Expert Surgeons Research Articles

Early outcomes of treatment selections for infrarenal abdominal aortic aneurysms: The first five year experience of a single center

Aim: We examined the criteria governing patient selection in contemporary practice in cases of infrarenal abdominal aortic aneurysm (AAA) treated electively or urgently in our Cardiovascular Surgery Clinic (CVSC). Material and Methods: From January 2019 to January 2024, we retrospectively evaluated infrarenal AAA patients treated either electively or urgently with Open Surgical Repair (OSR) or standard Endovascular Aortic Repair (EVAR) at our CVSC. The primary endpoints are distribution of AAA patients by treatment modality, early morbidity and mortality. The secondary endpoints were intensive care unit (ICU) duration and length of hospital stay (LOS). Results: A total of 332 patients received EVAR (Group 1), including 296 elective cases, while 90 patients underwent OSR (Group 2), with 66 being elective. Early mortality rates were significantly lower in the EVAR group (1.3% for elective and 27.8% for emergent) compared to the OSR group (6.1% for elective and 54.2% for ruptured cases, p=0.001). Major postoperative complications occurred in 12.5% of elective EVAR patients and 39.4% of elective OSR patients (p=0.001), while in ruptured cases, the rates were 11.1% and 58.3%, respectively (p=0.001). Comparisons of ICU duration and LOS also favored EVAR (p=0.001). Conclusion: EVAR offers a survival benefit in the early period compared to OSR. The choice of treatment should be tailored to the patient's comorbidities, preferences, and the vascular surgeon's expertise. Advanced aortic centers with hybrid operating rooms (HOR) and specialized CVSCs should aim for optimized patient outcomes and cost-effectiveness in our country.

Key Takeaways From the ISASS Webinar Series on Current and Emerging Techniques in Endoscopic Spine Surgery | Part 2: Polytomous Rasch Analysis of Learning Curve and Surgeon Endorsement of Biportal, Interlaminar, and Transforaminal Endoscopic Stenosis Decompression, Discectomy, and Laminectomy in Combination With Interspinous Process Spacers.

The International Society for the Advancement of Spine Surgery hosted the second of a series of 4 webinars on endoscopic spine surgery techniques. The second webinar focused on the application of unilateral biportal endoscopy for discectomy and laminectomy in combination with interbody fusion and interspinous process spacers. This series was intended to identify current trends with contemporary modern endoscopic spine surgery techniques. To analyze the level of surgeon endorsement for the presented endoscopic spine surgery techniques before and after the webinar utilizing polytomous Rasch analysis, as well as to evaluate the potential for these insights to inform clinical guideline recommendations. A survey was available to 667 potential respondents during the Zoom webinar, collecting data on surgeon endorsements using a Likert scale. The polytomous Rasch model was employed to analyze responses while considering the complexity of decisions against surgeon expertise, developing a logarithmic measurement scale, allowing objective statistical analysis of categorical variables, highlighting incongruent or out of order items vs congruent and in order items, and driving improvement in clinical guidelines. Of the 667 surgeons who participated in the webinar, 224 accessed, 122 started, and 61 completed the prewebinar survey, achieving a 50.0% completion rate. Respondents comprised primarily orthopedic surgeons (70.5%) and neurosurgeons (24.6%), with fellows and medical students each making up 1.6%. These surgeons estimated that mastering the learning curve of endoscopic spine surgery required an average of 18.08 cases corroborated by postwebinar responses averaging 15.78 cases. Descriptive statistics revealed an acknowledgment of a learning curve in mastering endoscopic spine surgery, with a slight increase in recognition postwebinar (81.8% up from 80.3%). The data underscored the importance of cadaver courses and high-volume surgical practice before the webinar and highlighted the value of mentorship afterward, indicating a preference shift toward more interactive learning. The confidence in various endoscopic techniques saw notable changes, particularly for procedures involving interlaminar lateral canal decompression and the combined use of transforaminal endoscopic decompression with interspinous process spacers, which saw an increase in high-level endorsements postwebinar. Polytomous Rasch analysis provided insights into training methods and procedural techniques, with mentorship and cadaver courses emerging as key elements for mastering the learning curve. The analysis also highlighted a general consensus on the effectiveness of percutaneous endoscopic interlaminar decompression for lateral canal stenosis, reflecting evolving surgeon preferences and consensus on best practices. Infit and outfit statistics from the Rasch analysis suggested a good fit between the survey responses and the Rasch model both before and after the webinar, indicating minimal data distortion due to bias. Differential item functioning analysis showed no significant bias in item responses between orthopedic surgeons and neurosurgeons in the prewebinar survey, but it identified potential bias for one item postwebinar-unilateral biportal endoscopic laminectomy for central stenosis. This webinar highlighted the importance of hands-on training methods such as cadaver courses and mentorship in mastering the complex spinal endoscopy procedures. The application of polytomous Rasch analysis provided a detailed understanding of surgeons' current preferences and perceptions, as well as the evolving consensus on best practices in endoscopic spine surgery, displaying wide acceptance of the percutaneous interlaminar endoscopic decompression for lateral canal stenosis decompression and a growing interest in integrating endoscopic techniques for more comprehensive spinal care, including wide decompression and spinal stabilization. Assessing surgeon confidence and acceptance of endoscopic spinal surgeries using polytomous Rasch analysis. Level 2 (inferential) and 3 (observational) evidence because Rasch analysis provides statistical validation of instruments rather than direct clinical outcomes.

