Minimally Invasive Procedure Research Articles

Trocar-assisted extraocular technique for intrascleral intraocular lens fixation using a 90°-curved forceps: a modified extraocular forceps-guided technique.

To investigate the surgical outcomes of intrascleral intraocular lens (IOL) fixation using a modified extraocular forceps-guided technique. Retrospective case series. Overall, 81 eyes of 78 patients who underwent intrascleral IOL fixation using the modified extraocular forceps-guided technique were included. The procedure entailed creating 2 scleral half-layer T-shaped incisions perpendicular to the main incision and forming a scleral tunnel. A 25-gauge trocar was inserted at the lower end of the T-shaped incision to perform vitrectomy. A 27-gauge needle was inserted from the left-hand port, and the leading haptic was inserted into the needle lumen. After removal of the right-hand trocar, a 90°-curved intrascleral fixation forceps was inserted into the eye, exposing the tip at the main incision, thus allowing the tip of the extraocular trailing haptic to be gripped and both haptics to be pulled out. The left-hand trocar was removed, and the haptics were buried in the scleral tunnel. The surgical outcomes of this technique were retrospectively evaluated on the basis of the medical records. The induction of haptics was successful in all cases. The preoperative best-corrected visual acuity improved from 0.35±0.68 to 0.12±0.36 logMAR postoperatively (P<0.01). The refractive error was -0.27±0.87 D; IOL decentration, 0.39±0.18 mm; IOL tilt, 5.97±2.65°; IOL astigmatism, 0.35±0.36 D; and corneal endothelial cell loss, 10.3±12.7%. There were no serious complications related to the surgical technique. The modified extraocular forceps-guided technique allows for safe and straightforward induction of the trailing haptics and enables the performance of intrascleral IOL fixation with minimal scleral incisions.

A Minimally Invasive Approach for Managing Umbilical Hernia and Rectus Abdominis Diastasis: A Single-Center Case Series

Introduction Umbilical hernias (UHs) and rectus abdominis diastasis (RAD) are distinct abdominal conditions that, though separate, frequently overlap in the context of surgical management. The debate over the most effective repair techniques continues, despite the proposal of numerous methods and guidelines. In this study, we reported a novel surgical technique involving a minimal incision for managing both UHs and RAD. Methods Following the de-identification of data, the necessary information was retrospectively collected from the clinical profiles of patients managed through our technique. The records included patient demographics, smoking, body mass index (BMI), family and patient history of hernias, parity, clinical symptoms, comorbidities, operation time, hospital admission, treatment outcomes, and follow-up. All the included cases had small-sized UHs (≤ 2 cm) and RAD. Results The patients' ages ranged from 23 to 44 years (34.3 ±5.65), with a mean BMI of 26.8±2.74 kg/m². All patients were multiparous women, with the majority having experienced three pregnancies. Clinical symptoms included pain and swelling in all cases. The surgical procedure duration varied from 30 to 45 minutes, with a mean of 33±4.9 minutes, and no complications were encountered intra or postoperatively. All the cases were discharged home the same day of the operation. There were no instances of hernia recurrence after a mean of 6.4 months of follow-up. Conclusion The technique discussed in this study may play a crucial role in effectively managing patients with UHs ≤ 2 cm and/or RAD, offering satisfactory outcomes with no complications and minimal operating times.

Making minimally invasive procedures more sustainable: A systematic review comparing the environmental footprint of single-use versus multi-use instruments.

