Expert Surgeons Research Articles

Single-port versus multi-port laparoscopic and robotic inguinal hernia repair: a systematic review and network meta-analysis.

The evolution of minimally invasive surgery has transformed inguinal hernia repair (IHR). The innovative single-port technique reduces the number of surgical incisions. However, the benefits of single-port IHR remain controversial. Our systematic review and network meta-analysis assess the efficacy and clinical outcomes of single-port laparoscopic inguinal hernia repair (SPL-IHR), multi-port laparoscopic inguinal hernia repair (MPL-IHR), single-port robotic inguinal hernia repair (SPR-IHR), and multi-port robotic inguinal hernia repair (MPR-IHR). A comprehensive search was conducted in PubMed, EMBASE, Cochrane, and Ovid for articles published before January 2024, focusing on complication rates, recurrence, seroma, hematoma, operative time, post-operative pain, and cosmetic outcomes of laparoscopic or robotic IHR. Both extraperitoneal (TEP) and transabdominal (TAPP) approaches were analyzed using MetaInsight. MPL-TAPP was used as the standard for comparison. Thirty-seven studies, including 5,038 patients, 36.92% (1,860 patients) underwent MPL-TEP, 23.64% (1,191 patients) SPL-TEP, 22.23% (1,120 patients) MPR-TAPP, 10.08% (508 patients) MPL-TAPP, 5.40% (272 patients) SPL-TAPP, and 1.73% (87 patients) SPR-TAPP. There were no significant differences in the rates of post-operative complications, hernia recurrence, hematoma, or seroma among the techniques when compared to MPL-TAPP. For secondary outcomes, MPR-TAPP significantly increased the operative time for unilateral hernia repair by a mean difference (MD) of 10.60 min [95% CI: 2.16-19.04]. Conversely, for bilateral hernia repair, there was no significant difference. Post-operative pain was significantly higher for MPL-TEP and SPL-TEP, with MDs of 1.44 [95% CI: 0.43 to 2.44] and 1.22 [95% CI: 0.18 to 2.26], respectively. SPL-TEP was significantly favored in cosmetic outcomes over MPL-TEP, with an MD of 0.65 [95% CI: 0.07 to 1.24]. In our network meta-analysis, the risk of post-operative complications, including recurrence, hematoma, and seroma, does not significantly vary among single-port and multi-port laparoscopic or robotic techniques. This suggests that surgical technique selection can rely on surgeon expertise and resource availability, without compromising outcomes.

Corneal Clarity after Phacoemulsification: Nuclear Management by Stop and Chop vs Divide and Conquer Methods

Background: Restoration of effective vision is the principal aim of all modalities of cataract surgery including Phacoemulsification. Energy level of ultrasonic power in Phacoemulsification and turbulence of fluid in the anterior chamber plays an important role in corneal endothelial cell loss influencing post-operative corneal clarity. Objectives: To compare post-operative corneal clarity after Phacoemulsification by two techniques of nuclear divisions: stop and chop with divide and conquer. Methodology: This prospective observational study was conducted at Shaheed Monsur Ali Medical College and Hospital, Uttara, Dhaka from January, 2023 to June, 2023. The study was carried out on 30 outdoor patients undergoing Phacoemulsification at SMAMCH and Mirpur Eye Hospital, Dhaka. The selected patients underwent detailed ocular and systemic examinations with relevant investigations and divided equally into two groups comprising of 15 in group A (stop and chop) and 15 in group B (divide and conquer). Phacoemulsification was done in all patients by a single expert surgeon. Patients were followed up after 1 week, 4 weeks and 12 weeks of surgery. Corneal endothelial cell count and central corneal thickness were assessed in each visit. Mean value of these mentioned parameters in follow-up periods were compared between two groups. Unpaired t test was done to assess the level of significance. Results: The mean age + standard deviation (SD) of the study subjects was 61.5+2 years, out of which 13(43.33%) were males and other 17(56.67%) females. Pre-operative value of mean endothelial cell count was 2620+70.20/mm2 in group A and 2625+71.10/mm2 in group B. Postoperative mean value + SD of endothelial cell count was 2420+68.90/mm2, 2345+66.64/mm2, 2310+66.04/mm2 respectively after 1 week, 4 weeks and 12 weeks of surgery in group A and 2410+69.54/mm2, 2340 +6587/mm2, 2310+64.45/mm2 in group B respectively. Mean value + SD of central corneal thickness was 545+40.50 micrometer, 535+40.02 micrometer and 532+39.85 micrometer respectively after 1 week, 4 weeks and 12 weeks after surgery in group A and 547+43.98 micrometer, 537+41.23 micrometer and 533+40.63 micrometer respectively in group B. Conclusion: Quantitative assessment and comparison of endothelial cell count and central corneal thickness shows that at end of the study, there was no remarkable difference in mean values of endothelial cell count and central corneal thickness between two methods. Journal of Monno Medical College December, 2023; 9 (2):37-40

