throughout the literature researchers and clinicians have highlighted a relationship between excessive movement of the pin and skin and an increase in the patient's risk of infection, however, currently no studies have addressed this role of pin-movement on pin-site wounds. This preliminary study describes a novel in vitro pin-site model, developed using a full-thickness human skin equivalent (HSE) model in conjunction with a bespoke mechanical system which simulates pin-movement. The effect of pin-movement on the wound healing response of the skin equivalents was assessed by measuring the expression of pro-inflammatory cytokines. Six human skin equivalent models were divided into three test groups: no pin as the control, static pin-site wound and dynamic pin-site wound (n = 3). On day 3 concentrations of IL-1α and IL-8 showed a significant increase compared to the control when a static fixation pin was implanted into the skin equivalent (p < 0.05) and (p < 0.005) respectively. Levels of IL-1α and IL-8 increased further in the dynamic sample compared to the static sample (p < 0.05) and (p < 0.0005). This study demonstrates for the first time the application of HSE model to study external-fixation pin-movement in vitro. The results of this study demonstrated pin-movement has a negative effect on soft-tissue wound-healing, supporting the anecdotal evidence reported in the literature, however further analysis of wound heading would be required to verify this hypothesis.

Essential Surgical Techniques During Fully Endoscopic Spine Surgery: A Historical Review and Future Perspectives

Full-endoscopic spine surgery (FESS) offers minimally invasive techniques for treating spinal lesions with smaller incisions, leading to reduced tissue damage and consequently more rapid patient recovery. The essential techniques in FESS —namely, the transforaminal and interlaminar approaches—have evolved with technological advances in endoscopic systems and surgeon expertise. The transforaminal approach consists of “inside-out” and “outside-in” techniques that have distinct applications depending on the patient’s condition. The interlaminar approach, similar to traditional spinal surgery techniques, is gaining wider acceptance due to its efficacy in addressing unique anatomical challenges. Advanced procedures, such as endoscopic laminectomy and interbody fusion surgery, coupled with navigation systems, have broadened the scope of endoscopic spine surgery, making it an increasingly vital tool in modern spinal surgery.

Technique Articles Are More Effective at Increasing Social Media Attention in Comparison With Original Research Articles: An Altmetrics-Based Analysis

PurposeTo compare social media attention and citation rates between technique articles and matched original research articles (ORAs) regarding surgical procedures.MethodsAll technique articles published from August 2019 through July 2020 in the free, electronic versions of Arthroscopy Techniques and JBJS Essential Surgical Techniques were matched by topic to articles in the “Original Research” sections of Arthroscopy, Sports Medicine, and Rehabilitation and JBJS Open Access in a 4:1 ratio within this time frame. The primary outcome was the Altmetric Attention Score (AAS). Secondary outcomes included citations, bibliometrics, and social media metrics. Independent t tests were used to compare primary and secondary outcomes between technique articles and ORAs. A multivariate linear regression analysis was performed to determine the association between article type and social media attention while controlling for confounding bibliometric characteristics.ResultsA total of 285 matched research articles (n = 57, 20.0%) and technique articles (n = 228, 80.0%) were included. The mean AAS among all technique articles was 3.63 ± 10.08 (range, 0-96) whereas the mean AAS among all ORAs was 1.30 ± 3.98 (range, 0-25), representing a statistically significant difference (P = .016). The mean citation rate among all technique articles was not significantly different from that among ORAs (P = .73). Multivariate linear regression analysis showed a statistically significant positive association between AAS and article type, with an additional mean increase in the AAS of 2.91 (95% confidence interval, 0.04-5.77; P = .047) for every technique article compared with an ORA. Furthermore, a significant positive relation was noted between the article origin and the AAS, with an increase in the AAS of 3.00 (95% confidence interval, 0.82-5.17; P = .007) for every article published in North America compared with an article originating from another continent.ConclusionsTechnique articles resulted in significantly greater AASs and social media attention in comparison with open-access ORAs on similar topics. Publications that described technical procedures in a technique journal and studies from North America were positively associated with greater AASs and greater numbers of citations received by articles.Clinical RelevanceAn improved understanding of how much attention is given to technique articles versus matched ORAs by social media may influence the methods authors and journals use for distributing content. The present study suggests that one option to increase the amount of social media attention received for a particular study may be to utilize an accompanying surgical technique video or illustrations as these are easily shareable on social media and offer rapid dissemination of knowledge, similar to that of an infographic. However, physicians who view multimedia within technique articles should be encouraged to review the accompanying articles and the supporting original research as a primary source before making changes in their clinical practice.

