Preoperative Preparation Research Articles

The effectiveness of a cesarean delivery bundle with vaginal preparation, cefazolin, and azithromycin in reducing postoperative infections: A before-and-after study.

To evaluate the effectiveness of a cesarean delivery (CD) bundle including preoperative vaginal preparation, cefazolin and azithromycin administration, compared with cefazolin alone, in reducing postoperative infections, among women undergoing CD during the second stage of labor. In August 2016, our departmental protocol for preventing infectious morbidity in second-stage CD was revised from preoperative intravenous 2 g cefazolin alone, to preoperative intravenous 2 g cefazolin, intravenous 500 mg azithromycin, and vaginal cleansing with povidone-iodine. In this before-and-after study, the medical records of women who underwent CD during the second stage of labor were reviewed, comparing two time periods: January 2014 to August 2016 (control group, cefazolin alone) and November 2016 to January 2021 (CD bundle group). Obstetric characteristics, postoperative infections, and neonatal outcomes were compared between groups. Composite infectious morbidity was defined as one or more of: endometritis, surgical-site infection (SSI), abscess, urinary tract infection, and postpartum fever. During the study period, there were 5265 intrapartum CD, among them 457 were during the second stage of labor. The CD bundle group (n = 331) had lower rates of endometritis, SSI, and composite infectious morbidity compared with the control group (n = 126, 1.2% vs. 4.8%, P = 0.030; 3.0% vs. 7.1%, P = 0.049, 6.9% vs. 14.3%, P = 0.014, respectively). Neonatal outcomes did not differ between groups. Multivariable regression analysis adjusted for confounders revealed that the CD bundle reduced the risk for the composite infectious outcome, with adjusted odds ratio 0.08 (95% confidence interval 0.01-0.50). In second-stage CD, adding preoperative azithromycin and vaginal cleansing to cefazolin was efficacious in reducing postoperative infections.

Recommendations for perioperative skin care in total joint arthroplasty: antimicrobial wash lotion, precleaning and hair removal

Periprosthetic joint infection (PJI) is aserious complication in arthroplasty surgery. The preoperative preparation of the skin plays an important role in infection prevention. Asystematic literature review was conducted on the topic of antimicrobial wash lotion, precleaning, and shaving. Existing evidence was summarized by the committee of the German Arthroplasty Society and recommendations were formulated. By applying alocal antiseptic before the operation, the risk of wound infection and PJI can be significantly reduced. This causes areduction in revision surgery and leads to ashorter average hospital stay. If hair removal is necessary, it is ideally performed shortly before the procedure using an electric clipper. The use of arazor is not recommended.

Preoperative Optimization of Patients Undergoing Orthopedic Foot and Ankle Surgery: A Single Institution Cohort.

Careful preoperative patient preparation for orthopedic foot and ankle surgery can help manage postoperative expectations and avoid suboptimal outcomes. Our quality improvement initiative aimed to reduce emergency department (ED) visits within 30 days postsurgery by enhancing preoperative education. We focused on four outcomes associated with receipt of written preoperative information: (1) related ED visits within 30 days of surgery, (2) average number of patient portal messages, (3) phone calls initiated by patients, and (4) staff team experience survey results. All patients undergoing foot and ankle surgery by two surgeons at one institution from July 2023 to January 2024 were included. Through a series of six plan, do, study, act (PDSA) cycles lasting 1month each, we evaluated 431 patients (55.9% female, 61.4% White, 92.4% English speakers). Patients who received written preoperative information were significantly less likely to present to the ED for related concerns within 30 days of surgery compared with those receiving no written preoperative information (p = .0068). In addition, we observed fewer portal messages and phone calls from patients receiving written preoperative information (p = .3644, p = .0541). An increase in the use of standardized written preoperative information yields decreased ED visits and frequency of inquiries from patients through portal messages and phone calls.

Lidocaine 2% and Xylocaine Spray as A Combination in Successful Awake Intubation in Difficult Airway: How to Do it?

