Excellent Cosmetic Effect Research Articles

Natural orifice trans-oral, trans-vestibular endoscopic thyroidectomy: Surgical steps and technique.

Natural orifice scarless cosmetic surgeries are becoming a reality with increasing experience of advanced laparoscopic surgeries and availability of modern energy sources. Many techniques of minimally invasive video-assisted thyroidectomy through cervical and extra-cervical routes such as chest wall, trans-axillary, sub-mental, post-auricular and trans-luminal approach have been attempted. However, trans-oral trans-vestibular endoscopic thyroidectomy with its excellent cosmetic effect has become the more popular option among the surgical community with advantages such as decreased hospital stay and minimal complications. In this case report, we describe natural orifice trans-oral, trans-vestibular endoscopic thyroidectomy approach (NO-TOTVET) and add to literature the technique in which NO-TOTVET can be utilised, thus adding to the repertoire of the operating surgeon.

Natural Orifice Trans-oral, Trans-vestibular Endoscopic Thyroidectomy (NO-TOTVET): a Case Series.

Natural orifice scarless cosmetic surgeries are becoming a reality with the increasing experience of advanced laparoscopic surgeries and the availability of modern energy sources. Many techniques of minimally invasive video-assisted thyroidectomy through cervical and extra-cervical routes such as chest wall, trans axillary, submental, post-auricular, and trans-luminal approach have been attempted. However, trans-oral trans-vestibular endoscopic thyroidectomy with its excellent cosmetic effect and minimal side effects has become the more popular option among the surgical community. In this case series, we present 11 patients operated via natural orifice trans-oral, trans-vestibular endoscopic thyroidectomy approach (NO-TOTVET) by the same surgical team. From November 2022 to July 2023, NO-TOTVET was performed for 11 consecutive patients presenting with goiter to the Department of General Surgery, Command Hospital Eastern Command Kolkata. Surgery was performed using a 10-mm midline port inserted opposite incisors and two 5-mm ports inserted opposite to the left and right canine in the gingivo-buccal sulcus. NO-TOTVET was completed successfully through these ports without converting to open thyroidectomy. The demographic data and surgical outcomes of the patients were retrospectively analyzed. Eleven patients with a mean age of 37.5 ± 10.4years were incorporated into this study. Three patients presented with papillary thyroid micro-carcinomas, and eight presented with benign nodules. A total of six hemithyroidectomies and five near-total thyroidectomies were done. All surgeries were performed successfully without conversion to open thyroidectomy. The mean operating time was 138.8 ± 33.2min, and the average hospital stay was 1.5days. Two patients developed seroma, and one patient had cutaneous burns. Transient recurrent laryngeal nerve paralysis was observed in one patient. There was no evidence of postoperative bleeding, infection, tetany, or any other complications. NO-TOTVET is a safe and effective technique in the hands of a trained surgeon and is a viable alternative to open thyroidectomy. It is a true scarless surgery with advantages like decreased hospital stay and minimal complications. This case series adds to the literature the scenarios and technique in which NO-TOTVET can be utilized, thus adding to the repertoire of the operating surgeon.

The possibilities of minimally invasive approach in aortic root surgery

The trend towards minimally invasive and excellent cosmetic effect has affected the most difficult section of cardiac surgery – the aortic root. To date, there are various minimally invasive approach for the correction of aortic root pathol ogy, which are used in single clinics in the world. The objective of this literature review was to study the current state of minimally invasive aortic root surgery and critically evaluate methods of correcting its pathology from different types of minimally invasive approach. The minimally invasive approach to these operations is presented in this review of the literature. A mutual comparison of minimally invasive approaches was carried out, their advantages over the traditional approach were determined. Despite the attractiveness of the technique, there are serious limitations of its wide appli cation, such as a long learning curve, an extremely low number of long-term results and the absence of multicenter, randomized comparison studies with traditional approach.

Endoscopic thyroidectomy via areola approach for stage T1 papillary thyroid carcinoma: feasibility, safety, and oncologic outcomes.

