Preoperative Planning Research Articles

Prediction of vesicouterine adhesions by transvaginal sonographic sliding sign technique: validation study.

Adhesions between the uterus, bladder and anterior abdominal wall are associated with clinical sequelae, including chronic pelvic pain and dyspareunia, and can also yield complications during surgery. The transvaginal sonographic (TVS) sliding bladder sign is a minimally invasive diagnostic tool to evaluate the presence of vesicouterine adhesions. This study aimed to determine the predictive value and intra- and interobserver variation of the TVS sliding bladder sign in the assessment of vesicouterine adhesions. This was a prospective observational double-blind diagnostic accuracy study conducted at the Amsterdam University Medical Center. Patients scheduled for gynecological laparoscopic surgery for a benign disorder between January 2020 and December 2022 were included consecutively. All patients underwent preoperative TVS, including a dynamic sliding bladder sign examination in our outpatient clinic. Videoclips of the TVS scans were stored for offline assessment and used as an index test. The recordings of both TVS and laparoscopy were evaluated for diagnostic characteristics of vesicouterine adhesions by independent assessors, who were blinded to the clinical situation in addition to the laparoscopic findings when assessing recordings of TVS and vice versa. The presence of adhesions on laparoscopy was used as the reference standard. The positive predictive value (PPV), negative predictive value (NPV), specificity and sensitivity of the sliding bladder sign were calculated. In addition, inter- and intraobserver variability of the sliding bladder sign on TVS were assessed. Of 116 included women, 57 had a negative sliding bladder sign on TVS, while on laparoscopy, 51 women had mild and 28 had severe vesicouterine adhesions. A negative sliding bladder sign had a PPV of 94.7% (95% CI, 88.9-100%) for the presence of any vesicouterine adhesions, and a positive sliding bladder sign had a specificity of 91.9% (95% CI, 83.1-100%). For severe adhesions, the negative sliding bladder sign had a sensitivity of 89.3% (95% CI, 77.8-100%) and a positive sliding bladder sign had a NPV of 94.9% (95% CI, 89.3-100%). When using Cohen's kappa coefficient, inter- and intraobserver agreement between assessors was good. Sliding bladder sign evaluation using TVS is a reliable diagnostic tool for the prediction of vesicouterine adhesions on laparoscopy. A negative sliding bladder sign indicates the presence of vesicouterine adhesions, while a positive sliding bladder sign makes the presence of severe adhesions unlikely. Establishing vesicouterine adhesions by TVS may optimize preoperative planning, and can be used for future studies to evaluate the relationship between symptomatology and vesicouterine adhesions and, subsequently, the effect of adhesion-prevention interventions. © 2024 The Authors. Ultrasound in Obstetrics & Gynecology published by John Wiley & Sons Ltd on behalf of International Society of Ultrasound in Obstetrics and Gynecology.

Efficacy analysis of 3D printing prefixed nail path model assisted lumbar and sacral hemivertebra orthopaedic surgery

To analyze the safety and effectiveness of 3D printing prefabricated nail path model assisted lumbosacral hemivertebra orthopaedic surgery. A retrospective analysis was performed on 8 patients with lumbosacral hemivertebra deformity admitted from January 2016 to July 2021, including 3 males and 5 females, aged 6 to 15 at the time of surgery. The hemivertebra of 4 cases located on the left side and 4 cases on the right side. The hemivertebra of 1 case located at L2,3, 2 cases at L3,4, 2 cases at L4,5, and 3 cases at L5S1. Four cases were fully segmented hemivertebra and 4 cases were incomplete segmented hemivertebra. The patient CT data was imported into Mimics 21.0 software for modeling, and then the model data was imported into 3-Matic software. The vertebra requiring screw placement was selected to simulate the optimal screw placement angle and length, and the model was printed for preoperative planning and intraoperative guidance. All patients underwent orthopedic surgery with the aid of 3D printing preset nail path model. The safety and effectiveness of the 3D printing prefabricated nail tunnel model assisted lumbosacral hemivertebra orthopaedic surgery was evaluated by comparing the imaging parameters of the patients. The main outcome measures were the Cobb angle of the main curve, the Cobb angle of the proximal compensatory curve, the coronal balance index C7 plumb line-center sacral vertical line(C7PL-CSVL), the accuracy of nail placement, and the correction rate of scoliosis before surgery, 1 week and 1 year after surgery. All of 8 patients were followed up for 13 to 31 months. A total of 98 pedicle screws were placed in 8 patients. The number of pedicle screw grades A, B, C, D, E was 38, 46, 10, 4, 0 screws. The screws of grade A and B were defined as good position, the accuracy rate of screw placement was 85.7%. The Cobb angle of the main curve were 21° to 38° before operation, 5° to 11° at 1 week after operation, 7°to 12° at 1 year after operation. The Cobb angle of the proximal compensatory curve were 16° to 39° befoer operation, 7° to 12 °at 1 week after operation, 7° to 14° at 1 year after operation, the correction effect remained good with no correction loss. The coronal balance index C7PL-CSVL were 20 to 35 mm before operation, 11 to 18 mm at 1 week after operation, 10 to 16 mm at 1 year after operation, the coronal imbalance improved. The scoliosis correction rate was 65.6% to 84.2% 1 week after surgery, and 61.9% to 81.6% 1 year after surgery. The use of 3D printing prefixed nail tunnel model in lumbosacral hemivertebra osteotomy is safe and effective, and can significantly improve patients' local deformities. It is a reliable method to assist lumbar sacral hemivertebra osteotomy.

