Optimal Surgical Planning Research Articles

Metastatic papillary thyroid carcinoma with internal jugular vein tumor thrombus - A case report and review of the literature

Papillary thyroid carcinoma (PTC) is the most common malignancy of the thyroid gland, typically associated with an indolent course and favourable prognosis. However, although rare, PTC can demonstrate aggressive behaviour, including vascular invasion with extension into major vessels. Intraluminal tumor thrombus involving the great veins, such as the internal jugular vein (IJV), is an uncommon but significant complication. We present the case of a 56-year-old male who was referred to our clinic for evaluation of a right-sided anterior neck mass. Neck ultrasonography revealed a 5.5 x 6.5 cm heterogeneous mass within the right thyroid lobe and a suspected intraluminal thrombus in the right internal jugular vein. Fine-needle aspiration biopsy under ultrasound guidance confirmed the diagnosis of papillary thyroid carcinoma. Subsequent preoperative contrast-enhanced computed tomography (CT) of the neck confirmed the presence of an intraluminal tumours thrombus extending into the right IJV. The patient underwent total thyroidectomy, right modified radical neck dissection, and resection of the involved segment of the IJV. Postoperatively, the patient received radioactive iodine (I-131) ablation therapy. At the one-year follow-up, imaging studies indicated a recurrence of the disease. A review of the literature focusing on vascular involvement in PTC and diagnostic methods for tumours thrombus reveals that, while rare, intraluminal tumor thrombus should be considered in patients with PTC, especially when there is evidence of vascular invasion. Early and accurate preoperative diagnosis using Doppler ultrasonography and/or contrast-enhanced CT is critical for optimal surgical planning and improved prognosis. Given the potential for recurrence, vigilant long-term follow-up is recommended.

Single Incision Plus One Port Laparoscopic Proximal Gastrectomy with Double Channel Anastomosis for Gastric Cancer Treatment.

Single-incision plus one-port laparoscopic proximal gastrectomy with double-channel anastomosis (SILT-DT) is a minimally invasive surgical approach for treating proximal gastric cancer. This technique includes comprehensive laparoscopic resection of the proximal stomach, lymph node dissection, and double-tract anastomosis. By integrating single-port laparoscopic surgery with an auxiliary operating hole, SILT-DT reduces procedural difficulty while facilitating the placement of an abdominal drainage tube. Compared to the traditional five-port laparoscopic gastrectomy, SILT-DT requires fewer ports and results in shorter incision lengths, contributing to reduced postoperative pain and faster recovery. A thorough preoperative evaluation was conducted to ensure procedural success, with factors such as tumor size, stage, location, and patient BMI carefully considered. This comprehensive assessment allowed for optimal patient selection and surgical planning. Postoperative follow-up demonstrated no significant complications, underscoring the safety and efficacy of SILT-DT. This innovative technique offers a promising minimally invasive alternative for managing proximal gastric cancer while maintaining excellent clinical outcomes.

Automatic Reproduction of Natural Head Position in Orthognathic Surgery Using a Geometric Deep Learning Network.

Background: Accurate determination of the natural head position (NHP) is essential in orthognathic surgery for optimal surgical planning and improved patient outcomes. However, traditional methods encounter reproducibility issues and rely on external devices or patient cooperation, potentially leading to inaccuracies in the surgical plan. Methods: To address these limitations, we developed a geometric deep learning network (NHP-Net) to automatically reproduce NHP from CT scans. A dataset of 150 orthognathic surgery patients was utilized. Three-dimensional skull meshes were converted into point clouds and normalized to fit within a unit sphere. NHP-Net was trained to predict a 3 × 3 rotation matrix to align the CT-acquired posture with the NHP. Experiments were conducted to determine optimal point cloud sizes and loss functions. Performance was evaluated using mean absolute error (MAE) for roll, pitch, and yaw angles, as well as a rotation error (RE) metric. Results: NHP-Net achieved the lowest RE of 1.918° ± 1.099° and demonstrated significantly lower MAEs in roll and pitch angles compared to other deep learning models (p < 0.05). These findings indicate that NHP-Net can accurately align CT-acquired postures to the NHP, enhancing the precision of surgical planning. Conclusions: By effectively improving the accuracy and efficiency of NHP reproduction, NHP-Net reduces the workload of surgeons, supports more precise orthognathic surgical interventions, and ultimately contributes to better patient outcomes.