Healthcare systems contribute 5%-10% of the global carbon footprint. Given the detrimental impact of climate change on population health, health systems must seek to address this environmental responsibility. This is especially relevant in the modern era of minimally invasive procedures (MIP) where single-use instruments are increasingly popular. We compared the environmental footprint of single-use versus multi-use instruments in MIP. We conducted a systematic review across five databases to identify relevant original studies, following the PRISMA guidelines. We extracted environmental impact data and performed a quality assessment of included studies. We included 13 studies published between 2005 and 2024. Eight employed Life Cycle Analysis (LCAs), which is the gold standard methodology for studies evaluating environmental impact. The instruments studied included laparoscopy systems, endoscopes, cystoscopes, bronchoscopes, duodenoscopes, and ureteroscopes. Six studies, including three high quality LCAs and one fair quality LCA, showed that single-use instruments have a significantly higher environmental footprint than their multi-use counterparts. Six studies suggested a lower environmental footprint for single-use instruments, and one study presented comparable results. However, these studies were of poor/fair quality. Although our systematic review yielded mixed results, all high quality LCAs suggested multi-use instruments may be more environmentally friendly than their single-use counterparts. Our findings are limited by inter-study heterogeneity and methodological quality. There is an urgent need for additional research employing gold standard methodologies to explore the interplay between environmental impact and operational factors such as workflow efficiency and cost-benefit ratio to allow health systems to make more informed decisions.

Robotic versus open mini-incision living donor nephrectomy: Single centre experience.

Robotic surgery is associated with less tissue manipulation and earlier recovery with minimal incision. The aim of this study was to compare the short-term clinical outcomes between robotic-assisted donor nephrectomy (RDN) and open mini-incision donor nephrectomy (ODN). From 2016 to 2019, 141 cases involving RDN were analysed. Patient outcomes were compared with those of 191 patients who underwent ODN from 2010 to 2015. Demographics, operation factors, perioperative outcomes, and complications were retrospectively reviewed. The RDN group presented with less blood loss than the ODN group (p=0.023). The length of hospital stay was significantly shorter in the RDN group than in the ODN group (p<0.005). The overall rate of complications was low and there was no significant difference in complication rates between the groups. The robotic approach has benefits over the traditional open approach, including shorter length of hospital stay and reduced intraoperative blood loss.

Management of large head and neck defects in the vessel-depleted neck.

Surgery, radiation, and chemotherapy are often utilized in the treatment of head and neck cancer. These treatments can cause extensive scarring within the neck and can limit the viability of recipient vessels for further microvascular reconstruction. Patients with vessel-depleted necks provide a significant challenge for microvascular surgeons and are a topic of much discussion in the field. While reconstruction in the vessel-depleted neck is an active area of interest, the patient population is rare. Therefore, single institution series with small numbers comprise the majority of published literature. Recent publications describe techniques for identifying adequate recipient vessel options outside of the field of treatment with excellent free flap outcomes. Further, recent summary articles describe techniques for addressing issues with pedicle length that can arise when using vessels that are far from the defect to be reconstructed. When viable vessel options are available within the treatment field, these recipient vessels can be used with good reliability and free flap success. If in-field recipient vessels are not available, minimal access incisions can be used to identify superficial temporal, angular, contralateral facial, or transverse cervical vessels. Further away from the treatment field, internal mammary vessels can be harvested through open or robotic approaches. If the use of these distant vessels creates issues with pedicle length, interposition vein grafts, arteriovenous (AV) loops, or flow-through flaps can be used to augment vessel length.

Minimally Invasive Sinus Tarsi Approach versus Extensile Lateral Approach for Sanders Type II &amp; III Calcaneal Fractures (Systematic Review &amp; Meta-analysis)