Application of Virtual Planning and Three-Dimensional Printing Guide in Surgical Management of Craniosynostosis

This study aims to elaborate on the application of virtual surgical planning (VSP) and 3-dimensional printing guides (3DP) in the surgical management of craniosynostosis and compare their surgical outcomes with traditional surgical planning (TSP). A retrospective review of patients who underwent cranial vault and cranio-orbital remodeling procedures for craniosynostosis was performed. VSP was accomplished by establishing a 3D model from DICOM format CT data. Patients' skull shape were adjusted according to the age-matched standard skull, cutting and reconstruction guides were printed using a 3D printer. The change of anthropometric cranial indices, the so-called degree of correction, before and after the operation was evaluated to assess the surgical outcome. The TSP group serves as the historical control group, and surgical outcomes were compared among propensity-matched patients in the VSP+3DP group. In total, 120 patients with various presentations of craniosynostosis were operated on from 2005 to 2024, and 77 received surgery with VSP+3DP. There were 35 matched pairs. Both had 17 male patients with similar age and body weight. A greater degree of correction was achieved in the VSP+3DP group (9.75% vs. 6.36%, P value=0.016) with less intraoperative blood loss (144.57 mL vs. 296.86 mL, P value<0.001), shorter operation time (335.23 minutes vs. 348.34 minutes, P value=0.501), and hospital stay (10.31 days vs. 12.63 days, P value=0.009). With virtual surgical planning and 3D printing guides, precise preoperative planning, efficient intra-operative correction of cranial deformity, and objective surgical outcome assessment are achieved in craniosynostosis operations.

Novel technique for achieving the under-correction of native tibial varus in calipered restricted kinematically aligned total knee arthroplasty - A validation study

PurposeRestricted kinematic alignment (rKA) TKA is relatively newer technique for achieving an overall under-corrected limb alignment. The present study aims to provide an easy and reproducible technique for achieving calipered rKA-TKA (crKA-TKA) using routine instrumentation. MethodA prospective study was conducted including 30 patients (30 knees). All patients underwent crKA-TKA by the same surgeon. Pre-operatively all patients underwent long film standing radiographs, and coronal angles were measured to plan tibial bony cuts and the femoral axis angle (FAA) to restore tibial varus under correction and native distal femoral anatomy, respectively. Intra-operatively while taking tibial cuts, the alignment rod was noted to be always pointing towards the “third metatarsal” of the ipsilateral foot. Results30 patients underwent total knee replacement with crKA technique. Angular corrections were satisfactory with all patients reaching the target MPTA of 87.48 ± 0.78 and LDFA of 90.301 ± 2.66 as planned, with an overall under-corrected limb alignment. HKA was achieved within a target of < ± 3 degrees of the native knee (3.56 ± 1.29). Post-operative radiological parameters were checked by two separate observers with excellent intra-class correlation coefficients. ConclusionThe present study validates a novel intra-operative technique of confirming an under-corrected native tibial varus while performing crKA-TKA. The radiological outcomes of the study confirm that with careful pre-operative planning, coronal angular targets were easily achievable with very less outliers. Study further establishes that this method of calipered technique in rKA-TKA using routine digital templating software and standard instrumentations is an alternative method of executing rKA. Level of evidenceIV, Prospective case series.