Awake intubation is a technique used to insert an endotracheal tube while maintaining the patient's consciousness. It is particularly beneficial for patients with difficult airway anatomy, as it allows better visualization using a fiber optic bronchoscope, reduces discomfort with local anesthesia, and ensures the preservation of spontaneous breathing. This approach is critical in high-risk procedures such as total thyroidectomy. This case report aims to describe the application of awake intubation in a high-risk patient undergoing total thyroidectomy due to a thyroid mass causing tracheal narrowing. A 47-year-old female with airway management difficulties (LEMON 3/10, MOANS 0/5) was scheduled for a 3–4-hour total thyroidectomy. Preoperative preparation included fasting, informed consent, and ensuring complete anesthesia equipment. Airway preparation involved Xylocaine spray and Lidocaine nebulization, followed by premedication with Dexamethasone, Diphenhydramine, and Midazolam. Induction was achieved using Propofol, and intubation was performed with an endotracheal tube guided by a fiber optic bronchoscope. Maintenance of anesthesia utilized Oxygen, Sevoflurane, and Atracurium. The results show the patient tolerated the awake intubation procedure well, with no episodes of desaturation or significant bleeding during surgery. Postoperative management included analgesia with Fentanyl and Ketamine, as well as respiratory therapy intervention (RTI) during recovery. Awake intubation, combined with effective airway preparation and anesthesia protocols, provides a safe and reliable approach for managing patients with difficult airways, particularly in high-risk procedures like total thyroidectomy. The technique ensured patient comfort, maintained oxygenation, and minimized perioperative complications.

The impact of different gastrointestinal reconstruction techniques on gut microbiota after gastric cancer surgery

IntroductionGastric cancer is one of the common malignant tumors in the digestive tract, characterized by high incidence and mortality rates. This is particularly significant in China, where a large proportion of global new cases of gastric cancer and related deaths occur. In recent years, with the continuous development of molecular biology technology, people have gained a deeper understanding of the gastrointestinal microbiome, and studies have shown that it is closely related to the occurrence, development, and therapeutic response of gastric cancer. Although surgical intervention is crucial in significantly extending the survival of gastric cancer patients, the disruption of the balance of the intestinal microbiota caused by surgery itself should not be overlooked, as it may affect postoperative recovery.MethodsThis study was approved by the Biomedical Ethics Committee of Sichuan Mianyang 404 Hospital. A random sampling method was used to select patients who underwent gastric cancer surgery at the hospital from January 2023 to December 2023. All patients signed written informed consent forms. Standardized perioperative management was conducted for the patients in the study, including preoperative preparation, intraoperative handling, and postoperative treatment. Fecal samples were collected from patients before surgery (before bowel preparation) and around one week after surgery for 16S rRNA sequencing analysis, through which differential biomarkers and related functional genes were sought.ResultsThe study results indicated that there was no significant difference in the diversity of the gut microbiota between the two groups. Compared with the R-Y group, the DTR surgical method significantly altered the structure of the gut microbiota, affecting the types, quantities, and proportions of intestinal bacteria. Furthermore, the DTR group exhibited poorer postoperative nutritional absorption capacity compared to the R-Y group, as indicated by a lower F/B ratio. The R-Y group showed a richer abundance of Bacteroidetes and a lower abundance of Proteobacteria, as well as a higher F/B ratio after surgery. These findings provide new insights into the changes in the gut microbiota following gastric cancer surgery, which may be of significant importance for postoperative recovery and long-term health management.DiscussionThis study reveals the impact of different gastrointestinal reconstruction techniques on the postoperative gut microbiota of gastric cancer patients, providing new insights into the physiological changes during the postoperative recovery period. Although there was no significant difference in microbial diversity between the DTR group and the R-Y group, the DTR group showed more pronounced changes in microbial structure postoperatively, which may be associated with an increased risk of postoperative infection. These findings emphasize the importance of considering the impact on the gut microbiota when selecting gastric cancer surgery methods. However, the study had a limited sample size and did not delve into changes in metabolites. Future studies should expand the sample size and conduct metabolomic analyses to further validate these preliminary findings.

