Excision Technique Research Articles

Preoperative Wire Localization: A Simple Guidance Technique for Excision of Deep, Painful, Small, Soft Tissue Neurofibromas.

A novel use of preoperative wire localization to aid in the removal of small deep-seated soft tissue nerve sheath tumors is described. Wire localization is commonly used in breast surgery, and applying this technique in neurosurgery will enable the surgeon to directly reach the lesion with smaller incisions and prevent unnecessary soft tissue dissection.

Surgical treatment of benign subungual tumours—a systematic review and case series

**Background**: Proper surgical technique is critical in the excision of benign subungual tumours to ensure complete tumour removal and prevent nail deformities. A systematic literature review was performed to identify approaches to excision and their clinical outcome. We present a series of rare benign subungual tumours to highlight different approaches and their outcomes.**Methods**: A systematic review of English language literature was conducted using the PubMed database between 1 January 1962 and 31 December 2021 for studies describing surgical approaches to benign subungual tumours. Search terms include ‘glomus tumour’, ‘subungual exostosis’, ‘osteoid osteoma’, ‘fibro-osseous pseudotumour of the digit’, ‘enchondroma’ and ‘implantation dermoid tumour’. We performed a retrospective review of patient records from our institute from 2021–2022. Six patients with subungual tumours were selected.**Results**: Twenty-one studies (with a total of 228 participants) described various techniques for excision of benign subungual tumours. The majority of the studies (n = 18) described the transungual approach, which allows maximum tumour exposure but with risk of nail deformity postoperatively. Other approaches described include lateral subperiosteal (n = 3), periungual (n = 2), nail bed margin (n = 1) and fish mouth (n = 2). Outcomes were measured using the rate of postoperative nail deformity and rate of tumour recurrence. Our series of patients were treated with excision using the transungual (5 of 6) and periungual approach (1 of 6), with good results. **Conclusion**: The available literature demonstrates that the transungual approach is the most widely used technique for removal of subungual tumours. This technique provides excellent tumour exposure; however, it is associated with damage to the nail bed. Our case series suggests that risk of nail dystrophy can be minimised by meticulous nail bed repair.

Dorsum preservation rhinoplasty: a matched cohort comparison of upper and lower septal excision techniques

Dorsum preservation rhinoplasty: a matched cohort comparison of upper and lower septal excision techniques

SP10.11 Does Specialised training reduce the recurrence rate of pilonidal sinus disease surgery?

Abstract Background Pilonidal sinus surgery is challenging, and its recurrence rates have been reported to be high as 30% in a number of series. Long-term morbidity, recurrent infection, non-healing, and chronic wound discharge affect patients’ quality of life. This study aimed to compare the recurrence rate of the different surgical techniques of pilonidal sinus disease in our institution. Methods A retrospective study was done of adults who had elective pilonidal surgery from 2016-2021. Recurrence was defined as an active disease that required surgical intervention >30 days after surgery. Results were analysed for the different operative techniques used. Results 208 patients were included,167 (80.3%) were male with a mean age of 31.2 years. The mean follow-up was 47 months. The recurrence was reported in 19 cases (9%). Out of 17 cases done by excision and lay-open technique, 11.8% had a recurrence, while 9.8% of 143 recured after simple excision and closure. Only 3 of 48 cases with the flap technique had a recurrence. When the surgeon specialty was analysed as a factor of recurrence, colorectal surgeons did 38% (19/208) of the cases including flap technique, and their recurrence rate was 6.3% (5/79). In comparison, non-colorectal general surgeons operated on 50.5% (105/208) of the cases with no flap technique, and their recurrence rate was 11.4% (12/105). Only 2 out of 24 cases were operated by plastic surgeons had a recurrence. Conclusions Flap reconstruction yields a low recurrence rate in pilonidal sinus disease surgery. Specialised training for this procedure should be encouraged for the colorectal trainees, that may improve the outcome.

