Intraoperative Complications Research Articles

Posterior chamber phakic intraocular lenses for correcting ametropia in stable keratoconus.

The use of posterior chamber phakic intraocular lenses are a reasonable option in the armamentarium to treat refractive error in patients with keratoconus. We present our experience with the use of posterior chamber phakic intraocular lens (PCPIOL) for the management of ametropia in patients with keratoconus. Patients included those with stable keratoconus treated in the Corneoplastic Unit, Queen Victoria Hospital. East Grinstead, United Kingdom, with PCPIOL (ICL Staar Surgical and IPCL Care Group) to improve their visual acuity. Data were obtained from preoperative visit and 1, 3, 6 and 12 months after surgery. Clinical characteristics, pre- and postoperative uncorrected (UDVA) and best corrected (CDVA) logMAR visual acuities and perioperative complications were analyzed. 23 eyes of 21 patients were included. UDVA changed from 0.75 preoperatively to 0.18 post-surgery (P = < 0.001) and CDVA from 0.07 to 0.12 (P = 0.12). Seventy percent of the cases increased 3 or more lines of UDVA while none of the eyes lost more than 2 lines of CDVA. No significant difference in final UDVA was found between patients with and without previous keratoplasty (0.27 and 0.18, P=0.38), previous corneal collagen crosslinking (0.16 and 0.3, P=0.24), intracorneal ring segments (0.2 and 0.2, P=0.94) or type of lens implanted (0.2 ICL and IPCL. P = 0.94). One intraoperative complication reported was an inverted PCPIOL insertion and postoperatively 4 axis rotations and 1 cataract were observed. The use of PCPIOL in patients with stable keratoconus is effective in improving their UDVA, even in cases with previous corneal procedures such as keratoplasty, crosslinking and intracorneal rings. Rotation is the most common postoperative complication.

Comparison of Transoral and Transcutaneous Approaches for Gender-Affirming Thyroid Cartilage Reduction: A Case Series of 246 Patients.

Thyroid cartilage reduction (TCR) for gender-affirming neck surgery can reduce prominent thyroid notches and improve dysphoria. TCR can be performed with a transoral or transcutaneous approach. This study aims to review TCR approaches and outcomes. A retrospective chart review of all TCRs at a multi-institutional, integrated healthcare system from May 2016 to July 2024 was performed. Patient demographics, operative details, and post-operative complications were reviewed. Major complications included invasive interventions (corticosteroid injections for scars, fluid drainage, etc) or intraoperative complications. Minor complications included infections, hypertrophic scarring, and temporary voice changes. Chi square tests and Mann-Whitney U tests were performed to evaluate differences in postoperative outcomes by surgical approach. A total of 246 patients underwent TCR with 207 patients (84.1%) in the transcutaneous group and 39 patients (15.9%) in the transoral group. The median patient age was 30.7 years (interquartile range, IQR 24.9-39.0). Median BMI was 22.7 kg/m2 (IQR 20.6-25.5). There were no significant differences between transcutaneous and transoral groups, for median age (30.1 years vs 33.4 years, p=0.08) or median BMI (22.6 kg/m2 vs 23.7 kg/m2, p=0.28). Total major complication was 9.3% and minor complication was 10.6%. There were no significant differences between transcutaneous and transoral groups in rates of major (9.2% vs 10.3%, p=0.83) or minor (12.1% vs 2.6%, p=0.08) complications. TCR can be an effective treatment for neck dysphoria. Transoral approach avoids visible neck scars and is not associated with increased peri-operative complications. Further research is needed to determine the long-term outcomes of TCR.

Outcomes of cataract surgery training among ophthalmology trainees in the independent sector and within the NHS

ObjectiveThe surge in National Health Service (NHS) cataract procedures in the independent sector (IS) has reduced opportunities for cataract surgical training among ophthalmology trainees. This study aims to analyse IS...

Surgical anatomy of lateral lymph node dissection: landmarks and areas of dissection in minimally invasive surgery.

Lateral lymph node dissection (LLND) for rectal cancer is a vital procedure to achieve en bloc removal of metastatic laterallymph nodes with surrounding fat tissues, guided by precise anatomicallandmarks. The anatomy of the lateral compartment, however, isnot straightforwardfor the majority of surgeons. Inadequate knowledge of the vascular and neural anatomy may increase the risk of intraoperative complications such as bleeding, nerve injury andincompletelymph node dissection. Minimallyinvasive surgery provides enhanced visualization of the surgical anatomyin the lateral compartment. Comprehensive knowledge of surgical anatomy is indispensable for successful LLND, and simplifying the anatomy into the planes makes the procedure accessible for surgeons. This article presentsanatomical landmarks essential forstandardizing the step-by-step procedures ofLLNDand review the literature. i.e., for safe implementation of the procedures.

