Shorter Operative Time Research Articles

Comparison of the outcomes between ultrasonic devices and clamping in hepatectomy: a meta-analysis.

Recent advances in ultrasound technology have led to widespread adoption of ultrasonic energy devices in liver resections. While various studies have assessed the comparative advantages of ultrasonic devices and traditional clamp-crushing, their findings vary. Moreover, a specific systematic review on this topic has not yet been conducted. This study aims to present a comprehensive, up-to-date analysis comparing outcomes between ultrasonic devices and conventional clamp-crushing methods in liver resection, based on currently available literature. We conducted a systematic literature search in databases such as PubMed, Embase, Web of Science, and CNKI up to November 2023. Studies that compared the efficacy or safety of ultrasonic devices against traditional clamp-crushing methods in hepatectomy were included. The analysis covered intraoperative outcomes like operating time, blood loss, and transfusion rate, as well as postoperative outcomes such as complication rate, mortality, postoperative bleeding, and bile leakage. Review Manager version 5.3 (Cochrane Collaboration, Oxford, UK) and Stata 17.0 (Stata Corp, College Station, TX, USA) were used for data analysis. Thirteen studies, involving a total of 1,417 patients (630 using ultrasonic devices and 787 using clamp-crushing methods), were included. The clamp-crush method resulted in a shorter operation time. Contrarily, the ultrasonic device group experienced reduced blood loss and lower transfusion rates. Postoperatively, there was no significant difference in mortality or postoperative bleeding between the groups. However, the ultrasonic group had a lower overall complication rate, particularly a reduced incidence of bile leakage. Overall, the ultrasonic devices were associated with improved perioperative outcomes. The findings suggest that ultrasonic devices provide better outcomes in hepatectomy compared to traditional clamp-crushing techniques. Nonetheless, large-scale randomized controlled trials are needed to confirm these results due to potential heterogeneity and biases. The choice of using ultrasonic devices should consider the surgeon's experience and individual patient circumstances.

Clinical efficacy of three plating systems in management of mandibular parasymphyseal fractures: a retrospective study.

The main goal of management of the mandibular fracture is to obtain the pre-injury contour of the bone and pre-injury occlusion as well as regain function early. For Parasymphyseal fractures, the ideal fixation method is still debatable. It could range from rigid to semi-rigid fixation. The current study aimed to compare the clinical and radiographic effect of two miniplates, 2.3 high-profile Miniplates, and three-dimensional (3D) Miniplates for internal fixation treatment of mandibular para-symphyseal fractures. The study reviewed 240 medical records, dividing 60 patients into three treatment groups: Group I (25 patients received 2.0 mini plates), Group II (22 patients received 2.3 high profile miniplate), and Group III (13 patients received 3D miniplate). Data included demographics, fracture diagnosis, radiographs, maxillomandibular fixation use, surgical time, intervention, postoperative stability, and complications. The present study included 60 patients with mandibular parasymphyseal fractures, divided into three treatment groups: Group I (n = 25, 41.67%), Group II (n = 22, 36.67%), and Group III (n = 13, 21.67%). The study found no significant differences in age and sex distribution among the three groups, but the mean surgery time varied significantly. Group II had the highest rate of complications at 22.73%, followed by Group I at 20% and Group III at 7.69%. In conclusion, the (3D) Miniplates could provide better internal fixation treatment of mandibular para-symphyseal fractures in terms of easy use, short surgery time and less complication such as malocclusion and infection.

HPB SO19 - Comparison of perioperative outcomes of open (CUSA) versus laparoscopic (LOTUS) major hepatectomy – revisited. First evaluation of efficacy and safety of AEONTM stapler

Abstract Background In 2019, preliminary data matching 40 cases demonstrated improved outcomes of laparoscopic major liver resections using the BOWA-LOTUSTM liver blade (Devon, UK). An updated and expanded comparison between open and laparoscopic major hepatectomies is presented as well as evaluating of an endovascular stapler AEON™ (Lexington Medical, Massachusetts, USA). Method January 2020 to June 2023 patients were identified from a prospectively maintained database. Propensity score matching analysis used R statistical tool in SPSS (IBM, New York, USA) to isolate matched open and laparoscopic cases. LOTUSTM ultrasonic energy device was used for parenchymal transection in laparoscopic cases and CUSA (Valleylab, Colorado, USA) in open procedures. AEONTM endovascular stapler was used from early 2021. Results 86 patients constitute the study population after applying propensity score matching analysis in a 1:1 ratio. The median (range) age in the matched sample was 63 (27-83) yrs. Hospital stay (mean 7.8 v 14.7 days; p=0.025) and blood transfusion requirement (0 v 4 units; p=0.035) were all significantly improved when comparing laparoscopic to open. Comparison of the AEONTM stapler with Endo-GIA (Medtronic, MN, USA) showed no significant difference in any outcome measure, although AEONTM demonstrated (non-significantly) a reduced trend in operating time comparing all cases (56 v 69 mins; p=0.300) and laparoscopic (56 v 71 min; p=0.295). Conclusion The LOTUS liver blade continues to be associated with acceptable outcomes in laparoscopic liver resections. The AEONTM endovascular stapler was equivalent to other staplers with a trend towards a shorter operating time in liver transectional surgery.

