Low Complication Rate Research Articles

Percutaneous Carotid Access in Endovascular Aortic Arch Repair: Initial Experience.

Direct percutaneous access to the carotid artery (diPerCa) during endovascular aortic arch repair (EVAAR) can potentially present a minimally invasive access with lesser local adverse events. A retrospective review of consecutive EVAAR between January 2018 and January 2024, in a tertiary referral center, was performed to identify cases, in which diPerCa was used. Patients who were planned for EVAAR with no previous carotid intervention were included. A standardized technique was employed where an ultrasound-guided retrograde puncture of the carotid artery was performed with a micro-puncture set and a suture-mediated closure device (pre-closure technique). Of the 13 included patients, technical success was achieved in 12 (92.3%), with one intraoperative death unrelated to diPerCa. Major complications included one case of carotid pseudoaneurysm and one case of non-flow-limiting carotid dissection. Minor complications were unilateral recurrent laryngeal nerve palsy in one case and new-onset dizziness in one case. All carotid arteries remained patent without stenosis, with one case of non-progressing dissection noted at the conclusion of the mean follow-up of 22.5±2.4 months. Direct percutaneous carotid access with suture-mediated closure devices during EVAAR is feasible with acceptable results and low incidence of clinically relevant neurological and local complications. Further studies are needed to confirm these findings and evaluate long-term outcomes. Direct percutaneous carotid access (diPerCa) during endovascular aortic arch repair (EVAAR) offers a minimally invasive alternative to retrograde access via open surgical exposure. This technique, supported by suture-based closure devices, demonstrates no stroke and low rates of local complications. Overall outcomes are promising, suggesting diPerCa as a feasible option for select patients. Further research is warranted to validate these findings and assess long-term outcomes.

Quantifying treatment burden: the patient burden score a study of 758 patients across three clinical urologic scenarios

ObjectivesTo develop a comprehensive scale that measures the three burden types of any treatment, including expected, unexpected (complications), and need for ancillary procedures.MethodsA panel of experts created a scale that assessed the burden of all aspects of treatment, including hospitalization, anesthesia, surgery, and follow-up. The total score is defined as the burden score (BS). BS was calculated retrospectively for patients in three clinical scenarios in urology, each with two acceptable treatment options: patients with a small renal mass (T1a) treated with either partial nephrectomy (PN, 139 patients) or percutaneous ablation (PA, 83 patients), patients with bladder cancer (stages T2-4a, N0, M0) treated with radical cystectomy (RC, 162 patients) or trimodal therapy (TMT, 88 patients), and patients with upper ureteral stones ≤ 10 mm treated with either ureteroscopy (137 patients) or extracorporeal shock-wave lithotripsy (SWL, 150 patients).ResultsBoth PN and PA provided excellent oncological results (5-year recurrence-free survival ≥ 97%) and low complication rates. However, the BS of PN was more than twice that of PA (27.3 ± 7.7 vs. 12.5 ± 6.4, p < 0.01). RC and TMT showed identical 3-year disease-specific survival rates (73%), but the BS of TMT was significantly lower (53.8 ± 11.1 vs. 42.0 ± 11.6, p < 0.01). Both ureteroscopy and SWL have achieved high stone-free rates (≥ 97%) and low complication rates. However, the BS of ureteroscopy was significantly lower (7.8 ± 3 vs. 9.0 ± 3.5, p < 0.01).ConclusionPA treatment for small renal masses, TMT for muscle-invasive bladder cancer, and ureteroscopy for upper ureteral stones provided similar success rates to those of PN, RC, and SWL, but with significantly lower BS. This tool can assist in patient consultation when multiple treatment options are available. The concept of BS can be extended to other fields of medicine.

Clinical outcomes of microwave ablation for solitary T1N0M0 papillary thyroid carcinoma: a more than 5-year follow-up study.

