Shorter Operative Time Research Articles

Application of Voltage Optimization Strategy for Rotary Power Flow Controllers in Loop Closing of Distribution Networks

To mitigate voltage limit issues in the operation of a novel electromagnetic voltage regulation device, this paper presents a flexible loop-closing control strategy with voltage optimization. The approach uses a two-stage path optimization: in the first stage, the voltage phase at the loop-closing point is adjusted to ensure smooth operation, while in the second stage, the voltage magnitude is optimized to prevent voltage limits and achieve seamless regulation. By integrating phase angle difference calculations with coordinated rotation angle control, the simulation results show that this strategy reduces loop-closing current by approximately 95.87% compared to direct loop closing, decreases voltage fluctuations by around 50.0% compared to traditional methods, and shortens operation time by 40.14%. This approach significantly enhances system stability and response speed, effectively addressing the issue of excessive loop-closing current caused by voltage deviations at distribution network tie switches.

The usefulness of transarterial embolization before transurethral resection of bladder tumor for patients with large bladder tumors.

To assess the usefulness of transarterial embolization (TAE) before a transurethral resection of bladder tumor (TURBT) procedure for large bladder tumors, intra- and postoperative outcomes were retrospectively compared between patients with and without TAE before TURBT. Thirty-seven patients underwent TURBT for complete resection of bladder tumors with a diameter of 3 cm or greater between January 2013 and December 2023 at the Department of Urology, Hyogo Medical University. For 13, TAE was performed 1 or 2 days before TURBT. In the TAE group, tumor volume was significantly larger [74.1 ± 42.7 (28.9-190.5) cm3 vs. 17.3 ± 14.3 (6.1-69.8) cm3, p < 0.05] and operative time significantly shorter [119 ± 49.8 (74-263) min vs. 143 ± 28.1 (107-218) min, p = 0.012] as compared with the non-TAE group. Furthermore, the change in hemoglobin level was significantly less in the TAE group [-0.6 ± 0.8 (0.4 to -2.3) mg/dL vs. -1.0 ± 0.7 (0.1 to -3.1) mg/dL, p = 0.008]. TAE before TURBT for a large bladder tumor contributes to less blood loss and shorter operative time, thus allowing resection to be performed safely without serious complications.

Clinical Outcomes of XEN45 Gel Stent Implantation (Ab Externo, Open Conjunctival Approach) versus Trabeculectomy: A Real-World Study

Purpose: To compare the clinical outcomes of XEN45 gel stent implantation surgery (&lt;i&gt;ab externo&lt;/i&gt;, open conjunctiva) with those of trabeculectomy.Methods: We retrospectively reviewed electronic medical record of 57 patients (62 eyes) treated with XEN implantation surgery (&lt;i&gt;ab externo&lt;/i&gt;, open conjunctival approach) between April 1, 2021, and July 31, 2023, by the same surgeon. Preoperative clinical data including intraocular pressure (IOP), the number of glaucoma medications, and visual acuity were collected from 1 day to 12 months postoperatively. These data were compared and analyzed with those of 67 patients (78 eyes) received trabeculectomy between February 1, 2017, and April 30, 2022, by the same surgeon. Statistical analyses were performed with &lt;i&gt;p&lt;/i&gt; &lt; 0.05 as significant.Results: Complete surgical success rate was 33.9% and 57.7% of the XEN and trabeculectomy groups, respectively (&lt;i&gt;p&lt;/i&gt; = 0.005). The qualified success rate was 79.0% and 93.6%, respectively (&lt;i&gt;p&lt;/i&gt; = 0.011). Postoperatively, the XEN group used more glaucoma medications than the trabeculectomy group (1.21 ± 1.05 vs. 0.69 ± 0.90, &lt;i&gt;p&lt;/i&gt; = 0.003 at postoperative month 12). After postoperative month 1, the XEN group had a higher IOP (15.77 ± 5.07 mmHg vs. 13.17 ± 3.81 mmHg; at postoperative month 12, &lt;i&gt;p&lt;/i&gt; = 0.001) and lower corneal astigmatism than the trabeculectomy group (1.32 ± 0.79 diopters vs. 1.88 ± 1.45 diopters, &lt;i&gt;p&lt;/i&gt; = 0.020 at postoperative month 6). There was no significant difference in preoperative and postoperative best-corrected visual acuity (logMAR) between the groups at any of the follow-up period (favorable visual acuity subgroup; logMAR &lt; 0.7). Postoperative complications were 0 cases of XEN group and 13 cases of trabeculectomy group (0% vs. 16.7%, &lt;i&gt;p&lt;/i&gt; = 0.001). Also, XEN surgery (24 minutes 40 seconds ± 6 minutes 26 seconds) had a shorter operation time than the trabeculectomy (40 minutes 18 seconds ± 8 minutes 27 seconds, &lt;i&gt;p&lt;/i&gt; &lt; 0.001).Conclusions: Compared to trabeculectomy, XEN surgery (&lt;i&gt;ab externo&lt;/i&gt;, open conjunctiva) showed relatively lower effectiveness (surgical success rate, IOP reduction). However, it demonstrated advantages as a minimally invasive glaucoma surgery, including a surgical success rate approaching about 80%, stability in inducing corneal astigmatism, fewer postoperative complications, and shorter operation times.