VS 10 - HPB Pancreas preserving total duodenectomy, How I do it

Abstract Background Patients with duodenal polyps particularly patients with familial adenomatous polyposis syndrome (FAP) are at increased risk of developing duodenal cancer. Pancreas preserving total duodenectomy is an alternative to pancreaticoduodenectomy. Advantages over pancreaticoduodenectomy include: shorter operative time, fewer and safer anastomoses, allowing future endoscopic surveillance and preserving the entire pancreas with both exocrine and endocrine functions. The complication rate is comparable if not fewer than pancreaticoduodenectomy. Here, we present our standardised operative technique for this procedure. Method This a video presentation of the technique of this novel procedure. The video has been edited with added narrative comments on the different steps of the procedure. Results This is a video presentation of the technique of pancreas preserving total duodenectomy in a patient with familial adenomatous polyposis syndrome to treat Spiegelman IV duodenal polyps. Conclusion The PPTD provides a feasible and probably favourable if not better alternative to classical pancreaticoduodenectomy particularly in patients with FAP syndrome.

Decompression and reconstruction the spinal TB lesion of a single vertebra through thoracoscopy alone or combined with foraminal endoscopy.

This study aimed to compare the clinical efficacy of thoracoscopy combined with transforaminal endoscopy and thoracoscopy alone in the treatment of thoracic tuberculosis. Patients with thoracic tuberculosis who visited our hospital from February 2018 to October 2022 were retrospectively analyzed. The patients were divided into thoracoscopic combined transforaminal endoscopic surgery group (group A) and thoracoscopic surgery alone group (group B) according to the surgical methods. Surgery-related information, VAS score, ODI score, degree of spinal cord function improvement, fusion time, and progression of kyphotic deformity were compared. A total of 37 patients were included, 16 in group A and 21 in group B. Postoperative follow-up time was 10-48 months, with an average of 28.62 ± 10.53 months. All patients had significant improvement in chest and back pain and spinal cord function after the operation. There were statistical differences in operation time, intraoperative blood loss, incidence rate of complications, and JOA score at 1 week and 3 months after operation between the two groups (P<0.05). There was no significant difference in VAS, ODI score, kyphotic angle correction, kyphotic correction loss angle, postoperative drainage volume, and fusion time between the two groups (P>0.05). All patients had no recurrence of thoracic tuberculosis during follow-up. Thoracoscopy combined with transforaminal endoscopy produce equivalent long-term results with shorter operation time, less intraoperative blood loss, less complications and higher surgical safety comparing to thoracoscopy alone. And thoracoscopy combined with transforaminal endoscopy can fully decompress and facilitate the early recovery of spinal cord function.

Long-term outcome for patients with distal radius fractures treated with volar locking plates versus percutaneous wires.

Fractures of the distal radius are the most common fractures of the upper extremity. The choice of surgical method has been debated and studies show that short-term differences, in favour of volar locking plates, are indistinguishable at 1 year follow-up. Few studies have investigated long-term outcomes beyond one year. The aim of this study was to investigate long-term (6-10 years) patient-reported outcomes after distal radius fracture surgery, and to determine how fracture pattern/complexity (Buttazzoni fracture type) affects the results. 303 patients surgically treated for a distal radius fracture, from 2012-2016 were included. The questionnaires used were PRWE, Quick-DASH and EQ-5D. Previous studies have shown that fracture type influences the choice of surgical method and therefore fracture type was adjusted for in the statistical analysis. We found that patients treated with K-wires had significantly better Quick-DASH scores (p <0.05) and a lower degree of pain (PRWE pain scale) (p <0.05) than patients treated with volar locking plates. There was no difference between the two groups regarding the remaining outcome measures for any Buttazzoni type of fracture. On the basis of these results, K-wires can be considered an equivalent option to locking plates because of equal or better long-term outcomes, lower costs, and shorter operation times.