To evaluate the feasibility, safety, and oncologic outcomes associated with endoscopic thyroidectomy via the areolar approach (ETAA), compared with conventional open thyroidectomy (COT) for the treatment of stage T1 papillary thyroid carcinoma (PTC). Between January 2021 and June 2022, a total of 1204 patients diagnosed with PTC underwent screening, out of which 138 patients were selected for inclusion in the study population after propensity score matching (92 patients in the ETAA group and 46 patients in the COT group). The study included the collection and analysis of clinicopathologic characteristics, intraoperative outcomes, postoperative outcomes, complications, and follow-up data using R software. The operative time for the ETAA group was longer than that for the COT group (160.42 ± 32.21 min vs. 121.93 ± 29.78 min, p < 0.0001). However, there were no significant differences between the two groups in terms of intraoperative blood loss, the extent of surgical resection, the number of dissected lymph nodes, the number of metastatic lymph nodes, and the rate of parathyroid autotransplantation. Postoperative drainage and C-reactive protein levels were higher in the ETAA group than in the COT group, but there were no significant differences in 24-hour visual analogue scale scores, white blood cell counts, drainage duration, or postoperative hospital stay. Complication rates were similar between the two groups, and no permanent recurrent laryngeal nerve palsy or hypoparathyroidism was observed. Patients who underwent ETAA reported greater cosmetic satisfaction and quality of life than those who underwent COT. During the follow-up phase, only one patient in the COT group developed lateral cervical lymph node involvement requiring reoperation. ETAA is a safe and feasible surgical method for patients with stage T1 PTC, providing results similar to COT in terms of oncologic completeness, while avoiding neck scars, with excellent cosmetic effects. Chinese Clinical Trial Registry center, identifier ChiCTR2300077109.

A new “Stethoscope” autopsy incision in comparison to various conventional incisions along with suturing techniques and body packing methods for post autopsy reconstruction

Post autopsy reconstruction (PAR) plays a vital role in the external appearance of dead bodies while handing over to grieving family members. Autopsy surgeons should not only be restricted to autopsy findings/techniques but should also give importance to PAR. Autopsy incision includes various conventional incisions like I, Y, and Modified Y-shaped. The most commonly used incision is I -shaped in most of the autopsy because it is easy for quick suturing but it produces a poor cosmetic appearance because suturing produces visible suture over the front of the neck and chest of a corpse and improper suturing in the skin flaps leads to gapping causes leakage of body fluids at the suture site. More often that leads to avoidable, unnecessary emotional distress for grieving family members. That creates a negative image of forensic practice in society and sometimes with administrative complaints. The authors conducted an observation based study on the medicolegal autopsy that included ten cases that involved “Stethoscope” and various conventional incisions and explored suturing techniques and body packing methods. The study observed that the proposed “Stethoscope” incision was feasible, less time-consuming for suturing, had an excellent cosmetic effect, and was cost-effective. The suturing technique revealed that invisible sutures leads to good cosmetic outcomes but is more time-consuming and costly. The body packing method showed the excellent result of no leakage of body fluid from the suture site. The authors proposed a “Stethoscope” method of incision that can be practiced and adopted for a better cosmetic appearance and humanitarian aspect for grieving relatives. The body packing method renders the body non-hazardous to the public and attendants while handling and transporting. The authors highlight the importance and sensitization of autopsy surgeon/mortuary staff to restructure the corpse with the best cosmetic appearance for the Dignified Management of the Dead and Humanitarian Forensics.

Успішний досвід лікування інфантильної гемангіоми зони критичної локалізації місцевими β-блокаторами