Beyond the Supracondylar Humeral Fracture

Pediatric fractures are quite common and are a substantial part of subspecialist and general orthopaedic trauma practices. The differences in bone biomechanics, capacity to remodel, and strength and regenerative capacity of the periosteum require considerably different theory and approaches to fracture management compared with adults. Specifically, pediatric trauma care often involves growth-respecting minimally invasive or percutaneous fixation techniques that utilize indirect or closed reduction. The management of pediatric fractures, in contrast with those in adults, focuses less on the newest hardware to solve mechanical problems of bone and more on the potential for managing the dynamic system of an immature skeleton. The clinician must consider the growth plate for fixation strategies but also for the potential of further growth to remodel injuries. Diagnostically, the clinician must consider which fractures can be treated less invasively and which are likely to worsen if left alone or with minimal treatment. Overtreatment of a simple fracture may result in increased burden on the child and their family, as well as in additional procedures and exposure to complications, whereas undertreatment can expose them to loss of reduction, malalignment, and potential long-term complications many years in the future. JBJS Essential Surgical Techniques, in a collaborative effort with Children’s ORthopaedic Trauma and Infection Consortium for Evidence-based Study (CORTICES), is excited to present this digital collection of commonly encountered or enigmatic injuries that are unique to children. These techniques represent cutting-edge as well as tried-and-true techniques that on-call orthopaedists can utilize in their practice whether they are pediatric orthopaedists or generalists who are called on to navigate these sometimes unfamiliar waters.

Effectiveness and Safety of Percutaneous Nephrolithotomy (PCNL) in Malrotated Kidneys

Background and Aim: The renal stones of any size could be effectively managed through an essential surgical technique known as Percutaneous Nephrolithotomy (PCNL). The large size renal stones with abnormal kidneys imposed additional challenges for PNCL in anomalous kidneys. The present study aimed to evaluate the effectiveness and safety of Percutaneous Nephrolithotomy in malrotated kidneys. Place and Duration: Conducted at Urology department of Mian Gul Abdulhaq Jehanzeb Kidney Hospital Manglawar, Swat for duration of two years (from May 2019 to April 2021). Materials and Methods. This single-centered retrospective study was conducted on 80 patients who underwent percutaneous nephrolithotomy with malrotation kidneys. The individuals with anomalous kidneys and complex calculi were enrolled in this study. These patients had kidneys anomalies such as horseshoe kidneys, crossed fused ectopia, malrotation kidneys, pelvic and complete stone clearance. Posterior or anterior approaches were followed for the procedure after preoperative evaluation in kidney anomalies. Retrograde catheterization was carried out under spinal and general anesthesia with the patients. For all the patients, stone size and clearance were measured. Results: Of the total 80 kidneys anomalies patients, 55 (68.7%) were male and 25 (31.3%) were females. Overall mean age was 35.26 ± 13.51. The stone size varied from 1.3cm to 7 cm. Patients were categorized into two groups based on stone sizes such as group I (1.3-2.5 cm) had 42 (52.5%) and group II (25-7cm) 38 (47.5%) patients. The patients included renal pelvis 19 (23.6%), the pelvic ureteric junction (PUJ) 8 (10%), horseshoe kidneys 2 (2.5%), crossed fused ectopia 9 (11.3%), and malrotation kidneys 3 (3.8%).The stone clearance was completed in 77 (96.3%) patients. The statistically significant factor for complete clearance was the staghorn stone calculus. Conclusion: Percutaneous nephrolithotomy is a safe and effective procedure for large renal stones management in patients of anomalous kidneys. Higher renal stones clearance can be achieved with minimum morbidity by suitable preoperative evaluation and technical experts. Keywords: Malrotated kidney; Nephrostomy, Percutaneous; Nephrolithiasis; Abnormality