Abstract Background Open reduction and internal fixation (ORIF) is becoming more common in Calcaneal fractures of Sanders types II and III. The extensile lateral approach (ELA) appears to be the gold standard. Aim of the Work We aimed to compare the clinical outcomes of intra- articular calcaneus fractures treated with open reduction and internal fixation with via Extensile lateral approach (routine treatment) versus those via a sinus tarsi approach (minimally invasive treatment). Materials and Methods This systematic review conducted on 7 studies enrolled 734 patients with Sanders type II &amp; III calcaneal fractures comparing he clinical outcomes of intra-articular calcaneus fractures treated with open reduction and internal fixation (ORIF) via Extensile lateral approach (routine treatment). The outcome measures considered: Postoperative wound complications, AOFAS score, Time to surgery, Surgical operative time, 24 hours Postoperative VAS score, Bohler's angle improvement, Gissane's angle improvement, Calcaneus width reduction, Recovery of calcaneus length, Length of hospital stay. Results Regarding postoperative wound complication, minimal invasive procedure significantly reduced the rate of wound complications other than open reduction. Concerning American Orthopedic Foot and Ankle Society score (AOFAS) score, there was no significant difference between ORIF and minimally invasive (MI) method. With reference to time to surgery, there was a significant difference between ORIF and minimally invasive (MI) method. As regard surgical operative time, MI had a significant reduction in operative time. According 24 hours Post operative VAS score, there was no significant difference between ORIF and minimally invasive (MI) method. Concerning Bohler's and Gissane's angles improvement, there was no significant difference between ORIF and minimally invasive (MI) method. With reference to calcaneus width reduction, there was no significant difference between ORIF and minimally invasive (MI) method. According recovery of calcaneus length, the current study showed no significant difference between ORIF and minimally invasive (MI) method. Concerning length of hospital stay, the ORIF consume more hospital stay than minimally invasive methods. Conclusion In contrast to ELA, minimal invasive procedure (STA) reduced the rate of wound complication. There was no significant difference between ELA and STA regarding the anatomical and functional outcome. The STA showed significant reduction in time to surgery and operative time.

Assessment of Use of Subcutaneous Mastectomy with Silicon Prostheses as Treatment of Early Breast Cancer

Abstract Background Breast cancer is the most common cancer among women and the second most common cause of cancer death in the United States. Approximately 268,600 new breast cancer diagnoses and 41,760 cancer- related deaths in the U.S. were estimated for 2019. SSM (skin sparing mastectomy) is defined as a simple or radical surgery with modified minimal incisions that retain the widest possible coverage and sub-cutaneous breast groove but dry the NAC, flaws of previous biopsies and/or scarring caused by diagnostic percutaneous biopsies. Access to the armpit for a possible sentinel-node biopsy or axillary dissection is obtained through the same incision. An additional incision may be necessary to perform the reconstructive procedure (e.g., microsurgical axillary anastomosis). Objective To study the risks and benefits of use subcutaneous mastectomy with silicon prosthesis as treatment of early breast cancer: as regards the impact of radiotherapy administration on implant, psychological impact, operative time and post-operative complications including complication of silicon, effect on wound healing. Patients and Methods This prospective interventional study was conducted at tertiary care hospital at the general surgery department in Ain Shams University hospitals and Misr University for Science and Technology (MUST) hospital and from November 2021, till July 2022 and performed on total 15 females suffering from stage I-II infiltrating breast carcinomas. Results The current study revealed that mean ±SD of age of the studied cases was 46.3±7.4. Regarding tumor site, LOQ was the most frequent (40.0%), followed by UIQ (33.3%), then UOQ (20.0%) and lastly LIQ (6.7%). Concerning T grades, T1 was in (46.7%), while the remaining (53.3%) were T2. Concerning N grades, N0 was in (73.3%), while the remaining (26.7%) were N1. Sentinel lymph nodes done in 73.3% of cases. As regards operative characteristics, Axillary clearance done in less than half of cases (46.7%), while nipple sparing achieved in less than quarter of cases (20.0%). As regards post-mastectomy treatment, majority of cases (86.7%) received hormonal therapy, adjuvant radiotherapy to axilla was (46.7%), chemotherapy (33.3%), while immunotherapy was (6.7%). As regards postoperative side effects, Pain was the most frequent postoperative side effect; detected in (33.3%) of cases, followed by seroma (20.0%), then flap necrosis (13.3%), and the least frequent was hematoma (6.7%). As regards postoperative patients’ satisfaction, mean ±SD of Postoperative patients’ satisfaction was 7.3±1.5 with range 5.0 − 10.0. Near half of the studied cases (46.7%) had 7.0 − 8.0 satisfaction grade. Conclusion Skin-sparing mastectomy (SSM) and nipple-sparing mastectomy (NSM) with immediate subcutaneous silicon implantation are an acceptable and safe method for breast reconstruction. It offers a number of advantages including ease of dissection for surgeons, improved symmetry, and low complication rates. With improvements in surgical techniques in preserving mastectomy skin flap viability, the traditionally higher rates of complications in subcutaneous implants may be outdated. The present study can burden the knowledge and shed some light on future prospective studies with larger sample sizes to evaluate a cost benefit analysis and patient and surgeon assessment of outcomes to directly compare with traditional submuscular single- or 2- stage implant-based reconstruction.