Comparison of Visual Acuity Outcomes of Phacoemulsification and Small Incision Cataract Surgery

Background. The visual outcomes of phacoemulsification (Phaco) and manual small incision cataract surgery (MSICS) have been extensively studied, with research indicating that both methods are highly effective in restoring vision. Purpose. This study was aimed at comparing the visual acuity outcomes of the two surgical techniques. Methods. A total of 90 participants were scheduled for cataract surgery at Adetula Opticals & Eye Clinic, Oshodi-Isolo, Lagos State, Nigeria, from June to August 2023. The participants were divided into two groups of 45, a group was scheduled for Phaco (0.92 ± 0.65; 6/60-6/36) and SICS (1.32 ± 0.81; 3/60) logMAR. Visual acuities (VAs) were measured pre- and postoperatively. Results. The difference in mean VA pre-op of -0.40 (95% confidence interval (CI): -0.096, -0.71) between the two techniques was statistically significant (p = 0.000). There was no significant difference in the logMAR VAs between the techniques post-operatively (p = 0.06), although the visual outcome with the two methods showed the tendency of a better VA (0.11± 0.17 [6/9 - 6/6]) as opposed to that of the other two techniques (0.22 ± 0.32; [6/12 - 6/9]). Conclusion. Both techniques have been refined to a point where they provide comparable long-term visual outcomes, making the choice of method dependent on specific patient needs, surgeon expertise, and available resources.

Evaluation of Optical Tracking to Distinguish Surgeon Experience During Endoscopic Stone Surgery.

Introduction and Objectives: Optical tracking (OT) has shown potential in assessing surgical skill but has yet to be evaluated for endoscopic urologic surgery. We sought to evaluate the potential for OT to distinguish expert and trainee surgeons during flexible ureteroscopy (fURS) for kidney stone treatment in both simulated and live surgical settings. Methods: We performed OT analysis of six surgeons performing stone localization during fURS in two settings. In the first setting, surgeons were tasked with fiducial localization in three separate kidney phantoms during fURS. In the second setting, surgeons performed stone localization via fURS in five separate patients. Surgeons were categorized as "expert" (n = 3, endourologist, average case volume of >100 fURS per year) or trainee (n = 3, trainee, <100 fURS per year). OT metrics were recorded for both settings using the Microsoft HoloLens 2© as the surgeons viewed the surgical monitor during fURS. Standard OT metrics of experts and trainees were compared, and included: area of eye gaze movement, gaze distance traveled, number of gaze fixation points, percentage of gaze fixation dwell time, and number of saccades. Results: In the simulated setting, the average time for stone localization was greater for trainees compared to experts (318 seconds vs 52 seconds, p < 0.01). Additionally, the mean area of eye gaze movements with area of interest (AOI) was greater for trainees compared to experts (1430 cm2 vs 1060 cm2, p < 0.01). The total gaze distance traveled was also greater for trainees compared to experts (1480 cm vs 730 cm, p < 0.01). In the live surgical setting, average time for stone localization was similar for trainees and experts (74 seconds vs 51 seconds, p = 0.05). The total area of eye gaze movements in AOI was greater for trainees compared to experts (700 cm2 vs 30 cm2, p < 0.01). Additionally, the total gaze distance traveled was greater for trainees compared to experts (14,000 cm vs 680 cm, p < 0.01). This suggests more varied and less point specific concentration on the surgical screen by trainees. There was no difference in percentage of gaze fixation dwell time and number of saccades between experts and trainees in either setting. Conclusions: OT analysis can objectively distinguish surgical experience between experts and trainee surgeons performing fURS in both simulated and live surgical settings. These findings may play a role in future surgical training and skills assessment.

Roles of pediatric surgeons in palliative pediatric oncology.

