Preoperative Planning Research Articles

Risk Factors Analysis of Urosepsis Following Retrograde Intrarenal Surgery: A Retrospective Study

Background: Sepsis post retrograde renal surgery (RIRS) is a grave complication. Proper monitoring, antibiotic management, and understanding of risk factors are crucial to reduce sepsis risk and enhance patient outcomes. Objective: To determine risk factors causing postoperative sepsis after RIRS for renal stones. Methods: A retrospective/prospective cohort enrolled 145 patients who underwent RIRS for renal and/or ureteral stones at Ghazi AL-Hariri Hospital for Surgical Specialties. Eligible patient data were collected, including demographic (age, gender), stone parameters (site, side, size), preoperative and postoperative investigations and antibiotic regimen, operative parameters (type of ureteroscope used, prior DJ stent), and postoperative records. Results: Patients aged 19-69 years, predominantly males (60.7%), and 25.5% had diabetes. Stones were predominantly located in the upper pole (36.6%), 44.8% of stones were medium-sized (15-20 mm), and 49.7% were moderate density (800–1200 HU). Post-operatively, 17% of cases developed urosepsis. Multivariate analysis identified diabetes, longer surgery duration, elevated postoperative CRP, and uncontrolled HbA1c as independent risk factors for urosepsis. E. coli was the most common pathogen (44%). The average hospital stay was 2 days, with 49.7% discharged within a single day. The median duration of DJ stenting was 6 weeks. Conclusions: Analysis highlights the multifactorial risk of developing urosepsis post-RIRS, including diabetes, longer procedural time, higher postoperative inflammatory markers, and complex stone characteristics. Comprehensive preoperative planning and meticulous intraoperative techniques will alleviate these risks and help urologists maximize patient outcomes and minimize urosepsis incidence.

Impact of CT-based navigation, large femoral head, and dual-mobility liner on achieving the required range of motion in total hip arthroplasty.

This study aimed to investigate whether the use of CT-based navigation enhances: 1) the accuracy of cup placement; and 2) the achievement rate of required range of motion (ROM). Additionally, we investigated the impact of using a large femoral head and dual-mobility liner on the achievement rates. This retrospective study analyzed 60 manual and 51 CT-based navigated primary total hip arthroplasties performed at a single facility. Postoperative CT scans and CT-based simulation software were employed to measure the cup orientation and to simulate the ROM. We compared the absolute errors for radiological inclination (RI) and radiological anteversion (RA) between the two groups. We also examined whether the simulated ROM met the required ROM criteria, defined as flexion > 110°, internal rotation > 30°, extension > 30°, and external rotation > 30°. Furthermore, we performed simulations with 36 mm femoral head and dual-mobility liner. The absolute errors of RI and RA from the preoperative plan were significantly smaller in the CT-based navigation group (3.7° (SD 3.5°) vs 5.1° (SD 3.5°); p = 0.022, and 3.9° (SD 3.5°) vs 6.8° (SD 5.0°); p = 0.001, respectively). The proportion of cases achieving the required ROM in all directions was significantly higher in the CT-based navigation group (42% vs 63%; p = 0.036). The achievement rates of the required ROM were significantly higher with the use of a 36 mm ball or dual-mobility liner compared to the use of a 32 mm ball (65% vs 51%; p = 0.040 and 77% vs 51%; p ≤ 0.001, respectively). CT-based navigation enhanced required ROM achievement rates by > 20%, regardless of the ball diameter. The improved accuracy of cup placement through CT-based navigation likely contributed to the enhancement. Furthermore, the use of large femoral heads and dual-mobility liners also improved the required ROM achievement rates. In cases with a high risk of dislocation, use of these devices is preferred.

Radiological relations of sigmoid sinus with oto-neuro-surgical landmarks with its surgical risk-stratification indicating classification.

