Operative Time Cost Research Articles

Comparative study of open elbow arthrolysis with and without hinge external fixation for the treatment of post-traumatic elbow stiffness

BackgroundThe present study aimed to compare the functional outcomes of hinged external fixators and non-external fixation in open elbow arthrolysis (OEA) for post-traumatic elbow stiffness (PTES) and to evaluate their applicability and limitations in patients with posttraumatic elbow stiffness.MethodsThe clinical data of patients with PTES treated with OEA at our hospital between March 2015 and June 2022 were retrospectively analyzed. The assessed variables were the operation time, intraoperative blood loss volume, duration of hospitalization, and treatment costs. The elbow range of motion (ROM), Mayo Elbow Performance Score (MEPS), shortened disabilities of the arm, shoulder and hand questionnaire (Q-DASH) score, Oxford Elbow score (OES), Broberg and Morrey score (BMS), visual analog scale (VAS) for pain, and complications such as pin tract infection and heterotopic ossification were compared between patients with and without hinge external fixation. We also compared the baseline characteristics and functional outcomes of patients with and without hinge external fixation.ResultsA total of 156 patients (48 patients with hinged external fixators and 108 patients without external fixators) diagnosed with PTES were included in this study. The mean follow-up was 15.8 ± 3.6 months. Compared with patients without external fixators, those with external fixators showed significantly greater improvements in elbow flexion and extension ROM (59.6° ± 26.1° vs. 46.2° ± 26.2°, p = 0.004) but had a significantly longer duration of hospitalization (p < 0.001), significantly longer operation time (p < 0.001), significantly higher treatment costs (p < 0.001), and significantly greater intraoperative blood loss volume (p < 0.001). There were no significant differences between the two groups in terms of improvement in elbow rotation ROM, MEPS score, VAS score for pain, OES score, Q-DASH score, BMS score, or incidence of complications.ConclusionThe use of a hinged external fixator in open arthrolysis for posttraumatic elbow stiffness may result in short-term improvements in flexion-extension range of motion but is accompanied by increased blood loss, longer operative time, extended hospitalization, and higher costs. Further studies are needed to confirm these findings.Clinical trial numberNot applicable.

Endoscopic injection vs anti-reflux surgery for moderate- and high-grade vesicoureteral reflux in children: a cost-effectiveness international study

Even if vesicoureteral reflux is a common condition in children, there are no guidelines about the best therapeutic approach. This study aims to compare the results of endoscopic injection and ureteral reimplantation in children with grade III, IV and V VUR. A multicenter retrospective study included children with grade III, IV and V VUR treated from 2003 to 2018 at three Departments of Pediatric Surgery. Patients were divided into Group A (endoscopic injections) and Group B (anti-reflux surgery), B1 (open, OUR), B2 (laparoscopic, LUR) and B3 (robot-assisted laparoscopic RALUR). Follow-up was at least 5 years. 400 patients were included, 232 (58%) in group A and 168 (42%) in group B. Mean age at surgery was 38.6 months [3.1–218.7]. Mean follow-up was 177.8 months [60–240]. Group A had shorter operative time than group B (P < 0.01); lower analgesic requirement (p < 0.05), shorter hospital stay (P < 0.05) and lower overall costs (p < 0.05), but higher postoperative PNPs (p < 0.01), lower success rate (p < 0.01) and higher redo-surgery percentage (p < 0.01). No differences in terms of postoperative complications, success rate and mean radiation exposure between the two groups. Endoscopy is associated with shorter operative time, shorter hospitalization and lower cost, also in case of multiple injections. Recurrence rate after surgery is lower meaning lower rate of re-hospitalization and radiation exposure for children.

