Reduced Operating Time Research Articles

Robot-assisted esophagectomy with extended mediastinal lymph node dissection: The learning curve and surgical outcomes.

457 Background: We have performed thoracoscopic surgery (TMIE) and robot-assisted surgery (RAMIE) for esophageal cancer with extensive mediastinal lymph node dissection, including resection of the sympathetic nerve layers and the thoracic duct. We studied the learning curve, short-term results, and mid-to-long-term outcomes of RAMIE for esophageal cancer at our institution. Methods: We compared surgical times at different stages of the procedure. For mid to long-term outcomes, we analyzed 360 cases of TMIE/RAMIE performed between January 2009 and June 2022, comparing the incidence of postoperative complications, recurrence-free survival, and patterns of recurrence between RAMIE and TMIE. Recurrent laryngeal nerve palsy (C-D I) was evaluated using postoperative endoscopy or contrast swallowing tests to assess even mild paralysis. Results: The average console time in the thoracic procedure was 234.4 minutes, with Group A (294.5 minutes, range: 211-397 minutes) showing significantly longer times compared to Group B (190.5 minutes, range: 130-257 minutes). Blood loss was almost 0ml in 10 cases (50%) in Group A and 25 cases (62.5%) in Group B. Postoperative complications included pneumonia in 5 cases (8.3%) and recurrent laryngeal nerve palsy (C-D III) in 5 cases (8.3%), with no significant difference between the groups. However, surgical time for lymph node dissection around the recurrent laryngeal nerve was significantly shorter in Group B compared to Group A. Long-term analysis included 326 TMIE and 34 RAMIE cases. Mild recurrent laryngeal nerve palsy (>C-D I) was observed in 92 cases (28%) of TMIE and 7 cases (21%) of RAMIE, showing a lower tendency in the RAMIE group (p=0.338). Pneumonia (>C-D II) occurred in 57 cases (18%) in the TMIE group and 3 cases (9%) in the RAMIE group, with a relatively lower incidence in the RAMIE group (p=0.178). For patients with cT1N0M0 who did not receive preoperative chemotherapy, the 3-year recurrence-free survival rates were 95% for TMIE and 93% for RAMIE. Conclusions: RAMIE demonstrated a significant reduction in operative time due to the standardization of the procedure, particularly in the dissection of recurrent laryngeal nerve lymph nodes and other upper mediastinal maneuvers. RAMIE also showed a potential reduction in the incidence of recurrent laryngeal nerve palsy and pneumonia compared to TMIE. In terms of long-term outcomes, RAMIE maintained local control similar to TMIE, with further improvements in safety expected.

Deep-learning based electromagnetic navigation system for transthoracic percutaneous puncture of small pulmonary nodules

Percutaneous transthoracic puncture of small pulmonary nodules is technically challenging. We developed a novel electromagnetic navigation puncture system for the puncture of sub-centimeter lung nodules by combining multiple deep learning models with electromagnetic and spatial localization technologies. We compared the performance of DL-EMNS and conventional CT-guided methods in percutaneous lung punctures using phantom and animal models. In the phantom study, the DL-EMNS group showed a higher technical success rate (95.6% vs. 77.8%, p = 0.027), smaller error (1.47 ± 1.62 mm vs. 3.98 ± 2.58 mm, p < 0.001), shorter procedure duration (291.56 ± 150.30 vs. 676.44 ± 246.12 s, p < 0.001), and fewer number of CT acquisitions (1.2 ± 0.66 vs. 2.93 ± 0.98, p < 0.001) compared to the traditional CT-guided group. In the animal study, DL-EMNS significantly improved technical success rate (100% vs. 84.0%, p = 0.015), reduced operation time (121.36 ± 38.87 s vs. 321.60 ± 129.12 s, p < 0.001), number of CT acquisitions (1.09 ± 0.29 vs. 2.96 ± 0.73, p < 0.001) and complication rate (0% vs. 20%, p = 0.002). In conclusion, with the assistance of DL-EMNS, the operators got better performance in the percutaneous puncture of small pulmonary nodules.

Pancreas-guided C-shaped surgical procedure: a safer and more efficient procedure for laparoscopic left hemicolectomy in obese patients.

