Shortening Surgery Time Research Articles

Application of Integrated Medical and Nursing Care Model in the Perioperative Period of Endoscopic Precision Surgery

Objective: This study aims to evaluate the application effects of the integrated medical and nursing care model in the perioperative period of endoscopic precision surgery, to improve surgical efficiency and patient satisfaction. Methods: A prospective randomized controlled study design was adopted. From January 2023 to December 2023, 240 patients who underwent endoscopic precision surgery in our hospital were selected and randomly divided into an experimental group (120 patients) and a control group (120 patients). The experimental group implemented an integrated medical and nursing care management model, while the control group used traditional perioperative management. The surgery time, hospital stay, postoperative complication rate, and patient satisfaction of the two groups were compared. Results: The average surgery time of the experimental group was 15% shorter than that of the control group (P<0.05), and the average hospital stay was reduced by 20% (P<0.01). The postoperative complication rate of the experimental group was 5%, compared to 15% for the control group (P<0.05). In the patient satisfaction survey, the satisfaction score of the experimental group (9.2±0.8) was significantly higher than that of the control group (7.5±1.2) (P<0.001). Conclusion: The integrated medical and nursing care model can significantly improve the efficiency and quality of perioperative management in endoscopic precision surgery, shorten surgery time and hospital stay, reduce the incidence of complications, and enhance patient satisfaction. It is recommended that the integrated medical and nursing care model be widely used in perioperative management of endoscopic precision surgery.

Comparative analysis of two methods in circumcision: a new disposable device versus classic sleeve technique

PurposeCircumcision is the most common surgical procedures performed in males. Medical circumcision is recommended for diseases such as phimosis, paraphimosis, balanoposthitis and common urinary tract infections, although there is no exact indication. Conversely, Jewish and Muslim individuals commonly undergo circumcision regardless of medical necessity. Circumcision devices are designed to shorten surgery time, achieve an aesthetic appearance and ensure safe surgery. The aim of this study is to evaluate the effectiveness of the NeoAlis clamp, a disposable circumcision device, by comparing it with the sleeve technique in children.Materials and methodsBetween 2017 and 2023, retrospective evaluation of 2626 patients who underwent circumcision using either the NeoAlis clamp (group 1) or the sleeve technique (group 2) was conducted. Operation time, results, cost, complications were compared between the two groups.ResultsThe study encompassed 2626 patients who fulfilled the inclusion criteria. Group 1 comprised 2403 patients, whereas Group 2 consisted of 223 patients. The overall complication rate, as denoted by n = 47, was 1.7%. Group 1 operation time was shorter than group 2. Bleeding, the most feared complication in the early period, was higher in the second group. No statistically significant difference was observed between the two groups regarding cost comparison.ConclusionThe primary concern during circumcision is to avoid complications related to general anesthesia in newborns and infants. The use of disposable ring devices has been facilitated by the shorter operation time and the absence of the need for sutures when performing circumcision under local anesthesia. However, knowledge of advanced surgical circumcision techniques is necessary in cases of bleeding and inappropriate ring placement.

Intraoperative tranexamic acid administration in cranial meningioma surgery: a meta-analysis of prospective randomized, double-blinded, and placebo-controlled trials.

Cranial meningioma surgeries often involve significant blood loss and transfusions. Tranexamic acid (TXA) has been used to reduce blood loss in various surgeries. This meta-analysis of randomized placebo-controlled trials (RCTs) evaluates the impact of TXA in cranial meningioma surgery. Pubmed, Web of Science, and Cochrane Library were searched for RCTs. Studies were compared for: Blood loss, operative time, hospital stay, reoperation rates, allogeneic and autologous transfusion, and incidence of complications. Seven RCTs with 490 patients receiving TXA and 491 receiving placebos were included. TXA significantly shortened operative time (Mean Difference (MD): -20.95; 95%CI: -39.94 to -1.95; p=0.03). Blood loss was lower with TXA (MD: -262.7 ml; 95%CI: -397.6 to -127.8; p=0.0001). Odds of reoperation were not significantly different (OR: 0.44; 95%CI: 0.13-1.45; p=0.18). TXA significantly reduced the need for RBC transfusions (OR: 0.47; 95%CI: 0.22-0.99; p<0.05). No significant differences were observed regarding postoperative seizures (OR: 1.06; 95%CI: 0.56-2.03; p=0.85), hydrocephalus (OR: 0.25; 95%CI: 0.03-2.29; p=0.22), or hematoma (OR: 0.52; 95%CI: 0.22-1.28; p=0.16). Hospital stay was shortened in the TXA group (MD: -1.23; 95%CI: -2.41 to -0.05; p=0.04). This meta-analysis suggests that a single intraoperative dose of TXA reduces blood loss, allogeneic blood transfusions and shortens surgery time.