Pediatric surgeons engaged in oncology will inevitably treat patients receiving palliative care, but their role in this context is poorly described. This article identifies some of the challenges and opportunities of surgical involvement in pediatric oncology palliative care, underscoring how the surgeon's expertise can be exploited to significantly benefit children with cancer. Specific examples of skills (procedural, communication, and coordination) that surgeons can provide to the multidisciplinary palliative care teams are described and the importance of collaboration is highlighted.

What Is the Optimal Method of Fixation for Scaphoid Nonunion Relative to the Location of the Lesion?

Scaphoid nonunion is a typical complication of scaphoid fractures, with the nonunion rate varying by the location of the scaphoid. The current widely used method for treating scaphoid nonunion, which is challenging for surgeons, is the headless compression screw (HCS). Various surgical approaches, such as the scaphoid plate, have been proposed to address the problem of screw fixation; however, no consensus exists regarding the optimal treatment method. This study focused on analyzing appropriate treatment methods based on the anatomical location of the scaphoid nonunion. Ninety-seven patients with scaphoid nonunion were treated between 2008 and 2023. All patients underwent treatment using 1 HCS or scaphoid volar locking plate with nonvascularized bone graft from the distal radius depending on the scaphoid's location. The scaphoid angle and bone union were confirmed using radiological examinations. The clinical evaluations included range of motion, pain, grip strength, and functional wrist scores. Fifty-seven patients were included in the final analysis. In the screw group, 26 patients (26/42 [62%]) obtained a bone union, and all 15 patients (15/15 [100%]) in the plate group obtained a union ( P = 0.005). In the waist group, 16 patients with screw (16/25 [64%]) and 8 using a plate (8/8 [100%]) showed bony healing. In the proximal group, 3 patients with HCS (3/9 [33%]) and 4 using plate (4/4 [100%]) showed bone union. In the distal group, 7 patients with a screw (7/8 [87%]) and 3 with the plate (3/3 [100%]) showed bone union. Significant differences were found in the waist ( P = 0.047) and proximal groups ( P = 0.026), but not in the distal group ( P = 0.521). All groups showed improved radiological angles associated with the scaphoid and better clinical outcomes postoperatively. Plate fixation was overall superior to screw fixation for scaphoid nonunion, especially in the waist and proximal poles, providing better union rates and stability. For the distal group, both methods are effective, with the choice depending on the surgeon's expertise and patient factors. The results highlight the importance of the lesion's anatomical location in selecting the appropriate fixation method.

Virtual Reality Surgical Planning of a Complex Two-Jaw Defect

Head and neck reconstruction poses challenges requiring stable coverage and optimal appearance and functionality. In complex cases, and beyond the right choice of flap, Virtual Reality (VR) surgical software and preoperative planning, are needed to optimize outcomes. Our patient is a 16-year-old with a history of rhabdomyosarcoma necessitating maxillary-mandibular defect reconstruction. VR-based preoperative planning facilitated the intervention by creating 3D-VR models of facial anatomy and fibula, simulating resection margins, and creating surgical guides for intraoperative use. Our 2-team surgeons opted for a single-staged reconstruction using a vascularized fibula free flap. This case demonstrates successful single-flap reconstruction of a maxillary-mandibular defect, addressing challenges of recipient vessel scarcity, fibrotic scarring, and poor tissue quality. It also underscores the efficacy of a 2-team approach and VR-based preoperative planning in achieving successful outcomes in complex maxillary-mandibular reconstruction. The use of a single fibula flap minimized possible complications and operative time, and the 2-team approach helped by combining the expertise and training of craniofacial and microsurgical trained surgeons. Acknowledging limitations in imaging quality and real-time adaptability, we advocate for continued exploration of VR technologies in enhancing surgical precision in challenging cases.

Periprosthetic acetabular fractures: classifications, treatment and challenges

Periprosthetic acetabular fractures (PPAF) are fractures of the acetabulum with ahip endoprosthesis in place. They are arare complication, although they are occurring more frequently due to the increase in patients being fitted with total hip arthroplasty (THA) and the long service life of the implants. At present, only asmall amount of scientific literature exists, particularly regarding the surgical treatment of these fracture types.The aim of this paper is to provide an overview of the topic of PPAF with acritical review of the current literature and to present the necessary surgical treatment.An evaluation of the current literature on the topic of PPAF with afocus on the surgical treatment of fractures is carried out.Surgical treatment is technically demanding due to the pelvic ring instability with removal of the bone tension for secure acetabular cup fixation and should lead to the recovery of the biomechanical stability of the pelvis and thus the secure anchoring of the acetabular cup. An interdisciplinary approach requiring both trauma surgery and orthopaedic expertise is certainly recommended, as older and comorbid patients with poor bone quality are particularly frequently affected.The treatment of periprosthetic acetabular fractures, especially in older patients, requires not only the individual expertise of surgeon involved in the operation but also agoal-oriented and consistent interdisciplinary approach by the surgeons involved from the fields of orthopaedics and trauma surgery in view of the patients' frequent comorbidities. By working together, the optimal and individualized operation can be performed for the patient.

