Preoperative Planning Technique Research Articles

Concordance between freehand SPECT and conventional scintigraphy for sentinel lymph node detection in breast cancer

IntroductionFreehand SPECT can be a useful imaging technique for preoperative planning of sentinel lymph node biopsy (SLNB) as it allows localization of the sentinel node by 3D and real-time tomographic imaging and determines its depth after a few minutes of scanning.The aim of the study was to evaluate the correlation between the number of detected SNs between freehand SPECT images and lymphoscintigraphy (LS). Materials and methods100 patients with a diagnosis of invasive breast cancer and no clinical evidence of lymph node involvement prospectively underwent SLNB. The preoperative study included freehand SPECT imaging at 15min after injection and LS imaging at 25 and 60−90min after injection (early and late). The observed agreement was analyzed and a concordance study was performed between the number of SNs detected with freehand SPECT and LS. ResultsThe observed agreement in the detection of SNs between freehand SPECT and early LS was 72%; between freehand SPECT and late LS was 85%; and between early and late LS was 87%. In the concordance study, there was moderate concordance between freehand SPECT and early LS (kappa coefficient: 0.42); moderate-high concordance between freehand SPECT and late LS (kappa coefficient: 0.60); and moderate-high concordance between early and late LS (kappa coefficient: 0.70), with no significant differences between them (p-value=0.16). ConclusionFreehand SPECT showed a moderate-high concordance with conventional imaging studies and could be a valid alternative for the presurgical study of SLNB in breast cancer.

Right-sided minimally invasive direct coronary artery bypass: Preoperative planning and surgical technique

Right-sided minimally invasive direct coronary artery bypass: Preoperative planning and surgical technique

Concordancia entre SPECT portátil y la gammagrafía convencional para detección de ganglio centinela en cáncer de mama

IntroductionFreehand SPECT can be a useful imaging technique for preoperative planning of sentinel lymph node biopsy (SLNB) as it allows localization of the sentinel node by 3D and real-time tomographic imaging and determines its depth after a few minutes of scanning.The aim of the study was to evaluate the correlation between the number of detected SNs between freehand SPECT images and lymphoscintigraphy (LS). Materials and methodsOne hundred patients with a diagnosis of invasive breast cancer and no clinical evidence of lymph node involvement prospectively underwent SLNB. The preoperative study included freehand SPECT imaging at 15min after injection and LS imaging at 25 and 60–90min after injection (early and late). The observed agreement was analyzed and a concordance study was performed between the number of SNs detected with freehand SPECT and LS. ResultsThe observed agreement in the detection of SNs between freehand SPECT and early LS was 72%; between freehand SPECT and late LS was 85%; and between early and late LS was 87%. In the concordance study, there was moderate concordance between freehand SPECT and early LS (kappa coefficient: 0.42); moderate-high concordance between freehand SPECT and late LS (kappa coefficient: 0.60); and moderate-high concordance between early and late LS (kappa coefficient: 0.70), with no significant differences between them (p-value=0.16). ConclusionFreehand SPECT showed a moderate-high concordance with conventional imaging studies and could be a valid alternative for the presurgical study of SLNB in breast cancer.

Advanced Preoperative Planning Techniques in the Management of Complex Proximal Humerus Fractures.

This review evaluates the current literature on the recent advances of preoperative planning in the management of complex proximal humerus fractures (PHF). PHFs canpose a considerable challenge for orthopaedic surgeons due to their diversity inpresentation and complexity. Poor preoperative planning can lead to prolongedoperations, increased blood loss, higher risk of complications, and increased stress on the surgical team. Recent advances have seen the evolution of preoperative planning from conventionalmethods to computer-assisted virtual surgical technology (CAVST) and three-dimensional (3D) printing, which have been highlighted as transformative tools for improvingpreoperative planning and postoperative outcomes. CAVST allows the creation of 3D renderings of patient-specific anatomy, clearlydemonstrating fracture patterns and facilitating detailed planning for arthroplasty orsurgical fixation. The early studies show promising outcomes however the literaturecalls for more high-quality randomised controlled trials. Using 3D printing for high-fidelity simulation involving patient-specific physicalmodels offers an immersive experience for surgical planning. Preoperative planningwith 3D printing reduces operative time, blood loss and use of fluoroscopy. Thetechnology's potential to produce customisable surgical implants further improves itsversatility. There is a need for a cost analysis for the use of these technologies within theorthopaedic field, particularly considering the high expense of 3D printing materials andextended hospital stays until the printed models are available. CAVST and 3D printing also show promising applications within high-fidelity simulationsurgical training, with CAVST offering possibilities in virtual reality and haptic-enhancedsimulations and 3D printing providing physical models for trainee surgeons to honetheir skills. Moving forward, a reduction in the cost of 3D printing and the advancement of CAVSTusing artificial intelligence would lead to future improvement. In conclusion,preoperative planning supported by these innovative technologies will play a pivotalrole in improving surgical outcomes and training for complex PHF cases.