Infantile hemangioma (IH) is the most common benign vascular tumor in infants and children under one year of age. 12% of children with IH have a tendency to develop dangerous complications, the development of which depends on the area of tumor localization, its size, growth rate, and the patient's age. Careful history taking and physical examination make it possible to verify IH located in critical localization zones (physiological openings, neck, palms and feet) where complications are most likely to develop and to choose the correct method of treatment in a timely manner. Difficulties may arise for the doctor when choosing between the appointment of local or systemic therapy with β-blockers when the IH is located in the critical localization zone. Purpose - to present possibilities and successful experience of choosing between systemic and local treatment IH with β-blockers in the critical localization zone in a child. Clinical case. 2-month-old boy’s parents came to the clinic with complaints about the appearance of a bright red neoplasm in the area of the upper lip in the child, which appeared 6 days after birth and had a tendency to active increase and infiltration of soft tissue. After examining, a clinical diagnosis was made: infantile hemangioma in the critical localization zone (in the area of the skin of the upper lip) in the proliferation phase. Ultrasound diagnosis of the tumor with a special skin sensor made it possible to establish the depth of infiltration. Taking into account the localization of the tumor next to the vital opening, the rapid growth of the tumor, the risk of breast-feeding disruption due to tumor infiltration of soft tissues and the child's age, a decision was made to refer the child for further examination to rule out contraindications to the appointment of systemic β-blockers. During the follow-up examination, local treatment with the β-blocker propranolol was prescribed. During the next two weeks of using local β-blockers, the growth of the hemangioma stopped, ultrasound recorded the cessation of deep proliferation. According to the obtained results, the doctor made a decision to continue treatment with local β-blockers without switching to systemic treatment. An 8-month course of treatment with local β-blockers made it possible to achieve complete stabilization and further regression of the tumor with an excellent cosmetic effect. Conclusions. Infantile hemangiomas are dangerous tumors in children of the first year of life and require careful observation and timely treatment. The article presents a clinical case of a child with critical localization IH, who was prescribed systemic β-blockers according to treatment protocols. In this case, the treatment with local β-blockers made it possible to obtain an excellent therapeutic and cosmetic effect. The research was carried out in accordance with the principles of the Helsinki Declaration. The informed consent of the patient was obtained for conducting the studies. No conflict of interests was declared by the authors.

Clinical Applications of Poly-Methyl-Methacrylate in Neurosurgery: The In Vivo Cranial Bone Reconstruction.

Background: Biomaterials and biotechnology are becoming increasingly important fields in modern medicine. For cranial bone defects of various aetiologies, artificial materials, such as poly-methyl-methacrylate, are often used. We report our clinical experience with poly-methyl-methacrylate for a novel in vivo bone defect closure and artificial bone flap development in various neurosurgical operations. Methods: The experimental study included 12 patients at a single centre in 2018. They presented with cranial bone defects after various neurosurgical procedures, including tumour, traumatic brain injury and vascular pathologies. The patients underwent an in vivo bone reconstruction from poly-methyl-methacrylate, which was performed immediately after the tumour removal in the tumour group, whereas the trauma and vascular patients required a second surgery for cranial bone reconstruction due to the bone decompression. The artificial bone flap was modelled in vivo just before the skin closure. Clinical and surgical data were reviewed. Results: All patients had significant bony destruction or unusable bone flap. The tumour group included five patients with meningiomas destruction and the trauma group comprised four patients, all with severe traumatic brain injury. In the vascular group, there were three patients. The average modelling time for the artificial flap modelling was approximately 10 min. The convenient location of the bone defect enabled a relatively straightforward and fast reconstruction procedure. No deformations of flaps or other complications were encountered, except in one patient, who suffered a postoperative infection. Conclusions: Poly-methyl-methacrylate can be used as a suitable material to deliver good cranioplasty cosmesis. It offers an optimal dural covering and brain protection and allows fast intraoperative reconstruction with excellent cosmetic effect during the one-stage procedure. The observations of our study support the use of poly-methyl-methacrylate for the ad hoc reconstruction of cranial bone defects.

How to improve photodynamic therapy-induced antitumor immunity for cancer treatment?

Photodynamic therapy (PDT) is a promising method of tumor ablation and function-preserving oncological intervention, which is minimally invasive, repeatable, and has excellent function and cosmetic effect, with no cumulative toxicity. More importantly, PDT can induce immunogenic cell death and local inflammation, thus stimulating the body's immune response. However, the weak immunity induced by PDT alone is insufficient to trigger a systemic immune response towards cancer cells. To overcome this obstacle, multiple strategies have been investigated, including tumor microenvironment remodeling, tumor vaccines, subcellular-targeted PDT, and synergistic therapies. This review summarizes the latest progress in the development of strategies to improve the PDT-induced immune effect for enhanced cancer treatment.

Application of Various Methods to Evaluate the Postoperative Characteristics of Expanded Pedicled Deltopectoral Flap for Large Facial Scars.