A recent update on the fixation techniques for femoral neck fractures: A narrative review

Femoral neck fractures present significant challenges in orthopedic surgery, particularly due to technical difficulties and a high complication rate. Surgical intervention is generally recommended, with osteosynthesis and arthroplasty being the main treatment options. Osteosynthesis techniques, including dynamic hip screw (DHS), multiple cannulated screws (MCS), and the femoral neck system (FNS), aim to achieve stable fixation and facilitate fracture healing. Factors influencing the choice of osteosynthesis include fracture displacement, bone quality, patient age, and the presence of posterior tilt. While DHS offers high stability, MCS is preferred in stable type fractures with minimal invasive procedures. FNS, a newer technique, combines the advantages of DHS and MCS, providing strong fixation with minimal soft tissue damage. Considering the comprehensive findings of biomechanical and clinical studies to date, when performing osteosynthesis for unstable femoral neck fractures, caution should be exercised with MCS as it may have slightly inadequate fixation strength compared to DHS and FNS. FNS, being the newest technique, demonstrates superior fixation strength comparable to DHS and is as minimally invasive as MCS. However, it is essential to remember that long-term follow-up results are lacking for FNS.

Osteochondroma at the Ventro-Medial Surface of the Scapula Causing Pseudo Winging Scapular Resection with Computer-Assisted Navigation: A Case Report and Literature Review

Purpose: Osteochondromas, the most common benign bone tumors, primarily occur in the long bones, with scapular osteochondromas constituting less than 1% of cases. A unique challenge in ventral scapular osteochondromas is limited visibility from the dorsal side. Computer-assisted surgery, which is widely employed in tumor surgery is a promising solution for minimally invasive resection with reduced muscle injury. Methods: We present the case of a thirteen-year-old female with a ventral scapular osteochondroma that cause winging and snaping of her left arm. The patient underwent computer-assisted surgery under general anesthesia in the prone position. The procedure involved a minimal incision over the crest of the scapular spine, enabling precise identification of the tumor from the dorsal side using navigation tools. Results: The tumor, identified as an osteochondroma on CT scans, was successfully resected with minimal soft tissue damage. Postoperatively, the patient's arm was immobilized for two weeks, followed by a pain-free return to normal activity. Radiographic evaluation confirmed complete tumor removal. Conclusions: Computer-assisted navigation can help locate the ventral osteochondroma of the scapula with minimal soft tissue damage and a quicker recovery time.

Morphological characteristics and reduction techniques of sagittal beak-like deformity of head-neck fragment in femoral intertrochanteric fractures