The surgical risk is higher for obese patients undergoing laparoscopic left hemicolectomy. To enhance the surgical safety and efficacy for obese patients, we have innovatively integrated the advantages of various surgical approaches to modify a pancreas-guided C-shaped surgical procedure. The safety and quality were assessed through a retrospective analysis. Colon cancer patients who underwent laparoscopic left hemicolectomy were categorized into two groups, C-shaped group and Medial-to-lateral group. Baseline data, operative safety indices, operative quality indices and learning curve were subjected to statistical analysis. The complete mesocolic excision rate and R0 resection rate were 100% in both groups. In terms of surgical safety, C-shaped group experienced significantly less blood loss (50(20) mL vs. 50(50) mL, p = 0.002), shorter total operative time (252.65 ± 50.43min vs. 280.12 ± 70.45min, p = 0.004) and no organ damage occurred. All patients were classified into four BMI grades (I: BMI < 18.5kg/m2; II: 18.5 ≤ BMI < 24kg/m2; III: 24 ≤ BMI < 28kg/m2; IV: BMI ≥ 28kg/m2). The total operative time and estimated blood loss were significantly lower in obese patients (BMI grade III and IV) of C-shaped group. In addition, intra-group analysis further confirmed that this modified surgical technique could effectively enhance safety and efficiency for obese patients. Learning curve analysis revealed a significant reduction in total operative time after the completion of 20 surgeries. Utilization of the pancreas-guided C-shaped surgical procedure in obese patients ensures reliable surgical outcomes and significantly increases safety and efficiency. In addition, it is easier to learn and master.

Comparison of effectiveness between two surgical methods for humeral lateral condyle fractures in children

To compare the effectiveness of ultrasound-guided closed reduction with Kirschner wire fixation and open reduction with Kirschner wire fixation in the treatment of humeral lateral condyle fracture (HLCF) in children. A clinical data of 53 children with HLCF admitted between May 2020 and April 2023 and met selective criteria was retrospectively analyzed. Of these, 25 cases were managed with closed reduction and Kirschner wire fixation under ultrasound guidance (closed group), while 28 cases underwent open reduction and Kirschner wire fixation (open group). There was no significant difference between the two groups in terms of gender, age, cause of injury, fracture side, fracture classification, and time from injury to operation ( P>0.05). The following variables were recorded and compared between the two groups: operation time, intraoperative fluoroscopy frequency, fracture healing time, incidence of complications, and the Flynn elbow function score at last follow-up. In the closed group, the fractures were successfully reduced under ultrasound guidance, with no nerve damage reported in either group. The operation time and intraoperative fluoroscopy frequency were significantly less in the closed group than in the open group ( P<0.05). One case of infection (Kirschner wire irritation) was observed in the closed group, while 3 cases in the open group (2 of Kirschner wire irritation and 1 of incision infection). However, the difference in the incidence of infection between the two groups was not significant ( P>0.05). All patients in both groups were followed up 6-18 months (mean, 10.2 months). X-ray examinations confirmed that fractures had healed in both groups, with no significant difference in healing time ( P>0.05). During follow-up, 5 cases of lateral humeral process formation were observed in the closed group, compared to 12 cases in the open group, although this difference was not significant ( P>0.05). At last follow-up, the excellent and good rate of elbow joint function was evaluated as 96.0% (24/25) in the closed group and 92.9% (26/28) in the open group according to the Flynn scoring criteria, with no significant difference between the two groups ( P>0.05). Both groups showed no occurrence of ossifying myositis or elbow internal/external rotation. The effectiveness of ultrasound-guided closed reduction and Kirschner wire fixation in the treatment of HLCF in children is comparable to open reduction and Kirschner wire fixation, but the former can reduce operation time and intraoperative fluoroscopy frequency, and obtain lower the incidence of complications.

Perioperative changes in anxiety and comfort in third molar extraction patients sedated with midazolam.