Sutureless and rapid-deployment versus conventional bioprosthetic aortic valve replacement in patients with aortic stenosis: a systematic review and meta-analysis of randomised controlled trials

Abstract Background Sutureless aortic valve replacement (SUAVR) has become an alternative to conventional bioprosthetic aortic valve replacement (CAVR) for the treatment of aortic stenosis. This procedure was designed to shorten surgery time, enable optimal valve insertion, and improve surgical outcomes. Purpose This study aimed to compare the clinical outcomes between SUAVR and CAVR for treating patients with aortic stenosis. Methods Systematic searches were conducted from the inception to December 2022, using 4 databases: PubMed, Scopus, Embase, and Web of Sciences. Randomised controlled trials comparing SUAVR versus CAVR were included for analyses. Data were extracted and analysed using predefined clinical outcomes. The revised Cochrane risk-of-bias tool for randomized trials version 2.0 was used to assess the quality of included RCTs. A meta-analysis with risk ratio (RR) or mean difference (MD) was performed to compare clinical outcomes such as aortic cross-clamp (ACC) time, cardiopulmonary bypass (CPB) time, mortality, and complications at 30 days and 1 year. Results The study included 4 articles with a total of 478 SUAVR and 485 CAVR patients. Compared to CAVR, SUAVR had a significantly shorter ACC time (MD -25.1 minutes, 95%CI -44.5 to -5.8, I2 =97%, p 0.01) and CPB time (MD -22.8 minutes, 95% CI -42.4 to -3.2, I2 =93%, p 0.02). There was no significant difference in mortality at 30-day (RR 1.04, 95%CI 0.34-3.15, I2 =0%, p 0.952) and 1-year follow-up (RR 1.08, 95%CI 0.56-2.06, I2 =0%, p 0.822). Complications including myocardial infarction, stroke, major bleeding, renal failure, and endocarditis, did not significantly differ between the two groups. However, permanent pacemaker implantation was significantly higher after SUAVR at 30 days (RR 3.25, 95%CI 1.81-5.84, I2 =0%, p &amp;lt;0.01) and 1 year (RR 2.97, 95%CI 1.71-5.16, I2 =0%, p &amp;lt;0.01). Conclusions SUAVR had significantly shorter ACC and CPB times than CAVR. SUAVR required more permanent pacemaker implantation than CAVR. Mortality and other complications were comparable between the two groups.

Feasibility analysis of treating breast cancer patients with breast-conserving surgery via a periareolar incision combined with non-lipolytic suspension-type mastoscopy