To summarize the morphological characteristics of sagittal beak-like deformity of head-neck fragment in femoral intertrochanteric fractures and to investigate the technical skills in fracture reduction. A clinical data of 31 patients with femoral intertrochanteric fractures between May 2021 and April 2023 was retrospectively analyzed. The fractures had sagittal beak-like deformity of head-neck fragment in all patients. There were 13 males and 18 females, with an average age of 76.2 years (range, 68-83 years). The time from injury to operation was 36-76 hours (mean, 51.2 hours). Fractures were classified as type A1.2 in 10 cases, type A1.3 in 11 cases, type A2.2 in 6 cases, and type A2.3 in 4 cases according to the AO/Orthopaedic Trauma Association (AO/OTA)-2018 classification; and as type A1.3 in 10 cases, type A2.1 in 11 cases, type A2.2 in 6 cases, type A2.3 in 2 cases, and type A2.4 in 2 cases according to a novel comprehensive classification for femoral intertrochanteric fractures proposed by the "Elderly Hip Fracture" Research Group of the Reparative and Reconstructive Surgery Committee of the Chinese Rehabilitation Medical Association. Based on preoperative X-ray films, CT scan and three-dimensional reconstruction, the fractures were classified into two types: type 1 (14 cases), with uncomplicated fracture morphology, severe bone interlocking and (or) soft tissue incarceration; type 2 (17 cases), with severe fracture crushing, obvious dissociation between bone blocks, and severe soft tissue hinge destruction. After the failure of the closed reduction, all patients underwent fracture reduction assisted with instrument via anterior minimal incision and proximal femoral nail antirotation nails internal fixation. The operation time, intraoperative fluoroscopy, intraoperative visible blood loss, length of hospital stay, and incidence of complications were recorded. The fracture reduction quality and stability score were assessed at immediate after operation under fluoroscopy. The fracture healing was evaluated and healing time was recorded by X-ray films. The pain visual analogue scale (VAS) score was performed at 48 hours after operation and Parker-Palmer activity score at 3 months after operation for function evaluation. The operation time was 39-58 minutes (mean, 46.3 minutes); fluoroscopy was performed 13-38 times (mean, 23.5 times) during operation; the intraoperative visible blood loss was 45-90 mL (mean, 65.3 mL). The fracture reduction quality and stability score were rated as good in 29 cases and acceptable in 2 cases. The pain VAS score was 2-6 (mean, 3.1) at 48 hours after operation. Eleven patients developed deep vein thrombosis of the lower limbs after operation. Patients were hospitalized for 6-10 days (mean, 7.3 days). All patients were followed up 5-8 months (mean, 6.5 months). All fractures healed at 3.5-8.0 months after operation (mean, 4.5 months). Parker-Palmer activity score at 3 months after operation was 9 in 28 cases and 6 in 3 cases. The femoral intertrochanteric fracture with sagittal beak-like deformity of head-neck fragment is difficult to manually reduce. The pin combined with cannulated screw insertion to the neck cortex can hold the fragment and assist fracture reduction, which is a simple and effective technique.

Magnetic Soft Catheter Robot System for Minimally Invasive Treatments of Articular Cartilage Defects.

Articular cartilage defects are among the most common orthopedic diseases, which seriously affect patients' health and daily activities, without prompt treatment. The repair biocarrier-based treatment has shown great promise. Total joint injection and open surgery are two main methods to deliver functional repair biocarriers into the knee joint. However, the exhibited drawbacks of these methods hinder their utility. The repair effect of total joint injection is unstable due to the low targeting rate of the repair biocarriers, whereas open surgery causes serious trauma to patients, thereby prolonging the postoperative healing time. In this study, we develop a magnetic soft catheter robot (MSCR) system to perform precise in situ repair of articular cartilage defects with minimal incision. The MSCR processes a size of millimeters, allowing it to enter the joint cavity through a tiny skin incision to reduce postoperative trauma. Meanwhile, a hybrid control strategy combining neural network and visual servo is applied to sequentially complete the coarse and fine positioning of the MSCR on the cartilage defect sites. After reaching the target, the photosensitive hydrogel is injected and anchored into the defect sites through the MSCR, ultimately completing the in situ cartilage repair. The in vitro and ex vivo experiments were conducted on a 3D printed human femur model and an isolated porcine femur, respectively, to demonstrate the potential of our system for the articular cartilage repair.

