Preoperative Planning Research Articles (Page 1)

Four-dimensional computed tomography (4DCT) is a well-established modality for preoperative localization of parathyroid adenomas1-3. However, the relationship between enhancement patterns and histologic features such as lesion cellularity remains unclear. This study evaluates whether enhancement patterns correlate with lesion cellularity in surgically confirmed parathyroid adenomas. A retrospective cohort study was performed on 134 patients (194 parathyroid lesions) who underwent 4DCT for preoperative localization and subsequent parathyroidectomy. After excluding lesions that were not visualized on 4DCT, not resected, or lacked pathology data on cellularity, 121 lesions in 95 patients were included in the final analysis. Enhancement patterns were categorized into Type A, B, or C based on previously published criteria4. Cellularity was dichotomized into increased and non-increased groups using an 80% cutoff. Mixed effect logistic regression analysis was performed to adjust for potential confounders. Among the 121 lesions with reported enhancement pattern and cellularity, 26 (21.5%) exhibited Type A enhancement, 65 (53.7%) Type B, and 30 (24.8%) Type C. Increased cellularity was observed in 88 lesions (72.7%). Type A enhancement was independently associated with increased cellularity (OR 6.1, 95% CI 1.3-29.3, p=0.02) after adjusting for confounders. Larger lesion size was also a significant predictor of increased cellularity (p<0.001). No significant correlation was found between enhancement category B or C and cellularity. Type A enhancement on 4DCT is independently associated with increased cellularity in parathyroid adenomas. These findings suggest that enhancement kinetics may serve as a surrogate marker for histologic features, providing additional information for preoperative planning and surgical decision-making. 4DCT = four-dimensional contrast-enhanced computed tomography neck; MGD = multi-gland disease; pHPT = primary hyperparathyroidism; PTH = parathyroid hormone; SPECT = single photon emission-computed tomography.

The digitalization of numerous dental workflows has significantly expanded the possibilities of digital treatment planning in recent years. By using additively manufactured templates and guides, preoperative planning can be realized reliably and minimally invasively on the patient. However, these devices may break under mechanical stress during use, so that fragments may remain in the surgical field, be swallowed or aspirated. This study investigates the radiologic detectability of additively manufactured materials in surrounding soft tissue. The visual detectability of standardized scan bodies and splinters of 15 different materials used in dentistry was analyzed using cone-beam computed tomography (CBCT). Porcine muscle and subcutaneous tissue were used as surrounding structures. In addition, computed tomography (CT) was used to measure the radiation densities of the materials in Hounsfield units to obtain quantitative reference values for the recognizability of the materials in comparison with soft tissues. The radiodensities in CT images of all modern materials used in computer-aided manufacturing ranged from 68.94 ± 5.32 HU to 130.47 ± 4.52 HU and were thus very similar to those of muscle tissue. In CBCT images, large cylinders as well as small splinters of these materials were hardly visible in both subcutaneous fat and muscular tissues. Overall, the small splinters were more difficult to differentiate from the surrounding tissue than the larger cylinders. The conventional dental materials Futar D® and Luxatemp® exhibited significantly higher radiopacity at 1031.18 ± 12.97 HU and 3243.96 ± 69.03 HU. The results of this study show that neither CT nor CBCT may currently not be suitable for visualising modern 3D-printed dental materials against surrounding soft tissue. This is due to the materials' insufficient radiopacity, which prevents clear delineation. Classic materials for temporal direct restorations and silicones were much easier to detect than the tested additively manufactured materials.