Detailed pre-operative HRCT scan-based measurement of the distance between surgical landmarks with lateral or sigmoid sinus (SS) and classification of its relations with surgical landmarks. Observational Study. Tertiary care center. Patient volunteers above 18 years of age undergoing scans for various reasons. Axial Sections of HRCT of 260 temporal bones obtained from patient volunteers were studied with the help of RadiAnt DICOM Viewer (version 2023.1). Closest distance of the SS from the posterior wall of the external auditory canal wall (CW), the vertical portion of the facial nerve (VPFN), the short process of incus (SPI), lateral (LC), and posterior semi-circular canal (PC), was measured. The SS relation with the mastoid was classified as type 1-4 depending upon the shortest distance of the sinus from the posterior canal wall millimeters. The mean distance of the SS from surgical landmarks was 14.6 ± 2.7mm for SPI, 11.1 ± 3.1 for CW, 11.4 ± 2.9 for VPFN, 10.1 ± 2.8 for PC, and 11.9 ± 2.7 LC. All measured distances were significantly more on the left side (p < 0.05, Z test), except the difference in distance from LC. The greatest range of variation (5.2 to 21.8mm) was seen in the distance between SS and VPFN. The most common type of relationship between SS and CW was type 3, present in 64% of subjects, while the least common group was type 1, with nearly 1% of subjects. The assessment of distances and relations of various surgical landmarks with SS, with the proposed novel classification based on SS-CW distance, can be essential for preoperative planning and risk mitigation.

How to Use Virtual Reality from Echocardiographic-Acquired Images.

Our goal of this review is to describe the current evidence and future applications of virtual reality (VR) from echocardiographic acquired images to enhance diagnostic accuracy and improve the visualization of cardiac structures by providing immersive 3-dimensional (3D) environments for better interpretation, communication between healthcare providers, families and trainees. Virtual reality is a powerful tool for education, procedural planning and simulation. Using readily available echocardiographic images for this purpose is feasible, effective and safe. This document highlights the increasing role of VR in procedural planning, education, and intraprocedural guidance using three-dimensional echocardiography (3DE). Key advancements include the development of smaller 3D transthoracic and pediatric transesophageal probes with better temporal resolution, which enable enhanced imaging for preoperative planning. VR allows surgeons to visualize dynamic 3D cardiac models created from echocardiographic or Computed Tomography (CT) data, enabling better pre-surgical rehearsal, device selection, and landing zone visualization. It also provides immersive training tools for echocardiographers and offers potential for intraprocedural guidance in interventions such as atrial septal defect closures. These developments underscore the growing synergy between VR and 3DE for refining diagnosis and procedural strategies.

Molecular landscape and therapeutic strategies in pediatric differentiated thyroid carcinoma.

There has been significant progress in understanding the molecular landscape of pediatric differentiated thyroid carcinoma over the past two decades. Classification of pediatric differentiated thyroid carcinoma into three-tiers, RAS-like mutant, BRAF-mutant, and kinase-fusions, accurately reflects an increasing risk for invasive behavior, including regional and distant metastasis. In clinical practice, somatic oncogene testing for nodules with indeterminate cytology per the Bethesda System for Reporting Thyroid Cytopathology provides objective data to optimize surgical planning. In addition, knowledge of the somatic oncogene for widely invasive carcinomas allows for incorporation of oncogene-specific inhibitory therapy both in the adjuvant and neoadjuvant setting. In the present review, we review the risk factors, clinical presentation, and evaluation of pediatric DTC, highlighting the correlation among ultrasound features, cytology, and oncogenic driver of the tumor. We subsequently propose an integrated, multi-modal approach that can be used to improve diagnostic accuracy and reliability for pre-operative planning as well as identify and discuss which pediatric patients may benefit from systemic oral targeted therapy.