Urgent focus on enhanced recovery after surgery of AIDS patients with limb fractures.

The incidence of limb fractures in patients living with HIV (PLWH) is increasing. However, due to their immunodeficiency status, the operation and rehabilitation of these patients present unique challenges. Currently, it is urgent to establish a standardized perioperative rehabilitation plan based on the concept of enhanced recovery after surgery (ERAS). This study aimed to validate the effectiveness of ERAS in the perioperative period of PLWH with limb fractures. A total of 120 PLWH with limb fractures, between January 2015 and December 2023, were included in this study. We established a multidisciplinary team to design and implement a standardized ERAS protocol. The demographic, surgical, clinical, and follow-up information of the patients were collected and analyzed retrospectively. Compared with the control group, the ERAS group had a shorter operating time, hospital stay, preoperative waiting time, postoperative discharge time, less intraoperative blood loss, and higher albumin and haemoglobin on the first postoperative day. The time to removal of the urinary catheter/drainage tube was shortened, and the drainage volume was also significantly reduced in the ERAS group. There was no significant difference in the visual analogue scale (VAS) scores on postoperative return to the ward, but the ERAS group had lower scores on the first, second, and third postoperative days. There were no significant differences in the incidence of complications, other than 10% more nausea and vomiting in the control group. The limb function scores at one-year follow-up were similar between the two groups, but time to radiological fracture union and time to return to physical work and sports were significantly reduced in the ERAS group. The implementation of a series of perioperative nursing measures based on the concept of ERAS in PLWH with limb fracture can significantly reduce the operating time and intraoperative blood loss, reduce the occurrence of postoperative pain and complications, and accelerate the improvement of the functional status of the affected limb in the early stage, which is worthy of applying in more medical institutions.

SURG-34. NEURO ENDOSCOPIC VS CRANIOTOMY APPROACH IN SUPRATENTORIAL HYPERTENSIVE INTRACEREBRAL HEMORRHAGE: AN UPDATED META-ANALYSIS

Abstract INTRODUCTION Intracerebral hemorrhage (ICH) is a serious medical condition associated with high mortality and disability rates. Surgical interventions, including neuro-endoscopic surgery (NES) and craniotomy, are employed to manage ICH and improve patient outcomes. This meta-analysis compares the effectiveness of NES versus craniotomy in treating ICH. METHODS A systematic literature search was conducted to identify relevant studies comparing NES with craniotomy for ICH. Inclusion criteria encompassed primary or secondary results from randomized controlled trials (RCTs) or observational studies (OSs) with confirmed supratentorial ICH. Data were extracted, and methodological quality was assessed using appropriate tools. Statistical analysis was performed using Comprehensive Meta-Analysis. RESULTS Twenty-six studies (n=3237 patients) were included in the analysis. NES was associated with significantly lower mortality compared to craniotomy (OR: 0.45, 95% CI 0.33 to 0.60, p &amp;lt; 0.00001). Hematoma evacuation rates were higher with NES (SDM: 1.505, 95% CI 0.835 to 2.160, p &amp;lt; 0.00001). NES also showed better functional outcomes (OR: 3.31, 95% CI 1.78 to 6.17, p = 0.0002) and reduced blood loss (SDM: -3.06, 95% CI -3.979 to -2.141, p = 0.000). Additionally, NES was associated with shorter hospital and ICU stays, shorter operative times, and fewer complications such as infection and rebleeding. CONCLUSION NES emerges as a promising alternative to craniotomy for treating ICH, offering advantages in terms of mortality reduction, improved functional outcomes, and fewer complications. Future studies should explore advancements in neuro-endoscopic techniques to optimize patient outcomes further.

Nice knots assistance in comminuted and displaced clavicle fractures reduce intraoperative blood and shorten operation time with a satisfactory postoperative clinical outcome