This study aimed to evaluate the long-term efficacy and safety of microwave ablation (MWA) for solitary T1N0M0 papillary thyroid carcinoma (PTC) and compare them between T1a and T1b disease. This retrospective study included 136 patients with solitary T1N0M0 PTC who were treated with MWA and followed up for more than 5 years. Outcomes were compared between patients with T1a and T1b disease. The primary outcomes were disease progression and disease-free survival (DFS). The secondary outcomes included the volume reduction rate (VRR), the rate of complete disappearance, and complications. During a mean follow-up period of 70.6 ± 10.5 months, the overall disease progression rate was 5.88%. The incidences of lymph node metastases (LNMs) and new tumors were 2.21% and 5.15%, respectively. No patient was diagnosed with local recurrence, distant metastasis, or death due to PTC. There were no significant differences between the T1a and T1b groups in terms of disease progression (3.81% vs 12.90%, p = 0.15), LNMs (1.90% vs 3.23%, p = 0.54), or new tumors (2.86% vs 12.90%, p = 0.08). The 5-year DFS rate was 94.85%, the VRR was 99.7% ± 2.0%, and 97.79% of the tumors disappeared. Hoarseness occurred in five patients (3.68%). MWA is a long-term effective and safe option for patients with solitary T1N0M0 PTC, providing a minimally invasive alternative for those who refuse surgery or active surveillance. Question MWA, as a minimally invasive alternative for treating PTC, lacks comparison with surgical resection and active surveillance. Findings MWA resulted in overall disease progression in 5.88% of patients with solitary T1N0M0 PTC over more than 5 years of follow-up. Clinical relevance MWA is a safe, effective, and minimally invasive treatment for solitary T1N0M0 PTC, with high DFS rates and low complication rates, benefiting patients seeking alternatives to surgery or active surveillance.

Multiple Serratus- and High-Oblique LipoTransfer guided by Ultrasound (Multi-SHOT): Cadaveric and Clinical Study

Abstract Background Body contouring procedures are now increasingly popular among male patients who desire a lean and athletic appearance. Dynamic Definition Liposculpture (HD2) employs a comprehensive, 360-degree approach to achieve natural-looking results. Several authors have highlighted the efficacy and safety of fat grafting techniques in body contouring, which are strategically applied to enhance muscle definition. Objectives We are reporting our experience with ultrasound-guided intramuscular fat grafting to the serratus anterior muscles and the superior third of the internal and external oblique muscles (Multi SHOT) in addition to High Definition Liposculpture. Methods We conducted a retrospective cohort study across 2 specialized plastic surgery centers. Our study included adult male patients with ectomorph and mesomorph body biotypes who underwent Multi SHOT in addition to HD2. Descriptive statistical analysis was used to summarize demographic, surgical, and clinical variables. Given the sample size, high satisfaction rates, and low complication rates, no bivariate analysis was performed. Results A total of 81 consecutive male patients underwent High Definition Liposculpture combined with the Multi-SHOT technique. Mean age was 40.27 years (SD = 8,34 years), and the mean Body Mass Index (BMI) was 26.79 kg/m2 (SD = 2,47 kg/m2). Additional fat grafting of trunk muscles was performed to enhance the aesthetic outcomes. No complications associated with the technique were reported. Conclusions Our findings provide valuable insights about the safety and efficacy of the Multi-SHOT technique to enhance the athletic and muscular appearance of the male anterior torso. Further studies with greater sample size are required to support our findings.

Comparative efficacy and safety of 180W XPS vs. 120 W HPS GreenLight laser therapy for benign prostatic hyperplasia: a systematic review and meta-analysis.

To compare the surgical and functional outcomes of the 120 W HPS and 180 W XPS GreenLight laser vaporization systems in the treatment of benign prostatic hyperplasia (BPH). In January 2024, a comprehensive search across PubMed, Cochrane Library, and EMBASE was conducted following PRISMA guidelines, registered under PROSPERO (CRD42024531176). Studies comparing 120 W and 180 W GreenLight lasers in BPH treatment were assessed for clinical outcomes. Eight studies were included. The 180 W XPS system improved operation time (MD: 12.70, 95% CI [5.29-20.11], p=0.0008), lasing duration (MD: 10.09, 95% CI [0.85-19.33], p=0.03), and catheterization duration (MD: 0.43, 95% CI [0.12-0.74], p=0.007). No significant differences in energy consumption, energy density, or length of hospital stay were found. Functional outcomes such as International Prostate Symptom Score and maximum urinary flow rate showed no significant differences, except in quality of life (MD: 0.43, 95% CI [0.06-0.80], p=0.02) and prostate-specific antigen levels (MD: -0.77, 95% CI [-1.28 to -0.25], p=0.003). The 180 W system exhibited a lower rate of overall (OR: 1.52, 95% CI [1.14-2.04], p=0.005) and minor complications (OR: 1.84, 95% CI [1.27-2.66], p=0.001), with no significant differences in major complications or other adverse events. The 180 W XPS system demonstrates enhanced efficiency and reduced complication rates, offering a favorable option for BPH treatment, particularly for larger prostates. Future studies should focus on randomized trials to confirm these findings and assess long-term outcomes.