Accuracy, Safety, and Efficiency in Robotic-Assisted vs. Freehand Dental Implant Surgery: A 6-Month Follow-Up Randomized Controlled Trial.

To assess the implant accuracy, safety, and efficiency between robotic-assisted and freehand dental implant placement with a half-year follow-up. Patients requiring single-tooth implant restorations were recruited and randomized into two groups: robotic-assisted surgery and freehand implant surgery. The accuracy of implant positioning was compared by assessing immediate postoperative CBCT scans against preoperative planning software. Intraoperative and postoperative complications were recorded, and data were analyzed using an intention-to-treat approach. The time required for implant placement in each group was documented. A 6-month follow-up measured the implant survival rates. The study included 24 patients (median age 36, 18 female). In the robotic-assisted surgery group, the average platform global deviation, apex global deviation, and angular deviation were 0.70 ± 0.11 mm, 0.70 ± 0.12 mm, and 1.09° ± 0.67°, respectively. In the freehand implant surgery group, these measures were 1.24 ± 0.59 mm, 2.13 ± 1.26 mm, and 7.43° ± 6.12°, respectively, with statistically significant differences. Regarding the duration of surgery, the robotic-assisted surgery group required 18.8 ± 4.89 min. Intraoperative and postoperative complications were similar across both groups, and the implant survival rate was 100% in both groups at the 6-month follow-up. This study found that robot-assisted implant placement offers higher accuracy in implant positioning compared to freehand placement, while requiring longer operation times. Future developments should focus on simplifying the registration and design of robot systems to enhance efficiency and facilitate their broader clinical adoption.

Surgical Complications After Fronto-orbital Advancement for Craniosynostosis: Analysis of a National Database.

Fronto-orbital advancement (FOA) is the standard surgical intervention for patients with craniosynostosis and associated fronto-orbital dysmorphology. Although previous studies have provided insights into center-specific complications, comprehensive, large-scale analyses remain limited. This study utilizes a national database to address these gaps, offering a large-scale perspective on FOA outcomes. Patients aged 0 to 16 years who underwent FOA from 2007 to 2015 were identified using the PearlDiver database. Patients were divided into early (0-5 y) and late (6-16 y) groups. Complications were identified using a combination of ICD and CPT codes. Intraoperative complications, including hematoma/hemorrhage, cerebrovascular infarction, and cardiac arrest, were defined as those occurring within 48 hours of the procedure. Postoperative complications analyzed at intervals of 0, 30, 90, 180, and 365 days post-operation included cerebrospinal fluid leak, hardware-related complications, hemorrhage, seizure, surgical site infection, wound dehiscence, and death. Summary statistics were conducted utilizing Bellwether software in PearlDiver. A total of 2026 patients underwent FOA, with a mean of 1.5 years in the younger cohort (n=1905) and 9.0 years in the older cohort (n=121). Although rare, hemorrhage was the most common intraoperative complication. One-year postoperative complications were predominantly related to wound dehiscence and surgical site infection in the younger (5.10%) and older (14.1%) cohorts. The 1-year reoperation rate was 7.2% for the younger cohort and 19.0% for the older cohort. FOA is a safe operation with an overall low complication rate. However, older patients demonstrate a higher rate of reoperations, emphasizing the need to identify the optimal timing for FOA in patients with craniosynostosis.

A retrospective cohort study of laparoscopic enhanced view totally extra-peritoneal Rives-Stoppa (eTEP-RS) repair of incisional ventral hernias in patients with morbid obesity