Academic impact of French Hip & Knee Surgery Society (SFHG): A bibliometric analysis

IntroductionThe French Hip & Knee Surgery Society (SFHG) brings together French-speaking hip and knee expert surgeons. There has been an exponential growth of orthopaedic surgical activity over the last decade and hip and knee surgery clinical research has had a similar growth. Despite this, the SFHG's contribution to the orthopaedic literature remains poorly known. To answer this question, we conducted a bibliometric study using data from the national SIGAPS database between 2013 and 2022 to determine: (1) the number of publications produced by SFHG members, (2) the proportion of articles produced by SFHG members in relation to French orthopaedic production, (3) impact markers for articles produced by SFHG member surgeons, (4) collaboration networks between SFHG member surgeons. HypothesisThe number of articles produced by SFHG member surgeons will represent a significant proportion of French scientific output in orthopaedics. Material and methodThe analysis was carried out by cross-referencing the SFHG membership list with the French database of the “Système d'interrogation, de gestion, d'analyse des publications scientifiques” (SIGAPS) and the InCites platform. Among the 189 SFHG members, we identified a list of 183 SIGAPS identifiers in the national database, corresponding to 127 distinct individuals with publications over the period 2013–2022. Several indicators were studied: number of publications; SIGAPS score for the different WoS categories; number and percentage of publications in the top1% and top10%. ResultsOf SFHG's 189 members, 127 have been identified by the SIGAPS database as “publishers”. Over the last decade, 2306 articles have been published by SFHG members. The number of publications has risen steadily, from 203 publications in 2013 to 261 publications in 2022. All SIGAPS categories were represented. Most articles were published in rank D (n = 719; 31.2%) C (n = 552; 23.9%) and B (n = 549; 23.8%) journals. Authors were in first (n = 624) or last position (n = 730) in 58.7% of publications. Orthopaedics (1,639; 71.1%), Surgery (1,124; 48.7%) and Sports surgery (335; 14.5%) were the most frequently observed topics. Orthopaedics & Traumatology: Surgery & Research is the most popular journal for SFHG members' articles, with 655/2306 articles published over the last decade, representing a 32.2% market share. Of the 2160 publications indexed on the Web of Science, 1807 (83.7%) had a French corresponding author. 31 articles (1.4%) were in the Top 1% of most-cited articles worldwide, and 310 were in the Top 10% of most-cited articles worldwide (14.5%). DiscussionSFHG is a major player in orthopaedic research in France. In 2022, it accounted for 19% of the annual volume of French scientific publications in the field of orthopaedics and traumatology. Level of evidenceIV; Retrospective study without control group.

Posterior approaches to the acetabulum.

Posterior approaches, particularly the Kocher-Langenbeck approach, remain the workhorses in the treatment of acetabular fractures. Various modifications have been developed, each offering specific advantages depending on surgical requirements. The modified Gibson approach, for example, is suggested to provide enhanced visualization of the superior acetabulum, although recent cadaveric studies have not consistently substantiated this benefit. The Ganz approach, which involves bigastric trochanteric osteotomy with safe surgical hip dislocation, is particularly advantageous for managing complex and comminuted posterior acetabular fractures, as it enables a 360° view of the acetabulum and femoral head. Overall, posterior approaches are associated with low rates of complications, with heterotopic ossification being the most prevalent. The choice of surgical approach and patient positioning should be guided by the surgeon's preference and expertise, tailored to the specific fracture pattern and patient characteristics.