B-Guide System: Improving the Predictability of Complete-Arch Implant and Prosthetic Placement Using Fixed Prosthesis Guides.

Computer-aided implant placement (CAIP) offers improved accuracy and reduced invasiveness. However, traditional static CAIP (sCAIP) protocols for complete-arch restorations often involve multiple guides and clinical steps, increasing the risk of soft tissue trauma and procedural complexity. This article introduces the B-guide technique, which integrates implant placement and interim prosthesis delivery into a single device to simplify the procedure and minimize tissue damage. The B-guide combines the implant osteotomy and placement guide with an abutment placement and prosthesis pick-up mechanism. The guide remains in place post-implantation, allowing immediate prosthesis conversion. A 55-year-old female patient underwent complete-arch rehabilitation using the B-guide, enabling immediate implant placement and loading. The B-guide minimized soft tissue trauma and eliminated the need for multiple guides, significantly reducing treatment complexity and time. The B-guide simplifies procedures and improves predictability compared with traditional systems by integrating prosthetic adaptation and implant placement, reducing cumulative errors. However, its success is heavily reliant on the operator's expertise, especially in preoperative planning and design. By integrating implant and prosthesis placement into a single guide, the B-guide reduces surgical complexity, minimizes trauma, and enhances prosthetic outcomes, improving clinical efficiency.

Radiological Approach to Assessment of Lower-Limb Alignment-Coronal and Transverse Plane Analysis.

Lower-limb alignment deformities constitute a significant clinical concern, as they can lead to serious complications, including progressive degenerative diseases and disabilities. Rotational deformities may give rise to conditions such as joint arthrosis, patellar instability, and the degeneration of the patellofemoral cartilage. Therefore, a comprehensive evaluation of lower-limb alignment is essential for the effective patient management, preoperative planning, and successful correction of these deformities. The primary assessment method employs full-length standing radiographs in the anteroposterior (AP) projection, which facilitates accurate measurements of the anatomical and mechanical axes of the lower limb, including angles and deviations. The outcomes of this analysis are vital for the meticulous planning of osteotomy and total knee arthroplasty (TKA). In addition, computed tomography (CT) provides a specialized approach for the precise evaluation of femoral and tibial rotation. In this area, there are potential opportunities for the implementation of AI-based automated measurement systems.

Bone Mineral Density Distribution in the Posterior Wall of the Lateral Mass Evaluated by Computed Tomography Osteoabsorptiometry

Abstract Objective Cervical open-door laminoplasty using plates and miniscrews is gaining popularity. One of the complications of this procedure is the loosening or back-out of the miniscrews inserted in the lateral mass (LM). Bone mineral density (BMD) measured by computed tomography (CT) has been used as a predictor of bone strength. However, bone density distribution in the LM remains unclear. Materials and Methods We investigated bone density distribution in the posterior wall of the LM. A total of 120 LMs were analyzed from the patients who underwent laminoplasty. The distribution of BMD defined by Hounsfield unit (HU) in the posterior wall of the LM was measured by CT osteoabsorptiometry. The posterior wall was divided into nine zones, which consisted of three columns (lateral, center, and medial) and three rows (cranial, center, and caudal). BMD in each zone was averaged and compared by zones and cervical levels. Results Overall mean ± standard deviation BMD was 1,092 ± 433 HU. Averaged BMD in the entire posterior wall was highest at C4 (1,365 ± 459 HU), second highest at C3 (1,239 ± 435 HU), and lower in the lower levels. BMD in the medial–center zone (1,357 ± 443 HU) was the highest in all zones. BMD in the medial–caudal region at C7 was only 59% of the highest BMD in the medial–center region at C4. Conclusion The medial–center to the cranial region was most suitable for miniscrew fixation for laminoplasty. These biomechanical findings would be useful in the preoperative planning of laminoplasty especially for the determination of the LM screw entry points and in the design of laminoplasty implants.

