Operative Technique Research Articles

Guidelines for standard operation of imaging modalities in orbital diseases (2024)

Orbital disorders include conditions originating from the orbital bones, surrounding tissues, and post-orbital septum. They also include systemic ailments affecting the orbit. Different clinical symptoms make up the complex range of orbital disorders. Because these disorders mostly impact the orbital area instead of the intraocular compartment, there is little diagnostic usefulness for typical ophthalmic visual tests. As such, the vital instruments for diagnosing and evaluating orbital illnesses have become ophthalmic imaging modalities, including ocular ultrasonography (B-scan), computed tomography (CT), and magnetic resonance imaging (MRI). One way to improve the precision and promptness of diagnosing orbital diseases is to standardize the functioning of widely used imaging equipment and define the radiological features of orbital abnormalities. Such programs are crucial for the care of patients with orbital disorders since they considerably reduce the number of misdiagnoses and missed diagnoses in these individuals. The underlying concepts, operational techniques, and normal and pathological imaging findings associated with common diagnostic tools for orbital illnesses are all thoroughly reviewed in this guideline. The objective is to improve primary healthcare settings’ diagnostic competence in the field of orbital pathology and to standardize procedures for diagnosing orbital disorders.

Pediatric Bone Sarcoma Biopsy Tract Excision: Is it Safe to Resect Separately?

Biopsy is an essential part of proper diagnostic workup in pediatric bone sarcomas impacting surgical planning, chemotherapeutic treatments, and prognostic determination. Two main biopsy techniques are currently used: closed biopsy (core needle or fine needle aspiration) and open biopsy. Historical oncologic teaching is for resection of the biopsy tract with the tumor specimen due to the theoretical risk for biopsy tract tumor contamination; however, this can restrict surgical planning and increase morbidity. This study evaluates oncologic outcomes at this institution, comparing open versus closed biopsy, and biopsy tract resection with or separate from the main tumor resection. Retrospective review of a single institution of all patients treated for bone sarcomas from 2006 through December 2021. Patient and tumor characteristics, biopsy technique, biopsy resection method, and oncologic outcomes were collected. Subgroup statistical analysis was performed comparing closed biopsy and open biopsy techniques, and biopsy tract resection with the main tumor or separately. A total of 73 patients met the inclusion criteria, including 48 (65.8%) open biopsies and 25 closed biopsies [23 (31.5%) core needle biopsies and 2 (2.7%) fine needle aspirations]. Biopsy tract resection was performed with the main tumor in 36 (49.3%), separate in 37 (50.7%). There were no statistical differences in local recurrence, disease-free survival, metastatic progression, or overall survival between biopsy methodology analysis and biopsy tract removal methods. This study demonstrates the safety of both approaches for obtaining diagnostic tissues with low rates of biopsy tract seeding in both methods. In addition, it demonstrates that there is no difference in local recurrence, disease-free survival, metastatic progression, or overall survival between biopsy tract resection with or separate from the main tumor. Definitive surgical plan should not vary based on biopsy technique and biopsy tract management, but rather patient, tumor, institutional, and surgeon factors. Level III-retrospective chart review. The study was started after the patients were diagnosed and treated.

South African single surgeon experience: Comparison of oncological outcomes, robot-assisted radical prostatectomy versus open perineal radical prostatectomy.

Studies comparing oncological outcomes between robot-assisted radical prostatectomy (RARP) and open radical prostatectomy (ORP) are often limited by bias because of their multi-institutional and multiple surgeon design. Studies from a single institution and single surgeon are uncommon. To compare oncological outcomes between RARP and ORP at a single institution by a single surgeon. A retrospective cohort study of 2376 men with localized prostate cancer who underwent either RARP or ORP, from 1995 to 2020 at single institution, by one surgeon was done. The first 100 cases were discounted in both cohorts to account for the learning curve. Positive surgical margin (PSM) and biochemical recurrence (BCR) rates were measured for each cohort. A total of 1566 men underwent ORP and 810 underwent RARP. BCR rates of 29.2% were found in the ORP group versus 19.5% in the RARP group (p < 0.001). PSM rates of 15.4% were found in the ORP group versus 9.0% in the RARP group (p < 0.001). A multivariate analysis of preoperative prostate specific antigen (PSA) and tumor stage (T) shows no statistically significant association with recurrence when controlled for surgical technique. RARP produces better oncological outcomes when compared to ORP when performed by one experienced surgeon at a single institution. In this large study of men with prostate cancer still localized to the prostate. We found that better cancer removal and chances of cancer recurrence are reduced by a robot-assisted prostate removal technique, compared to the traditional open technique.