Wound healing and postoperative management in paediatric patients following 27-Gauge Transconjunctival Sutureless Vitrectomy for vitreoretinal conditions.

The utilization of 27-G TSV, or 27-Gauge Transconjunctival Sutureless Vitrectomy, poses distinct difficulties in the context of paediatric patients, particularly those younger than 14 years old, on account of the dearth of exhaustive documentation concerning the efficacy and results of these operations. Therefore, this retrospective study was to evaluate the safety and efficacy of 27-G TSV in paediatric patients, with emphasis on management of intraoperative and postoperative complications and postoperative wound healing. A total of 54 eyes of 52 paediatric patients who underwent 27-G TSV at Sichuan Provincial People's Hospital were included in the study. The average duration of follow-up was 9.32 ± 3.35 months. The complication with the highest incidence rate was Rhegmatogenous Retinal Detachment (RRD), which was detected in 27.8% cases. Familial Exudative Vitreoretinopathy (FEVR) and Persistent Fetal Vasculature (PFV) each accounted for 16.7% of the cases. Retinopathy of Prematurity (ROP) and Vitreous Haemorrhage (VH) constituted 11.1% and 14.8%, respectively, of the reported cases. Lens injury (1.9%), cannula slippage (7.4%) and wound leakage (5.6%) were intraoperative complications. Iatrogenic retinal detachment occurred at 3.7%. Hypotony (10.8% of patients), vitreous haemorrhage (9.3%), cataract formation (9.3%), ocular hypertension (8.1%) and retinal detachment (5.6%) were postoperative complications. Effective management strategies were executed, such as performing in situ trocar puncture to address cannula slippage and promptly suturing to address wound leakage. 27-G TSV exhibited promise as the therapeutic alternative for range of vitreoretinal disorders in paediatric patients, accompanied by complications that were controllable during and after the procedure. Strict preoperative planning and precise surgical technique are indispensable in order to maximize patient outcomes and guarantee effective wound healing and recovery within this particular demographic.

3D printing-assisted total hip arthroplasty and internal fixation for the treatment of fresh acetabular fracture and femoral head necrosis: A case report

Rationale: Posterior wall comminuted fractures of the acetabulum are typically caused by high-energy trauma, and the complex anatomical structure of the acetabulum makes their treatment challenging. However, reports of the treatment of fresh acetabular fractures combined with femoral head necrosis are extremely rare. Patient concerns: A 57-year-old male, injured in a car accident, presented with right hip pain and limited mobility. At the age of 50, the patient was diagnosed with avascular necrosis of the right femoral head, experiencing right hip pain and a limp while walking, for which conservative treatment was initiated. Diagnosis: The patient was clinically diagnosed with fresh comminuted posterior wall acetabular fracture and late-stage femoral head necrosis. Interventions: We applied 3D printing technology and computer-assisted virtual surgical techniques for preoperative planning, simulated fracture reduction, and designed personalized bone plates and screws for fixation of the posterior wall of the acetabulum. A single-stage total hip arthroplasty was performed to treat femoral head necrosis. Outcomes: He began walking with the assistance of a walker 1 month after surgery, and at 6 months post-surgery, the acetabular posterior wall fracture had effectively healed, allowing the patient to return to work. Lessons: The application of 3D printing technology in acetabular internal fixation and total hip arthroplasty is helpful for fracture assessment, facilitates smooth surgery, promotes fracture reduction and healing, restores hip joint function, and ensures a high level of safety.