Abstract Background Incisional hernia (IH) repair in morbidly obese (MO) patients poses significant challenges due to higher risks of complications and recurrence. Traditional open repairs are linked to increased morbidity, driving interest in minimally invasive techniques. The enhanced view totally extra-peritoneal Rives-Stoppa (eTEP-RS) technique shows promise as a laparoscopic method for IH repair, but data on its efficacy and safety in MO patients are limited. This study aims to evaluate the efficacy, safety, and feasibility of the eTEP-RS approach specifically for IH repair in this high-risk population. Methods Analysis of a retrospective cohort of consecutive patients undergoing laparoscopic eTEP-RS for IH repair between 2017 and 2022 which included 135 patients, categorized into two groups based on body mass index (BMI): the MO group (BMI &gt; 35 kg/m2) and the control group (BMI ≤ 35 kg/m2). We compared demographics, comorbidities, hernia characteristics, intra-operative data, post-operative outcomes, and hernia recurrence rates. Results Patients in the MO group had significantly more type 2 diabetes mellitus (n = 18, 51% vs n = 25, 25%; p = 0.004), hypertension (n = 35, 73% vs n = 75, 53%; p = 0.017), dyslipidemia (n = 29, 60% vs n = 58, 41%; p = 0.021), ASA score 3 (n = 18, 52% vs n = 23, 23%; p = 0.004), a history of previous umbilical hernia repair (n = 13, 27% vs n = 13, 9.2%; p = 0.002), and bariatric surgery (n = 10, 29% vs n = 13, 13%; p = 0.035). There were no differences in intra-operative characteristics, operative times, or intra-operative complications between groups. During a median follow-up period of 1 year (IQR 40–680 days), there were no differences in hernia recurrence (n = 2, 5.7% vs n = 9, 9%; p = 0.07), time to recurrence, or chronic analgesia usage between groups. Conclusion The laparoscopic eTEP-RS approach was safe and effective for IH repair in patients with MO, demonstrating comparable post-operative outcomes and recurrence rates to those with a lower BMI in a selected cohort of patients.

Preliminary Results of Microsurgical Sperm Retrieval in Azoospermic Patients: A Randomized Controlled Trial Comparing Operating Microscope vs. Surgical Loupes

Objectives: To compare surgical outcomes and sperm retrieval rates (SRRs) between conventional microsurgical-assisted testicular sperm extraction (m-TeSE—Group A) and testicular sperm extraction performed with surgical loupes (l-TeSE—Group B) in adult males with non-obstructive azoospermia (NOA). Methods: A multicentric prospective randomized trial (ethics committee no. 202/2022) in accordance with the CONSORT guidelines was conducted from March 2022 to April 2024. Adult males with NOA without genetic alterations who signed the informed consent were enrolled. SRRs, intra- and postoperative complications (according to the Clavien–Dindo classification), and hormonal profile changes were considered as outcomes during the follow-up period. Results: A total of 42 NOA patients were enrolled. The median age was 35 years (IQR: 33–49). The preoperative median FSH was 16.5 mIU/mL (IQR: 11.6–22.5) and the total testosterone was 4.6 (3.5–5.6). Overall, the SRR was 22.6%, with sperm retrieved from 19 testes. Histopathological findings reported Sertoli cell-only syndrome (SCOS) in 46.4% (39 cases), hypospermatogenesis in 26.2%, and germ cell arrest in 26.2% of the patients. No intraoperative complications were recorded. The postoperative complications were minimal (Clavien–Dindo grade I), but no significant differences were recorded in-between the two surgical approaches. Considering the operative time of the testicular exploration alone, Group B seemed to be faster than the m-TeSE, with a median time saving of 8 min (p &lt; 0.01). Conclusion: The use of surgical loupes was safe and comparable with m-TeSE in terms of the SRRs and complication rates. L-TeSE offered a reduction in the operative time compared with m-TeSE.

Intraoperative Complications in Acetabular Fracture Management Using the Stoppa Approach: A Retrospective Cohort Study

Intraoperative Complications in Acetabular Fracture Management Using the Stoppa Approach: A Retrospective Cohort Study

Robotic Surgery in Severely Obese Frail Patients for the Treatment of Atypical Endometrial Hyperplasia and Endometrial Cancer: A Propensity-Match Analysis at an ESGO-Accredited Center

Background and Objectives: Robotic-assisted laparoscopy (RS) has been widely adopted for the management of endometrial cancer (EC) due to favorable perioperative outcomes, especially in the context of obesity, which is an established risk factor for EC. This study retrospectively evaluated the perioperative outcomes of RS versus conventional laparoscopy (LS) in treating EC and atypical endometrial hyperplasia (AH). Methods: Between November 2021 and October 2023, 138 patients with AH or EC underwent surgery at the Clinic of Obstetric and Gynecological—Azienda Sanitaria Universitaria Friuli Centrale, Udine. All patients had total hysterectomy with bilateral salpingo-oophorectomy, with or without lymphadenectomy or sentinel lymph node biopsy. The study included 62 patients treated with LS and 62 with RS. Results: The median BMI was higher in the RS group (35.5 vs. 24 kg/m2, p = 0.001). There was no significant difference in operative time between the laparoscopic group and the robotic console time (median 130 vs. 130 min, p = 0.131). No significant differences were found in terms of blood loss, conversion to laparotomy, intraoperative complications, hospital stay, or early postoperative complications between the two groups. Conclusions: Our data confirm the feasibility of robotic surgery in obese patients, allowing surgical results comparable to those of laparoscopy in normal-weight patients.