Segmentation accuracy and consistency directly affect the safety of treatment and the reliability of decision-making in tumor delineation, organ-at-risk protection, preoperative planning, and follow-up evaluation. The U-shaped convolutional network still has limitations in cross-regional modeling and adaptive cross-layer fusion, while the Transformer/hybrid architecture, although capable of encoding global context, is computationally expensive and has limited interpretability. To address these issues, we propose a multi-group rational KAN (MGR-KAN) and embed it into the U-shaped framework to form U-GRKAN: replacing each edge B-spline with group-shared and inter-group diversified grouped rational functions, reducing the number of parameters by 48% compared to U-KAN, and achieving function-level interpretability through group-level response curves; further using channel attention for adaptive cross-layer fusion. We assessed four datasets (BUSI, GlaS, CVC, and COVID-19-CT-Seg) and achieved scores of 67.85/80.58, 88.25/93.75, 86.63/92.74, and 78.57/87.97 (IoU/F1), respectively, which represent improvements of 2.63/2.01, 0.75/0.42, 1.58/0.86, and 2.51/1.61 over the second-ranked model. Overall, U-GRKAN strikes a more balanced compromise between accuracy, complexity, and interpretability, and shows good generalization potential across various modalities.

To summarize the current evidence on the incidence, risk factors, diagnosis, prevention, and management of incisional hernias following robotic urologic surgery. Emerging evidence has highlighted both surgical and patient-related factors that influence the risk of incisional hernia. Surgical variables associated with higher incidence include midline extraction sites, midline trocar placement, prior abdominal surgery, non-bladed trocar use, and advanced tumor stage. Patient-specific contributors include visceral obesity and rectus diastasis. The financial impact is substantial, with U.S. healthcare expenditures for incisional hernia management estimated at $1.7billion annually, underscoring the need to optimize surgical technique and patient selection to reduce this burden. Incisional hernia (IH) remains a significant postoperative complication, even with the advent of minimally invasive and robotic surgical techniques. Studies report a variable incidence of IH 0.2-6.3% following robotic prostatectomy, with rates as high as 27% in robotic nephrectomy depending on imaging modality and hernia definition. Diagnosis is commonly made with CT imaging, which remains the gold standard for preoperative planning. Although many IHs are asymptomatic, they may progress to incarceration, necessitating emergency repair with significant morbidity and mortality. Risk factors for IH are multifactorial and include patient-related variables such as obesity, smoking, COPD, diabetes, and rectus diastasis, as well as surgical factors including trocar size and type, extraction site location, and fascial closure technique. Notably, midline and bladed trocar placements are associated with higher hernia risk, while Pfannenstiel extraction and use of non-bladed trocars may be protective. Management strategies remain inconsistent, and preventive measures such as prophylactic mesh, proven effective in general surgery, have yet to be evaluated in urologic robotic procedures. This review summarizes the current literature on IH following robotic urologic surgery, with emphasis on incidence, risk factors, diagnostic modalities, preventive techniques, and potential areas for future research. Given the growing use of robotics in urology and the rising economic burden of IH, better understanding of prevention and early intervention is essential to improving outcomes and reducing healthcare costs.

Relevance. Mandibular underdevelopment in adolescents without syndromic pathology is often associated with temporomandibular joint (TMJ) disorders and presents with marked facial asymmetry, malocclusion, and functional impairment. Conventional orthognathic surgery in patients with incomplete facial skeletal growth carries a high risk of relapse and considerable surgical morbidity. Mandibular distraction osteogenesis (DO) is regarded as a less invasive alternative to orthognathic surgery. Clinical case descriptions. Three adolescents (two females, 17 years; one male, 16 years) with nonsyndromic mandibular hypoplasia secondary to TMJ degenerative changes were included in case series. All patients underwent mandibular distraction osteogenesis using intraoral curvilinear distractors (Conmet, Moscow, Russia). Preoperative planning was performed using multislice computed tomography (MSCT) and lateral cephalometric radiography. Mandibular elongation aranged from 12 to 16 mm. Treatment resulted in substantial correction of facial asymmetry, normalization of occlusion, and satisfactory regenerate quality, as confirmed on CT and ultrasonography. No complications were observed. Conclusion. In adolescents, intraoral curvilinear distractors provide an effective, minimally invasive approach to correcting nonsyndromic mandibular hypoplasia, reducing the need for orthognathic surgery and minimizing complications.