Key Takeaways From ISASS Webinar Series on Endoscopic Spine Surgery Techniques | Part 4: Advancing the Curve on Surgeons' Experience With Complex Lumbar Revision Scenarios, Grades 1 to 3 Spondylolytic Spondylolisthesis, Cervical Foraminotomy, and Cervical Spondylotic Myelopathy.

The fourth webinar in a 4-part series hosted by the International Society for the Advancement of Spine Surgery explored contemporary endoscopic spine surgery techniques. This session covered complex revision strategies, endoscopic management of grades 1-3 spondylolytic spondylolisthesis, cervical foraminotomy, and decompression techniques for cervical spondylotic myelopathy (CSM). The aim was to assess surgeon endorsement of the discussed endoscopic spine surgery techniques both before and after the webinar using polytomous Rasch analysis. Additionally, the analysis sought to determine how these insights might shape clinical guideline recommendations. Before the webinar, which was attended by 868 potential participants, a survey was distributed to collect data on the level of support for various techniques using a Likert scale. The polytomous Rasch model analyzed these responses by evaluating decision complexity relative to surgeon expertise. This approach helped develop a logarithmic scale to objectively analyze categorical responses, distinguish between congruent and incongruent items, and contribute to the enhancement of clinical guidelines. Of the 868 surgeons, 263 accessed, 150 started, and 118 completed the prewebinar survey, with a completion rate of 78.7%. The participants were mainly orthopedic surgeons (59.3%) and neurosurgeons (34.7%) but also included residents (2.5%), fellows (1.7%), and interventional radiologists (1.7%). In the postwebinar phase, 298 participants accessed the survey, 169 started it, and 128 completed it, achieving a 75.7% completion rate. The demographics of postwebinar participants closely mirrored the initial group: 66.4% orthopedic surgeons, 23.4% neurosurgeons, 3.6% residents, 2.9% fellows, 0.7% medical students, and 2.9% interventional radiologists. The Rasch analysis confirmed high surgeon confidence for the posterior cervical foraminotomy and endoscopic treatment of spondylolytic spondylolisthesis grades 1 to 3 and posterior endoscopic decompression for CSM. Both pre- and postwebinar responses showed a good fit to the Rasch model for these endoscopic techniques, indicating minimal bias, supported by differential item functioning analysis. The application of the endoscopic surgery platform for procedures such as lumbar revision surgery for adjacent segment disease or failed interbody fusion cages and posterior decompression of CSM saw little shift in endorsement, as evidenced both in descriptive and the logarithmically transformed Rasch statistics. This webinar highlighted the evolving consensus on best practices in endoscopic spine surgery, displaying wide acceptance of endoscopic debridement of spondylolytic spondylolisthesis, cervical foraminotomy for herniated disc and bony stenosis, and posterior endoscopic decompression for CSM. Assessing surgeon confidence and acceptance of endoscopic spinal surgeries using polytomous Rasch analysis. Level 2 (inferential) and 3 (observational) evidence because Rasch analysis provides statistical validation of instruments rather than direct clinical outcomes.

