Minimally Invasive Procedure Research Articles

Percutaneous External Fixation of Redistributed Orbital Fat in Transcutaneous Lower Eyelid Blepharoplasty.

While percutaneous external fixation has gained popularity in transconjunctival blepharoplasty due to its simplicity and minimal incision, internal fixation remains the standard approach in transcutaneous blepharoplasty. This study aims to assess the safety and effectiveness of percutaneous external fixation specifically in transcutaneous fat repositioning blepharoplasty. From May 2022 to December 2023, a consecutive cohort of 97 patients underwent this surgical technique. Building upon the principles of transconjunctival fat repositioning, the procedure involved a minimal incision targeting the muscle layer, a conservative release of the tear trough ligament, and the repositioning of fat secured with percutaneous external fixation. Surgical outcomes were evaluated using the Barton grading system and FACE-Q scales for patient-reported outcomes. Following a mean follow-up of 7.2 months (ranging from 6 to 17 months), a resolution of tear trough deformities and eyelid bags was achieved in over 92% of cases. Notably, significant improvements (P < 0.05) were observed in lower eyelid aesthetics as measured by the FACE-Q scale, with a concomitant enhancement in patients' social confidence (P < 0.05). Overall, patients expressed satisfaction with their decision to undergo the procedure (71.0±19.1). Complications necessitating revision surgery included isolated cases of hematoma evacuation, fat injection, excision of excess fat, and skin excision. External fixation in transcutaneous blepharoplasty is technically less complex and minimally invasive, effectively securing transposed fat pedicles safely, presenting a viable alternative to conventional fixation techniques.

Perioperative considerations in anesthesia for minimally invasive repair of pectus excavatum, Nuss procedure

Pectus excavatum (PE) is a common anterior chest wall deformity that affects the heart and lungs depending on the severity of compression. The Nuss procedure, a minimally invasive repair of pectus excavatum, has evolved over the years with thoracoscopic assistance and minimal incision. Despite improved surgical techniques, pain and nausea are often the most common factors determining hospital length of stay. This review will explore the preoperative, intraoperative, and postoperative anesthetic considerations necessary for improving patient outcomes, reducing surgical stress, and shortening hospital stays for patients undergoing the Nuss procedure.

Outcomes of laser hemorrhoidoplasty for grade II-IV hemorrhoidal disease in Bangladesh

Background: Laser hemorrhoidoplasty is a minimal invasive procedure to treat hemorrhoids and has shown better outcomes. Less is known about its utility in a Lower middle-income country; Bangladesh. Method: Between March 2023 and December 2023, 86 patients with grade II-IV hemorrhoids underwent laser hemorroidoplasty. Follow up was assessed on 1st week, 2nd week and 6th weeks including pain, satisfaction, symptom improvement, incapacity for work, complications, reduction and recurrence. Results: The study included 86 patients, with a higher proportion of male participants (73.3%) with a mean age of 55.43±13.6 years. The majority of subjects (68.60%) had Grade 3 hemorrhoids. The average surgery duration was 14.70±4.70 minutes. All individuals experienced substantial decreases in the size of their hemorrhoids (100%) and reported high levels of satisfaction after the operation (97.7%). The use of the Wilcoxon signed-rank test demonstrated a statistically significant reduction in both the Visual Analog Scale (VAS) and Patient Global Impression of Improvement (PGI-I) ratings during the three subsequent observation periods( 1st week, 2nd week, and 6 wks). The 6th week complication rate was 19.8%. Additional mucopexy was performed on all patients with Grade IV and three patients with Grade III hemorrhoids. Conclusion: Laser hemorroidoplasty is a day-care procedure, that is safe and efficacious and can be used in rural area settings with good patient satisfaction. Mucopexy is required in some cases of large hemorrhoidal mass to prevent recurrence.

