Mean Operative Time Research Articles

A comparative study of two full-endoscopic foraminoplasty techniques for lumbar disc herniation.

This study aimed to compare the use of the endoscopic drill (ED) with the extra-endoscopic trephine (EET) in treating lumbar disc herniations with regard to efficiency, safety, and clinical outcomes. From January 2022 and June 2023, 136 patients who had the single-level LDH and received the transforaminal endoscopic surgery were divided into two groups according to the foraminoplasty technique: the EET group (n = 69) and the ED group (n = 67). Surgery-related parameters, complications, Visual Analogue Scale (VAS, 0-10), and Oswestry Disability Index (ODI, 0-100%) were assessed and compared among two groups. The mean operation time and the foraminoplasty time of the EET group was significantly shorter than that of the ED group (P < 0.05). Patients in ED group reported less back pain on the VAS during foraminoplasty than EET group. Although the total complication rate was similar between two groups, the incidence of neural irritation in ED group was significantly lower than that in the EET group. There were no significant differences in VAS or ODI scores at each follow-up visit between two groups. The application of EET and ED were both effective for full-endoscopic foraminoplasty, and have achieved good clinical outcomes. Although the efficiency of EET is higher than that of ED, it faces some problems during use, such as a high risk of neural irritation, intense intraoperative pain, and the trephine displacement. The ED technique is safe and controllable, which can be used as an ideal method for supplementary foraminoplasty.

Outcomes and complications of vertebral body tethering by patient gender.

Non-fusion surgical options for pediatric scoliosis management such as vertebral body tethering (VBT) offer an alternative to spinal fusion. With this study, we aim to evaluate the postoperative outcomes in boys versus girls who have undergone VBT. Our hypothesis is that girls and boys will have similar outcomes by 2-year follow-up. This study employed a review of retrospective data for patients who underwent VBT at 10 sites between 2011 and 2020. Patients were stratified based on gender. All patients had preoperative and 2-year follow-up and were evaluated for curve correction, complications, surgery metrics, and patient reported outcomes. 328 patients were included in this study: 277 girls and 51 boys. Mean age at surgery was 12.2years for girls and 13.4years for boys. Mean preoperative curve magnitude and curve flexibility was similar between both groups. Compared to girls, boys were older, heavier and taller at the time of surgery; BMI was not different between the groups. Skeletal maturity was not different preoperatively or at 2years.There were no significant differences for mean operative time, mean estimated blood loss, or levels instrumented. Postoperative stay was longer in the girls averaging 4.5days compared to 3.9days for the boys (p = 0.026).There were no statistically significant differences between boys and girls for the curve magnitude at final follow-up (28° vs 25° thoracic, 21° both groups lumbar) or percent correction (45% vs 38% thoracic, 38% vs 31% lumbar) at 2-year follow-up.Overall, 98 girls (35%) experienced medical or surgical complications compared to 18 boys (39%) (p = 0.599). Boys experienced higher rates of tether breakage at latest follow-up (33% vs. 17%, p = 0.008) and more loss of correction > 10° (10% vs. 3%, p = 0.03). Rates of reoperation were 15.9% in the girls and 15.7% in the boys (p = 0.972). Our study found that boys on average had higher body weight than girls and also higher rates of tether cord breakage and loss of correction. Despite these differences, curve correction, modulation, and reoperation rates were similar in both groups. Further work is needed to determine the relative impact of patient gender and weight on incidence of tether breakage.

Posterior Peroral Endoscopic Myotomy With Versus Without Sparing of the Oblique/Sling Fibers: A Meta-analysis.