BS SO13 - Reversal of OAGB- Audit and steps of surgery

Abstract Background OAGB is a well-established procedure that gives good outcomes in terms of benefits from obesity related morbidity and weight loss. The nutritional complications of OAGB are not common. The most common complication for OAGB is bile reflux which can be controlled with medical or surgical management. The need to convert OAGB to normal anatomy or sleeve does not arise frequently. It is needed in a few patients. It is a technically challenging procedure and should be done in expert centers Method We would like to present a video on the steps of reversal surgery. We recorded our procedure and used imovies software to edit it demonstrating each step of surgery with a written commentary for ease of understanding We would also take this opportunity to present an audit of our series of patients. We gathered our operative sheets from December 2016- Jan 2024. There were 12 patients who needed conversion or reversal. 10 needed conversion to RYGB for bile reflux. 2 needed reversal to normal anatomy. Results High quality video presentation with narration talking about steps of surgery and results from our audit Conclusion Reversal surgery is a technically challenging procedure. It should be done in expert center. Also, since this surgery is not needed frequently, it needs expert surgeons.

Is Half a Century-Based Suturing Pattern Worth the Upgrade? Evaluating a Novel Suturing Technique: Knot Less is More.

The aesthetic outcomes of wise pattern-based breast reduction and mastopexy procedures are significantly influenced by the final scar quality, which is directly impacted by the suturing technique. Over the past century literature on suture placement has remained limited, with little advancement in tissue approximation methods. The success of conventional suturing depends on the surgeon's skills and expertise and the selection of suture material. Proper deep placement of absorbable sutures is essential to reduce risks; in fact, incorrect placement can lead to complications such as poor scar quality and negative psychological effects on the patient, and occasionally more severe issues like delayed wound healing. Our experience with a running suturing technique for wise pattern-based mammoplasty indicates that reducing the number of knots can lead to a better overall experience for both the patient and the surgeon. This technique may improve aesthetic results, decrease complications, and streamline the surgical process.Level of Evidence IV This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266 .

Insights From the ISASS Webinar Series on Current and Emerging Techniques in Endoscopic Spine Surgery | Part 1: Polytomous Rasch Analysis of Surgeon Endorsement of Endoscopic Discectomy/Foraminotomy, Interbody Fusion, and Importance of Patient Feedback During Surgery.

The International Society for the Advancement of Spine Surgery hosted the first of a series of 4 webinars on endoscopic spine surgery techniques, focusing on end§oscopic discectomy, foraminotomy, instrumented endoscopic fusion, standalone lumbar interbody fusion with innovative materials, and the role of patient feedback in awake procedures. This series aims to share knowledge and discuss the complexities and clinical evidence of modern endoscopic spine surgery. To analyze the level of surgeon endorsement for the presented endoscopic spine surgery techniques before and after the webinar, utilizing polytomous Rasch analysis, and to evaluate the potential for these insights to inform clinical guideline recommendations. A survey was available to 1311 potential respondents during the Zoom webinar, collecting data on surgeon endorsements using a Likert scale. The polytomous Rasch model was employed to analyze responses, considering the complexity of decisions against surgeon expertise, developing a logarithmic measurement scale, allowing objective statistical analysis of categorical variables, highlighting incongruent or out-of-order items vs congruent and in-order items, and driving improvement in clinical guidelines. All 4 topics received higher confidence ratings demonstrated by descriptive statistics, highlighting the webinar's effective role in surgeon education and in identifying ongoing trends in spine surgery. The logarithmic transformation of these data during Rasch analysis showed noticeable shifts in surgeon confidence levels postwebinar, with increased endorsement for transforaminal full-endoscopic thoracolumbar interbody fusion for hard disc herniation and standalone endoscopic lumbar interbody fusion. The Wright plot and person-item map analyses demonstrated that the webinar effectively targeted areas of initial low confidence, significantly impacting surgeons' perceptions. Disordered endorsement thresholds remained in the topics of uniportal transforaminal discectomy/foraminotomy and patient feedback during endoscopic spine surgery, indicating issues in response category discrimination or confounding factors not captured by the survey. Ongoing controversies were highlighted by the influence of confounding factors, stemming from preconceived notions and limited familiarity with high-grade evidence. The first in the 4-part webinar series effectively shifted professional confidence and acceptance of innovative surgical approaches among spine surgeons. Observations indicated a high level of interest in applying the endoscopic surgery platform with other advanced technologies. The polytomous Rasch analysis provided nuanced insights into ongoing trends and areas in need of further clarification. Assessing surgeon confidence and acceptance of endoscopic spinal surgeries using polytomous Rasch analysis. Level 2 (inferential) and 3 (observational) evidence because Rasch analysis provides statistical validation of instruments rather than direct clinical outcomes.