Intentional weight reduction before surgery - A systematic review.

Obesity may increase complexity of surgical procedures and increase the risk of perioperative complications. Weight reduction by the use of low energy diet (LED, ≤1200kcal/day) or very low energy diet (VLED, ≤800kcal/day) can reduce postoperative complications after bariatric surgery, but for most other types of surgery the evidence for its use remains uncertain. The aim of this systematic review was therefore to evaluate the scientific evidence in general for this routine. The Medline, Embase, Web of Science and Cochrane databases were searched up until November 20, 2024 using the Cochrane risk of bias assessment tool for observational studies and the NIH quality assessment of controlled intervention studies for randomized trials. Operation time, surgeon's perceived difficulty, intraoperative complications, postoperative complications and relevant efficacy measures for specific procedures were considered as endpoints. A random-effects model was used to pool effect sizes for the main analyses. A total of 7053 studies were identified. After screening by title and abstract, followed by full text, 18 studies (9 RCTs and 9 observational studies) remained for the analyses including 854 patients who received the intervention and 979 controls. Preoperative LED/VLED resulted in an overall shorter operation time (standard mean difference 0.36, 95% CI 0.14-0.59, p=0.002), and reduced risk of postoperative complications after bariatric surgery, cholecystectomy, colorectal surgery and hernia repair (pooled RR 0.63, 95%CI 0.51-0.79, p<0.001). Heterogeneity between studies was high for operation time but very low for complications. No difference was seen for intraoperative complications, while the data did not allow further analyses on perceived difficulty of surgery or efficacy outcomes. The results support the use of LED/VLED for short-term preoperative weight reduction in patients with obesity planned for bariatric surgery and for those undergoing cholecystectomy, colorectal surgery and hernia repair. Further studies including a comparable control group are needed to evaluate its routine use for other surgical procedures. The protocol of this study was preregistered at the International Prospective Register of Systematic Reviews, PROSPERO.

A Novel Approach to Intermediate Cleft Rhinoplasty Utilizing a Pedicled Fibrofatty Flap

Summary: Patients with cleft lip ± palate may experience psychosocial issues related to their secondary cleft nasal deformities. These concerns can be addressed earlier instead of being required to wait until skeletal maturity. A novel early rhinoplasty intervention utilizing a dorsal fibrofatty pedicled flap is performed by the senior author to address nasal aesthetics in patients with secondary nasal deformities. This study aimed to describe this novel intermediate rhinoplasty technique and to evaluate improvement of nasal aesthetics. A retrospective review of patients with unilateral and bilateral cleft lip who underwent open rhinoplasty by a single surgeon at less than 10 years old from 2008 to 2023 was conducted. To evaluate aesthetic improvement, preoperative and postoperative photographs of patients were graded by 2 reviewers utilizing the Asher-McDade Aesthetic Index. Paired t tests compared preoperative and postoperative Asher-McDade Aesthetic Index nasal form and nasal deviation scores. A total of 43 patients underwent early rhinoplasty utilizing this technique at an average age of 5.5 ± 1.1 years. Compared with preoperative photographs, postoperative photographs of patients demonstrated a significant improvement in nasal form (P &lt; 0.001) and nasal deviation (P &lt; 0.001). No intraoperative or postoperative complications were reported. Only 1 (2.3%) patient underwent revisional surgery. Long-term follow-up will assess the finalized revision rate. This technique is a safe and valuable tool in patients who benefit from earlier treatment of secondary cleft nasal deformities due to significant asymmetry and psychosocial concerns.

The impact of acetabular revision in revision total hip arthroplasty for a Vancouver B2 fracture requiring a change of femoral component.