This study aimed to analyze changes in anxiety and comfort levels at each perioperative stage during third molar extraction under single-agent intravenous midazolam sedation, and to clarify how these conditions at each perioperative stage affect postoperative satisfaction. 115 who requested extraction of 1 ~ 4 third molars under single-agent intravenous midazolam sedation were targeted. These patients were administered a questionnaire survey one week after surgery. The questionnaire's five items (Anxiety before surgery, Comfort during surgery, Comfort after surgery, Amnesia, and Satisfaction) were evaluated using a visual analog scale (VAS). We investigated the correlation between each of the eight parameters which added age, operation time, and total amount of midazolam, to the VAS score. Furthermore, we compared each eight parameters according to the number of extracted wisdom teeth and sex differences. Regarding the correlation among each parameter, low preoperative anxiety were weak and positively correlated with reduced operation time reduced midazolam dosage, and an increase in postoperative comfort. All parameters influenced the patient's satisfaction level. Those levels were significantly affected by preoperative reassurance (r = 0.4402, p < 0.01), postoperative comfort (r = 0.5522, p < 0.01) amnesia (r = 0.5741, p < 0.01), and intraoperative comfort (r = 0.7578, p < 0.01). Each parameter had no significant difference depending on the number of teeth extracted. In comparison between men and women, only preoperative reassurance was significantly lower in women than in men (p<0.05). This sedation effectively managed preoperative anxiety and improved postoperative satisfaction. To obtain good sedative condition, Preoperative anxiolytics are recommended. This sedation is considered particularly effective in women.

Efficacy and safety of indocyanine green fluorescence navigation versus conventional laparoscopic hepatectomy for hepatocellular carcinoma: a systematic review and meta-analysis.

Indocyanine green (ICG) fluorescence imaging technology is increasingly widely used in laparoscopic hepatectomy. However, previous studies have produced conflicting results regarding whether it is truly superior to traditional laparoscopic hepatectomy. This study investigated the clinical effect of laparoscopic hepatectomy for hepatocellular carcinoma (HCC) using ICG imaging technology. A systematic review and meta-analysis, based on the preferred reporting items for systematic reviews and meta-analysis statement, were conducted (PROSPERO: CRD42024532356). A computer search was conducted in databases including CNKI, Wanfang, PubMed, Embase, Cochrane Library, and Web of Science from January 1, 1990, to April 30, 2024. A total of 17 articles were included after screening, comprising 4 randomized controlled trials and 13 case-control studies, with 1620 patients in total. Among these, there were 743 cases in the fluorescence laparoscopy group and 877 cases in the non-fluorescence laparoscopy group. Hepatectomy guided by indocyanine green fluorescence navigation significantly reduced operation time (MD = -23.25, 95% CI: -36.35 to -10.15, P = 0.0005), intraoperative blood loss (MD = -51.04, 95% CI: -69.52 to -32.56, P < 0.00001), and intraoperative transfusion rate (OR = 0.43, 95% CI: 0.27 to 0.69, P = 0.0004), while increasing the R0 resection rate (OR = 2.93, 95% CI: 1.73 to 4.96, P < 0.0001) and decreasing the postoperative complication rate (OR = 0.59, 95% CI: 0.43 to 0.82, P = 0.002). However, there was no statistically significant difference in postoperative length of hospital stay (MD = -0.67, 95% CI: -1.51 to 0.18, P = 0.12). In the treatment of HCC, hepatectomy guided by indocyanine green fluorescence navigation demonstrates superior efficacy and safety, its application and promotion are warranted.

Clinical applications of 3D printing in spine surgery: a systematic review.

The objective of this systematic review is to present a comprehensive summary of existing research on the use of 3D printing in spinal surgery. The researchers conducted a thorough search of four digital databases (PubMed, Web of Science, Scopus, and Embase) to identify relevant studies published between January 1999 and December 2022. The review focused on various aspects, including the types of objects printed, clinical applications, clinical outcomes, time and cost considerations, 3D printing materials, location of 3D printing, and technologies utilized. Out of the 1620 studies initially identified and the 17 added by manual search, 105 met the inclusion criteria for this review, collectively involving 2088 patients whose surgeries involved 3D printed objects. The studies presented a variety of 3D printed devices, such as anatomical models, intraoperative navigational templates, and customized implants. The most widely used type of objects are drill guides (53%) and anatomical models (25%) which can also be used for simulating the surgery. Custom made implants are much less frequently used (16% of papers). These devices significantly improved clinical outcomes, particularly enhancing the accuracy of pedicle screw placement. Most studies (88%) reported reduced operation times, although two noted longer times due to procedural complexities. A variety of 3DP technologies and materials were used, with STL, FDM, and SLS common for models and guides, and titanium for implants via EBM, SLM, and DMLS. Materialise software (Mimics, 3-Matic, Magics) was frequently utilized. While most studies mentioned outsourced production, in-house printing was implied in several cases, indicating a trend towards localized 3D printing in spine surgery. 3D printing in spine surgery, a rapidly growing area of research, is predominantly used for creating drill guides for screw insertion, anatomical models, and innovative implants, enhancing clinical outcomes and reducing operative time. While cost-efficiency remains uncertain due to insufficient data, some 3D printing applications, like pedicle screw drill guides, are already widely accepted and routinely used in hospitals.