Including conditions like obesity, diabetes, hypertension, and dyslipidemia, metabolic syndrome disrupts metabolic homeostasis and impairs recovery, increasing the risk of surgical complications. This study evaluates the impact of metabolic syndrome on spine surgery outcomes, addressing inconsistencies in the existing literature. Four databases were searched until December 2024 for studies comparing the postoperative complication rates of spine surgeries between patients with and without metabolic syndrome. Following deduplication, 2 authors independently reviewed the studies. For each included study, demographics and incidence rates of postoperative complications were extracted separately by 2 authors. Data analysis was performed using R. After deduplication, 115 studies were evaluated for inclusion in our study. Following the review of full texts, 11 studies were included. No significant differences were found between patients with and without metabolic syndrome in terms of mortality and nonhome discharge, pulmonary thromboendarterectomy, pneumonia, and sepsis (P > 0.05). However, metabolic syndrome was associated with a significantly increased risk of 30-day readmission (RR: 1.5, 95% CI: 1.2-1.8), reoperation (RR: 1.3, 95% CI: 1.1-1.6), cardiac complications (RR: 1.7, 95% CI: 1.5-2.1), respiratory complications (RR: 1.68, 95% CI: 1.17-2.40), cerebrovascular complications (RR: 2.0, 95% CI: 1.4-2.9), renal complications (RR: 4.48, 95% CI: 2.58-7.80), urinary complications (RR: 1.45, 95% CI: 1.41-1.48), venous thromboembolism (RR: 1.3, 95% CI: 1.1-1.6), and wound complications (RR: 1.6, 95% CI: 1.3-1.9). Metabolic syndrome might significantly increase the risk of some postoperative complications in spine surgery patients. These findings highlight the need for personalized preoperative planning and management strategies to mitigate surgery risks. Identifying and optimizing metabolic syndrome components before surgery may improve patient outcomes and reduce complication rates.

The Fontan procedure, employed in the management of children with single ventricle congenital heart disease, continues to present long-term complications. Notably, certain complications associated with this procedure are linked to imbalances in the distribution of hepatic blood flow. One promising strategy to address this challenge involves employing a digital twin to simulate diverse Fontan configurations. The objective is to identify an optimal design that ensures balanced hepatic blood flow and minimizes power losses. However, successful implementation depends on accurate, patient-specific estimates of pulmonary vascular resistance (PVR) for each lung at the pre-Fontan (Glenn) stage. In clinical practice, only the total PVR is typically measured, via catheterization using the Fick principle, but individual lung resistances can be derived by combining pressure data from catheterization (Cath) with flow data from cardiac magnetic resonance imaging (CMR). Still, notable discrepancies exist: Fick-based total PVR often differs significantly from Cath-CMR-based PVR due to differences in flow quantification, and neither method can distinguish between proximal and distal resistances within the Glenn pathway. An alternative method for estimating PVR was previously developed using a computational fluid dynamics (CFD) optimization framework. This method demonstrated a favorable correlation with PVR estimates derived from Cath-CMR, although it was not directly compared to clinical PVR values derived using the Fick principle. In this study, we compare three methods for calculating PVR, namely Fick-based, Cath-CMR-based, and CFD-based, using patient data from three independent institutions. Our results show that Fick-based PVR values are, on average, significantly lower than those obtained via the Cath-CMR and CFD methods. The CFD-based total PVR estimates show good agreement with the total Cath-CMR-based PVR. However, the elevated left proximal resistance present in the CFD method leads to a significant underestimation of the left lung resistance by the Cath-CMR method. This underscores the significance of incorporating proximal resistance in PVR estimation and supports the potential utility of the CFD-based method for preoperative planning in single ventricle patients.

Purpose This paper explores the transformative potential of three-dimensional (3D) printing (additive manufacturing) in the medical field, aiming at its applications in orthopaedics, biomedical implants, surgical tools, drug delivery, tissue engineering and medical education. The purpose of this study is to summarize the recent developments of 3D printing in biomedical applications. Design/methodology/approach This study explores the understanding of medical imaging techniques and compatible materials for the advancement of 3D printing manufacturing methods for biomedical applications. Findings The findings of this study show substantial enhancement in personalized person specific health care. Preoperative planning, personalized implants and innovative bioprinting techniques are improving patient outcomes. Tissue engineering applications, such as cartilage and vascular regeneration, demonstrate the growing potential of biocompatible materials and bioinks. Despite challenges in material selection, cost and immunogenicity, ongoing research continues to address these issues, further solidifying the role of 3D printing in modern health care. Originality/value This paper provides an understanding of 3D printing in health care, emphasizing its impact on personalized medicine and its potential to address unmet medical needs. By highlighting recent advancements and persistent challenges, this research contributes valuable insights into the ongoing evolution of additive manufacturing in clinical and biomedical contexts.