The purpose is to analyze and compare postoperative recovery and complication incidence between a periareolar incision combined with Suspension-type Mastoscopic Axillary Lymph Node Dissection (SMALND) and traditional inflated Mastoscopic Axillary Lymph Node Dissection (MALND). This was a randomized trial conducted from June 1, 2020, to April 30, 2022, in the Department of Second Breast Surgery, Shengjing Hospital of China Medical University, and the Department of Thyroid and Breast Surgery, Zibo Central Hospital, in accordance with the criteria of inclusion and exclusion. Overall, 126 patients diagnosed and treated for early-stage breast cancer were selected to undergo periareolar-incision breast-conserving surgery. Those patients who underwent periareolar-incision surgery combined with SMALND formed the observation group (SMALND Group), while those who underwent periareolar-incision surgery combined with traditional inflation became MALND Group. In the two groups, paired data “t” was used to examine, analyze, and compare the postoperative daily drainage volume and drain removal time, while paired data “χ2” was used to examine, analyze, and compare the incidences of postoperative upper limb edema and paresthesia. There were 64 cases in the SMALND Group and 62 cases in the MALND Group. Between the two clusters, no differences were found in age, clinical staging, BMI, and breast cancer classification (P > 0.05). The intraoperative surgery time of the SMALND Group was 43.37 ± 6.27 min while that of the MALND Group was longer: 45.72 ± 4.25 min (P < 0.05). The intraoperative hemorrhage volume of the SMALND Group was 88.33 ± 16.79 ml, less than that of the MALND Group: 96.76 ± 26.85 ml (P < 0.05). The postoperative axillary mean daily drainage volume of the SMALND Group was 38.17 ± 5.55 ml, less than that of the MALND Group: 40.72 ± 7.25 ml (P < 0.05). The drain removal time of the SMALND Group was 7.50 ± 1.60, less than that of the MALND Group: 9.00 ± 1.80 (P < 0.05). The upper limb edema incidence rate of the SMALND Group was 3.12% (2/64) and had no obvious difference from the MALND Group, which was 4.83% (3/62) (P = 0.62). The paresthesia incidence rate of the SMALND Group was 18.75% (12/64), while that of the MALND Group was 17.7% (11/62), without an obvious difference (P = 0.88). For axillary lymph node dissection, the use of non-lipolytic suspension-type mastoscopy has reduced the intraoperative hemorrhage volume of patients, shortened surgery time and postoperative recovery time, saved treatment expenses for patients, and avoided complications such as hypercapnia and subcutaneous emphysema caused by traditional inflated mastoscopic surgery. Moreover, it has not increased the incidence of postoperative upper limb edema and paresthesia, supporting its safety and effectiveness.

Efficacy and Clinical Outcomes of Minimally Invasive Direct Thoracic Interbody Fusion: A Retrospective Analysis.

A unique surgical approach - the minimally invasive direct interbody fusion (MIS-DTIF) - was previously introduced in our proof-of-concept study, which included four patients who underwent thoracic interbody fusion below the scapula at the T6/7 vertebral level. However, due to the novelty of this method, a report of associated operative parameters such as pain, function, and clinical outcomes from an expanded patient cohort was needed to assess the validity of our results. Following IRB approval, data wereanalyzed retrospectively from electronic health records between 2014 and 2021. Inclusion criteria were patients ≥18 years old who underwent minimally invasive thoracic interbody fusion using the MIS-DTIF technique for at least one vertebral level. The primary outcomes included demographic/radiographic features (e.g., age). Secondary outcomes included perioperative clinical features(e.g., preoperative and ≥1-year final follow-up (FFU)). Tertiary outcomes included perioperative complications. Both preoperative and FFU patient-reported pain and functional outcomes (ODI scores) were analyzed using t-tests to establish significance. Results: A total of 13 patients who underwent MIS-DTIF surgery were observed, with eight male patients and five female patients. The average age was 49.2 years, with an average BMI of 30.5 kg/m2. Of the surgeries included, the majority (69.23%) were 1-level thoracic vertebrae fusions - with 2-level fusionsand≥ 3-level fusions accounting for 15.38% and 15.38% of cases, respectively. The mean operative time was 58.9 ± 19.9minutes, with an average fluoroscopy time of 285.7 ± 126.8secondsand an average actual blood loss volume of 109.0 ± 79.0mL. The average hospital length of stay was 1.1 (±1.7) days, and no clinically significant perioperative complications were observed in this patient cohort. The average follow-up period was 12.1 ± 9.6months, with preoperative and FFU back pain visual analog scale (VAS) scores showing highly significant improvement (p<0.001). In addition to pain reduction, quality of life improvements wasnoted, with significant differences in some of the ODI domains between preoperative and FFU scores (p<0.05), as well as the overall total score between preoperative and FFU ODI assessment (p<0.001) - both of which reflect increased patient function and decreased disability. This study provides further evidence for the safety and efficacy of the MIS-DTIF approach for surgical management of symptomatically refractory patients with thoracic disc herniation or stenosis owing to degenerative disc disease or compression fractures. Additionally, the data gathered suggests that this minimally invasive procedure offers many clinical benefits, including less tissue damage, decreased intraoperative blood loss, shortened surgery time, and shortened hospital length of stay. Finally, in addition to significant pain intensity improvement, this study showed that treated patients highly benefited from 'sleeping' and 'return-to-work' domains and other ODI functional domains in activities of daily living (ADLs). More clinical studies are recommended in larger patient cohorts to ascertain the findings reported in this study.