Rapid reduction in surgical time and high level of accuracy in alignment and femoral component size prediction in robotic-assisted total knee arthroplasty with ROSA Knee System.

Robotic-assisted total knee arthroplasty (RA-TKA) has gained popularity for its potential ability to improve surgical precision and patient outcomes, despite concerns about its long learning curve and increased operative times. The aim of this study is to evaluate the learning curve of the ROSA® Knee System, the relationship between each phase of the learning curve and the accuracy of the robotic system in femoral component size and knee alignment prediction. A single surgeon retrospective analysis of total operative time (TOT) and total robotic time was conducted. The first 60 cases of RA-TKA performed between July 2023 and March 2024 were included. Six (10%) patients were excluded due to incomplete surgical reports. A cumulative sum analysis was used to identify the learning and proficiency phases of the surgeon's learning curve. Moreover, femoral component size prediction accuracy and the difference between planned and achieved knee alignment were analyzed. The projected learning curve showed a significant reduction in TOT after 10 cases, with mean time decreasing from 62.6 ± 7.92 min in the learning phase to 49.9 ± 8.10 min in the proficiency phase (p = 0.0008). The robotic procedure accounted for 48% and 42% of the TOT in the learning and proficiency phases, respectively. Prediction in femoral component size was accurate in 92.6% of cases. The difference between planned and achieved knee alignment was not statistically significant (1.1° ± 0.9°). The ROSA® Knee System allows a rapid learning curve in RA-TKA, with a significant reduction in operative time after the first 10 cases. An experienced orthopaedic surgeon specialized in knee arthroplasty can quickly reach a proficiency phase, maintaining high accuracy in alignment and femoral component sizing. These findings suggest that the ROSA® system is an effective and reliable tool for CR RA-TKA, offering precise and reproducible outcomes. IV.

Usefulness of Artificial Pneumothorax during Totally Endoscopic Off-Pump Left Atrial Appendage Closure and Surgical Ablation.

In totally endoscopic off-pump left atrial appendage (LAA) closure and surgical ablation, securing the operative field is sometimes difficult in some patients because of a narrow working space caused by an elevated diaphragm or ventricles. In this study, we aimed to investigate the effectiveness of a method that facilitates securing the operative field using an artificial pneumothorax. We analyzed 71 consecutive patients who underwent totally endoscopic off-pump LAA closure and bilateral pulmonary vein isolation. The factors contributing to the reduction in operative time were examined. The patients were divided into the following 2 groups according to whether or not an artificial pneumothorax was used: Group C comprised 24 patients without an artificial pneumothorax and Group A comprised 47 patients with an artificial pneumothorax. There were no hospital deaths or major complications. The operative time was significantly shorter in Group A (108 ± 26 minutes) than in Group C (198 ± 77 minutes) (p <0.0001). In totally endoscopic off-pump LAA closure and surgical ablation, an artificial pneumothorax may be useful in reducing the operative time.

Global research interest and publication trends on guided surgery in implant dentistry: A metrics-based analysis.

Digital surgical guides improve precision by detailing the direction, position, and angle of implants, which reduces surgery time and complications. A bibliometric analysis of guided surgery in implant dentistry is lacking. The aim of this metrics-based analysis was to analyze the trends and key characteristics of articles related to guided surgery in implant dentistry. The search was conducted in February 2024 on the Web of Science. The main characteristics of the studies were extracted and analyzed. Collaborative networks were generated using the Vosviewer software program. Dimension was consulted to measure Altmetric data. Correlation among data was determined by using the Spearman test. A total of 799 articles published between 1993 and 2023 were included. Most were case reports or series (n=26) using static guided surgery (n=672), primarily for dental implant placement (n=754). The studies typically employed a combination of cone beam computed tomography (CBCT) and digital scanning (n=316) for surgical planning. The most frequently used software program was coDiagnostiX (n=89), and the most commonly used guide type was the printed guide (n=161). The country with the most articles was the USA (n=137), though Europe stood out as the leading continent (n=398). The Vosviewer demonstrated strong collaborations among authors. According to Dimensions, significant mentions were identified in Mendeley, news outlets, and X. An emerging trend in guided implant dentistry research was identified over the past 30 years through the use of software programs and 3D-printers for the fabrication of surgical guides. Europe showed the greatest interest in this topic, predominantly conducting research on static guided surgery for implant placement. Additional clinical studies and systematic reviews are needed.