Percutaneous hallux fusion with calcaneus bone autograft: a retrospective cohort study of clinical and radiographic outcomes.

In the case of end-stage hallux rigidus, first metatarsophalangeal (MTP) joint arthrodesis is the gold-standard and is traditionally performed via an open approach. However, complications such as nonunion have been reported to be as high as 30%. Recently, there have been reports demonstrating a percutaneous approach to be effective and safe. Forty-nine patients with end-stage hallux rigidus underwent percutaneous first MTP joint arthrodesis with calcaneus autograft performed by a single surgeon. Each patient underwent a minimum of 24 month clinical and radiographic follow up, including 3 month post operative computed tomography scans. Clinical outcomes were assessed using the Visual Analog Scale (VAS) and Foot Function Index (FFI) preoperatively and at final follow-up. Mean follow-up was 27.3 months. Bone union was observed in 46 patients (93.9%). Mean time to union was 3.1 months. Nonunion rate was 6.1%. Overall complication rate was 12.2%. Mean pre- and postoperative VAS scores were 7.5 and 0.2, respectively (P < .0001). Mean pre- and postoperative total FFI values were 56.3 and 15.7 (P < .0001), respectively. Patient satisfaction after the procedure was 93.9%. Observed union rate is comparable to the average fusion rate previously reported for open and minimally invasive procedure union rates. Mean time to union was observed to be comparable to open procedures union time. Observed overall complication rate is similar to those reported for open techniques as well. Patient reported outcomes demonstrated a significant reduction in postoperative VAS and FFI for the percutaneous metatarsophalangeal arthrodesis with calcaneus bone autograft. Patient satisfaction rates compared favorably to those reported following open surgery.

Improved outcomes after groin hernia surgery in Sweden between 1992 and 2021: Swedish Hernia Register

PurposeSurgery for groin hernia is one of the most common operations in the world. Therefore, research concerning the outcomes of groin hernia surgery is extremely important both for the individual patient as well as for those providing the healthcare funding. The aim of this study is to evaluate the outcomes of hernia surgery in Sweden over a 30 year time period, from 1992 to 2021.MethodsAll groin hernia repairs in the Swedish Hernia Register between 1992 to 2021 were analyzed with emphasis on the surgical method, reoperation rate for recurrence and date of surgery, specifically 1992–2001, 2002–2011 and 2012–2021. By using personal identification numbers, a cumulative reoperation rate has been deduced for males and females separately.ResultsA total of 368,502 groin hernia operations identified in the Swedish Hernia Register between 1992 to 2021 were eligible for analysis. Since the register was begun, there have been significant changes in the choice of operative techniques, from suture repair in 1992 to open anterior mesh repair around the year 2000, until today, where an increasing proportion of hernias are repaired using laparo-endoscopic techniques. There has been a reduction in the reoperation rate for recurrence in both males and females, with the most pronounced improvement being seen in females. The laparo-endoscopic technique is associated with a reduced incidence of reoperation for recurrence in females.ConclusionGroin hernia surgery in Sweden has undergone substantial changes over the past 30 years. Reoperation for recurrence has decreased significantly during recent years, especially in females.

Preferences for Inguinal Hernia Repair in Infants: A Survey of the Eastern Pediatric Surgery Network.

