Intraoperative Experience Research Articles

Effect of mother's active pushing at cesarean delivery: a randomized controlled trial.

This study aimed to evaluate the effect of maternal active pushing during cesarean section (CS) on postoperative pain, intraoperative discomfort, and the mother's sense of control and participation. A prospective, randomized controlled study. Patients were randomly assigned into two groups. In the Conventional group (n = 45), the CS was performed traditionally without maternal pushing. In the Assisted group (n = 55), patients were instructed to push during delivery. Outcomes measures included patients' perceived pressure, pain, and sense of participation. Breastfeeding and postnatal depression were assessed using validated scales, along with maternal and neonatal outcomes, surgeon satisfaction, and operation duration. Patients in the Assisted group reported significantly lower fundal pressure intensity (VAS score 3 vs. 5, P < 0.01) compared to the Conventional group. There was no significant difference in postoperative pain. However, women in the Assisted group reported a greater sense of participation (6 vs. 0, P < 0.01) and control (4 vs. 0, P < 0.05) than those in the Conventional group. No significant maternal or neonatal complications were observed. Maternal active pushing during CS positively impacted intraoperative experience by reducing perceived pressure and enhancing the sense of control and participation, without adverse effects on maternal or neonatal outcomes. These findings support further research with larger, multi-center studies to validate the potential benefits of this approach. NCT05520580 ( https://clinicaltrials.gov/ct2/show/NCT05520580 ).

772. EVALUATING OUTCOMES OF LES OBSTRUCTION AND REFLUX IN PATIENTS UNDERGOING PERORAL ENDOSCOPIC MYOTOMY GUIDED BY THE 16CM IMPEDANCE PLANIMETRY CATHETER

Abstract Background Peroral endoscopic myotomy (POEM) is a standard treatment option in achalasia. The endoluminal functional lumen imaging probe (FLIP) system utilizes impedance planimetry to measure diameter and distensibility at the esophagogastric junction (EGJ) in real-time. Most reports of the intraoperative FLIP experience focus on the 8 cm balloon, but the 16 cm balloon catheter also provides topographical assessments in addition to EGJ metrics. The aim of this study is to determine the clinical outcomes after a tailored myotomy using the 16 cm balloon during POEM. Methods We conducted a retrospective review of consecutive patients who underwent POEM with intraoperative FLIP with the 16 cm balloon catheter between January 2020 and September 2023. Operative reports were reviewed, and data including FLIP metrics and topographical assessments and myotomy length, which was guided by FLIP panometry, were recorded. Clinical parameters for lower esophageal sphincter (LES) obstruction (defined by FLIP-EGJ metrics, BEDQ/Eckardt scores and/or need for LES re-intervention) and reflux (defined by GERD-HRQL/RSI scores, +pH testing, LA B/C/D reflux esophagitis, PPI use and/or need for anti-reflux surgery) were collected during the 6-36 month follow up time period. Results Of 100 patients (57 female, mean 56.1y), 82 had Achalasia, 15 EGJOO, and 3 hypercontractile esophagus. Myotomy length was tailored (mean 8.2cm, range 3 – 15) by FLIP, and 10% had a short myotomy (≤4cm). Among 16 patients with previous Heller, the myotomy targeted contractile activity proximal to the previous myotomy in 10 cases. On follow up of 71 patients (median time 14mo), clinical outcomes are noted in Table 1. Obstructive symptoms and FLIP metrics showed significant improvement. Repeat myotomy was required in 5.6%. While reflux symptom scores improved, 37.5% had abnormal %AET, 4.7% had reflux esophagitis, and 7.0% required anti-reflux surgery. Conclusion A tailored myotomy with guidance of a 16 cm FLIP catheter to assess EGJ metrics and topographical assessments during POEM appears to be safe and effective at 6-36 month follow up. A tailored myotomy allows for a shorter myotomy than traditional surgical lengths and can be extended to capture residual disease noted with the 16 cm FLIP catheter in patients with previous surgery. Use of the 16 cm balloon during POEM results in overall low rates of LES re-intervention and post-myotomy reflux.

Pectoral Nerve Block II for Cardiac Implantable Electronic Devices.