Efficacy of an artificial intelligence preoperative planning system for assisting in revision surgery after artificial total hip arthroplasty

ObjectiveTo explore the early efficacy of an artificial intelligence preoperative planning system (AIHIP system) for assisting in hip revision surgery.MethodsThe clinical data of 25 patients (26 hips) who underwent hip revision between June 2019 and December 2023 and who met the selection criteria were retrospectively analyzed. There were 13 males and 12 females; the ages ranged from 44 to 90 years, with a mean of 69.1 years. The patients' replacement of prosthesis model, operation time, hospitalization time, postoperative time out of bed, etc., as well as the occurrence of adverse events such as postoperative infection, fracture, and loosening of the prosthesis were recorded. The Harris Hip score (HHS) was used to evaluate the function of the affected limbs preoperatively, and 1 week and 6 months postoperatively, and hip mobility was compared preoperatively and 6 months postoperatively.ResultsAll 25 patients were followed up for 6 to 59 months, with an average of 25.3 months. Except for one patient who developed a thigh hematoma (treated with incision and drainage and decompression) and hip dislocation in one hip (repaired), the remaining patients experienced no adverse events such as loosening of the prosthesis or infection. The postoperative acetabular cup type matching degree completely matched 25 hips, not matching 1 hip (+ 2 number), for a matching rate of 96.15%; the femoral stem type matching degree completely matched 25 hips, generally matching 1 hip (-1 number), for a matching rate of 100%. The Harris scores were 54.7 ± 9.6 and 89.6 ± 7.0 at 1 week and 6 months after surgery, respectively, which were significantly improved (P < 0.05) compared with the preoperative scores of 33.5 ± 8.3, and further improved at 6 months after surgery compared with the 1-week period (P < 0.05). The patients' hip function was evaluated according to the Harris score at 6 months after surgery, and they were assigned to 23 good hips and 3 medium hips, which could satisfy daily life needs. Hip mobility at 6 months after surgery was 111.15 ± 9.72°, and the difference was statistically significant compared with the preoperative value of 79.42 ± 17.51° (t = -8.077, P < 0.001).ConclusionAIHIP system-assisted treatment of THA postoperative revision patients can improve the precision of revision surgery, and reduce the difficulty of surgery, in patients with good postoperative recovery and satisfactory early outcomes.

Dome osteotomy for cubitus varus correction in a 26-year-old male with left elbow gunstock deformation: a case report

Background: Cubitus varus deformity is a common complication of untreated elbow fractures in children but is rare and challenging to treat in adults. This study presents the first documented case of correcting cubitus varus deformity in an adult. Case presentation: A 26-year-old male laborer presented with a deformed left elbow and impaired limb function due to a childhood fall. Clinical examination revealed a 30-degree cubitus varus deformity (Grade IV), confirmed by x-rays of the limb showing malunion with increased Baumann’s and metaphyseal-diaphyseal angle. The surgical intervention involved a dome osteotomy using a triceps-splitting approach under general anesthesia. The deformity was corrected by manipulating the distal fragment in the coronal and sagittal planes and fixing it with a dynamic compression plate and interfragment screw. Postoperative care included immobilization in a long arm cast and progressive rehabilitation. Clinical discussion: This case demonstrates the effectiveness of dome osteotomy in correcting adult cubitus varus deformity. The technique provides precise correction by targeting the center of rotation of angulation, ensuring superior bone contact and stability. It also minimizes periosteal dissection, reducing the risk of thermal necrosis and preserving bone length. As compared to other osteotomy techniques, dome osteotomy allows for correction in multiple planes and achieves better functional and cosmetic outcomes, despite being technically demanding. Conclusion: Dome osteotomy is an effective surgical option for correcting cubitus varus deformity in adults, providing excellent functional and aesthetic results. This case highlights the importance of precise preoperative planning and meticulous surgical execution for optimal outcomes in patients with complex deformities.

Effect of Bone Microstructure Derived From CBCT on the Accuracy of Robot-Assisted Implant Surgery: A Retrospective Study.