Digital technology-assisted minimally invasive removal of odontoma with high impacted maxillary canine by double-fenestration technique: a case report.

Odontoma is a hamartoma or developmental malformation of dental tissues and often causes delayed or impacted permanent teeth. This paper reports a case of surgical removal of an odontoma that is closely attached to the labial bone plait and examines the extraction of accompanying high-impacted maxillary canine beside the nose and maxillary sinus. Digital technology was used in reconstructing a part of a patient's maxilla, odontoma, related teeth, and other adjacent anatomical structures, accurately determine the lesion boundary, and design an optimal surgical plan. The minimally invasive extraction of lesions and embedded teeth with a double-fenestration technique through the upper and lower paths not only preserved the continuity of the labial alveolar bone plate in the operative area and prevented postoperative bone collapse but also reduced the risk of maxillary sinus mucosal injury and perforation, improved surgical efficiency, and reduced the surgical trauma. These features were in line with the concept of minimally invasive alveolar surgery.

Finite Element Analysis of the Influence of the Z-Shaped Position of Cleft lip on the Postoperative Appearance.

In traditional surgery for patients with secondary deformities of cleft lip, the skin is usually cut open, and forceps are used according to the position of the flap. However, this method cannot predict the postoperative effect before surgery, especially the changes in the patient's lip. Moreover, in surgery, the design of the surgical flap is also quite random, needing more quantitative standards for its position and size, which makes it impossible to optimize the surgical effect, resulting in the surgical effect relying on the surgeon's surgical level. In this study, we attempted to scan the patient's face using infrared scanning equipment, establish a three-dimensional model of the patient's face, and compare the postoperative effects under different surgical positions through finite element analysis, especially comparing the displacement of the affected labial peak point to find the optimal surgical plan. In this way, the authors can predict the surgical effect before cleft lip and cleft palate surgery so that patients can directly see the effect after surgery and choose the most suitable scheme.

Balancing risks of surgical complications and positive margins for patients with invasive lobular carcinoma of the breast and elevated BMI: An institutional cohort study

BackgroundThe risks of postoperative complications in breast cancer patients vary by patient and tumor characteristics. Elevated BMI and invasive lobular carcinoma (ILC) increase risks of surgical complications and positive margins, respectively. MethodsWe retrospectively analyzed patients with BMI ≥30 ​kg/m2 from an institutional ILC database. The primary outcome was surgical complication rate by procedure type. The secondary outcome was positive margin rates by surgical approach, stratified by T stage. ResultsOf 154 analyzed patients, standard BCS, lumpectomy with oncoplastic closure, and simple mastectomy had the lowest complication rates (18.2 ​%, 17.0 ​%, 11.8 ​%). Oncoplastic reduction mammoplasty and mastectomy with aesthetic closure had the highest rates (35.5 ​%, 33.3 ​%). The overall positive margin rate was 28.5 ​%, significantly higher in BCS vs. mastectomy (37.4 ​% vs. 15.0 ​%, p ​= ​0.003). Oncoplastic surgery significantly reduced positive margin rates in BCS. ConclusionIn this study, 23.4 ​% of patients experienced surgical complications, with higher rates in oncoplastic/reconstructive approaches. However, oncoplastic surgery reduced positive margins, highlighting the importance of balancing risks for optimal surgical planning.

A Comprehensive Review of Topography and Axon Counts in Upper-Extremity Peripheral Nerves: A Guide for Neurotization

Currently, no comprehensive database detailing topography and axon counts exists. This study aims to review the axon counts and topography of the major peripheral motor nerves of the upper extremity to allow for optimal surgical planning for peripheral nerve reconstruction via neurotization. Peer-reviewed journal articles were identified through PubMed, ScienceDirect, Google Scholar, and CENTRAL. Studies were included for review based upon the identification of the described topography or axon count of any upper-extremity peripheral motor nerve. Animal research, laboratory studies, and unpublished studies were excluded from our review. A total of 43 studies were identified, and 38 of these met the inclusion criteria. Statistical analysis was performed to determine axon count averages for all upper extremity motor nerves identified in the included studies. Thirty-eight studies were reviewed, giving insights into the topography and axon counts of the major peripheral nerves of the upper extremity, including the brachial plexus and its terminal branches as well as common donor nerves such as the spinal accessory nerve and intercostal nerves. Studies showed considerable variability in reported axon counts. Existing data were relatively weak and included several case reports and series. Taking this into consideration, we posit that there is a need for further studies of upper-extremity nerve axon counts that include large study populations and more consistent methods of nerve specimen analysis. Understanding the topographical anatomy of donor and recipient nerves, as well as appropriately matching the motor axon counts for each donor and recipient, is helpful in upper-extremity nerve reconstruction.