Single versus dual fixation of distal femur fractures: A retrospective cohort study at a level one trauma centre in New Zealand

Background The study compares single versus combination fixation of distal femur fractures. Method We retrospectively reviewed patients over 60 between January 2016 and December 2022. Union rate, ambulatory status and complication rate were primary outcomes. Secondary outcomes included quality of reduction, operative time and rate of blood transfusion. Results A total of 92 patients received single fixation, and 22 patients received combination fixation. There was no difference in rate or time of fracture union. Patients with dual fixation were allowed to weight bear on discharge significantly more than single fixation patients (50% vs. 18.9%, p = 0.003). Intramedullary nail fixation, as a single method or combined with lateral plating, was associated with earlier weight bearing. Immediate post-operative weight bearing significantly increased the likelihood of discharging to home or rehabilitation versus discharging to a transitional care facility ( p &lt; 0.00001). There was no difference in the rate of blood transfusion, complication or mortality. Medial translation of the distal articular block was significantly lower with dual fixation (1.2% vs. 3.4%, p = 0.021). Operation time was longer with combination fixation (183 min vs. 134 min p &lt; 0.001). Conclusion Combination fixation allows earlier weight bearing, at the cost of longer operation time.

C-arm-guided versus ultrasound volumetric navigation-guided percutaneous transforaminal endoscopic discectomy for the treatment of lumbar disc herniation: A retrospective study.

To compare the clinical efficacy of lumbar percutaneous transforaminal endoscopic discectomy (PTED) for lumbar disc herniation (LDH) guided by C-arm fluoroscopy and ultrasound volumetric navigation (UVN). Fifty patients with LDH treated with PTED were retrospectively evaluated in this study. Groups A (n = 25) and B (n = 25) had intervertebral foramina punctures guided by C-arm fluoroscopy and UVN, respectively. The age, gender, height, weight, and body mass index of patients were recorded. We compared the puncture time, number of punctures, and puncture accuracy of patients in both groups. We also evaluated the clinical effectiveness of PTED surgery using the visual analog scale (VAS) and the Oswestry Disability Index (ODI). In addition, we recorded the duration of surgery, hospitalization, medical costs, and surgical complications in both groups. The average follow-up time of the 50 patients was 18.5 ± 4.3 months. The mean puncture time in groups A and B was 25.76 ± 5.28 and 14.34 ± 4.96 minutes, respectively, and the difference was statistically significant (P < .05). The mean number of fluoroscopies was significantly lower in group B than in group A, with 15.82 ± 2.29 versus 4.52 ± 0.51 times (P < .05). The puncture accuracy rate was 100% in both groups, with no statistical difference (P > .05). The VAS and ODI scores of patients in group A were similar to group B at all 3-time points: preoperatively, at 3 months postoperatively, and at 1 year postoperatively. However, both VAS and ODI were significantly improved postoperatively compared to preoperatively (P < .05). Moreover, group B has shorter operative time and higher medical cost than group A (P < .05). There was no significant difference in the length of hospitalization and surgical complication rate (P > .05). Both C-arm-guided and the UVN-guided PTED are safe and effective methods for the treatment of LDH. UVN-guided technique has the advantage of reducing puncture time and the number of punctures. However, UVN also has the disadvantage of high hospitalization costs.

Federated deep reinforcement learning based trajectory design for UAV-assisted networks with mobile ground devices

Exploiting highly maneuverable unmanned aerial vehicles (UAVs) has been considered as an efficient way to assist wireless systems, e.g., for applications of data collection. However, several challenges remain to be addressed in the design of such UAV-assisted networks, including multi-UAV joint trajectory determination, data privacy protection, and adaption to the complex channel environment particularly with mobile ground devices (GDs). In this paper, we study a multi-UAV assisted data collection system where UAVs collect data locally from mobile GDs. The aim is to minimize the whole operation time cost via jointly optimizing the UAVs’ three-dimensional (3D) trajectory together with the GDs’ communication scheduling, while satisfying the constraints of no-fly zones (NFZs) and collision avoidance. With a nonconvex feasible set (due to the NFZs), the established problem is nonconvex. Moreover, the randomness of GDs movements significantly reduces the performance of a typical redesign, i.e., determining the UAVs’ trajectory and users’ scheduling before starting the data collection task. To tackle these issues, we first transform the established problem into a Markov decision one, and then propose a multi-agent federated reinforcement learning (MAFRL)-based approach to optimize the dynamic long-term objective via jointly determining UAVs’ 3D trajectory and GD’s communication scheduling. A multi-step propagation technique and a dueling network architecture are adopted to enhance the neural network utilized to train agents, i.e., to accelerate the convergence rate of the proposed method and improve its overall stability. Finally, experimental results reveal the effectiveness of our proposed method in the considered practical scenario.