P.076 Long-term outcomes of radiofrequency ablation for temporal lobe epilepsy

Background: Radiofrequency ablation (RFA) is a minimally-invasive procedure that has been used to treat temporal lobe epilepsy (TLE), however its long-term efficacy is unknown. We aim to characterize the long-term outcomes of patients from the original series by Parrent and Blume (1999). Methods: Consecutive patients who underwent stereotactic RFA for TLE were retrospectively reviewed. Demographics, procedural details, and seizure outcomes until last follow-up were abstracted. Seizure-freedom after initial RFA treatment was estimated with Kaplan-Meier analysis. Results: 27 patients underwent RFA from 1994 to 2002. There were 14 female (52%) patients. 24 (89%) had mesial temporal sclerosis. Mean age at time of RFA was 33.1 years (range 12-45 years). 17 (63%) patients underwent left-sided RFA. 15 (56%) patients had further interventions: 4 (15%) underwent only repeat RFA, 1 (4%) had repeat RFA and anterior temporal lobectomy (ATL), and 10 (37%) underwent subsequent ATL only. Mean follow-up was 9.0 years (range 0.5-22.7 years). At last follow-up, 16 (59%) patients were seizure-free: 5 (19%) received one RFA treatment and 11 (41%) underwent additional procedures. Conclusions: Based on the original series describing the technique, stereotactic RFA for TLE is a safe, minimally-invasive procedure. The role of stereotactic RFA in the treatment of TLE remains to be determined.

Dilip's Transmucosal Internal Sphincterotomy: A Simplified Approach to Lateral Internal Sphincterotomy for Fissure in Ano.

Fissure in ano is a prevalent and painful condition, typically treated by lateral internal sphincterotomy after conservative measures fail. Dilip's transmucosal internal sphincterotomy introduces a simplified approach that reduces the risk of damaging the external sphincter, making it particularly suitable for less experienced surgeons. This innovation offers a less invasive method with minimal risk of incontinence, providing a safer, more accessible option. Transmucosal internal sphincterotomy simplifies the internal sphincterotomy process, offering a tailored approach that eliminates the need for extensive dissection. This method allows surgeons complete control over the internal sphincter bundle, facilitating a precise, customizable cut without the risks associated with traditional internal sphincterotomy, especially in obese patients where the intersphincteric groove is not visible, leading to potentially harmful blind incisions. The procedure is performed under saddle block anesthesia with the patient in the lithotomy position. A distinctive approach involving the use of retractors and stay sutures allows the internal sphincter to be made prominent and secured without extensive dissection. The division of the internal sphincter is achieved through a minimal mucosal incision, requiring no closure and significantly reducing postoperative pain and complications. Between December 2020 and February 2022, 124 patients received transmucosal internal sphincterotomy, showing significant benefits with a median operative time of 7 minutes and low postoperative pain. With a 2.5% infection rate effectively managed and a 3% transient incontinence rate, the majority healed within 9 weeks. Recurrence was rare at 1.6%. Transmucosal internal sphincterotomy presents significant advantages over traditional internal sphincterotomy, including reduced pain, lower risk of complications, such as hematoma, abscess, or fistula formation, and the absence of painful postoperative nodules. The success of transmucosal internal sphincterotomy suggests that it should be incorporated into surgical education, offering a less daunting and more reproducible method for treating fissure in ano that is especially beneficial for junior surgeons and improving patient outcomes.

Direct Intraocular Lens Extraction Using a Newly Developed Lens-Grabbing Forceps.

Background: Due to lower age thresholds for cataract surgery and increased longevity, cases with intraocular lens (IOL) dislocation requiring removal have increased. Traditional methods, such as cutting or folding the IOL within the eye, pose a high risk of complications, including corneal endothelial and iris damage. Methods: We developed a new minimally invasive technique for direct IOL removal using specially designed lens-grabbing forceps. These forceps can grasp and remove the IOL through a small incision in a single motion, significantly reducing intraocular manipulations compared to conventional methods. Results: In our test cases, IOL removal through a 2.2 mm corneal incision was completed in approximately 95 s, with minimal incision enlargement (about 0.16 mm) and a slight decrease in corneal endothelial cells. Conclusions: Our findings suggest that this technique is minimally invasive and safe for IOL removal, offering a promising alternative to existing methods.