Clinical and therapeutic implications of cavernous sinus invasion in pituitary adenomas.

Invasion of the cavernous sinus by pituitary adenomas impedes complete surgical resection, compromises biochemical remission, and increases the risk of further tumor recurrence. Accurate preoperative MRI-based diagnosis or intraoperative direct inspection of cavernous sinus invasion are essential for optimal surgical planning and for tailoring postoperative therapeutic strategies, depending on whether a total resection has been achieved, or tumoral tissue has been left in surgically inaccessible locations. The molecular mechanisms underlying the invasive behavior of pituitary adenomas remain poorly understood, hindering the development of targeted therapies. Some studies have identified genes overexpressed in pituitary adenomas invading the cavernous sinus, offering insights into the acquisition of invasive behavior. Their main limitation however lies in comparing purely intrasellar specimens obtained from invasive and non-invasive adenomas. Further, precise anatomical knowledge of the medial wall of the cavernous sinus is crucial for grasping the mechanisms of invasion. Recently, alongside the standard intrasellar surgery, extended endoscopic intracavernous surgical procedures with systematic selective resection of the medial wall of the cavernous sinus have shown promising results for invasive secreting pituitary adenomas. The first- and second-generation somatostatin agonist ligands and cabergoline are used with variable efficacy to control secretory activity and/or growth of intracavernous remnants. Tumor regrowth usually requires surgical reintervention, sometimes combined with radiotherapy or radiosurgery which is applied despite their benign nature. Unraveling the molecular pathways driving invasive behavior of pituitary adenomas and their tropism to the cavernous sinuses is the key for developing efficient innovative treatment modalities that could reduce the need for repeated surgery or radiotherapy.

Tandem stenosis of the cervical and thoracic spine: a systematic review

BackgroundTandem spinal stenosis (TSS) is a condition characterized by the narrowing of the spinal canal in multiple segments of the spine. Predominantly observed in the cervical and lumbar regions, TSS also manifests in the conjunction of the cervical and thoracic spine. The simultaneous occurrence of cervical and thoracic spinal stenosis engenders intricate symptoms, potentially leading to missed and delayed diagnosis. Furthermore, the presence of tandem cervical and thoracic stenosis (TCTS) introduces a notable impact on the decision-making calculus of surgeons when contemplating either one-staged or two-staged surgery. Currently, there is no agreed-upon strategy for surgical intervention of TCTS in the literature.MethodsMedical databases in English (Pubmed, Web of Science, Embase, the Cochrane Database of Systematic Reviews) and Chinese (CNKI, Wanfang Data, VIP CMJD) were searched using Medical Subject Heading queries for the terms “tandem cervical and thoracic stenosis”, “cervical stenosis AND thoracic stenosis”, “tandem spinal stenosis” and “concomitant spinal stenosis” from January 1980 to March 2023. We included studies involving adult individuals with TCTS. Articles exclusively focused on disorders within a single spine region or devoid of any mention of spinal disorders were excluded.ResultsInitially, a total of 1625 literatures underwent consideration for inclusion in the study. Following the elimination of the duplicates through the utilization of EndNote, and a meticulous screening process involving scrutiny of abstracts and full-texts, 23 clinical studies met the predefined inclusion criteria. Of these, 2 studies solely focused on missed diagnosis, 19 studies exclusively discussed surgical strategy for TCTS, and 2 articles evaluated both surgical strategy and missed diagnosis.ConclusionOur study revealed a missed diagnosis rate of 7.2% in TCTS, with the thoracic stenosis emerging as the predominant area susceptible to oversight. Therefore, the meticulous identification of TCTS assumes paramount significance as the inaugural step in its effective management. While both one-staged and two-staged surgeries have exhibited efficacy in addressing TCTS, the selection of the optimal surgical plan should be contingent upon the individualized circumstances of the patients.