This study aimed to assess the feasibility and effectiveness of the pectoral nerves (PECS) II block in facilitating cardiac implantable electronic device (CIED) insertion in a sample of 120 patients, with a focus on the percentage of cases completed without additional intraoperative local anesthesia. PECS II blocks were performed on the left side using ultrasound guidance in all 120 patients. Feasibility was assessed by the proportion of cases completed without the need for extra intraoperative local anesthetic. Secondary outcomes included the amount of additional local anesthetic used, intraoperative opioid requirements, postoperative pain scores, time to first postoperative analgesia, analgesic consumption, patient satisfaction, and block-related complications. Of the 120 patients, 78 (65%) required additional intraoperative local anesthetic, with a median volume of 8.2 mL (range 3-13 mL). Fifteen patients (12.5%) needed intraoperative opioid supplementation. Nine patients (7.5%) required postoperative tramadol for pain relief. In total, 98 patients (81.7%) reported high satisfaction levels with the procedure. The PECS II block, when combined with supplementary local anesthetic, provided effective postoperative analgesia for at least 24 h in 120 patients undergoing CIED insertion. While it did not completely replace surgical anesthesia in most cases, the PECS II block significantly contributed to a smoother intraoperative experience for patients.

Pain perception enhancement in consecutive second-eye phacoemulsification cataract surgeries under topical anesthesia.

Cataract is the main cause of visual impairment and blindness worldwide while the only effective cure for cataract is still surgery. Consecutive phacoemulsification under topical anesthesia has been the routine procedure for cataract surgery. However, patients often grumbled that they felt more painful during the second-eye surgery compared to the first-eye surgery. The intraoperative pain experience has negative influence on satisfaction and willingness for second-eye cataract surgery of patients with bilateral cataracts. Intraoperative ocular pain is a complicated process induced by the nociceptors activation in the peripheral nervous system. Immunological, neuropsychological, and pharmacological factors work together in the enhancement of intraoperative pain. Accumulating published literatures have focused on the pain enhancement during the second-eye phacoemulsification surgeries. In this review, we searched PubMed database for articles associated with pain perception differences between consecutive cataract surgeries published up to Feb. 1, 2024. We summarized the recent research progress in mechanisms and interventions for pain perception enhancement in consecutive second-eye phacoemulsification cataract surgeries. This review aimed to provide novel insights into strategies for improving patients' intraoperative experience in second-eye cataract surgeries.

Differences in coaching in single- versus dual-console robotic cases: a mixed-methods study.

A growing importance has been placed on development of trainee robotic surgical skills through simulation curricula and intraoperative experience. However, few studies have examined how console case type impacts learning outcomes.We sought to evaluate how intraoperative coaching and resident autonomy differ based on the use of a single- versus dual-console robot. Robotic single- and dual-console cases from February to September 2023 at a single institution were included. Faculty and trainees wore microphones to capture audio during the case. Pre/post surveys were administered, which included metrics on faculty coaching based on the Wisconsin Surgical Coaching Rubric (WiSCoR) and on trainee technical performance based on the Global Evaluative Assessment of Robotic Skills (GEARS). Statistical analysis of survey data was performed using SPSS. Audio from cases was coded by 2 researchers with a deductive approach using WiSCoR as a framework. Data were collected for 7 (38.9%) single and 11 (61.1%) dual-console cases across 9 case types from 4 surgical specialties. Chi-square analysis demonstrated no significant difference in percentage of case trainee spent in the operating surgeon role based on trainee level or console case type. Independent t-tests showed no significant difference in trainee autonomy, trainee performance, or faculty coaching scores based on console case type. Trainees rated faculty highest in WiSCoR Domains 1 (sharing responsibility) and 3 (providing constructive feedback). Qualitative analysis showed that for single-console cases, Domain 4 (goal setting) was most represented (34.0% of comments), while for dual-console cases, Domain 1 was most represented (37.0% of comments). Qualitative analysis highlights that despite similar survey-based faculty ratings across domains, coaching on self-reflection (Domain 2) is infrequently done, highlighting an opportunity for improvement in this area of coaching during robotic surgery.

Application of artificial intelligence to hepatobiliary cancer clinical outcomes research

The rapid evolution of modern technology has made artificial intelligence (AI) an important emerging tool in healthcare. AI, which is a broad field of computer science, can be used to develop systems or machines equipped with the ability to tackle tasks that traditionally necessitate human intelligence. AI can be used to perform multifaceted tasks that involve the synthesis of large amounts of data with the generation of solutions, algorithms, and decision support tools. Various AI approaches, including machine learning (ML) and natural language processing (NLP), are increasingly being used to analyze vast healthcare datasets. In addition, visual AI has the potential to revolutionize surgery and the intraoperative experience for surgeons through augmented reality enhancing surgical navigation in real-time. Specific applications of AI in hepatobiliary tumors such as hepatocellular carcinoma and biliary tract cancer can improve patient diagnosis, prognostic risk stratification, as well as treatment allocation based on ML-based models. The integration of radiomics data and AI models can also improve clinical decision making. We herein review how AI may be of particular interest in the care of patients with complex cancers, such as hepatobiliary tumors, as these patients often require a multimodal treatment approach.