Laparoscopic inguinal hernia repair (IHR) is being performed more frequently in children, but few studies have evaluated surgical practice patterns in infants. In this study, we surveyed pediatric surgeons within a regional consortium to assess current preferences for IHR strategy in infants. We hypothesized that early-career pediatric surgeons would prefer laparoscopic IHR over open IHR in this patient population. A Qualtrics survey addressing surgeon preferences for IHR was distributed to 160 pediatric surgeons at 19 member institutions affiliated with the Eastern Pediatric Surgery Network. Surgeons were stratified by self-reported number of years in attending practice. Responses were compared using t-tests and chi-square tests wherever appropriate. Ninety-eight surgeons responded to the survey (61% response rate; two incomplete responses were excluded). Forty respondents (41.7%) had 0-10ys of experience, 26 (27.1%) had 10-20ys of experience, and 30 (31.2%) had over 20 ys of experience. Over 90% of early-career surgeons reported a preference for laparoscopic IHR in infants, compared to less than 50% of mid-career surgeons and less than 20% of late-career surgeons (P<0.001). Respondents preferring laparoscopic IHR most commonly cited inherent assessment of the contralateral side, confirmation of hernia before repair, and technical ease of the laparoscopic approach as factors contributing to their preference. The majority of early-career pediatric surgeons prefer laparoscopic IHR over open IHR in infants, representing a substantial shift away from what is traditionally regarded as the gold standard open technique. Larger studies are needed to compare long-term outcomes after laparoscopic and open IHR in infants.

Return to Sport After Treatment of Stable Osteochondritis Dissecans Lesions of the Knee in Adolescents: A Systematic Review.

Treatment of stable osteochondritis dissecans (OCD) lesions of the knee in young patients poses the challenge of abstaining from competitive sports for months. Outcomes relevant to this patient population additionally include successful return to sport (RTS), return to the same level of sport, and the time needed to achieve both. To evaluate the adolescent population for RTS outcomes after treatment of stable OCD lesions of the knee and to compare RTS outcomes between patients treated nonoperatively and those who required surgery. Systematic review; Level of evidence, 4. A systematic search of the literature was conducted using the terms "knee,""return to play,""return to sport,""osteochondritis dissecans,""articular cartilage,""arthroscopic drilling,""open drilling," and "arthroscopic fixation" between inception and May 31, 2023 using PubMed, CINAHL, SPORTDiscus, and Ovid MEDLINE databases. Articles reporting RTS outcomes with a minimum of 6 months' follow-up were included. Articles were excluded if they were abstracts, editorials, letters, or reviews; were in languages other than English; had <6 months of follow-up, on average; had no data specific to the knee; had no RTS outcomes; consisted of skeletally mature patients; or involved only unstable OCD lesions. Available data were collected from 13 articles, consisting of level 3 and 4 evidence, which met inclusion criteria with a total of 710 patients and 783 knees. Ages ranged from 8 to 18 years, and the mean follow-up time ranged from 9.5 to 48 months. Nonoperative treatment consisted of activity modification, bracing, casting, and physical therapy to allow for healing of the subchondral bone. All patients attempted at least 6 weeks of nonoperative treatment. Operative treatment consisted of surgical drilling or internal fixation. The rate of successful nonoperative management for adolescents with stable OCD of the knee ranged from 40.3% to 87.5%. Of those treated successfully with nonoperative treatment, RTS rates ranged from 84.7% to 100%. Patients treated operatively had RTS rates of 100% and rates of return to the same level of sport ranging from 77.8% to 100% at 6 months' follow-up. Rates of return to the same level of sport varied between operative techniques used. Patients who underwent operative management demonstrated improvements in Lysholm and Tegner scores, and most knees were rated excellent or good according to the Hughston rating scale. The current literature demonstrates favorable short-term RTS outcomes after the nonoperative and operative management of stable OCD lesions of the knee in young athletes. When successful, nonoperative management demonstrated high RTS rates, and further research should investigate prognostic factors for successful nonoperative management. The operative management of stable OCD lesions resulted in high rates of RTS and return to the same level of sport, improvements in patient-reported outcomes, and minimal complications, which raises the question of the appropriate duration of nonoperative management in this patient population.

Comparative outcomes of Palmer, Umbilical Veress needle, and open entry techniques in robotic-assisted surgery: a propensity-matched analysis of 9482 patients.