Maintaining Posterior Tibial Slope and Patellar Height During Medial Opening Wedge High Tibial Osteotomy

Background: Increased posterior tibial slope (PTS) and decreased patellar height (PH) after medial opening wedge high tibial osteotomy (MOWHTO) have been repeatedly reported in the literature. However, this has been disputed in more recent biomechanical studies. Hypothesis: No change in PTS or PH would result after MOWHTO with the freehand technique, regardless of the degree of the coronal plane correction. Study Design: Case series. Methods: A total of 62 patients who underwent MOWHTO between 2018 and 2020 were included. Surgery was performed using a dedicated step-by-step protocol to reduce the risk of unintentional slope changes. All patients were evaluated preoperatively and at a 2-year follow-up with the Knee injury and Osteoarthritis Outcome Score and the University of California, Los Angeles physical activity scale. Pre- and postoperative radiographic lower limb alignment parameters—including hip-knee-ankle angle (HKA), medial proximal tibial angle (MPTA), mechanical lateral distal femoral angle, proximal posterior tibial angle (PPTA), joint line convergence angle, and joint line obliquity—were measured on full-length lower limb radiographs. PH measurements assessed on lateral and anteroposterior knee radiographs included the Caton-Deschamps, Insall-Salvati, and Schröter indices. Results: A significant change was observed in the coronal plane alignment, with an increase in the MPTA from 84.38° to 90.39° ( P < .001) and a consequent increase in the HKA from 172.19° to 180.15° ( P < .001). No significant changes were observed in the PTS, as evidenced by a postoperative PPTA of 80.6° versus a preoperative value of 80.4° ( P = .2). No significant changes were detected in the mean PH on all 3 indices used—pre- versus postoperative Caton-Deschamps, Insall-Salvati, and Schröter indices measured 0.95 versus 0.93 ( P = .2), 1.03 versus 1.03 ( P = .5), and 1.56 versus 1.54 ( P = .3), respectively. Conclusion: In this study, MOWHTO did not result in significant changes in the PTS or PH when accurate preoperative planning and precise intraoperative freehand technique were adopted..

Comparison and interobserver reliability of three different methods for measuring the amount of the tibial tuberosity advancement in the preoperative planning of TTAT.

The goal of preoperative planning techniques for advancement of the tibial tuberosity is to determine the amount of advancement required to achieve a postoperative patellar tendon angle of 90° and to select the optimal wedge size to achieve this target. Three radiographic methods for determining the advancement distance for the tibial tuberosity were evaluated for comparability and interobserver reliability. Among the methods developed, we decided to include the common tangent method, the tibial anatomy-based method, and the Bielecki method. For all techniques, radiographs were taken in mediolateral projection with the knee joint flexed at 135°. Three observers with different levels of experience independently evaluated and scored the degree of osteoarthritis for each stifle, as previously described, and performed measurements of the amount of advancement of the tibial tuberosity on 33 stifles using common tangent method, tibial anatomy-based method, and Bielecki method. According to the results, the overall score for osteoarthritis in the mediolateral view was influenced by the experience of the observers, which contradicts the results from a previous study. Regarding the measurement methods used to assess advancement, poor interobserver reliability was found for common tangent method and Bielecki method, while only a slightly moderate interobserver agreement was found for tibial anatomy-based method. These results are inconsistent with data collected by Bielecki and colleagues. Moreover, measurements from common tangent method and tibial anatomy-based method were overlapping, as confirmed previously. Conversely, Bielecki method showed no agreement with the other methods included in the present study, with a significantly higher mean rank, probably due to its correction formula. Based on the results of the present study, tibial anatomy-based method has better interobserver reliability and is easier to perform according to the observers.