The Clinical Outcome of Patients Undergoing Fontan Surgery; Over 10 Years of Experience in a Single Center

Background: The modified Fontan operation is one of the essential surgical techniques in children with congenital heart diseases. Therefore, we sought to identify the characteristics as well as the early and late outcomes of patients who have undergone Fontan operation during more than 10 years. Methods: This study was conducted with a cross-sectional design. The medical records of 52 patients who underwent modified Fontan operation from March 21th, 2006 to March 20th, 2018, at Tabriz Children's Hospital including the bassline, clinical and surgical data were extracted retrospectively reviewed. Patients were invited for follow up visits and clinical examination and echocardiographic evaluations were conducted. Findings: The most prevalent heart anomaly was tricuspid valve disorders (28 cases, 51.9%). The majority of patients (42 cases, 80.2 %) underwent intracardiac lateral tunnel Fontan. The most prevalent complications were prolonged pleural effusion and neurologic events (each one in 10 cases, 19.2%). The in-hospital mortality rate was 15.3%. The patients were followed for a median 7 years. The survival of those successfully followed was 74.5 percent in 5 years. The most common valvular disorder was mitral valve regurgitation (MR), which was present in 84% of cases. The group of patients with single ventricle had a significantly higher mortality rate than the other groups (P = 0.018). Conclusion: The clinical data of patients who have undergone Fontan surgery was reviewed. Despite acceptable survival, patients remain at risk for morbid events in particular prolonged pleural effusion and neurologic events. Moreover, patients with Fontan circulation should be strictly followed to investigate the development of MR and to timely repair in severe cases to prevent further deterioration. Of note, due to some limitations of our study, further multi-centric studies are warranted to confirm our findings.

JBJS Essential Surgical Techniques: Celebrating 10 Years of Innovation

The ten-year anniversary of JBJS Essential Surgical Techniques comes at a dramatic time in medical history: technological innovations have enabled and improved the techniques for teaching surgeons, traditional print publications have yielded to online platforms, and real-time analytics are utilized to gauge viewer interest. We are in the midst of a worldwide pandemic that has highlighted the value of learning from each other, and opened new avenues for doing so remotely. As we announce the 2020 JBJS Essential Surgical Techniques Award winners, we celebrate the evolution and progress of the orthopaedic community and of our journal. Over the past decade, we have seen continuous advancement in the quality of our peer-reviewed articles, which serve the important task of demonstrating surgical techniques with published outcomes. This year’s award winners continue that trend. Notably, the award-winning articles for both Subspecialty and Key Procedures focus on computerized navigation. In their Subspecialty Procedures article, Polly and Holton address the problem of sacroiliac joint pain, aptly performing arthrodesis with use of unique implants that result in less morbidity1. In their Key Procedures article, Gothesen et al. produced an elegant treatise on the use of computerized navigation in total knee arthroplasty, showing how best to achieve optimal implant alignment, size, and positioning2. These articles are sterling examples of how to utilize multimedia to demonstrate and articulate the fine details of a surgical procedure. Since the inception of JBJS Essential Surgical Techniques, we have been steadfast in our mission to provide high-quality, peer-reviewed content that can be utilized as a teaching tool for surgeons at all levels of experience. We provide instructive video articles that describe the best and latest surgical techniques that are supported by published outcomes. As such, we continue to innovate within the journal and for our authors, including: Reducing burden by providing templates for articles and video storyboards Adding in-line video to the article text, as well as other multimedia to enhance viewer understanding of the procedure Migrating from a largely written article to an all-video, online format featuring an enhanced abstract Increasing learning efficiency by enabling variable playback speed for video viewing Adding English-language captioning to broaden outreach internationally and provide greater accessibility When evaluating the impact of these changes, 1 metric to assess the value of an article is the interest that it generates. For that, we also present the top-10 most viewed JBJS Essential Surgical Techniques articles3-12. Although the frequency with which a procedure is performed plays a role in the viewership metrics, all of these articles are outstanding examples of the high-quality content we aim to provide. We will continue to push the envelope and lead by searching for and incorporating additional features as they become possible.