Robotic-assisted surgery offers several advantages over traditional methods, such as reduced blood loss and fewer complications. Establishing pneumoperitoneum is a critical step, with two primary techniques: the Veress needle (closed) and the Hasson (open) technique. Despite extensive studies in laparoscopic surgery, limited data exist regarding their use in robotic surgery. This study compares complication rates and predictors between Palmer, umbilical Veress needle, and open Hasson techniques in robotic surgery. In this retrospective cohort study of 9482 patients undergoing robotic surgery, we compared palmer, umbilical Veress needle, and Open Hasson techniques using propensity score matching. Primary outcomes were complication rates classified by the Clavien-Dindo system. We used logistic regression to analyze predictors of complications, such as needle attempts and adhesions. One thousand sixteen patients were matched between Palmer and umbilical groups and 310 between Veress needle and open groups. Umbilical insertion was associated with more complications than Palmer (OR 2.14, p = 0.033). Patients requiring more than four needle attempts had higher complication rates (OR 15.43, p = 0.002). Severe adhesions significantly increased complications. After adjustment, the choice of entry method was not independently associated with complications. Surgical entry complications in robotic-assisted surgery are more influenced by needle attempts and adhesions than by the choice of entry technique. Tailoring surgical plans based on patient characteristics and minimizing needle attempts can improve outcomes, underscoring the importance of individualized approaches over standardized methods.

More Anastomotic Ulcers, Less Dumping, and Equal Weight Loss in Long vs. Short Gastric Pouch in Laparoscopic Roux-en-Y Gastric Bypass.

Anastomotic ulcers (AU) at the gastroenterostomy are a common postoperative complication after laparoscopic Roux-en-Y gastric bypass (LRYGB). Possible risk factors for ulcer formation include active smoking, the use of non-steroidal anti-inflammatory drugs, increased tension or ischemia at the anastomosis, or factors that increase the acid secretion of the gastric pouch. Therefore, a longer gastric pouch may increase risk of AU formation after LRYGB. This study is a retrospective analysis of prospective collected data from patients undergoing LRYGB between 2009 and 2019 with a minimum follow-up of 2years. In 2018, we changed the operative technique from short to long gastric pouch LRYGB. We analyzed AU formation, dumping syndrome, age, weight evolution, obesity-associated medical problems, and NSAID in two groups: long (LP-GP) vs. short pouch (SP-GP) LRYGB. A total of 1058 patients were included in the analysis (178 with LP-GP and 880 with SP-GP). A long gastric pouch significantly increased the rate of AU (LP-GP 12.4% vs. SP-GP 2.6%, p ≤ 0.01, OR 5.3). In contrast, the appearance of dumping syndrome improved in patients undergoing LP-GP (LP-GP 49% vs. SP-GP 60%, P ≤ 0.01, OR 1.5). However, no difference was observed between the groups in terms of weight loss in the first 2years postoperative. LRYGB with a long compared to a short gastric pouch increases the rate of AU while decreasing the appearance of dumping syndrome. These findings influence the postoperative course of patients undergoing LRYGB, particularly concerning prolonged proton pump inhibitor prophylaxis and a possible tailored surgical approach.

A COMPARATIVE STUDY OF FEMORAL NERVE BLOCK (WITH AND WITHOUT DEXAMETHASONE) VERSUS INTRAVENOUS FENTANYL FOR POSITIONING AND DURATION OF POSTOPERATIVE ANALGESIA IN FRACTURE FEMUR PATIENT UNDER SPINAL ANESTHESIA

Objectives: The preferred technique for fracture femur operation is spinal anesthesia (SA). During position for SA, femoral nerve block (FNB) and intravenous (IV) fentanyl are used to decrease the pain. The analgesia provided by FNB with dexamethasone (FNBD), FNB only, and intra-venous fentanyl (FENT) was compared before positioning in patients undergoing femur fracture surgery. Methods: 90 patients of fracture femurs were randomized into three Groups A (FNBD), B (FNB), and C (FENT). The FNBD and FNB group patients received drug using ultrasound-guided method 5 min before positioning. In FNB, 10 mL of 2% lidocaine with adrenaline (1:200,000) with 10 mL of bupivacaine was injected, 8 mg of dexamethasone was added in FNDB group, and in the FNET group, received IV fentanyl 1 μg/kg 5 min before positioning. Spinal was given and pain score at baseline, 5, 15, and 30 min recorded. Results: The mean VAS was lowest for Group A and highest for Group C. The Quality of patient positioning is best in Group A and lowest in Group C and p value between Group A and C is &amp;lt;0.0001. The sample size came to be 30 per group by taking alpha as 5%, power of study as 95% and standard deviation as 3. Conclusion: Patient satisfaction, positioning during spinal, and analgesia were better with FNB with or without dexamethasone than IV fentanyl

Slow Down Fluids to Speed Up the Intestine - Exploring Postoperative Ileus in Pediatric Gastrointestinal Surgery.