Comprehensive aesthetic corrections of gynecomastia using the reproducible safe and minimally invasive surgical strategy

BackgroundMinimally invasive access and fast recovery are trends of gynecomastia surgery. We placed great importance on liposuction and modified original pull-through technique. The purpose of this study was to present a refined surgical strategy for gynecomastia in grade I and II. MethodsThe refined strategy embraced enhanced liposuction to remove the intraglandular fat sufficiently, followed by open resection of gland using the pull-through and bottom-up technique with adjuvant liposuction in the end. Surgical data were recorded and satisfactory questionnaires with 5-point scales were administered during follow-up. ResultsBetween January 2017 and May 2022, 165 patients underwent enhanced liposuction combined with the pull-through and bottom-up technique for gland excision. Age ranged from 12 to 56 years. The median length of surgery was 100 min. A median of 300 ml of fat was aspirated and a median of 20.8 g of gland was excised. Seventy-seven patients (46.7%) responded the questionnaires at least 6 months postoperatively, and the average overall satisfaction was 4.68 ± 0.52 points. Thirteen sides of breasts developed complications with a rate of 4.0%. ConclusionEnhanced liposuction combined with pull-through and bottom-up technique proved effective to treat grade I and II gynecomastia with minimal scarring and high satisfaction. The refined strategy was simple and safe, and would obtain optimal outcomes even for inexperienced surgeons.

A New Technique for Use Instead of Lateral Crural Overlay for Reduction of Nasal Tip Projection in Revision Rhinoplasty.

Correction of nasal tip projection (NTP) deformities involve techniques for the lower lateral cartilage of the nose. Previously, it would have been surgically difficult to perform the lateral crural overlay (LCO) technique for the second time in revision rhinoplasty in patients who already had undergone rhinoplasty with the LCO technique because of the length of the NTP. In this study, we evaluated the lateral crural segmental excision (LCSE) technique in patients with overprojected nasal tip in revision rhinoplasty. We retrospectively studied the cases of 19 patients who had initially undergone rhinoplasty with the LCO technique for overprojected nasal tip, and later underwent revision rhinoplasty with the LCSE technique after insufficient NTP was observed on facial analysis between 2018 and 2022. Of the patients, 12 (63%) were male, with an average age of 29.6 years, and 7 (17%) patients were female, with an average age of 25.3 years. Using Goode's formula, NTP indexes of patients measured 79.4±1.8 preoperatively and 56.0±1.3 postoperatively. Stastically significant difference was observed between preoperative and postoperative values. None of the patients had malnutrition at the incision margins, and all patients recovered on time and without any problems. Granulation tissue was detected in the mucosa in only one patient. The LCSE technique, with a short surgical time, recovery period without complications, and satisfactory nasal respiratory function, is preferred over a second LCO application in cases of NTP.

Near-infrared and hysteroscopy-guided robotic excision of uterine isthmocele with laser fiber: a novel high-precision technique