Contemporary use of 3D printed jigs and guides for osteotomies around the knee: a systematic review

Background. With improved accessibility of imaging and additive manufacturing, custom targeting guides and jigs are now widely accepted across many areas of orthopaedics. During orthopedic surgery, patient-specific guides assist in the accurate drilling and cutting of bone in conjunction with meticulous pre-operative planning. Given their increased uptake, it is important to define the lessons learned from recent clinical experience, and to document the reported benefits when using this technology intra-operatively. The aim of this review is to evaluate the potential benefits of patient-specific guides for osteotomies about the knee, and to clarify what evidence currently exists to support their use. Methods. A systematic review of PubMed, Embase, and Web of Science was performed for studies investigating the use of intra-operative patient-specific guides for realignment osteotomies about the knee. Randomised controlled trials, non-randomised studies, observational studies, case series, and case reports, as well as in vitro studies, were included. Screening was conducted with the Covidence software, and risk of bias was assessed with the Risk Of Bias In Non-Randomized Studies of Interventions (ROBINS-I) tool. Results. A total of 38 studies satisfied the inclusion criteria: 21 of these included patient-specific instrumentation (PSI) for high tibial osteotomy, 6 with distal femoral osteotomy, 4 — for combined tibial/femoral rotational corrective osteotomies, 4 — in double-level osteotomies, and 6 — for intra-articular osteotomies. The main outcomes reported were accuracy of surgical correction, typically with reference to pre-operative plans, and execution accuracy based on radiographic measurements. Other common outcomes were operative time, intra-operative fluoroscopy, and operative costs. Many studies were observational in nature, with no control groups available for suitable comparison. Conclusions. For corrective osteotomies about the knee, the literature suggests PSI has very strong potential to improve accuracy in achieving pre-operative targets. This was reported for both opening and closing wedge osteotomies of the femur, and for high tibial osteotomy. Some contradictory results have been reported for high tibial osteotomy, based on limited evidence from small studies that in many instances lacked controls for comparative analysis. Additional controlled trials are necessary to confirm the benefits of PSI for osteotomies about the knee, considering it has not yet been conclusively validated. The literature currently available indicates PSI can improve the accuracy of corrective osteotomies about the knee.

Dynamic job allocation method of multiple agricultural machinery cooperation based on improved ant colony algorithm

Contemporary large-scale and systematic agricultural operations demand the collaborative efforts of multiple agricultural machines with distinct functionalities. However, the failure of a single agricultural machine during collaborative operations jeopardizes the entire undertaking. To address this challenge, this paper proposes a multi-machine collaborative dynamic job allocation method based on the improved ant colony algorithm. Initially, the improved ant colony algorithm is employed to determine the optimal solution for harvester scheduling. This solution is then fed into the data conversion algorithm to acquire the necessary unloading point information for transport vehicle scheduling. Subsequently, the improved ant colony algorithm is once again utilized to optimize the transport vehicle scheduling. In cases of agricultural machinery failure or changes in the operating environment, two distinct methods are employed based on the situation. The first involves double-layer rescheduling of both harvester and transport vehicles, while the second employs single-layer rescheduling exclusively for the transport vehicles, yielding the respective rescheduling results. The outcomes demonstrate that the proposed solution method effectively identifies the current optimal scheduling plan for both the harvester and transport vehicle in the event of malfunctions. Moreover, under the premise that the unproductive waiting time of the harvester is reduced to zero, and the number of transport vehicles is minimized, it achieves the minimization of operating time cost and transportation cost. This method exhibits significant potential for seamless integration into the practical application of unmanned farms, providing a foundation for addressing scheduling and management challenges in multi-agricultural machinery collaborative operations within complex farmland operating environments.