Postoperative ileus is a known complication of gastrointestinal (GI) surgery. In adult populations, ileus is associated with higher amounts of intraoperative intravenous (IV) fluids. This study examines the relationship between intraoperative IV fluids and postoperative ileus in pediatric patients undergoing GI surgery. The cohort, part of an 18-center prospective trial of the implementation of an enhanced recovery protocol, consists of patients (ages 10-18 years) undergoing non-emergent GI surgery. Statistical analysis compared patients with and without postoperative ileus within 30 days of surgery, stratified by receipt of intraoperative IV fluids. Of 553 patients, 39 (7%) had postoperative ileus. Patients with ileus received a higher mean amount (1453±1219.7mL vs. 1180±838.7mL, p=0.02) of intraoperative IV crystalloid fluid and at a higher rate (9.2mL/kg/h vs. 7.4mL/kg/h, p=0.03) compared to those who did not. Only 4% of patients receiving less than 5mL/kg/h had ileus, 6.3% if receiving 6mL/kg/h to 10mL/kg/h, and 13.6% if receiving >10mL/kg/h. Patients with ileus had a longer length of stay compared to those who did not (11.3±10.7 days, vs. 4.9±6.2 days, p<0.001). There were no statistically significant differences in reason for surgery, type of surgery, American Society of Anesthesiologists (ASA) score, preoperative opioid use, operative technique, or type of anastomosis. Postoperative ileus in pediatric patients undergoing GI surgery is associated with higher amounts and rates of intraoperative IV fluids. Limiting intraoperative fluids is a key target for enhanced recovery protocols in children.

Letter to the Editor Regarding: The Use of Cranial Aneurysm Clips for Repair of Incidental Lumbar Durotomy: Operative Technique and Case Series.

Letter to the Editor Regarding: The Use of Cranial Aneurysm Clips for Repair of Incidental Lumbar Durotomy: Operative Technique and Case Series.

Coblator Assisted-Barbed Relocation Pharyngoplasty (Co-BRP) in Obstructive Sleep Apnea Surgical Treatment.

Barbed reposition pharyngoplasty (BRP) is a new technique to manage velo-pharyngeal obstruction and collapse in OSA patients. Tonsillectomy is a preliminary step of BRP surgery. Dissection of the PPM with monopolar or hot instruments is an essential step of the BRP technique. Tonsillectomy and muscle manipulation should be managed with careful attention due to the risk of muscle fibers rupture and surgical failure. We describe the coblator assisted BRP. The aim of this paper is to report the use and advantages of coblator technology in tonsillectomy and the velo-pharyngeal dissection before the PPM relocation with barbed sutures. In this operative technique study 100 OSA patients underwent Co-barbed technique. The CO-BRP technique has been considered fast, safe and minimally invasive with a low postoperative pain (mean value 3.63 ± 0.7). Postoperatively, a significant decrease in mean AHI from 35.63 ± 10.57 to 17.06 ± 5.92 (P < .005) emerged.

Minimally Invasive Plate Osteosynthesis Using Locking Plates for Distal Femur Fractures: A Retrospective Analysis of 40 Cases.

Distal femur fractures present significant surgical challenges due to their complex anatomy and limited soft tissue coverage. Minimally invasive plate osteosynthesis (MIPO) has emerged as a promising alternative to traditional open techniques, aiming to reduce soft-tissue damage while maintaining stable fixation, particularly when used with locking plates. This retrospective study analyzed 40 consecutive patients with distal femur fractures treated with MIPO and locking plates. The results showed a high union rate of 92.5%, with fractures healing within 16-24 weeks (mean: 19.2 weeks). Complications occurred in 12.5% of cases, including three cases of malalignment, one case of screw breakage, and one infection. Functional outcomes were positive, with 85% of patients achieving excellent or good results based on the Knee Society Score, indicating satisfactory postoperative mobility and joint function. MIPO using locking plates is a reliable and effective treatment for distal femur fractures, offering high union rates, manageable complication rates, and favorable functional outcomes while minimizing soft-tissue disruption.