To describe a novel high-precision technique for robotic excision of uterine isthmocele, employing a carbon dioxide laser fiber, under hysteroscopic guidance, and near-infrared guidance. Video article. A 36-year-old multipara with three prior cesarean sections presented to our infertility clinic with secondary infertility. The patient had been trying to conceive for 6 months without success. The patient underwent a hystero-salpingo contrast sonography which identified a large cesarean scar defect with a 1.4 mm residual myometrial thickness (RMT). The patient was counseled on surgical management with robotic approach due to RMT < 3 mm precluding her from hysteroscopic resection and the potential risk for a cesarean scar ectopic or abnormal placentation if she were to become pregnant in the future. She elected to undergo excision and repair and informed consent was obtained from the patient. The robot was docked for traditional gynecologic robotic surgery. The uterus was injected with 5 units of vasopressin. We used a carbon dioxide laser fiber (Lumenis® FIberLase) at a power of 5 watts as the sole energy source for dissection. The bladder was dissected off the uterus to identify the general area of the isthmocele. At that point, diagnostic hysteroscopy was performed using a 30-degree 5 mm hysteroscope (Karl Storz®) to identify and enter the isthmocele. Near-infrared vision (da Vinci Firefly®, Intuitive USA) was activated to precisely outline the extent of the isthmocele, which was not visible with simple transillumination from the hysteroscope. We proceeded with laser excision in infrared/grey scale using the laser at a power of 20 watts removing the entire area that was highlighted by the Firefly®. After full excision of the isthmocele, the hysteroscope was removed and was eventually replaced by a uterine manipulator (ConMed VCare DX®). The hysterotomy was closed with a two layer closure: 4 mattress sutures of 2-0 Vicryl (Ethicon®) followed by a running 2-0 PDS Stratafix (Ethicon®). The peritoneal layer was closed over these two layers with 2-0 PDS Stratafix (Ethicon®) in a running fashion. The uterine manipulator was removed and a 14 French Malecot catheter (Bard®) was placed in the uterine cavity to allow the healing to proceed with minimal risk of cervical stenosis. The bladder was backfilled to ensure integrity of the bladder wall. Interceed adhesion barrier (Gynecare®) was then placed over the area of the repair and the procedure was concluded. The patient included in this video gave consent for publication of the video and posting of the video online including social media, the journal website, scientific literature websites (such as PubMed, ScienceDirect, Scopus, etc.) and other applicable sites. Completion of excision and repair of cesarean scar defect without surgical complications. Robotic excision and repair of a sizable uterine isthmocele with carbon dioxide laser fiber and da Vinci Firefly® was completed successfully without any surgical complications. Diagnostic hysteroscopy was used to positively identify the isthmocele and provide transillumination. However, the thickness of the cervical myometrium only allows the hysteroscopic light to shine through the thinnest portion of myometrium at the apex of the isthmocele, while the near-infrared vision allowed by the da Vinci Firefly® technology was used to precisely identify the borders of the defect. The carbon dioxide laser was used to completely remove the defect while avoiding damage to delicate reproductive tissue and over-excision. No complications were identified during the postoperative visit. MRI three months after the surgery revealed a RMT of 10 mm at the location of excision compared to the initial RMT of 1.4 mm. Currently, there is no gold-standard technique for surgical management of isthmocele. This is the first description of the combined use of hysteroscopy, near-infrared vision and laser fiber for the robotic excision of isthmocele. This specific setup proves to be a useful technical improvement. The use of near-infrared vision combined with precise hysteroscopic targeting allows much clearer definition of the isthmocele borders, and the flexible laser fiber allows millimetric excision in the absence of appreciable lateral thermal spread. Further investigation is warranted to identify a gold standard surgical technique for patients with CSD.

Robot-assisted Laparoscopic Excision of Abdominal Wall Endometrioma Utilizing Intraoperative Ultrasound and Transabdominal Needle Placement

In patients with endometriosis, extra pelvic endometriosis is estimated to have an incidence of 11% and a rare subset of extra pelvic lesions include abdominal wall endometriosis with an incidence of 0.03-3.5%1,3. Evaluation for and surgical management of abdominal wall endometriosis is an essential skillset for the advanced gynecologic surgeon. In this video, we demonstrate a surgical technique for robot-assisted laparoscopic excision of abdominal wall endometriosis with intraoperative ultrasound-guided needle placement. Description and demonstration of surgical technique. Patient with previous history of 2 cesarean sections and right lower quadrant cyclic abdominal wall pain. Tertiary care, academic center INTERVENTIONS: Intraoperative ultrasound-guided needle placement to map location and boundaries of the lesion followed by minimally invasive resection of the lesion with the intermittent advancement and withdrawal of needles to confirm clear margins. Minimally invasive resection of abdominal wall endometriosis using intraoperative ultrasound guided needle placement is an effective technique to guide surgical dissection and allow for clear surgical margins and successful treatment of this rare condition.

Diagnostic considerations and surgical techniques for a large prolapsing submucosal myoma

We demonstrate a uterine-sparing technique for excision of a prolapsing submucosal myoma, including adequate exposure, myoma stalk clamping, morcellation technique, use of vasopressin, hysteroscopic evaluation, and insertion of intrauterine balloon.

Effectiveness of Carbon Localization for Invasive Breast Cancer: An Institutional Experience.