Comparison of the Transcranial Approach and Transsphenoidal Approach Based on the Anatomical Location of Origin in Pediatric Craniopharyngiomas

BackgroundVarious clinical classifications of craniopharyngiomas (CRPs) have been proposed to suggest optimal surgical planning. We aimed to evaluate the clinical outcomes of pediatric CRPs and the clinical significance of anatomical classification in relation to the diaphragm sellae. MethodsA retrospective review was conducted on patients under 18 years of age who underwent surgery for CRPs from July 1998 to August 2022. The patients were divided into transcranial approach (TCA), and transsphenoidal approach (TSA) groups, which included microscopic TSA and endoscopic endonasal approach (EEA) groups. EEA has been adopted at our institute since 2011. CRPs were classified by their origin and relationship with the diaphragm sellae. ResultsA total of 132 pediatric CRP patients were included in this study, 117 of whom underwent surgery for primary CRP and 15 for recurrent CRP. Among them, 89 (67.4%) underwent TCA, 9 (6.8%) had microscopic TSA, and 34 (25.8%) had EEA. In subdiaphragmatic CRPs with competent diaphragm sellae, TSA tended to yield better outcomes than did TCA in terms of stalk preservation and ophthalmological outcomes. After the introduction of EEA, the proportion of supradiaphragmatic CRPs treated via the TSA increased from 0% to 50% (p < 0.001). Gross total resection (HR=0.194; 95% CI=0.102–0.367, p < 0.001) and adjuvant therapy (HR=0.208; 95% CI=0.048–0.897, p = 0.035) were found to be positive prognostic factors for long-term tumor control. ConclusionsOver time, with the adoption of EEA at our institute, the impact of anatomical classification on the surgical apprpoach has decreased. Nevertheless, an individualized surgical approach should be employed to improve long-term outcomes and minimize complications for pediatric CRPs.

Multidisciplinary surgical management of severe posterior compartment endometriosis

BackgroundEndometriosis is a chronic, inflammatory, and hormone-dependent disease that affects approximately 10% of women in reproductive age. Endometriosis is categorized into different types, as superficial, deep, and ovarian endometriosis. When deep endometriosis occurs, the sigmoid and rectum are often affected (Becker et al. in Hum Reprod Open, 2022, https://doi.org/10.1093/hropen/hoac009). In the following article, we aim to demonstrate stepwise surgery for stage IV endometriosis involving the anterior rectosigmoid.MethodsWe present the case of a 26-year-old obese (BMI 35.87) woman with severe posterior pelvic compartment endometriosis, persistent abdominal pain, and constipation. On preoperative MRI of the pelvis, a 13 cm conglomerate incorporating both ovaries (kissing ovaries), uterine serosa, and the anterior rectosigmoid was observed (Fig. 1). Accordingly, interdisciplinary laparoscopic surgery with a gynecologist and colorectal surgeon was planned.ResultsThe total laparoscopic approach is demonstrated step by step in the video.ConclusionsDeep endometriosis is a rare condition. When involvement of other organs (e.g., the bowel) is suspected, preoperative endometriosis-specific imaging should be performed for optimal surgical planning. Experienced endometriosis multidisciplinary surgical teams can provide specialized and high-quality care for patients suffering from this debilitating disease (Luna Russo et al. in Minerva Ginecol, 2020, https://doi.org/10.23736/S0026-4784.20.04544-X).

Exérese de adenocarcinoma de cólon retal e reconstrução do ânus

Intestinal tumors in dogs, while relatively uncommon, often exhibit an infiltrative and aggressive behavior, necessitating thorough clinical staging for optimal therapeutic and surgical planning. This case report describes a canine patient with a highly aggressive neoplasm that required extensive surgical intervention. The tumor encompassed the perineal region, tail, anus, and a portion of the vagina. A 10 cm margin of the rectum, a 3 cm lateral margin, and a sentinel lymph node (iliac) were resected during surgery. Post-surgical recovery was followed by adjuvant therapy and postoperative chemotherapy.

Lower Extremity Muscle Tendon Interaction Around Knee During Gait Among Adolescent Children with Cerebral Palsy with Varying Crouch Angle.