A modified open surgical revision technique for malfunctioning peritoneal dialysis catheter

Backgrounds: The malfunction of peritoneal dialysis (PD) catheter is still an intractable problem. A modified open surgical revision technique with suturing fixation and without catheter removal for malfunctioning catheter was developed to evaluated the efficacy and safety between simultaneous catheter replacement technique. Methods: A total of 167 PD patients with malfunctioning catheter were retrospectively reviewed. For the salvage of PD catheters, patients underwent modified open surgical revision (group A) or simultaneous catheter replacement (group B). The baseline characteristics before operation, perioperative condition, complications and outcomes were compared between both groups. Results: Patients of group A showed significantly shorter operative time (67.4 ± 22.1 versus 82.8 ± 21.1 min, p = 0.009), less postoperative pain score within 24 h (median 0.0 versus 2.0, p < 0.001), quicker start of PD (1.06 ± 0.31 versus 1.89 ± 0.89 days, p < 0.001), shorter length of stay (9.89 ± 5.11 versus 12.55 ± 7.37 days, p = 0.020) than group B. In terms of complications, the incidence of recurred catheter malfunction in group A was significantly lower than those in group B (1/114 versus 12/53, p < 0.001). There were no significant differences in mechanical complications (bloody effluent, dialysate leakage, and hernia) and early peritonitis between the groups. The group A patients had a favorable catheter survival rate compared with group B (log-rank, p = 0.004). Conclusions: Our modified open surgical revision technique is a safe, simple and fast method, and offers a better outcome with minimal risk of recurrence of catheter malfunction without additional cost and equipment. This technique is worthy of clinical application.

Quality of Life after Open versus Closed Treatment for Mandibular Condylar Fractures

Objective: To compare the quality of life after surgical management with closed reduction and internal fixation (CRIF) versus open reduction and internal fixation (ORIF) for mandibular condylar fractures. Methodology: This analytical observational study was carried out between January 2024 to June 2024, at the Department of Oral and Maxillofacial Surgery, Jinnah Postgraduate Medical Centre, Karachi, focusing on patients with mandibular condylar fractures. The study assessed their quality of life using the General Oral Health Assessment Index (GOHAI) Questionnaire, with scores ranging from 1 to 3, where 1 denoted "Always," 2 indicated "Sometimes," and 3 represented "Never." Quality of life scores were categorized as high (34-36), medium (31-33), or low (&lt;30) based on the GOHAI results. Results: In this study there were 66.7% neglected patients had high quality of life, 15.4% had moderate, and 27.3% had low GOHAI, (p=0.084). Further, there were only 16.7% patient close reduction management had high quality of life, 5 (38.5%) had moderate, and 545.5% had low GOHAI. According to open reduction management, there were 83.3% patients had high quality of life, 61.5% had moderate, and 45.5% had low GOHAI, (p=0.157). Conclusion: Factors such as age, gender, neglected type, and treatment modality did not significantly affect the post-operative quality of life. However, mandibular fracture patients who underwent surgical treatment with open reduction technique, as assessed by the GOHAI parameter, experienced a high quality of life.

Full-Endoscopic J-Shaped Transforaminal L5 Nerve Decompression in Bertolotti Syndrome

This case report and video demonstrate the technique of full-endoscopic J-shaped transforaminal L5 exiting nerve decompression in Bertolotti syndrome. Bertolotti syndrome, characterized by a congenital lumbosacral transitional vertebra, often results in mechanical lower back pain and nerve root compression. A 69-year-old male presented with progressive radiating pain in the right leg and tingling in the L5 dermatome. Lumbar spine MRI revealed a right foraminal disc herniation at the L5–S1 level, with calcification and foraminal stenosis. The patient was also diagnosed with Castellvi type I Bertolotti syndrome, featuring a large L5 transverse process and a high iliac crest. These anatomical variations complicated the transforaminal approach, creating a narrow safety zone for conventional methods. The approach began with docking on the L5 transverse process. Endoscopic drilling was performed in a J-shaped configuration to partially resect the transverse process and alar wing, facilitating endoscope insertion into Kambin’s triangle. Foraminal decompression was achieved by removing the tip of the superior articular process (SAP), thereby decompressing the L5 exiting nerve root. Full-endoscopic spine surgery offers a safe and effective alternative to traditional open techniques for L5 nerve decompression in Bertolotti syndrome. This video presentation illustrates the intraoperative endoscopic approach, detailing the decompression techniques and highlighting the minimally invasive advantages of this method.