Congratulations to the 2019 JBJS EST Award Winners

In keeping with our tradition of offering awards for the best articles each year, JBJS Essential Surgical Techniques (EST) is pleased to announce the 2019 winners: Key Procedures Series Award: Dylan T. Lowe, Michael T. Milone, Leah J. Gonzalez, and Kenneth A. Egol for their work on “Repair of Tibial Plateau Fracture (Schatzker II)” (2019;9[3]:e25). Subspecialty Procedures Series Award: Anders Odgaard, Jonathan Eldridge, and Frank Madsen for their work on “Patellofemoral Arthroplasty” (2019;9[2]:e15). The article by Drs. Lowe, Egol, and colleagues addresses a very common fracture that is seen in a variety of settings, in both young and elderly patients, as a high or low-energy injury. Every orthopaedic surgeon likely will have managed at least 1 of these fractures. The authors present a superb video treatise and, in a concise 17 minutes, start with a mini-lecture format, transition to a case-based intraoperative video demonstrating their technique, clinically show their patient’s functional result, and conclude with a summary of both published outcomes and their technical “pearls” that all surgeons will find useful. Each treatment step is rapidly accessible by using the detailed content menu. Regardless of how many of these fractures you have treated, you will benefit and appreciate the fresh approach that the authors have taken to teach us about this fracture. Having this information online and viewable at any time at the point of care (e.g., while reviewing one’s surgical plan immediately before surgery) highlights the importance of how JBJS EST strives to enable surgeons to enhance the care of their patients. Dr. Odgaard’s team of authors take a different, but equally effective, approach to demonstrate patellofemoral arthroplasty. In a carefully thought-out sequence of steps, they use a combination of text, figures, and 16 video clips to provide JBJS EST readers with a swift understanding of not only how to perform this unique procedure but also when and why. Although patellofemoral arthroplasty is conceptually simple, there are numerous important factors that one must consider in order to ensure a superior outcome. Clearly, viewing these video clips will improve one’s understanding of the level of detail and thoughtfulness required for this procedure. Again, we congratulate the winners of this year’s awards for the best JBJS EST Key Procedures and Subspecialty Procedures articles. Each year, we see the creativity that authors use to craft and compose video-based technique articles that enhance the quality of our surgical artistry. We again challenge future authors by offering the awards again in 2020 as 1 more incentive for surgeons to share their expertise with their colleagues in JBJS EST—a journal utilizing online delivery, imagery, and video to optimize the educational experience while ensuring the highest quality through reliance on evidence-based outcomes and vetting by JBJS peer reviewers.

Grafting – Basic Principles and Surgical Applications, Part II

Grafting of blood vessels and nerves are essential surgical techniques which are used to restore continuity in cases of acute or chronic vascular or nervous damage. Due to superior outcomes autologous grafts are generally preferred over allografts or alloplastic grafts. Bone, cartilage and tendons are physiologically subjected to various degrees of mechanical stress, which has been observed to play a critical role in graft survival and remodeling. Bone grafting is used to replace missing bone or to enhance new bone formation in the treatment of fractures, delayed or non-unions or in reconstructive surgery after trauma or tumor resection. Unlike bone, cartilage and tendons have a low capacity for self-renewal due their avascular nature and low cellularity which presents challenges to graft survival and healing rates. This review contains 2 figures, and 68 references. Keywords: autograft, allograft, vascular grafting, nerve grafting, bone grafting, cartilage grafting, tendon grafting, tissue engineering, regenerative medicine

Postoperative hemorrhage complications following the Whipple procedure.