Several studies have hypothesized that sparing the oblique/sling fibers during posterior peroral endoscopic myotomy (POEM) may reduce the incidence of gastroesophageal reflux disease (GERD) and reflux esophagitis without compromising the established safety and efficacy of the procedure. This study compares perioperative, postoperative motility-related, and postoperative GERD-related outcomes between posterior oblique/sling fibers-sparing POEM (OFS-POEM) and conventional posterior POEM through a pairwise meta-analysis of comparative studies. We conducted a systematic literature review following PRISMA guidelines to identify articles directly comparing posterior OFS-POEM with conventional posterior POEM. A pairwise meta-analysis was performed using a random-effects model. Effect sizes were calculated as odds ratios for dichotomous data and mean differences for continuous data. No significant differences were observed in perioperative outcomes, including mean gastric myotomy length, mean operative time, and incidence of adverse events. Similarly, no significant differences were noted in postoperative motility-related outcomes, such as mean Eckardt score and mean integrated relaxation pressure. However, a statistically significant reduction in the incidence of symptomatic GERD was observed in favor of OFS-POEM, with a number needed to treat (NNT) of 10 (95% CI: 6-49). Interestingly, no significant differences were found in the incidence of objectively diagnosed postoperative GERD, such as the number of patients with DeMeester scores >14 or the incidence of reflux esophagitis. This study suggests that OFS-POEM may reduce the incidence of symptomatic GERD following POEM, without affecting the incidence of GERD diagnosed by pH studies (DeMeester score >14) or by endoscopy (reflux esophagitis). Future studies with larger sample sizes are needed to further investigate the impact of OFS-POEM on GERD incidence as determined by pH studies and endoscopic findings. Given the limitations of this study, no definitive conclusions can be drawn. Multicenter randomized controlled trials with larger sample sizes are required to reach more reliable conclusions. Furthermore, stratifying data according to the type and class of achalasia would provide valuable information on whether there are differences in outcomes among the various types and classes of achalasia.

A prospective comparative study of open versus laparoscopic stage II Fowler-Stephens orchidopexy in pediatric patients.

Laparoscopic Fowler Stephens orchidopexy, single stage or two-stage, is now routinely performed in non-palpable testis. We performed second stage orchidopexy as open inguinal approach and compared the outcome of this approach to two-staged laparoscopic orchidopexy. We performed a prospective randomized interventional study of two different approaches for intra-abdominal testis. In group A, Laparoscopic stage I (SFO) followed by open inguinal orchidopexy was compared for final outcome in group B cases, who underwent laparoscopic staged SF orchidopexy. The average duration between stage I SF and stage II SF was 6 months. All the procedures were done under GA and caudal analgesia. The pre-operative and post-operative USG dimensions were compared in cm and cm3/ml. The procedure outcome was considered successful if testis remained inside scrotum below mid-scrotal point. Any testis above the mid-scrotal point was considered as unacceptable or failure of procedure. This study was performed on 74 children with 84 testis (group 'A' 38 patients (48 testis) and group 'B' 36 patients (46 testes)), with average age was 3.3 ± 0.46 and 3.9 ± 0.58 years, respectively. In group 'A', 38 patients (48 testes) underwent lap SFO I followed by inguinal orchidopexy and in group 'B', 36 patients (46 testes) underwent laparoscopic staged SF O. The mean testicular volume pre-operative in group 'A' & 'B' was 0.28 ± 0.04 and 0.23 ± 0.06 cm2, respectively. The mean post-operative testicular volume was 0.34 ± 0.07 and 0.28 ± 0.05 cm2, respectively. The average follow-up of the patients in group 'A' & 'B' was 24 ± 3.67 and 20 ± 2.90 months, respectively. Testis was having good volume in 87.5% and 76.60% of these successful cases, respectively. There were (3/48) 6.25% (4/46) 8.69% testicular atrophy cases in group 'A' & 'B', respectively. The differences were not statistically significant (p < 0.05). The mean operative time in group A was 20 ± 8.07 min and group B 30 ± 7.19 min in stage II procedure. The success rate in group A was more than the group B which was statistically significant (p > 0.05). Our study connotes that open stage II orchidopexy is still feasible and practicable with better final outcome of management of non-palpable cases.

Awake, endoscopic lumbar interbody spinal fusion: 10 years of experience with the first 400 cases.

Awake, endoscopic spinal fusion has been utilized as an ultra-minimally invasive surgery technique to accomplish the goals of spinal fixation, fusion, and disc height restoration. While many techniques exist for this approach, this series represents a single institution's experience with a large cohort and the evolution of this method. The medical records of a consecutive series of 400 patients treated over a 10-year period were retrospectively reviewed. Endoscopic decompression, expandable intervertebral spacer deployment, and percutaneous screws were combined with liposomal bupivacaine to allow for the surgery to be performed without general endotracheal anesthesia (GETA) in the vast majority of cases. Clinical and radiographic postoperative results were reviewed with special attention to surgical complications, in particular dorsal root ganglion (DRG) irritation. All patients underwent surgery successfully without conversion to an open operation. Their mean age was 69.1 ± 10.4 years, and 42% of the patients were male. A total of 509 levels were fused, with the most common indication being spondylolisthesis (67.5%). The mean operative time was 84.6 ± 31.4 minutes, the mean intraoperative blood loss was 98 ± 63 ml, and the mean hospital length of stay was 1.93 ± 1.1 nights. Overall, 4.3% of the patients underwent planned GETA due to comorbidities, and 2% were converted to GETA intraoperatively. Eighty percent of the patients experienced > 75% improvement in leg pain, and 52% experienced > 75% improvement in axial back pain. Complications included transient DRG irritation (23%), adjacent-level disease requiring reoperation (3.5%), inadequate decompression (2.3%), and nonunion (1.8%). This large case series demonstrates that awake, endoscopic spinal fusion is a viable option with acceptable clinical and radiographic results in a select patient population. Meticulous attention to detail is required to limit the rate of DRG irritation, achieve interbody height restoration, and mitigate nonunions.