The expanded pedicled deltopectoral flap (EPDF) has been widely used to repair large facial scars. Although doctors and patients are usually satisfied with the outcomes, the actual functional recovery and cosmetic effects of EPDF are still unknown. It is, therefore, necessary to objectively investigate the effect of transferred EPDF by using a variety of methods. From January 2008 to December 2018, 52 patients who underwent EPDF surgery at Xijing Hospital were enrolled. Sense of touch, static 2-point discrimination, elasticity, and color were measured. Thermesthesia and algesthesia were also tested. Postoperative scars were evaluated using the patient and observer scar assessment scale. Satisfaction of patients, doctors, and laypersons was investigated. The algaesthesis, thalposis, and rhigosis scores were 4.7 ± 0.7, 3.7 ± 0.9, and 4.5 ± 0.8, respectively. The tactile score was 0.3 ± 0.2 mN, and 2-point discrimination was 10.1 ± 4.8 mm. L ∗ , a ∗ hemoglobin, and melanin content of the flaps were significantly different when compared with normal skin ( P < 0.05). The satisfaction of doctors, patients, and laypersons was 88.5%, 71.2%, and 67.3%, respectively. The higher satisfaction of patients was mainly associated with the smaller color difference between the flap and the surrounding skin, and lower patient and observer scar assessment scale score. These results confirm that excellent functional recovery and reliable cosmetic effects are observed when facial scars are repaired with EPDF. The methods used in this study can be applied to the evaluation of functional recovery and cosmetic outcomes of transferred flaps, which may provide a more comprehensive understanding of flap assessment.

Transoral Endoscopic Thyroidectomy Vestibular Approach (TOETVA): Surgical Outcomes and Learning Curve.

The transoral endoscopic thyroidectomy vestibular approach (TOETVA) has excellent cosmetic effects and its popularity is increasing worldwide. We present our experience with TOETVA and its short-term outcomes. This study included 110 consecutive patients who underwent TOETVA at a single institution between July 2016 and June 2020. We analyzed clinicopathologic data, short-term postoperative outcomes, and learning curve using cumulative summation (CUSUM) analysis. Of the 110 patients who underwent TOETVA, 101 had malignant disease and 100 (90.9%) underwent lobectomy. The mean age was 39.7 ± 9.7 years, and the mean tumor size was 1.0 ± 0.7 cm (range, 0.3–3.6 cm). Operation time was 168.0 ± 63.4 min for total thyroidectomy, 111.0 ± 27.7 min for lobectomy, and 73.7 ± 18.1 min for isthmusectomy. Five patients (4.5%) experienced transient vocal cord palsy (VCP) and one (0.9%) had permanent VCP. The swallowing impairment index-6 score was 2.18 ± 3.21 at postoperative three months, and 0.97 ± 1.72 at postoperative six months. The learning curve for lobectomy was 58 cases in CUSUM analysis. TOETVA is a safe and feasible approach with an acceptable operation time and a low complication rate. This approach is a surgical option for patients who desire excellent cosmesis.

The Use of Fascia Lata Free Graft for Lateral Canthus Reconstruction Following Mohs Lower Lid Surgery

We present a case of a 75-year-old patient who underwent reconstruction of the lower eyelid and lateral canthus following removal of 80% of the lower eyelid due to basal cell carcinoma. A Hughes transconjunctival eyelid-sharing flap was used to form the posterior lamella, and a free skin graft from the ipsilateral upper lid was used to recreate the anterior lamella. The lateral canthal ligament was reconstructed using a free fascia lata graft. A periosteal flap was not used due to local scarring that was the result of previous multiple lateral canthal surgeries. Skin preservation in the lateral canthal area and additional horizontal support for the lower eyelid were achieved by using a local advancement flap. This two-stage surgery produced excellent functional and cosmetic effects. Fascia lata free graft can be an alternative to the periosteal flap for reconstruction of the lateral canthal ligament when use of the lateral orbital periosteum is not feasible.

TransOral Endoscopic Thyroidectomy via Submental and Vestibular Approach: A Preliminary Report.