British Skull Base Society Consensus on Vestibular Schwannoma Surveillance

Abstract Objective Surveillance plays a crucial role in managing patients with vestibular schwannomas (VSs). Consensus is lacking on the optimal duration, frequency, and modality of imaging. Standardizing this approach would ensure safe and effective care, reduce patient distress, and promote consistency in management decisions among clinicians. Methods In July 2022, a multi-disciplinary Delphi consensus was conducted at the British Skull Base Society Meeting. Expert United Kingdom-based skull-base surgeons and neuroradiologists were presented semi-systematic literature reviews summarizing current evidence on VS management. Anonymized opinions were collated and discussed to reach a majority vote, which was deemed the final consensus opinion. Results Recommendations for VS managed by surveillance are: (1) surveillance frequency should decrease over time; (2) surveillance may be discontinued when the remaining lifetime risk of VS growth is <0.5% (∼8.5 years); (3) factors such as age, VS size, VS location, and cystic components should be considered. Surveillance after surgery or radiotherapy has limited evidence but recommendations are: (4) surveillance should be adjusted based on residual tumor size or nodular enhancement. Imaging modality and sequences are recommended to be (5) high-resolution magnetic resonance imaging with T1, T2, FIESTA/CISS multiplanar sequences, contrast is not required in untreated cases, and linear reporting of measurements is pragmatically sufficient. Conclusion This consensus and literature review provides an evidence and expert opinion–based guide to help clinicians with the surveillance of patients with VS. Further research should focus on better understanding the dynamic nature of growth risks and the growth characteristics of postintervention VS to enable personalized growth risk stratification.

Intraoperative Position System guided with Augmented Reality Improves the Learning Curve of Endovascular Navigation in Endovascular Naïve Operators