Transtemporal Endoscopic Deep Plane Face Lift.

Facial aging involves multifactorial changes affecting the bone, superficial musculoaponeurotic system, fat pads, and skin, primarily manifesting as the downward displacement of these structures. The transtemporal endoscopic deep plane face lift (TEDPF) suggests a vertical lifting method, targeting these issues without a preauricular incision. A retrospective study was conducted on 140 patients (133 women and 7 men) 33-67 years of age who underwent TEDPF from February 2020 to March 2023. Of these, 42 patients also received a neck lift. The surgical technique involved endoscopic dissection and vertical lifting and fixation of the superficial musculoaponeurotic system layer using specific suture points. An objective photographic analysis was performed by measuring preoperative and postoperative lower eyelid lengths to assess aesthetic outcomes. The follow-up period ranged from 18 to 36 months. Temporary frontal neuropraxia occurred in 5 patients, resolving within 3 weeks to 3 months. Revision surgery was required for 6 patients due to excess preauricular skin or temporal skin accumulation malar dimpling. Significant improvements were observed, especially in periorbital, nasolabial, and jowl areas, enhancing eye shape and reducing the need for lower blepharoplasty. Objective photographic analysis showed a significant reduction in lower eyelid length postoperatively, with a mean percentage reduction of 22.45% in eyelid length (P < 0.05). TEDPF achieves effective vertical lifting for facial rejuvenation, minimizes scarring, and reduces surgery time. It provides notable aesthetic improvements with manageable complications, suitable for patients prone to keloids or seeking less invasive options.

The Impact of Intracervical Terlipressin on Intravasation and Venous Embolization During Transcervical Myomectomy and Endometrium resection: A Randomized Controlled Study.

To investigate whether intracervical injection of terlipressin during hysteroscopic surgery could reduce the amount of intravasation, the incidence and severity of gas embolism, and the COHb levels in the blood. Randomized double-blind controlled trial. Gynecologic surgical unit in a general hospital. Patients who were scheduled for transcervical resection of type 1 or type 2 myomas (TCR-M), or for extensive transcervical endometrium resection (TCR-E). Patients were randomized to receive either terlipressin 0.85 mg or placebo injections intracervically at the beginning of the procedure. The amount of intravasation and level of COHb was measured at the end of the procedure. The incidence and severity of gas embolisms was determined during the procedure by transesophageal echocardiography (TEE). Study groups were compared using an Independent Samples T-Test or a Mann-Whitney U test as indicated. Forty-four patients were included in this study. No significant differences were found in intravasation volume, venous emboli and post-surgery COHb between study groups. There was a trend towards more severe embolisms (grade IV embolisms: 12 versus 6, p = .08), paradoxical embolisms (4 versus 2, p = .55) and a shorter operation time (mean of 43 versus 36 minutes, p = .09) in patients who received terlipressin compared to placebo. This study could not demonstrate a clear beneficial effect of intracervical terlipressin administration. However, further research is needed to investigate if terlipressin can reduce operation time, severe embolisms and the need for redo procedures.

Functional Outcomes, Operating Time, Bleeding Rate and Weight Bearing in Short Vs Long PFNA in IT Femur Fracture

