Incision Size Research Articles

Surgical Challenges for WIOL-CF® Dislocation without Capsular Bag Complex after Trauma: A Case Report

Purpose: To present a case of post-traumatic dislocation of the WIOL-CF<sup>®</sup> accommodating intraocular lens (IOL), composed of hydrogel material and featuring a full-optic body design, in a vitrectomized eye, highlighting considerations for surgical correction.Case summary: A 54-year-old man with a history of left-eye WIOL-CF<sup>®</sup> implantation and vitrectomy experienced sudden onset of vision deterioration in the left eye following trauma. The IOL was dislocated due to posterior capsule rupture, with the anterior capsulorhexis margin intact. The support-less circular design and material properties made it challenging to grasp the dislocated IOL in one attempt, and there was a risk of tearing when using intraocular forceps and an extrusion needle.Conclusions: The case of WIOL-CF<sup>®</sup> dislocation without the capsular bag emphasizes the importance of considering the structural vulnerability and propensity for fragmentation of the IOL during removal. Adequate corneal incision size, active utilization of perfluorocarbon liquid to approximate the IOL to the anterior chamber, and gentle removal in one attempt without applying excessive force are crucial steps in the removal of a dislocated IOL.

BN SO50 - The Resurgence of Veress Needle Insufflation: An Evaluation of Efficacy and Safety of One Surgeon’s Practice

Abstract Background Veress needle insufflation has been established as a safe and effective method of establishing pneumoperitoneum for laparoscopic surgery, with comparable risk profile to open methods. However, the blind nature of the procedure with potential complications such as iatrogenic bowel and blood vessel injury has seen this technique fall out of fashion with general surgeons. This study reviews the safety and efficacy of a single surgeon’s practice using Veress needle insufflation for Laparoscopic surgical procedures. Method A retrospective analysis was conducted on minimally invasive procedures performed between January 2019 and June 2024. In our practice, a standard or bariatric Veress needle is placed in a small incision at Palmer’s point. A manometer test is performed with CO2 insufflation at a low flow rate and raising the abdominal wall. If a low pressure is established, then the flow is increased to achieve adequate pneumoperitoneum before introduction of a midline 5mm camera port. Primary outcomes of this study include rate of conversion to open techniques (either Hasson’s or open cut down) and any complications. Results Of the 702 cases reviewed, five patients (0.71%) required conversion to open insufflation techniques. Two (0.28%) had bleeding from the omentum, and one patient (0.14%) experienced inadvertent bowel insufflation which was managed conservatively with no long-term morbidity. Notably there were no port site hernias. Conclusion This study supports the continued use of the Veress needle as a safe and effective method of insufflation in laparoscopic surgery. It offers minimal incision size, easier access in high BMI patients, and an alternative when adhesions and scarring limit access. Furthermore, adopting this technique can be particularly useful for appropriate port placement in robotic surgery, making it a valuable tool for modern surgical practices.

Efficacy of domestic single-hole robotic surgery system in the treatment of pediatric urological diseases