ObjectiveThis study aimed to compare the completion of gate cannulation task performed by participants of varying experience using fluoroscopy, the Intra-Operative Positioning System (IOPS) – an FDA-cleared endovascular navigation system that has been developed to reduce dependence on fluoroscopy – or an investigational augmented reality electromagnetic navigation technology based on IOPS. MethodsThe task consisted in the cannulation of the gate of a GORE Excluder AAA endoprosthesis bifurcated aortic stent graft (W.L. GORE & Associates, Flagstaff, AZ USA) deployed into a 3D printed abdominal aortic aneurysm (AAA) model connected to a 7000 MDX flow pump (Sarns Inc/3M, Ann Arbor, MI USA) reproducing physiological conditions. The procedure was performed in a hybrid operating room (GE Allia IGS 7). Each participant performed the cannulation task with fluoroscopy, standard IOPS guidance with flat screen display (IOPS-FS), and the investigational IOPS with augmented reality headset (IOPS-AR), in a randomly assigned order. All participants used the same sensorized guidewire and steerable 6Fr catheter during their three cannulation tasks. A total of 26 participants were classified in three groups of experience: Group 1 (endovascular naïve; n = 13), Group 2 (surgeon in training; n = 12) and Group 3 (one expert surgeon). Primary endpoints included cannulation time and technical success, which was defined as the advancement of the catheter over the guidewire within the main body of the aortic stent graft within a maximum 15 minutes cutoff time for each trial. ResultsIn group 1, the mean cannulation time was shorter using IOPS-AR versus fluoroscopy (4.3 ±4.4 min vs 7.1±4.9 min; P=.04), but not statistically different when comparing IOPS-FS and fluoroscopy (6.3±4.5 min vs 7.1±4.9 min; P=.63). In group 1, technical success was 77% with fluoroscopy and 92% with both IOPS-FS and IOPS-AR (P=.59). In group 2, although there was no significant difference between cannulation time amongst the three different endovascular approaches, there was a trend towards shorter cannulation times with IOPS-FS or IOPS-AR as compared to fluoroscopy (mean time of 2.5±0.9, 4.4±4.0 and 5.2±4.5 min, respectively). In group 2, technical success was 92% with fluoroscopy and 100% with both IOPS-FS and IOPS-AR (P>.99). The expert vascular surgeon repeated the cannulation task four times for each endovascular approach, with 100% technical success and no difference in mean cannulation time between the imaging modalities (P=.89). ConclusionsAugmented reality allows for reducing the gate cannulation time as compared to fluoroscopy in participants with no previous exposure to any endovascular procedure. This suggests that augmented reality can be beneficial for individuals early in their career and can mitigate the learning curve. As individuals become experts, their ability to adapt to different endovascular modalities increases, eliminating the learning curve altogether.

Measuring up: Ensuring Intra- and Interobserver Reliability in Stretched Penile Length with the SPLINT Technique

ABSTRACT Background: A discrepancy between the true and measured value of stretched penile length (SPL) may be a result of errors that can either be systematic or random. Hence, it becomes important to focus on the quality of measurements to prevent any iatrogenic harm to the patients. Objective: The objective of this study was to assess the magnitude of intra- and interobserver variations in the measurement of SPL with the SPLINT technique. Materials and Methods: SPL was measured prospectively in a cohort of 449 boys aged 0–14 years including 68 infants (substratified into Group I: >4 years, Group II: 4–8 years, and Group III: >8 years) with the SPLINT technique by expert (E: E1 and E2) and trainee (T: T1 and T2) surgeons after completing a three-tiered training module. Intra- and interobserver variability was assessed through descriptive statistics, intraclass correlation (ICC), relative technical error of measurement (rTEM), and reliability or R (%). Results: Intraobserver variability: the mean difference between the two readings (E1 and E2) is 0.08 cm (95% confidence interval [CI]: 0.073–0.087), ICC was 0.998 (95% CI: 0.997–0.998), and intraobserver variability ≤0.1 cm in 85% of the participants (n = 370 of 433). The rTEM and reliability (%) were 1.82% and 98.1% (Group I), 1.65% and 98.9% (Group II), and 1.09% and 99.7% (Group III), respectively. The intraobserver variability was observed to be inversely proportional to the age of the participants (correlation coefficient = −0.56). Interobserver variability was calculated separately for expert versus trainee and trainee versus trainee (T-vs-T) measurements. For expert versus expert, ICC, rTEM, and reliability (%) were 0.984, 2.4%, and 96.8% (Group 1), 0.992, 2.07%, and 98.3% (Group 2), and 0.997, 1.38%, and 99.05% (Group 3), respectively. A similar pattern of variability was observed for T-vs-T measurements. The reliability (%) of the SPL by experts is consistently more than that of trainees across all age groups; however, the difference ameliorates with the age of participant. Conclusions: The study has validated the SPLINT technique by demonstrating a high level of intra- and interobserver reliability. The adequacy of the training modules for SPL measurements described in this study has also been established. Evidence that the SPL can be used as an objective marker of penile dimensions is herewith furnished.

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.

A Systematic Review Comparing the Outcomes of Cemented Versus Uncemented Stems in Femoral Impaction Bone Grafting for Revision Hip Arthroplasty.