The aim of this study was to assess the necessity of revising the acetabular component in revision total hip arthroplasty (THA) in patients with a Vancouver type B2 periprosthetic femoral fracture (PFF) who require revision of the femoral component. The hypothesis was that revision of both the acetabular and femoral components and using a dual-mobility acetabular component would provide a lower postoperative risk of dislocation, without increasing perioperative morbidity and mortality. Data were retrospectively analyzed from a continuously gathered database. We included 150 revisions, performed between January 2015 and December 2022, in 150 patients, with 81 revisions limited to only the femoral component and 69 involving revision of both components. This resulted, after surgery, in 60 patients having a simple-mobility acetabular component and 90 having a dual-mobility component. The mean age of the patients was 79.7 years (SD 10.1), and 98 were female (65.3%). The mean follow-up was 31 months (SD 2.3). There were no significant differences between those in whom only the femoral component was revised and those in whom both components were revised with the use of a dual-mobility acetabular component for the rate of intraoperative complications, postoperative mortality, blood loss, the requirement of a blood transfusion, medical complications, dislocation (11/81 in the femoral component-only group vs 6/69 in the femoral + acetabular component revision group) or the overall need for reoperation at the final follow-up. Patients were at a significantly higher risk for dislocation when a simple-mobility component was retained (18.3% (n = 11) vs 6.7% (n = 6) for dual-mobility implants; p = 0.036). The revision rate prompted by postoperative instability was significantly higher in patients in whom a simple-mobility acetabular component was retained at revision (10% (n = 6) vs 0%; p = 0.002). Based on these results, concurrent revision of the acetabular component was not associated with a higher rate of mortality or increased morbidity and patients in whom a dual-mobility acetabular component was used were significantly less prone to dislocation. We thus recommend routine revision of the acetabular component in favour of a dual-mobility component for patients sustaining a Vancouver B2 PFF requiring revision of the femoral component if their initial THA included a simple-mobility acetabular component.

A COMPARATIVE ANALYSIS BETWEEN ELECTROSURGICAL VERSUS HARMONIC DISSECTION OF GALL BLADDER FROM ITS BED IN LAPAROSCOPIC CHOLECYSTECTOMY

Background: Various energy sources are now available like electrosurgical (monopolar and bipolar), ultrasonic shear devices, ultrasonic with bipolar and hydro dissection to separate gall bladder from liver bed. We conducted a study to compare electrosurgical and ultrasonic devices in dissection of gall bladder Method: A prospective randomized controlled study was conducted involving 100 patients with gallstone disease. Patients were divided into two groups by the process of closed envelope randomization into electrosurgery (Group A) or ultrasonic dissection(Group B) groups. Both groups were compared for ease and feasibility of procedure, intra-operative complications during the procedure, operative time, conversion of laparoscopic to open cholecystectomy, post operative complication, comparison of pain, duration of stay in hospital and cost factor. Observation: Various parameters were compared and it was observed that intraoperative bleeding was more in (28%) in the electrosurgery group in comparison to the harmonic group (8%). Injury to liver parenchyma was noticed less in the harmonic group (2%). Gall bladder perforation and bile leak were recorded more in electrosurgery patients (24%). Spillage of stone was 16% and 4% in Groups A and B respectively. Gut injury was observed in 2% of Group A in comparison to 0% in Group B. No CBD injury and postoperative complications were observed in either group. Post-operative hospital stay was lesser in Group B (1.98±0.51days) than in Group A (2.24±0.66 days). Postoperative pain was more in the electrosurgery group. Conclusion: Dissection with harmonic scalpel in laparoscopic cholecystectomy is safe and technically feasible and may further improve surgical outcomes in terms of reduced duration of postoperative stay in hospital and pain with a significant reduction in intraoperative complications.

Repeated maxillary sinusitis following sinus floor augmentation in an HIV-infected patient: A case report and literature review

A patient who underwent sinus floor augmentation (SFA) for dental implants at a local clinic was referred to our dental hospital for the treatment of maxillary sinusitis and oroantral fistula. After successfully treating them, a second SFA was performed by an experienced surgeon without any intraoperative complications. However, during postoperative follow-up, the patient developed severe maxillary sinusitis again and was referred to the Department of Otolaryngology for endoscopic sinus surgery under general anesthesia. During the preoperative assessment, routine laboratory testing revealed that the patient was positive for human immunodeficiency virus (HIV), a fact previously unknown to the healthcare providers. This case report discusses the increased risk of postoperative infection in HIV-infected patients and underscores the necessity of comprehensive pre-treatment evaluations for underlying health conditions in outpatient-based dental clinics. Additionally, a review of relevant literature is included to support these findings.