To explore the efficacy of domestic single-hole robotic surgery system in the treatment of pediatric urological diseases. A prospective review of clinical data of children who underwent laparoscopic surgery in the Department of Urology, Shanghai Children's Medical Center, School of Medicine, Shanghai Jiao Tong University, was conducted from July to November 2023. All surgeries were performed using the sharp single-port serpentine arm robotic surgery system, with an umbilical access route. All surgeries are performed by the same chief physician. Operative time, intraoperative blood loss, incision size, and postoperative complications were recorded. A total of 12 patients were included, consisting of 8 males and 4 females, aged 8.0-17.0 (13.5±2.7) years. The procedures included 5 pyeloplasties (1 case of bilateral pyeloplasty), with a unilateral operative time [M (Q1, Q3) ]of 180 (145, 200) minutes and a blood loss of 5 (5, 10) ml. Oral mucosa ureteroplasty was performed in 1 patient, taking 3 hours and 52 minutes with a blood loss of 10 ml. Renal cyst decortication was conducted in 1 case in 85 minutes with a blood loss of 20 ml. High ligation of the spermatic vein was conducted in 3 patients, with an average operative time of 97 minutes and no intraoperative blood loss. Bilateral gonadectomy was completed in 80 minutes with a blood loss of 5 ml. Ovarian cystectomy (1 case) was performed in 69 minutes with a blood loss of 5 ml. All surgeries were successfully completed without conversion to open surgery. Except for the oral mucosa ureteroplasty, which required an additional 5 mm auxiliary port, all procedures were performed through a 3 cm umbilical incision. Among the patients who underwent pyeloplasty, 1 case of urinary leak was identified and successfully treated conservatively with adequate drainage over 25 days. Re-stenosis was experienced by 1 patient with a long segment ureteral stricture postoperatively, while no Clavien-Dindo grade≥2 complications were observed in other patients. All umbilical wounds were concealed, and satisfactory postoperative appearances were noted. The domestic single-hole robotic surgery system is effective in treating pediatric urological diseases.

Our surgical technique for primary spontaneous pneumothorax via uniportal video-assisted thoracoscopic surgery (incision size: 1.8 cm).

Our surgical technique for primary spontaneous pneumothorax via uniportal video-assisted thoracoscopic surgery (incision size: 1.8 cm).

Comparison of diagnostic yields, operative times, and post-operative hemorrhage between twist drill versus burr hole craniotomy approaches for stereotactic needle brain biopsy.

Stereotactic frameless needle brain biopsy is a common neurosurgical procedure performed via twist drill or open burr hole approaches. We aim to compare diagnostic yields and surgical outcomes to delineate the safety and efficacy of both approaches. A retrospective database of all stereotactic needle biopsy procedures performed at a single institution over 30 months was conglomerated. Demographics, medical comorbidities, operative details/complications, immediate post-operative imaging, and pathology were abstracted. Two hundred and twenty-five needle biopsies were identified, of which 165 (73.3%) were open, and 60 (26.7%) were twist drill. Diagnostic pathology yield rates between open (84.8%) and twist drill (93.3%) approaches were similar (p = 0.15), with a median of 4 cores taken in each (p = 0.30). Diagnostic tissue yields with an intra-operative pause for pathology confirmation was 90.4% compared to 79.1% without pause (p = 0.036, OR 2.49). Median operative times for open versus twist drill procedures were 68.0min (IQR 49-83) versus 35.5min (IQR 26-54), respectively (Wilcoxon p < 0.001), which remained significant after controlling for awaiting intraoperative pathology using bivariable linear modeling (p < 0.001). Intraoperative bleeding through the needle cannula was noted in 22 patients (9.8%), including eight twist drill (13.3%) and 14 open needles (8.5%). Of 197 cases (87.6%) with post-operative cranial imaging (CT/MRI), 90 (45.7%) demonstrated some degree of post-operative hemorrhage characterized as superficial (n = 10, 11.1%), deep/intralesional (n = 64, 71.1%) bleeding, or both (n = 16, 17.9%). Bleeding rates between open (46.7%) and twist drill (43.3%) approaches were similar (p = 0.78). Post-operative clinical decline or neurological change was noted in 9 patients (4.0%), including one twist drill (1.7%) and eight open needles (4.8%), among which 7 (78%) had deep blood products identified on post-operative imaging. Stereotactic needle biopsy via twist drill approach has similar diagnostic yield rates, asymptomatic bleeding rates, and post-operative complications with significantly shorter operative time and smaller incision size than conventional open burr hole needle biopsy. Using intra-operative frozen histopathology for presumed sufficient diagnostic tissue may improve final pathologic diagnostic rates regardless of approach technique.

How do intraocular lens materials influence the outcome of cataract surgery?