Although the Whipple operation is an essential surgical technique, its high morbidity (30% to 60%) and mortality (5%) are problems to be addressed. The incidence of postoperative hemorrhage has been reported between 5% and 16% in the literature. In this study, the data and results regarding postoperative hemorrhage complications from our clinic were evaluated. The files of 185 patients who had undergone Whipple operation in our hospital in the last five years were evaluated retrospectively, and the causes of hemorrhage were attempted to be determined. It was found that 6 out of the 13 (7%) patients who had hemorrhage died. In six of there 13 cases, hemorrhage occurred due to fistulas from the portal vein, gastroduodenal artery, and pancreatic arteries at variable periods. Two cases were found to have developed disseminated intravascular coagulation as a result of sepsis. Early intervention was performed in two cases who bled from the meso veins and in one case who bled from the portal vein. Laparotomy and hemostasis were performed in a patient who bled from the gastric anastomosis line. In a patient who had been taking low molecular weight heparin, bleeding from the drains and nasogastric tube stopped following the cessation of the drug. Preventive procedures such as connection of the vascular structures, use of vascular sealants, omental patching during surgery, and reducing the risk of complications by using somatostatin analogs were performed to prevent hemorrhages after Whipple operations. In addition to standard methods, angiography and embolization have emerged as effective methods in the diagnosis and treatment of hemorrhages. Furthermore, determination and elimination of independent risk factors, such as jaundice, affecting fistula formation and bleeding in the perioperative period, is important for prevention.

Surgical skills deficiencies and needs of rural general practitioners in South Africa.

At present, much of the global surgical workforce consists of non-specialist physicians (general practitioners (GPs)) whose only formal surgical training was in medical school as an undergraduate. However, there is widespread concern that GPs do not have the skills necessary to deliver essential surgical care in a rural setting. This requires that a specific training programme be developed to train rural GPs in essential surgical skills for rural settings. To perform a critical analysis to determine essential surgical skills required by GPs in rural South Africa, with the intention of developing the content of an accredited continuing professional development (CPD) learning programme to address needs identified. This was a descriptive study in which a desk-top review analysis and a questionnaire survey were used to obtain both qualitative and quantitative data on essential skills required for rural surgical practice. Of 300 GPs, 102 (34.0%) completed the questionnaire. Some of the skills listed as essential for rural surgical practice were removal of foreign objects not in the visual axis (90.0%), packing of epistaxis (93.0%), haematoma drainage (78.3%) and wound debridement and suturing (96.0%). The study also identified the outcomes and essential content of a proposed CPD programme to provide GPs in the rural setting with the required surgical skills. Enhancing skills of GPs in essential surgical techniques and procedures through an accredited CPD short learning programme will ensure that adequate and comprehensive essential surgical care is provided to people living in rural communities.

Techniques for Learning Descemet Membrane Endothelial Keratoplasty for Eyes of Asian Patients With Shallow Anterior Chamber.

To describe several essential surgical techniques that overcome difficulties in performing Descemet membrane endothelial keratoplasty (DMEK) for inexperienced surgeons, especially those who perform DMEK on eyes of Asian patients. Nine eyes of 9 Asian patients with bullous keratopathy who underwent DMEK were analyzed retrospectively. All patients were given a diuretic such as D-mannitol or acetazolamide shortly before surgery, with retrobulbar anesthesia and a Nadbath facial nerve block. Core vitrectomy before DMEK was performed in several cases in which a high vitreous pressure during surgery was predicted. The donor graft was stained with trypan blue, and a 25-G anterior chamber maintenance cannula was used to maintain the anterior chamber depth during graft insertion in all eyes. The cornea became clear in all eyes. The best spectacle-corrected visual acuity had improved significantly 6 months after the surgery compared with preoperative values (P = 0.026). The corneal endothelial cell density was 1371 cells per square millimeter at postoperative 6 months. Although DMEK is technically difficult, especially for inexperienced surgeons who operate on eyes of Asian patients, controlling anterior chamber pressure using various manipulations may help to prevent iatrogenic primary graft failure and lead to successful DMEK.

Essential Surgical Technique for Arthroscopic Capsular Release in the Treatment of Shoulder Stiffness.