Impact of Low-Density Lipoprotein Levels on Rates of Pseudarthrosis After Anterior Cervical Discectomy and Fusion

Study Design. Retrospective cohort study. Objective. To understand how pre-operative LDL levels, statin intake, and fish oil intake affect rates of pseudarthrosis after single-level and multi-level ACDF. Summary of Background Data. Anterior cervical discectomy and fusion (ACDF) is commonly performed to treat cervical degenerative diseases or injuries causing neck pain, myelopathy, and radiculopathy. Pseudarthrosis following ACDF can lead to persistent symptoms and may require revision surgery. No studies have explored the link between low-density lipoprotein (LDL) levels and statin or fish oil intake on pseudarthrosis in ACDF. Methods. Patients undergoing ACDF were identified using TriNetX, a healthcare database with over 100 million patients. Pseudarthrosis rates following single-level and multi-level ACDF were compared between patients with high versus low LDL within one year before surgery. Pseudarthrosis rates were also compared between patients taking or not taking a statin as well as patients taking or not taking fish oil within six months before surgery. For all analyses, patients underwent propensity score matching in a 1:1 ratio based on relevant demographic factors and co-morbidities. Results. Patients with an LDL above 142 mg/dL, compared to below 66 mg/dL, had significantly higher rates of pseudarthrosis at 6-months, 1-year, and 2-years after single-level and multi-level ACDF. Patients not taking a statin or fish oil, compared to those taking a statin or fish oil respectively, also had significantly higher rates of pseudarthrosis at all time points after multi-level ACDF, but not single-level ACDF. Conclusion. Low LDL levels are associated with reduced rates of pseudarthrosis after single-level and multi-level ACDF. Statin and fish oil intake prior to surgery are also associated with reduced rates of pseudarthrosis after multi-level, but not single-level, ACDF. These associations may be used for pre-operative planning, patient optimization, and risk stratification.

Risk factors and treatment strategies for adjacent segment disease following spinal fusion (Review).

Adjacent segment disease (ASD) is a significant clinical complication following cervical and lumbar spinal fusion surgery, characterized by the degeneration of spinal segments adjacent to the fused area. The present literature review aimed to elucidate the risk factors contributing to ASD and to evaluate current and emerging treatment strategies. Epidemiological data indicate that patient‑related factors such as age, pre‑existing spinal degeneration and comorbidities, along with surgical factors including the type of fusion, instrumentation and alignment correction, play pivotal roles in ASD development. Biomechanical alterations post‑fusion further exacerbate the risk. The underlying mechanisms of ASD involve changes in spinal kinematics and disc degeneration, driven by inflammatory and degenerative processes. Diagnostic modalities, such as magnetic resonance imaging and computed tomography scans, are essential for early detection and accurate diagnosis. Preventive strategies emphasize meticulous preoperative planning, advanced surgical techniques and postoperative rehabilitation. Treatment approaches range from conservative methods such as physical therapy and pharmacological interventions to surgical solutions, including revision surgeries and the use of motion‑preserving technologies. Emerging therapies, particularly in regenerative medicine, show promise in mitigating ASD. The present review underscored the necessity of a multidisciplinary approach to optimize patient outcomes and highlighted the need for ongoing research to address gaps in the current understanding of ASD in both cervical and lumbar regions.

Orthopedic Surgery in Osteogenesis Imperfecta in Adults.

Osteogenesis imperfecta is a genetic disorder, mainly characterized by bone fragility. In adult with osteogenesis imperfecta, surgical treatment may be indicated as an emergency procedure in the event of a fracture, or as a scheduled procedure in case of patient functional impairment due to many causes, such as persistent pain, complex bone deformities, and degenerative arthropathies. In all cases, a multidisciplinary approach is recommended. It is essential to consider the patient's characteristics and expectations regarding treatment, as well as the local conditions, which may be complex due to the poor bone quality, bone deformity, and the presence of hardware implanted during childhood. The procedure can be very complex and challenging and each patient is a unique case. An accurate preoperative planning is mandatory to select the appropriate surgical technique, which can be either conservative or prosthetic, and to evaluate its feasibility and the risk-benefit ratio. The aim is to improve the patient's quality of life and autonomy as long as possible.