The aim of this study was to investigate the influence of bone microstructure on the accuracy of robot-assisted dental implant surgery. This retrospective study analyzed 52 patients who received robot-assisted implant surgery between January 2023 and October 2023. Cone beam computed tomography (CBCT) scans were used to evaluate bone microstructural parameters, including the bone volume (BV), tissue volume (TV), bone volume fraction (BV/TV), bone surface (BS), bone surface fraction (BS/BV), trabecular thickness (Tb.Th), and trabecular separation (Tb.Sp). Preoperative and postoperative CBCT data were used to evaluate implant accuracy, and the relationship between bone microstructure parameters and implant deviation including platform deviation, apex deviation, and angular deviation was statistically analyzed. In robot-assisted implant surgery, BS/BV was a potential facilitator of several implant deviations, while BV/TV and Tb.Th were potential inhibitors of apex global deviation and angular deviation, respectively. Implant deviations were divided into two groups of large and small deviations by median, and the receiver operating characteristic (ROC) curve analysis showed that Tb.Th had the largest area under the ROC for predicting large apex global deviation, 0.711 (p < 0.001), with an optimal cutoff value > 0.179, a sensitivity and specificity of 70.37% and 76.92%. The study concluded that bone microstructure might affect the accuracy of dental implant placement in robotic surgeries. Incorporating bone quality assessments into preoperative planning may enhance the precision and outcomes of implant procedures, highlighting the potential for further refinement in robotic-assisted dental surgery techniques. ClinicalTrials.gov identifier: ChiCTR2400085813.

Stress shielding influences shoulder function after reverse shoulder arthroplasty using a short stem at minimum 2 years follow-up and can be predicted using a preoperative planning software: A retrospective cohort study

Background The aim of the study was to assess if 3D CT-scan-based planification of distal filling ratio (DFR) is accurate when compared to postoperative DFR calculated on plain X-rays. A secondary aim was to investigate if an association between clinical outcomes and the degree of stress shielding (SS) exists. Methods Fifty patients with short-stem reverse shoulder arthroplasties, preoperative CT scans, and a minimum 24-month radiographic follow-up were included in the study. At 24 months follow-up, all patients were evaluated by assessing the postoperative filling ratios, the 3D DFRs, the simple shoulder test, Constant-Murley score, and visual analogue scale through a prospectively data collection and statistically analyzed. Results A correlation between the 3D DFR and SS onset (rs 0.54; P &lt; 0.001), and between postoperative DFR and SS (rs 0.71; P &lt; 0.001), was found. The 3D DFR and the postoperative DFR were correlated (rs 0.89; P &lt; 0.0001). SS negatively affects the postoperative range of motion, decreasing the forward elevation of the shoulder. Conclusion The calculation of DFR based on 3D CT planning is a good predictor of humeral SS after short-stem RTAs. The presence of SS decreases clinical outcomes by lowering the anterior elevation of the shoulder. Level of evidence Case series.

The Assessment of the Prevalence of Impacted Third Molars, Its Relation to Space Available for Eruption, and Its Effect on the Adjacent Second Molar in Adults From 18 to 65 Years of Age Using Orthopantomograms: A Retrospective Cross-Sectional Study.