This review summarizes the evidence on the effect of intraocular lens (IOL) material on the outcomes of cataract surgery, as well as on the surgical procedure itself. Differences in capsular biocompatibility between IOL materials lead to variations in capsular stability and posterior capsule opacification (PCO), while differences in uveal biocompatibility affect postoperative inflammatory response. Refractive outcomes are affected by both incision size and the rotational stability of toric IOLs. Small incision sizes favour hydrophilic IOLs. Rotational stability of hydrophobic and hydrophilic IOLs were comparable in recent studies. Visual outcomes are affected by chromatic aberrations, dysphotopsia, lens opacifications and PCO. Hydrophilic IOLs are associated with reduced chromatic dispersion. Hydrophobic IOL opacifications are caused by sub-surface glistenings, while hydrophilic IOL opacifications are due to surface calcifications. Some surgeries, including pars plana vitrectomy and lamellar corneal transplants, were shown to increase the risk of IOL calcifications, although the mechanism is still unknown. Hydrophilic IOLs have greater ease of manipulation, greater resistance to IOL damage, and higher uveal biocompatibility. Hydrophobic IOLs show better PCO prevention than hydrophilic IOLs, and should be preferred in highly myopic eyes where Nd:YAG capsulotomy might increase the risk of retinal detachment.

Right thoracotomy with central cannulation for valve surgery: 10 years of experience.

The aim of this study is to report the early outcomes of valvular heart surgeries performed via the right thoracotomy approach. While thoracotomy with femoro-femoral bypass is an established method for minimally invasive open-heart surgeries, thoracotomy with conventional cannulation is still being explored. In our center, we conducted 958 valvular heart surgery cases using the right anterolateral thoracotomy approach with central cannulation and data were analyzed. This is a retrospective observational study based on prospectively collected data from patients who underwent valvular heart surgery at our center spanning from April 2013 to April 2023. The data encompass demographics, procedures, operative techniques, post-operative morbidity, mortality, and a 1-month follow-up. Our study revealed no procedure-related mortality. No patient required conversion to median sternotomy. Smooth cannulation and satisfactory exposure were achieved in all patients. The study encompassed a wide age range, from 14 to 68 years, with 618 female patients (64.5%) and 340 male patients (35.5%). The average cross-clamp time ranged from 38 to 90min, the duration of cardio-pulmonary bypass ranged from 45 to 105min, post-operative extubation ranged from 3 to 8h, the average drain volume ranged from 100 to 350ml, and the incision size ranged from 5 to 7cm. Our data demonstrate that conventional cannulation via the right antero-lateral thoracotomy approach for valvular heart disease is a viable alternative to reduce the side effects associated with sternotomy and femoral cannulation. This procedure is safe, reproducible, and provides the same level of treatment quality.

Effective minimally invasive strategy for mixed-type gynecomastia using vacuum-assisted mastectomy and power-assisted liposuction

IntroductionMixed-type gynecomastia is a benign male breast condition characterized by the proliferation of glandular and adipose tissues. Conventional open surgery has been the main approach for treating gynecomastia. However, this method has been associated with complications, including breast deformity, noticeable scar, nipple necrosis, and hypoesthesia. In contrast, Vacuum-assisted biopsy systems and liposuction have demonstrated significant advantages in minimal invasive breast surgery. AimsOur study aimed to investigate the effectiveness of combining vacuum-assisted mastectomy with power assistant liposuction (VAM+PAL) for patients with mixed-type gynecomastia compared to conventional open surgery. MethodsSixty patients with mixed-type gynecomastia, treated between January 2019 and June 2023, were included in this study. VAM+PAL was performed on 30 patients (59 breasts), while open excision with peri-areola approach was performed on another 30 patients (59 breasts). The efficacy, complications, outcomes, scar cosmesis, and patient satisfactions were assessed. ResultsCompared to open excision for gynecomastia, the VAM+PAL group demonstrated a substantial reduction in incision size (4.47±1.21cm vs. 0.97±0.74cm, p<0.001) and lower scores of Vancouver scar scale (3.23±2.27 vs. 1.10±1.47, p<0.001). No drainage tubes were required for postoperative hematoma/seroma prevention. The patients in the VAM+PAL group had a significantly lower complication rate (18.64% vs. 3.39%, p=0.008), particularly in bruise and hypoesthesia. All VAM+PAL patients reported superior satisfaction with the outcomes in breasts and nipples. ConclusionThe combination of vacuum-assisted mastectomy and power assistant liposuction can be used as an efficient minimally invasive method to treat mixed-type gynecomastia with acceptable complications, superior scar cosmesis, and satisfying outcomes.