The final oncological and aesthetic results of breast-conserving surgery (BCS) are influenced by the precise localization of breast cancer (BC) tumors and by the quality of the intraoperative margin assessment technique. This study aimed to assess the effectiveness of the carbon localization (CL) technique by determining the success rate of BC identification and the proportion of adequate complete resection of BC lesions. We conducted a cross-sectional retrospective study of patients treated with primary BCS for invasive BC who underwent CL of their BC lesion at the Jules Bordet Institute between January 2015 and December 2017. Descriptive statistics with categorical and continuous variables were used. The success rate of tumor identification and the rate of adequate excision were calculated using the test of percentages for independent dichotomous data. This study included 542 patients with 564 nonpalpable BC lesions. The median pathological tumor size was 12 mm. Of these, 460 were invasive ductal carcinomas. Most of the tumors were of the luminal subtype. CL was performed using ultrasound guidance in 98.5% of cases. The median delay between CL and surgery was 5 days, with 46% of the patients having CL one day before surgery. The lumpectomy weighed 38 g on average, with a median diameter of the surgical sample at 6 cm and a median volume of 44 cm3 (6-369). One-stage complete resection was successfully performed in 93.4% of cases. In 36% of cases, an intraoperative re-excision was performed, based on intraoperative macroscopic pathological margin evaluation. The tumor was identified in 98.9% of cases in the breast surgical specimen. This study demonstrated high success rates for BC tumor identification (99%) and one-stage complete resection (93.4%) after BCS and CL. These results show that CL is an effective, simple, and inexpensive localization technique for successful excision of BC lesions during BCS.

Modified Limbal-Conjunctival Autograft Surgical Technique: Long-Term Results of Recurrence and Complications.

The aim of this study was to report the recurrence and complication rates of a modified limbal-conjunctival autograft surgical technique for pterygium excision. This was a retrospective, single-surgeon, single-operating environment, consecutive case series of 176 eyes in 163 patients with a biopsy-proven diagnosis of pterygium. All patients underwent excision using a 23-gauge needle to "behead" the pterygium head, followed by a limbal-conjunctival autograft including ∼50% of the palisades of Vogt. Outcomes measured included recurrence, defined as any conjunctival fibrovascular growth, and complication rates. Correlations between preoperative patient characteristics, pterygium morphology, and intraoperative factors (width of corneal extension, conjunctival defect, and graft) with postoperative recurrence were examined using logistic regression models. The median age was 59.5 years and 122 eyes (69.3%) had primary pterygium (type I: 17%, II: 37.5%, and III: 45.5%). Kaplan-Meier analysis demonstrated the median pterygium-free follow-up period to be 723 days (range 46-7230 days). Recurrence was observed in 3 eyes of 2 patients (1.7%). No postoperative graft-related complications were observed. Postoperative symptomatology was transient. Age demonstrated a negative correlation with recurrence (odds ratio 0.888, 95% CI, 0.789-0.998, P = 0.046). However, no other correlations with preoperative or intraoperative factors, including whether pterygium was primary or recurrent, were identified (all P > 0.05). This modified limbal-conjunctival autograft technique represents an effective alternative that offers a very low recurrence rate and avoids extensive dissection or antimetabolites, with minimal complications and transient postoperative symptomatology, over a long-term follow-up period. This technique is relatively simple and successful for both primary and recurrent pterygia. Future comparative studies with other surgical techniques may determine which are superior.

Efficacy of Fenestration Technique for Lumbar Disc Excision in Pain Relief

Objective: To determine the outcomes of lumbar disc excision by fenestration technique for pain relief in lumbar radiculopathy due to prolapsed intervertebral disc. Methodology: This is a descriptive study conducted in a joint venture of orthopedic and neurosurgeons in a private hospital of Lahore. Study was completed in six months duration from July to December 2022. All patients presenting with lower back pain, straight leg raise test positive on &lt;60 degrees and prolapsed disc at the level of L4/L5 or L5/S1 L discs on MRI. Those with multilevel disc prolapse, previous history of spinal surgery, cauda equine syndrome and patients with lumbar stenosis were excluded from the study. All study patients were operated under general anesthesia in knee chest position. Efficacy of the procedure was determined using Dennis Pain Scale. Important findings were documented when patient was discharged. SPSS version 20 was used for statistical analysis. Results: 125 patients were studied including 73(58.4%) males and 52(41.6%) females. Patients with the age of 20-60 years were included in this study with the mean age of 47.3 ± 5.2 years. Most commonly involved disc level was L4-L5 in 77(61.6%) and L5-S1 in 48(38.4%) cases. Unilateral radicular pain was present in 94(75.2%) cases and bilateral pain was present in 31(24.8%) cases. According to Dennis Pain Scale out of 125 cases 78(62.4%) patients presented in Dennis pain scale P4 and among them complete recovery achieved in 70(89.7%) cases. Conclusion: Surgical intervention is necessary in selected patients with prolapsed intervertebral disc with chronic unilateral or bilateral radicular pain. Fenestration technique for disc excision is a very good procedure for prolapsed disc. Keywords: Sciatica, Disc Excision, Prolapsed Disc, Radiculopathy

Appropriate Surgical Margins for Excision of Squamous Cell Carcinoma of the Lower Lip.