Accuracy of Preoperative 3D vs 2D Digital Templating for Cementless Total Hip Arthroplasty Using a Direct Anterior Approach

BackgroundAn important aspect of preoperative planning for total hip arthroplasty is templating. Although two-dimensional (2D) templating remains the gold standard, computerized tomography (CT)-based three-dimensional (3D) templating is a novel preoperative planning technique. This study aims to compare the accuracy of a 2D and 3D plan using an anterior approach for the placement of the same uncemented prosthesis. MethodsTwo consecutive cohorts of 100 patients each were retrospectively analyzed. We analyzed the accuracy of the size of the implant (stem, cup, head), the length of head, and offset. As a secondary criterion, we analyzed the rates of stems with more than 3° of varus, fracture, and/or subsidence at 3 months postoperatively. ResultsWithin the exact size, the accuracy of the stem and cup size with the 2D plan was 69% and 56%, respectively. With the 3D plan accuracy being 88% (P = .0046) and 96% (P < .0001), respectively. Regarding size and length of the implant head, accuracy was 86% and 82% with the 2D plan and 100% (P < .0001) and 94% (P = .016), respectively, with the 3D plan. The offset of the implants increased beyond 3 mm in 23% of patients in the 2D group and in 5% of patients in the 3D group (P = .0003). The rate of varus stems was 10% in the 2D group and 2% in the 3D group (P = .03). Two fractures and one case of subsidence occurred in the 2D group. None were identified in the 3D cohort. ConclusionsA CT-based 3D plan is more accurate for implant size selection, allows better prosthetic offset, and reduces the rate of varus stems.

Preoperative planning in reverse shoulder arthroplasty: plain radiographs vs. computed tomography scan vs. navigation vs. augmented reality.

Reverse shoulder arthroplasty (RSA) has become a highly successful treatment option for various shoulder conditions, leading to a significant increase in its utilization since its approval in 2003. However, postoperative complications, including scapular notching, prosthetic instability, and component loosening, remain a concern. These complications can often be attributed to technical errors during component implantation, emphasizing the importance of proper preoperative planning and accurate positioning of prosthetic components. Improper baseplate and glenosphere positioning in RSA have been linked to impingement, reduced range of motion, and increased scapular notching. Additionally, the relationship between component positioning and intrinsic stability of RSA has been established, with glenoid component retroversion exceeding 10° posing a risk to implant stability. Adequate initial glenoid baseplate fixation, achieved through optimal seating and the use of appropriate screws, is crucial for long-term success and prevention of early failure. Factors such as lateralization and distalization also influence outcomes and complications in RSA, yet standardized guidelines for preoperative planning in these parameters are still lacking. Despite the impact of component position on outcomes, glenoid component implantation remains challenging, with position errors being common even among experienced surgeons. Challenges arise due to factors such as deformity, bone defects, limited exposure, and the absence of reliable bony landmarks intraoperatively. With the evolving understanding of RSA biomechanics and the significance of implant configuration and positioning, advancements in preoperative planning and surgical aids have emerged. This review article explores the current evidence on preoperative planning techniques in RSA, including plain radiographs, three-dimensional imaging, computer planning software, intraoperative navigation, and augmented reality (AR), highlighting their potential benefits and advancements in improving implant position accuracy.

Mako™ Robotic-Arm Assisted Medial Unicompartmental Knee Arthroplasty: Surgical Technique from the Office to the Operating Room.

The utilization of robotic-arm assisted unicompartmental knee arthroplasty (UKA) or partial knee arthroplasty (PKA) for the treatment of medial unicompartmental osteoarthritis has continued to increase. This is in part due to the consistently reproducible accuracy and precision of implant planning, intra-operative ligament balancing software, tracking optimization software, robotic-arm assisted bone preparation, excellent survivorship rates, and improvements in many patient-reported outcomes compared to manual UKA, using the Stryker Mako™ Robotic Partial Knee System (Stryker, Mako Surgical Corp., Mahwah, New Jersey). Training in the utilization of robotic-arm assistance can be time-consuming and comes with an associated learning curve even after the in-person training and coursework is complete, like most procedures. Therefore, our aim was to describe the pre-operative planning and intra-operative surgical technique for using a robotic-arm assisted partial knee system for UKA/PKA in patients who have unicompartmental medial knee osteoarthritis. Specifically, we will discuss: 1) pre-operative planning; 2) operative setup; 3) intra-operative steps; 4) execution of the plan; and 5) trialing, implantation, and final assessments.

CHANGES IN THE POSTERIOR TIBIAL SLOPE AND PATELLAR HEIGHT IN MEDIAL OPENING WEDGE HIGH TIBIAL OSTEOTOMIES: ARE THEY INEVITABLE OR SURGICAL ERRORS?