Among many treatments for shoulder stiffness, which is a common debilitating condition, arthroscopic capsular release is an effective surgical method for patients who have not responded to conservative treatment, as it provides visual control of the capsular release with a lower risk of potential traumatic damage than manipulation under anesthesia. Place the patient either in the lateral decubitus position or in the beach-chair position, depending on one's preference. Create a standard posterior viewing portal, an anterior portal, and a lateral portal for approaching the glenohumeral joint and the subacromial space. Begin the capsular release with the rotator interval and middle glenohumeral ligament using a 3.0-mm 90° electrocautery device through the anterior portal. Begin the anterior capsular release below the long head of the biceps tendon origin and preserve the glenoid labrum. As the electrocautery device may not reach the inferior portion of the inferior glenohumeral ligament, switch the working portal to the posterior portal for an easier approach to the inferior portion. Begin this procedure with the camera in the lateral portal viewing the anterior portion of the subdeltoid space. The goal for the patient is to achieve an immediate range of motion by performing active-assisted and passive range-of-motion exercises including pendulum circumduction or the pulley exercise. In our recently reported series of seventy-five patients who had a rotator cuff tear with simultaneous shoulder stiffness, treatment with an anterior and inferior capsular release showed favorable results. IndicationsContraindicationsPitfalls & Challenges.

Essential Surgical Technique for French-Door (Double-Door) Laminoplasty

We describe the surgical technique and the pitfalls of French-door laminoplasty. Position the patient to keep the cervical spine "parallel to the floor" or in the "reverse Trendelenburg position" with only a slight incline and place intraoperative neurological monitors to prevent intraoperative neurological deterioration. Use the common cervical posterior approach to expose the lamina and ligamentum flavum. Cut the center of each lamina and create bilateral grooves using a high-speed burr. Open the lamina bilaterally and create a small hole in each one using a high-speed burr. Create bone struts from the spinous processes and tie them to each lamina. Perform meticulous closure of the wound to avoid wound-healing complications. In our original study12, we treated forty-six patients with French-door laminoplasty and compared the surgical results of this procedure with those of open-door laminoplasty in a prospective, randomized controlled manner.IndicationsContraindicationsPitfalls & Challenges.

Corneal Surgery (with DVD-ROM), Zuberbuhler B, Tuft S, Gartry D, Spokes D, (2013), ISBN: 978-3-642-12501-0, Springer

Corneal Surgery is a joint venture by British cornea specialists from Moorfields Eye Hospital, St. Thomas Hospital in London, and St. James University Hospital in Leeds. The authors provide a portable and condensed overview of the current surgical techniques in cornea and external eye disease. They do not aim to provide an extended textbook and also their aim is not to present cutting-edge new procedures but rather commonly available and established surgical techniques. The authors succeeded in providing a very condensed overview of all commonly performed surgical techniques in corneal surgery. The omission of all references and exhaustive discussions allows them to keep the textbook in an acceptable and portable format. The book starts with an introduction into anatomy and common surgical procedures as well as corneal examination techniques. All modern examination techniques such as OCT, topography, and wavefront systems are well covered. They then describe all common surgical techniques for ocular surface and reconstructive surgery such as amniotic membrane transplantation, superficial keratectomy, and PTK. The next large chapter covers discussions on eye banking, penetrating, as well as all modern lamellar surgical transplant approaches. Here, DSAEK, DMEK, as well as DALK are well covered. The last large chapter covers corneal refractive surgical procedures focusing on LASIK, LASEK, PRK, and also introducing all the common laser platforms available. Very helpful for the budding corneal surgeon is the last section of the book, which is a wet laboratory introduction and description, which is accompanied by a DVD explaining the essential surgical techniques in corneal surgery. In my opinion, this handy textbook is a very well condensed and concise overview of the most commonly performed surgical techniques in corneal and refractive surgery. It will be very helpful for the budding corneal surgeon, the corneal and refractive surgery fellow, and also as a short reference book for corneal surgeons. Since references are missing, the presented evidence is somewhat subjective, and also in certain aspects reflecting more the common practice pattern in the UK. These are not always representative for other European countries, which seems to be especially true for the modern surgical procedures such as a corneal crosslinking, DMEK, and DALK. In summary, I think this condensed and well-pictured essential surgical technique guide will be helpful for budding corneal surgeons and is a quick reference guide for more experienced ophthalmic surgeons with a cornea focus.