Purpose: Transoral endoscopic thyroidectomy via vestibular approach (TOETVA), with its excellent cosmetic effect, has become increasingly popular worldwide. Nonetheless, anatomic obstacles have limited its development to a certain extent. Here, we present our preliminary outcomes of transoral endoscopic thyroidectomy via submental and vestibular approach (TOETSMVA), which can overcome those limitations.Methods: From November 2019 to March 2020, we performed TOETSMVA in 21 consecutive patients with thyroid carcinoma at Zhongshan Hospital, Xiamen University. A 1.5-cm lateral incision was made at two fingers below the mandible; two 5-mm incisions were made in the vestibule near the first molars; TOETSMVA was completed through these incisions. The demographic data and surgical outcomes of the patients were retrospectively reviewed.Results: Twenty-one patients with a mean age of 37.5 ± 10.4 years were incorporated into this study. Fourteen patients had papillary thyroid micro-carcinomas, two had papillary thyroid carcinomas, and five had benign nodules. Eight patients had lymph node metastases. All surgeries were performed successfully without conversion to open thyroidectomy. The mean operation time was 138.8 ± 33.2 min; the average hospital stay was 3.3 ± 0.8 days. No patients developed cutaneous paralysis in the midline chin region. Transient recurrent laryngeal nerve paralysis was observed in one patient. There was no evidence of postoperative bleeding, infection, tetany, or other complications.Conclusion: TOETSMVA was shown to be a safe and advisable alternative for selected patients. This approach can overcome the limitations of TOETVA without sacrificing cosmetic results.

Treatment of infected wounds with methylene blue photodynamic therapy: An effective and safe treatment method.

Bacterial resistance is a problem during the process of healing of infected wounds. As a therapy, photodynamic therapy (PDT) has broad-spectral antibacterial activity and non-selective action, which makes it possible to deal with antibiotic resistance.. Methylene blue is a commonly used medicine, but it is rarely used in clinical practice as a photosensitizer. The effect of methylene blue photodynamic therapy (MB-PDT) on infected wounds remains unclear. Our study aims to evaluate the safety and efficacy of MB-PDT on infected wounds. In this study, 5 patients with infected wounds were included, all of them were treated with MB-PDT by using the red LED which irradiated the wounds directly (635 nm, 120 J/cm2, 100 mW/cm2). The frequency and course of treatment were determined by the severity of the wound. After an average of 4 PDT session, infected wounds of all the patients healed.. The treatment also showed an excellent cosmetic effect. According to the follow-up periods of patients ranged from 3 to 12 months, there were no recurrences and side effects. MB-PDT has a great healing effect on infected wounds, and it is a safe, cheap and active clinical therapy.

A comparative study of endoscopic assisted lateral neck dissection and open lateral neck dissection in the treatment of cervical lymph node metastasis of papillary thyroid carcinoma

Objective:A prospective randomized controlled study of patients with thyroid papillary carcinoma requiring lateral neck dissection was conducted to investigate the thoroughness, safety and cosmetic features of endoscope-assisted lateral neck dissection. Method:Patients who underwent total thyroidectomy, bilateral central lymph node dissection and unilateral lateral neck dissection for papillary thyroid cancer were randomly divided into two groups: endoscopic assisted group and open group, 18 cases in each group. The clinical characteristics, operation conditions, postoperative complications and aesthetic satisfaction of the two groups were compared. Result:There were no statistically significant differences between the endoscopic group and the open group in age, gender, tumor size, dissection side, operation time, postoperative hospital stay, number of lymph nodes to be dissected, number of metastatic lymph nodes, postoperative hoarseness, and hypoparathyroidism（P>0.05）; No hematoma or lymphatic leakage occurred in the two groups after surgery, and no tumor recurrence or residual was found in the ultrasound review at 6 months after surgery. Serum Tg level in the endoscopic group was higher than that in the open group at 6 months after surgery, but the difference between the two groups was not statistically significant（P>0.05）; The neck pain score at day 3 after operation, the neck numbness and discomfort score at month 1 after operation, and the aesthetic satisfaction score at 3 months after operation in the endoscope assisted group were better than that in the open group（P<0.05）. Conclusion:Endoscope-assisted lateral neck dissection is safe, feasible and with excellent cosmetic effect for the treatment of lymph node metastasis in the lateral cervical region of papillary thyroid carcinoma.