Ultrasound-Guided Female Equilibrated Minimal Muscularization and Enhancement (U-Femme)

Abstract Background High-Definition Liposculpture has undergone significant evolution since its initial description, with the goal of achieving more natural outcomes and a muscular-defined appearance. The introduction of intramuscular fat grafting has enhanced contouring capabilities, with its applications extending to various muscle groups. Subperiosteal fat grafting efficacy and safety is well-established in facial surgery. Objectives Describe our technique of combining ultrasound-guided subperiosteal lipoinjection of the anterior superior iliac spine (Bikini Bridge) plus intramuscular fat grafting of the internal oblique muscles with High Definition Liposculpture. Methods A retrospective cohort study was conducted across different specialized plastic surgery centers. Adult patients who underwent Bikini Bridge and Dynamic Definition Liposculpture were included. All patients were informed of the innovative use of the technique and consented to participate. Descriptive statistical analysis was performed to summarize the variables. Results A total of 105 consecutive patients were included for analysis. Patients were mostly women (86,7%) plus 14 male patients (13,3%) who were in gender reassignment process. Mean age was 34,3 years (SD 8,7 years) and median body mass index was 22,9 kg/m2 (SD 2,74 kg/m2). All patients underwent fat grafting the Iliac spines + the oblique muscles as an additional procedure to High Definition Liposculpture. Median volume of fat injected was 15 cc (IQR 12 cc) for the iliac spines and 40 cc for the internal obliques. No major complications were reported. Conclusions Ultrasound-guided intramuscular and subperiosteal fat grafting of the abdomen is a safe and reproducible procedure, resulting in a harmonious and athletic appearance with natural-looking outcomes, high satisfaction, a very low rate of complications.

Can suction technology be a potential game changer that reshapes pediatric endourological interventions? Results from a scoping review.

To systematically review the use of suction/vacuum-assisted retrograde intrarenal surgery (RIRS) and percutaneous nephrolithotomy (PCNL) in children/adolescents with kidney stones. The PICOS model (Patient Intervention Comparison Outcome Study type) was used to frame and answer the clinical question; P: children and adolescent men with kidney stones; I: use of suction during PCNL or RIRS; C: no suction devices or none; O: complications and stone-free rate (SFR); S: prospective and retrospective studies; case reports. The literature search was performed on 14th May 2024 using Embase, PubMed, and Scopus. Only English papers were accepted. Ten articles were included. There were 9 papers on mini-PCNL and the remaining one compared mini-PCNL with RIRS. PCNL studies found excellent SFR (73-100%) with zero transfusion rate and a low rate of infectious complications (fever up to 9.6% and sepsis rate of 1%). Among these studies, there was a case report on the use of shock pulse lithotripter with complete stone clearance. Our review shows that there is little data on the use of suction/vacuum-assisted mini-PCNL/RIRS in kidney stone children/adolescents. However, these preliminary data demonstrated that vacuum-assisted mini-PCNL had excellent SFR with a low rate of complications.