Full-course resection control strategy in glioma surgery using both intraoperative ultrasound and intraoperative MRI.

BackgroundIntraoperative ultrasound(iUS) and intraoperative MRI (iMRI) are effective ways to perform resection control during glioma surgery. However, most published studies employed only one modality. Few studies have used both during surgery. How to combine these two techniques reasonably, and what advantages they could have for glioma surgery are still open questions.MethodsWe retrospectively reviewed a series of consecutive patients who underwent initial surgical treatment of supratentorial gliomas in our center. We utilized a full-course resection control strategy to combine iUS and iMRI: IUS for pre-resection assessment and intermediate resection control; iMRI for final resection control. The basic patient characteristics, surgical results, iMRI/iUS findings, and their impacts on surgical procedures were evaluated and reported.ResultsA total of 40 patients were included. The extent of resection was 95.43 ± 10.37%, and the gross total resection rate was 72.5%. The median residual tumor size was 6.39 cm3 (range 1.06–16.23 cm3). 5% (2/40) of patients had permanent neurological deficits after surgery. 17.5% (7/40) of patients received further resection after the first iMRI scan, resulting in four (10%) more patients achieving gross total resection. The number of iMRI scans per patient was 1.18 ± 0.38. The surgical time was 4.5 ± 3.6 hours. The pre-resection iUS scan revealed that an average of 3.8 borders of the tumor were beside sulci in 75% (30/40) patients. Intermediate resection control was utilized in 67.5% (27/40) of patients. In 37.5% (15/40) of patients, the surgical procedures were changed intraoperatively based on the iUS findings. Compared with iMRI, the sensitivity and specificity of iUS for residual tumors were 46% and 96%, respectively.ConclusionThe full-course resection control strategy by combining iUS and iMRI could be successfully implemented with good surgical results in initial glioma surgeries. This strategy might stabilize resection control quality and provide the surgeon with more intraoperative information to tailor the surgical strategy. Compared with iMRI-assisted glioma surgery, this strategy might improve efficiency by reducing the number of iMRI scans and shortening surgery time.

Application of electromagnetic navigation in endoscopic transforaminal lumbar interbody fusion: a cohort study.

Clinical retrospective cohort study. To explore the application of the electromagnetic navigation system in Endo-TLIF. From May 2019 to March 2020, 76 patients with single-segment lumbar spondylolisthesis treated by electromagnetic navigation-assisted Endo-TLIF (NE group) and conventional Endo-TLIF (CE group) were enrolled in the study. Time of pediclescrew implantation, entire operation time, the number of intraoperative X-ray fluoroscopy exposures, total blood loss, incisionlength, ambulation time, accuracy of pedicle screws, complications, visual analog scale for back and leg pain, Oswestry Disability Index, Japanese Orthopedic Association score and postoperative fusion rates were recorded, respectively. There were no significant differences in preoperative demographics between the NE and CE groups (P > 0.05). The mean number of intraoperative X-ray fluoroscopy exposures, guidewires insertion, entire operation time, total blood loss and adjustment rate of screws in the NE group were significantly less compared with the CE group (P < 0.05, respectively). There were no significant differences in clinical parameters between the two groups at different time points in the follow-up period (P > 0.05). There was no statistical difference in fusion rates between the two groups. In addition, one case of cage subsidence was observed after surgery in the CE group. Electromagnetic navigation systems could be applied throughout the entire surgical course and ameliorate theshortcomingsofthe conventional Endo-TLIF technique to reduce radiation exposure, improve accuracy, avoid repetitive operations and shorten surgery time and the required learning curve of the procedure. Diagnostic: individual cross-sectional studies with consistently applied reference standard and blinding.

THE NOVEL USE OF HIGH-FLOW POLYIMIDE CANNULAS TO IMPROVE SILICONE OIL INJECTABILITY IN VITREORETINAL SURGERY.