Objective: Rehabilitation of the atrophic posterior maxilla is challenging due to insufficient bone quantity and quality. Conventional approaches, such as sinus floor elevation or onlay bone grafting, are associated with higher morbidity, longer treatment times, and increased complications. Pterygoid implants offer a less invasive alternative, utilizing dense cortical bone in the pterygoid apophysis and posterior maxillary tuberosity to provide distal anchorage and full-arch prosthetic support, while avoiding the need for sinus augmentation. Clinical evidence indicates high survival rates, making them a reliable option for posterior maxillary rehabilitation. Materials and Methods: This prospective clinical study included 15 patients (aged 49–78 years) with unilateral posterior maxillary tooth loss that was unsuitable for conventional implants. Each patient received one pterygoid implant and two compressive implants. Preoperative planning included CBCT scans. Surgical procedures involved flap elevation, precise drilling, and manual insertion with high insertion torque. Immediate prosthetic loading was performed within seven days. Postoperative care included antibiotics, analgesics, chlorhexidine mouthwash, and oral hygiene instructions. Implant failure was defined as detectable mobility or conditions requiring removal. Results: All 45 implants (15 pterygoid and 30 compressive) survived over the 12-month follow-up, with no failures observed at 3, 6, or 12 months. Survival rates were 100% for both implant types, and no differences were noted across follow-up periods. Conclusions: Pterygoid implants demonstrate high survival rates and represent a predictable, minimally invasive option for posterior maxillary rehabilitation. Proper preoperative planning and surgical expertise are essential, and further long-term studies are recommended to confirm standardized protocols and durability.

Background: Circumferential calcification of the left atrium, commonly referred to as "porcelain atrium" or "coconut atrium," was first documented in 1898 in patients with rheumatic heart disease. This condition has also been observed in individuals with end-stage renal disease and those who have undergone thoracic radiotherapy. It predominantly affects women, accounting for approximately 74% of reported cases. Methodology: Informed, written consent was obtained from the patient prior to the preparation of this case report. All clinical data and patient history were collected through a one-on-one interview with the patient and a review of the patient’s electronic health records. Clinical Case: A 50-year-old female with a history of rheumatic heart disease, previously treated with closed mitral valvuloplasty and percutaneous transvenous mitral commissurotomy, presented with severe dyspnea and heartburn. She was admitted for a coronary angiogram in preparation for a double valve replacement. The angiogram revealed normal coronary arteries but significant calcification of the left atrium. Transthoracic echocardiography confirmed severe mitral stenosis, mild mitral regurgitation, moderate aortic regurgitation, and a grossly dilated left atrium, with preserved left ventricular systolic function. Following an uneventful recovery, the patient was discharged and scheduled for the planned valve surgeries. Conclusion: This case underscores the rare occurrence of massive left atrial calcification, often termed "porcelain atrium," in patients with long-standing rheumatic heart disease. Despite its rarity, such calcification can complicate surgical interventions, highlighting the need for thorough preoperative imaging and careful surgical planning. Specialized surgical techniques such as total endoatriectomy of the left atrium or calcium core debridement with valve replacement may be considered.