Short-term outcomes of preoperative computed tomography angiography versus standard assessment in patients with BMI ≥ 25.0kg/m2 undergoing laparoscopic gastrectomy: the GISSG20-01 randomized clinical trial.

Laparoscopic gastrectomy lacks hand-direct tactile sense and has a limited surgical field compared to laparotomy. Apart from textbook classification, there are anatomical variations in the gastric arteries. Laparoscopic gastrectomy presents technical difficulties and necessitates a more comprehensive comprehension of regional anatomy than open surgical procedures. We aimed to compare efficacy and safety of preoperative computed tomography angiography (CTA) associated with surgical decision-making for laparoscopic gastrectomy. The GISSG 20-01 study was a multicenter, open-label, randomized clinical trial. The enrollment criteria mainly included histologically confirmed gastric cancer patients with BMI ≥ 25kg/m2. Eligible patients were randomly assigned to the CTA group or the non-CTA group in a 1:1 ratio. The primary endpoint was the volume of intraoperative blood loss. Between November 2020 and December 2021, 382 patients were enrolled and randomly assigned. After exclusion of 25 patients, 357 patients were included in the modified intention-to-treat population (179 in the CTA group and 178 in the non-CTA group). The mean intraoperative blood loss (CTA vs non-CTA; 74.2 vs 95.0mL, P = 0.005) and operation time (215.4 vs 231.2min, P = 0.004) was significantly lower in the CTA group. Total number of retrieved lymph nodes was similar in two groups (32.2 vs 30.2, P = 0.070). The CTA group had a significantly lower surgery task load index sore than the non-CTA group (36.6 vs 41.7, P < 0.001). There was no significant difference in postoperative complications rate of 14.5% in the CTA group and 22.5% in the non-CTA group (difference, -8.0% [95% CI, -16.0 to 0.1]; P = 0.053). Preoperative CTA associated with surgical decision-making could relieve surgery burden and lead to a better surgical performance compared with non-CTA support, which including decreased blood loss volume, vessel damage and operation time. NCT04636099.

Utilising uniportal video-assisted thoracoscopic surgery for pericardial window: A 12-year single-centre experience in the diagnosis and treatment of pericardial effusion.

Uniportal video-assisted thoracoscopic surgery (Uni-VATS) is an effective minimally invasive technique for pericardial drainage, biopsy and window creation in cases of pericardial effusion (PE). This retrospective study evaluated 73 patients with PE who underwent pericardial window procedures between 2012 and 2024. Intraoperative and post-operative data related to Uni-VATS were assessed. The mean age of the patients was 53.79 ± 17.79 years (10-82 years), with 34 (46.6%) females and 39 (53.4%) males. The mean volume of pericardial fluid drained after window creation was 446.23 ± 199.81 cc (75-1100 cc). The mean operation time was 42.87 ± 12.79 min, and chest drain removal occurred after an average of 1.8 ± 1.2 days. The mean duration until discharge or referral to the follow-up clinic was 5.98 ± 2.14 days. In addition to the pericardial window procedure, pleural biopsy was performed in 12 patients, mediastinal mass biopsy in eight patients and wedge resection for parenchymal nodules in six patients. Microbiologic and virologic cultures of the fluids were negative in all cases. Among the 41 patients with benign cytology, pericardial biopsy results indicated tuberculosis in four patients (5.4%), amyloidosis in one patient (1.3%) and chronic or subacute nonspecific pericarditis in the remaining patients. Uni-VATS is a novel and safe technique that may be the preferred choice for pericardial window due to its diagnostic and therapeutic efficacy, ability to perform simultaneous procedures, favourable impact on operation duration/hospital stay, low complication rates and superiority compared to traditional methods.

Koala Sleeve: innovative technique for enhanced GERD control without sacrificing weight loss.