BackgroundThis study aims to evaluate the efficacy and clinical outcomes of Nice knot-assisted fixation in the management of comminuted and displaced clavicle fractures.MethodsA systematic search was conducted across multiple electronic databases, including PubMed, Embase, Cochrane Library, China Biology Medicine (CBM) database, CNKI, Wanfang, and VIP database, to identify studies comparing Nice knot-assisted fixation with traditional surgical treatment for displaced midshaft clavicle fractures. The primary outcomes assessed included fracture healing times, hospitalization days, complications, and functional outcomes. Secondary outcomes such as intraoperative blood loss, operative time, incision length, and fluoroscopy time were also evaluated. Data were analyzed using random-effects models, and summary statistics including Mean Difference (MD), risk ratios (RRs) and theirs’ 95% confidence intervals (CIs) were calculated.ResultsScreening of the literature yielded a total of 11 studies meeting the inclusion criteria, involving 754 patients. Meta-analysis of the pooled data demonstrated a significant advantage of Nice knot-assisted fixation over traditional surgical treatment in terms of operative time (MD = -11.53, 95% CI: -18.16 to -4.91, p = 0.0006) and blood loss (MD = -14.19, 95% CI: -20.93 to -7.45, p = 0.00001). Additionally, Nice knot-assisted fixation was associated with reduced fracture healing time (MD = -0.63, 95% CI: -1.12 to -0.14, p = 0.01) rather than hospitalization days (MD = -0.47, 95% CI: -1.14 to 0.21, p = 0.18) and complications (RR = 0.48, 95% CI: 0.23 to 1.01, p = 0.05) compared to traditional surgical treatment. Moreover, nice knot-assisted fixation was associated with increased constant-murley score and Neer score, and reduced visual analogue scale (VAS) score compared to traditional surgical treatment.ConclusionThis study highlights that Nice knot assistance offers advantages in reducing intraoperative blood loss, shortening operation time, and achieving favorable postoperative outcomes.

Increasing trends of laparoscopic procedures in non-obstetric surgery during pregnancy over 17 years at a single center: Retrospective case-control study.

This study aimed to examine the diseases requiring surgery during pregnancy, the changes in surgical methods over time, and the characteristics of surgeries performed in different trimesters. A retrospective study conducted at Bundang CHA Hospital between 2006 and 2023 analyzed surgeries performed during pregnancy and compared laparoscopic and open approaches across the three trimesters of pregnancy. Additionally, general (appendicitis, cholecystitis) and gynecologic (heterotopic pregnancy, adnexal torsion) cases were compared. Among 36 181 delivery patients, 101 (0.28%) underwent surgery. The most common conditions were appendicitis (44.6%), cholecystitis (1.9%), heterotopic pregnancy (23.8%), adnexal torsion (27.7%), and cancer (1.9%). The laparoscopic group had a shorter operative time (41.5 ± 19.3 vs. 57.9 ± 33.9 min, p = 0.009) and hospital stay (4.9 ± 2.7 vs. 9.0 ± 9.8 days, p = 0.016) than open surgery group. Heterotopic pregnancy (47.1%) and adnexal torsion (39.2%) were common in the first trimester, whereas appendicitis peaked in the second (80%) and third trimesters (66.7%). The increasing use of assisted reproductive technology (ART) has led to a rise in gynecological patients requiring surgery in the first trimester, resulting in more laparoscopic surgeries during this period. Interestingly, an increase in laparoscopic surgery was also observed in general surgery during the second and third trimesters. Perioperative tocolysis was more frequent (51.1% vs. 3.8%, p < 0.001) and of longer duration (4.6 ± 8.8 vs. 0.1 ± 0.6 days, p = 0.001) after general surgical procedures. Laparoscopic surgery during pregnancy offers several advantages such as shorter operative time and hospital stay. Since 2011, laparoscopic surgery for the entire gestational period has been on the rise.

Current era HOLEP with MOSES 2.0 technology compared to the gold standard TURP.

Bipolar TURP is regarded as the gold standard for treatment of BPH. Historically, when compared to HOLEP, bTURP has been found to have shorter operative times and is considered more efficient. We sought to compare the efficiency, efficacy, and safety of current era HOLEP with MOSES 2.0 technology (MOLEP) and bTURP. We performed a retrospective review of patients who underwent bTURP or MOLEP at our institution between 2018 and 2023. Preoperative, intraoperative, and postoperative characteristics were collected for analysis. Analysis was done with SPSS software with significance defined as p < 0.05. We identified 195 bTURPs and 918 MOLEPs performed at our institution. Men undergoing MOLEP had significantly higher pre-op prostate volume and resected weight (61ml v 123ml and 15g v 70g, p < 0.001, respectively) when compared to bTURP patients. MOLEP was completed in significantly less OR and procedure time compared to bTURP (66min vs. 73min, p < 0.001; 90min vs. 111min, p = 0.026, respectively). These results remained significant when controlling for age and prostate volume. At a mean follow up of 3.7 months, HOLEP patients were significantly more likely to be medication (0 vs. 35.84% p < 0.001) and catheter free post-operatively (0.95% vs. 5.68%, p < 0.001) compared to bTURP. In our contemporary cohort, MOLEP is faster and more efficient than bTURP. These findings remained significant despite being performed on larger prostates and in patients more likely to be anticoagulated. Furthermore, MOLEP patients are more likely to remain catheter and medication free at follow-up when compared to bTURP.