Placement of a Compass Knee Hinge: Surgical Technique

BJS Essential Surgical Techniques (JBJS EST) is the premier journal describing how to perform orthopaedic surgical procedures, verified by evidence-based outcomes, vetted by peer review, while utilizing online delivery, imagery and video to optimize the educational experience, thereby enhancing patient care. WHAT MAKES JBJS ESSENTIAL SURGICAL TECHNIQUES ESSENTIAL READING? Edited by Edward Cheng, MD, JBJS EST is an online journal for orthopaedic surgeons, from seasoned veterans to those just starting out in this field. It offers readers a continuously expanding online library of thoroughly vetted surgical procedures. Easy to Read, Easy to Absorb: Each surgical procedure is described step by step and illustrated extensively with images to encourage greater understanding of the procedure and concepts. Video excerpts are frequent features. Indications, contraindications, pitfalls, and challenges are clearly highlighted. Peer reviewed and derived from a top-quality published clinical article: Readers can be confident that these procedures are based on solid scientific concepts, because all articles contain outcomes that have been reported on in previously published peer-reviewed publications. JBJS EST articles are subjected to the same rigorous editorial, peer-review, and copyediting process that has established The Journal of Bone & Joint Surgery's reputation for excellence. Contributions to JBJS EST are welcomed from anywhere in the world and are considered on their merits. Articles must be written in English and should be submitted as outlined in the Instructions to Authors. All authors must abide by the JBJS Ethics Policies.

Contralateral C7 Nerve Transfer with Direct Coaptation to Restore Lower Trunk Function After Traumatic Brachial Plexus Avulsion Injuries: Surgical Technique

BJS Essential Surgical Techniques (JBJS EST) is the premier journal describing how to perform orthopaedic surgical procedures, verified by evidence-based outcomes, vetted by peer review, while utilizing online delivery, imagery and video to optimize the educational experience, thereby enhancing patient care. WHAT MAKES JBJS ESSENTIAL SURGICAL TECHNIQUES ESSENTIAL READING? Edited by Edward Cheng, MD, JBJS EST is an online journal for orthopaedic surgeons, from seasoned veterans to those just starting out in this field. It offers readers a continuously expanding online library of thoroughly vetted surgical procedures. Easy to Read, Easy to Absorb: Each surgical procedure is described step by step and illustrated extensively with images to encourage greater understanding of the procedure and concepts. Video excerpts are frequent features. Indications, contraindications, pitfalls, and challenges are clearly highlighted. Peer reviewed and derived from a top-quality published clinical article: Readers can be confident that these procedures are based on solid scientific concepts, because all articles contain outcomes that have been reported on in previously published peer-reviewed publications. JBJS EST articles are subjected to the same rigorous editorial, peer-review, and copyediting process that has established The Journal of Bone & Joint Surgery's reputation for excellence. Contributions to JBJS EST are welcomed from anywhere in the world and are considered on their merits. Articles must be written in English and should be submitted as outlined in the Instructions to Authors. All authors must abide by the JBJS Ethics Policies.

Arthroscopic Hill-Sachs Remplissage with Bankart Repair: Strategy and Technique

BJS Essential Surgical Techniques (JBJS EST) is the premier journal describing how to perform orthopaedic surgical procedures, verified by evidence-based outcomes, vetted by peer review, while utilizing online delivery, imagery and video to optimize the educational experience, thereby enhancing patient care. WHAT MAKES JBJS ESSENTIAL SURGICAL TECHNIQUES ESSENTIAL READING? Edited by Edward Cheng, MD, JBJS EST is an online journal for orthopaedic surgeons, from seasoned veterans to those just starting out in this field. It offers readers a continuously expanding online library of thoroughly vetted surgical procedures. Easy to Read, Easy to Absorb: Each surgical procedure is described step by step and illustrated extensively with images to encourage greater understanding of the procedure and concepts. Video excerpts are frequent features. Indications, contraindications, pitfalls, and challenges are clearly highlighted. Peer reviewed and derived from a top-quality published clinical article: Readers can be confident that these procedures are based on solid scientific concepts, because all articles contain outcomes that have been reported on in previously published peer-reviewed publications. JBJS EST articles are subjected to the same rigorous editorial, peer-review, and copyediting process that has established The Journal of Bone & Joint Surgery's reputation for excellence. Contributions to JBJS EST are welcomed from anywhere in the world and are considered on their merits. Articles must be written in English and should be submitted as outlined in the Instructions to Authors. All authors must abide by the JBJS Ethics Policies.