A Pilot Study of an Endoluminal-Suturing Device as a Treatment Strategy for Patients With Obesity and Obstructive Sleep Apnea

Background and Objective Obstructive sleep apnea (OSA) is a multifactorial disease, and obesity is the most prevalent risk factor for OSA. Endoscopic sleeve gastroplasty (ESG) is a minimally-invasive procedure used for treating obesity. This prospective study tested the potential benefit of weight loss via an ESG device, endomina&lt;sup&gt;®&lt;/sup&gt;, for reduction of apnea-hypopnea index (AHI) in patients with class I obesity and severe OSA.Methods Ten patients with BMI values of 28 to 34.9 kg/m&lt;sup&gt;2&lt;/sup&gt; and severe OSA underwent ESG and lifestyle management for 6 months. Patients underwent polysomnography before and 6 months after the endoscopic procedure. The primary endpoint was the percentage of AHI reduction six months after the endoscopic procedure. Secondary endpoints were the proportion of patients with AHI reductions of 50% six months after ESG, improvements in respiratory parameters and sleepiness, effectiveness on weight loss, and correlations with decreased AHI.Results Patients experienced 54% (±11%) reductions in AHI. Seven patients had an AHI reduction of ≥50%, and five had an AHI of &lt;15 events/h. Total body weight loss (TBWL) and excess weight loss (EWL) were 10.1% (±3.4%) and 45.4% (±14.0%), respectively, and there was no correlation between AHI and TBWL/EWL. There was an overall improvement in respiratory sleep parameters after ESG, except for snoring, and a reduction in daytime sleepiness.Conclusions These results suggest that using an ESG device, endomina&lt;sup&gt;®&lt;/sup&gt;, with lifestyle modification for promoting weight loss in class I obese patients with severe OSA is a promising treatment strategy for reducing OSA and improving respiratory parameters and daytime sleepiness.

The Agnikarma(~Cauterization) - A Mastery Procedure in Susruta Samhitha.

Ayurveda is the ancient science of human civilization. Sushruta Samhita is the most important literature in surgery. Maharshi Sushruta, known as the father of surgery has also explained the Para-surgical procedures in different diseases among them Agnikarma as the greatest/superior curative treatment to avoid recurrence. We can observe Susruta has explained in detail the importance of Agnikarma, varieties, and criteria of successful cauterization, specific sites, indications, patterns, and pre and post-cautery management. Agnikarma has its Ushna Guna and Sookshma Guna it pacifies the vata and Kapha and burns the unwanted tissue done by the different materials such as Shalaka (gold, silver, panchadhatu, etc), Ajashakrut, Godanta, Madhu, Guda, Sneha (oil, Ghrita). In the present study humble attempt was made for Ayurvedic surgical practice. This study concludes that Agnikarma(cauterization) is a very effective and simple, non-occurrence and minimal invasive procedure able to be conducted at the Out Patient Department(OPD) level.

3D-printed injectable nanocomposite cryogel scaffolds for bone tissue regeneration

Cryogels are known for their high water content and interconnected macroporosity, two relevant features in tissue engineering approaches. The cryogel structure can support tissue growth as it allows nutrient and oxygen diffusion, removal of waste products, as well as an enhancement of cell infiltration and proliferation. Bioactive glass nanoparticles are biocompatible and clinically approved bioactive materials widely used as implants in the human body to repair or replace diseased or damaged bones. They are known to facilitate bone binding while stimulating bone growth. Indeed, the combination of cryogels with bioactive nanoparticles has already demonstrated promising results for bone regeneration. Although the developed biomaterials succeed in bone regeneration, they lack suitability for minimal invasive procedures or patient-specificity. Here, we demonstrate a freeform 3D printed nanocomposite cryogel, resorting to an ink composed of functionalized gelatin and bioactive glass nanoparticles with methacrylate groups. Complex structures with multiple layers were 3D printed in a xanthan gum supporting bath. The developed 3D printed nanocomposite cryogels demonstrate the ability to recover their shape without any permanent damage, withstanding up to 65 % compression upon injection. Additionally, they stimulate the differentiation of human adipose-derived stem cells into the osteoblast lineage, therefore promoting bone tissue growth. We further demonstrated their suitability for minimal invasive therapeutics by filling a reproduction of a maxillofacial defect. The developed 3D-printed nanocomposite cryogels offer robust shape-recovery properties, easy injectability, tailored geometry into patient-specific injuries, and high osteogenic bioactivity, showcasing its versatility for bone regeneration purposes.