Comparison of the short-term efficacy of MIS-TLIF and Endo-LIF for the treatment of two-segment lumbar degenerative disease

BackgroundThis study retrospectively compared short-term clinical outcomes and complications of minimally invasive surgery transforaminal lumbar interbody fusion(MIS-TLIF)and endoscopic lumbar interbody fusion(Endo-LIF))for two-segmental lumbar degenerative disease, aiming to guide spine surgeons in selecting surgical approaches.MethodsFrom January 2019 to December 2023, 30 patients were enrolled,15 in the MIS-TLIF group and 15 in the Endo-LIF group. All patients were followed up for more than 3 months after surgery and the following information was recorded: (1)surgery time, difference in hemoglobin between preoperative and postoperative, surgical costs, first time out of bed after operation, postoperative hospitalization time, postoperative complication; (2) ODI score (The Oswestry Disability Index), leg and back VAS score (Visual Analogue Scale), and lumbar vertebra JOA score (Japanese Orthopaedic Association Scores); (3) MacNab score at final follow-up to assess clinical outcome, CT to evaluate lumbar fusion.ResultsThere were significant differences between the two groups regarding operation time and cost, with the MIS-TLIF group performing significantly better. Intraoperative bleeding was considerably less in the Endo-LIF group compared to the MIS-TLIF group. However, there were no significant differences in the time of the first postoperative ambulation, postoperative hospitalization time, and postoperative complications. There was no significant difference in preoperative VAS, ODI, and JOA between the two surgical groups There were no significant differences in VAS(leg), ODI, and JOA scores between the two groups before and at 1 day,7 days, 1 month, 3 months and final follow-up. However, at 1 day postoperatively, the VAS( back)score in the Endo-LIF group was lower than that in the MIS-TLIF group, and the difference was statistically significant. At the final follow-up, all patients achieved grade III and above according to the Bridwell criteria, and there was no significant difference between the two surgical groups compared to each other. According to the MacNab score at the final follow-up, the excellent rate was 80.00% in the Endo-LIF group and 73.33% in the MIS-TLIF group, with no significant difference between the two groups.ConclusionThere was no significant difference in short-term efficacy and safety between Endo-LIF and MIS-TLIF for two-segment degenerative lumbar diseases. MIS-TLIF has a shorter operative time and lower costs, while Endo-LIF causes less tissue damage, blood loss, and early postoperative pain, aiding long-term recovery. Both MIS-TLIF and Endo-LIF are promising for treating two-segment lumbar degenerative disease. The choice of a surgical procedure depends on the patient’s financial situation, their ability to tolerate surgery, and the surgeon’s expertise.

Clinical effectiveness of robotic versus laparoscopic and open surgery: an overview of systematic reviews

ObjectiveTo undertake a review of systematic reviews on the clinical outcomes of robotic-assisted surgery across a mix of intracavity procedures, using evidence mapping to inform the decision makers on the...

Does Sequential Thoracoscopic Sympathectomy Affect the Development of Postoperative Compensatory Sweating in Children?

BackgroundThe development of compensatory sweating (CS) following thoracoscopic sympathectomy (TS) for palmar hyperhidrosis (PH) is the major drawback of this procedure. Several techniques were proposed to minimize the occurrence of CS such as changing the level of sympathectomy or conducting it sequentially on both sides with an interval between the two procedures. The aim of this study is to compare sequential T3-T4 TS versus bilateral same-setting T3-T4 TS regarding the development and severity of postoperative compensatory sweating. MethodsThis comparative study included 38 patients (20 females and 18 males) with primary palmar hyperhidrosis between March 2020 and March 2023. Patient's ages ranged between 5 and 18 years, and they were divided into two groups: group I included 23 patients treated with sequential T3-T4 TS; and group II included 15 patients who underwent bilateral same-setting T3-T4 TS. Both groups were compared with regard to patient characteristics, operative details, and postoperative outcomes. ResultsThere were no significant sex or age distribution differences among both groups. The mean cumulative operative time was significantly longer in group I (38 versus 27 min). There was no statistically significant difference in the rate of compensatory sweating between groups I and II (6/23 [26%] vs 5/15 [33%], respectively; p = 0.77). No over-dryness or recurrence occurred in any patient in either group. ConclusionSequential TS does not seem to have superior results when compared to bilateral same-setting TS regarding the development of compensatory sweating. Conducting bilateral same-setting TS is both safe and feasible with shorter operative time, hospital stay, and overall cost. Level of evidenceIV.