P1185 Preoperative bowel preparation in Crohn’s disease patients: final results of the prospective observational study

Abstract Background Mechanical bowel preparation (MBP) in combination with oral antibiotics (OA) might decrease the risk of postoperative morbidity in colorectal surgery. However, there is a lack of data regarding the impact and safety of MBP in Crohn’s disease patients. MBP could even increase the morbidity by causing obstructive symptoms. Methods Patients with Crohn’s disease undergoing ileocolic or colorectal resections which were concluded by formation of an anastomosis were included in this prospective observational study. Exclusion criteria were: emergency surgery, no preoperative MBP, presence of colorectal malignancy, mere small bowel resection, simultaneous fecal diversion. The primary endpoint of the study was the occurrence of anastomotic complications (i.e., anastomotic leak, perianastomotic abscess, peritonitis or fistula). Secondary endpoint was occurrence of intraabdominal septic complications. “Incomplete MBP” was defined as an inability to drink the whole amount of scheduled 2 L of polyethylene glycol solution. Results 284 patients were included. Side effects of MBP (nausea, vomiting, abdominal pain) occurred in 78 patients (29%). Fifty-three patients (19%) were not able to complete MBP. Female sex, emergency hospitalization, decreased hemoglobin level and scheduled ileocolic resection were associated with an incomplete MBP (p<0.05). The incidence of anastomotic complications was 5%, intraabdominal septic complications occurred in 7% of patients. An incomplete MBP was not associated with anastomotic complications or intraabdominal septic complications. Conclusion Preoperative MBP is associated with a considerable incidence of side-effects in Crohn’s disease patients. However, intake of lesser amounts of MBP-solution than scheduled was not associated with an increased risk of postoperative morbidity.

Impact of Care Bundles Including Preoperative Skin Preparation and Vaginal Cleaning Supplies on Preventing Surgical Site Infections in Caesarean Deliveries

Impact of Care Bundles Including Preoperative Skin Preparation and Vaginal Cleaning Supplies on Preventing Surgical Site Infections in Caesarean Deliveries

Transauricular vagus nerve stimulation in preventing post-traumatic stress disorder in emergency trauma surgery patients in China: a study protocol for a multicenter, double-blind, randomised, controlled trial

IntroductionThe incidence of post-traumatic stress disorder (PTSD) in emergency trauma surgery patients is 24%, emphasising the urgent need for effective early interventions and treatments. Transauricular vagus nerve stimulation (ta-VNS) modulates...

Joint replacement for rheumatoid arthritis: When, why, and how! Insights from an orthopedic surgeon.

The past several decades have seen significant advancements in joint replacement surgery for rheumatoid arthritis (RA). Joint replacement procedures have become vital options for patients with severe joint damage and functional impairment. There has been an increased emphasis on personalized surgical strategies that tailor joint replacement decisions based on a patient's unique clinical characteristics and the extent of joint damage. Achieving personalized outcomes requires clearly understanding the patient's baseline joint function and comparative data on different prosthetic designs and techniques. Comprehensive preoperative preparation is fundamental to ensuring surgical success. This includes thoroughly evaluating the patient's medication history, the extent of joint damage, and overall systemic health. Despite careful surgical planning, trade-offs between different replacement options often remain. In this paper, we review the perioperative preparation and surgical techniques in joint replacement surgery for RA. Additionally, we discuss the challenges in optimizing postoperative rehabilitation and preventing complications, which remains a key factor in achieving full recovery and maximizing the benefits of joint replacement surgery for RA patients. The pathological basis of RA is an acute or chronic inflammation of the synovial membrane. As a result, synovial joints throughout the body can be affected, including joints in the upper limbs (shoulders, elbows, wrists, metacarpophalangeal joints, and interphalangeal joints) as well as in the lower limbs (hips, knees, and ankles). If drug treatments fail to control inflammation adequately, recurrent synovitis in the affected joints can lead to swelling, effusion, cartilage erosion, and eventual cartilage loss. Due to decreased weight-bearing, along with the use of various medications-particularly glucocorticoids-widespread subchondral bone osteoporosis, bone marrow edema, and bone destruction may occur, leading to cystic degeneration and even extensive bone defects. In the advanced stages of RA, deformities can develop, such as "boutonniere" and "swan-neck" deformities in the fingers, ulnar deviation of the wrist, "otto pelvic" due to central acetabular erosion and dislocation of the hip, varus or valgus deformities of the knee, flexion contractures, and destruction or fusion of the ankle joint. The foot can also present deformities, such as hallux valgus and overlapping toes. Total joint replacement surgery has become the most effective surgical treatment for severe joint destruction and deformities in late-stage RA. Among all joints, the hip and knee are the most frequently replaced, as their dysfunction severely impacts the patient's ability to walk, leading to disability and loss of mobility. In this review, we provided a comprehensive discussion on the perioperative management of patients with RA, focusing on preoperative preparation, intraoperative planning, and postoperative rehabilitation and assessment. Rheumatology Department Perspective on Preoperative Preparation for RA Joint Replacement Surgery.