Prognosis of Tissue Stiffness Through Multilayer Perceptron Technique With Adaptive Learning Rate in Minimal Invasive Surgical Procedures

Prognosis of Tissue Stiffness Through Multilayer Perceptron Technique With Adaptive Learning Rate in Minimal Invasive Surgical Procedures

Radiation dosage is related to changes in lymphocyte count, interleukin-6, and c-reactive protein levels during C-arm use in closed femoral nailing surgery

Introduction: Although the C-arm allows real-time image capture and intensification to allow accurate placement of implants and fixation devices with minimal incisions, these advantages have the disadvantage of the amount of radiation exposure to operating room personnel, especially surgical operators. The exposure mainly was low dose (&lt;1 Sv). However, the effects of low-dose exposure may be accurate and should be considered seriously. Methods: This research was an observational prospective cohort study. A total of 30 residents who met the inclusion criteria had blood samples taken before and after femoral nailing surgery. Then, the blood sample underwent a complete blood count, IL-6, and CRP levels examination. During surgery, C-arm radiation will be measured using a personal dosimeter. The statistical tests used were descriptive statistics, proportion comparison analysis with the dependent t-test, and simple linear regression tests. Results: Univariate analysis using paired t-test proved changes in lymphocyte count, IL-6, and CRP levels of orthopedic residents before and after femoral nailing surgery with c-arm guiding with a statistically significant difference, based on p-values respectively: p=0.001; p=0.001; p=0.002. Simple linear regression test proved that radiation dosage of c-arm during operation is associated with a change in lymphocyte count, IL-6 and CRP levels before and after femoral nailing surgery with R squared values respectively: 0.474 (p=0.001), 0.694 (p=0.001) and 0.701 (p=0.001). Conclusion: Radiation dosage of c-arm during femoral nailing surgery is related to changes in lymphocyte count, interleukin-6, and c-reactive protein levels among orthopedics and traumatology residents.

Tibialis Anterior Tendon Reconstruction Utilizing Split Tendon Turn-down: A Case Report and Technique Guide.

Tibialis anterior tendon (TAT) ruptures are rare, equating to less than 1% of all musculotendinous injuries. These injuries can be acute or atraumatic, with the latter often associated with chronic degenerative tendinopathy. Surgical repair is indicated when conservative measures fail in meeting functional demands. Direct end-to-end repair is the preferred method for TAT ruptures but may not be feasible with a large tendon defect. Various surgical techniques have been described to address this pathology, including allograft tendon interposition or extensor hallucis longus (EHL) transfer. The authors present a unique technique utilizing a minimal incision TAT turn-down with dermal matrix allograft augmentation, and, in addition, a case implementing this technique in a patient with a large insertional defect. The patient's postoperative course and outcomes were favorable, with improvements in pain, satisfaction, functional scores, and strength. The surgical technique offers versatility and can be adapted to different tendon defect sizes. It also allows for minimal-incision exposure, beneficial for patients with comorbidities or compromised skin integrity. In conclusion, the authors present a case report and surgical technique for the management of large-deficit, chronic TAT ruptures using split TAT turn-down. This technique provides a potential solution for cases where direct end-to-end repair is not feasible.Level of Evidence: Level V.