Background Squamous cell carcinoma (SCC) is the most common malignancy on the lower lip. Surgical excision, the standard treatment for SCC, requires full-thickness excision. However, no consensus exists about the appropriate surgical margin. Therefore, we investigated the appropriate surgical margin and excision technique by analyzing 23 years of surgical experience with lower-lip SCC. Methods We reviewed 44 patients with lower-lip SCC who underwent surgery from November 1997 to October 2020. Frozen biopsy was performed with an appropriate margin on the left and right sides of the lesion, and the margin below the lesion was the skin above the sulcus boundary. If the frozen biopsy result was positive, an additional session was performed to secure a negative margin. Full-thickness excision was performed until the final negative margin. In each patient, the total number of sessions performed, final surgical margin, and recurrence were analyzed. Results Forty-one cases ended in the first session, 2 ended in the second session, and 1 ended in the third session. The final surgical margins (left and right; n = 88) were 5 mm (66%), 7 mm (9%), 8 mm (2.3%), 10 mm (20.4%), and 15 mm (2.3%). During an average follow-up of 67.4 months (range, 12-227 months), recurrence occurred in one patient. Conclusion The final surgical margin was 5 mm in 66% (58/88) of the cases, and 97.7% (86/88) were within 10 mm. Therefore, we set the first frozen biopsy margin to 5 mm, and we suggest that a 5-mm additional excision is appropriate when frozen biopsy results are positive.

Oncoplastic Breast Reconstruction for Large Pediatric Breast Tumors: A Case Series.

Large breast fibroadenomas in pediatric females may cause discomfort, asymmetry, and psychological stress, and patients may elect for surgical excision. There are no criteria for reconstruction after the excision of these masses, and the research is limited in describing oncoplastic techniques in pediatric fibroadenoma excision. Nononcoplastic techniques, such as mastectomy with implant or flap reconstruction, have been used for pediatric fibroadenoma excision reconstruction. Oncoplastic techniques using Wise pattern or circumareolar incisions have shown to have efficacious outcomes. In addition, pediatric females undergoing breast surgery risk long-term complications such as continued breast asymmetry due to further breast growth, nipple and breast hypoesthesia, and future breastfeeding difficulty. This case series describes the oncoplastic techniques used for large benign mass excision and reconstruction of 3 pediatric females. A Wise pattern technique was used for all 3 patients, and 2 underwent a free-nipple graft. Oncoplastic techniques for pediatric breast mass excision provide satisfactory aesthetic outcomes with minimal surgical morbidity. Further research assessing the long-term effects of pediatric breast mass excision and reconstruction would be beneficial.

Single Stage Excision and Thick Split Thickness Skin Graft Technique for Facial Giant Congenital Melanocytic Nevi with Consideration of Facial Aesthetic Subunits: A Case Report and Literature Review

Due to their three-dimensional anatomy, functional importance, and esthetic appeal, giant congenital melanocytic nevus (GCMN) of the face pose the greatest challenge to reconstructive surgeons, especially when there are few donors and a significant deformity. A 25-year-old male patient presented with a facial GCMN. GCMN management involves complete nevus removal and reconstruction using tissues of the same color, thickness, and as the surrounding skin. Some defect closure options were inapplicable due to the almost complete forehead defect. This study aims to report the author's successful experience treating an adult case of GCMN with single-stage excision and subunit facial restoration using thick split-thickness skin graft (STSG). In this case, thick STSG is considered to prevent the risk of secondary contracture and conspicuous discoloration. In addition to esthetic and functional outcomes, the patient's social status and self-esteem also improved. This technique promises esthetic results, such as reduced downtime, and improved psychological function.