Sleeve gastrectomy (SG) is the most frequently performed bariatric surgery worldwide, offering effective weight loss and improvement in metabolic conditions. However, one of its major complications is the exacerbation or development of gastroesophageal reflux disease (GERD), affecting over 30% of patients. While Roux-en-Y gastric bypass (RYGB) is often the preferred alternative for patients with pre-existing GERD, it may not be suitable for all patients due to contraindications or patient preference. This study introduces a novel modification to SG, combining it with horizontal gastroplasty to address GERD symptoms without compromising weight loss outcomes. The procedure involves a standard SG with complete fundus resection, followed by the creation of a horizontal valve at the gastroesophageal (GE) junction using three horizontal mattress sutures. Seven patients with preoperative GERD were selected for this technique. Post-operative outcomes were assessed, including weight loss and GERD symptom resolution. The mean operative time was 76 min, with no procedure-related complications. Three months postoperatively, the average percentage of excess weight loss (%EWL) was 68%. Importantly, none of the patients reported GERD symptoms, indicating effective reflux control. Sleeve gastrectomy with horizontal gastroplasty appears to be a promising, simple, and safe option for patients with GERD undergoing SG. This technique may offer a viable alternative to RYGB for managing GERD in bariatric patients. Further studies are needed to validate these initial findings and assess long-term outcomes.

Analysis of postoperative complications in patients undergoing anorectal malformation surgery: are there any predisposing factors?

To describe our experience with anorectal malformation (ARM) patients, while analyzing complications and risk factors. A retrospective study of ARM patients aged 0-18 years old undergoing surgery from 2006 to 2023 was carried out. Demographic variables, associated malformations, age and repair surgery operating times, presence and type of colostomy, previous intestinal preparation, and presence and type of surgical complications -intestinal occlusion, anal prolapse, stenosis, bleeding, dehiscence, extrusion, anoplasty misposition, urethral perforation, and stomal complications- were collected. 89 patients were studied. 44 patients were boys and 45 were girls. Median age was 7 years (3-18). Baseline treatment was posterior sagittal anorectoplasty (PSARP) in 61 (69%) patients, and colostomy in 24 (27%) patients (4/24 loop, 1/24 Hartmann, 19/24 divided ends). Median age at PSARP was 5.4 months (5 days-7 years), with a mean operating time of 112 min (38-259). The incidence of complications was 38% (34/89). The most frequent complication was anal prolapse (19%) (1/3 reintervention as a result of pain/bleeding), followed by dehiscence (17%). Statistically significant differences were noted between intestinal preparation (p=0.001, -1.49 95% CI: -2.69 to -1.24), presence of colostomy (p=0.05, -2,54 95% CI: -6.5 to -0.987), and age at surgical repair (p=0.047, 1.198 95% CI: 1.1 to 3.15) with the incidence of complications. The age-complications correlation score was 0.21 (p=0.046). No differences in terms of operating time (p=0.073) and type of colostomy (p=0.81) were observed. 38% of the patients had complications. Intestinal preparation, presence of colostomy, and age at repair can have an impact on the incidence of complications. The first two could stand as protective factors (RR=-1,49 and -2.54, respectively). Age would increase the risk by 1.2-fold.

The Impact of a Resident, Fellow, or Physician Assistant on Operative Time and Complication Rate in Closed Reduction and Percutaneous Pin Fixation of Pediatric Distal Humerus Supracondylar Fractures