Optimal management and surgical planning of severe bony deformities and muscle tendon unit contractures demands comprehensive evaluation of all structures including the dynamic muscle tendon length of all muscles around the joint during gait. Present study aimed to explore dynamic muscle-tendon length for all muscles around the knee joint along with pelvis, hip, and ankle joint kinematics among adolescent children with varying crouch angle. Muscle-tendon length of 29 adolescent children with cerebral palsy with varying crouch angles was computed using a full-body musculo-skeletal model and expressed as a percentage of muscle-tendon length during walking compared to resting condition. Children with knee flexion angle greater than 25° demonstrated lower anterior pelvic tilt and 11% greater muscle-tendon length of semimembranosus and biceps femoris during stance phase of gait compared to children with knee flexion angle less than 25° and typically developing children (p < 0.01). The findings of present study reported that routine bedside clinical evaluation in adolescent children with knee flexion angle greater than 25° revealed moderate shortening of hamstring muscle in supine position. Whereas instrumented objective evaluation of gait demonstrated lengthened hamstring muscle and reduced hip extension and relatively lower anterior pelvic tilt. Therefore, it may be valuable to add objective assessment of dynamic muscle-tendon length to kinematics of all lower-extremity joint motion during gait, in order to understand the muscle-joint interactions; particularly in children with severe crouch and plan specific, tailor-made surgical and non-surgical interventions.

Fully Automatic Fine-Grained Grading of Lumbar Intervertebral Disc Degeneration Using Regional Feature Recalibration Network.

Accurate fine-grained grading of lumbar intervertebral disc (LIVD) degeneration is essential for the diagnosis and treatment design of high-incidence low back pain. However, the grading accuracy is still challenged by lacking the fine-grained degenerative details, which is mainly due to the existing grading methods are easily dominated by the salient nucleus pulposus regions in LIVD, overlooking the inconspicuous degeneration changes of the surrounding structures. In this study, a novel regional feature recalibration network (RFRecNet) is proposed to achieve accurate and reliable LIVD degeneration grading. Detection transformer (DETR) is first utilized to detect all LIVDs and then input to the proposed RFRecNet for the fine-grained grading. To obtain sufficient features from both the salient nucleus pulposus and the surrounding regions, a regional cube-based feature boosting and suppression (RC-FBS) module is designed to adaptively recalibrate the feature extraction and utilization from the various regions in LIVD, and a feature diversification (FD) module is proposed to capture the complementary semantic information from the multi-scale features for the comprehensive fine-grained degeneration grading. Extensive experiments were conducted on a clinically collected dataset, which consists of 500 MR scans with a total of 10225 LIVDs. An average grading accuracy of 90.5%, specificity of 97.5%, sensitivity of 90.8%, and Cohen's kappa correlation coefficient of 0.876 are obtained, which indicate that the proposed framework is promising to provide doctors with reliable and consistent fine-grained quantitative evaluation results of the LIVD degeneration conditions for the optimal surgical plan design.

A CFD-based framework to evaluate surgical alternatives in cerebral aneurysms

ABSTRACT Computational Fluid Dynamic (CFD) simulations on patient-specific geometries may guide the choice between alternative surgical interventions, especially in the case on non-conventional treatments. We propose and formalise a CFD-based framework to evaluate alternative surgical interventions. It provides surgeons with the CFD analyses of different surgical options, so that they may decide the best strategy based on quantitative haemodynamic parameters for each surgical alternative. The proposed framework is largely automatised and, when it necessarily requires the intervention of a human operator due to the patient-specific nature, this intervention is well-formalised to reduce inter-operator variability and guarantee reproducibility. To provide preliminary evidence on the effectiveness of the framework, we present its application to complex Intracranial Aneurysms (IAs), which involve less than 5% of brain aneurysms, but are usually at a high risk of rupture and often show unexpected response to therapy. Complex IAs include aneurysms that cannot be treated with conventional therapies, such as neck clipping, sac coiling or stenting, while instead their treatment requires the sacrifice of the parent artery. In particular, we refer to a giant cavernous sinus aneurysm inside the left internal carotid artery. Results show the ability of the framework to provide haemodynamic quantitative evaluations, which can be useful additional information for the neurosurgeon towards optimal surgical planning.