Introduction Third molar impaction surgeries are part of the most common minor oral surgeries performed by maxillofacial surgeons. In spite of being part of the everyday evaluation, the importance of preoperative planning and intraoperative and postoperative complications cannot be overlooked. This study aims to evaluate the prevalence, patterns, available eruption space, and impact of third molar impaction on the adjacent second molar in an adult population. Methods A retrospective observational cross-sectional study was conducted over a total of 380 panoramic radiographs from patients aged 18-65 years, which was analyzed to assess the incidence, angulation, and space available for the eruptionof impacted third molars and their effects on the adjacent second molars. Orthopantomograms (OPGs) from January 2023 to December 2023 were included in the study. A total of 1280 third molarsfrom 380 OPGs were studied encompassing an extensive range of demographics. Results The results showed that54.7%(208/380) of the studied population had at least one impacted third molar, with a higher prevalence in the mandibular arch. Vertical impaction was the most common pattern (224/419, 53.46%), followed by mesioangular (92/419, 21.95%), horizontal (85/419, 20.28%), and distoangular (18/419, 4.29%) impactions. Notably, the study found a relevant association between impacted third molars and the development of distal caries in the adjacent second molar (76/419, 18.13%). These findings highlight the importance of early radiographic evaluation of impacted third molars to prevent potential damage to adjacent teeth and inform clinical decisions regarding the management of such cases. The study also highlights that there is a significant amount of third molar impaction seen in women (211/380, 55.52%) compared to men, and the age group range with the highest incidence of third molar impaction is 18-25 years (399/1280, 31.20%). Additionally, a significant number of mandibular impacted third molars present with some level of nerve involvement, whereas more than 80% of maxillary impacted third molars showed sinus approximation. This study also presents a novel concept of "eruption space ratio," which is the ratioof the mesiodistal width of the crown of the third molar to the space available posterior to the second molar for eruption. When it was compared to the angulation, a substantial link was seen, although none was seen in relation to the level of impaction. Conclusion This study underlines the need for proactive dental care in populations with a high prevalence of third molar impaction, aiming to mitigate the risks to the adjacent second molars and to eliminate possible postoperative complicationsthrough timely intervention.

Maxillary reconstruction using the “Autoplan” software

The aim of the study: to improve the functional and aesthetic results of surgical treatment of maxillary defects using additive technologies and the “Autoplan” software. Materials and methods. The study included 110 patients (60 - main group and 50 - control group) with maxillary defects. In patients of the main group with maxillary defects, a 3-stage algorithm was used using the “Autoplan” software. The postoperative results were assessed 6 months after the operation and included the following parameters: functional, aesthetic result, and surgery time. Results. In the main group, a good aesthetic result was achieved in 29 (48.33%) cases, in the control group - in 17 (34%) (p0.05). Main group, good speech quality was achieved in 31 (86.11%) cases, control group - 22 (78.57%) (p0.05). Main, an unrestricted diet was noted in 26 cases (72.22%), control - 18 (64.29%) (p0.05). The mean time of the reconstructive stage using scapular flap: main - 210±35 minutes, control - 300±35 min (time reduction by 30±13.4%); fibular flap: main - 180±16 min, control - 260±36 min (time reduction by 30, 77 ± 11.2%); ALT flap: main - 175±17 min, control - 220±33 min (time reduction by 20.45±13.3%); radial flap: group — 130±12 min, control — 170±12 min (time reduction by 23.53±8.1%). Conclusion. We can assume that the use of additive technologies, individualized fixation systems and preoperative planning is an integral part of modern reconstructive surgery, which in practice allows to reduce the time of surgery, as well as to obtain good functional and aesthetic results.

Navigating challenges and maximizing potential: Handling complications and constraints in minimally invasive surgery