We sought to compare operative times and complications for attending surgeons operating alone or with an assistant including an orthopedic resident, fellow, or physician assistant (PA) for closed reduction and percutaneous pinning (CRPP) of pediatric supracondylar humerus fractures (SCH), an archetypal procedure integral to the education of orthopedic trainees. Using a retrospective database collected following institutional review board approval, a 1-way ANOVA (non-parametric) was used to assess the effect of assistant absence or presence by type of assistant on mean operative time. We analyzed the association between the attending surgeon assistant categories and the complication rate using Fisher's Exact Test. The study was performed at Gillette Children's Specialty Healthcare, St. Paul, Minnesota, and Children's Minnesota in St. Paul and Minneapolis. These three affiliated metropolitan hospitals, the last of which is a level 1 trauma facility, all share the same group of orthopedic surgeons, trainees, and physician assistants. All patients under 14 years of age treated with CRPP for Gartland type 2, 3, 4 and flexion type closed supracondylar fractures between April 2006 and September 2016 were analyzed. Of 1053 patients identified by Current Procedure Terminology code 24358, data was available for 888 patients. Out of the 888 patients, 44.1% were operated on by a surgeon alone, 48.4% with a resident, 4.8% with a fellow and 2.6% with a physician assistant. The ANOVA revealed a statistically significant increase (p < 0.001) in operative times when a resident participated compared to the other categories. The shortest mean surgery time (34.7 minutes) occurred when an attending surgeon and PA were present. The longest mean time (44.3 minutes) occurred with a surgeon and resident. This difference, at 9.6 minutes, constituted 28% more time. There were 40 patients with a complication, a rate of 4.5%. The rate for each of the assistant categories was surgeon alone 5.6%, with a resident 3.3%, with a fellow 4.7%, with a PA 8.7%. The Fisher's Exact Test results showed no statistically significant association between the type or absence of assistant and the complication rate. Differences in operative times were observed across assistant categories although the mean time difference was statistically insignificant between the surgeon unassisted versus assisted by the fellow or a PA. The finding of statistically increased operative times with resident participation in this study for this specific procedure is consistent with results for most other reported orthopedic surgeries. Complication rates did not vary based on the participating personnel.

Revisiting Tension Band Principle Using Fiber Tape in Patella Fractures in Terms of Functional Outcomes, Complications, and Resurgery.

Post-operative complications related to hardware, particularly symptoms caused by it, such as implant impingement, wire breakage, and skin infection are frequently reported following surgical management of patellar fractures with stainless steel wires. As a potential solution, some researchers have advocated for the use of non-absorbable sutures for fracture fixation. This study aims to investigate the clinical and radiological outcomes of patients treated with fiber taping as an alternative technique. We conducted a retrospective evaluation of 20 patients diagnosed radiographically with displaced patellar fractures (including transverse, poles, and severely comminuted). These patients underwent tension band technique with the help of high strength polyethylene fiber tape. Clinical and radiological outcomes were meticulously assessed, with specific attention to union time, complications, and functional outcome assessed by the Lysoholm scoring system, all of which were carefully observed and documented. The mean age of the patients was 42.5 ± 14.3 years, and the majority were male (70%). The mean operative time was 68.5 ± 22.4 min. All fractures achieved union without any reported cases of wound complications, infections, loss of reduction, or implant failure. The mean Lysholm Knee Score improved from 36.4 ± 8.2 at baseline to 92.1 ± 5.9 at 12-month post-surgery. The visual analogue scale for pain decreased from 7.8 ± 1.4 at baseline to 0.8 ± 0.6 at 12 months. The mean range of motion improved from 96.5° ± 12.8° of flexion and -5.2° ± 3.1° of extension at baseline to 134.2° ± 6.1° of flexion and 0.6° ± 0.7° of extension at 12 months. Our investigation into a modified tension band technique using fiber tape sutures revealed encouraging clinical outcomes, marked by minimal complications. The adoption of fiber tape as a substitute for metal wire counterparts in patellar fracture treatment shows potential for reducing hardware related symptoms and shows lesser morbidity.

Semi-closed-circuit vacuum-assisted mini percutaneous cystolithotomy (vamPCL) in the pediatric population: Initial experience of a novel technique in native and augmented bladders.

Bladder stones (BS) in children are a rare condition and represent 1-5% of all urinary tract stones. With advances in miniaturized endoscopes and intracorporeal lithotripters, percutaneous cystolithotomy has been demonstrated to be an effective, safe and quick technique, despite the longer operative time. This limitation may be overcome by a semi-closed-circuit vacuum-assisted technology (vamPCL), characterized by a continuous inflow and a suction-controlled outflow (ClearPetra®). To assess the safety and efficacy of a vamPCL characterized by continuous inflow and suction-controlled outflow to treat bladder stones in pediatric patients with native or augmented bladder. From January 2021 up to December 2023, we prospectively collected variables on consecutive vamPCL procedures (Fig.) The stone-free rate (SFR) was defined as absence of stones or residual fragment <5mm diagnosed with ultrasound. Six patients with a median age of 139 months (55-212) were recruited for the study. Three patients (50%) with the initial diagnosis of extrophy-epispadia complex had an augmented bladder, whereas of the remaining three (50%) with an initial diagnosis of anorectal malformation two had an augmented bladder. All patients had a Mitrofanoff conduit opening on the right flank, except for one (16%) with umbilical access. The mean cumulative stone size was 24mm±14,2. The mean operating time was 78,3min±14,7. One procedure was interrupted after 90min due to the overall size (>50mm). Stone removal was achieved only via suction in all cases. All vamPCL procedures were completed without intraoperative complications. Fever for 24h (1/6; 16%) was the only post-operative complication. The mean stay of the suprapubic catheter was 3.4 days±1,5 and of the trans-Mitrofanoff catheter was 9.3 days±4,5. The SFR was confirmed in all the cases with US performed after 2 months. Only one male patient (16%) had recurrent stones after 8 months and he is waiting for second surgery. Mean follow-up was 7.2 months±9,4. In the present study we demonstrated that vamPCL is safe and feasible in selected cases especially in those with augmented bladder. To our knowledge, this manuscript is the first to present the use of the ClearPetra® for the treatment of bladder stones. To our knowledge, this manuscript is the first to present the use of the ClearPetra® for the treatment of bladder stones. The vamPCL seems to be sustainable, safe and feasible for bladder stones treatment in selected children.