Objective: In order to manage intertrochanteric (IT) femur fractures, this study compares the functional outcomes, operating time, bleeding rate, and weight-bearing capability using short and long proximal femoral nail antirotation (PFNA). Methods: Patients who received PFNA for IT femur fractures between April and September of 2024 were the subjects of a retrospective investigation. Based on the length of the PFNA used, sixty patients were split into two groups: thirty received a short PFNA and thirty received a long PFNA. The time it took to reach full weight-bearing, operating time, intraoperative bleeding rate, and functional results as measured by the Harris Hip Score (HHS) at 6 and 12 weeks were among the important factors assessed. A statistical analysis was performed on the data to identify any noteworthy variations between the two groups. Results: There were 60 patients in the trial; 30 were in the long PFNA group and 30 were in the short PFNA group. The short PFNA group had an average operating duration of 45 minutes, which was considerably less than the long PFNA group's 65 minutes (p&lt;0.05). The short PFNA group experienced a considerably lower intraoperative blood loss (average of 140 ml) than the long PFNA group (average of 210 ml) (p&lt;0.05). The HHS's measure of functional outcomes showed no statistically significant difference in scores at 12 weeks (p=0.65) between the two groups. There was no discernible difference in the recovery period between the two groups' average time to reach full weight-bearing, which was 8 weeks. The lengthy PFNA group had slightly fewer complications, such as fixation failure, but the difference was not statistically significant (p=0.58). Conclusion: Reduced operating time and less intraoperative bleeding are two benefits of short PFNA, without sacrificing weight-bearing ability or functional results. While both short and long PFNA offer comparable functional outcomes, addressing IT femur fractures may benefit more from short PFNA's potential for greater effectiveness and safety. Additional investigation, including prospective studies, is important to corroborate these results and evaluate enduring consequences.

An MRI-guided stereotactic neurosurgical robotic system for semi-enclosed head coils.

Magnetic resonance imaging (MRI) offers high-quality soft tissue imaging without radiation exposure, which allows stereotactic techniques to significantly improve outcomes in cranial surgeries, particularly in deep brain stimulation (DBS) procedures. However, conventional stereotactic neurosurgeries often rely on mechanical stereotactic head frames and preoperative imaging, leading to suboptimal results due to the invisibility and the contact with patient's head, which may cause additional harm. This paper presents a frameless, MRI-guided stereotactic neurosurgical robotic system. The robot features a seven-degree-of-freedom (7-DOF) remote center of motion, with five DOFs for preoperative trajectory alignment to the target lesion and two DOFs for defining the depth and twisting motion of the needle during insertion, thus to minimize tissue damage. The system employs interactive MRI guidance for real-time visualization of the puncture process, showing great potential in reducing surgery time, enhancing targeting accuracy, and improving safety. Experiments were conducted on the proposed system to evaluate signal-to-noise ratio (SNR) and geometric distortion. During the simultaneous operation and imaging, the system demonstrated less than 10.02% SNR attenuation and less than 0.1% geometric distortion, ensuring image usability. The free-space positioning accuracy of the system was evaluated using a laser tracker, revealing a tip position repeatability error within 0.3 ± 0.1mm.

Preoperative surgical planning MRI for fibroids: What the surgeon needs to know and what to report.

Uterine leiomyomata, commonly known as fibroids, are prevalent benign tumours affecting a significant percentage of women of reproductive age. Although many patients remain asymptomatic, a substantial proportion experience severe symptoms, including abnormal uterine bleeding and adverse reproductive outcomes. Surgical intervention often becomes necessary for patients with symptomatic fibroids, despite advancements in medical therapies. This article explores the critical role of Magnetic Resonance Imaging (MRI) in the preoperative planning and management of fibroid surgeries. MRI has been proven superior to traditional imaging methods, such as transvaginal ultrasound (TVS), offering a more accurate evaluation of fibroid size, location, number, and characteristics. This enhanced imaging aids in surgical planning by providing detailed anatomical insights, helping gynaecologists choose the appropriate surgical techniques and predict potential complications. Moreover, MRI is instrumental in assessing the risk of malignancy, guiding decisions onwhether to proceed with myomectomy or hysterectomy. Technological advancements, such as 3D MRI modelling and augmented reality, promise further improvements in surgical outcomes by enhancing anatomical understanding and precision. These innovations, along with artificial intelligence integration, show potential in reducing operation times and improving patient outcomes. This review underscores the essential role of MRI in contemporary fibroid management and highlights future directions in the field.

New Productive Force: The Preliminary Report of First Craniofacial Surgical Robot IST Multicenter Clinical Trial in China.