Pelvic tilt affects superolateral coverage, but not superomedial coverage of the femoral head following periacetabular osteotomy

BackgroundPelvic tilt is an important sagittal parameter that varies greatly among individuals. The objective of this study was to quantify the effect of pelvic tilt on femoral head coverage and range of motion in a dysplastic population following periacetabular osteotomy. MethodsTwenty-three dysplastic hips from 19 patients (17 female, 2 male) were included in this study. Three-dimensional models were reconstructed using pre-operative CT images, and patient-specific neutral pelvic tilt was obtained on an anteroposterior X-ray. Following a simulated periacetabular osteotomy, the pelvic tilt was changed from −15° to +15°, and the effects on femoral head coverage and hip range of motion was quantified using a customized MATLAB program. FindingsPelvic tilt did not significantly affect total femoral head coverage (P > 0.2). However, a 15° anterior tilt from neutral resulted in a 17.72 ± 9.45% increase in anterolateral coverage and a 23.96 ± 7.48% decrease in posterolateral coverage (P < 0.0001), as well as an 18.2 ± 8.4° loss of internal rotation at 90° of hip flexion. Contrarily, posterior pelvic tilt led to a 26.79 ± 9.04% reduction in anterolateral coverage (P < 0.0001) and an 18.02 ± 9.57% increase in posterolateral coverage (P < 0.0001), and the maximum internal rotation increased 11.8 ± 3.7°. InterpretationWhile pelvic tilt did not affect total femoral head coverage, it had a significant impact on the distribution of coverage within the superolateral region of the femoral head. Anterior pelvic tilt led to increased anterolateral coverage, but also had a negative impact on hip range of motion. An optimal surgical plan should achieve adequate coverage while not significantly limiting the patient's mobility.

CLINICAL AND IMAGING CHARACTERISTICS, TNM STAGING OF PATIENTS WITH CERVICAL LYMPH NODE METASTASES IN PAPILLARY THYROID CANCER AT CAN THO ONCOLOGY HOSPITAL

Background: Thyroid carcinomas are the most common endocrine malignancies. The cervical lymph node metastasis rate in patients with PTC ranges from 30-80% and there is a significant difference in survival at 14 years for those with and without lymph node metastases. Therefore, the early detection of metastatic cervical lymph nodes plays an essential role in deciding upon the optimal surgical treatment plan for the majority of patients, which will allow careful postoperative screening, adjuvant therapies, and minimizes the chance of disease recurrence, so we conducted this study. Objectives: To evaluate clinical and imaging characteristics, TNM staging of papillary thyroid carcinoma patients with cervical lymph node metastases at Can Tho Oncology Hospital between 2021 and 2023. Materials and methods: This was a descriptive cross-sectional study, including 52 patients who underwent total thyroidectomy and therapeutic neck dissection. Evaluating general characteristics such as age, gender, reasons for encounter, thyroid nodule and cervical lymph node characteristics on clinical examination and imaging, cancer staging. Results: The average age was 40.0 ± 14.1 years (range 13 - 71). The female/male ratio was 2.5:1. The most common age group was &lt;55 years (86.5%). Half of the patients (50%) were admitted to our institute due to palpable neck mass. The proportion of palpable nodules on clinical examination was three quarters. Nodule locating in a single lobe was the dominant characteristic (about 90%). The TIRADS classifications were TIRADS 5 (55.8%), TIRADS 4 (40.4%) and TIRADS 3 (3.8%). The common location of metastatic cervical lymph node was lateral compartment (86.6%). The absence of central hilar structure shown on ultrasound was 94.2%. Stage I thyroid cancer had the highest rate (84.6%). Conclusions: The presence of nodules in a single lobe was the most notable characteristic of thyroid cancer. TIRADS 4 and 5 were shown on ultrasonography in the majority of patients. The lateral compartment was the most common location for metastatic cervical lymph nodes, while the central hilar structure of those nodes mostly absent.