Investigating the Impact of ERAS Protocols on Postoperative Outcome in Patients Undergoing Colorectal Surgery.

Background: Enhanced Recovery After Surgery (ERAS) protocols have been increasingly adopted in colorectal surgery to improve postoperative outcomes. Objective: This study investigates the impact of ERAS protocols on postoperative outcomes in patients undergoing colorectal surgery Methods: This is a cross-sectional study conducted on 60 consecutive patients undergoing colorectal surgery at Jinnah hospital from January 2024 to August 2024. The participants were divided into two groups with 30 participants each. Group I was treated as per ERAS protocol while Group II was given traditional care. Demographic data, mean operative time, Length of hospital stay, post operative pain and post operative complication was noted in both groups. Data was assessed on SPSS version 24. Results: The mean operative time was notably shorter in Group I at 55.4 minutes compared to 64.7 minutes in Group II, (p-value=0.006). Post- operative pain, assessed via the Visual Analogue Scale, showed lower scores in Group I on all measured days: Day 1 (3.71 ± 0.97 vs. 4.69 ± 0.93, p = 0.033), Day 2 (2.32 ± 0.85 vs. 3.13 ± 0.95, p = 0.03), and Day 3 (1.49 ± 0.79 vs. 1.98 ± 0.98, p = 0.04) (Table 2). Additionally, Group I experienced a quicker return to oral intake (1.3 ± 0.4 days vs. 1.9 ± 0.7 days, p = 0.005) and mobilization (2.1 ± 0.9 days vs. 3.6 ± 1.1 days, p = 0.04). Conclusion: This study highlights the significant advantages of implementing ERAS protocols in colorectal surgery, demonstrating improved postoperative outcomes, compared to traditional care.

Full-Endoscopic Midline Foraminoplasty: An Alternative Method for Treating Lumbar Foraminal Stenosis

Objective: To describe the full-endoscopic lumbar foraminoplasty with midline skin incision (FEFM) and lateral recess decompression procedure and to report its clinical outcomes at the 1-year follow-up.Methods: Consecutive patients with lumbar foraminal and/or lateral recess stenosis who underwent FEFM procedures were retrospectively reviewed. Clinical outcomes were evaluated with a visual analogue scale (VAS) of back and leg pain and Oswestry Disability Index (ODI) up to 1 year postoperatively. The complications and recurrence rate were also recorded.Results: A total of 30 cases (51 levels) were included (L3–4, 6 cases [11.8%]; L4–5, 23 [45.1%]; L5–S1, 22 cases [43.1%]). VAS scores collected at preoperative, postoperative day 1, 3 months, 6 months, and 1 year were 9.16, 1.7, 1.36, 1.3, and 1.43, respectively. The ODI scores collected at preoperative, postoperative 3 months, 6 months, and 1 year were 46.63, 11.5, 10.66, and 10.46, respectively (p&lt;0.05). The mean operation time was 88.7 minutes (range, 45–152 minutes). The length of hospital stay was 1.21 days (range, 1–3 days). No immediate complications were identified, and no patients experienced a recurrence of symptoms requiring revision surgery.Conclusion: FEFM is an effective procedure for treating foraminal and/or lateral recess stenosis. It demonstrates the capability to decompress both bilateral foraminal and lateral recess stenosis through a single-entry point.

3D-Printed "Jigsaw Puzzle" in Craniomaxillofacial Comminuted Fracture Reduction.