Treatment of penile curvature with aldehyde free bovine pericardium graft: an original and prospective evaluation of a cohort of patients with peyronie’s disease

Introduction: Peyronie´s disease (PD) is a common condition that can cause penile curvature and /or deformities and therefore affecting the male sexual function. The most effective treatment for clinically significative and stable penile curvature due to PD is the reconstructive surgery that involves techniques that do not shorten the penile length. Among the techniques that correct the curvature restoring the penile length, the incision and/or excision of the plaque, followed by the reconstruction of the defect with a graft remains as the gold standard. Although several materials have been used as a graft in the treatment of penile curvature due to PD, none have shown results good enough to be considered as the first choice. Herein, we aimed to evaluate the results of the surgical treatment of patients with penile curvature due to PD using a new biograft. Methodology: We performed the surgical management with graft technique in twelve men suffering from penile curvature due to PD. Penile curvature was measured before and one year after the reconstructive procedure. The graft of choice was the bovine pericardium graft segment treated with L-Hydro aldehyde-free technology. Erectile function was evaluated by the IIEF questionnaire and penis length was measured by a rigid rule during the pharmacological induced erection test. Results: The overall success rate of correction of the penile curvature was 90.9% and the patient’s satisfaction rate was 91.7%. No serious adverse events were found and erectile function impaired in 18.2%.There was an increase in penile length in 91.7% and this ranged from 0.7 to 3.0 cm. Conclusion: Correction of penile curvature due to Peyronie's disease using the technique of incision and/or excision of the plaque with the aldehyde-free bovine pericardium graft has high success rates in terms of both penile shaft rectification and patient satisfaction. L-hydro bovine pericardium graft is easy to handle surgically, allows a tight anastomosis and does not present serious postoperative complications. Furthermore, it can be used simultaneously with penile implants and appears to have a role in restoring penile length.

(055) Effect of Loop Electrosurgical Excision Procedure (LEEP) on Female Sexual Function

Abstract Introduction Cancer of the uterine cervix is the third most common gynecologic cancer and accounts for approximately 528,000 new cancer cancers globally, on an annual basis. Cervical cancer continues to be the second leading cause of cancer death for women aged 20 to 39. Human papillomavirus (HPV) infection is responsible for the majority of cervical cancer cases. Screening with cervical cell cytology in conjunction with HPV testing is an effective screening technique that enables providers to risk-stratify women with cervical dysplasia for subsequent development of invasive cervical cancer. Colposcopy is a diagnostic technique utilized as a follow-up for abnormal cervical screening test results. Depending on the adequacy of the colposcopy procedure and the patient’s histology, an excisional procedure may be required. Loop electrosurgical excision (LEEP) is one of three common techniques employed to remove the pre- cancerous transformation zone. Theoretically this “minimally invasive” approach reduces thermal injury to surrounding structures, causes less intraoperative bleeding, and creates smaller excised specimens. The aim of this technique is to minimize cervical trauma compared to other excisional techniques. However, to date, there have been no prospective studies to examine the effect of excisional biopsy on patient-centered outcomes, such as sexual satisfaction post-procedure and subsequent development of subsequent sexual dysfunction. A 2015 review article found only 6 studies examining the effect of excisional biopsy on sexual dysfunction. There have only been four published prospective studies examining the effect of LEEP on sexual function, and only two of them utilized validated research questionnaires. Our university-based clinic performs approximately 1000 colposcopies and 100 LEEP procedures annually. The Medical Faculty Associates practice providers care to both a racially and socioeconomically diverse patient population. Objectives We plan to conduct a prospective cohort study in 736 women comparing FSFI and FSDS-R scores, and the prevalence of sexual dysfunction (defined as FSFI &amp;lt; 26 points) among patients who undergo colposcopy versus patients who undergo both colposcopy and LEEP. Methods The FSFI and FSDS-R questionnaires will be completed at their initial encounter after having an abnormal pap smear. This initial questionnaire will serve as our baseline measurement. If the patient did not need any additional procedures, they will complete the FSFI and FSDS-R questionnaires at 6 and 12 weeks after colposcopy. If further excision is required, patients will complete the questionnaires at 6 and at 12 weeks after their LEEP procedure. Results Results are pending completion of study enrollment. Analyses will be controlled for parity, age, menopausal status, psychotropic medication use, anxiety or depression diagnosis. Conclusions We anticipate our study to find no difference in FSFI score or FSDS-R score among women who have undergone colposcopy versus colposcopy versus LEEP. We plan to have interim results to present at the upcoming conference. Disclosure No.