Near-Infrared Autofluorescence Signatures of Single- vs Multigland Disease in Primary Hyperparathyroidism

The success of parathyroidectomy depends on accurate intraoperative localization and identification of all diseased glands in parathyroid exploration based on surgeon expertise to prevent persistent hyperparathyroidism. Near-infrared autofluorescence (NIRAF) imaging has recently emerged as a promising adjunctive intraoperative tool for localizing parathyroid glands; however, its potential utility in the assessment of parathyroid glands has yet to be established. To analyze the differences in NIRAF signatures of parathyroid glands in single vs multiple glands in primary hyperparathyroidism (pHPT). This prospective diagnostic study analyzed in vivo NIRAF images of parathyroid glands obtained during parathyroidectomies between November 18, 2019, and December 31, 2023, at a single tertiary referral center. Pixel intensities of the images were measured using third-party software. Patients who underwent parathyroidectomy for sporadic pHPT using a second-generation NIRAF imaging device were included. Patients with multiple endocrine neoplasm disorders were excluded. In vivo NIRAF images obtained during the procedures were analyzed. Near-infrared autofluorescence imaging during parathyroidectomy. The primary outcomes were the autofluorescence intensity and heterogeneity of single adenomas and multigland disease (ie, double adenomas and 3- or 4-gland hyperplasia) in sporadic pHPT. Normalized autofluorescence intensity was calculated by dividing the mean pixel intensity of the parathyroid gland by the background tissue. A heterogeneity index was calculated by dividing the standard deviation by the mean pixel intensity of the gland. The secondary outcome was the visibility of each parathyroid gland on NIRAF imaging before it became apparent to the naked eye during exploration. A total of 1287 in vivo NIRAF images obtained from 377 patients (median [IQR] age, 66 [56-73] years; 299 female [79.3%]) were analyzed. Of all patients, 230 (61.0%) had a single adenoma, 91 (24.1%) had double adenomas, and 56 (14.9%) had 3- or 4-gland hyperplasia. A mean (SD) of 3.4 (1.1) parathyroid glands were identified in the procedures. A comparison of 581 diseased glands (45.1%) and 706 normal glands (54.9%) showed a lower median normalized autofluorescence intensity of 2.09 (95% CI, 1.07-4.01) vs 2.66 (95% CI, 1.43-4.20; effect size = 0.36) and higher heterogeneity index of 0.18 (95% CI, 0.07-0.41) vs 0.11 (95% CI, 0.01-0.27; effect size = 0.45), respectively. Of diseased glands, single adenomas (233 [40.1%]) vs double adenomas (187 [32.2%]) and 3- or 4-gland hyperplasia (161 [27.7%]) had a lower median autofluorescence intensity of 1.92 (95% CI, 1.02-4.44) vs 2.22 (95% CI, 1.10-3.97; effect size = 0.21), respectively. On receiver operating characteristic analysis, the optimal autofluorescence intensity threshold to differentiate between single adenomas vs multigland disease was 2.14, with a sensitivity of 64.4%, specificity of 58.1%, and area under the curve of 0.626. These findings suggest that parathyroid glands in single- vs multigland disease may exhibit different autofluorescence characteristics. Although the effect size was modest, the differences identified should be kept in mind when assessing the parathyroid glands during surgical exploration.

Objective performance indicators versus GEARS: an opportunity for more accurate assessment of surgical skill.

Surgical skill evaluation that relies on subjective scoring of surgical videos can be time-consuming and inconsistent across raters. We demonstrate differentiated opportunities for objective evaluation to improve surgeon training and performance. Subjective evaluation was performed using the Global evaluative assessment of robotic skills (GEARS) from both expert and crowd raters; whereas, objective evaluation used objective performance indicators (OPIs) derived from da Vinci surgical systems. Classifiers were trained for each evaluation method to distinguish between surgical expertise levels. This study includes one clinical task from a case series of robotic-assisted sleeve gastrectomy procedures performed by a single surgeon, and two training tasks performed by novice and expert surgeons, i.e., surgeons with no experience in robotic-assisted surgery (RAS) and those with more than 500 RAS procedures. When comparing expert and novice skill levels, OPI-based classifier showed significantly higher accuracy than GEARS-based classifier on the more complex dissection task (OPI 0.93 ± 0.08 vs. GEARS 0.67 ± 0.18; 95% CI, 0.16-0.37; p = 0.02), but no significant difference was shown on the simpler suturing task. For the single-surgeon case series, both classifiers performed well when differentiating between early and late group cases with smaller group sizes and larger intervals between groups (OPI 0.9 ± 0.08; GEARS 0.87 ± 0.12; 95% CI, 0.02-0.04; p = 0.67). When increasing the group size to include more cases, thereby having smaller intervals between groups, OPIs demonstrated significantly higher accuracy (OPI 0.97 ± 0.06; GEARS 0.76 ± 0.07; 95% CI, 0.12-0.28; p = 0.004) in differentiating between the early/late cases. Objective methods for skill evaluation in RAS outperform subjective methods when (1) differentiating expertise in a technically challenging training task, and (2) identifying more granular differences along early versus late phases of a surgeon learning curve within a clinical task. Objective methods offer an opportunity for more accessible and scalable skill evaluation in RAS.