Can 3D imaging modeling recognize functional tissue and predict liver failure? A retrospective study based on 3D modelling of the major hepatectomies after hepatic modulation

BackgroundThanks to the introduction of radiomics, 3d reconstruction can be able to analyse tissues and recognise true hypertrophy from non-functioning tissue in patients treated with major hepatectomies with hepatic modulation.The aim of this study is to evaluate the performance of 3D Imaging Modelling in predict liver failure.MethodsPatients submitted to major hepatectomies after hepatic modulation at Sanchinarro University Hospital from May 2015 to October 2019 were analysed.Three-dimensional reconstruction was realised before and after surgical treatment. The volumetry of Future Liver Remnant was calculated, distinguishing in Functional Future Liver Remnant (FRFx) i.e. true hypertrophy tissue and Anatomic Future Liver Remnant (FRL) i.e. hypertrophy plus no functional tissue (oedema/congestion) These volumes were analysed in patients with and without post hepatic liver failure.ResultsTwenty-four procedures were realised (11 ALPPS and 13 PVE followed by major hepatectomy). Post hepatic liver failure grade B and C occurred in 6 patients. The ROC curve showed a better AUC for FRFxV (74%) with respect to FRLV (54%) in prediction PHLF > B. The increase of anatomical FRL (iFRL) was superior in the ALPPS group (120%) with respect to the PVE group (73%) (p = 0,041), while the increase of functional FRFX (iFRFx) was 35% in the ALLPS group and 46% in the PVE group (p > 0,05), showing no difference in the two groups.ConclusionThe 3D reconstruction model can allow optimal surgical planning, and through the use of specific algorithms, can contribute to differential functioning liver parenchyma of the FLR.

Finite element analysis of the knee joint stress after partial meniscectomy for meniscus horizontal cleavage tears

ObjectiveTo establish a finite element model of meniscus horizontal cleavage and partial resection, to simulate the mechanical changes of knee joint under 4 flexion angles, and to explore what is the optimal surgical plan. MethodsWe used Mimics Research, Geomagic Wrap, and SolidWorks computer software to reconstruct the 3D model of the knee joint, and then produced the horizontal cleavage tears model of the internal and lateral meniscus, the suture model, and the partial meniscectomy model. These models were assembled into a complete knee joint in SolidWorks software, and corresponding loads and boundary constraints were added to these models in ANSYS software to simulate the changing trend of pressure and shear force on femoral condylar cartilage, meniscus, and tibial cartilage under the flexion angles of 0°, 10°, 20°, 30° and 40° of the knee joint. At the same time, the difference of force area between medial interventricular and lateral interventricular of knee joint under four states of bending the knee was compared, to explore the different effects of different surgical methods on knee joint after horizontal meniscus tear. ResultsWithin the four medial meniscus injury models, the lowest peak internal pressure and shear force of the knee joint was observed in the meniscal suture model; the highest values were found in the bilateral leaflet resection model and the inferior leaflet resection model; the changes of pressure, shear force and stress area in the superior leaflet resection model were the most similar to the changes of the knee model with the meniscal suture model. ConclusionSuture repair is the best way to maintain the force relationship in the knee joint. However, resection of the superior leaflet of the meniscus is also a reliable choice when suture repair is difficult.

Evaluation of the Efficacy and Results of Intraoperative Nerve Conduction in Nerve Reconstruction of the Hand

Nerve reconstruction in the hand is a critical aspect of hand surgery, aiming to restore sensory and motor function and improve overall hand functionality. Intraoperative nerve conduction, a neurophysiological technique, plays a pivotal role in nerve reconstruction surgeries. This literature review evaluates the efficacy and results of intraoperative nerve conduction in hand nerve reconstruction. Theoretical Framework: Intraoperative nerve conduction involves electrical stimulation of nerve fibers and the recording of nerve conduction responses in real-time during surgery. The technique aids in nerve identification, assessment, and surgical decision-making. Discussion: Intraoperative nerve conduction has shown efficacy in guiding surgical interventions and predicting postoperative outcomes. It has been particularly useful in complex nerve injuries, providing valuable feedback for optimal surgical planning. Challenges: Despite its benefits, intraoperative nerve conduction has limitations, such as timing issues and the need for skilled neurophysiologists and specialized equipment. Future Implications: Standardizing protocols and conducting larger prospective studies can enhance its reliability and identify specific scenarios where intraoperative nerve conduction provides the greatest benefit. Conclusion: Intraoperative nerve conduction is a valuable tool in hand nerve reconstruction, contributing to improved patient outcomes and the advancement of hand surgery. Continued research and technological advancements hold promise for its further optimization and wider applicability in the field.