Intraoperative pain prediction of percutaneous kyphoplasty under local anesthesia by preoperative experimental pain assessment.

Percutaneous kyphoplasty (PKP) is the preferred treatment for osteoporotic vertebral compression fractures (OVCF) Currently, the preoperative anesthesia methods for PKP are mainly local anesthesia and tracheal intubation general anesthesia. To assess whether patient sensitivity to pain measured preoperatively could predict the patients' pain response during PKP treatment under local anesthesia, to facilitate the development of an optimal preoperative anesthesia plan for patients. Fifty-five female patients diagnosed with osteoporotic single vertebral fracture who were treated with PKP under local anesthesia were selected. The patients' pain sensitivities, including pain threshold and pain tolerance threshold, were evaluated with a pain test device on the day before the operation in the ward. Heart rate (HR), mean arterial pressure (MAP), and blood oxygen saturation (SpO2) were recorded before anesthesia, post-anesthesia, after needle puncture, and after balloon dilatation. At the same time, blood was drawn at the above time points to determine the level of norepinephrine (NA) as an indicator of intraoperative pain stress response. The numerical rating scale (NRS) during surgery was recorded at the end of the surgery. The preoperative pain tolerance threshold of 55surgical patients was correlated with the intraoperative NRS score (r=-0.768, P< 0.001), as well as with the preoperative and intraoperative changes in HR (r=-0.791, P< 0.001), MAP (r=-0.819, P< 0.001), and NA (r=-0.553, P< 0.001). Thus, the lower the preoperative pain tolerance threshold, the more severe the patient's response to pain during PKP treatment under local anesthesia, and the greater the hemodynamic changes. Consequently, the intraoperative experience becomes worse. However, there was no correlation between preoperative pain threshold and NRS scores (r=-0.069, P= 0.616) nor between the preoperative and intraoperative changes in HR (r= 0.103, P= 0.453), MAP (r= 0.086, P= 0.535), and NA (r=-0.058, P= 0.674). The results indicated that preoperative pain assessment could predict the level of pain response in OVCF patients during PKP surgery under local anesthesia.

First clinical implementation of insertion force measurement in cochlear implantation surgery.

The significance of atraumatic electrode array (EA) insertion in cochlear implant (CI) surgery is widely acknowledged, with consensus that forces due to EA insertion are directly correlated with insertion trauma. Unfortunately, the manual perception of these forces through haptic feedback is inherently limited, and techniques for in vivo force measurements to monitor the insertion are not yet available. Addressing this gap, we developed of a force-sensitive insertion tool capable of capturing real-time insertion forces during standard CI surgery. This paper describes the tool and its pioneering application in a clinical setting and reports initial findings from an ongoing clinical study. Data and experiences from five patients have been evaluated so far, including force profiles of four patients. The initial intraoperative experiences are promising, with successful integration into the conventional workflow. Feasibility of in vivo insertion force measurement and practicability of the tool's intraoperative use could be demonstrated. The recorded in vivo insertion forces show the expected rise with increasing insertion depth. Forces at the end of insertion range from 17.2 mN to 43.6 mN, while maximal peak forces were observed in the range from 44.8 mN to 102.4 mN. We hypothesize that this novel method holds the potential to assist surgeons in monitoring the insertion forces and, thus, minimizing insertion trauma and ensuring better preservation of residual hearing. Future data recording with this tool can form the basis of ongoing research into the causes of insertion trauma, paving the way for new and improved prevention strategies.

Enhanced Total Hip Arthroplasty Education Using Augmented Reality: A Survey From a Tertiary Center.