Accurate Battery Life Prediction Using Early-Cycle Features

Data-driven machine learning (ML) applications on battery prognosis are thriving with compatible accuracy owing to advancements in computing and data storage technologies. Unfortunately, several experimental obstacles including sparse operating conditions and time cost affect the data quality which restricts the ML model generalizability and applicability given the nonlinear degradation pattern for lithium-ion batteries (LIBs). From a broader perspective, multiple electrochemical attributes have not been investigated thoroughly and therefore, we proposed to build an early-cycle lifetime prediction model by exploring the capability of features extracted from the battery’s extrinsic properties (ex: temperature, dis/-charge time) using cycling data taken from only up to the first 10 cycles. A simple linear model is employed and validated on datasets amounting about 200 cells in total with various environmental temperature settings, cycling protocols, and lithium-based cathode chemistries such as lithium - iron phosphate (LFP), nickel cobalt aluminium oxide (LNCA), and nickel manganese cobalt oxide (LNMC) with mean absolute percentage error (MAPE) cycle life prediction less than 17.3%. Integrating the short-listed explored features together with state-of-the-art features on a fast-charging dataset of 124 LFP cells, the model achieved a satisfying 11.8% overall MAPE using data from the first 10 cycles. This work provides an impactful insight into simple feature engineering on early-cycle prediction applications. Details on the methodology, data-standard challenges, and wider applications will be discussed to explore further derivation of potent early-cycle features.

Current and Future of Robotic Surgery in Thyroid Cancer Treatment.

Thyroid cancer is among the most common endocrine malignancies, necessitating effective surgical interventions. Traditional open cervicotomy has long been the standard approach for thyroidectomy. However, the advent of robotic surgery has introduced new possibilities for minimally invasive procedures with benefits in terms of cosmetic outcomes, enhanced precision, comparable complication rates, and reduced recovery time. This study mainly reviewed the most widely used and well-known robotic thyroidectomy approaches: the transaxillary approach, the bilateral axillo-breast approach, and the transoral approach. This review examines the current status and future potential of robotic surgery in thyroid cancer treatment, comparing its efficacy, safety, and outcomes with those of conventional open cervicotomy. Challenges such as a longer operative time and higher costs exist. Future directions include technological advancements, tele-surgery, single-port surgery, and the integration of artificial intelligence. Robotic surgery holds promise in optimizing patient outcomes in thyroid cancer treatment.

Enhancing surgical precision in early-stage non-small cell lung cancer: A novel approach through temporary pulmonary vascular occlusion.

To evaluate a novel intraoperative localization technique utilizing temporary pulmonary arteriovenous occlusion for enhancing the precision of sublobar resections in early-stage NSCLC. Conducted from January to November 2023, this study involved 140 patients. During the surgery, key pulmonary vessels were identified using preoperative three-dimensional (3D) imaging and temporarily occluded with noninvasive clamps to isolate the target lung segment. Following vascular occlusion, indocyanine green (ICG) was administered intravenously to precisely delineate the resection margins. After visually confirming the marked areas, the clamps were released, and a targeted partial resection was performed on the delineated segment. Surgical data, including operation times, surgical margins, and hospitalization costs, were collected and compared with those from a historical control group of 110 patients who underwent traditional pulmonary wedge resections. In the study group, the median surgical margin achieved was 16 mm, which was statistically significant compared to 15 mm in the control group (p < 0.05). Operation times were reduced to an average of 58.43 ± 12.962 min, showing a decrease from the control group's average of 69.50 ± 17.544 min (p < 0.05). Hospitalization costs were also lower, averaging $4772.98 ± 624.339 for the study group versus $5161.34 ± 856.336 for the control group (p < 0.05). Patient safety was maintained with no increase in surgical complications. The technique, leveraging temporary pulmonary arteriovenous occlusion, offered a significant advancement in the surgical treatment of peripheral early-stage NSCLC. It reduced operation time and lowered overall surgical costs. This method represented a promising alternative to traditional surgical approaches.