Removal of an embedded esophageal fishbone by minimal incision using the gel immersion endoscopic ultrasound-guided technique.

Removal of an embedded esophageal fishbone by minimal incision using the gel immersion endoscopic ultrasound-guided technique.

Laparoscopic Appendectomy: A Safe and Feasible Procedure in Emergency Department of a Public Sector Hospital

OBJECTIVES: To evaluate LA (laparoscopic appendectomy) in terms of operative time, post-operative recovery and rate of post-operative complications in Department of Surgery, Benazir Bhutto Hospital, Rawalpindi METHODOLOGY: A prospective Descriptive study. This study was carried out at Benazir Bhutto Hospital, Rawalpindi. The data was collected prospectively for a duration of five years, from March 2019 to March 2024. Data was collected prospectively for patients operated for acute appendicitis by laparoscopic appendectomy with the help of questionnaires. Data of patients undergoing laparoscopic appendectomies over five years was collected by consective non-probabilty sampling technique. RESULTS: 108 patients underwent laparoscopic appendectomy from March 2019 to March 2024 with follow-up of up to 01 month. 50(46.2%) men and 58(53.7%) women were included in the study. The mean age was 28±7.8 years. The mean operative time was 45±24.3 mins. 3.3% of operations required conversion to laparotomy. The mean length of stay was 1.5±3 days. Post-operative pain on the visual analog scale averaged around 6 on day one and reduced thereafter. The mean resumption of physical activity was 6 hrs. post-operatively. There was no death in the 30-day postoperative period. No complication occurred except for port site skin infection in 3 patients, intrabdominal abscess in 1, and fever in 9 patients. CONCLUSION: Our study advocates that laparoscopic appendectomy is a safe minimal invasive procedure with minimal complications.

Optimal Surveillance of Metachronous Gastric Lesion after Endoscopic Resection of Early Gastric Cancer.

Endoscopic resection (ER)-a minimal invasive procedure, compared to surgical gastrectomy, with the advantage of preserving the entire stomach and maintaining the patient's quality of life-is a widely used curative treatment for early gastric cancers (EGCs). Despite its advantages, such as the preservation of the whole stomach, a large area of the gastric mucosa with histologic changes such as atrophy and intestinal metaplasia remains after ER, and so does the risk of metachronous gastric cancers (MGCs). Therefore, regular surveillance endoscopy after curative ER of EGCs is important so that MGCs are detected early and so minimally invasive ER remains a treatment option. To date, the optimal interval for surveillance endoscopy after curative ER of EGCs has not been established. Therefore, this review summarizes the results of the published studies on this topic with the aim of establishing the optimal surveillance interval for early identification of MGCs. Based on my review, the median timing of MGC occurrence is within 3 years, and reports suggest biannual endoscopy during the first 3 years; however, the evidence suggests that individual patient characteristics may influence the risk of MGCs. Therefore, stratified endoscopic strategies for surveillance based on patient characteristics, such as age, family history of gastric cancer, synchronous gastric lesions, and corpus intestinal metaplasia, should be applied.