The injection of high-viscosity silicone oil lengthens injection time. New polyimide cannulas offer a greater inner diameter than conventional metal cannulas at the same gauge. We compared the injection time for polyimide and metal cannulas at 23 G for a variety of silicone oils including a 12,500-mPas prototype oil. In this laboratory study, injection time was measured three times per cannula and per oil. Warming the oil before injection to up to 42°C was also evaluated. Finally, the feasibility of polyimide cannulas was tested in vitrectomized porcine eyes. The 23-G polyimide cannula mostly decreased injection times. The time to inject 5 mL of Siluron Xtra and Siluron 5000 decreased by 6:02 (76.9%) minutes (483 vs. 121 seconds) and 12:01 (74.7%) minutes (973 vs. 252 seconds), respectively. Although the 23-G metal cannula failed to inject 12,500 mPas oil, 5 mL was injected in 10:21 minutes using the polyimide cannula. Prewarming Siluron 5000 to 42°C lowered the injection time by 9.0% and by 12.1% when using the metal or polyimide cannula, respectively. Polyimide cannulas allow a clinically relevant decrease in injection time. They may not only shorten surgery time but could also ease the use of next-generation ultra-high-viscosity silicone oils. Prewarming silicone oil leads to decreased injection times.

Cone-Beam Navigation Can Reduce the Radiation Exposure and Save Fusion Length-Dependent Operation Time in Comparison to Conventional Fluoroscopy in Pedicle-Screw-Based Lumbar Interbody Fusion.

This study investigates the advantages and disadvantages of cone-beam-based navigated standardized posterior lumbar interbody fusion surgery (PLIF), regarding the radiation exposure and perioperative time management, compared to the use of fluoroscopy. Patients treated receiving an elective one- to three-level PLIF were retrospectively enrolled in the study. The surgery time, preparation time, operation room time, and effective dose (mSv) were analyzed for comparison of the radiation exposure and time consumption between cone-beam and fluoroscopy; Results: 214 patients were included (108 cone-beam navigated, and 106 traditional fluoroscopies). Using cone-beam navigation, reductions in the effective dose (2.23 ± 1.96 mSv vs. 3.39 ± 2.32 mSv, p = 0.002) and mean surgery time of 30 min (143.62 ± 43.87 min vs. 171.10 ± 48.91 min, p < 0.001) were demonstrated, which leveled out the extended preparation time of 7–8 min (37.25 ± 9.99 min vs. 29.65 ± 7.69 min, p < 0.001). These effects were fusion length dependent and demonstrated additional benefits in multisegmental surgeries. The cone-beam navigation system led to a reduction in the perioperative time requirements and radiation exposure. Furthermore, the controversially discussed longer preparation time when using cone-beam navigation was amortized by a shortened surgery time, especially in multilevel surgery.

Combined indocyanine green and quantitative perfusion assessment with hyperspectral imaging during colorectal resections.

Anastomotic insufficiencies still represent one of the most severe complications in colorectal surgery. Since tissue perfusion highly affects anastomotic healing, its objective assessment is an unmet clinical need. Indocyanine green-based fluorescence angiography (ICG-FA) and hyperspectral imaging (HSI) have received great interest in recent years but surgeons have to decide between both techniques. For the first time, two data processing pipelines capable of reconstructing an ICG-FA correlating signal from hyperspectral data were developed. Results were technically evaluated and compared to ground truth data obtained during colorectal resections. In 87% of 46 data sets, the reconstructed images resembled the ground truth data. The combined applicability of ICG-FA and HSI within one imaging system might provide supportive and complementary information about tissue vascularization, shorten surgery time, and reduce perioperative mortality.

Hard Tissue Preservation and Recovery in Minimally Invasive Alveolar Surgery Using Three-Dimensional Printing Guide Plate.