Abstract Minimally invasive surgery (MIS) has revolutionized the field of surgery by offering reduced trauma, faster recovery times, and improved patient outcomes compared to traditional open procedures. However, the widespread adoption of MIS is not without challenges, and managing complications and limitations is essential for optimizing patient safety and surgical efficacy. This study provides a comprehensive overview of the strategies employed in the management of complications and limitations associated with MIS. Complications in MIS can arise from various factors, including anatomical variations, unexpected bleeding, or difficulties in instrument manipulation. Recognizing the potential for complications is crucial, and surgeons must be equipped to make real-time decisions, including the possibility of converting to open procedures when necessary. Patient selection plays a pivotal role, with thorough preoperative assessments helping identify individuals who may be at higher risk for complications. Limitations in MIS are diverse and can stem from anatomical challenges, such as restricted access in confined spaces or complex structures. While technological advancements, such as robotic-assisted surgery and advanced imaging, have mitigated some limitations, ongoing efforts are directed toward overcoming challenges related to limited range of motion and maneuverability in intricate anatomical locations. Strategies for the management of complications and limitations involve a multidisciplinary approach. Surgeon training and proficiency in MIS techniques are paramount, emphasizing the importance of ongoing education and simulation-based training. Thorough preoperative planning, including a comprehensive assessment of patient history and anatomical considerations, helps anticipate potential challenges. Additionally, advancements in technology, such as enhanced imaging and robotic-assisted systems, contribute to improved visualization and precision during MIS. Regular maintenance and calibration of equipment, along with an emphasis on team communication and collaboration, further enhance the safety and effectiveness of MIS. The management of complications and limitations in MIS requires a holistic approach, encompassing surgical expertise, technological innovations, and meticulous preoperative planning. By addressing these challenges, the field of MIS continues to evolve, offering patients minimally invasive options with enhanced safety and efficacy.

The impact of bicuspid valve morphology on the selection of TAVI devices: an in-silico study

Abstract Aims Bicuspid aortic valve (BAV) represents a challenge for transcatheter aortic valve implantation (TAVI). Few data are reported about the procedural implications of BAV using different self-expandable devices. The aim of this study is to investigate how BAV and tricuspid aortic valve (TAV) morphologies influence device selection and their impact on the potential development of post-operative conduction disturbances, using a novel in-silico approach. Methods and Results Five patients with BAV undergoing TAVI were enrolled. TAVs were virtually modeled within each BAV patient-specific anatomy, resulting in ten virtual patients. Acurate Neo2 and Evolut R implantations were subsequentially simulated across all cases. Post-implantation stresses exerted on both the stent and aortic root were measured, allowing a comparative analysis of the impact of the two valve morphologies. Comparing stent stresses between BAV and TAV configurations, the stress gap increased by 21.96 ± 5.35 % (p = 0.01) in Acurate Neo2 cases (n = 6) compared to Evolut R cases (n = 4). The analysis of aortic root stresses showed no significant differences between BAV (n = 5) and TAV (n = 5) configurations, with a mean stress difference of 5.1 ± 8.17 % (p &amp;gt; 0.05). Conclusion Our patient-specific model shows that high radial force devices, such as Evolut R, demonstrate consistent expansion regardless of valve morphology, without increasing the risk of post-implantation conduction disturbances, hence resulting more suitable for BAV cases. Incorporating this methodology into pre-operative planning could support clinicians in selecting the most suitable device with a patient-specific approach.

Cervical pedicle screw placement with patient-specific 3D-printed guides: accuracy and safety in a clinical experience.

Cervical pedicle screw (CPS) instrumentation offers significant biomechanical advantages compared to lateral mass or transarticular fixation. Nonetheless, malpositioning complications constitute a relevant concern. Customized patient-specific 3D-printed templates have been developed to improve CPS placement accuracy and safety. The aim of this study is to present our experience with this surgical technique and its accuracy and safety in a clinical setting. This single-center retrospective observational study of prospectively collected data included patients undergoing CPS fixation surgery using a patient-specific 3D template guide system. All patients underwent a 3D-volumetric high-resolution CT scan of the cervical spine for preoperative surgical planning. Postoperative CT scans were used to evaluate pedicle perforation, CPS trajectories, and deviations between the planned and the actual screw position. A total of 115 CPS were implanted in 25 patients, with 107 (93.1%) of the screws completely placed inside the pedicle. Cortical breach within 2mm was observed in 8 (6.9%) cases, with no cases of more severe pedicle infractions or perioperative neurovascular complication. No differences of CPS accuracies were found between each metameric fusion level, and between monolateral or bilateral templates. Mean total deviations were 0.75mm vertically and 0.51mm horizontally at the screw entry point, and 0.72mm vertically and horizontally at the narrowest pedicle point. Mean total sagittal and transverse angular deviations were 2.94° and 3.04°, respectively. Cervical pedicle screw placement using patient-specific guides is safe and accurate, supporting the feasibility of this technique in posterior cervical spine fusion surgery.