WP5.8 - Robotic versus laparoscopic general surgery in the emergency setting: a systematic review

Abstract Introduction Robot-assisted general surgery, a cutting-edge technology in minimally-invasive procedures, is increasingly utilised in elective general surgery, demonstrating advantages over laparoscopy in select cases. While laparoscopy remains a standard approach for common acute abdominal conditions, the role of robotic surgery in emergency general surgery is unclear. This systematic review aims to compare outcomes in acute general surgery settings for robotic versus laparoscopic surgeries. Method A PRISMA compliant systematic search across MEDLINE, EMBASE, Science Citation Index Expanded, and Cochrane library was performed. The literature review focused on articles comparing perioperative outcomes of emergency general surgery managed laparoscopically versus robot-assisted. A descriptive analysis was performed and outcome measures recorded. Results Six articles, reporting on 1063 patients, compared outcomes of robotic and laparoscopic procedures. Two covered cholecystectomies, while the others addressed ileocaecal resection, subtotal colectomy, hiatal hernia and perforated gastrojejunal ulcer repair. The level of evidence was low. Laparoscopic bowel resection in inflammatory bowel disease (IBD) patients had higher complications; no significant differences were found in complications for other operations. Operative time showed no differences for cholecystectomies, but robotic approaches were longer for other procedures. Robotic cases had shorter hospital length of stay, though the associated costs were significantly higher. Conclusion Perioperative outcomes for emergency robotic surgery in selected general surgery conditions are comparable to laparoscopic surgery. However, recommending robotic surgery in the acute setting requires a well-powered large population study for stronger evidence.

Diverse fluvial aggradation and incision response to interglacial—Glacial transitions in the headwaters of the Yangtze River, SE Tibetan Plateau

As a key geomorphic archive, staircase sequences of terraces and sediments record the history of fluvial aggradation and incision, which are related to tectonic activities, climatic fluctuations, and varying base levels. While numerous studies have investigated their influence on the formation of fluvial terraces, the manner in which rivers adapt to diverse climatic transitions (specifically, the shifts from warm to cold and from cold to warm) remains a subject of ongoing debate, particularly when considered within varying tectonic and climatic contexts. Here, we address this issue by reconstructing terrace distributions and identifying sedimentary features with OSL dating in the headwaters of the Yangtze River in the southeastern Tibetan Plateau. We discovered two distinct sets of thick valley-filling sequences at different elevations indicating two phases of aggradation during the penultimate and last glacial periods, when the Yangtze River was in a transport-limited condition. During the warmer interglacial and deglacial periods, increased monsoon precipitation led to higher discharge, causing the river to incise into these valley fills. In addition, superimposed tectonic activities produced diverse river response to the climatic transition from interglacial to glacial between the upstream shallow valley and the downstream deeply incised gorge. In the upper valley, stable tectonic conditions resulted in minimal incision, with younger deposits overlying older ones. Conversely, in the downstream gorge, with more intense tectonic activities, sediments only partially covered the riverbed. These sediments acted as abrasion tools, facilitating rapid incision during the warm-to-cold transition, thereby creating two separated valley fills. This finding enhances our understanding of how tectonic forces influence river responses to interglacial—glacial cycles.

451. PREDICTIVE FACTORS FOR PNEUMONIA AND ANASTOMOTIC LEAK AFTER TRANSTHORACIC ESOPHAGECTOMY FOR CANCER AND FAILURE TO RESCUE ANALYSIS ON 1355 PATIENTS