Diverting ileostomy for treatment of ileoanal pouch dysfunction: a technical note

BackgroundThe ileal pouch-anal anastomosis (IPAA) is a restorative procedure performed after proctocolectomy to improve quality of life in patients with colorectal conditions like ulcerative colitis, familial adenomatous polyposis, and selected cases of Crohn’s disease and Lynch syndrome. However, severe pouch dysfunction can occur, often necessitating further surgical intervention.ObjectiveThis technical note aims to describe the operative approach and perioperative management for diverting ileostomy as a treatment for dysfunctional ileoanal pouches.MethodsIndications for the procedure include complications such as pelvic sepsis, pouchitis, fistulas, and Crohn’s disease of the pouch. Preoperative planning involves a multidisciplinary team, stoma site marking, and imaging to assess bowel integrity. The surgical technique utilizes laparoscopic access with careful adhesiolysis to minimize bowel injury, with intraoperative pouchoscopy to identify anatomical landmarks. An ileostomy is created by selecting a tension-free small bowel segment and approximating it to a pre-marked stoma site. Attention is given to preserving bowel length to allow for potential future restorative procedures. Postoperative care focuses on stoma management and addressing ongoing pouch dysfunction symptoms.ConclusionsDiverting ileostomy offers symptom relief for patients with pouch dysfunction while avoiding more complex procedures like pouch excision. It is a valuable option in managing pouch failure.

Study on accuracy of prosthesis size selection for Naton robot-assisted medial unicondylar knee arthroplasty

To analyze the accuracy of prosthesis size selection in Naton robot-assisted medial unicondyle knee arthroplasty by comparing the actual prosthesis size used during operation and the preoperative planning. The clinical data of 100 patients (110 knees) who underwent Naton robot-assisted medial unicondylar knee arthroplasty between June 2023 and July 2024 was retrospectively analyzed, including 47 knees on left side and 63 knees on right side. There were 37 males (40 knees) and 63 females (70 knees) with a mean age of 65.4 years (range, 59-71 years). Body mass index was 22.2-28.6 kg/m 2 (mean, 25.4 kg/m 2). The disease duration ranged from 1 to 8 years (mean, 3.4 years). Preoperative planning was performed by Naton robotic surgical system based on lower limb CT data. The final prosthesis size after osteotomy was recorded and compared with the preoperative plan to analyse whether it was consistent with the preoperative plan, as well as the situation of knee flexion and extension gaps (<0.5 mm, >2.0 mm) corresponding to the different models of prostheses. During operation, 5 patients (5 knees) were treated with traditional UKA due to mechanical arm failure, software obstacles, significant bone amputation bias, or loose reference frame, and were excluded from the final analysis. The remaining 95 patients (105 knees) successfully received Naton robot-assisted surgery, and no related complications occurred. The prosthesis size was consistent with the preoperative plan in 101 knees (96.2%) on the femur side, 100 knees (95.2%) on the tibia side, and 97 knees (92.4%) on both femur and tibia sides. The prosthesis size was inconsistent in 3 cases (2.86%) on the femur side alone, 4 cases (3.81%) on the tibial side alone, and 1 case (0.95%) on both femur and tibial sides. Among the prostheses with different models, the flexion and extension gaps were less than 0.5 mm in 3 knees, the flexion gap was less than 0.5 mm and the extension gap was more than 2.0 mm in 3 knees, and the flexion gap was more than 2.0 mm and the extension gap was less than 0.5 mm in 2 knees. The accuracy of prosthesis size selection for Naton robot-assisted medial unicondylar knee arthroplasty is relatively high.

Design, manufacturing, and multi-modal imaging of stereolithography 3D printed flexible intracranial aneurysm phantoms.

Physical vascular phantoms are instrumental in studying intracranial aneurysms and testing relevant imaging tools and training systems to provide improved clinical care. Current vascular phantom production methods have major limitations in capturing the biophysical and morphological characteristics of intracranial aneurysms with good fidelity and multi-modal imaging capacity. With stereolithography (SLA) 3D printing technology becoming more accessible, newer flexible and transparent printing materials with higher precision controls open the door for improving the efficiency and quality of producing anthropomorphic vascular phantoms but have rarely been explored for the application. This technical note intends to report the feasibility of using SLA 3D printing technology to manufacture flexible intracranial aneurysm phantoms with similar scales to the real anatomy, as well as their capacity for multi-modal flow imaging and analysis, including ultrasound flow imaging, high-speed filming, and particle image velocimetry analysis. We designed and 3D-printed two intracranial aneurysm phantoms with an SLA 3D printer using Formlabs Elastic 50A resin. By using a micropump to introduce cyclical flows in the phantoms, we first employed conventional Doppler and vector flow ultrasonography to observe and measure different fluidic properties. Then, a high-speed camera was used to record particles flowing within the phantom, and we further conducted a particle image velocimetry analysis, including the distribution of mean 2D velocity vectors, average velocity magnitudes, and the mean vorticity fields in the phantom for the high-speed imaging data. We successfully 3D-printed flexible intracranial aneurysm phantoms with similar dimensions to the real anatomy. Additionally, we validated the phantoms' ability to allow visualization, measurement, and analysis of flow dynamics based on both real-time ultrasound and optical imaging. Our proof-of-concept study illustrates that SLA 3D printing using commercial elastic resins can significantly contribute towards facilitating the fabrication of flexible intracranial aneurysms phantoms for training, research, and preoperative planning.