Maxilla-first patient-specific osteosynthesis vs mandible-first bimaxillary orthognathic surgery using splints: a randomized controlled trial.

Patient-specific osteosynthesis plates and three-dimensional virtual surgical planning with patient-specific surgical guides have significantly advanced orthognathic surgery, enhancing surgical accuracy. This study compares the outcomes of the mandible-first approach using an intermediate splint and manually bent osteosynthesis plates with the maxilla-first approach utilizing patient-specific osteosynthesis fixation in bimaxillary orthognathic surgery. This multi-centre randomized controlled trial included 88 patients, with 77 completing the study. Patients were randomly assigned to either the 'mandible-first' group (mandible-first with an intermediate splint) or the 'maxilla-first with PSO' group (maxilla-first with patient-specific osteosynthesis). Postoperative evaluation using cone beam computed tomography images showed significantly lower deviations from the preoperative plan in the maxilla-first with PSO group compared to the mandible-first group, for anteroposterior (median 1.0mm vs 1.8mm, P = 0.008) and left/right translations (median 0.4mm vs 0.8mm, P = 0.003), and yaw rotation (median 0.5° vs 1.0°, P = 0.013). Regarding clinical accuracy (categorized as optimal, good, or suboptimal), 59.5% of the patients in the maxilla-first with PSO group had an optimal or good result compared to 17.5% in the mandible-first group. The study findings suggest the maxilla-first PSO approach offers enhanced accuracy, supporting its adoption in orthognathic surgery for better surgical outcomes.

Comprehensive Management of Bowel Endometriosis: Surgical Techniques, Outcomes, and Best Practices

Bowel endometriosis is a complex condition predominantly impacting women in their reproductive years, which may lead to chronic pain, gastrointestinal symptoms, and infertility. This review highlights current approaches to the diagnosis and management of bowel endometriosis, emphasizing a multidisciplinary strategy. Diagnostic methods include detailed patient history, physical examination, and imaging techniques like transvaginal ultrasound (TVUS) and magnetic resonance imaging (MRI), which aid in preoperative planning. Management options range from hormonal therapies for symptom relief to minimally invasive surgical techniques. Surgical interventions, categorized as shaving excision, disc excision, or segmental resection, depend on factors such as lesion size, location, and depth. Shaving excision is preferred for its minimal invasiveness and lower complication rates, while segmental resection is reserved for severe cases. This review also explores nerve-sparing strategies to reduce surgical morbidity, particularly for deep infiltrative cases close to the rectal bulb, anal verge, and rectosigmoid colon. A structured, evidence-based approach is recommended, prioritizing conservative surgery to avoid complications and preserve fertility as much as possible. Comprehensive management of bowel endometriosis requires expertise from both gynecologic and gastrointestinal specialists, aiming to improve patient outcomes while minimizing long-term morbidity.

Major approaches and scientific relevance of virtual surgery in implant dentistry: a systematic review

Introduction: Dental implant procedures have increased worldwide, reaching approximately one million dental implants per year the optimization of faster and more accurate techniques by dentists and postoperative surgeons with better results and quality of life stimulated the development of numerous software and hardware for performing computer-guided surgeries, the so-called Guided Surgeries (GS). Objective: The present study carried out a systematic review to highlight the optimization of the safety and effectiveness of digital dental implants. Methods: The rules of the Systematic Review-PRISMA Platform were followed. The research was carried out from June to July 2024 and developed based on Scopus, PubMed, Science Direct, Scielo, and Google Scholar. The quality of the studies was based on the GRADE instrument and the risk of bias was analyzed according to the Cochrane instrument. Results and Conclusion: A total of 112 articles were found. A total of 42 articles were fully evaluated and 14 were included in the systematic review. A total of 32 studies were excluded because they did not meet the GRADE criteria, and 20 studies were excluded because they had a high risk of bias. Preoperative virtual planning and reconstruction of the mandible guided by dental implants through preoperative designs provide high success rates for the implant and dental rehabilitation, benefiting also prosthetic restorations supported by fixed implants. Still, the concept of using personalized implants with the help of 3D virtual treatment planning, stereolithographic models, and computer-assisted design greatly improves mandibular restoration and helps to obtain a good facial profile, and aesthetic and dental rehabilitation, avoiding complications with autologous grafts.