A Systematic Review of Ureteral Reimplantation Techniques in Endometriosis: Laparoscopic Versus Robotic-Assisted Approach.

Introduction: Endometriosis, characterized by the presence of endometrial tissue outside the uterus, includes deep endometriosis (DE), which can affect the urinary tract. Ureteral endometriosis (UE) is a rare but significant manifestation that can lead to ureteral obstruction, hydronephrosis, and potential kidney loss. This systematic review evaluates the effectiveness and outcomes of laparoscopic versus robotic-assisted ureteral reimplantation techniques in patients with UE. Materials and Methods: A systematic literature search was conducted following PRISMA guidelines across PubMed, MEDLINE, Embase, Web of Science, and the Cochrane Library, from inception to July 2024. Studies included patients with UE who underwent ureteral reimplantation using laparoscopic or robotic-assisted techniques. Data on patient demographics, surgical technique, duration of surgery, complications, follow-up duration, and clinical outcomes were extracted and analyzed. Results: Twelve studies met the inclusion criteria, comprising 225 patients in the laparoscopic group and 24 in the robotic-assisted group. Lich-Gregoir ureteral reimplantation, with or without a psoas hitch, was the predominant technique used. The average surgery duration was 271.1 min for the laparoscopic group and 310.4 min for the robotic-assisted group. Recurrence rates for UE were 2.95% for laparoscopic and 5.9% for robotic-assisted procedures. The robotic-assisted group had a significantly shorter hospital stay (6.7 days vs. 9.1 days, p < 0.01). Postoperative complication rates were comparable between the two techniques (p = 0.422). Conclusions: Both laparoscopic and robotic-assisted techniques for ureteral reimplantation in UE are safe and effective, with the choice of technique guided by surgeon expertise and specific clinical scenarios. However, the limited number of robotic cases introduces a bias, despite statistical significance.

The surgical management of third ventricle region tumors

ObjectivesThe goal of this study was to characterize the largest known cohort of patients presenting with different tumor pathologies in the third ventricle region to better understand outcomes of surgical management. MethodsAll patients undergoing surgical intervention on tumors in or encroaching upon the third ventricle at Loyola University Medical Center between the years 1986–2021 were reviewed. Information recorded included presenting symptoms, pre- and post-operative interventions, tumor pathology, operative technique, extent of resection (EOR), and approach of operation. The primary clinical outcome was Karnofsky Performance Status (KPS) score. ResultsNinety-seven patients underwent 123 operations. Forty-six (47.4 %) patients were female, and the median age at operation was 39 years. Eighty-seven (70.7 %) operations were open, and 36 (29.3 %) were endoscopic. Gross total resection (GTR) was achieved in 34.4 % of operations, near-total resection (NTR) in 31.5 %, subtotal resection in 25.0 %, and biopsy alone in 9.3 %. Median KPS increased pre- to postoperatively, regardless of surgical technique. Adjusting for preoperative KPS, age, and operation number, regression analysis demonstrated a trend that lesser EOR is associated with lower KPS at most recent follow-up (p=0.031 for NTR vs GTR, p=0.022 for biopsy vs GTR). There was no statistically significant association between the most recent KPS and either open or endoscopic surgical technique, with or without adjusting for the previously stated factors (p=0.26). There was no association between postoperative complication rates or age with either surgical technique. ConclusionsHere, we characterize a large cohort of patients presenting for neurosurgical evaluation of tumors in the region of the third ventricle. Our results demonstrate a trend that a more aggressive resection may yield better KPS outcomes. Additionally, both open and endoscopic techniques lead to a similar improvement in clinical outcome and rates of complication. While ultimate surgical approach and technique is determined by individual tumor characteristics, patient health status, and surgeon expertise, ability to resect the tumor in its entirety should be taken into consideration.

Exploring AI-chatbots’ capability to suggest surgical planning in ophthalmology: ChatGPT versus Google Gemini analysis of retinal detachment cases

BackgroundWe aimed to define the capability of three different publicly available large language models, Chat Generative Pretrained Transformer (ChatGPT-3.5), ChatGPT-4 and Google Gemini in analysing retinal detachment cases and suggesting...