Comparison of the efficacy and safety of mini-percutaneous nephrolithotomy versus retrograde intrarenal surgery for the treatment of kidney stones in overweight or obese patients: a systematic review and meta-analysis.

To discuss the differences in the effectiveness and security of kidney stones in overweight or obese patients by mini percutaneous nephrolithotomy (MiniPCNL) and retrograde intrarenal surgery (RIRS). We exhaustively searched numerous databases, including PubMed, Embase, Web of Science, Cochrane Library, and CNKI, covering all records from their initiation date until September 2023. This included controlled trials focusing on the use of MiniPCNL and RIRS in the treatment of kidney stones in overweight or obese patients. The gathered data was then analyzed using the Review Manager 5.4 software. 9 studies including 1122 patients were included. Meta-analysis showed that: The MiniPCNL group had higher overall complications, grade I complications, length of hospital stay(LOS), first stone-free rate (SFR), and final SFR in obese patients, with no significant difference between the two groups in terms of operative time(OT), hemoglobin drop, and grade II complication rate. There were more overall complications, grade I complications, final SFR, and LOS with MiniPCNL in patients with stones > 2cm compared to no significant difference in grade II complications. MiniPCNL performed in the prone position had higher final SFR, less OT, hemoglobin drop, and no statistically significant difference in overall complications or LOS. Sheaths using > 14F had higher overall complication rates, final SFR, and LOS, and no statistical differences in OT and first SFR between the two modalities. In the MiniPCNL subgroup aged ≤ 50 years, there were higher first SFR, final SFR, and shorter OT, and in the MiniPCNL subgroup aged > 50 years, there were more OT, LOS, and hemoglobin drop, with no statistical difference in overall complications between the two groups. Our study showed that MiniPCNL in obese patients had higher initial SFR and final SFR, fewer procedures, but more postoperative complications, LOS, and grade I complications compared with RIRS. Similar results were seen in patients in the prone position, with stones > 2cm and age ≤ 50 years. [ https://www.crd.york.ac.uk/PROSPERO/ ], identifier PROSPERO (CRD42023467284).

Clinical Efficacy and Complications of Spinal Surgery Unilateral Biportal Endoscopy for Cervical Spondylosis: A Systematic Review and Meta-Analysis

This systematic review and meta-analysis evaluated the clinical efficacy and complications of unilateral biportal endoscopy (UBE) for treating cervical spondylosis (CS), providing evidence-based guidance for optimal treatment decisions. Relevant studies on UBE for CS were identified through comprehensive searches of PubMed, Embase, Web of Science, and the Cochrane Library up to April 22, 2024. Studies included patients diagnosed with CS who underwent UBE surgery and reported outcomes such as VAS scores, NDI scores, and postoperative complications. Data extraction and quality assessment were performed independently by two reviewers. Statistical analyses were conducted using Stata 15, employing random-effects models due to significant heterogeneity (I2 > 50%). Nine publications, comprising 353 patients and 400 operation levels, met the inclusion criteria. The mean follow-up duration was 17.01 months, and the operative time for a single level was 71.29 minutes. The average VAS score for neck pain decreased from 6.08 preoperatively to 1.52 postoperatively, the average VAS score for arm pain decreased from 7.13 to 1.35, and the average NDI decreased from 34.61 to 6.83 at the final follow-up. The mean satisfaction rate (good or excellent using the Macnab criteria) was 91%. The overall complication rate was 5%, with the most frequent complication being a dural tear (1%), followed by nerve root injury or transient hypoesthesia (0.3%). UBE demonstrates strong efficacy and safety in treating CS, with significant improvements in pain and disability scores, shorter operative times, and lower complication rates.

Efficacy comparison of the S8 navigation-assisted correction versus manual correction in adolescent congenital scoliosis