Imaging findings in suspected penile fracture: alternative diagnoses and surgical correlation.

The primary objective is to compare the imaging and surgical findings in a cohort of patients with suspected penile fracture (PF). Retrospective cohort study of all patients with suspected PF over an 11-year period at a tertiary referral andrology centre. All dedicated presurgical imaging with ultrasound (US) and MRI was analysed and correlated with intraoperative findings; alternative diagnoses were recorded. One hundred and ninety-three patients were included. One hundred and four (54%) had alternative diagnoses to PF including dorsal vein rupture and haematoma. Ninety-nine (51%) underwent surgical exploration of which 89 (46%) had PF. US correctly confirmed the presence and marked the site of fracture in 92% of cases. MRI was primarily used as a problem-solving tool (13 cases) and demonstrated a more extensive injury than US (12 cases). The reported size of tunical defect on imaging was a median of 7 mm (IQR 4-10) significantly smaller than on exploration (median 20 mm, IQR 10-30; P < .0001). US has a high positive predictive value in the confirmation of PF. MRI improves the detection and characterizing the extent of injury. Imaging marking informs surgical incision but defect size is under appreciated on all imaging modalities. Penile imaging has a high positive predictive value to not only confirm the diagnosis of PF but to stage the extent of injury and mark the skin, which impacts the surgical technique. Alternative diagnoses to fracture are common and imaging could prevent unnecessary surgical exploration.

Use of Advanced Energy Devices and Fiberoptic Retractors in Single-Incision Breast-Conserving Surgery for Breast Cancer.

The use of advanced energy devices for mastectomy and axillary lymph node dissection can reduce perioperative blood loss, seroma formation, and drainage duration/volume. Retraction using fiberoptic retractors can help visualize deep and narrow surgical fields. We aimed to compare the postoperative outcomes between single-incision breast-conserving surgery (SIBCS) and conventional breast-conserving surgery (CBCS) with axillary staging using advanced energy devices and conventional equipment, respectively. We retrospectively reviewed the medical records of 244 patients who underwent BCS with axillary surgery between March 2018 and September 2019 at Severance Hospital. The patients were grouped based on the device used to aid in axillary staging: CBCS group (n=117) used conventional electrocautery; and SIBCS group (n=127) used advanced energy devices and fiberoptic retractors. The two groups were compared for postoperative outcomes. The mean patient age was 55.9 and 53.1 years in the CBCS and SIBCS groups, respectively. Incision size was significantly smaller in the SIBCS group than in the CBCS group (6.3±2.1 cm vs. 7.5±2.5 cm, p=0.044). There were no significant differences between the two groups in terms of operating time (126.0±40.0 min vs. 127.0±63.0 min, p=0.828), operative blood loss (11.0±31.0 mL vs. 7.0±18.0 mL, p=0.100), drainage duration (7.0±3.0 d vs. 8.0±4.0 d, p=0.288), and complications (1.70% vs. 2.36%, p=0.523). Using advanced energy devices for SIBCS with axillary staging reduced incision size and provided better cosmetic outcomes compared to those using the conventional method. Advanced energy devices may offer better surgical outcomes in patients who undergo BCS with axillary staging.

Impact of minimally invasive surgery on immune function and stress response in gastric cancer patients.