Abstract Background Pneumonia (PN) and anastomotic leak (AL) represent the most feared complications after transthoracic esophagectomy for cancer, the former more commonly observed after open and the latter after minimally-invasive (MI) procedures. Studies comparing these two complications with focus on predictive risk factors and procedure-related failure-to-rescue (FTR) are sparse. Aim of the study was to explore such aspects with a large multicentric dataset. Methods All patients who underwent an Ivor Lewis transthoracic esophagectomy for cancer between 2008 and 2022 in four tertiary centers were queried. Predictive risk factors for pneumonia, anastomotic leak and in-hospital mortality were analyzed with univariable models. FTR was defined as in-hospital death following a major complication. Patients were then classified and compared according to the type of operation [open, hybrid-laparoscopic, hybrid-robotic, standard minimally-invasive (MIE) or robotic minimally-invasive (RAMIE)]. Pneumonia and anastomotic leak associated FTR was calculated and compared across the groups. Machine-learning models (neuronal nets, support vector machines and random forests classifier) were applied to predict complications and FTR. Results In total, 1,355 patients were included. Significant (p&amp;lt;0.05) predictors for PN (n=211, 15.6%) were ASA=4, preexisting cardiac and pulmonary conditions, conversion (thoracotomy), neoadjuvant therapy and age. Those for AL (n=160, 11.8%) were preexisting cardiac condition, conversion (thoracotomy) and operation time. Overall FTR-rate was 3.6%. Age&amp;gt;65y, preexisting cardiac and pulmonary condition, AL, PN, postoperative bleeding, sepsis, pulmonary embolism, myocardial infarction, arrhythmia and need for blood transfusion were the risk factors significantly associated with in-hospital mortality. PN- and AL- associated FTR rates did not significantly differ among the different operation types (Figure 1). Machine-learning models were unable to predict complications or FTR properly. Conclusions Our study showed that there is a greater number of factors associated with pneumonia rather than anastomotic leak, probably making the prevention of this complication more challenging to achieve. However, pneumonia- and leak-associated FTR-rates did not significantly differ among the groups, demonstrating that the implementation of minimally-invasive procedures can be safely carried out, if experience is provided.

Needle-Like Multifunctional Biphasic Microfiber for Minimally Invasive Implantable Bioelectronics.

Implantable bioelectronics has attracted significant attention in electroceuticals and clinical medicine for precise diagnosis and efficient treatment of target diseases. However, conventional rigid implantable devices face challenges such as poor tissue-device interface and unavoidable tissue damage during surgical implantation. Despite continuous efforts to utilize various soft materials to address such issues, their practical applications remain limited. Here, a needle-like stretchable microfiber composed of a phase-convertible liquid metal (LM) core and a multifunctional nanocomposite shell for minimally invasive soft bioelectronics is reported. The sharp tapered microfiber can be stiffened by freezing akin to a conventional needle to penetrate soft tissue with minimal incision. Once implanted in vivo where the LM melts, unlike conventional stiff needles, it regains soft mechanical properties, which facilitate a seamless tissue-device interface. The nanocomposite incorporating with functional nanomaterials exhibits both low impedance and the ability to detect physiological pH, providing biosensing and stimulation capabilities. The fluidic LM embedded in the nanocomposite shell enables high stretchability and strain-insensitive electrical properties. This multifunctional biphasic microfiber conforms to the surfaces of the stomach, muscle, and heart, offering a promising approach for electrophysiological recording, pH sensing, electrical stimulation, and radiofrequency ablation in vivo.

Transvaginal uterine niche repair: surgical technique and outcome.

A uterine niche after caesarean section may play a role in secondary infertility. The transvaginal approach is a newly developed minimally invasive surgical technique for repairing a uterine isthmocele. To report on the feasibility, effectiveness, and safety of the transvaginal uterine niche repair. The technique is demonstrated in a live-surgery video. A retrospective chart review involving all patients with secondary infertility who underwent a transvaginal uterine niche repair in Ziekenhuis Oost-Limburg between August 2019 and July 2022 was conducted. We compared the pre- and postoperative residual myometrial thickness as a primary surgical outcome measurement. The pregnancy ratio and the peri- and postoperative complications were also reported. A total of 26 patients underwent a transvaginal uterine niche repair with an average operation time of 44 minutes. No major surgical complications were reported. 23 patients (88%) had good postoperative myometrial integrity, while 3 patients had a partial or complete postoperative recurrence of the uterine niche. The average pre- and postoperative myometrial thicknesses were 1.6 mm and 6.4 mm respectively. 64% of patients desiring pregnancy became pregnant after the transvaginal niche repair. There were no obstetric complications reported. A transvaginal approach is a safe and effective technique for uterine niche repair. It offers good results in re-establishing myometrial integrity and may favour fertility outcomes. It represents a valid minimal invasive procedure for patients with a very thin residual myometrial thickness and secondary infertility without leaving a visual scar.