Objective: Comparison of the efficacy of S8 navigation system-assisted correction versus manual correction in the treatment of adolescent congenital scoliosis (ACS). Methods: A cohort study. A retrospective analysis was conducted on the clinical and imaging data of 48 patients with congenital scoliosis who were treated at the Honghui Hospital Affiliated with Xi'an Jiaotong University between May 2021 and January 2023. Based on the auxiliary systems, the patients were divided into two groups: the S8 navigation system-assisted correction group (navigation group, n=20) and the C-arm-assisted manual correction group (manual group, n=28). The primary outcome measures were coronal balance (CB), sagittal vertical axis (SVA), lumbar lordosis (LL), pelvic incidence (PI), pelvic tilt (PT), pelvic incidence-lumbar lordosis mismatch (PI-LL), and the Scoliosis Research Society-22 (SRS-22) questionnaire. The secondary outcome measures included surgery-related conditions and postoperative complications. Results: Of the 48 patients, there were 21 males and 27 females, with a mean age of (13.3±3.0) years. There was no statistically significant differences in preoperative distance of C7 plumb line to center sacral vertical line (C7PL-CSVL), SVA, LL, PI, PT, PI-LL mismatch, or SRS-22 scores between the two groups (all P>0.05). Postoperatively, the C7PL-CSVL and SVA in the navigation group were both better than in the manual group [(12.51±11.86) mm vs (19.64±1.33) mm, (15.72±3.64) mm vs (25.42±2.53) mm, both P<0.05]. There was no statistically significant differences in postoperative LL, PI, PT, PI-LL mismatch, or SRS-22 scores between the two groups (all P>0.05). The accuracy rates for Grade 0 and Grade 0+1 screw placements were 91.17% (93/102) and 95.09% (97/102) in the navigation group, respectively, which were higher than those in the manual group [84.45% (125/148) and 91.89% (136/148), respectively] (both P<0.05). The rates of adjacent facet joint violation in Grades A, B, and C were 88.23% (90/102), 11.76% (12/102), and 0 (0/102) in the navigation group, respectively, which were all better than those in the manual group [83.44% (121/145), 8.96% (13/145), and 7.58% (11/145)] (P=0.015). The navigation group had shorter operative time, single screw placement time, and total screw placement time, and the distance between the screws and the cortex was closer compared to the manual group (all P<0.05). Intraoperative blood loss in the manual group was higher than that in the navigation group (P<0.05). The average curve correction rate in the navigation group (74.68%±10.70%) was better than that in the manual group (59.60%±6.90%) (P<0.001). The intraoperative fluoroscopy dose in the navigation group was higher than that in the manual group [(416±70) mGy vs (360±81) mGy, P=0.015]. The incision length in the navigation group was longer than that in the manual group (P<0.05). There was no statistically significant difference in preoperative VAS pain score between the two groups (P>0.05). The postoperative visual analogue scale scores of pain on day 3 was better in the navigation group [(2.60±0.22) vs (3.10±0.32), P<0.001], while there was no statistically significant differences at other time points between the two groups (all P>0.05). No complications occurred in either group. Conclusion: The S8 navigation system demonstrates good corrective outcomes, high screw placement accuracy, low facet joint violation, and favorable clinical results in the treatment of adolescent congenital scoliosis, making it an ideal auxiliary tool.

The short-term outcomes of laparoscopic enucleation of pancreatic tumors with exposing the Wirsung duct.

It is widely believed that the prerequisite for safely performing enucleation is that the distance between the tumor and the main pancreatic duct (MPD) is at least 2-3mm. However, enucleating a deep pancreatic tumor adjacent to the MPD remains challenging, particularly when exposure or repair of the MPD is necessary. This study reported our initial experience with this procedure and demonstrated the feasibility and safety of the MPD exposure or repair. Patients who underwent laparoscopic enucleation (LapEN) with exposing the MPD from January 2017 to August 2023 were collected and analyzed in this retrospective cohort study. Data from procedures of laparoscopic middle pancreatectomy (LMP) and LapEN for superficial tumors were collected for comparative analyses. A total of 26 patients were enrolled, 27 tumors were enucleated. Tumor located in the pancreatic head and neck (n = 20), and the body (n = 7). The mean tumor size, operating time, and blood loss were 2.3cm, 163min, and 63ml, respectively. MPD injuries occurred in 8 cases due to the need for complete tumor resection, which were repaired or reconstructed using 6-0 PDS-II with or not inserting a plastic stent. 10 cases (38.5%) developed surgical-related complications, seven (26.9%) were classified as Clavien-Dindo grade I, and three (11.5%) were Clavien-Dindo grade IIIa. Biochemical leakage occurred in 16 cases (61.5%), clinically relevant pancreatic fistula (CR-POPF) occurred in 10 cases (38.5%). Two patients (7.7%) experiencedpost-pancreatectomy hemorrhage. Further analyses indicated LapEN with MPD exposure had a longer operating time and higher incidence of CR-POPF compared to LapEN for superficial tumors, but a shorter operating time and less blood loss compared to LMP (P < 0.05). Laparoscopic enucleation with exposing the MPD is feasible and safe with the support of precise preoperative assessments, meticulous intraoperative dissection, well familiarity with the anatomy of the MPD, and excellent surgical skills.