The integration of artificial intelligence (AI) is rapidly transforming the field of breast reconstruction, with applications spanning surgical planning, complication prediction, patient-reported outcome assessment, esthetic evaluation, and patient education. A comprehensive narrative review was performed to evaluate the integration of AI technologies in breast reconstruction, encompassing preoperative planning, intraoperative use, and postoperative care. Emerging evidence highlights AI’s growing utility across these domains. Machine learning algorithms can predict postoperative complications and patient-reported outcomes by leveraging clinical, surgical, and patient-specific factors. Neural networks provide objective assessments of breast esthetics following reconstruction, while large language models enhance patient education by guiding consultation questions and reinforcing in-clinic discussions with accessible medical information. As these tools continue to advance, their adoption in everyday practice is becoming increasingly relevant. Staying current with AI applications is essential for plastic surgeons, as AI is not only reshaping breast reconstruction today, but is also poised to become an integral component of routine clinical care.

Description of Case: A 58-year-old man presented with progressive fatigue and dyspnea. Echocardiography showed mixed valve disease with severe aortic stenosis (AS), severe aortic regurgitation (AR), left ventricular hypertrophy, and preserved ejection fraction. Coronary angiography was normal. Chest computed tomography angiography revealed a quadricuspid aortic valve (QAV) with severe calcification and aneurysmal dilation of the ascending aorta to 47 mm. At the time of the operation, the quadricuspid valve was functionally bicuspid, with two raphes. An additional cusp was present between the right and left coronary cusps (Nakamura Type 1) with 2 equal larger cusps and 2 unequal smaller cusps (Hurwitz and Roberts Type F). The right and supernumerary cusps, and the left and non coronary cusps, were fused respectively. All cusps were significantly thickened and calcified. The degenerated valve was excised and replaced with a size 27 bioprosthetic valve. The ascending aorta was resected and replaced with a straight graft. Postoperative echocardiography confirmed a low mean gradient and normal function, and the patient had an uncomplicated recovery. Discussion: QAV is a rare congenital anomaly found in less than 0.05% of the general population and less than 1.5% of patients undergoing aortic valve surgery. Anatomic QAV with functionally bicuspid morphology and ascending aortic dilation (&gt; 45 mm) is rarer still, with unclear etiology and surgical implications. The most common valvular dysfunction with QAV is AR, with pure AS and mixed valve disease occurring in only 0.7% and 8.4% of QAV cases, respectively. Although AR is typically managed with surgical repair, QAV-related AR often requires valvular replacement, either immediately or after initial repair attempts. The functional bicuspid nature of the QAV in this case may help explain the presence of severe AS and ascending aortic dilation, conditions that are less common in QAV but more prevalent in bicuspid aortic valves (BAVs). This case emphasizes the complexity of managing QAV, particularly when severe AS and calcification preclude valve repair. The concomitant ascending aortic aneurysm necessitated combined surgical intervention, highlighting the need for comprehensive preoperative planning. The case suggests that the association between QAV and ascending aortic aneurysms is understudied, especially in the setting of functionally BAVs.

Clinical models for predicting massive intraoperative blood loss (IBL) in spinal metastasis surgery exhibit a systematic, vascularity-dependent bias, underestimating risk in non-hypervascular tumors while overestimating it in hypervascular ones. We aimed to develop and validate an AI model integrating MRI radiomics to reduce this bias and improve risk stratification. This retrospective study included 601 patients who underwent surgery for spinal metastases between January 2016 and December 2022. They were randomized to a development cohort (n=479) and a test cohort (n=122). Clinical characteristics and radiomic features from T1c MRI were used to develop predictive models. Based on internal validation across nine machine learning algorithms, the best-performing model was selected. External testing was performed using an independent cohort of 101 patients to assess generalizability. The primary outcome was defined as massive IBL, with an estimated blood loss of 2,500ml or more. Model performance was evaluated using the area under the curve (AUC), calibration curves, and decision curve analysis. An AI tool was developed to facilitate clinical use. Among the 702 patients included, the combined model integrating MRI radiomics and clinical variables outperformed the clinical model in both internal (AUC: 0.901 [95%CI: 0.8330-0.9690] vs. 0.735 [95%CI: 0.6238-0.8458]) and external validation cohorts (AUC: 0.885 [95%CI: 0.8052-0.9639] vs. 0.604 [95%CI: 0.4355-0.7720]). Subgroup analysis revealed that in non-hypervascular tumors, the combined model significantly increased the sensitivity for identifying massive bleeding (0.85 vs. 0.30, p<0.001). In hypervascular tumors, the specificity was notably enhanced (0.81 vs. 0.55, p<0.001), and meanwhile the false-positive rate was reduced. The use of AI tools also improved the prediction performance of spine surgeons. The model is freely accessible for download at https://github.com/banluqihao/A-predict-tool-for-spinal-metastases-surgery. By integrating MRI radiomics features, our model reduces the systemic biases of clinical-only models that depend on unreliable histological surrogates. This enables more accurate and individualized risk stratification, providing a reliable tool to guide preoperative planning and support more accurate risk stratification for patients with spinal metastases.