Different Internal Fixation Methods for Sanders Type II and III Calcaneal Fractures: A 5-Year Retrospective Study and Finite Element Analysis.

Soft tissue defects and postoperative wound healing complications related to calcaneus fractures may result in significant morbidity. The aim of this study was to investigate whether percutaneous minimally invasive screw internal fixation (PMISIF) can change this situation in the treatment of calcaneal fractures, and aimed to explore the mechanical effects of different internal fixation methods on Sanders type III calcaneal fractures through finite element analysis. This retrospective analysis focused on 83 patients with Sanders II and III calcaneal fractures from March 2017 to March 2022. Among them, 32 patients underwent PMISIF, 24 patients underwent tarsal sinus incision plate internal fixation (TSIPIF), and 27 patients underwent extended lateral incision plate internal fixation (ELIPIF). The present study aimed to compare various parameters, including the perioperative hospital stay, intraoperative blood loss, operative time, postoperative drainage volume, incidence of postoperative wound complications, and Gissane angle and Bohler angle data before surgery, after surgery, and at the last follow-up, among the three treatment groups. Additionally, three different finite element models were created to simulate Sanders III calcaneal fractures treated with PMISIF, TSIPIF, and ELIPIF. The models were subjected to longitudinal stresses of 350 and 700 N, and the displacement and stress distribution were analyzed to compare the stability of each model. Compared with ELIPIF and TSIPIF, PMISIF has several advantages, including shorter operative times, smaller incisions, shorter hospital stays, and lower incidences of postoperative complications. At the 12-month time point after the operation, the percentages of patients with excellent and good American Orthopedic Foot and Ankle Society (AOFAS) functional scores were 96.9%, 91.7%, and 96.2%, respectively, for the three methods, demonstrating similar outcomes. Intraoperative blood loss in the PMISIF group was comparable to that in the TSIPIF group and lower than that in the ELIPIF group. There were no significant differences in the Gissane or Bohler angles among the three groups before or after the operation. However, the differences in the Gissane and Bohler angles after the operation within each group were statistically significant compared with those before the operation. Finite element analysis revealed that stress in all three internal fixation models was primarily concentrated on the subtalar articular surface, whereas displacement was mainly observed on the medial side of the subtalar articular surface. The peak stress and displacement of bone fragments and implants in the PMISIF model were lower than those in both the TSIPIF and ELIPIF models. PMISIF can achieve excellent and good rates comparable to those of TSIPIF and ELIPIF. Additionally, this approach offers the advantages of reduced operative trauma, a lower incidence of complications, and shorter preoperative preparation and hospitalization times. Furthermore, this approach can achieve a similar level of biomechanical stability.

Perioperative Outcomes in Patients with and Without Chronic Preoperative Therapeutic Anticoagulation Undergoing Metabolic Surgery at an Academic Medical Center.