Study of Functional Outcomes of Cataract Surgery at the Secondary Ophthalmology Center of Nara

The treatment of cataract-related blindness is surgical, allowing for vision restoration. The objective of this study was to evaluate the functional outcomes of adult cataract surgery at a secondary ophthalmology center. This was a prospective and descriptive study of adults undergoing cataract surgery through extracapsular extraction over a 6-month period. Results were analyzed using the Monitoring Cataract Surgical Outcome (MCSO) software and compared to WHO standards. Out of 163 eyes from 141 patients, 160 eyes (98.2%) received posterior chamber implants, with a mean age of 65.1 years. Visual acuity was ≥3/10 with correction in 54% of cases, while 8.6% had poor visual acuity (&lt;1/10). The proportion of patients with good outcomes increased to 76.6% with better correction, while 6.3% had poor outcomes. Posterior capsule rupture was the most common intraoperative complication (62.5%). These results are below WHO standards and highlight causes of poor outcomes, primarily refractive errors (36.4%) and sequelae (27.2%). Identifying these causes emphasizes the need to improve surgical skills, equipment, and postoperative refraction.

Safe access to laparoscopic cholecystectomy in patients with previous periumbilical incsions: new approach to avoid entry related bowel injury

BackgroundPatients with prior abdominal surgeries are at higher risk of intra-peritoneal adhesions near the trocar entry site, increasing the likelihood of organ injury during laparoscopic cholecystectomy (LC). This study evaluates a novel technique where the epigastric trocar is inserted first, after creating pneumoperitoneum, to allow safe dissection of adhesions under direct vision before placing the umbilical trocar.MethodsThis prospective study included 244 patients with symptomatic uncomplicated gallstone disease and a history of previous abdominal surgeries extending to the umbilicus. Patients were randomly assigned to two groups: Group I (n = 98) underwent traditional umbilical trocar-first LC using the Hasson technique, while Group II (n = 146) received LC using the epigastric trocar-first approach. Operative time, complications, and conversion rates were analyzed.ResultsThere was no significant difference in the demographics between both groups. The epigastric trocar-first approach significantly reduced total operative time (41.6 ± 7.7 min vs. 46.8 ± 8.8 min, p = 0.031) and small bowel injury rates (p = 0.006). Otherwise, intraoperative complications were comparable. Conversion to open surgery was lower in Group II (2.1% vs. 8.2%, p = 0.012). Postoperative pain at 6 h was significantly lower in Group II (p = 0.001).ConclusionsThe epigastric trocar-first approach, offers a safer alternative for patients with prior abdominal surgeries when undergoing LC. This approach is safe; minimizes bowel injury risk, reduces conversion rates, and enhances patient recovery. This approach may also be beneficial in other laparoscopic procedures requiring safe entry in patients with prior abdominal surgeries. Further studies are recommended to validate its broader clinical application.

Outcomes and efficacy of robotic-assisted radical prostatectomy using the CMR Versius platform: a prospective study on 118 patients with 1-year follow-up.

To evaluate the outcomes and efficacy of robot-assisted radical prostatectomy (RARP) using the Versius robotic surgical system, aiming to provide comprehensive data on perioperative outcomes, postoperative recovery, and complications. All cases of RARP using the CMR Versius platform performed at Cairo University Hospitalover a two-year period were enrolled in this study. All patients had pathologically confirmed prostate cancer in both localized and locally advanced stages. Data were prospectively collected including preoperative parameters as patients' demographics, serum PSA, and Gleason score after trans-rectal ultrasound guided biopsy. Intraoperative parameters and complications were assessed. Postoperatively, we monitored the oncological and functional outcomes such as continence and sexual functions for at least 12months. Follow up of PSA was done at 6weeks, 3 and 6months, postoperatively. One-hundred-and-eighteen patients continued the follow-up till 12months. The median patient age was 64.26 ± 7.13years. The median PSA value at diagnosis was 9(4.16-64) ng/ml and the median prostate size was 50 (20-167) grams. The mean docking time, console time, and the total operative time were 13.17 ± 1.157, 194.75 ± 24.3 and 225.76 ± 25min, respectively and the median blood loss was 307.46 ± 61.44ml. The mean hospital stay and the mean catheter time were 2.16 ± 0.867 and 7.26 ± 1.441days, respectively. Forty-nine patients underwent nerve-sparing RARP (bilateral in 41 patients and unilateral in 8 patients). Post-operative continence and potency showed progressive improvement over time during follow-up. Twelve months postoperatively, 90.7% of patients were totally continent and 49% of those patients who underwent nerve-sparing RARP (24/49) were potent. With a positive safety profile and a successful oncological outcome, the use of the CMR system for robot-assisted radical prostatectomy presents a safe and promising method in the surgical management of prostate cancer.