Splenic Artery Embolization for Post-Liver Transplant Ascites

AbstractOrthotopic liver transplantation (OLT) is the treatment of choice for end-stage liver disease. However, OLT may be associated with certain postoperative management challenges. Though refractory ascites (RA) is not a common complication post-OLT, it can have a significant impact on patient outcomes and quality of life. RA post-OLT can be caused by portal hyperperfusion. In this article, a systematic review of the literature was pursued to analyze the effectiveness of splenic artery embolization (SAE) with RA after OLT. Data sources included MEDLINE, EMBASE, and CENTRAL from inception to March 2024. Studies reporting on patients treated with SAE for the management of RA following OLT, from inception to March 2024, were included. Morbidity, mortality, and clinical resolution were synthesized through a narrative review. A total of eight articles were identified, including 80 patients. In the majority of the patients, the SAE was performed using a vascular plug. After SAE, no cases associated with mortality were reported. Severe complications (Clavien III) occurred in 2.5% (n = 2) of patients. The success rate, with clinical resolution of symptomatology (ascites), ranged in these articles between 97 and 100%. The approach to the management of RA post-OLT should focus on identifying the underlying cause. If the RA is associated with portal hyperperfusion, it can be managed with SAE. Particularly proximal SAE seems to be highly effective for the resolution of ascites and the procedure is associated with a low complication rate.

DIEP flap with implant placement has a favorable complication profile compared to implant-only or flap-only reconstruction.

Hybrid deep inferior epigastric perforator (DIEP) flap and simultaneous silicone implant breast reconstruction procedures ("DIEP+I") have many conceptual advantages compared to either reconstruction method alone, but the outcomes of DIEP+I reconstruction have not yet been well studied. Therefore, the purpose of this study was to compare the outcomes of DIEP+I with implant-only and DIEP-only reconstruction. A retrospective review was conducted of patients undergoing DIEP+I, implant-only, and DIEP-only breast reconstruction from 2019-2023 at a single institution. Demographics and complication rates were compared between groups. A total of 145 patients were included in the DIEP+I (N = 26), implant-only (N = 59), and DIEP-only (N = 60) groups. The DIEP+I group had a lower overall complication rate than implant-only reconstruction (18.4% vs 41.1%, P = 0.014), which was primarily due to the lower incidence of infections in the DIEP+I group (2.6% vs 22.2%, P = 0.006). Accordingly, DIEP+I reconstruction decreased the odds of infection by 90% (OR = 0.095, P = 0.024) compared to implant-only reconstruction. The DIEP+I group had similar rates of wound healing and implant-related complications compared to the implant-only and DIEP-only groups, and no patients in the DIEP+I group experienced flap loss. DIEP+I breast reconstruction had a lower rate of infectious complications than implant-only reconstruction, and no higher rate of flap compromise or wound healing complications. This technique could be considered as a means of minimizing infection risk in patients with other risk factors who are seeking implant-based reconstruction, and of enhancing breast projection in patients who are seeking DIEP flap reconstruction.

Interposition versus transposition technique in microvascular decompression for trigeminal neuralgia secondary to vertebrobasilar dolichoectasia: a systematic review and pooled meta-analysis.

Limited data are available comparing the interposition and transposition techniques for microvascular decompression (MVD) in patients with trigeminal neuralgia (TN) secondary to vertebrobasilar dolichoectasia (VBD); this study aims to review current findings on TN associated with VBD and compare the interposition and transposition techniques in terms of surgical morbidity and patient outcomes. Following the PRISMA guidelines, PubMed/Medline, Web of Science, and SCOPUS databases were searched to identify studies reporting patients undergoing MVD for TN secondary to VBD. The studies were divided into two groups, interposition and transposition, based on the microvascular decompression technique used. Studies not reporting the diagnostic criteria, included less than five cases, or were not available in English were excluded. Fourteen eligible papers were retrieved, of which five studies reported cases undergoing the interposition technique, eight studies for the transposition technique, and one study reported cases from both groups. Data including preoperative and postoperative BNI class, comorbidities, and postoperative complications were retrieved to analyze and compare the two techniques in terms of efficacy and long-term outcomes in treating TN secondary to VBD. Both interposition and transposition techniques for MVD yield high rates of pain relief in patients with TN secondary to VBD. While both approaches demonstrate similar efficacy, the interposition method is associated with a lower rate of long-term complications. Further research, preferably through randomized prospective studies, is needed to refine surgical strategies and improve patient outcomes.