Background/Objectives: Patients on chronic anticoagulation undergoing metabolic surgery represent an increased risk of complications, including both bleeding and thrombotic events, such as deep vein thrombosis (DVT) and pulmonary embolism (PE). The optimal perioperative management of patients who are receiving chronic anticoagulation therapy (CAT) is complex. In the colorectal surgery literature, patients on CAT have a 10% rate of peri-procedural bleeding and a 3% rate of thromboembolism. The aim of this study was to evaluate and compare the safety and postoperative outcomes between patients with and without CAT undergoing Roux-en-Y gastric bypass (RYGB) or sleeve gastrectomy (SG) at a tertiary referral center in the United Arab Emirates (UAE). Methods: All patients who underwent primary bariatric surgery between September 2015 and July 2019 were retrospectively reviewed. The first group included patients with CAT, and the second group included patients without CAT. Demographics, perioperative outcomes, and postoperative results were examined. Results: Our study included 542 patients, 22 (4%) with CAT and 520 (96%) without CAT. Mean age was 46.3 ± 10.5 years in the CAT group and 36.0 ± 11.7 years in the non-CAT group (p < 0.001); median BMI was 41.8 (range 33.1-61.3) and 42.7 (range 30.1-78.4) kg/m2, respectively (p = 0.52). The CAT group had significantly higher rates of hypertension (77.2% vs. 32.5%, p < 0.001), obstructive sleep apnea (81.8% vs. 31.5%, p < 0.001), and coronary artery disease (31.8% vs. 2.8%, p < 0.001). In the CAT group, 8/22 (36.4%) patients underwent Roux-en-Y gastric bypass and 14/22 (63.6%) sleeve gastrectomy, compared to 228/520 (43.8%) and 292/520 (56.2%), respectively, in the non-CAT group (p = 0.51). There were no statistically significant differences in postoperative emergency department (ED) visits (18.1% vs. 24.2%, p = 0.51), early major complications (4.5% vs. 3.4%, p = 0.54), readmission rates within 30 days (4.5% vs. 3.6%, p = 0.56), or late complications (4.5% vs. 4.2%, p = 0.60). Mean length of stay was significantly longer in the CAT group (4.6 vs. 2.6 days, p < 0.001). The mean follow-up was 10 ± 7.3 months for the CAT cohort and 11 ± 9.7 months for the non-CAT cohort (p = 0.22). Weight loss outcomes at 12 months were comparable, with a percent total body weight loss (TBWL) of 27.0 ± 7.3% in the CAT group and 28.9 ± 8.3% in the non-CAT group (p = 0.29). There were no deaths in either group. Conclusions: In this series, at a tertiary referral center in the UAE, metabolic surgery is safe for CAT patients. Multidisciplinary preoperative preparation might be warranted to avert potential complications.

Successful Anesthetic Management of Pheochromocytoma in a Patient with Preoperative Hypertension: A Case Report

Background: Pheochromocytoma, a rare tumor arising from chromaffin cells in the adrenal medulla, poses significant anesthetic challenges due to its propensity to release catecholamines, potentially leading to life-threatening hypertensive crises. This case report describes the successful anesthetic management of a patient with pheochromocytoma presenting with preoperative hypertension. Case presentation: A 37-year-old female with a 12x5 cm right adrenal tumor diagnosed as pheochromocytoma was scheduled for adrenalectomy. She presented with a history of uncontrolled hypertension, episodic headaches, diaphoresis, and palpitations. Preoperative management focuses on blood pressure control using alpha and beta-adrenergic blockers. Anesthesia was induced with propofol, fentanyl, and atracurium, while nitroglycerin and sevoflurane were used to maintain hemodynamic stability. The patient's blood pressure was closely monitored throughout the procedure, with interventions made to manage fluctuations during tumor manipulation. Conclusion: Successful anesthetic management of pheochromocytoma requires meticulous preoperative preparation, vigilant intraoperative monitoring, and prompt pharmacological interventions. This case highlights the importance of a multidisciplinary approach, including endocrinologists, anesthesiologists, and surgeons, to optimize patient outcomes.

Bibliometric Analysis of the Effects of Prolonged Preoperative Fasting on Patients