Mid-transversal hepatectomy: breaking new ground in parenchymal sparing hepatectomies.

We, herein, describe a case of complex parenchyma-sparing hepatectomy for multiple bilobar colorectal liver metastases (CRLMs). A 61-year-old woman, previously operated for an occlusive adenocarcinoma of the transverse colon and undergoing adjuvant chemotherapy, developed metachronous bilobar CRLMs. After administration of a II line chemotherapy with partial response, she was referred to our hospital. The pre- and post-treatment imaging recognized seven liver lesions, with a bilobar distribution involving segments 3, 4, 5, 8, and 7. After multidisciplinary team evaluation, the surgical strategy was planned by means of three-dimensional reconstruction and simulation software. The planned and executed procedure consisted of a unique transection plane comprising partial resection of segments 3-4-5-8-7, thus removing the central transversal portion of the liver. Accurate preoperative planning and intraoperative ultrasound for resection guidance allowed us to achieve a complex parenchymal sparing procedure in an advanced disease that would be usually candidate for major resection and staged hepatectomy.

TIPS AND TRICKS IN SURGICAL TREATMENT OF LARGE VESTIBULAR SCHWANNOMAS

Vestibular schwannomas (VS) frequently referred to as acoustic neuromas are the most common tumours of the cerebellopontine angle. They are benign, generally slow-growing tumors that arise from the vestibular portion of the eighth cranial nerve. For patients with large vestibular schwannomas or those exhibiting symptoms from the tumor’s mass effect, surgical intervention remains the preferred treatment approach. This paper discusses the surgical management of patients with large vestibular schwannomas operated in our department and emphasizes the use of intraoperative monitoring for preserving facial nerve function. We review the key surgical steps and highlight the importance of preoperative planning, patient position, and the use of microsurgical techniques to optimize the surgical outcome. Gross total resection of large vestibular schwannomas is associated with worse facial nerve outcomes. Our preferred treatment strategy, especially for older patients, is planned subtotal resection followed by periodic imaging evaluation and radiotherapy in cases of documented tumor growth. This approach may lead to superior facial nerve preservation and improved quality of life for individuals with large vestibular schwannomas. Conclusion The optimal treatment approach for vestibular schwannoma remains a subject of debate. Gross total resection has traditionally been the gold standard for large tumors, but this is often accompanied by a higher risk of postoperative facial nerve dysfunction. Planned subtotal resection with the goal of preserving facial nerve function, followed by closed observation is an alternative approach.

Innovative 3-Dimensional Imaging in Preoperative Evaluation for Secondary Cytoreductive Surgery in Recurrent Ovarian Cancer—A Pilot Study

ObjectiveThe efficacy of secondary cytoreductive surgery (SCS) in recurrent ovarian cancer remains controversial, necessitating meticulous preoperative planning. While three-dimensional (3D) imaging has transformed surgical approaches in various disciplines, its application in gynaecologic oncology is nascent. This study introduces a novel investigation employing preoperative 3D modelling in SCS preparation. MethodsA retrospective analysis was undertaken at a university-affiliated tertiary medical centre, examining patients who underwent SCS for recurrent ovarian cancer between 2017 and 2022. Patients were stratified into 2 cohorts: those with preoperative CT-based 3D imaging (group A) and those without (group B). Demographic profiles, clinical data, and surgical outcomes were compared between the groups. ResultsAmong the 76 identified patients, 18 were deemed suitable for surgery, with 7 in group A undergoing preoperative 3D modelling. Demographics encompassing age and performance status were consistent across both groups, while Serous histology was more prominent in group B. Although operative metrics and collaborative endeavours exhibited no statistically significant variance, the attainment of optimal debulking with no residual disease (R0) was substantially higher in group A (100%) compared to group B (54%), with a significance level of P = 0.05. ConclusionCT-based 3D modelling in the preoperative phase of SCS for ovarian cancer shows potential for enhancing surgical planning. While this pioneering research highlights the potential benefits of integrating 3D imaging into gynaecologic oncology, the limitations of this retrospective study imply that these findings are primarily hypothesis-generating. Further prospective studies are necessary to validate the impact.