The effect of pin distractor assistance on the reduction of fibular fractures in the treatment of ankle fracture: A retrospective case-control study.

This study will evaluate the therapeutic effect of pin distractor assisted reduction of fibular fracture on ankle fracture. A retrospective analysis was performed on 98 patients diagnosed as ankle fracture or pilon fracture. These patients were all combined with fibular fracture. Retrospective analysis included 48 patients in the experimental group (distractor assisted reduction) and 48 patients in the control group (without pin distractor). The statistical indexes include: the time spent in fracture reduction and fixation, the length of surgical incision, the operative blood loss of fracture operation, the incidence of incision skin necrosis, the incidence of fracture end splitting during reduction, the quality of fracture reduction, the time of fracture healing, infection rate, and The American Orthopedic Foot and Ankle Society score at the last follow-up. There were statistical differences between the 2 groups in the time spent in the reduction and fixation of fractures, the incidence of fracture end splitting during reduction, the quality of anatomical reduction of fractures, and the healing time of fractures. The experimental group was better than the control group. In addition, for patients with long spiral fracture, comminuted fracture, osteoporotic fracture and preoperative delay time for operation more than 2 weeks, the time spent in the reduction and fixation of fracture, the operative blood loss of fracture operation, the incidence of fracture end splitting during reduction, the quality of anatomical reduction of fracture, and the healing time of fracture in the experimental group are also better than those in the control group. The pin distractor assisted reduction of fibular fracture has the advantages of simple operation, less trauma, short operation time, less operative blood loss, and fewer complications. It is especially suitable for patients with long spiral fibular fracture, comminuted fracture, osteoporotic fracture, and long preoperative delay time in ankle fracture.

Clinical and Radiologic Comparisons Between Oblique Lumbar Interbody Fusion Combined with Percutaneous Pedicle Screw Fixation and Transforaminal Lumbar Interbody Fusion for Adult Isthmic Spondylolisthesis: A 2-year Follow-Up Study

Adult isthmic spondylolisthesis(AIS) results in the anterior translation of the vertebral body with neural encroachment. Although oblique lumbar interbody fusion(OLIF) is minimally invasive technique that use a retroperitoneal plane to achieve indirect decompression compared to transforaminal lumbar interbody fusion(TLIF), research on OLIF for AIS remains limited. Therefore, we aimed to compare the clinical and radiological outcomes of these two surgical techniques for AIS. We analyzed the details of 62patients with AIS who were treated with either OLIF(n=26) or TLIF(n=36) between 2019 and 2022, with a minimum 2-year follow-up. The two surgical techniques were compared in terms of perioperative surgical, radiological, and clinical outcomes. The correlation between the severity of foraminal stenosis and clinical outcomes was evaluated. The OLIF group experienced significantly less blood loss, shorter operative times, and shorter hospital stay than the TLIF group. Radiological assessments showed no significant preoperative differences in disc height or slippage ratios, but postoperative slippage correction was significantly greater in the OLIF group than in the TLIF group(13.5±8.0 versus 5.0±8.9; p<0.001). The clinical outcome improvement ratios did not differ significantly between the two groups. The correlation between preoperative severity of foraminal stenosis and clinical outcomes in the OLIF group was not significant. OLIF is more advantageous than TLIF in terms of blood loss, operative time, hospital stay and anterolisthesis correction. In addition, good clinical outcomes were obtained with indirect decompression alone, regardless of the severity of foraminal stenosis. Therefore, OLIF is a good surgical option for the treatment of AIS.

Positioning for Emergency Laparoscopic Splenectomy for Traumatic Splenic Rupture.

To determine whether the right-lateral decubitus or supine position is superior for emergency laparoscopy for traumatic splenic rupture. Descriptive study. Place and Duration of the Study: Department of General Surgery, Central Hospital of Shaoxing, Affiliated Hospital of China Medical University, Zhejiang, China, from January 2015 to December 2022. Clinical data of 96 patients who underwent laparoscopic surgery (LS) for traumatic splenic rupture were analysed. The patients were divided into two groups according to surgical position. Group A (n = 42) patients were placed in the right-lateral decubitus position and Group B (n = 54) patients were placed in the supine position. The operation time, intraoperative blood loss, conversion to laparotomy rate, postoperative length of hospital stay, and complications rates were compared between the two groups. Compared with Group B, Group A had a shorter operation time (145.5 ± 24.4 min vs. 169.0 ± 15.3 min, p = 0.0001), less intraoperative blood loss (75.3 ± 35.3 ml vs. 110.3 ± 50.6 ml, p = 0.0002), fewer conversions to laparotomy (2.4% vs. 16.7%, p = 0.023), fewer cases of postoperative pancreatic leakage (7.1% vs. 24.1%, p = 0.027), and fewer complications (23.8% vs. 53.7%, p = 0.003); all differences were significant. There was no statistically significant difference in the postoperative length of hospital stay, hospital cost, or rate of complications such as fever, postoperative abdominal infection, postoperative bleeding or venous thrombosis between the two groups. For patients with traumatic splenic rupture, the right-lateral decubitus position is best for LS. Laparoscopy, Traumatic splenic rupture, Splenectomy, Surgical position.