ABSTRACT Preoperative fasting is a common practice in the surgical field, which aims to minimize complications and ensure patient safety. Understanding its impact and optimizing protocols are essential in clinical practice. This study analyzed the bibliometric and network overview of publications on the effects of extended preoperative fasting on patients, using VOSViewer. This bibliometric analysis explores the research landscape on the effects of extended preoperative fasting duration on patients. Using VOSViewer, this study identified key contributors and clusters in the literature, highlighting significant research gaps. Bibliometric methods were used to analyze publications regarding the effects of extended preoperative fasting. Using VOSViewer, this study identified key contributors and groups in the literature, which highlighted significant research gaps. Bibliometric methods were used to analyze publications regarding the effects of extended preoperative fasting. Data were aggregated and visualized using VOSViewer to map the publication network and identify thematic clusters. China and the UK emerged as the main contributors with 7 articles each, followed by Brazil and India. Three main clusters were identified: a red cluster focusing on fasting duration, side effects, dehydration risk, and intraoperative management; a blue cluster exploring the effects of fasting on surgical outcomes, hunger, and procedural aspects; and a green cluster addressing guideline development, elective surgery, and preoperative preparation. These findings underscore the importance of extended preoperative fasting in clinical practice and highlight significant research opportunities. Future research could focus on personalized fasting protocols, long-term effects, psychological impact, and innovative monitoring technologies to improve the quality of patient care. Keywords: Preoperative Fasting, Effects Of Prolonged Fasting, Bibliometric Analysis, Vosviewer, Surgical Outcomes, Patient Care

PREOPERATIVE HOSPITALIZATION AS A BRIDGING STRATEGY FOR WEIGHT LOSS IN PATIENTS WITH BODY MASS INDEX = 50 KG/M2 WHO ARE CANDIDATES FOR BARIATRIC SURGERY.

Preoperative hospitalization with the purpose to obtain more effective weight loss provides intensive care for patients who have a higher body mass index (BMI) and associated diseases that involve a greater risk of peri- and postoperative complications. It is a therapeutic strategy that can make it possible to overcome obstacles related to the difficulty of adhering to obesity treatment. To analyze the implementation of a preoperative hospitalization strategy for weight loss in patients eligible for bariatric surgery. Retrospective study that included 194 patients with a BMI=50 kg/m2. They were grouped according to preoperative preparation strategies: inpatient (n=32) and outpatient (n=162), who underwent Roux-en-Y gastric bypass (RYGB) or sleeve gastrectomy (SG) between 2010 and 2020. The groups were compared regarding preoperative weight loss before and after the strategies and postoperative up to two years after surgery. Most patients were female and there were significant differences in age group (an average of 42.94 years in the preoperative hospitalization strategy group and 37.73 in the outpatient strategy group). The mean BMI in the hospitalized group was 63.01±8.72 kg/m2, and in the outpatient group it was 54.95±4.31 kg/m2. There was a significant difference only between initial and preoperative weight in the hospitalized group. Furthermore, the difference between initial weight and last recorded weight up to two years after surgery was significant in each group. The occurrence of associated diseases was higher in the outpatient group. Patients following the preoperative hospitalization strategy experienced significant weight loss before surgery.

The effect of preoperative vaginal preparation with povidone-iodine on post-caesarean section infection

Objective: To evaluate the effect of preoperative vaginal antiseptic cleansing with Povidone-iodine on the occurrence of post-caesarean section infectious morbidity. Methodology: A single-blind randomized controlled study of 180 women who had preoperative vaginal preparation with povidone-iodine before emergency CS at the University of Ilorin teaching hospital during the study period, The primary outcome measures were fever, endometritis and wound infection. Analysis was done using Chi-square tests, t-tests and logistic regression. Results: The study result shows that the prevalence of post-caesarean section infection morbidity was 26.5%. There was a statistically significant difference in educational level attained and social class (p&lt;0.001) between both groups. The incidence of post-caesarean infection was significantly lower among the subjects compared to the controls (16.3% vs.36.6%,p-0.003). Using univariate and multivariate binary logistic regression, PVP-I use and chorioamnionitis remain significant independent predictors of infectious morbidity. PVP-I is associated with lesser odds (OR; 0.307) while those with chorioamnionitis are eight times more likely to have a postoperative infection (p-0.006). Conclusion: The incidence of post-caesarean fever and endometritis was significantly reduced in those scrubbed with both abdominal and vaginal Povidone-iodine compared to those who had standard abdominal scrub alone for emergency caesarean section. Vaginal cleaning with Povidone-iodine is safe.