For total hip arthroplasty (THA), a new technology in the evolution of computer-assisted surgery has emerged in the form of augmented reality (AR). We sought to determine the impact of AR on resident and fellow education after implementation at an academic teaching center. The senior author's intraoperative technique allows for the orthopedic trainee to use AR to correct the acetabular component's position after an attempt is made with standard instrumentation. One year after the implementation of this AR method, both resident and fellow trainees were issued an anonymous survey regarding their experience and descriptive statistics were calculated for the results. Sixteen trainees responded to the survey. One hundred percent felt the use of AR improved their understanding of acetabular component placement and improved their intraoperative experience. Sixty-nine percent reported feeling there was a small increase in operative time but 25% reported no increase in operative time when using AR. Seventy-five percent of trainees felt that patients benefited from the technology and would be in favor of AR if they were having a THA. The majority of those surveyed reported a desire to use AR in their practice if it is available. Computer-assisted surgery has demonstrated variable impacts on orthopedic education. After the implementation of AR at an academic teaching center, all trainees reported it improved their intraoperative experience and their understanding of acetabular component placement. Further studies are needed to determine if AR is able to improve a trainee's component placement. [Orthopedics. 2024;47(4):e157-e160.].

Intraoperative application and early experience with novel high-resolution, high-channel-count thin-film electrodes for human microelectrocorticography.

The study objective was to evaluate intraoperative experience with newly developed high-spatial-resolution microelectrode grids composed of poly(3,4-ethylenedioxythiophene) with polystyrene sulfonate (PEDOT:PSS), and those composed of platinum nanorods (PtNRs). A cohort of patients who underwent craniotomy for pathological tissue resection and who had high-spatial-resolution microelectrode grids placed intraoperatively were evaluated. Patient demographic and baseline clinical variables as well as relevant microelectrode grid characteristic data were collected. The primary and secondary outcome measures of interest were successful microelectrode grid utilization with usable resting-state or task-related data, and grid-related adverse intraoperative events and/or grid dysfunction. Included in the analysis were 89 cases of patients who underwent a craniotomy for resection of neoplasms (n = 58) or epileptogenic tissue (n = 31). These cases accounted for 94 grids: 58 PEDOT:PSS and 36 PtNR grids. Of these 94 grids, 86 were functional and used successfully to obtain cortical recordings from 82 patients. The mean cortical grid recording duration was 15.3 ± 1.15 minutes. Most recordings in patients were obtained during experimental tasks (n = 52, 58.4%), involving language and sensorimotor testing paradigms, or were obtained passively during resting state (n = 32, 36.0%). There were no intraoperative adverse events related to grid placement. However, there were instances of PtNR grid dysfunction (n = 8) related to damage incurred by suboptimal preoperative sterilization (n = 7) and improper handling (n = 1); intraoperative recordings were not performed. Vaporized peroxide sterilization was the most optimal sterilization method for PtNR grids, providing a significantly greater number of usable channels poststerilization than did steam-based sterilization techniques (median 905.0 [IQR 650.8-935.5] vs 356.0 [IQR 18.0-597.8], p = 0.0031). High-spatial-resolution microelectrode grids can be readily incorporated into appropriately selected craniotomy cases for clinical and research purposes. Grids are reliable when preoperative handling and sterilization considerations are accounted for. Future investigations should compare the diagnostic utility of these high-resolution grids to commercially available counterparts and assess whether diagnostic discrepancies relate to clinical outcomes.

Evaluation of the 3D Technology in the Auto-transplantation: An Original Research

ABSTRACT Introduction: Using three-dimensional printed duplicates of the donor teeth, three-dimensional auto-transplantation is a medical procedure that moves a tooth from one location inside a patient to another. The intraoperative practicability during 3D auto-transplantation of teeth was evaluated in the present study. Material and Methods: A prospective multicenter clinical study was done among the subjects. “Preoperative cone-beam computed tomography imaging,” “computer-assisted design (CAD),” and “computer-assisted manufacturing (CAM)” were used in all operations to make a 3D duplicate of the donor teeth. The clinical parameters that were evaluated were the time required for the fit, number of attempts to fit, and intra-operative experience. Results: Canines, premolars, molars, and one extra tooth were all transplanted during the 200 auto-transplantation surgeries among 152 subjects. An initial satisfactory fit of the donor tooth and an extra-alveolar time of less than one minute were achieved in 80% of the surgeries. The extra-alveolar time exceeded 3 minutes in ten teeth. Difficulties that were faced were related to the imaging, patient cooperation, and the bone quality. Conclusions: The application of the duplicate teeth by 3D printing of a donor tooth all through auto-transplantation techniques reduced the time the tooth stays extra-alveolar as well as the efforts at transplant fitting during implantation. This allowed for more challenging surgeries as well as a speedy and reliable therapy.