A 71-year-old female with a history of severe aortic stenosis status post aortic valve replacement with a 23mm bioprosthetic valve and aortic root enlargement with bovine pericardial patch 6 years prior, presented with progressive dyspnea and NYHA class III symptoms. Echocardiography revealed preserved left ventricular function and a normally functioning bioprosthetic aortic valve, but severe mitral annular calcification (MAC) with significant mitral stenosis (Mean gradient: 11 mmHg, Mitral valve area: 1.6 cm^2). Cardiac CTA showed severe circumferential MAC with &gt;75% annular involvement and a MAC score of 8. Following multidisciplinary discussion, consensus was reached to proceed with a hybrid open transcatheter mitral valve-in-MAC replacement via right thoracotomy using an atrialized (80% atrial, 20% ventricular) approach to mitigate the risk of LVOT obstruction identified on preprocedural CT planning. Right femoral cannulation and right anterior thoracotomy were performed. Following the initiation of cardiopulmonary bypass, the pericardium and left atrium were opened. The mitral valve was severely stenotic with extensive calcification involving both leaflets and the annulus, precluding full debridement. Consequently, only a portion of the anterior leaflet was resected to prevent displacement into the left ventricular outflow tract during valve inflation. A balloon-expandable valve was deployed using nominal volume plus 5 mL for optimal expansion and anchoring, aided by atrial sutures and an atrialized cuff. The prosthesis successfully circularized the annulus and was confirmed competent with no evidence of a paravalvular gap or leak. A hybrid open transcatheter mitral valve-in-MAC procedure offers a viable option for patients unsuitable for conventional surgery or transcatheter approaches. While standard implantation places the valve 2 mm above the annulus (20% atrial, 80% ventricular), we employed an atrialized technique to minimize LVOT obstruction and avoid valve-septal contact. Additional balloon inflation facilitated annular circularization, ensuring full valve expansion and sealing. Meticulous preoperative planning with cardiac CT is essential to guide procedural strategy and optimize outcomes.

Introduction: Cardiac amyloidosis (CA) is an infiltrative cardiomyopathy associated with significant morbidity and mortality. The natural history and optimal surveillance strategies for at-risk patients are incompletely defined. We present a patient with initially mild, non-specific cardiac magnetic resonance (CMR) abnormalities who then developed dramatic phenotypic expression of CA on CMR five years later. Methods: Retrospective review of the patient's clinical course was conducted using the electronic health record. Case Presentation: A 54-year-old White male with refractory atrial fibrillation after ablation underwent CMR for preoperative planning prior to mini Maze and left atrial appendage ligation. CMR showed subtle late gadolinium enhancement (LGE) of the basal inferoseptum with normal left ventricular (LV) cavity size, wall thickness, and mildly reduced LV ejection fraction (56%). He re-presented five years later with heart failure symptoms and palpitations. Transthoracic echocardiography measured the LV ejection fraction to be reduced at 45% with restrictive filling characteristics. Repeat CMR was performed and demonstrated findings consistent with CA: wall thickening (maximum 2 cm), diffusely elevated native T1 values, abnormal gadolinium kinetics, and widespread subendocardial LGE. Technetium pyrophosphate scan showed tracer uptake in the ventricular myocardium. Genetic testing did not identify any pathogenic mutations, and serum and urine testing did not identify a monoclonal dyscrasia. The patient was diagnosed with wild type transthyretin CA and started on acoramidis. Discussion: Timely diagnosis of CA is crucial, as therapies are more effective early in disease. Advanced imaging such as CMR can evaluate for CA or phenotypic mimics. However, if an initial study is negative despite clinical suspicion, optimal timing for repeat testing is uncertain due to limited understanding of early CA progression. Risk stratification scores such as Mayo ATTR-CM and AMYloidosis Index (AMYLI) scores have been described as screening tools for CA. Our patient had a Mayo score of 4 (screened out) and AMYLI score of 4.3 (not screened out), highlighting the clinical suspicion that can persist despite non-diagnostic testing. Conclusions: This case illustrates that the “warranty period” of a CMR that does not show clear signs of CA despite reasonably high clinical suspicion may be under 5 years. Further investigations are necessary to define progression and screening intervals.