For completely impacted teeth, it is of great significance to locate teeth accurately, preserve hard tissue and recovering the height of alveolar ridge. This can be effectively solved by the digital three-dimensional printing guide technology. Ten patients with completely impacted tooth were selected in this experiment. After cone-beam computed tomography scan, the dicom formal computed tomography data was analyzed for threedimensional reconstruction by mimics 17.0 software. Then determining the surgical plan and making surgical guide plate. Threedimensional printing guide plate assisted piezosurgery was used to remove bone and extract impacted teeth. After that, the removed bone cap was back to the original position. Cone-beam computed tomography was used for each operated patients after 1 week and 6 months. The surgical guide plates can locate teeth accurately and the surgery time was reduced for all patients. A week later, all patients healed well and removed the stitches on time. Cone-beam computed tomography showed that the retention of bone caps was good and there was no displacement. All patients showed a normal parameter of pain. Six months later, cone-beam computed tomography showed good bone formation in the extraction area, which filled with new bones completely. The recovery of bone outline and height of alveolar crest at the surgical site were basically consistent with those before the operation. Three-dimensional printing guide plates combining with fenestration and bone-cap restoration can locate impacted teeth accurately, reduce the extraction volume of bone, shorten surgery time, and alleviate complications. This was conducive to preserve and restore hard tissue and had great prospective.

Outcomes of Preoperative Embolization of Juvenile Nasopharyngeal Angiofibroma

Background: These are rare fibro-vascular neoplasms, out of all head and neck tumors, JNA contributingfor only less than 0.5%. JNA incidence rate almost 1/150,000 and affects men and adolescents’ malesObjectives: To study outcome and the role of Pre-operative Embolization of surgeries for JuvenileNasopharyngeal Angiofibroma.Methods: A retrospective cross sectional study conducted at Al-Sader Medical City during the period 2010through 2020 included 15 male patients who were managed for JNA, in whom embolization was performedpreoperatively.Results: The study included 15 male patients with an average age of 16.4 ± 3.1 (standard deviation) (range:11-22) years. The duration of the procedure is 126 minutes, on average and ranged 75 to 180 minutes;Average intra-operative blood loss was 300 (range: 150-750) ml. The postoperative hospitalization periodwas 2 days in 14 cases and a recurrence rate of 13.3% was reported.Conclusions: The use of preoperative embolization in JNA patients has been very beneficial in shorteningsurgery time, improve bloodless of the operative site, with a significant reduction in intraoperative bloodloss, reduction in postoperative hospitalization time, and reduction in recurrent rate.

Surgical revision strategies for postoperative spinal implant infections (PSII).

Over the last years the number of spine surgeries with instrumentation has grown to an indispensable column in the treatment for different pathologies of the spine. A further increase in the incidence of instrumented spinal surgery is expected throughout the next years. Although the implementation and development of new techniques offer faster and more minimal invasive procedures, shortening surgery time, reducing soft tissue injury and revision due to hardware misplacement, the incidence of postoperative spinal implant infections (PSII) remains high. PSII related complications and revision procedures pose an enormous socioeconomic burden. Therefore, standardized strategies and protocols for treatment of PSII are urgently needed. While in former times hardware exchange or hardware removal was common practise in the field of spine surgery this approach has changed over the last years. Although the evidence from clinical studies in the field of PSII is of limited evidence, critical variables for revision strategies of PSII have been identified. Further, to quickly advance in the field of PSII it is certainly important to extrapolate and learn using data regarding the management from other fields of prosthetic joint infections. This should include clinical as well as experimental work in particular in the context of the biofilm, sonication as well as microbiological concepts. Over the last years, at our institution standardized procedures for diagnostic, surgical as well as antimicrobial treatment have been developed, based on the latest recommendations in peer-reviewed literature and our own data. Here we give an overview about surgical revision strategies for PSII and discuss the key points of our standardized protocol.

Needle Transportable Semi-Automatic Hair Follicle Implanter and Image-Based Hair Density Estimation for Advanced Hair Transplantation Surgery