Gastric cancer remains a leading cause of cancer-related mortality globally. Traditional open surgery for gastric cancer is often associated with significant morbidity and prolonged recovery. To evaluate the effectiveness of laparoscopic minimally invasive surgery as an alternative to traditional open surgery for gastric cancer, focusing on its potential to reduce trauma, accelerate recovery, and achieve comparable oncological outcomes. This study retrospectively analyzed 203 patients with gastric cancer who underwent surgery at the Shanghai Health Medical College Affiliated Chongming Hospital from January 2020 to December 2023. The patients were divided into two groups: Minimally invasive surgery group (n = 102), who underwent laparoscopic gastrectomy, and open surgery group (n = 101), who underwent traditional open gastrectomy. We compared surgical indicators (surgical incision size, intraoperative blood loss, surgical duration, and number of lymph nodes dissected), recovery parameters (time to first flatus, time to start eating, time to ambulation, and length of hospital stay), immune function (levels of IgA, IgG, and IgM), intestinal barrier function (levels of D-lactic acid and diamine oxidase), and stress response (levels of C-reactive protein, interleukin-6, and procalcitonin). The minimally invasive surgery group demonstrated significantly better outcomes in terms of surgical indicators, including smaller incisions, less blood loss, shorter surgery time, and more lymph nodes dissected (P < 0.05 for all). Recovery was also faster in the minimally invasive surgery group, with earlier return of bowel function, earlier initiation of diet, quicker mobilization, and shorter hospital stays (P < 0.05 for all). Furthermore, patients in the minimally invasive surgery group had better preserved immune function, superior intestinal barrier function, and a less pronounced stress response postoperatively (P < 0.05 for all). Laparoscopic minimally invasive surgery for gastric cancer not only provides superior surgical indicators and faster recovery but also offers advantages in preserving immune function, protecting intestinal barrier function, and mitigating the stress response compared to traditional open surgery. These findings support the broader adoption of laparoscopic techniques in the management of gastric cancer.

Syringosubarachnoid shunting with augmented reality navigation through a keyhole laminectomy of the upper thoracic spine: illustrative case.

A syringosubarachnoid (SS) shunt combined with keyhole hemilaminectomy is a beneficial procedure that can reduce the size of the skin incision and the risk of complications. However, ingenuity is needed to confirm the position of the syrinx during surgery. The authors present a case in which they treated syringomyelia in the upper thoracic spine using augmented reality (AR) to confirm syrinx formation, bone resection, and skin incision. Microscope-based AR was an appropriate and practical choice in this case. By placing the reference array at the Mayfield clamp, it was possible to use AR from the point of skin incision. Under AR navigation, an SS shunt tube can be placed in the short syrinx. AR navigation enables pinpoint SS shunt tube insertion with minimal skin incision and bone resection. It is particularly useful for upper thoracic and small syrinx lesions. https://thejns.org/doi/10.3171/CASE24130.

Medial Patellofemoral Ligament Reconstruction in Adolescents: What Parents Care About.

Numerous techniques exist for pediatric medial patellofemoral ligament (MPFL) reconstruction (MPFL-R). Pediatric orthopaedic surgeons and patient families must navigate choices between allograft and autograft, incision type, and surgery cost. While previous research has found similar surgical outcomes among different MPFL-R techniques, minimal data exists on what patients and their families prefer. To engage in shared decision-making (SDM), pediatric orthopaedic surgeons must understand family preferences, including between incision type and cost. We conducted a study utilizing choice-based conjoint (CBC) analysis to explore these preferences. A survey was developed using Sawtooth Software (Lighthouse Studio version 9.2.0) to gather demographic information and preferences on surgical scenarios via CBC analysis. Anonymous participants, recruited via the Prolific crowdsourcing platform, qualified if they were US residents over 18 years of age with children aged 13 to 17. Data analysis involved the Hierarchical Bayes (HB) method to generate utility scores to determine the desirability of attributes. The study included 496 participants who prioritized surgical success (average importance 48.8%) followed by co-pay amount (21.5%), incision size (17.4%), and return to sport (12.3%). Participants earning over $200,000 annually prioritized incision size over cost (25.8% vs. 12.1%, P<0.0053). Those with incomes below $50,000 valued recovery time at a lesser extent than other income groups (10.4% than 12.3% overall importance P<0.0003). The sex of the child significantly influenced preferences: incision size was more important to parents of girls (21.1%) than boys (14.0%, P<.0001). The importance of surgery success and recovery time also differed by sex, being higher for boys (50.4%, 13.1%) than girls (47.0%, 11.7%; P=0.025, 0.026, respectively). This CBC analysis suggests parents of adolescent patients undergoing MPFL-R most value surgical success (avoiding revision surgery), followed by copay, incision size, and time to return to sport. Of note, parent income level and sex of the child significantly influenced parental preferences. We hope this information will assist orthopaedic surgeons in SDM in MPFL-R surgery. Level III.