This paper presents the authors' team's research on a craniofacial surgical robot developed in China. Initiated in 2011 with government funding, the craniofacial surgical robot project was officially launched in Shanghai, developed jointly by the Ninth People's Hospital affiliated with Shanghai Jiao Tong University School of Medicine and the Shanghai Jiao Tong University medical-engineering team. Currently, based on multiple rounds of model surgeries, animal experiments, and clinical trials, our team is applying for approval as a Class III medical device from the National Medical Products Administration (NMPA). As an innovative tool in the field of craniofacial surgery, it fills a technological gap within the country. This study is a multicenter cohort study based on patient data from Shanghai Ninth People's Hospital from 2019 to 2024. Inclusion criteria included patients who underwent craniofacial surgery with complete follow-up data, with the primary variable being the use of robotic assistance in craniofacial surgery. Data analysis involved descriptive statistics, t tests, and multivariable regression, with a significance level set at P<0.05. The craniofacial surgical robot has been widely explored in the fields of congenital deformities, tumor reconstruction, and esthetic surgery. In the clinical trials discussed in this article, which included experiments on both craniofacial deformity correction surgeries and esthetic surgeries, a total of 39 patients were enrolled. In mandibular osteotomy surgery, robotic-assisted procedures can reduce osteotomy length error by an average of 2.2mm and mandibular angle error by 9.09 degrees, while also decreasing the average surgery time by 10.43 minutes. In hemifacial microsomia distraction osteogenesis surgery, robotic-assisted surgery can reduce osteotomy length error by an average of 4.6mm and shorten the average surgery time by 60 minutes. The robotic-assisted group also showed better perioperative outcomes for patients. The surgical precision was improved and there was a significant reduction in postoperative complications. The authors' research team has completed the first multicenter study on craniofacial surgical robots in China, demonstrating that this robot significantly enhances surgical precision, reduces operation time, and improves perioperative patient indicators. These findings indicate that the robot is highly effective in assisting surgeons with complex procedures. The study suggests that, in the future, this robot is likely to be widely adopted in craniofacial surgery, significantly advancing surgical efficiency and precision, and bringing transformative progress to clinical practice.

Fully Navigated Single-Position Prone Lateral Lumbar Interbody Fusion: A Detailed Technical Report and Description of 15 Cases.

Navigation increases the precision and safety of pedicle screw placement and has been used to place interbody cages for lateral lumbar interbody fusion. Single-position surgery shortens its duration and that of anesthesia. The aim of this study was the feasibility of simultaneous cage and screw placement in a single prone position using intraoperative navigation without the need for additional fluoroscopy and a detailed technical description of this procedure. We retrospectively analyzed 15 patients who underwent simultaneous navigated lateral lumbar interbody fusion and posterior instrumentation in a single prone position. A detailed technical description of the procedure is provided. Surgery duration, blood loss, complications, and radiographic parameters were recorded. A total of 24 cages were placed in 15 patients. The mean time taken for cage placement was 21 ± 6.70 minutes, and there were no major complications. Mean surgery duration and blood loss per case, including posterior instrumentation, were 263 ± 94 minutes and 315 ± 143 mL, respectively. There were significant improvements in pre- to postoperative Oswestry Disability Index scores (51.38 ± 15.93 vs 32.81 ± 17.18, P < 0.001) and segmental lordosis (3.26° ± 8.97° vs 13.09° ± 15.25°, P < 0.001). The present study's results showed the feasibility of lateral lumbar interbody fusion using simultaneous posterior pedicle screw instrumentation and intraoperative navigation in a single prone position. Navigated lateral lumbar interbody fusion and posterior instrumentation in a single prone position possibly reduces operating time and blood loss and reduces exposure of operation room personnel to radiation.

Long-term effectiveness of stand-alone anchored spacer in multilevel anterior cervical discectomy and fusion compared with cage-plate system: a systematic review and meta-analysis.