Modern methods of preparing autologous vein for bypass surgery (non-systematic review)

INTRODUCTION: The use of an autologous vein conduit in bypass operations is the leading trend in vascular and cardiac surgery. In the context of a high risk of repeated interventions and of limited availability of high-quality venous resources, it is important that the autovenous conduit remain functional as long as possible. AIM: To study the dynamics of conclusions from the modern research works on harvesting, preservation and quality assessment of autovein grafts in the postoperative period. The graft patency after open and endoscopic harvesting is comparable. Unsatisfactory results in terms of the long-term patency of an endoscopically harvested autovein may be associated with a long period of training in endoscopic techniques. They facilitate fast healing of postoperative wounds on the leg and reduce pain syndrome. The no touch open harvest technique, the use of low pressure when distending an autovenous graft, and ligation of the tributaries are factors that reduce the risk of postoperative hyperplasia of intima, thus contributing to a long-term functioning of the shunt and reducing the number of reinterventions. The preferable method of harvesting an autovenous graft for bypass surgeries in the lower limbs is an open bridging method. Keeping the autovenous graft in the whole autologous blood before the bypass surgery is also believed to reduce the risk of autograft injury, but randomized studies with a greater number of observations are required. Control of the graft quality before and after application of anastomosis and initiation of blood flow helps to improve the immediate and long-term bypass patency, and is performed using ultrasound imaging, measurement of blood flow transit time, angiographic examination, introduction of indocyanine green, and thermal imaging. CONCLUSION: This review presents a modern multicomponent analysis of the role of mechanical, thermal, environmental and organic factors in the formation of the properties of an autovein conduit, essential for maintaining its maximal patency as of an arterial bypass, and the methods of intraoperative patency control.

Hybrid Therapies for the Management of Aortic Dissection: Bridging Open Surgery and Endovascular Innovation

Aortic dissection is a life-threatening condition characterized by the separation of the layers within the aortic wall, leading to a false lumen with the potential for severe complications, including rupture, malperfusion, and death. The management of aortic dissection has evolved significantly, with hybrid therapies emerging as a promising approach, particularly for complex cases involving extensive aortic involvement or high surgical risk. Hybrid therapies combine open surgical techniques with endovascular interventions to optimize outcomes by leveraging the strengths of both modalities. This article provides a comprehensive review of the current state of hybrid therapies in aortic dissection management, including their indications, technical considerations, and clinical outcomes. We explore the role of hybrid procedures in both acute and chronic phases of aortic dissection, focusing on scenarios such as aortic arch and thoracoabdominal involvement. Additionally, we discuss patient selection criteria, advances in imaging for procedural planning, and the challenges of long-term surveillance. By synthesizing recent evidence, we aim to highlight the potential of hybrid approaches to improve survival and reduce morbidity in this complex patient population.

'Ingsun Titip Tajug Lan Fakir Miskin' Mentifak Culture of Cirebon Ethnicity Studied from the Ethnopedagogical Dimension

This study aims to identify the values of local wisdom in the mentifact culture of the Cirebon Ethnic saying "ingsun titip tajug lan fakir miskin". The research used a qualitative method. Data were collected or extracted using open interview techniques, documentation studies and direct observation of Cirebon cultural heritage sites. Informants include, Cirebon cultural figures, education figures and Cirebon community leaders. The data validation uses triangulation techniques. Triangulation is an approach taken by researchers to explore and perform qualitative data processing techniques. The research resulted in the conclusion that; the expression petatah petitih Cirebon contains local wisdom values; (1) the value of faith and devotion to God Almighty; (2) social values and togetherness, (3) the value of responsibility, and (4) the value of mutual cooperation. These values can be used as learning materials and resources through an ethnopedagogical approach in elementary schools. Recommendations that the expression of petatah petitih 'ingsun titip tajug lan fakir miskin' can be implemented into culture-based learning in the Cirebon ethnic community as an effort to preserve local culture.