TIPS, a Trick for Transcaval TEVAR Access.

We described an alternative access for thoracic endovascular aortic repair (TEVAR) deployment using a transjugular intrahepatic portosystemic shunt (TIPS) needle for gaining transcaval access to the abdominal aorta. A 63-year-old man presented with a penetrating atherosclerotic ulcer in the descending aorta. Traditional transfemoral and transaxillary access were not possible. A transcaval access was established using a TIPS needle to puncture from the caval vein to the aorta. Next, the access was gradually upsized until a 22 french large-bore transcaval access was achieved. Afterwards the thoracic endograft was positioned and deployed accustomed. The infrarenal aortocaval fistula was closed with a covered stent. When classic TEVAR access is not possible, transcaval access is a valuable and minimally invasive alternative access. We prefer the use of a TIPS needle for gaining access and use a covered stent for closing the aortic access site when possible instead of using electrified wires nor a transseptal occluder device. Preoperative planning remains key. We discribe a transcaval access with a TIPS needle and closing of the aortocaval fistula with a covered stent. We are one of fiew reports of transcaval puncturing instead of using an electrified wire and the first using a TIPS needle for gaining transcaval access. We hope this case and our comments help other surgeons, radiologists and patients when they are in need of a transcaval access and contribute to a successful procedure.

Transcutaneous osseointegrated prosthetic system (TOPS) with an intramedullary prosthesis : Management of the femoral stump with concurrent total hip arthroplasty

Simultaneous implantation of aTOPS (transcutaneous osseointegrated prosthetic system) and THA (total hip arthroplasty) or staged approach. Patients with aTOPS who have coxarthrosis. Patients with an existing THA who have required above-knee amputation and need aTOPS. Patients with an existing TOPS who sustain amedial femoral neck fracture and are not stabilizable with osteosynthesis. Atypical anatomy, osteomyelitis, radiation or chemotherapy to the affected limb in the last 18months, peripheral occlusive arterial disease with critical ischemia, diabetes mellitus with polyneuropathy, local dermal or systemic infection, immunocompromised state or use of immunosuppressants, cognitive impairment or lack of compliance for the system, other significant physical impairments. Individualized preoperative planning based on CT data. Access similar to conventional THA for existing TOPS. Implantation of an artificial acetabulum with amatching inlay. Similar approach for medial femoral neck fractures without reconstructive options. For existing THA and prior above-knee amputation, removal of existing shaft and potentially neck component for modular prosthesis. Subsequent implantation of TOPS stem in conventional manner. Additional THA requires appropriate rehabilitation following endoprosthesis guidelines, tailored to the TOPS situation. For simultaneous implantation of TOPS and THA the patients' load-bearing capacity and mobilization depend on the duration of the implanted stem. Only 4patients have been treated at BGU Murnau making statistical analysis not feasible. Three of the 4patients experienced significant pain relief and improved mobility shortly after surgery. One patient remained as immobile postoperatively as preoperatively due to inability to achieve pain-free full weight-bearing.

Transabdominal sonographic sliding signs for preoperative prediction of dense intra-abdominal adhesions in women undergoing repeat Cesarean delivery.