Manual Sutureless (MSICS) Cataract Surgery and Corneal Astigmatism

The most frequent preventable cause of blindness worldwide is cataracts. Manual Small Incision Cataract Surgery (MSICS) is still very much in use, even though cataract surgery is always changing. The resurgence of MSICS can be attributed to its low cost and safety, as it primarily uses easily sterilizable equipments and does not require sophisticated technology. This study aims to assess corneal astigmatism and manual sutureless (MSICS) cataract surgery after a month of follow-up. Forty individuals with cataract diagnoses were enrolled in this prospective study. During the procedure, a posterior chamber intraocular lens (IOL) implantation was done in addition to a superior manual minor incision under local anesthesia. The findings indicated that 15% or so of the patients experienced astigmatism following surgery. Also the findings revealed that sphere and cylinder refraction was significantly influenced by surgery. The means of sphere refraction before and after surgery were 3.93±6.37 and 0.93±0.98 D, while the corresponding means for cylinder refraction were 1.37±1.08 and 1.94±1.18 D. The results showed that means preoperative and postoperative Keratometry of cornea (K1) were 43.09±1.21 and 43.37±1.42 mm, while the corresponding means of Keratometry (K2) were 43.97±1.35 and 44.49±1.59 mm. The study concluded that the length of the superior incision (6.0 mm) may have contributed to the higher mean SIA than reported in other studies. However, more research is required to determine the impact of incision size on surgically produced astigmatism.

Green Guidewire Combined with Epidural Needle-Saline Separating Minimize Invasiveness and Optimize Outcomes in Single-Port Laparoscopic Treatment for Pediatric Inguinal Hernia.

Objective: To investigate the application value, feasibility, and safety of modified single-port laparoscopic surgery in the treatment of pediatric inguinal hernia. Methods: One hundred and twenty cases of children with indirect inguinal hernia admitted from 2017 to 2022 were enrolled in the Control and Observation groups, with 80 and 40 cases, respectively. They underwent traditional open high ligation of the hernia sac and modified single-port laparoscopic high ligation of the hernia sac, respectively. The operation duration, surgical incision size, intraoperative bleeding, postoperative hospital stay, first ambulation time, and hospitalization expenses were compared between the two groups, as well as the incidence of surgical complications in the two groups. Results: The surgical incision size, intraoperative bleeding, postoperative hospital stay, and first ambulation time of the Observation group were less than those of the Control group. There was no significant difference in operation duration or hospitalization expenses between the two groups. Only two cases in the Observation group showed suture knot reactions after surgery, with no incision infection, inguinal hematoma, iatrogenic cryptorchidism, etc. The overall incidence of complications in the Observation group was lower than that of the Control group. Conclusion: Modified single-port laparoscopic surgery for inguinal hernia in children has the advantages of minimal invasiveness, and enhanced recovery, along with fewer complications and recurrence, hence it is worthy of recommendation in clinical practice.

Shape and Size of the Annulus Fibrosus Excision Alters the Biomechanics of the Intervertebral Disc.