Finite element stress analysis of the hindfoot after medial displacement calcaneal osteotomy with different translation distances.

The medial displacement calcaneal osteotomy (MDCO) is one of commonly used procedures to restore the hindfoot alignment of the flatfoot deformity. However, the selection of the amount of translation for MDCO and its biomechanical effect on the hindfoot was rarely reported. This study employs finite element analysis to investigate stress distribution in the hindfoot following MDCO across varying translation distances. An adult-acquired flatfoot deformity (AAFD) finite element (FE) model consisting of 16 bones, 56 ligaments, and soft tissues was used. MDCO procedure was simulated with the translation distance of 0mm, 2mm, 4mm, 6mm, 8mm, 10mm, 12mm, and 14mm. Contact pressure on the plantar surface, the articular surface of the tibiotalar joint and the subtalar joint, and von Mises stress on the resection surface of the calcaneus under different translation distances were analyzed and compared. Results showed the MDCO reduces 12.46 to 33.32% peak contact pressure on the plantar surface, the tibiotalar joint, and the posterior facet of the subtalar joint, and shifts pressure from lateral to medial. But the difference in peak pressure for different translation distances larger than 4mm was small. The MDCO also reduces the stress on the distal calcaneal resected surface. The study highlights the use of patient-specific computational modeling for preoperative plans.

Accuracy, Safety, and Efficiency in Robotic-Assisted vs. Freehand Dental Implant Surgery: A 6-Month Follow-Up Randomized Controlled Trial.

To assess the implant accuracy, safety, and efficiency between robotic-assisted and freehand dental implant placement with a half-year follow-up. Patients requiring single-tooth implant restorations were recruited and randomized into two groups: robotic-assisted surgery and freehand implant surgery. The accuracy of implant positioning was compared by assessing immediate postoperative CBCT scans against preoperative planning software. Intraoperative and postoperative complications were recorded, and data were analyzed using an intention-to-treat approach. The time required for implant placement in each group was documented. A 6-month follow-up measured the implant survival rates. The study included 24 patients (median age 36, 18 female). In the robotic-assisted surgery group, the average platform global deviation, apex global deviation, and angular deviation were 0.70 ± 0.11 mm, 0.70 ± 0.12 mm, and 1.09° ± 0.67°, respectively. In the freehand implant surgery group, these measures were 1.24 ± 0.59 mm, 2.13 ± 1.26 mm, and 7.43° ± 6.12°, respectively, with statistically significant differences. Regarding the duration of surgery, the robotic-assisted surgery group required 18.8 ± 4.89 min. Intraoperative and postoperative complications were similar across both groups, and the implant survival rate was 100% in both groups at the 6-month follow-up. This study found that robot-assisted implant placement offers higher accuracy in implant positioning compared to freehand placement, while requiring longer operation times. Future developments should focus on simplifying the registration and design of robot systems to enhance efficiency and facilitate their broader clinical adoption.

Breakthroughs in Skull Base Laboratory Training and Preoperative Planning: Lateral Thinking and Repurposing Old/Obsolete Imaging CDS

Breakthroughs in Skull Base Laboratory Training and Preoperative Planning: Lateral Thinking and Repurposing Old/Obsolete Imaging CDS