Significance of Specimen Extraction Site in Minimizing Hernia Risk After Distal Pancreatectomy.

Incisional hernia (IH) results in significant morbidity to patients and financial burden to healthcare systems. We aimed to determine the incidence of IH in distal pancreatectomy (DP) patients, stratified by specimen extraction sites. Imaging in DP patients in our institution from 2016 to 2021 were reviewed by radiologists blinded to the operative approach. Specimen extraction sites were stratified as upper midline/umbilical (UM) versus Pfannenstiel. IH was defined as fascial defect on postoperative imaging. Patients without preoperative and postoperative imaging were excluded. Of the 219 patients who met our selection criteria, the median age was 64 years, 54% were female, and 64% were White. The majority were minimally invasive (MIS) procedures (n=131, 60%), of which 52% (n=64) had a UM incision for specimen extraction, including 45 hand-assist and 19 purely laparoscopic procedures. MIS with Pfannenstiel incisions for specimen extraction was 48% (n=58), including 44 robotic and 14 purely laparoscopic procedures. Mean follow-up time was 16.3 months (standard deviation [SD] 20.8). Follow-up for MIS procedures with UM incisions was 16.6 months (SD 21.8) versus 15.5 months (SD 18.6) in the Pfannenstiel group (p=0.30). MIS procedures with UM incisions for specimen extraction had a 17.8 times increase in odds of developing an IH compared with MIS procedures with Pfannenstiel extraction sites (p=0.01). The overall odds of developing an IH increased by 4% for every month of follow-up (odds ratio 1.04; p<0.001). A Pfannenstiel incision should be performed for specimen extraction in cases with purely laparoscopic or robotic distal pancreatectomy, when feasible.

Syringosubarachnoid shunting with augmented reality navigation through a keyhole laminectomy of the upper thoracic spine: illustrative case.

A syringosubarachnoid (SS) shunt combined with keyhole hemilaminectomy is a beneficial procedure that can reduce the size of the skin incision and the risk of complications. However, ingenuity is needed to confirm the position of the syrinx during surgery. The authors present a case in which they treated syringomyelia in the upper thoracic spine using augmented reality (AR) to confirm syrinx formation, bone resection, and skin incision. Microscope-based AR was an appropriate and practical choice in this case. By placing the reference array at the Mayfield clamp, it was possible to use AR from the point of skin incision. Under AR navigation, an SS shunt tube can be placed in the short syrinx. AR navigation enables pinpoint SS shunt tube insertion with minimal skin incision and bone resection. It is particularly useful for upper thoracic and small syrinx lesions. https://thejns.org/doi/10.3171/CASE24130.

Short-term outcomes of the "minimal skin incision and no stoma" procedure in needlescopic intersphincteric resection and delayed coloanal anastomosis for low rectal cancer.

Needlescopic surgery is a minimally invasive procedure that uses thin trocars with 3-mm diameter. We used Turnbull-Cutait pull-through and delayed coloanal anastomosis in needlescopic surgery to avoid diverting ileostomy during intersphincteric resection for low rectal cancer. In this study, we aim to assess the diverting ileostomy avoidance rate and technical safety of this "minimal skin incision and no stoma" procedure. This single-center retrospective study was conducted at the Cancer Institute Hospital, a tertiary referral center in Japan. Between January 2017 and December 2020, 11 patients underwent needlescopic intersphincteric resection with diverting ileostomy (NSI group), and 19 patients underwent needlescopic intersphincteric resection with delayed coloanal anastomosis (NSD group) for low rectal cancer. Data regarding patient backgrounds and short-term outcomes, including diverting ileostomy avoidance rate, pathological results, and postoperative defecatory function, were compared between the groups. There were no statistically significant differences between the NSI and NSD groups with respect to patient background, operation time (239min versus 220min, p = 0.68), estimated blood loss (45g versus 25g, p = 0.29), R0 resection rate (100% versus 100%, p = 1.00), and length of postoperative hospital stay (16days versus 17days, p = 0.42). The diverting ileostomy avoidance rate was 94.4% in the NSD group. The LARS and Wexner scores 12months after surgery were not significantly different between the two groups. Needlescopic intersphincteric resection and delayed coloanal anastomosis can be safely performed in selected patients with a high rate of diverting ileostomy avoidance and comparable short-term outcomes.