Differences in Clinical Outcomes between One-Stage and Staged Flexible Ureteroscopy for the Treatment of Upper Urinary Tract Stones.

Upper urinary tract stones (UUTSs) are among the most common types of urinary stones, and their incidence rate has been increasing annually in recent years, seriously affecting the daily lives of patients. This study aimed to compare the treatment efficacy of one-stage and staged flexible ureteroscopic lithotripsy (FURL) for UUTSs. A total of 142 patients with UUTSs admitted to our hospital between December 2019 and March 2023 were selected for retrospective analysis, including 76 patients who received staged FURL (control group) and 66 patients who received one-stage FURL (observation group). The duration of surgery, length of stay, stone clearance rate, incidence of postoperative complications (from postsurgery to discharge), and total hospitalization cost were analyzed in both groups. The visual analog scale (VAS) score and activities of daily living (ADL) score were assessed before surgery (T0), 3 days after surgery (T1), and 7 days after surgery (T2). Patients were followed up for 1 month after surgery, and their quality of life was assessed using the MOS Item Short Form Health Survey (SF-36). There was no difference in the stone clearance rate or incidence of postoperative complications between the two groups (p > 0.05). The operation time, hospitalization time and hospitalization cost in the observation group were 75.58 ± 15.91 min, 4.20 ± 1.24 days and 14312.62 ± 1078.89 yuan, respectively, which were lower than those in the control group (p < 0.05). In addition, the VAS score at T3 was decreased to 1.49 ± 0.70, while the ADL and SF-36 scores were higher in the observation group (p < 0.05). One-stage FURL shortens the duration of surgery and length of stay, reduces hospitalization costs, and improves the quality of life of patients with UUTSs.

Robotic Total Knee Arthroplasty: An Update.

Total knee arthroplasty (TKA) is a gold standard surgical procedure to improve pain and restore function in patients affected by moderate-to-severe severe gonarthrosis refractory to conservative treatments. Indeed, millions of these procedures are conducted yearly worldwide, with their number expected to increase in an ageing and more demanding population. Despite the progress that has been made in optimizing surgical techniques, prosthetic designs, and durability, up to 20% of patients are dissatisfied by the procedure or still report knee pain. From this perspective, the introduction of robotic TKA (R-TKA) in the late 1990s represented a valuable instrument in performing more accurate bone cuts and improving clinical outcomes. On the other hand, prolonged operative time, increased complications, and high costs of the devices slow down the diffusion of R-TKA. The advent of newer technological devices, including those using navigation systems, has made robotic surgery in the operatory room more common since the last decade. At present, many different robots are available, representing promising solutions to avoid persistent knee pain after TKA. We hereby describe their functionality, analyze potential benefits, and hint at future perspectives in this promising field.