A qualitative study on patients’ and health care professionals’ perspectives regarding care delivered during CIED operation

BackgroundCardiac implantable electronic devices (CIEDs) has proven to be an invaluable tool in the practice of cardiology. Patients who have undergone CIED surgery with local anesthesia may result in fear, insecurity and suffering. Some studies have put efforts on ways to improve intraoperative experience of patients with local anesthesia, but researches concerning experiences of CIED patients during surgery is in its infancy.MethodsBased on semi-structured and in-depth interviews, a qualitative design was conducted in a tertiary general hospital in China from May 2022 to July 2023.Purposeful sampling of 17 patients received CIED surgery and 20 medical staff were interviewed. Thematic analysis with an inductive approach was used to identify dominant themes.ResultsFour themes emerged from the data: (1) Safety and success is priority; (2) Humanistic Caring is a must yet be lacking; (3) Paradox of surgery information given; (4) Ways to improve surgery experiences in the operation.ConclusionsIntraoperative care is significant for CIED surgery. To improve care experience during surgery, healthcare professionals should pay attention to patients’ safety and the factors that affecting humanistic caring in clinical practice. In addition, information support should consider information-seeking styles and personal needs. Besides, the four approaches presented in this study are effective to improve the intraoperative care experience.

Awake Unilateral Biportal Endoscopic Decompression Under Local Anesthesia for Degenerative Lumbar Spinal Stenosis in the Elderly: A Feasibility Study with Technique Note.

Here, we introduce a novel strategy of awake unilateral biportal endoscopic (UBE) decompression, which applies conscious sedation combined with stepwise local anesthesia (LA) as an alternative to general anesthesia (GA). The study aims to evaluate the feasibility of awake UBE decompression for degenerative lumbar spinal stenosis (DLSS) in elderly patients. This retrospective study included 31 consecutive patients who received awake UBE decompression for DLSS in our institution from January 2021 to March 2022. Clinical results were evaluated using patient-reported outcomes measures (PROM) including visual analog scale for leg pain (VAS-LP), Oswestry Disability Index (ODI), and modified MacNab criteria. The anesthesia effectiveness and intraoperative experience were evaluated by intraoperative VAS and satisfaction rating system. UBE decompression was successfully performed in all patients under LA combined with conscious sedation. 26 (83.9%) patients rated the intraoperative experience as satisfactory (excellent or good) and 5 (16.1%) as fair. The mean intraoperative VAS was 3.41±1.26. The VAS and ODI at each follow-up stage after surgery were significantly improved compared to preoperative scores (p < 0.01). At the last follow-up, 28 patients (90.3%) classified the surgical outcome as good or excellent, and 3 (9.7%) as fair. There were no serious complications or adverse reactions observed in the study. Our preliminary results suggest that awake UBE decompression is a feasible and promising alternative for elderly patients with DLSS.

Prevalence of co-morbidities and referral patterns in routine preoperative evaluation: A retrospective observational analysis in a tertiary care government hospital

The initial interaction between patients and anaesthesiologists during pre-anaesthesia check-ups (PAC) is a crucial opportunity to diagnose and pre-optimize co-morbidities that might go unnoticed. This proactive approach contributes to safe anaesthesia administration, uneventful intra-operative experiences, and smooth post-operative recovery. Our study assesses the prevalence of diverse co-morbidities within a tertiary care centre's PAC. After analysing data from 3 months involving 905 patients, 624 individuals exhibited co-morbidities, with 217 cases being newly identified within the PAC clinic. Among female patients, anaemia emerged as the most prevalent anomaly (219 cases), while hypertension dominated among male patients (171 cases). Overall, anaemia constituted the most common co-morbidity (362 cases). A comprehensive clinical assessment during the Pre-Anaesthetic Clinic empowers formulation strategies for pre-optimization and treatment of co-morbidities. Timely intervention is pivotal, not only to prevent surgery delays but also to avert potentially catastrophic outcomes arising from untreated conditions. This approach translates into expedited patient recovery, minimizing anaesthesia-related complications. The Pre-Anaesthetic Clinic plays a pivotal role in diagnosing and intervening in patient co-morbidities. Beyond diagnosis, it is a crucial early intervention and treatment platform, significantly enhancing the overall surgical recovery process.