One-Year Real-World Outcomes of Ab-Externo Gel Stent Placement From the EXPAND Study.

In the real-world, retrospective, EXPAND study of consecutive adults with glaucoma, ab-externo gel stent implantation effectively lowered intraocular pressure (34%) and the medication burden (61%), with transient/self-resolving hypotony as the most frequent adverse event (28%). To assess effectiveness and safety of ab-externo gel stent (GS) implantation in glaucoma. Multicenter, real-world, retrospective study. Consecutive adults with glaucoma and ab-externo GS implantation (with/without phacoemulsification or open/closed conjunctiva) ≥12 months before study entry. Data were extracted between the baseline/preoperative and last follow-up visit or date of secondary surgical intervention (SSI). Primary effectiveness endpoint: proportion of primary eyes (first eye in bilaterally implanted patients) at Month 12 (M12) achieving ≥20% intraocular pressure (IOP) reduction from baseline without medication increase, clinical hypotony, vision loss to counting fingers, or SSI. Secondary effectiveness endpoints included complete success (IOP ≤18mmHg and ≥20% IOP reduction from medicated baseline without medication, clinical hypotony, or SSI); qualified success (same but without medication increase); and needling rate. Key safety endpoints (all eyes): intraoperative complications, postoperative adverse events (AEs), and SSIs. The safety population included 466 eyes; 80.7% received the GS alone and 85.0% were implanted with closed conjunctiva. At M12, 39.1% of all primary eyes (N=413) and 54.9% of primary eyes with IOP and medication data at baseline and M12 (N=213) achieved the primary endpoint. At M12 among all primary eyes, the complete success, qualified success, and needling rates were 33.5%, 56.5%, and 28.6%. Most eyes (97.9%) had no intraoperative complications. The most frequent postoperative AE was transient/self-resolving hypotony (IOP<6mmHg; 28.1%). Sixty-nine (14.8%) eyes required an SSI. Ab-externo GS placement effectively lowered IOP and the medication count without unexpected complications/AEs, expanding implantation options based on patients' needs and surgeons' preferences.

Optimizing Prostate Cancer Surgery for Seniors: Single-Port Robotic-Assisted Platform.

Background: The Da Vinci single-port (SP) platform is being used more frequently in radical prostatectomy (RP). In this study we aimed to compare the complications and oncological outcomes of the Da Vinci SP platform in robotic-assisted radical prostatectomy (SP-RARP) between elderly and young age-groups and to further examine differences between young-old and old-old patients. Materials and Methods: Data from 193 patients who underwent SP-RARP between December 2018 and June 2024 were analyzed. Patients were categorized into two age-groups: young (18-64 years) and elderly (65+ years). The elderly group was further divided into young-old (65-69 years) and old-old (70+ years) subgroups. The analysis considered variables related to patient characteristics, intraoperative outcomes, complications, and postoperative oncological outcomes. Results: The median age of the patients at the time of surgery was 64 (9.5) years. The intraoperative complication rate of 1.6%, with no cases requiring conversion to open surgery. The overall incidence of postoperative adverse events was 24.4%, and the 30-day readmission rate was 11.4%. Intraoperative complications and 30-day readmission rates were similar between groups (P = .593 and P = .821, respectively), while the postoperative complication rate was significantly higher in the younger patient group (P = .012). The median length of hospital stay (LOS) was 7 (22) hours and 110 (57%) patients were discharged on the same day (SDD). LOS and SDD rates were similar between groups (P = .389 and P = .529, respectively). The 3-year and 5-year biochemical recurrence (BCR)-free survival rates were 80.5% and 75.1%, respectively. The BCR-free survival rates were similar between both young and elderly patients and between the young-old and old-old groups (P = .751, P = .765, respectively). Conclusion: SP-RARP is a feasible option for elderly patients, delivering acceptable oncological outcomes with a low incidence of postoperative complications.