To assess the accuracy and utility of transabdominal sonographic paraumbilical and suprapubic sliding signs in predicting intra-abdominal adhesions in women undergoing repeat Cesarean section (CS) and the association of repeat CS with short-term maternal and neonatal outcomes. This was a prospective observational study of pregnant women with a history of CS who were scheduled for third-trimester elective or emergency CS at a tertiary referral and teaching hospital between July 2021 and June 2022. In order to evaluate the role of transabdominal sonographic paraumbilical and suprapubic sliding signs in the prediction of intra-abdominal adhesions, participants underwent a high-resolution transabdominal ultrasound scan prior to repeat CS. Free cephalad and caudad gliding of the uterus under the abdominal wall during deep inhalation and exhalation in each area was considered a positive sliding sign, suggesting a low risk of intra-abdominal adhesions. The absence of such movement was considered a negative sliding sign, suggesting a high risk of intra-abdominal adhesions. The presence or absence of intra-abdominal adhesions was then confirmed during surgery by physicians who were blinded to the sonographic sliding-sign findings. The type of adhesion, structures involved, method of adhesiolysis, incision-to-delivery time, 1-min and 5-min Apgar scores, maternal and neonatal injury and other short-term complications were also reported. Of 419 women with a history of at least one previous CS who underwent repeat CS, the preoperative sonographic paraumbilical and suprapubic sliding signs were negative in 173 (41.3%) and 178 (42.5%) women, respectively. On repeat CS, 224 (53.5%) women had intra-abdominal adhesions, of which 165 (39.4%) had dense adhesions and 59 (14.1%) had only filmy adhesions. The sensitivity and specificity of a negative preoperative paraumbilical sliding sign in predicting the presence of dense intra-abdominal adhesions in women undergoing repeat CS were 94.6% (95% CI, 92.4-96.7%) and 93.3% (95% CI, 90.9-95.7%), respectively. A negative suprapubic sliding sign also showed high sensitivity (95.2% (95% CI, 93.1-97.2%)) and specificity (91.7% (95% CI, 89.1-94.4%)). Additionally, a negative sliding sign at both locations in the same patient had robust sensitivity (90.2% (95% CI, 87.3-93.0%)) and specificity (96.3% (95% CI, 94.5-98.1%)). We found that the risk of dense intra-abdominal adhesions increased with parity and the number of previous CS. Dense intra-abdominal adhesions were associated with increased incision-to-delivery time, higher risk of maternal bladder injury, intraoperative bleeding and postpartum hemorrhage. Dense intra-abdominal adhesions are common in women with a previous history of CS and are associated with delayed delivery of the neonate and increased risk of adverse maternal outcomes. The transabdominal sonographic paraumbilical and suprapubic sliding signs are robust methods for the accurate preoperative prediction of dense intra-abdominal adhesions in patients with a history of CS. As the techniques are easy to learn and perform, the sliding sign should be used more widely for triaging patients at high risk of dense intra-abdominal adhesions for appropriate preoperative planning. © 2024 International Society of Ultrasound in Obstetrics and Gynecology.

NIMG-87. MULTIREGIONAL, MRI-LOCALIZED SAMPLING OF HIGH GRADE GLIOMAS REVEAL SEX-DISTINCT PATTERNS OF 5-ALA FLUORESCENCE AND IMAGING FEATURES

Abstract High grade gliomas (HGGs) are aggressive brain tumors that are difficult to remove completely, leading to poor survival rates. Contrast enhancement on T1Gd magnetic resonance imaging (MRI) has traditionally been used to guide resection, however it often underestimates true tumor burden, adding a layer of uncertainty for surgeons during pre-operative planning. Fluorescence guided surgery using 5-aminolevulinic acid (5-ALA) has emerged as an intraoperative solution and understanding it in conjunction with MRI features can address the limitations of routine T1Gd imaging during surgical planning. Here we investigate sex-specific patterns in HGGs using 5-ALA fluorescence and imaging features. We analyzed a patient dataset of 202 multiregional MRI-localized biopsies from 42 HGG patients (20 male and 22 female). Data included patient demographics, 5-ALA status (positive or negative), MRI annotations (CE = contrast enhancement, NE = non-enhancement, BAT = brain around tumor non-enhancement), and survival outcomes. Statistical analyses included Wilcoxon rank-sum tests, Kruskal-Wallis tests, and chi-squared tests to assess differences in imaging annotations and 5-ALA positive vs negative status among sex cohorts. Among all samples, CE and BAT were associated with higher 5-ALA positivity, while NE was associated with higher 5-ALA negativity (p = 0.02119). Female patients were less likely to have detectable 5-ALA in their multiregional biopsy samples than males (p &amp;lt; 0.0001). CE at the biopsy location was more likely to be indicative of 5-ALA positivity in males than females (p = 0.001927); whereas NE was associated with higher 5-ALA negativity in females than males (p = 0.03426). BAT was associated with higher 5-ALA positivity in males than females (p = 0.03895). Our study reveals sex-specific patterns in 5-ALA fluorescence and image features among HGG patients. These unique features may serve as potential pre-surgical markers for tumor regions that are more likely to benefit from 5-ALA-guided resection.