As the number of hair follicles transplanted in a patient is approximately 2000 or more, hair transplantation by a manual implanter requires a considerable amount of time and money and demands a great amount of patience and pain tolerance from both patients and surgeons. In addition, many surgeons frequently experience musculoskeletal disorders owing to the numerous simple repetitive motions of the shoulder and wrist during the procedure. Moreover, the results of the surgery may vary depending on the skill of the surgeon. Although the hair follicle extraction technology has advanced in recent years, the hair follicle transplantation technology still uses a simple hand-held implanter owing to the difficulty of transplanting hair follicles and hair. In this study, a needle transportable semi-automatic hair follicle implanter that can continuously transplant hair follicles is introduced to alleviate the inconvenience of the existing manual implanter. In the developed semi-automatic implanter, a plurality of needles, into which the hair follicles are inserted, are sequentially supplied from the needle supply magazine to the implanter body by the guide groove. The hair follicles in the supplied needles are transplanted to the scalp through the forward and backward movement of the needle gripper and driving motors. The developed implanter can transplant several hair follicles without any replacement, which can shorten surgery time and reduce the fatigue experienced by patients and surgeons. The effectiveness of the proposed implanter was verified through the results of animal and clinical experiments.

3D-printed pelvis model is an efficient method of osteotomy simulation for the treatment of developmental dysplasia of the hip.

Developmental dysplasia of the hip (DDH) is a congenital or developmental deformation of the hip joint, which may require a high number of surgical interventions. It has been indicated that 3D printing may be used to simulate a fractured pelvis to facilitate the fixation of plates during the surgical procedure. In the present double-blinded randomized clinical trial, the utility of the 3D-printed pelvis model, comprising 3D reconstruction, reverse engineering and rapid prototyping, in the treatment of DDH was evaluated with 3D CT as control. The value of the 3D-printed pelvis model in the surgical management and development of a strategy for an individualized operation for DDH using osteotomy simulation was also assessed. The results indicated that use of the 3D-printed pelvis model increased the success rate of the operation with a shortened surgery time and post-operative recovery time for DDH patients. In addition, the application of the 3D-printed pelvis model allowed for more efficient surgical management of DDH than 3D CT and promoted post-operative recovery of the DDH patients. Pre-operative planning using the 3D-printed pelvis model was feasible for DDH patients. Furthermore, few patients exhibited delayed incision healing, wound infection or nonunion in the DDH group with osteotomy simulation using the 3D-printed pelvis model or 3D-CT. In conclusion, the present study indicated that the 3D-printed pelvis model, including 3D reconstruction, reverse engineering and rapid prototyping, constitutes an efficient tool for pelvic osteotomy simulation, which improves personalized pre-operative planning by providing a visual and accurate osteotomy model for patients with DDH (Chinese Trial Registry No. KCT0012374).

Compact Two Degrees-of-Freedom External Fixator System for Correction of Persistent Clubfoot Deformity

Bone deformities are often complex three-dimensional (3D) deformities, and correcting them is difficult. To correct persistent clubfoot deformity in adolescents or adults, an external fixator is sometimes used to encourage tissue growth and preserve healthy tissues. However, it is difficult to set up, resulting in long surgeries and steep learning curves for surgeons. It is also bulky and obstructs patient mobility. In this paper, we introduce a new approach of defining clubfoot deformity correction as a six degrees-of-freedom (6DOF) correction, and then reducing it to just two degrees-of-freedom (2DOF) using the axis-angle representation. Therefore, only two physical trajectory joints are needed, which in turn enables a more compact fixator design. A computer planner was developed to minimize the bulk of the external fixator, and to optimize the distraction schedule to avoid overstretching the soft tissues. This reduces the learning curve for surgeons and shortens surgery time. To validate the system, a patient-specific clubfoot simulator was developed, and four experiments were performed on the clubfoot simulator. The accuracy of midfoot correction was 11 mm and 3.5 deg without loading, and 41 mm and 11.7 deg with loading. While the external fixator has to be more rigid to overcome resistance against correction, the surgical system itself was able to achieve accurate correction in less than 2 h. This is an improvement from the current method, which takes 2.5–4.5 h.