AbstractIntroductionChanges in posterior tibial slope (PTS) and patellar height (PH) following proximal tibial osteotomies have been a recent focus for knee surgeons. Increased PTS and decreased PH following medial opening wedge high tibial osteotomy (MOWHTO) have been repeatedly reported in the literature. However, this has been disputed in more recent biomechanical studies.MethodologyA total of 62 cases who underwent MOWHTO were included. Surgery was performed using a dedicated step-by-step protocol focusing on the risks of unintentional slope changes. Clinically, all patients were evaluated preoperatively and at 2 years follow-up with the KOOS scores and UCLA physical activity scale. Preoperative and postoperative radiographic lower limb alignment parameters were measured on full-length lower limb radiographs, including (HKA), (MPTA), (mLDFA), proximal posterior tibial angle (PPTA), (JLCA) and(JLO). PH measurements were assessed on radiographs.ResultsThere was a significant change in the coronal plane alignment; the mMPTA changed from 84.38° to 90.39°, and the HKA changed from 172.19° to 180.15° (Both P &lt; 0.0001). There was no significant change in the PTS as evidenced by a postoperative PPTA of 80.56 ° from a preoperative of 80.36°. And no significant change in the PH with all the indices; preoperative Caton Deschamps, Insall Salvati, and Schröter indices measured 0.95, 1.03, and 1.56, respectively. In comparison to postoperative measures of 0.93, 1.03, and 1.54, respectively.ConclusionMOWHTO does not change the PTS or PH when accurate preoperative planning and precise intraoperative freehand technique are adopted. Involuntary modification of these anatomic parameters should be considered surgical errors.

Literature Review of Flaps in Reconstructive Surgery: Definition, Indications, Complications and Management

this literature review article, the topic of flaps in reconstructive surgery will be addressed in detail, focusing on their definition, indications, complications and management. The epidemiology of flaps and their significance in clinical practice will be explored. The methods used for the implementation of flaps will be discussed, highlighting the importance of preoperative planning and surgical techniques. In addition, the complications associated with flaps will be discussed and a comprehensive discussion on the advantages and challenges of their use in reconstructive surgery will be presented. A conclusion summarising the key aspects of this review will be provided

Facial Feminization Surgery: Preoperative Planning and Surgical Technique for a Harmonious Outcome.

Feminization of the face is as important as genital or chest surgeries in alleviating gender incongruence in transgender individuals. It comprises a myriad of procedures that address the skeletal and/or soft tissue components to give a harmonious result. The surgeries are custom-tailored for each individual based on facial anatomy as well as her desired changes for optimal results. A thorough understanding of the differences in male and female facial anatomy is crucial. The use of computed tomographic imaging with three-dimensional reconstruction and stereolithography models can greatly improve the planning as well as execution of these surgeries. There is an increase in demand for these surgeries, with a paucity of centers providing them. The aim of this article is to highlight the comprehensive facial feminization procedures, which have a high patient as well as surgeon satisfaction rate.

Fixation dans le sacrum proximal avec des vis ilio-sacrées convergentes : modification technique pour la planification préopératoire et résultats d’une série de cas

IntroductionThere are some situations where pelvic surgeons may want to place iliosacral screws with differing trajectories (Sacroiliac and Sacral styles) but may not be able to because of overlapping trajectories. HypothesisSacroiliac and Sacral style screws can be placed in S1 in select patients by using a preoperative planning technique off the 3D reconstructed surface rendered preoperative CT scan. Materials/methodsRetrospective review of all patients receiving iliosacral screws using the described technique. ResultsSix patients received iliosacral screws using the described technique. When the preoperative planning technique demonstrated feasibility, all screws were able to be safely placed. DiscussionPlacing Sacroiliac and Sacral style screws within S1 may be ideal in some injury patterns. The described technique allows pelvic surgeons facile in iliosacral screw techniques to preoperatively plan for this construct. Level of evidenceVI; Retrospective case series.

Optimizing Surgical Performance Using Preoperative Virtual Reality Planning: A Systematic Review.