Outcome Comparison of Multidirectional Locked Nailing and Plating for Distal Tibial Fractures: A Comparative Analytical Study

Introduction: This comparative analytical study explores the functional outcomes of treating distal tibial fractures using multidirectional locked nailing and plating. Distal tibia fractures, resulting from high-energy trauma, pose challenges due to soft tissue damage, infection risks, and potential unfavorable outcomes. Our study seeks to evaluate and contrast the functional results of treating distal tibial fractures using multidirectional locked nailing versus plating techniques. Materials and Methods: Conducted at Saveetha Medical College and Hospital from August 2022 to October 2023, the study involved 20 cases meeting specific criteria. Adult patients (18-70 years) with closed fractures and grade I compound fractures of distal tibia (AO type 43-A1, 43-A2, and 43-A3) were included. The cases were evenly divided between multidirectional locked nailing and plating groups. Subsequent evaluations, comprising both radiographic and clinical analyses, were performed at 6, 12, and 24-week intervals. Results: The study encompassed various parameters, including age distribution, causes of fractures, weight-bearing protocols, and joint movements. Multidirectional locked nailing demonstrated a shorter fracture union time, promoting earlier weight-bearing and functional exercises. Ankle and knee scores in this group indicated successful joint function restoration but with a higher malunion rate. Plating exhibited a lower malunion rate but a prolonged time to union. Complications, including superficial infections and wound dehiscence, were observed, emphasizing the importance of postoperative monitoring. Despite challenges, the plate group achieved satisfactory functional outcomes, highlighting fair to good ankle scores and full knee movement in all cases. Conclusion: In conclusion, the study underscores the distinctive advantages and considerations of each treatment approach. Multidirectional locked nailing facilitates faster union and joint function restoration but carries a higher malunion risk. Plating, with a lower malunion rate, requires meticulous postoperative care. The choice between the two methods should be individualized, considering patient-specific factors, fracture characteristics, and the surgeon's expertise. This research contributes valuable insights for informed decision-making in distal tibia fracture treatment.

Parathyroid gland identification and angiography classification using simple machine learning methods.

Near-infrared indocyanine green angiography allows experienced surgeons to reliably evaluate parathyroid gland vitality during thyroid and parathyroid operations in order to predict postoperative function. To facilitate equal performance between surgeons, we developed an automatic computational quantification method using computer vision that portrays expert interpretation of visualized parathyroid gland near-infrared indocyanine green angiographic fluorescence signals. Near-infrared indocyanine green-parathyroid gland angiography video recordings (Fluobeam® LX, Fluoptics, Grenoble-part of Getinge-Göteborg) from patients undergoing endocrine cervical surgery in a high-volume unit were used for model development. Computation (MATLAB, Mathworks, Ireland) included segmentation-identification of the parathyroid gland (by autofluorescence), image stabilization (by linear translation) and adjusted time-fluorescence intensity profile generation. Relative upslope and maximum intensity ratios then trained a simple logistic regression model based on expert interpretation and outcome (including hypoparathyroidism), with subsequent unseen testing for validation. The model was trained on 37 patient videos (45 glands, 29 judged well perfused by parathyroid gland angiography experts), achieving feature data separation with 100% accuracy, and tested on 22 unseen videos (27 glands, 15 judged well perfused), including four in real time. Segmentation-guided parathyroid gland detection correctly identified all parathyroid glands during unseen testing along with three additional non-parathyroid gland regions (90% positive predictive value). Subsequent time-fluorescence intensity profile extraction with vitality prediction was shown feasible in all cases within 5 min, with a 96.3% model accuracy (sensitivity and specificity were 93.3 and 100% respectively) when compared with expert judgement. Automatic parathyroid gland perfusion quantification using simple machine learning computational methods discriminates parathyroid gland perfusion in concordance with expert surgeon interpretation, providing a means for near-infrared indocyanine green-parathyroid gland signal evaluation.