Arterial and venous coupling by microvascular anastomotic coupling device in head and neck reconstruction

Objective To assess the value of using microvascular anastomotic coupling device(MACD) in head and neck reconstruction, especially in arterial coupling. Our experience was summed up to improve the success rate of anastomosis. Methods This research had enrolled all patients performed free flap reconstruction in our department from January, 2015 to Auguest, 2016. The data were obtained on type of free flap, donor and recipient vessels, type of MACD, time of anastomosis and so on. Results 169 patients were included in this study. Free flap reconstructions were done by manual suture in 25 patients and MACD in 144 patients. Coupling the arteries and veins by MACD[(5.7 ± 1.2)min and (5.1 ± 1.0) min, respectively] had taken less time than manual suture[(21.4 ± 3.1)min and (23.2 ± 4.2)min, respectively]. 223 MACD were used totally to couple 44 arteries and 179 veins. There was no significant statistical difference in vascular crisis and flap survival between manual suture and MACD(P > 0.05). One arterial crisis (2.3%) and on flap loss was found in the patients coupling arteries by MACD. Conclusion MACD is a optimal method for coupling veins of free flap in head and neck reconstruction, because of high success rate and shortening surgery time. As well MACD can be a important option in arterial anastomosis after appropriate vessels choosing and pretreatments. Key words: Microvascular anastomotic device; Head and neck; Reconstruction; Surgical flap; Arterial anastomosis

Effect of Da Vinci robot-assisted laparoscopic radical prostatectomy on the respiratory system of elderly patients in intensive care units

Objective To explore the effect of Da Vinci robot-assisted laparoscopic radical prostatectomy on the respiratory function of elderly in Intensive Care Units(ICU). Methods Thirty-nine elderly patients received Da Vinci robot-assisted laparoscopic radical prostatectomy(RARP) from January 2015 to April 2016 and 25 cases received conventional laparoscopic radical prostatectomy from January 2014 to December 2014 admitted into ICU were retrospectively analyzed.Their comorbidities, blood loss and transfusion during surgery, aterial blood gas(ABG) analysis and respiratory complications after operation, clinical outcomes between the two groups were compared. Results Compared with conventional laparoscopic radical prostatectomy, RARP group spent more time in surgery((4.23±1.44) h vs.(3.25±1.31) h, t=2.783, P<0.05), more patients need ventilation(11 vs.1, χ2=4.378, P<0.05). ABG analysis showed respiratory and metabolic acidosis with lower pH(7.29±0.09 vs.7.35±0.05, t=3.886, P<0.05), HCO3-((20.05±2.50) mmol/L vs.(22.86±2.53) mmol/L, t=3.473, P<0.05), BE(-5.11±3.94 vs.-3.64±1.17, t=5.018, P<0.05) and higher pCO2(46.15±8.31 vs.40.25±6.57, t=2.475, P<0.05), Lac((3.54±1.99) mmol/L vs.(2.91±1.39) mmol/L, t=2.254, P<0.05). Conclusion RARP may cause carbon dioxide retention and respiratory complications on elderly patients.It may reduce postoperative respiratory complications by shortening surgery time, lowering pneumoperitoneum pressure, hyperventilation, recruitment maneuvers and chest physical therapy. Key words: Prostatectomy; Robotic assisted surgery; Elderly; Respiratory systems; Intensive Care Units

Intraocular lens implantation without the use of ophthalmic viscosurgical device.

The purpose of this study was to determine whether single-piece hydrophilic acrylic intraocular lens can be safely implanted without the use of ophthalmic viscosurgical devices. This retrospective study comprised 100 eyes having phacoemulsification and intraocular lens implantation without the use of ophthalmic viscosurgical device. 80 eyes with the use of a viscosurgical device are used as control group. In this intraocular lens implantation technique, the anterior chamber was maintained with an irrigation cannula and intraocular lens was implanted with a lens injector. Visual acuity, corneal clarity and edema, intraocular pressure, and corneal endothelial cell count were evaluated preoperatively and postoperatively at days 1, 7, and 30. Corneal endothelial cell count was repeated 2weeks after surgery. Complications of this technique were also evaluated. No significant complications of this intraocular lens implantation technique, such as posterior capsule rupture, intraocular lens buttonholing, zonular dialysis, Descemet's tear/detachment, occurred. On the seventh postoperative day, 90% of eyes achieved 20/20 or better vision. There was no difference in corneal endothelial cell loss between viscoelastic device-used and not-used cases (p=0.356). When implanting intraocular lens without the use of ophthalmic viscosurgical device, significant intraoperative complications did not occur. The possible advantages are shortened surgery time, avoidance of postoperative IOP spike from ocular viscosurgical device (OVD) remnant, and reduced cost.