Surgery is often a complex process that requires detailed 3-dimensional anatomical knowledge and rigorous interplay between team members to attain ideal operational efficiency or "flow." Virtual Reality (VR) represents a technology by which to rehearse complex plans and communicate precise steps to a surgical team prior to entering the operating room. The objective of this study was to evaluate the use of VR for preoperative surgical team planning and interdisciplinary communication across all surgical specialties. A systematic review of the literature was performed examining existing research on VR use for preoperative surgical team planning and interdisciplinary communication across all surgical fields in order to optimize surgical efficiency. MEDLINE, SCOPUS, CINAHL databases were searched from inception to July 31, 2022 using standardized search clauses. A qualitative data synthesis was performed with particular attention to preoperative planning, surgical efficiency optimization, and interdisciplinary collaboration/communication techniques determined a priori. Preferred Reporting Items for Systematic Review and Meta-Analysis guidelines were followed. All included studies were appraised for their quality using the Medical Education Research Study Quality Instrument (MERSQI) tool. One thousand and ninety-three non-duplicated articles with abstract and full text availability were identified. Thirteen articles that examined preoperative VR-based planning techniques for optimization of surgical efficiency and/or interdisciplinary communication fulfilled inclusion and exclusion criteria. These studies had a low-to-medium methodological quality with a MERSQI mean score of 10.04 out of 18 (standard deviation 3.61). This review demonstrates that time spent rehearsing and visualizing patient-specific anatomical relationshipsin VR may improve operative efficiency and communication across multiple surgical specialties.

Assessment of sacral osseous fixation pathways for same-level dual transiliac-transsacral screw insertion.

The purpose of this study is to (1) describe a pre-operative planning technique using non-reformatted CT images for insertion of multiple transiliac-transsacral (TI-TS) screws at a single sacral level, (2) define the parameters of a sacral osseous fixation pathway (OFP) that will allow for insertion of two TI-TS screws at a single level, and (3) identify the incidence of sacral OFPs large enough for dual-screw insertion in a representative patient population. Retrospective review at a level-1 academic trauma center of a cohort of patients with unstable pelvic injuries treated with two TI-TS screws in the same sacral OFP, and a control cohort of patients without pelvic injuries who had CT scans for other reasons. Thirty-nine patients had two TI-TS screws at S1. Eleven patients, all with dysmorphic osteology, had two TI-TS screws at S2. The average pathway size in the sagittal plane at the level the screws were placed was 17.2mm in S1 vs 14.4mm in S2 (p = 0.02). Twenty-one patients (42%) had screws that were intraosseous and 29 (58%) had part of a screw that was juxtaforaminal. No screws were extraosseous. The average OFP size of intraosseous screws was 18.1mm vs. 15.5mm for juxtaforaminal screws (p = 0.02). Fourteen millimeters was used as a guide for the lower limit of the OFP for safe dual-screw fixation. Overall, 30% of S1 or S2 pathways were ≥ 14mm in the control group, with 58% of control patients having at least one of the S1 or S2 pathways ≥ 14mm. OFPs ≥ 7.5mm in the axial plane and 14mm in the sagittal plane on non-reformatted CT images are large enough for dual-screw fixation at a single sacral level. Overall, 30% of S1 and S2 pathways were ≥ 14mm and 58% of control patients had an available OFP in at least one sacral level.

Three-Dimensional Versus Two-Dimensional Laparoscopy in Laparoscopic Liver Resection: A Systematic Review and Meta-Analysis.