Clinical efficacy and learning curve of percutaneous endoscopic cervical discectomy for symptomatic cervical spondylotic radiculopathy

BackgroundThis study aimed to evaluate the clinical efficacy and learning curve of percutaneous endoscopic cervical discectomy (PECD) in treating patients with symptomatic cervical spondylotic radiculopathy (CSR).MethodsA total of 105 patients with single-segment symptomatic CSR treated between January 2020 and January 2022 were retrospectively analyzed and divided into PECD and ACDF groups based on the surgical approach. Patient demographics, operation time, estimated intraoperative blood loss, complications, postoperative hospital stay, total hospitalization cost, neck dysfunction index (NDI), arm and neck visual analog scale (VAS) scores were compared and analyzed. The learning curve of the PECD group was assessed using cumulative sum (CUSUM) analysis.ResultsThere was no statistically significant difference in baseline data between the two groups (P > 0.05). The PECD group had shorter operative time, smaller incision length, less estimated intraoperative bleeding, lower total hospitalization costs, and shorter postoperative hospital stays compared to the ACDF group (P < 0.05). Postoperative NDI, arm VAS, and neck VAS scores improved significantly in both groups compared to preoperative values (P < 0.05). However, no significant difference was found between the two groups during the same period (P > 0.05). There were also no significant differences between the PECD and ACDF groups in the number of intraoperative fluoroscopies, complications, or surgical success rates (P > 0.05). As more cases accumulated, a trend toward shorter operative times was observed in the PECD group. When grouped according to the learning curve, with the 23rd case as the cutoff point, there was no significant difference in clinical outcomes between the learning phase and proficient phase groups (P > 0.05).ConclusionsPECD is a safe and effective procedure for treating single-segment CSR, offering clinical outcomes comparable to ACDF. PECD has a notable learning curve, requiring beginners to perform 23 cases to reach proficiency. However, longer operative times do not negatively impact preclinical outcomes.Trial registrationRetrospectively registered.

Novel device for blunt dissection in third space endoscopy: Preliminary animal study (with video)

AbstractBlunt dissection is not commonly performed in flexible endoscopic procedures. We developed a novel blunt dissection device and evaluated its feasibility, safety, and potential effectiveness in third space endoscopy procedures.The device consists of a cotton swab and a flexible shaft. To evaluate its functionality, creation of 4-cm submucosal tunnels in live swine stomachs was attempted by either blunt dissection using our device or sharp dissection using a standard monopolar knife. Data on factors such as completion rate, operating time, adverse events, necessity of submucosal injection, and dissected submucosal thickness were collected.Eighteen submucosal tunnels were successfully created (sharp: 9, blunt: 9) by two experienced endoscopists and one novice endoscopist. Median operating time was significantly shorter in the blunt dissection group (239 vs. 429 s, P = 0.008). In the sharp dissection group, the experienced endoscopists did not cause any muscle layer injuries, but the novice endoscopist caused muscle layer injuries in all cases. In the blunt dissection group, neither experienced nor novice endoscopists caused muscle layer injuries. The blunt dissection group required significantly fewer submucosal injections (0 vs. 5, P &lt; 0.001). Median dissected submucosal thickness was similar between the groups.Blunt dissection using our device was feasible, safe, and potentially effective in third space endoscopy procedures by shortening operating time, reducing submucosal injections, and potentially minimizing muscle layer injury.