Comparison of NeedleTrainer™ and ultrasound tissue simulator in a simulated environment among novice regional anaesthesia practitioners

BackgroundUtilising ultrasound technology has resulted in higher success and lower complication rates during regional anaesthesia (RA) procedures. Proper training is necessary to accurately identify structures, optimise images, and improve hand–eye coordination. Simulation training using immersive virtual environments and simulation models has enabled this competency training to be conducted safely before performing on patients. We conducted a study to compare the simulator performance and users’ feedback on a Blue Phantom Regional Anaesthesia Ultrasound Training Block and NeedleTrainer™.MethodsForty-seven participants were recruited via convenient sampling during a RA workshop for novice practitioners. They were divided into the N or B group and then crossover to experience using both Blue Phantom and NeedleTrainer model. Time-to-reach-target, first-pass success rate, and complication rate were assessed, while the learning and confidence scores were rated using six-item and three-item questionnaires, respectively, via a 5-point Likert scale.ResultsBlue Phantom model has a longer time-to-target as compared to the NeedleTrainer model (16 ± 8 vs 8 ± 3 s, p < 0.001), higher first- pass success rate (100% vs 80.9%), and lower complication rate (0% vs 19.1%). Higher overall learning satisfaction scores (28 ± 4 vs 25 ± 4, p = 0.003) and confidence scores after training (13 ± 2 vs 12 ± 2, p < 0.001) were recorded for the Blue Phantom model.ConclusionsWe postulated that the artificial intelligence structure recognition software enables NeedleTrainer users to attain shorter time-to-target. That being said, Blue Phantom provides better operator learning satisfaction, improved confidence, higher success and lower complication rates among novice RA practitioners, possibly due to greater tactile feedback during the simulated training.

A New Guiding Suturing Technique for Reshaping of the Antihelix in Patients with Prominent Ears.

Prominent ears are the most common congenital anomaly of the head and neck. A complete understanding of the definition of prominent ears is necessary. The present retrospective study described guiding sutures to hold the antihelix in a temporary corrected position before placing the permanent Mustardé sutures. This study was performed between January 2021 and February 2023. All patients with prominent ear deformities subjected to guiding sutures and Mustardé-based otoplasty were included. The surgical-related outcomes and surgeons' satisfaction were evaluated. The patients' satisfaction and health-related quality of life were reported. The current study included 60 patients with prominent ear deformities. There were 34 (56.66%) males and 26 (43.33%) females with a mean age of 12.2±7.8 years. The mean total operative time was 49±22 minutes. Five (8.33%) patients had suture extrusion, and no case of asymmetry, recurrence, or skin necrosis was documented.There were 55 (91.66%) patients satisfied with the final appearance of their ears, and five (8.33%) patients were not satisfied. The mean general health subscale was 57.1±6.9, and the mean physical health subscale was 8.7±1.5. The guiding sutures allowed easy accessibility for reshaping the antihelix in patients with prominent ears. These sutures allowed a relatively shorter operative time, and stable reshaping of the antihelix allowed for a shorter recovery time. This was associated with a low complication rate with no asymmetry, recurrence, or revision surgery.Patients operated on under local anesthesia achieved shorter operative time and better pain control. This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266 .

Side effects and complications of high dose-rate brachytherapy: literature review and our own observations

Background. Among malignant tumors in men in Russia, prostate cancer is the most common comprising 17 %. Despite the high effectiveness of radiotherapy for prostate cancer in about 20 % of patients, radiation damage of the pelvic organs develops affecting bladder, rectum, and intrapelvic cellular tissue.Aim. To evaluate early and late complications of high dose-rate brachytherapy.Materials and methods. Literature review was performed, and our own results of treatment of 276 patients using high dose-rate brachytherapy as monotherapy with different fractionation regimens: 19 Gy per 1 fraction and 15 Gy per 2 fractions were analyzed.Results. High dose-rate brachytherapy as monotherapy is associated with low complication rate. There were no statistically significant differences between singleand two-fraction regimens. Evaluation of complication severity per the RTOG (Radiation Therapy Oncology Group) classification did not show complication severity above grade III. Early complications were diagnosed in 1.1 %, late in 3.3 % of cases. Between the treatment and comparison groups, no statistically significant differences in the frequency of urinary system organ symptoms per the IPSS (International Prostate Symptom Score) questionnaire were registered. Mean score per the IPSS prior to treatment was 4.0 (3.0–6.0) in the treatment group and 4.0 (3.0–8.5) in the comparison group. Mean follow-up duration in the treatment group was 65.0 (60.0–70.0) months, in the comparison group – 55.0 (49.5–65.0) months. After the treatment, mean IPSS score was 5.0 (4.0–5.0) in the treatment group and 5.0 (3.0–7.0) in the comparison group.Conclusion. High dose-rate brachytherapy as monotherapy and in combination with external beam therapy is a safe and effective treatment method in prostate cancer. Serious and late complications are rare, however toxic effects of severity grades I or II can develop. Careful patient selection for brachytherapy, therapy planning methods, as well as active management of early and late toxicity by a multidisciplinary team with knowledge and experience in treatment of side effects of radiotherapy can help optimize treatment with high dose-rate brachytherapy.