Background: Three-dimensional (3D) laparoscopy provides stereopsis and may reduce operating time (OT) and morbidity. However, there is a paucity of literature on its use in laparoscopic liver resection (LLR). This study aims to compare outcomes between 3D and two-dimensional (2D) LLR. Materials and Methods: PubMed, Embase, Scopus, and the Cochrane Library were systematically searched from inception to November 2022. The inclusion criterion was studies comparing intraoperative characteristics and/or postoperative outcomes between 3D and 2D LLR. Studies on the use of 3D image reconstruction techniques for preoperative planning were excluded. Primary outcomes were OT, estimated blood loss (EBL), and overall morbidity. Secondary outcomes were other postoperative complications, need for reoperation, and in-hospital mortality. Results: Four studies with 361 patients (3D: n = 159, 2D: n = 202) were included. There were 65.3% males (overall: n = 236/361). Age, sex, body-mass index, incidence of diabetes mellitus, hepatitis B and/or C carrier, receipt of neoadjuvant chemotherapy, tumor size, and incidence of multiple tumors were comparable between 3D and 2D LLR. No studies reported on Child-Pugh status. One study included only patients with hepatocellular carcinoma, two studies included patients with mixed histopathology, and one study did not report on histopathology. There was no significant difference in OT (mean difference [MD] -31.6 minutes, 95% confidence interval [CI]: -89.7 to 26.5), EBL (MD -454.1 mL, 95% CI: -978.8 to 70.6), need for reoperation (odds ratio [OR] 0.91, 95% CI: 0.18-4.61), and in-hospital mortality (OR 0.52, 95% CI: 0.06-5.50) between 3D and 2D LLR. Overall morbidity was lower in 3D LLR (OR 0.56, 95% CI: 0.32-0.98, P = .04). However, the learning curve (LC) was not described in the included studies and may confound outcomes. Conclusions: 3D LLR may reduce overall postoperative morbidity compared with 2D LLR, but results may be confounded by the lack of standardization of surgeons' experience and the LC of 3D LLR.

Transposition of functioning muscles in complex treatment of adult patients with injuries of the bracheric plexus (literature review)

Introduction. Injuries to the brachial plexus are one of the most severe types of injuries to the nerves of the upper limb, and variants with the separation of the roots from the spinal cord represent a very difficult category of injuries to treat. Among patients who have received such injuries, there is a very high incidence of disability, since it is possible to achieve only partial restoration of the function of the upper limb. Recently, the method of transposition of functioning muscles has been growing in popularity due to its reliability and relatively short recovery time of function.The purpose of the work is to analyze the literature data on the possibility of using the method of transposition of functioning muscles in the complex treatment of victims with brachial plexus injuries.The authors have searched PubMed and RSCI databases over the past 25 years for keywords: peripheral nerve damage, tendon transposition, transposition of functioning muscles, nerve injury, brachial plexus injury, spinal cord root avulsion. In the selected 23 most relevant papers, the muscles used for transposition, indications and timing of operations, results and complications were analyzed, compared with other methods of surgical treatment of brachial plexus injuries. The analysis of studies has shown that the transposition of functioning muscles allows in most cases to restore the target movement to the useful level of M3–M4 on the MRC scale, is a more reliable method and allows achieving better results, especially in patients with severe complete injuries of the brachial plexus. An important disadvantage of free hip thin muscle transplantation operations is the risk of microanastomosis thrombosis, which requires detailed preoperative planning and good microsurgical technique of the operating team.Conclusion. Free transplantation of 2 functioning muscles is currently the method of choice for restoring upper limb movements in patients with complete brachial plexus injuries.

ЛАПАРОСКОПИЧЕСКАЯ ПИЕЛОПЛАСТИКА ПРИ ГИДРОНЕФРОЗЕ ПОДКОВООБРАЗНОЙ ПОЧКИ У МАЛЬЧИКА 3 ЛЕТ

Authors describe a clinical case of a combination of a horseshoe kidney and hydronephrosis of its left half in a 3-year-old male patient and laparoscopic pyeloplasty of the identified pathology. Based on the results of preoperative CT, the diagnosis was confirmed and obstruction of the pyeloureteral segment was found as a source of hydronephrosis. Laparoscopic surgery made it possible to clarify the anatomy of the horseshoe kidney and the reason for the pyeloureteral segment obstruction in the form of a high discharge of the ureter from the pelvis. The Anderson-Hynes pyeloplasty with pelvic stenting was performed. The duration of the surgical intervention was 70 minutes. The need for analgesia persisted for 1 day (paracetamol 15 mg/kg/8 h). The drainage tube was removed after a follow-up ultrasound examination on the 3rd day, after which the patient was discharged for outpatient follow-up. The duration of follow-up was 6 months. The patient was asymptomatic throughout the control period. Repeated ultrasound performed 6 months after the surgical intervention revealed a decrease in the anteroposterior diameter of the pelvis to 8 mm. Conclusion: laparoscopic pyeloplasty is a feasible and safe procedure in patients with complex renal anatomy accompanied by the pyeloureteral segment obstruction. Accurate preoperative planning and standardized technique are the keys to successful treatment.