The second generation of the Bonebridge (BB) bone conduction implant was shown to be a viable option even for younger children with conductive or mixed hearing loss. However, preoperative imaging often shows only small areas where the FMT (4.5mm) or screws (4.0mm) can be fully and safely inserted without the need to use lifts. Navigation systems allow precise placement of the device and prevent potential complications such as dural or vascular injuries. The latest version of the preoperative planning software Otoplan® allows to assess bone thickness and perform virtual implantation. Six children between 3 and 12years of age underwent BB implantation using Otoplan® with export of the planned BB position to a navigation system. Prior to an intraoperative cone beam CT (CBCT), 3 marker screws were placed in the temporal bone. Images were loaded into Otoplan® to virtually define the optimal BB position and export the corresponding model. CBCT scan and model were then loaded into an electromagnetic navigation system. The screws were used to accurately register the system, and the planned BB placement was projected onto the patient. BB implantation was performed accordingly and finally the marker screws were removed. Possible complications were monitored and the audiological success was measured using an age-appropriate speech test. Bone thickness at the screw location was over 4.0mm in every case, documenting the accuracy of the procedure. No medical complications occurred intraoperatively, during the immediate hospital stay, or up to and including the initial fitting 4-6weeks after implantation. Speech test results were greater than or equal to 90% in all measurable patients. Virtual implantation with Otoplan® can be loaded into a navigation system to mark the safe position of the screws on the temporal bone. Projecting the planned position onto the patient using navigation is a practical tool that can make implantation more reliable and safer for patients.

Artificial intelligence (AI) and machine learning (ML) are increasingly influencing aesthetic and reconstructive surgery. These technologies are transforming clinical workflows by enhancing precision, personalization, and operational efficiency across various stages of surgical care. Aim: To review the current applications, measurable benefits, and challenges of AI and ML in aesthetic and reconstructive surgery, and to explore their potential future impact on the field. Material and methods. This review synthesizes findings from recent studies, technological assessments, and clinical applications of AI and ML in surgical practice. Key areas examined include preoperative planning, imaging, robotic systems, intraoperative tools, and postoperative monitoring. Results. AI and ML have been shown to reduce surgical planning time by up to 35 % and improve breast symmetry assessment accuracy by over 90 %. Robotic systems and AI-powered automation enhance minimally invasive procedures and optimize intraoperative decisions. Furthermore, AI supports postoperative care through predictive modeling, complication monitoring, and real-time data interpretation. Despite these advances, challenges persist, including algorithmic bias, data privacy concerns, and the need for robust clinical validation. Conclusions. AI and ML are poised to significantly reshape aesthetic and reconstructive surgery. As these technologies continue to evolve, addressing ethical and regulatory challenges will be essential for their safe and effective integration into clinical practice.