Minimally invasive treatment of pilonidal sinus disease (a systematic review and meta-analysis)

AIM: to estimate the effectiveness of minimally invasive methods for treatment of chronic inflammation in pilonidal sinus disease by systematic review.PATIENTS AND METHODS: fifty-two clinical trials were selected from 2,576 papers in databases for systematic review. It included the following methods: the fibrin glue, the sinusectomy, the video-assisted pilonidal sinus treatment, the laser coagulation and the chemical destruction using crystallized phenol or its solution. Regarding the last two methods, a meta-analysis was carried out.RESULTS: the meta-analysis demonstrated the high effectiveness of phenol and laser coagulation for pilonidal sinus disease. When comparing the results of phenol use and excisional techniques, there was a significant difference in higher frequency complications rate after excisional techniques (HR 0.42; 95% CI: 0.05–3.71), while the recurrence rate was the same (HR 0.98; 95% CI: 0.45–2.16). The probability of recurrence was significantly higher than after excision techniques in compare with SiLaC (HR 4.02; 95% CI: 1.13 14.3, p = 0.03). However, there was no significant differences in complication rate after SiLaC and excisional techniques (HR 0.63; 95% CI: 0.29–1.34).CONCLUSION: the chemical destruction and laser coagulation are the most effective methods for pilonidal sinus treatment.

Comparison of conventional right colectomy and complete mesocolic excision technique—case–control analysis of short-term results

Summary Introduction The long-term oncologic advantages of complete mesocolic excision (CME) with central vascular ligation and extended lymphadenectomy in right-sided colon cancer have been emphasized in several studies, without compromise of perioperative morbidity or mortality; however, prospective randomized data are scarce. Methods We performed a single-center non-randomized case–control study comparing conventional non-CME right colectomies (nCME) and complete mesocolic excision (CME) procedures during the period from January 2019 to December 2020. Perioperative morbidity, length of hospital stay (LOHS), operative time, and lymph node yield were analyzed. Results A total of 131 patients underwent surgery for right-sided colon cancer, with 28 (21%) in the CME group and 103 (79%) in the conventional group. Operative time was significantly longer in the CME group (p &lt; 0.001) compared to conventional procedures. The duration of hospitalization was statistically similar (p = 0.226), no difference was observed in 30-day morbidity (p = 0.166), and the majority of complications in both groups were grades 0–2 (CME: 82%; nCME: 91%). There were no 30-day mortalities. The lymph node yield in CME was significantly higher compared to the conventional surgery (p = 0.041). Conclusion Complete mesocolic excision (CME) for right-sided colon cancer is safe without increasing complications or hospital stay, with an acceptable increase in operative time. The significant increase in lymph node yield enables better staging and may lead to improved long-term oncologic outcomes.

Understanding melanoma in situ: Lentigo maligna surgical treatment terminology and guideline adherence, a targeted review

Malignant melanoma in-situ, lentigo maligna (MMIS-LM) can be successfully treated with several different surgical techniques; however, the literature is inconsistent in defining them. To comprehensively define and describe the national guideline recommended surgical techniques used to treat MMIS-LM to help clarify and standardize this terminology to ensure compliance with the guidelines. A targeted literature review was performed from 1990 to 2022 focusing on articles that discussed the national guideline recommended surgical techniques of wide local excision, Mohs micrographic surgery (MMS), modified Mohs surgery, and staged excision/Slow-Mohs for MMIS-LM, as well as the related methods of tissue processing. National Comprehensive Cancer Network and American Academy of Dermatology guidelines were reviewed to identify how the techniques need to be employed to be compliant with guideline recommendations. We describe the various surgical and tissue processing techniques and discuss advantages and disadvantages of each. This paper was styled as a narrative review defining and clarifying terminology and technique and does not investigate these topics more broadly. Understanding the methodology and terminology for these surgical procedures and tissue processing methods is critical so that both general dermatologists and surgeons can employ these techniques effectively for optimal patient care.