Evaluating the accuracy of a cataract surgery simulation video in depicting patient experiences under conscious anesthesia

PurposeTo evaluate the accuracy of a point-of-view cataract surgery simulation video in representing different subjective experiences of patients undergoing the procedure.MethodsOne hundred consecutive post-cataract-surgery patients were shown a short simulation video of the surgery obtained through a porcine eye model during the first postoperative week. Patients then answered a multiple-choice questionnaire regarding their visual and tactile intraoperative experiences and how those experiences matched the simulation.ResultsOf the patients surveyed (n = 100), 78% (n = 78) recalled visual experiences during surgery, 11% recalled pain (n = 11), and 6.4% (n = 5) recalled frightening experiences. Thirty-six percent of patients (n = 36) were interviewed after their second cataract surgery; there was no statistically significant difference between anxiety scores reported before the first eye surgery and second eye surgery (p = 0.147). Among all patients who recalled visual experiences (n = 78), nearly half (47.4%) reported that the video was the same/similar to their experience. Forty-eight percent of the patients recommended future patients to watch the video before their procedures, and more than a third (36%) agreed that watching the video before surgery would have helped them to relax.ConclusionsOur model reflects the wide range of subjective patient experiences during and after surgery. The high percentage of patients who found the video accurate in different ways suggests that, with more development, point-of-view cataract simulation videos could prove useful for educational or clinical use. Further research may be done to confirm the simulation’s utility, by screening the video for subjects before operations.

Patients’ caring experience during procedures under regional anesthesia in Mainland China: A phenomenology study

BackgroundAlthough regional anesthesia is common, the procedure results in feelings of uncertainty and anxiety in some patients. Increased care is needed for these patients under general anesthesia. Few studies have focused on the intraoperative caring experience of patients during regional anesthesia. This study focused on the caring experience of patients during procedures involving regional anesthesia. MethodsThe descriptive phenomenology method of Husserl was employed. Semi-structured interviews were conducted with a purposive sample in five Grade III-A hospitals in Zhengzhou City, Henan Province. The seven-step analysis method of Colaizzi was applied for the analysis, summation, and theme refinement of the interview data. ResultsA total of 14 patients from five hospitals participated in the interviews. Four domains and 16 themes emerged during analysis: be informed (about the operation site, progression of the operation, informed in advance, receive explanation for abnormal experience); take care of my body (painless, gentle movements, special care); be protected (work seriously, favorable atmosphere, skilled, authority); and treated as an individual (pay attention, accompany, ask for opinions, encourage patient expression, humorous). ConclusionPatients during procedure under regional anesthesia had specific caring experiences relative to other patients. Medical staff should recognize the importance of regional anesthesia patients’ intraoperative caring experience. Hospital administrators should offer support to allow healthcare staff to provide targeted caring for patients during procedure under regional anesthesia.

Intravascular ultrasound to aid in the diagnosis and revision of an intra-aortic pedicle screw: illustrative case.

Pedicle screw impingement on vessel walls has the potential for complications due to pulsatile effects and wall erosion. Artifacts from spinal instrumentation create difficulty in accurately evaluating this interface. The authors present the first case of intravascular ultrasound (IVUS) used to characterize a pedicle screw breach into the aortic lumen. A 21-year-old female with surgically corrected scoliosis underwent computed tomography angiography (CTA) 3 years postoperatively, which revealed a pedicle screw within the thoracic aorta lumen. Metal artifact distorted the CTA images, which prompted the decision to use intraoperative IVUS. The IVUS confirmed the noninvasive imaging findings and guided final decisions regarding aortic endograft size and location during spine hardware revision. For asymptomatic patients presenting with pedicle screws malpositioned in or near the aorta, treatment decisions revolve around the extent of vessel wall penetration. Intraluminal depth can be obscured by artifact on computed tomography or magnetic resonance imaging or inadequately evaluated by a transesophageal echocardiogram. In our intraoperative experience, IVUS confirmed the depth of vessel lumen violation by a single pedicle screw and no wall penetration by two additional screws of concern. This was useful in deciding on thoracic endovascular aortic repair graft size and landing zone and facilitated safe spinal instrumentation removal and revision.

Accuracy and patient-centered results of static and dynamic computer-assisted implant surgery in edentulous jaws: a retrospective cohort study.