Comparison of the efficacy of the modified S-P approach and the Ganz method for surgical hip dislocation in Pipkin I fractures: an early follow-up study

BackgroundFemoral head fractures result from high-energy trauma and may be associated with posterior dislocation of the hip joint. An appropriate surgical approach is essential for improving clinical outcomes and preventing complications. This study aims to compare the clinical efficacy of the modified Smith-Peterson (mS-P) approach and Ganz surgical dislocation (GSD) approach in the treatment of Pipkin I fractures.MethodsWe conducted a retrospective analysis of patients diagnosed with Pipkin I fractures at Pidu District People’s Hospital from June 2010 to May 2020. Of these, 11 cases were treated with the mS-P approach and 12 cases were treated with the GSD approach. All patients were followed for 12–55 months, with a mean duration of 37.7 months. Basic demographic information, perioperative-related records, postoperative complications, and outcomes at the final follow-up were compared. Functional evaluations included the Thompson-Epstein Score, the Modified Harris Hip Score (MHHS), and the Vail Hip Score (VHS).ResultsOverall, 21 patients were included in the study. We found that the mS-P approach was associated with a smaller incision, shorter operative time, and reduced intraoperative blood loss compared to the GSD approach (P < 0.05). The mean MHHS was 83.5 ± 9.14 and 75 ± 9.22 in the mS-P group and GSD group, respectively, P = 0.048. The mean VHS was 83.9 ± 7.4 and 74.4 ± 11.28 in the mS-P group and GSD group, respectively, P = 0.034. Thompson-Epstein scores in the mS-P group were excellent (6 patients), good (3 patients), and fair (1 patient). In the GSD group, the scores were excellent (3 patients), good (5 patients), and fair (2 patients). Among the postoperative complications, avascular necrosis (AVN) occurred in 1 patient in each of the mS-P and GSD groups. Heterotopic ossification (HO) occurred in 5 patients in each of the mS-P and GSD groups. 2 patients in the mS-P group developed post-traumatic osteoarthritis (PTOA), compared to 5 patients in the GSD group. One patient in the GSD group developed a sciatic nerve injury (SNI).ConclusionsThis study suggests that the mS-P approach offers advantages over the GSD approach in terms of surgical efficiency and surgical trauma. However, longer-term follow-up is required to fully assess complications and functional outcomes.

Management of a young HoFH patient during pregnancy using Lipoprotein Apheresis (whole blood): A novel experience.

The pregnancy of a patient with homozygous familial hypercholesterolemia (HoFH) represents a challenge in the clinical setting due to the high cardiovascular risk of the mother and maternal-fetal morbidity. The lipid lowering drugs are generally contraindicated and lipoprotein apheresis (LA) is the only accepted treatment in HoFH pregnant woman. Liposorber D, an LA technique on whole blood, has good efficacy, safety, and short operative time. We present a 31-year-old Caucasian pregnant woman with HoFH clinical phenotype on lipid-lowering treatment with Lomitapide and Evolocumab, discontinued during pregnancy. In multidisciplinary team it was decided to submit the patient to LA throughout the pregnancy. Liposorber D sessions (a whole blood technique) were performed on a strict weekly frequency. The treatment resulted in massive decrease of total cholesterol (TC) and LDL cholesterol (LDL-c), with no significant side effects. The pregnancy presented a normal course and a cesarean section was performed on clinical indications unrelated to the use of LA. She gave birth to a healthy male child at 37 weeks of gestation. LA is considered the only effective, safe and accepted therapy during HoFH pregnancy. This is the first reported case of successful pregnancy treated with Liposorber D, a whole blood LA technique. LA with dextran sulfate has been an effective and safe choice for the mother and fetus. Furthermore it was reasonably well tolerated from the beginning of pregnancy management to its conclusion.