Robot-assisted partial nephrectomy vs. percutaneous cryoablation for T1a renal tumors: a single-center retrospective analysis of outcomes and costs.

The aim of this study is to compare perioperative, functional, and oncological outcomes between robot-assisted partial nephrectomy (RAPN) and cryoablation (CRYO), based on a 3-year experience at our Institution. Additionally, a secondary aim is to conduct a comparative cost analysis between the two procedures. A retrospective analysis was conducted, including patients who underwent RAPN or CRYO between January 2020 and December 2023. Group 1 consisted of 59 patients who underwent RAPN, while Group 2 included 38 patients who had CRYO. The evaluation parameters included baseline characteristics, perioperative, functional, and oncological outcomes, as well as total hospitalization costs. Operative time (OT), average length of hospital stay (LOS), and emetic blood loss (EBL) were significantly lower in the CRYO group. Furthermore, CRYO showed a significantly lower rate of postoperative complications of any grade (7.8% vs 16.9%); however, this was associated with a considerably higher recurrence rate (5.7% vs 1.7%). No substantial differences were found in long-term functional outcomes (ΔeGFR). In terms of costs, CRYO was more cost-effective than RAPN (€5473 vs €10,672), although the gap was partially offset by a higher reimbursement "DRG" rate for robotic partial nephrectomy (€7386 vs €4384). Robot-assisted partial nephrectomy (RAPN) remains the preferred option for treating small renal masses (sRM), providing excellent oncological results and acceptable morbidity. However, percutaneous cryoablation is a valid alternative, particularly for patients unfit for surgery, as long as meticulous postoperative follow-up is carried out.

Outpatient periurethral injections of polyacrylamide hydrogel (Bulkamid®) under local anesthesia in the office: a prospective single-center series

ObjectiveTo report our experience of outpatient peri-urethral injections of Bulkamid® under local anesthesia in the office in female patients for stress urinary incontinence (SUI). Polyacrylamide hydrogel (Bulkamid®) is a relatively recent bulking agent which may have a better safety profile than previous generations. MethodsThe data of all women who underwent outpatient peri-urethral Bulkamid® injections under local anesthesia in the office at a single academic center were collected prospectively between November 2019 and August 2023. This therapeutic option was offered to patients who had SUI if > 80-year-old and/or had multiple comorbidities or if they declined all other therapeutic options. ResultsNinety-two patients were included. The mean age was 78 years (30-97). Twenty-two patients experienced postoperative complications (21%), seventeen were Clavien 1 complication, only one complication was Clavien =4. The USP SUI and OAB subscores and the ICIQ-SF were all significantly improved at 3 months (p<0.001). The VAS for urethral coaptation self-assessed by the surgeon at the end of the procedure was the strongest predictor of postoperative outcomes.Peri-urethral Bulkamid® injections are feasible in an outpatient setting in the office using a simplified local anesthesia protocol with a great tolerance and with similar functional outcomes than previously reported. The injections have a low rate of complications and every complication has been well tolerated. ConclusionThese options may be of great value in frail patients and those looking for a minimally invasive treatment. The local anesthesia protocol with the office setting may be of particular interest.

Complications and risk factors associated with zygomatic implants: retrospective analysis with 73 consecutive patients followed for 3.5 years.