Application of self-stabilizing zero-profile three-dimensional printed artificial vertebral bodies for treatment of cervical spondylotic myelopathy

To evaluate the safety and effectiveness of applying self-stabilizing zero-profile three-dimensional (3D) printed artificial vertebral bodies in anterior cervical corpectomy and fusion (ACCF) for cervical spondylotic myelopathy. A retrospective analysis was conducted on 37 patients diagnosed with cervical spondylotic myelopathy who underwent single-level ACCF using either self-stabilizing zero-profile 3D-printed artificial vertebral bodies ( n=15, treatment group) or conventional 3D-printed artificial vertebral bodies with titanium plates ( n=22, control group) between January 2022 and February 2023. There was no significant difference in age, gender, lesion segment, disease duration, and preoperative Japanese Orthopedic Association (JOA) score between the two groups ( P>0.05). Operation time, intraoperative bleeding volume, hospitalization costs, JOA score and improvement rate, incidence of postoperative prosthesis subsidence, and interbody fusion were recorded and compared between the two groups. Compared with the control group, the treatment group had significantly shorter operation time and lower hospitalization costs ( P<0.05); there was no significant difference in intraoperative bleeding volume between the two groups ( P>0.05). All patients were followed up, with a follow-up period of 6-21 months in the treatment group (mean, 13.7 months) and 6-19 months in the control group (mean, 12.7 months). No dysphagia occurred in the treatment group, while 5 cases occurred in the control group, with a significant difference in the incidence of dysphagia between the two groups ( P<0.05). At 12 months after operation, both groups showed improvement in JOA scores compared to preoperative scores, with significant differences ( P<0.05); however, there was no significant difference in the JOA scores and improvement rate between the two groups ( P>0.05). Radiographic examinations showed the interbody fusion in both groups, and the difference in the time of interbody fusion was not significant ( P>0.05). At last follow-up, 2 cases in the treatment group and 3 cases in the control group experienced prosthesis subsidence, with no significant difference in the incidence of prosthesis subsidence ( P>0.05). There was no implant displacement or plate-screw fracture during follow-up. The use of self-stabilizing zero-profile 3D-printed artificial vertebral bodies in the treatment of cervical spondylotic myelopathy not only achieves similar effectiveness to 3D-printed artificial vertebral bodies, but also reduces operation time and the incidence of postoperative dysphagia.

Robotic versus laparoscopic anterior resection for the treatment of stage II and III sigmoid colon cancer: a propensity score-matched analysis.

Robot-assisted laparoscopic anterior resection is a novel technique. However, evidence in the literature regarding the advantages of robot-assisted laparoscopic surgery (RLS) is insufficient. The aim of this study was to compare the outcomes of RLS versus conventional laparoscopic surgery (CLS) for the treatment of sigmoid colon cancer. We performed a retrospective study at the Northern Jiangsu People's Hospital. Patients diagnosed with sigmoid colon cancer and underwent anterior resection between January 2019 to September 2023 were included in the study. We compared the basic characteristics of the patients and the short-term and long-term outcomes of patients in the two groups. A total of 452 patients were included. Based on propensity score matching, 212 patients (RLS, n = 106; CLS, n = 106) were included. The baseline data in RLS group was comparable to that in CLS group. Compared with CLS group, RLS group exhibited less estimated blood loss (P = 0.015), more harvested lymph nodes (P = 0.005), longer operation time (P < 0.001) and higher total hospitalization costs (P < 0.001). Meanwhile, there were no significant differences in other perioperative or pathologic outcomes between the two groups. For 3-year prognosis, overall survival rates were 92.5% in the RLS group and 90.6% in the CLS group (HR 0.700, 95% CI 0.276-1.774, P = 0.452); disease-free survival rates were 91.5% in the RLS group and 87.7% in the CLS group (HR 0.613, 95% CI 0.262-1.435, P = 0.259). Compared with CLS, RLS for sigmoid colon cancer was found to be associated with a higher number of lymph nodes harvested, similar perioperative outcomes and long-term survival outcomes. High total hospitalization costs of RLS did not translate into better long-term oncology outcomes.

Incorporating Robotic Cholecystectomy in an Acute Care Surgery Practice Model is Feasible.