(283) Report of Newly Developed Penile Enhancement Surgery Using Midline Fixation Technique of Dermal Garft, Multi-layer Dissection Method, Multilayer Suture Lengthening and Minimal Skin Incision

Abstract Introduction Many physicians have tried to develop the surgical techniques to make safer and more effective results in penile enhancement surgery. Objective To accomplish better results of penile enhancement surgery, We aim to introduce newly developed more effective surgical techniques and safer processes in penile enhancement surgery. Methods 2023 Patients underwent penile enhancement surgeries. All patients adopted pre-pubic minimal skin incision with newly developed retractors. Allogenic dermal graft was fixed for girth enhancement. And midline fixation between penile skin inner surface and midline site of dermal graft was performed with surgifit 3.0. to accelerate the attachment of skin and graft. We use newly developed dissection technique with curved iris scissors and electro-cutting to dissect surgical plain between dartos and buck’s fascias. To perform lengthening procedure, fundiform ligament was dissected and pre-pubic dead space was approximated by multi-layer transverse suturing. Results Mean operation time was 46 min and mean incision length was 3.3 cm. Postoperative penile length after 3 months was elongated on average 2.7 cm. postoperative inflammation rate was 1.2% and no garfts failure was observed. Conclusions For more effective and safer penile enhancement and lengthening, multi-layer dissection technique, multi-layer suturing lengthening and mid-line fixation technique with minimal pre-pubic incision (4m penile surgery) are very useful. Disclosure No.

(216) Benefit of Closed Wound Drainage System with Negative Pressure in Penile Enhancement Surgery

Abstract Introduction Many patients have had penile enhancement surgery and the surgeon try to reduce postoperative complications including hemorrage, infection, wound dehiscence etc. we want to evaluate the benefits of closed wound drainage system with negative pressure in penile enhancement surgery. Objective we want to evaluate the benefits of closed wound drainage system with negative pressure in penile enhancement surgery. Methods We have experienced 500 penile enhancement surgery. We adopted a pre-pubic minimal incision and dissected penile shaft and pre-pubic space. Inserted graft materials were Allograft dermal grafts which were fixed at the Buck's fascia. And we dissected fundi-form ligaments and sutured transversely pre-pubic dead space with PDS 2.0. In group 1, silastic drain were inserted in 250cases in order to drain postoperative bleeding and prevent inflammation. In group 2, the remain 250 cases adopted closed wound drainage system with negative pressure. Results In group 1, the wound infecton rate was 2.9% and no dermal graft infection was showed. In group 2, the wound infection rate was 0.6% and no dermal graft infection was appeared. Group 1 using closed wound drainage system with negative pressure is more effective than group 2 using silastic drain in order to reduce wound infection rate. Conclusions In penile augmentation surgery using Allogenic dermis, Using closed wound drainage system with negative pressure is safer than using silastic drain as postoperative drainage system. Disclosure No.

(217) Report of Surgical Treatment Using Allogenic Dermal Graft Penoplasty to Treat Premature Ejaculation

Abstract Introduction Premature ejaculation is the major factor that causes low satisfaction of sexual intercourse. Ejaculation time is determined by various factors including such as psychological, habitual and physical factors, sensitive penile shaft and glans. Objective This study aimed to report the effectiveness and the safety of newly adopted surgical treatment using allogenic dermal graft. Methods We had performed Dermal graft surgery for treating premature ejaculation in 56 men who have short time ejaculatory problems within 5 minutes on average. We adopted a pre-pubic minimal incision and dissected penile shaft and pre-pubic space. Inserted graft materials were Allograft dermis which were fixed at the Buck's fascia. Glans sulcus was dissected from 8 o’clock to 4 o’clock and the thin strip shaped graft was fixed at the dissected space of glans sulcus. Vibratory sense of glans and penile shaft was estimated by biothesiometry and ejaculatory time was surveyed at both preoperative and postoperative status (5month~18month). Results 48 patients answered that their ejaculatory time was considerably delayed. And 7 patients slightly delayed. Among them, 1 man answered that there was no surgical effects despite of slightly being reduced penis sense. Following being asked raising their frequency of sexual intercourse, 1 man with no surgical effect was considerably improved in delaying the ejaculatory time. Among 136 cases, the inflammation on wound site occurred in 2 patients fully recovered in 2 weeks. No other complication occurred. Conclusions The surgical treatment using allogenic dermal graft is very effective in treating premature ejaculation. And this surgical procedure is very safe without no series complication. Disclosure No.