This retrospective study analyzed zygomatic implant (ZI) survival and implant success (based on ORIS criteria) in patients treated for maxilla atrophy or after reconstruction failure. Implants were placed as quads (4 ZIs) or hybrids (ZIs and conventional implants in premaxilla) in edentulous patients using various surgical approaches, evolving from the sinus slot to Chow's extended sinus lift technique with or without Bichat fat pad. The procedure was followed by immediate loading, while clinical and radiographic evaluations spanned at least 1 year after implantation. The primary outcome was the implant survival at follow-up, and the secondary was the implant success, assessed as complications according to ORIS criteria: prosthetic offset, sinus status, peri-implant soft tissue health, and implant stability. A total of 73 consecutive patients, treated with 217 ZIs and 76 conventional implants, were included, with mean follow-up of 3.5 years (range, 1-9.8 years). Four ZIs failed in 3 patients, including 1 patient with a zygomatic bone fracture. The cumulative survival rate was 98.16%. Although in 2 additional cases, implants lost stability, they achieved delayed osseointegration. Other complications included 21 sinus reactions (excluding the 4 failures) and 28 peri-implant inflammatory reactions. ZIs offered a predictable treatment option for extreme upper jawbone atrophy with a relatively low complication rate and no severe injuries. The Chow technique with the Bichat fat pad positively impacted ZI success and survival, whereas smoking, implantation in fresh sockets, and the limited experience of the surgeon negatively affected the outcomes.

Restoring mobility: roles of percutaneous consolidation for pelvic ring bone lesions-a multicenter study.

This study aimed to assess the early functional rehabilitation outcomes following percutaneous consolidation for pelvic ring tumor lesions. In this multicenter retrospective study, patients with pelvic bone tumor lesions, whether primitive or metastatic, underwent percutaneous consolidation (cementoplasty, screw fixation, or both). The primary outcome was postoperative weight-bearing ambulation. Secondary outcomes included hospitalization duration, procedural complications, and long-term consolidation. Inclusion criteria were patients treated for prophylactic consolidation or pathological fractures. Kaplan-Meier analysis was used for the primary outcome and hospital stay, with p-values < 0.05 indicating significance. A total of 143 consecutive procedures were performed in 138 patients (mean age, 65 years ± 13; 68 men) who underwent percutaneous screw fixation, cementoplasty, or both. Postoperative weight-bearing ambulation was achieved in 142/143 cases (99%). In total, 117/143 (82%) of these were in the first 24 h. 81/143 (57%) were discharged within 24 h (median, one day; Q3, one day; Q4, 112 days). 133/138 (96.5%) patients achieved long-term consolidation. The most common pattern was isolated acetabular involvement (N = 40; 28%). Of the 19 adverse events, 10 were asymptomatic. Three patients had delayed infections and one required screw removal. Percutaneous consolidation effectively achieved postoperative weight-bearing ambulation and represents a safe and durable treatment option for patients with pelvic bone lesions. ClinicalTrials.gov: NCT06155890. Question How can radiology continue to help improve care for patients with metastatic pelvic ring lesions? Findings 99% of patients achieved postoperative weight-bearing, with 82% doing so within 24 h. Clinical relevance Percutaneous consolidation enabled rapid functional rehabilitation of oncology patients, allowing short hospital stays with low complication rates, and demonstrating the expanding role of radiologists in diagnosis, risk assessment, and treatment planning, thereby enhancing patient care.

Preoperative Radiation Therapy is Not Associated with Postoperative Complications in Patients with Retroperitoneal Sarcoma.

The role of preoperative radiation therapy (RT) in the management of retroperitoneal sarcomas (RPS) remains controversial. A legitimate concern is the potential for worse outcomes after surgery for RPS with preoperative RT. The purpose of this study was to evaluate the impact of preoperative (± intraoperative) RT on postoperative complications in patients undergoing surgery for RPS. A total of 99 patients who underwent curative-intent surgery for primary RPS of any histology after preoperative RT from 2003 to 2021 were analyzed. Univariate and multivariate logistic regression analyses were performed to identify factors associated with postoperative morbidity and mortality. The median preoperative RT dose was 57.4Gy, and 17 patients received intraoperative RT to a median dose of 10Gy. The median number of organs resected was two. Postoperative complications within 30 days of surgery occurred in 47% of patients, including severe complications (Clavien-Dindo grades ≥IIIa) in 20% of patients. The 90-day mortality rate was 2%. On multivariate analysis, concomitant vascular resection was the only significant predictor of severe postoperative complications (odds ratio 8.76; p=0.0069). Despite increasing median preoperative RT doses from 50.4Gy in 2003-2012 to 63Gy (on a clinical trial) in 2013-2021, severe postoperative morbidity rates actually decreased from 26.3% to 16.1% (p=0.303). The administration of preoperative (± intraoperative) RT to patients with RPS resulted in similar postoperative complications as reported after surgery alone. Continuous advances in surgical and radiotherapeutic expertise resulted in lower complication rates over time despite increasing radiation doses.