Surgical treatment of comminuted and multiple facial fractures is challenging, as identifying the bone anatomy and restoring the alignment are complicated. To overcome the difficulties, 3D-printed "jigsaw puzzle" has been innovated to improve the surgical outcome. This study aimed to demonstrate the feasibility of 3D-printed model in facial fracture restoration procedures. Patients with traumatic craniomaxillofacial fractures treated at a single institution were enrolled in this study. The exclusion criteria included the presence of mandibular fractures, greenstick fractures, isolated fractures, and revision cases. Fine-cut (1-mm thick) computed tomography images of each patient were assembled into a 3D model for preoperative planning. Major fragments were segmented in virtual surgical planning, printed out with a 3D printer as "jigsaw puzzle" pieces, and assembled with plates and screws as in surgical rehearsals. We further matched our study group with a control group of patients who underwent the corresponding procedures to compare operative time. Nine patients with craniomaxillofacial fractures were included in the study, including 2 patients with zygomaticomaxillary complex fractures and 7 patients with multiple fractures. No remarkable postoperative complications, such as enophthalmus or optic nerve injury, that require additional or revision surgery were noted. The mean operative time was 391 and 435 minutes in the study and control groups, respectively. The t test results were not statistically significant. Surgeons can perform comprehensive preoperative planning, simulation, and obtain a real-time reference for facial bone reduction by using the 3D-printed "jigsaw puzzle" in multiple complicated craniomaxillofacial fractures.

Clinical Feasibility and Technical Aspects of Single Port Robotic TransAnal Minimally Invasive Surgery (SP-rTAMIS) for Rectal Neoplasm.

Single port robotic platform offers articulation and 360° camera rotation for anorectal tumour excision in a narrow pelvic space. This study assesses the clinical usefulness and outcomes of SP robotic transanal surgery. Nine patients who underwent transanal excision using the SP robotic platform were included. A GelPOINT path Transanal Access channel with insufflation stabilisation bag was used to maintain rectal inflation. All patients underwent full-thickness excision without intraoperative complications. The mean distance from anal verge was 6.41cm. Prone position was used regardless of the direction of the tumour due to the 360° rotation. The mean operative time was 66.1min. The mean docking time was 8.7min with only one docking. All oncologic resection margins were negative, and recurrence was not observed during follow-up. SP robotic transanal surgery allows flexible vision and meticulous procedures in narrow spaces; therefore, this method has greater feasibility and oncologic safety.

Impact of single layer reconstruction following surgery for chronic calcific pancreatitis: a retrospective analytical study

Background: Surgery is an effective treatment for chronic calcific pancreatitis (CCP), addressing intractable pain and complications. While many studies predict outcomes of various surgical procedures, few focus on the impact of reconstruction type. This retrospective study analyzed the outcomes of single-layer pancreaticojejunostomy (PJ) following surgery for CCP. Aim was to evaluate outcomes of single-layer PJ in CCP patients, focusing on complications, pain relief, exocrine insufficiency, and endocrine dysfunction, compared with historical controls. Methods: The study included 250 CCP patients treated at a tertiary care center in Chennai, India, from January 2011 to December 2024. Surgical ductal clearance and single-layer Roux-en-Y PJ using non-absorbable/delayed absorbable sutures were performed. Data on intraoperative parameters, postoperative complications, and follow-up assessments at 1, 2, and 3 months were analyzed. Primary outcomes included reductions in pancreatic fistula, bleeding, and infections. Secondary outcomes included operative time and duct size. Results: The median age was 38 years, with a male predominance (74%). Frey’s procedure was the most common (59.2%), and the mean operative time was 170 minutes. Complications included pancreatic fistulas (6.4%) and infections (9.6%), with a low mortality rate (0.4%). Postoperatively, 91% of patients achieved pain relief, and 64.4% of diabetics had improved glycemic control. Single-layer PJ showed shorter operative times than two-layer PJ with similar pain relief and blood loss. Complications decreased significantly (from 45% to 8%), alongside reduced postoperative pain scores. Conclusions: Single-layer PJ is a safe, effective reconstruction method for CCP, reducing surgical complexity and related complications.