Modern imaging techniques provide various opportunities for assessing vascular anatomy, but their comparative effectiveness in creating accurate three-dimensional models of the renal arterial bed remains poorly understood. Material and methods . A systematic review of the scientific literature for the period 2005–2022 was conducted using the PubMed, Scopus, Web of Science and eLIBRARY.RU databases. Technical characteristics, diagnostic capabilities and limitations of ultrasonography, computed tomography and magnetic resonance imaging were analyzed. Results. Ultrasonography is an accessible screening method, but has limitations in constructing accurate 3D models. Computed tomography angiography provides the highest spatial resolution and detailing of vascular architecture, but is associated with radiation exposure and the risk of nephropathy. Magnetic resonance imaging represents an optimal balance between visualization quality and safety, especially with the use of non-contrast techniques and dynamic sequences. Conclusions. It is advisable to use a comprehensive approach using complementary visualization methods to create accurate threedimensional models of renal arterial vessels, which allows compensating for the limitations of each individual method. The introduction of modern 3D modeling technologies into clinical practice helps improve preoperative planning and increase the safety of organ-preserving kidney surgeries, which is of fundamental importance for a personalized approach in modern urology and vascular surgery.

Aim Prosthetic joint infection (PJI) is a challenging complication after total hip arthroplasty. The two-stage approach is still considered the gold standard for chronically infected patients. Hip spacer implantation during the interim period aims to manage infection and provide temporary stability while maintaining limb length and offset, which are crucial for functional outcomes. This study aims to evaluate the restoration of radiographic femoral (FO), acetabular (AO), and global offset (GO) following articulating hip spacer implantation in patients with chronic PJI. Methods A retrospective analysis was conducted on patients treated for chronic hip PJI with a two-stage revision at our institution. Demographic and clinical data was obtained from a prospectically collected database. Radiographic data was analyzed preoperatively and post-spacer placement to measure changes in femoral, acetabular, and global offsets. Offset measurements were performed using standardized anteroposterior radiographs of the pelvis, and results were compared to preoperative baseline values. The restoration of these parameters was correlated with functional outcomes assessed at the interstage time. Complications were recorded during the interstage and post-reimplantation period. Results The study included 40 patients with a mean age of 63,7±10,4 years. Mean follow-up was 26,7 ±8,6 Following hip spacer implantation, the mean femoral, acetabular, and global offset was 48,1 ±7,6, 36,1±5,9 and 84,2±7,1, respectively. The differences between preoperative and post spacer implantation values was considered not statistically relevant (FO P 0.2997, AO: p: 0.8, GO p: 0.3293.). A statistically significant association was observed between optimal offset restoration and improved functional scores, as assessed by the Harris Hip Score (HHS) and Oxford Hip Score (OHS) at the time of spacer placement. However, complete offset restoration was rarely achieved, with certain discrepancies noted in cases of severe bone loss or varus hip morphology. Conclusion Hip spacer placement in PJI treatment provides adequate restoration of femoral, acetabular, and global offset, which is associated with better interim functional outcomes. While spacers offer effective infection control and satisfactory mechanical stability, optimizing offset restoration remains challenging, especially in complex cases. Acetabular spacer implantation and adequate preoperative planning facilitate GO and biomechanical restoration. Future spacer designs that better approximate native hip biomechanics may improve interim functionality and facilitate the eventual reimplantation phase.

Proximal femoral medullary canal morphology is a key determinant of cementless stem fit, primary stability, and load transfer in total hip arthroplasty (THA), yet population-level three-dimensional characterization remains limited. This study was designed to quantify variability in canal geometry and to capture dominant anatomical modes of variation with statistical shape modeling (SSM). Computed tomography data from 763 candidates for primary THA (389 female, 374 male; 20-92 years) were analyzed. Endosteal contours of the proximal canal were processed to build a point-correspondent SSM by principal component analysis (PCA). Five geometric features were evaluated per specimen: equivalent radius (normalized), roundness, major-axis angle (torsion), flare index, and curvature. Substantial inter-individual variability was observed across all features, with differences by sex and age. The first three principal components accounted for 68.4% of total variance, and each showed interpretable associations with at least one geometric feature. Model behavior was examined by synthetic sampling within ±2 SD (specificity) and by 10-fold cross-validation (generalization), indicating faithful reconstruction of real shapes and stable performance on held-out data. These findings provide a compact description of proximal canal shape variation and its key geometric drivers. The resulting population map is expected to support implant selection and sizing in preoperative planning, inform shape-based classification, and guide design envelopes for standard and personalized stems, with potential efficiencies in manufacturing and material use.