Single site multi puncture supine (SMS) PCNL procedure in patient with complex renal stone: One incision, why should more?

Since percutaneous nephrolithotomy (PCNL) was introduced in 1976, it has been the standard procedure for large renal stones. Over time, the PCNL technique changed and developed into various techniques. We introduce single-site multipuncture supine (SMS) PCNL to give a cosmetic advantage due to less tissue injury in complex renal stones. This study aimed to determine the outcome of SMS PCNL procedure in patients with complex renal stones diseases. This study was a retrospective study including all patients with kidney stones who had undergone SMS PCNL at the Urology Department of Saiful Anwar General Hospital from March 2019 until December 2022. All SMS PCNL procedures were performed by a single operator. The patients were divided into three groups that included that were treated with 2, 3, and 4 punctures. The data were collected using SPSS ver. 25. Ninety-three patients were included in this study. The characteristics of the patient, such as gender, age, and BMI, were not significantly different among the groups. The outcome of the SMS PCNL procedure showed a low complication rate during operation in 2-,3-, and 4-puncture groups (3.2%, 7.4%, and 0%, respectively). The Stone Free Rate (SFR) showed no significant difference between the 3 groups (p = 0.496). The SFR was 85.7% in 2-puncture, 77.8% in 3-puncture, 66.7% in 4-puncture group. The AUC of Guy's Stone Score with cut-off value was 3.5 (AUC = 0.549, p-value = 0.541, CI 95%). Single-Site Multi Puncture PCNL is a safe and efficient approach to complex renal stones. Single-Site Multipunctures Supine PCNL is comparable with other techniques of PCNL and gives minimal tissue injury that would benefit for cosmetic.

Resection of Early Colorectal Neoplasms Using Endoscopic Submucosal Dissection: A Retrospective Multicenter Cohort Study.

Background: Endoscopic submucosal dissection (ESD) is a reliable method that can replace surgery in the treatment of early colorectal cancer under certain conditions. Aim: The aim of the study was to analyze factors influencing the ESD procedure in early colorectal cancer, with the intention of improving its effectiveness. Patients and Methods: We conducted a multicenter, retrospective cohort study on 214 patients who underwent ESD procedures for early colorectal cancer from January 2016 to October 2023. Results:En bloc resection was achieved in 197 (92.1%) of ESD procedures, R0 resection in 149 (69.6%), and curative resection in 54 (40.9%). The submucosal invasion was classified as level 1 (SM1) in 96 cases (45.3%), level 2 (SM2) in 61 cases (28.8%), and level 3 (SM3) in 36 cases (17%). R0 resection was achieved more often in the rectum-92 (81.4%), compared to the right-24 (64.9%) and left colon-33 (61.1%), p = 0.009. In rectal tumors, R0 resection was achieved in 51 (98.1%) SM1 invasion, 27 (73%) SM2 invasion, and 13 (65%) SM3 invasion (p < 0.001). Lateral and vertical resection margins were positive in 12 (7.7%) and 52 (25.2%) cases, respectively. Vertical resection margins were statistically more often positive in lesions located in the right colon-11 cases (28.9%) and left colon-21 cases (38.9%), than in rectum-20 cases (17.5%); p = 0.010. Complications were found in 32 (15%) cases of ESD procedure-perforation in 12 cases (5.6%) and delayed bleeding in four cases (1.9%). Procedures performed in the right colon were associated with a significantly higher risk of any complications (30%) and perforations (15%) than those performed in the rectum (10.3% and 2.6%) or the left colon (13.8% and 5.2%; p = 0.016; p = 0.015), respectively. Conclusions: ESD for early colon cancer is a viable strategy due to its effectiveness and low complication rate. The ESD technique performed in the rectum yields the best results; however, in the right colon, it still requires careful attention.