Short term outcomes of laparoscopic surgery after treatment of colorectal cancer

Background: Colorectal cancer is a significant health concern globally and in Bangladesh. Laparoscopic surgery is increasingly used for its treatment due to its minimally invasive nature, but comprehensive data on its short-term outcomes and complications in the Bangladeshi population is limited. Methods: This prospective observational study was conducted from September 2018 to October 2019 at the Department of Surgical Oncology, National Institute for Cancer Research and Hospital, Dhaka. Thirty-nine patients diagnosed with colorectal cancer and undergoing laparoscopic surgery were included. Data on demographics, clinical presentations, colonoscopy findings, operative details, and postoperative outcomes were collected and analyzed using SPSS for Windows, version 22.0. Results: The study population consisted of 58.97% males and 41.03% females. The most common chief complaints were per-rectal bleeding (48.72%) and abdominal pain (17.95%). Colonoscopy findings revealed ulcer proliferative lesions in 64.10% of patients. The mean operation time was 159.36 minutes, and the mean approximate blood loss was 124.5 ml. The mean postoperative hospital stay was 4.56 days. Minor postoperative complications included urinary tract infections (30.77%) and perineum infections (15.38%), while major complications included surgery conversion (12.82%) and postoperative mortality (2.56%). Conclusions: Laparoscopic surgery for colorectal cancer offers significant benefits, such as reduced operative time, lower blood loss, and shorter hospital stays. However, the incidence of postoperative complications remains a concern, highlighting the need for improved surgical techniques and postoperative care. Addressing these challenges is crucial for optimizing patient outcomes and enhancing the adoption of laparoscopic surgery in Bangladesh.

Laparoscopic anatomical SVIII resection via middle hepatic fissure approach: Caudal or cranio side.

Laparoscopic hepatectomy is a proven safe and technically feasible approach for liver tumor resection, but laparoscopic anatomical SVIII resection (LASVIIIR) remains rarely reported due to poor accessibility, difficult exposure, and the deep-lying Glissonean pedicle. This study examined the safety, feasibility, and perioperative outcomes of LASVIIIR via a middle hepatic fissure approach at our institution. To investigate the safety, feasibility, and perioperative outcomes of LASVIIIR via a middle hepatic fissure approach at our institution. From November 2017 to December 2022, all patients with a liver tumor who underwent LASVIIIR were enrolled. The perioperative outcomes and postoperative complications were evaluated. Thirty-four patients underwent LASVIIIR via a middle hepatic fissure approach from the side or cranio side and were included. The mean operation time was 164 ± 54 minutes, and the intra-operative blood loss was 100 mL (range: 20-1000 mL). The mean operative times were, respectively, 152 ± 50 minutes and 222 ± 29 minutes (P = 0.001) for the caudal side and cranial side approaches. In addition, the median blood loss volumes were 100 mL (range: 20-300 mL) and 250 mL (range: 20-1000 mL), respectively, for the caudal and cranial sides (P = 0.064). Three patients treated using the cranial side approach experienced bile leakage, while 1 patient treated using the caudal side approach had subphrenic collection and underwent percutaneous drainage to successfully recover. There were no differences regarding postoperative hospital stays for the caudal and cranial side approaches [9 (7-26) days vs 8 (8-19) days] (P = 0.226). LASVIIIR resection remains a challenging operation, but the middle hepatic fissure approach is a reasonable and easy-to-implement technique.

Safe Implementation of Robotic Surgery for Gynecologic Diseases at a Tertiary Center: Retrospective Analysis of 149 Cases and Review of the Literature

Abstract Objectives: The initial learning curve is a barrier to introducing robotic surgery. Evidence regarding appropriate simulation programs that allow for a smooth introduction of gynecological robotic surgery remains limited. Materials and Methods: We retrospectively analyzed 149 patients who underwent robotic surgery for gynecologic diseases. Before their first procedure, the surgeons completed a robotic surgery training program. Assistant surgeons also completed simulation programs, including setup procedures and manipulation of the robotic arm. Results: The mean (± standard deviation) operative, setup, and console times were 170 ± 54 min, 22 ± 8 min, and 126 ± 51 min, respectively. No patient required blood transfusion or conversion to laparoscopy or laparotomy. Patients undergoing surgery by the same surgeon were divided into three groups (first-third, middle-third, and last-third of patients undergoing surgery) to assess chronological changes. No statistically significant differences were found between the operative and console times among these groups. The setup times for the middle and last third of patients were 20 ± 7 min and 18 ± 7 min, respectively, which were statistically significantly shorter than those for the first third of patients. No significant differences in the operative and console times done by five physicians who completed programs were observed between the first 75 and the latter 74 procedures; however, the setup times of the latter 74 procedures were significantly shorter than those of the first 74 procedures (25 ± 9 min vs. 19 ± 6 min; P &lt; 0.001). Conclusion: The setup time was influenced by clinical experience. An appropriate simulation program allowed a safe implementation of robotic surgery.