Intraoperative neuromonitoring of the RLNs during TOETVA procedures

Transoral endoscopic thyroidectomy by vestibular approach (TOETVA) is now being performed in increasing frequency and getting more and more attention. TOETVA is carried out through three incisions in the oral vestibular area. Thyroidectomy is performed endoscopically using conventional laparoscopic instruments, an energy based device and neuromonitoring instruments. Intraoperative neuromonitoring is one of the tools of utmost importance, used for navigation and confirmation of the functional integrity of the recurrent nerve during TOETVA. The aim of this study is to give information about the standards and technique of intraoperative neuromonitoring of the recurrent laryngeal nerves during TOETVA procedures. TOETVA is a safe technique with no visible scarring and hence resulting in an excellent cosmetic effect. We believe that neuromonitoring of the recurrent laryngeal nerves also minimizes the risk of nerve damage and is an essential safety component in this technique.

Minithoracotomy vs. Conventional Mitral Valve Surgery for Rheumatic Mitral Valve Stenosis: a Single-Center Analysis of 128 Patients.

ObjectiveTo compare the in-hospital outcomes of a right-sided anterolateral minithoracotomy with those of median sternotomy in patients who received a mitral valve replacement (MVR) because of rheumatic mitral valve stenosis (RMS).MethodsThis is a retrospective analysis of 128 patients (34% male) with RMS between 2011 and 2015. The median age was 53 years (45; 56). The mean ejection fraction was 58.4±6.3%. All the subjects were divided into two groups - Group 1 contained 78 patients who underwent MVR via minithoracotomy (MT-MVR), while Group 2 contained 50 patients who underwent MVR via median sternotomy (S-MVR).ResultsIn the MT-MVR group, a mechanical prosthesis was implanted in 72% of cases, while it was implanted in 90% of cases in the S-MVR group (P=0.01). The duration of myocardial ischemia was similar (MT-MVR, 77±24 min; S-MVR, 70±18 min) (P=0.09). However, the cardiopulmonary bypass time was lower in the S-MVR group than in the MT-MVR group (99±24 min and 119±34 min, respectively) (P≤0.001). There was no difference in the duration of mechanical ventilation, intensive care unit stay, and hospitalization period. Postoperative blood loss was lower in the MT-MVR group (P≤0.001) than in the S-MVR group. There are no statistically significant differences in postoperative complications (superficial wound infection, stroke, delirium, pericardial tamponade, pleural puncture, acute kidney insufficiency, and implantation of pacemaker). The overall in-hospital mortality was 3.9% (P=0.6)ConclusionThe minimally invasive approach for RMS is feasible and has an excellent cosmetic effect without increasing the risk of surgical complications.

Hyperpigmentation After Sclerotherapy Management

Introduction: Varicose tributaries and spider veins are a widespread problem, especially in female patients. Yet this pathology doesn't influence the functionality of the extremity, it decreases life quality. Many women feel embarrassed with the bluish legs, thus trying to hide the 'imperfection' with special clothes or avoiding public places. Sclerotherapy is a cost-effective and relatively simple procedure that provides an excellent cosmetic effect in short time. No hospitalization is needed, no special regime is prescribed, the patient can get back to everyday activity in a half-hour after the procedure. In some cases, it is the only option for treatment. Time-effectiveness is also the key in a modern rapidly moving world. Methods: A prospective study was made in AngioLife vascular center. One hundred twenty-six patients after sclerotherapy were analyzed from April 2018 to January 2019. 87% female, 13% male, predominantly Caucasians (98%). Spider veins in 70% of cases and varicose tributaries in 30%. We used Aethoxysclerol as a sclerosant agent in all cases. We usually use a 3ml syringe with a 31G needle for spider veins. 10ml syringe and 25G needle for veins bigger than 2mm and 27G needle in smaller veins. No more than 8ml of sclerosant agent in total per session. The concentration was as recommended by the manufacturer. Sulodexide orally 25mg per day and Diosmine 600mg daily were prescribed to 60 patients. Diosmin 600mg orally alone was prescribed to 66 patients of the control group. Results: Photographic control was made the day after sclerotherapy, in 7 days, one month and three months after the procedure. The incidence of hyperpigmentation was 10% in patients with spider veins and 25% in patients with varicose veins in one-month follow-up in all groups. Three months' follow-up showed a significant decrease of skin discoloration rate in Sulodexide group: 2% of patients with spider veins and 10% of patients with varicose veins had brownish signs visa 8% and 20% respectively in the control group. Almost 5% of patients had signs of matting on sclerotherapy site in both groups. No adverse events, such as bleeding were observed in the Sulodexide group. Conclusion:-The use of Sulodexide seems to be effective in management and prophylactic of post-sclerotherapy hyperpigmentation-Further research is needed to evaluate effectiveness and safety of Sulodexide Disclosure: Nothing to disclose