Different minimally invasive surgical methods to hysterectomy for benign gynecological disease: A systematic review and network meta-analysis.

This network meta-analysis aimed to compare the perioperative efficacy of various minimally invasive hysterectomy procedures for treating benign gynecological diseases and to assess whether vaginal natural orifice transluminal endoscopic hysterectomy (VNOTEH), a recently emerging procedure, is inferior to traditional laparoscopy. We searched PubMed, Cochrane Library, Embase, China National Knowledge Infrastructure (CNKI), China Biology Medicine disc (CBM), Wanfang Data, and China VIP Database from inception to August 2022 and updated in June 2023. We included randomized controlled trials (RCTs) comparing different minimally invasive hysterectomy techniques in patients with benign gynecological conditions. The intervention measures included nine minimally invasive hysterectomies. The two researchers used the Cochrane risk-of-bias assessment tool for study appraisal. All statistical analyses and drawings were performed using STATA 17.0 and R 4.4.1. A network meta-analysis (NMA) was conducted to compare the effectiveness of minimally invasive hysterectomy and rank its relative impact probabilistically. A total of 78 RCTs involving 7640 patients and nine minimally invasive hysterectomy methods with 16 intervention combinations were included in this study. Among these, 2, 63, and 13 studies were deemed to have a low, medium, and high risk of bias, respectively. Based on the Surface Under the Cumulative Ranking (SUCRA) probability ranking results of NMA, laparoendoscopic single-site surgery-laparoscopic-assisted vaginal hysterectomy (LESS-LAVH) demonstrated superior outcomes in terms of complications, infections, and 24-h postoperative pain scores. LAVH exhibited better performance in injuries and hospital stays, total laparoscopic hysterectomy showed the least blood loss, and vaginal hysterectomy had the shortest operation time. LESS-LAVH and LAVH are recommended options, if feasible. Meanwhile, VNOTEH can achieve comparable results to traditional laparoscopy but requires careful attention to the risk of injury and infection. Future research should aim to broaden the search scope by including high-quality, large-scale, multicenter RCTs.

Positioning for Emergency Laparoscopic Splenectomy for Traumatic Splenic Rupture.

To determine whether the right-lateral decubitus or supine position is superior for emergency laparoscopy for traumatic splenic rupture. Descriptive study. Place and Duration of the Study: Department of General Surgery, Central Hospital of Shaoxing, Affiliated Hospital of China Medical University, Zhejiang, China, from January 2015 to December 2022. Clinical data of 96 patients who underwent laparoscopic surgery (LS) for traumatic splenic rupture were analysed. The patients were divided into two groups according to surgical position. Group A (n = 42) patients were placed in the right-lateral decubitus position and Group B (n = 54) patients were placed in the supine position. The operation time, intraoperative blood loss, conversion to laparotomy rate, postoperative length of hospital stay, and complications rates were compared between the two groups. Compared with Group B, Group A had a shorter operation time (145.5 ± 24.4 min vs. 169.0 ± 15.3 min, p = 0.0001), less intraoperative blood loss (75.3 ± 35.3 ml vs. 110.3 ± 50.6 ml, p = 0.0002), fewer conversions to laparotomy (2.4% vs. 16.7%, p = 0.023), fewer cases of postoperative pancreatic leakage (7.1% vs. 24.1%, p = 0.027), and fewer complications (23.8% vs. 53.7%, p = 0.003); all differences were significant. There was no statistically significant difference in the postoperative length of hospital stay, hospital cost, or rate of complications such as fever, postoperative abdominal infection, postoperative bleeding or venous thrombosis between the two groups. For patients with traumatic splenic rupture, the right-lateral decubitus position is best for LS. Laparoscopy, Traumatic splenic rupture, Splenectomy, Surgical position.