Biomechanical testings and finite element analysis. This study aims to investigate how annulus fibrosus (AF) incision size (RIS, Ratio of incision width to AF height) and shape affect intervertebral disc (IVD) biomechanics. A validated finite element model of lumbar spines simulated various incisions in the middle-right posterior region of the AF, with different sizes and shapes. Simulations included axial compression, flexion, extension, bending, and rotation. Parameters assessed included stability, re-herniation, and IVD degeneration by analyzing stress, height, Intradiscal pressure (IDP), and the range of motion (ROM). Incision increased AF stress and ROM under 3 Nm moment, with values rising as RIS increased. RIS exceeding 40% resulted in a 20% AF stress increase during compression and extension, while RIS over 50% led to over 20% AF stress increase during other motions. Incision stress also increased with higher RIS, particularly surpassing 50% RIS. IDP rose across all incision shapes. Endplate stress increased (9.9%-48.9%) with larger incisions, with average increases of 12.8%, 12.7%, 30.5%, and 22.8% for circular, oval, square, and rectangular incisions. Compression and rotation minimally affected NP pressure (<15%), while flexion (19.8%-38.8%) and bending (18.5%-43.9%) had a more pronounced effect. ROM increased with RIS (20.0% ∼ 77.4%), especially with an incision RIS exceeding 40%. AF injury elevates AF stress, reduces spine stability, heightens degeneration risk with increasing RIS. Reherniation risk rises when RIS exceeds 40%. Circular or oval incisions maintain spine biomechanics better than square or rectangular ones.

Comparison of dynamic hip screw with anti-rotation screw and femoral neck system internal fixation for the treatment of garden II-IV type femoral neck fractures.

Femoral neck fractures, which are fractures occurring from the femoral head to the base of the femoral neck, are prevalent in the elderly population. With the progression of societal aging, the incidence of femoral neck fractures has been steadily increasing, making it a significant global issue that urgently needs to be addressed. To compare the efficacy and safety of dynamic hip screw (DHS) with anti-rotation screw and femoral neck system (FNS) internal fixation for the treatment of Garden II-IV type femoral neck fractures. A total of 90 patients with Garden II-IV type femoral neck fractures were randomly assigned to either the control group (n= 45) treated with DHS and anti-rotation screw or the experimental group (n= 45) treated with FNS. Surgical outcomes, including incision size, blood loss, operation time, fluoroscopy frequency, and fracture healing time, were compared. Postoperative complication rates, reoperation rates, Harris scores, and visual analogue scale (VAS) scores were also assessed. The experimental group demonstrated significantly reduced incision length, blood loss, operation time, and fluoroscopy frequency compared to the control group (P< 0.01). No significant differences were observed in fracture healing time, Garden classification, or fracture reduction outcomes between the two groups (P> 0.05). At 6 months post-treatment, both groups showed significant improvements in Harris scores and VAS scores compared to pre-treatment (P< 0.05), with no significant differences between the groups (P> 0.05). The rates of internal fixation failure, nonunion, and avascular necrosis of the femoral head, as well as overall incidence of postoperative complications and reoperation rates, showed no significant differences between the two groups (P> 0.05). Both DHS with anti-rotation screw and FNS internal fixation demonstrated comparable efficacy and safety profiles in the treatment of Garden II-IV type femoral neck fractures. The experimental group showed advantages in terms of reduced incision length, blood loss, operation time, and fluoroscopy frequency, while maintaining similar clinical outcomes and complication rates.