Piezosurgery for Infra- and Supratentorial Craniotomies in Brain Tumor Surgery

Piezoelectric surgery represents an innovative technique to perform safe and effective osteotomies and is an alternative to traditional bony tissue management using rotating or perforating instruments. We evaluated the safety and feasibility of craniotomies using an ultrasonic device that allows the selective cut of mineralized structures, avoiding damages to the vascular, dural, and parenchymal structures. We analyzed a series of 300 patients (age range, 1-81 years; SD ± 15.2) who underwent elective cranial surgery for brain tumors, in which the craniotomy was performed using a piezoelectric device. Pre- and postoperative imaging, clinical notes, and intraoperative details were collected. There were 197 patients (66%) who underwent surgery for supratentorial tumors; the remaining 103 patients (34%) underwent surgery for infratentorial ones. Tumors involved the skull base in 125 cases. Meningiomas, gliomas, and schwannomas represented the most common histotypes. Duraplasty for dural damages was not necessary in all cases; no venous sinuses or parenchymal injuries were reported during bone work. We noted in 13 cases (4.3%) a minor dural tear, requiring only direct sutures. Bone flaps were always intact after craniotomy. No subgaleal cerebrospinal fluid (CSF) collection or CSF leak was recorded. Because of the minimal bone gap, we always achieved correct bone flap ossification. No reabsorption or mobilization of bone flap was noted. We illustrate the feasibility and safety of a piezosurgical cutter to perform craniotomies. This alternative technique appears to be safe, with excellent cosmetic effects, adding another tool to the neurosurgical armamentarium.

Inguinal hernia repair by Bianchi incision in boys: a retrospective study.

Open inguinal hernia repair by Bianchi incision is a potential alternative technique for the treatment of IH. This study aims to retrospectively analyze boys with IH, who underwent open IH repair by Bianchi incision. A total of 3300 boys (1-144months) with IH from April 2007 to September 2015 were enrolled into this study. An open high scrotal incision (Bianchi incision) to ligate the processus proximal to the internal inguinal ring was performed in patients for IH repair. Then, all patients were followed up after 7days, 1month, and 1year. Operation time, hernia recurrence, hydrocele, testicular atrophy, cosmetic results, and the satisfaction of parents were evaluated. Among these 3300 boys, 1662 (50.36%) and 1349 (40.88%) boys with IH were operated on the right and left side, respectively, while 289 (8.76%) patients underwent bilateral surgery. The average operation time was 13.0 ± 2.3min for unilateral cases and 25.2 ± 4.2min for bilateral cases. Furthermore, among these 3300 boys, 309 boys (9.36%) were lost to follow-up, and the remaining 2991 boys underwent a total of 3245 IH repairs. The complications included 20 recurrences who were repaired with the same technique, one wound rupture, and one acquired undescended testis. No infection, obvious scrotal hematoma, testicular atrophy, and vas deferens injury were found during the follow-up. In most instances, the scars were invisible, obtaining an excellent cosmetic effect. Inguinal hernia repair by Bianchi incision is a safe, easy and effective technique with cosmetic benefits, which could be a reliable alternative for the treatment of pediatric inguinal hernia.

Surgical anatomy for transoral endoscopic thyroid surgery through vestibular approach (TOETVA)

Transoral endoscopic thyroid surgery through vestibular approach (TOETVA) is well accepted by patients and doctors because of its minimal invasion, excellent cosmetic effect and superiority for level VI/VII lymph node dissection. It has considerable prospection and has been applied in treatment of benign thyroid diseases and follicular thyroid tumors including suitable differentiated thyroid cancer (DTC). To better understand the procedure of TOETVA and its key points, the anatomy from transoral vision should be mastered first of all. Previous studies have demonstrated the anatomical feature of transoral thyroidectomy on animals and cadavers. Here, we are to summarize our experience of transoral thyroidectomy on human from the vision of clinical anatomy.