The role of robotic surgery in the nonelective setting remains poorly defined. Accessibility, patient acuity, and high turn-over may limit its applicability and utilization. The goal is to characterize the role of robotic cholecystectomy (CCY) in a busy acute care surgery (ACS) practice at a quaternary medical center, and compare surgical outcomes and resource utilization between robotic and laparoscopic CCY. Adult patients who underwent robotic (Da Vinci Xi) or laparoscopic CCY between 01/2021-12/2022 by an ACS attending within 1 week of admission were included. Primary outcomes included time from admission to surgery, off hour (weekend and 6p-6a) cases, operation time, and hospital costs, to reflect "feasibility" of robotic compared to laparoscopic CCY. Secondary outcomes encompassed surgery-related outcomes and complications. The proportion of robotic CCY increased from 5% to 32% within 2years. In total 361 laparoscopic and 89 robotic CCY were performed. Demographics and gallbladder disease severity were similar. Feasibility measures-operation time, case start time, time from admission to surgery, proportion of off-hour cases, and cost-were comparable between robotic and laparoscopic CCY. There were no differences in surgical complications, common bile duct injury, readmission, or mortality. Conversion to open surgery occurred more often in laparoscopic cases (5% vs 0%, P = .02, OR = 1.05). Robotic CCY is associated with fewer open conversions and otherwise similar outcomes compared to laparoscopic CCY in the non-elective setting. Incorporation of robotic CCY in a busy ACS practice model is feasible with available resources.

A comparison of one point versus two point fixation in the management of zygomatico-maxillary complex fractures

The zygomaticomaxillary complex (ZMC) fractures are highly frequent injuries. There is a variety of operative techniques for fixation of ZMC fractures, with no consensus about the best technique. We aim to compare one-point versus two-point fixation of tripodal zygomatic fractures. This study was carried out on 34 patients admitted to the trauma unit in Sanjay Gandhi Institute of Trauma and Orthopaedics in the period from September 2022 to August 2023. Patients were divided into two groups (group 1; one-point fixation, and group 2; two- point fixation). When compared to the one-point fixation group, only 14 patients had substantial stability with a P-value of &amp;#60;0.05 being statistically significant. In contrast, nearly all patients in the two-point fixation group had higher stability. In the two-point fixation group, nearly all patients had a post-operative scar; in the one-point fixation group, however, only two patients had the same scar, and the mouth opening was also improved. In two-point fixation, paraesthesia was observed in nearly seven patients, while in one-point fixation, it was present in only two patients.The one-point fixation technique for tripodal ZMC fractures is considered effective as the two-point fixation technique; and it offers advantages of scarless operation, reduced operation time, fewer complications, and lower cost.

Techniques and Technologies for the Intraoperative Assessment of Component Positioning, Leg Lengths, and Offset in Total Hip Arthroplasty: A Systematic Review

BackgroundMany techniques and technologies exist for the intraoperative assessment of component positioning, leg lengths, and offset in total hip arthroplasty, but with limited comparative data. We conducted a systematic review of the available literature to evaluate the range of techniques and technologies for the intraoperative assessment of component position as well as leg lengths and offset in terms of accuracy, precision, surgical time, cost, and relationship to clinical outcomes. MethodsA comprehensive search of the Embase and Medline databases from 1974 to 2023 was performed. We included controlled or comparative prospective clinical studies. Cochrane’s risk-of-bias tool for randomized trials and Risk of Bias in Non-Randomized Studies – of Interventions tools were used by 2 independent reviewers to evaluate each study for risk of bias. We conducted both qualitative and quantitative analyses of the studies included. However, a meta-analysis was deemed not to be feasible due to heterogeneity. ResultsOur review included 25 studies with 52 intraoperative techniques and technologies. Mechanical guides and computerized navigation were most frequently evaluated in the included studies. Computerized navigation systems consistently showed the greatest accuracy and precision across all measures, at the cost of longer mean operative time. In contrast, freehand techniques demonstrated the poorest accuracy and precision. Insufficient data were found to reach any meaningful conclusions in terms of differences in overall surgical cost or clinical outcomes. ConclusionsEvidence shows that computerized navigation systems are most accurate and precise in positioning components during total hip arthroplasty. Further research is needed to determine their health and economic impact and whether the accuracy and precision of navigated techniques are justified in terms of clinical outcomes.