Ear and skull base paraganglioma: review of literature

The actuality of the research is determined by the lack of systemized information on the ear and skull base paraganglioma. Currently, from 500 to 1000 cases of paraganglioma or pheochromocyte are diagnosed in the United States of America annually. The combined morbidity of benign tumor forms is evaluated to be between 0.7 to 1.0 for 100000 people per year. Even though the results in understanding the nature of paraganglioma, as well as treatment thereof, are successful, the amount of literature on this topic only increases. The research aims to analyze study of the terminology, classification, diagnostics, and treatment of paraganglioma. Special attention was brought to the preoperative preparation and embolization of vessels, which supply blood to the tumor as well as to the problem of repeated bouts of glomangioma. The objective of the research is the selection of relative sources, argumentation analysis, and material systematization. For the analysis, 53 research articles were included. During the compilation of this study, such methods, as analysis, synthesis, information collection and systematization, and genera­lization, were used. In this article, various paraganglioma classifications, endoscopic treatment methods, other aspects of paraganglioma therapy, and diagnosis and treatment thereof, were presented. More and more researchers recommend individual and adapted approaches for each case with the inclusion of factors, related to the patient, including age, treatment goals, other infections, gene status, anatomical issues, caused by the tumor growth, its sizes, and other factors. This literature review focuses on ear and skull base paragangliomas, rare, usually benign, hyper-vascularized neuro­endocrine tumors often treated surgically. Alternative treatments like cyber-knife, gamma-knife, and endoscopic approaches are also discussed, highlighting their efficacy for specific cases. The study emphasizes individualized treat­ment plans considering patient-specific factors, with stereotactic radiosurgery being a safe and effective option for many patients. Materials of the research can be used by doctors of various specializations to enrich their knowledge and for further study of paragangliomas of various localizations.

Technological Advancements in Augmented, Mixed, and Virtual Reality Technologies for Surgery: A Systematic Review.

Recent advancements in artificial intelligence (AI) have shown significant potential in the medical field, although many applications are still in the research phase. This paper provides a comprehensive review of advancements in augmented reality (AR), mixed reality (MR), and virtual reality (VR)for surgical applications from 2019 to 2024 to accelerate the transition of AI from the research to the clinical phase. This paper also provides an overview of proposed databases for further use in extended reality (XR), which includes AR, MR, and VR, as well as a summary of typical research applications involving XR in surgical practices. Additionally, this paper concludes by discussing challenges and proposed solutions for the application of XR in the medical field. Although the areas of focus and specific implementations vary among AR, MR, and VR, current trends in XR focus mainly on reducing workload and minimizing surgical errors through navigation, training, and machine learning-based visualization. Through analyzing these trends, AR and MR have greater advantages for intraoperative surgical functions, whereas VR is limited to preoperative training and surgical preparation. VR faces additional limitations, and its use has been reduced in research since the first applications of XR, which likely suggests the same will happen with further development. Nonetheless, with increased access to technology and the ability to overcome the black box problem, XR's applications in medical fields and surgery will increase to guarantee further accuracy and precision while reducing risk and workload.

Automatic MRI-TRUS Fusion Technique for Transperineal Biopsy Guidance: From Preoperative Planning to Intraoperative Navigation.

Targeted and systematic transperineal biopsy of lesions guided by magnetic resonance imaging (MRI) and transrectal ultrasonography (TRUS) fusion technique may optimize the biopsy procedure and enhance the detection of prostate cancer. We described the transperineal biopsy guided by an automatic MRI-TRUS fusion technique, and evaluated the accuracy and feasibility of this method in a prospective single-center study. The proposed method focuses on automating the delineation of prostate contours in both the MRI and TRUS images, the registration and fusion of MRI and TRUS images, the generation and visualiztion of the systematic biopsy cores in their corresponding locations within the 2D and the 3D views, as well as the computation and visualiztion of needle trajectories from preoperative planning to intraoperative navigation. A total of 76 patients with clinically suspected prostate cancer underwent systematic (SBx) and targeted (TBx) biopsies, all performed by a single urologist with more than 10 years of experience. The detection rates of prostate cancer (PCa) and clinically significant prostate cancer (csPCa) were recorded. We also measured preoperative registration time, duration of the overall surgical procedure, and postoperative complication rates within the first week following the surgery. Descriptive analyses were presented in this study. PCa was identified in 73.7% (56/76) of the subjects, while csPCa was identified in 61.8% (47/76). The preoperative registration time was 5.0 min (IQR: 4.4-6.0), while the overall surgery duration was 24.8 min (IQR: 23.2-27.2). Postoperatively, 12 patients experienced immediate hematuria, and one patient reported dysuria 1 day following surgery. The automatic MRI-TRUS fusion technique for transperineal biopsy is feasible and safe, with preoperative planning to intraoperative navigation it offering convenient and efficient preoperative preparation and surgical procedure.