This study aimed to compare implant positioning accuracy and patient-centered results between static and dynamic computer-assisted implant surgery (s-CAIS and d-CAIS) in edentulous jaws. The current study retrospectively evaluated a total of 110 implants placed in 22 fully edentulous patients via s-CAIS or d-CAIS (n = 11). The accuracy of implant positioning was assessed by measuring the implant's angular deviation and deviation at the platform and apex from the preoperative design postoperatively. Patient-centered results, including preoperative and intraoperative patient-reported experiences and postoperative patient-reported outcomes, were extracted from the medical records. The nested t test and chi-square test were used to compare accuracy and patient-centered results between s-CAIS and d-CAIS postoperatively. The implants in the s-CAIS group showed significantly smaller angular deviation (2.32 ± 1.23°) than those in the d-CAIS group (3.87 ± 2.75°). In contrast, the platform and apical deviation were significantly larger in s-CAIS (1.56 ± 1.19mm and 1.70 ± 1.09mm, respectively) than d-CAIS (1.02 ± 0.45mm and 1.00 ± 0.51mm, respectively). Furthermore, the implants in the s-CAIS group deviated significantly (p < 0.001) more toward the coronal direction than those in the d-CAIS group. Notably, all patients in the s-CAIS group reported an obvious foreign body sensation during surgery, representing a significant difference from the d-CAIS group. Compared to s-CAIS, d-CAIS is a reliable technique for the placement of multiple implants in fully edentulous patients with less linear deviation and less foreign body sensation. The retrospective study was registered on the Chinese Clinical Trial Registry on August 8th, 2022, with registration number No. ChiCTR2200062484. Despite the increasing use of computer- assisted implant surgery in fully edentulous patients, clinical evidence comparing implant positioning accuracy and patient-centered results between static and dynamic CAIS systems is scarce. Our study demonstrated that compared to s-CAIS, d-CAIS is a reliable technique for the placement of multiple implants in fully edentulous patients with less linear deviation.

Analysis of factors affecting intraoperative conversion from thoracoscopic radical resection of lung cancer to thoracotomy and intraoperative management experience.

To explore the factors affecting the intraoperative conversion of video-assisted thoracoscopic surgery (VATS) to thoracotomy in patients with lung cancer. The clinical data of 80 patients with lung cancer in The Fourth Hospital of Hebei Medical University from May 2019 to December 2021 were retrospectively analyzed. The patients who were treated with VATS alone were included into thoracoscopy group (n= 40), and those who were intraoperatively converted from VATS to thoracotomy were included into conversion group (n= 40). The medical record data were collected, the influencing factors of intraoperative conversion from VATS to thoracotomy were analyzed, and the surgical indexes and postoperative complications were compared between the two groups. Multivariate regression model showed that tumor in the upper lobe, central lung cancer, history of pulmonary tuberculosis, pleural adhesion ≥ Grade-4 and maximum tumor diameter ≥ 35 mm were risk factors for patients with lung cancer undergoing conversion from VATS to thoracotomy (p< 0.05). In the conversion group, the surgical duration and hospital stay were longer, the intraoperative bleeding volume and thoracic drainage volume were larger, and the total incidence of postoperative complications was higher than those in the thoracoscopy group (p< 0.05). Conversion from VATS to thoracotomy may increase the risk of complications in patients with lung cancer. Tumor in the upper lobe, central lung cancer, history of pulmonary tuberculosis, high degree of pleural adhesion and large tumor diameter are risk factors for conversion from VATS to thoracotomy.

Receptive music therapy as an intraoperative aid for neuro-monitoring during growth rod surgery in a 5-year-old girl with severe congenital scoliosis: A case report

Neuromonitoring with sensory and motor evoked potentials is an essential tool during spinal correction surgeries to prevent any unforeseen cord injury intraoperatively and neurological deficit in the post-operative period. The muscle contraction and twitches resulting from cortical stimulation with a 200-250mA current are picked up by various subcutaneous/intradermal electrodes placed in the arms, hands, and legs creating a real-time assessment of any spinal cord injury caused by spinal implants or corrective maneuvers. During the neuromonitoring phase most anesthetic drugs such as volatile agents, neuromuscular blockers, and propofol may cause an interference with the electrode signals and therefore cannot be used. This could lead to significant risk of intraoperative awareness. Cases of intraoperative awareness have led to medical negligence and such incidents are the cause for 2% of the legal claims against anesthetists while patients with intraoperative awareness experience describe it as the worst thing they have ever suffered from. We therefore decided to use receptive music therapy, a novel aid in reducing chances of awareness during neuromonitoring.