Femoral impaction bone grafting is a crucial technique in revision hip arthroplasty, addressing bone loss and ensuring implant stability. The choice between cemented and uncemented stems significantly influences the outcomes and long-term success of the procedure. This systematic review aims to compare the clinical outcomes of cemented versus uncemented stems in femoral impaction bone grafting. A comprehensive search of PubMed, MEDLINE Complete, and the Cochrane Library databases was conducted in accordance with Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. Studies evaluating the outcomes of femoral impaction bone grafting with cemented or uncemented stems were included. The primary outcome measured was the rate of loosening of the femoral component, while secondary outcomes included the incidence of complications such as dislocation, infection, fractures, overall patient mortality, and cardiopulmonary diseases. The literature search yielded 78 articles, with 36 meeting the inclusion criteria. These included one randomized controlled trial, 16 cohort studies (10 retrospective and six prospective), and 15 case series. Most surgeries were revision procedures, with aseptic loosening being the most common indication. For the cemented technique, 1,588 hips were analyzed, with 8.00% experiencing aseptic loosening, 3.53% dislocation, 3.87% infection, 37.33% mortality, 7.57% fractures, and 1.13% cardiopulmonary complications. For the uncemented technique, 464 hips were analyzed, with 1.72% aseptic loosening, 4.74% dislocation, 1.5% infection, 38.47% mortality, 7.76% fractures, and 0.65% cardiopulmonary complications. This systematic review highlights that both cemented and uncemented techniques for femoral impaction bone grafting offer unique benefits and challenges, with the choice depending on patient-specific factors. The uncemented technique, with a lower risk of femoral component loosening, may be better suited for younger, active patients with good bone quality, despite a slightly higher risk of fractures and dislocations. In contrast, the cemented technique, offering immediate stability, is more appropriate for elderly patients with compromised bone quality but carries a higher risk of loosening and cardiopulmonary complications. The decision should be tailored to the patient's clinical profile, including age, bone quality, comorbidities, and the surgeon's expertise.

InceptionResNetV2 Based Eye Cataract Detection

An eye lens is a key source for visualizing things. Sometimes it may be cloudy, caused by cataracts, and disturb the visualization process. It is necessary to detect and treat the cataract in its early stages; otherwise, it may lead to blindness. For the early detection of eye cataracts, many solutions have been proposed in past years by experts. However, it requires an expert ophthalmologist or eye surgeon to detect cataracts in its early stages because early detection of cataracts is a challenging task. Now this is the era of digitalization and AI. Everyone is talking about AI. Many researchers use AI to propose a solution to this problem. This study also proposed an AI-based cataract detection solution. A binary class eye fundus images data set was used for this research work. The ”Cataract” data set is a famous dataset for detecting cataracts on KAGGLE. Some image augmentation techniques were used to enhance the data set proficiency. In this study, InceptionResNetV2 was applied with some hyper-parameter tuning. The proposed methodology achieved a training accuracy of 99% and a validation accuracy of 98%.

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.

La prise en charge des cancers médullaires de la thyroïde en 2024

MANAGING MEDULLARY THYROID CARCINOMA IN 2024: Medullary thyroid carcinoma is a rare neuroendocrine thyroid cancer with a heterogeneous prognosis which has the particularity of being associated with a RET gene mutation, germline in 20-25% of cases in the context of multiple endocrine neoplasia type 2 (NEM2), and somatic in 70% of sporadic cases. It is often diagnosed on a thyroid nodule or in the context of genetic screening. Calcitonin is a biological marker, used for diagnosis, monitoring of therapeutic response and prognostic evaluation. The only curative treatment is surgery for localized disease. The extent must be carefully assessed, particularly in terms of calcitonin levels and imaging, and carried out by an expert surgeon. The prognosis of locally advanced or metastatic disease is highly heterogeneous. Histological factors, such as high grade, or biological factors, such as calcitonin doubling time, can help assess prognosis. The development of multi-kinase inhibitors cabonzantinib and vandetanib, and RET-targeted inhibitors selpercatinib, has completely changed the therapeutic arsenal for advanced disease, but their prescription is reserved to progressive disease with high tumor volume or to symptomatic disease inaccessible to local treatment in expert centers from the ENDOCAN-TUTHYREF network. Active surveillance is the alternative of choice for slowly progressing disease.

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.