Significance of Misoprostol-Induced Cervical Ripening Prior to Hysteroscopy.

Background Hysteroscopy, a minimally invasive procedure for diagnosing and treating intrauterine pathologies, can be challenging due to inadequate cervical dilation, leading to procedural difficulties and patient discomfort. Misoprostol, a synthetic prostaglandin E1 analog, is increasingly used for cervical ripening to ease hysteroscopic procedures. Objective To evaluate the efficacy and safety of misoprostol for cervical ripening prior to hysteroscopy. Material and methods This prospective study included 539 women who presented to the Gynecology OPD for elective hysteroscopy. Participants were randomly assigned to either Group A (n=300), who received 400 µg misoprostol vaginally at night before hysteroscopy, or Group B (n=239), who had a placebo. The outcomes assessed were cervical dilation, procedural time, patient-reported pain during hysteroscopy, and placement of a copper IUD on post-insertion day 1 as defined by the visual analog score (VAS), incidence of cervical lacerations, or adverse side effects. Results Group A had significantly higher rates of achieving greater cervical dilation compared to Group B. Specifically, 50% of patients in Group A achieved a dilation of 7-8 mm, and 15% achieved dilation greater than 8 mm, whereas only 10% and 5% of patients in Group B achieved these levels of dilation, respectively. The need for additional mechanical dilation was lower in Group A (10% vs. 55%). Procedural times were shorter in Group A, with 75% of procedures taking 10 minutes or less compared to 30% in Group B. Patient-reported pain was also lower in Group A. Conclusion Misoprostol improves cervical ripening before hysteroscopy, reducing the need for mechanical dilation, shortening operation time, and lowering pain levels. Despite moderate side effects, it remains a key preoperative cervical preparation due to its procedural and patient comfort benefits.

Risk analyses for perioperative morbidities after aseptic knee revision arthroplasty

IntroductionTotal lower limb arthroplasties are standard orthopedic surgeries that are steadily increasing in modern civilization. In proportion, the number of revision arthroplasties and the corresponding financial burden for healthcare systems will increase. The present clinical investigation analyzed morbidities after aseptic revision knee arthroplasty.MethodsData from 122 patients following aseptic revision TKA (total knee arthroplasty) were collected. The study collected information on systemic and surgical complications during hospitalization and follow-up, blood transfusion units, and changes in Hb and CRP levels. Hb and CRP were measured preoperatively and on postoperative days 1, 2, and 4. Statistical analyses were performed using IBM SPSS version 29.ResultsSignificant differences were observed in systemic, surgery-related and blood transfusion rates and reasons for knee replacement changes based on age and gender. Of the patients, 38.5% received a full component change, 11.5% received a partial component replacement (either femoral or tibial), 30.3% had an isolated inlay change, and 19.7% underwent debridement only. Femoral and tibial loosening were more frequent in patients over 75 years and those with longer intervals between the initial operation and re-presentation (p = 0.001). Patients with movement deficits and malposition presented earlier for consultation (p = 0.02). Prolonged high CRP levels were significantly correlated with systemic complications, longer hospital stays, and extended operative times.ConclusionsAseptic knee revision arthroplasty is a complex procedure with perioperative morbidities that can significantly impact outcomes. Age and gender are crucial factors in managing complications during hospitalization and follow-up. Elderly patients, particularly those over 75 years, are more prone to aseptic loosening and require tailored preoperative preparation. The study underscores the importance of individualized patient care strategies to mitigate risks and improve outcomes in aseptic knee revision arthroplasty.Trial registration: Not applicable.