COMPARAÇÃOENTRECIRURGIAABERTAEMINIMAMENTEINVASIVAPARA ÚLCERAPÉPTICAPERFURADA

This study conducts a systematic review comparing open surgery and laparoscopic repair techniques for perforated peptic ulcer. The research was performed using PubMed and ScienceDirect databases, covering studies published in the last five years. Nine articles directly comparing the two surgical techniques were included, evaluating factors such as hospitalization time, postoperative complications, wound healing time, and infection rates. The results suggest that laparoscopic surgery offers several advantages, including reduced hospital stay and faster recovery, while open surgery remains relevant in specific cases. The analysis highlights the importance of selecting the surgical technique based on the patient's clinical condition and the surgeon's expertise, with laparoscopy emerging as the preferred approach in most cases. This study aims to provide evidence that can guide surgical practice, promoting better outcomes and a more patient-centered approach to the management of perforated peptic ulcers.

581. SURGICAL TREATMENT OF ACUTE SYMPTOMATIC POST-ESOPHAGECTOMY DIAPHRAGMATIC HERNIA

Abstract Background Post esophagectomy diaphragmatic hernia (PEDH) is a rare, often asymptomatic condition, but it can also present as a life-threatening complication leading to emergency treatment. Acute onset of symptoms such as epigastric pain, shortness of breath and evidence of serious complications like strangulation, necrosis or perforation of the herniated organs represent an indication for emergency surgery. The aim of the present study is to report the experience of a tertiary care center for esophageal disease and to describe the clinical and surgical management of acute-onset PEDH treated in an emergency setting. Methods A retrospective analysis of a prospectively collected database of esophagectomies for cancer (hybrid, open, transhiatal or minimally invasive) performed at our Institution between January 2013 to June 2022 was performed. Early PEDH was defined as onset within 90 days from surgery. All patients with acute presentation of volvulus, ischemia, respiratory dysfunction or perforation were treated surgically by two expert surgeons. Results Among 357 patients, 10 had an urgent PEDH requiring surgery within 24 hours after onset of symptoms. Early PEDH was diagnosed in 5 patients (median time 4 days) and 3 of them had a concomitant diagnosis of anastomotic leak. Late hernia was treated at median time of 249 days. Organ resection was performed in 4 patients. Surgical access was laparoscopy in 8 patients, open and thoracotomy in 2. Cruroplasty was performed in 8 cases. Mortality was 0%. Recurrence was 10%. No preoperative risk factors for PEDH were identified (Table 1). Conclusions Diaphragmatic hernia could be a challenging complication after esophagectomy, that could present either as an early or late complication. Its early recognition is of paramount importance given its association with anastomotic leak or strangulation. Laparoscopic repair should be considered as the approach of choice in high-volume centers and cruroplasty with or without mesh positioning should be evaluated.

806. MINIMALLY INVASIVE REVISION FUNDOPLICATION, IS IT SAFE AND FEASIBLE? SINGLE CENTER EXPERIENCE

Abstract Introduction Laparoscopic fundoplication has become standard of care for patients with refractory gastroesophageal reflux disease, large and symptomatic hiatal hernia. Failure rate for laparoscopic fundoplication was between 2 to 17%. Doing Revisional Antireflux surgery is technically difficult. Our aim is to analyse symptomatic improvement post surgery, safety and durability of procedure in patients who underwent revision fundoplication at our centre Patients and Methods 22 patients underwent Minimally invasive revision fundoplication between January 2019 to January 2022 were taken into study, of them 12 gentlemen and 10 women were noted. Modified DeMeester score was calculated in all patients preoperatively and on 6 months follow up. Results All patients underwent primary surgery laparoscopically. 14 patients (63.6%)had recurrent reflux symptoms and 8 patients (36.3%) had severe dysphagia. Revision fundoplication was done laparoscopically in 20 patients and 2 patients Robotic surgery was done. Intraoperatively 11 patients had wrap migration, 8 patients had tight wrap, 3 patients had twist of wrap. In the re-do anti-reflux surgery (ARS) procedure, floppy Nissen fundoplication was performed in 86.4% of the patients, which amounts to 19 patients., and 3 patient underwent a 270-degree Toupet fundoplication. In 2 patients, additional composite mesh reinforcement was employed. 13.6 % of patients had intraoperative complications, 9.09 % of patients had pleural injury, 4.7 % had intraoperative bleeding, 9.09% of patients had gallstone disease, for which cholecystectomy was done. All patients anterior and posterior vagus identified and preserved. On follow up 80% of patients had resolution of symptoms, 18% needed intermittent PPI. At a median follow up of 18 months, no surgical failure was noted in endoscopy. Conclusion Laparoscopic revision fundoplication is a safe procedure when operated in a high volume centre by an expert surgeon.