For anterior cervical discectomy and fusion (ACDF), stand-alone anchored spacers (SAAS) and cage-plate system (CPS) are currently employed. However, controversy remains over the effectiveness and security of these two apparatuses in multilevel ACDF. The aim of this study was to demonstrate the global long-term effectiveness and safety of SAAS versus CPS with multilevel ACDF. We conducted a systematic review of studies comparing SAAS with CPS for multilevel ACDF using four electronic databases. Data from this meta-analysis were analyzed with Stata MP 17.0. A total of nine trials comprising 584 patients were selected for inclusion. SAAS significantly reduced operative time, intraoperative bleeding and the incidence of postoperative dysphagia compared with CPS. The SAAS group exhibited significantly smaller cervical sagittal angle (CSA) and fusion segmental height (FSH) compared to CPS group. At final follow-up, the rate of cage sinking was higher in SAAS group compared to CPS group. At the endpoint, there was no difference in JOA score, NDI score, fusion rate or the incidence of adjacent segment degeneration (ASD). SAAS provided comparable long-term effectiveness and safeness for multilevel ACDF regarding JOA scores, NDI scores, fusion rates and ASD rates at endpoint compared to CPS. In comparison to CPS, SAAS demonstrated significant advancement in the reduction of operative time, intraoperative blood loss and the incidence of postoperative dysphagia. As a consequence, SAAS appeared more desirable than CPS among people who needed multilevel ACDF. Yet in long-term observation, SAAS was inferior to CPS in maintaining CSA and FSH and in preventing cage descent. However, whether or not radiographic abnormality has an impact on clinical presentation awaits confirmation from research with more longitudinal follow-up.

Laser-guided percutaneous microwave ablation for lung nodules: a promising approach with reduced operation time

BackgroundPulmonary nodule ablation is an effective method for treating pulmonary nodules. This study is based on the traditional CT-guided percutaneous microwave ablation (MWA) of pulmonary nodules. By comparing laser guidance technology with freehand method, this study aims to explore the safety and efficacy and patients’ pain scores of these two approaches.MethodsThis study retrospectively analyzed 126 patients who underwent CT-guided percutaneous lung ablation at the First Affiliated Hospital of Soochow University from April 2020 to April 2024. Based on the guidance method, we divided those patients into the laser guidance group and the freehand group. The primary outcome such as operation time, the number of ablation needle adjustments, postoperative pain scores, postoperative hospital stay, and postoperative complications were analyzed.ResultsThe laser guidance group had a significantly shorter mean operation time compared to the freehand group (39.3 ± 13.65 min vs. 43.82 ± 19.12 min, p < 0.01), and in the laser guidance group, fewer ablation needle adjustments were required than in the freehand group (3.3 ± 1.34 time vs. 4.37 ± 1.39 times, p < 0.001). As compared to the freehand group, the laser guidance group had fewer cases of mild pneumothorax (13.16% vs. 38.33%, p < 0.05). The postoperative pain score at 1 h and 1 day of the two groups showed no statistical difference.ConclusionBoth methods are safe and effective. The laser guidance technology significantly reduces the number of puncture adjustments and the operation time compared to the freehand method. Laser guidance technology effectively reduces the incidence of mild pneumothorax.

Development and Application of a Fully Automated Chemiluminescence Enzyme Immunoassay for the Detection of Antibodies Against Porcine Circovirus 3 Cap.

Porcine circovirus 3 (PCV3) is a small non-enveloped circovirus associated with porcine dermatitis and nephropathy syndrome (PDNS). It has occurred worldwide and poses a serious threat to the pig industry. However, there is no commercially available vaccine. PCV3 capsid protein (Cap) is an ideal antigen candidate for serodiagnosis. Here, a novel fully automated chemiluminescence enzyme immunoassay (CLEIA) was developed to detect antibodies (Abs) to Cap in porcine serum. Recombinant PCV3 Cap, self-assembled into virus-like particles (VLPs), was produced using baculovirus and coupled to magnetic particles (Cap-MPs) as carriers. Combined with an alkaline phosphatase (AP)-adamantane (AMPPD) system, Cap-Abs can be rapidly measured on a fully automated chemiluminescence analyzer. Under optimal conditions, a cut-off value of 31,508 was determined, with a diagnostic sensitivity of 96.8% and specificity of 97.3%. No cross-reactivity was observed with PCV1 and PCV2 and other common porcine pathogens, and both intra-assay and inter-assay coefficients were less than 5% and 10%, respectively. Prepared Cap-MPs can be stored at 4 °C for more than 6 months. Importantly, this CLEIA had a good agreement of 95.19% with the commercially available kit, demonstrating excellent analytical sensitivity and significantly reduced operating time and labor. A serological survey was then conducted, and showed that PCV3 continues to spread widely in South China. In conclusion, our CLEIA provides time and labor-saving, and a reliable tool for PCV3 epidemiological surveillance.