Hybrid coronary revascularization: position paper of the European Society of Cardiology Working Group on Cardiovascular Surgery and European Association of Percutaneous Cardiovascular Interventions.

Myocardial revascularization in coronary artery disease via percutaneous coronary intervention or coronary artery bypass graft (CABG) surgery effectively relieves symptoms, significantly improves prognosis and quality of life when combined with guideline-directed medical therapy. Hybrid coronary revascularization is a promising alternative to percutaneous coronary intervention or CABG in selected patients and is defined as a planned and/or intended combination of consecutive CABG surgery using at least 1 internal mammary artery to the left anterior descending (LAD), and catheter-based coronary intervention to the non-LAD vessels for the treatment of multivessel disease. The main indications for hybrid coronary revascularization are (i) to achieve complete revascularization in patients who cannot undergo conventional CABG, (ii) to treat patients with acute coronary syndromes and multivessel disease with a non-LAD vessel as the culprit lesion that needs revascularization and (iii) in highly select patients with multivessel disease with complex LAD lesions and simple percutaneous coronary intervention targets for all other vessels. Hybrid coronary revascularization patients receive a left internal mammary artery graft to the LAD artery through a minimal incision along with percutaneous coronary intervention to the remaining diseased coronary vessels using latest generation drug-eluting stents. A collaborative environment with a dedicated heart team is the optimal platform to perform such interventions, which aim to improve the quality and outcome of myocardial revascularization. This position paper analyses the rationale of hybrid coronary revascularization and the currently available evidence on the various techniques and delves into the sequence of the interventions and pharmacological management during and after the procedure.

Clinical and radiological outcome of surgical hallux valgus correction: open versus minimally invasive

IntroductionHallux valgus (HV) is the most common forefoot deformity. Surgical correction of HV aims to reduce pain, preserve joints, and re-establish foot function while restoring the hallux valgus angle (HVA) and intermetatarsal angle (IMA). Many surgical procedures have been proposed, including open and minimally invasive (MI) techniques. This study aimed to compare the midterm outcomes of open vs. MI procedures and their impact on the duration of surgery, hospital stay, HVA, and IMA post-operatively.Materials and methodsOne hundred and twenty HV patients operated by open or MI surgery between October 2019 and October 2022 were included. One hundred three patients met the inclusion criteria and consented to the study. Patients were prospectively surveyed for foot functionality, post-operative pain, and complications using the AOFAS score. Radiographic measurements of HV angles, length of hospital stay, and surgery duration were analysed.ResultsMI surgery patients had significantly better AOFAS scores (p < 0.001) 12 months post-operatively compared to open surgery. Complication rates were lower in the MI group (3.8% vs. 33.3%, p < 0.001). MI surgery patients also had shorter hospital stays (0.9 ± 0.3 days vs. 2.0 ± 0.0 days) and surgery duration (19.7 ± 2.3 min vs. 80.7 ± 6.8 min). MI surgery was more effective in correcting the IMA but equally effective as open surgery for HVA correction.ConclusionMI surgery resulted in better patient satisfaction, fewer complications, and more precise correction of IMA values. Moreover, the duration of surgery and hospital stay were significantly lower in patients undergoing MI surgery. Further research is needed to validate these findings in controlled, prospective randomised trials.

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.