ИСПОЛЬЗОВАНИЕ AR-НАВИГАЦИИ ПРИ ПОСТАНОВКЕ ВЕНТРИКУЛЯРНЫХ ДРЕНАЖЕЙ НА КАДАВЕРНОМ МАТЕРИАЛЕ

Augmented reality (AR) technologies are being actively introduced into medicine. AR can be used as a navigation tool in neurosurgery. The purpose of our study is to evaluate the accuracy of placement of external ventricular drainage, the size of the incision and the duration of this manipulation in an animal model using AR navigation and without its use. A CT scan of an animal model (ram's head) was performed, the results were segmented and loaded into AR-glasses. Participants in the experiment are divided into 2 groups of 5 people each. In the main group, ventricular drainage was placed using AR navigation, in the control group without its use. The average incision size in the non-AR group was 29.58 ± 1.566 mm. In the AR group 29.42 ± 1.279 mm. The differences in the two groups are statistically insignificant (p=0.797). In the AR group, the mean operative time was 10.26 ± 1.121 min. In the group without AR use 13.64 ± 1.588 min. The differences between the groups are statistically significant (p&lt;0.05). In the AR group, drainage was inserted into the ventricle in 47 of 50 cases (94%). In the group without the use of AR in 40 cases out of 50 (80%). These differences are statistically significant (p=0.037). AR navigation does not affect the size of the incision, but increases the accuracy of drainage placement and reduces the duration of the procedure. This shows the possibility of using this technology in clinical practice, however, additional research on the use of AR in phantom models is required.

Clinical efficacy and performance evaluation of a bendable remote robot system for a bone tumour surgery: A pilot animal study.

Traditional open surgery for bone tumours sometimes has as a consequence an excessive removal of healthy bone tissue because of the limitations of rigid surgical instruments, increasing infection risk and recovery time. We propose a remote robot with a 4.5-mm diameter bendable end-effector, offering four degrees of freedom for accessing the inside of the bone and performing tumour debridement. The preclinical studies evaluated the effectiveness, clinical scenario, and usability across 12 total surgeries-six phantom surgeries and six bovine bone surgeries. Evaluation criteria included skin incision size, bone window size, surgical time, removal rate, and conversion to open surgery. Preclinical studies demonstrated that the robotic approach requires significantly smaller incision size and procedure times than traditional open curettage. This study validated the performance of the proposed system by assessing its preclinical effectiveness and optimising surgical methods using human phantom and bovine bone tumour models.

Имплантация гидрофобной акриловой монофокальной интраокулярной линзы, предустановленной в инжектор

Aim. To evaluate clinical and functional results of implantation of a new hydrophobic acrylic monofocal IOL in a preloaded injector. Methods. The prospective study included 60 patients (66 eyes) after Hoya iSert® 250/251 IOL implantation (31 patients, 35 eyes, group 1) and a new Hoya Vivinex Multisert® XY1-SP IOL (29 patients, 31 eyes, group 2). IOL viscoimplantation was performed in 100 % of cases in group 1; in group 2 viscoimplantation was done in 45.1 % of cases and hydroimplantation in 54.9 %. Intraoperatively, corneal incision size was measured with a ruler before and after IOL implantation. Results In both groups, there was a statistically significant (p&lt;0.05) increase of UCDVA from 0.28±0.09 in the preoperative period to 0.7±0.17 3 months after surgery in group 1 and from 0.24±0.10 in the preoperative period to 0.84±0.18 3 months after surgery in group 2. Slightly lower values of UCDVA in group 1 may be associated with a higher level of surgically induced astigmatism (SIA) in this group. Similar dynamics was shown for BCDVA (from 0.52±0.21 before surgery to 0.95±0.19 after 3 months of follow-up in group 1 and from 0.55±0.20 before surgery to 0.98±0.21 after 3 months of follow-up in group 2). No difference was found between the studied groups. After IOL implantation, there was an increase in incision size to 2.4±0.12 mm in group 1 and 2.1±0.08 mm in group 2 (p=0.04). Mean SIA after 3 months of observation was 1.1±0.16 D in group 1 and 0.48±0.07 D in group 2 (p=0.0007). Conclusion. This study presents a comparative analysis of implantation results with monofocal hydrophobic acrylic Hoya Vivinex IOL in a Multisert® preloaded injector and monofocal Hoya 250/251 IOLs in an Isert® injector. The advantage of the new IOL implantation in reducing the incidence of surgically induced astigmatism was shown. Key words: cataract; monofocal IOLs; Vivinex; Hoya 250; Hoya 251; surgically induced astigmatism.