Long-Term Clinical Outcomes for Bone-Anchored Hearing Implants: 3-Year Comparison Between Minimally Invasive Ponto Surgery and the Linear Incision Technique With Tissue Preservation.

To compare the 3-year outcomes of the modified minimally invasive Ponto surgery (m-MIPS) to both the original MIPS (o-MIPS) and linear incision technique with soft tissue preservation (LIT-TP) for inserting bone-anchored hearing implants (BAHIs). Prospective study with three patient groups: m-MIPS, o-MIPS, and LIT-TP. Tertiary referral center. In the m-MIPS group, 24 patients with 25 implants were enrolled. The o-MIPS and LIT-TP groups included 25 patients (25 implants) each. The patients underwent BAHI surgery using m-MIPS, o-MIPS, or LIT-TP. Implant survival and implant stability were compared between all groups. Soft tissue status, skin sensibility, subjective numbness, and hearing-related quality of life (HRQoL) were compared between m-MIPS and LIT-TP and o-MIPS and LIT-TP, respectively. Implant survival was comparable between m-MIPS and LIT-TP (96 versus 100%), with o-MIPS showing nonsignificant lower survival (88%). Both MIPS groups exhibited fewer (adverse) skin reactions, better skin sensibility, and less subjective numbness than LIT-TP throughout visits. At 3 years, soft tissue status, sensibility, and numbness were comparable between groups. Device use was consistent among groups (83-86% daily users). All groups demonstrated significant improvement in HRQoL post-surgery based on GBI, GHSI, and APHAB total scores. Compared with LIT-TP, m-MIPS showed comparable long-term implant survival, fewer (adverse) skin reactions, and earlier sensibility and numbness recovery. M-MIPS resulted in favorable clinical and QoL outcomes with low intra- and postoperative complication rates until 3 years after surgery. It is therefore considered a safe technique for BAHI insertion. Moreover, with a shorter surgery time and the ability to operate under local anesthesia in a controlled outpatient setting, m-MIPS appears to be a more efficient alternative to LIT-TP.

Advantages of Robotic Total Mesorectal Excision With Partial Prostatectomy Compared With Open Surgery for Rectal Cancer: A Single-Center Retrospective Cohort Study.

Robotic total mesorectal excision (TME) with resection of adjacent organs has been increasingly used for locally advanced rectal cancer; however, few studies have focused on robotic TME with partial prostatectomy. Therefore, this study aimed to demonstrate the advantages of robotic TME with partial prostatectomy compared with open surgery for rectal cancer. This retrospective cohort study examined consecutive patients with rectal cancer who underwent robotic or open TME with partial prostatectomy at a high-volume center in Japan from April 2003 to March 2022. The patients were divided into robotic (n = 14) and open (n = 11) surgery groups. The short- and long-term outcomes of these patients were compared. More transabdominal partial prostatectomies were performed in the robotic surgery group than in the open surgery group (71.4% vs. 9.1%, p = 0.001). Moreover, sphincter-preserving surgery was performed in 35.7% of patients in the robotic surgery group. The robotic surgery group had shorter operative times (401 min vs. 435 min, p = 0.047), less blood loss (56 mL vs. 484 mL, p < 0.001), lower complication rates (28.6% vs. 72.7%, p = 0.047), and shorter postoperative hospital stays (8 days vs. 18 days, p < 0.001) than the open surgery group. No significant differences were observed in the positive radial margin rate (7.1% vs. 9.1%, p = 1.000) or long-term outcomes between the two groups. Compared with open surgery, robotic TME with partial prostatectomy facilitates transabdominal partial prostatectomy, resulting in more sphincter-preserving surgeries and better short-term outcomes.

Intentional weight reduction before surgery - A systematic review.

Obesity may increase complexity of surgical procedures and increase the risk of perioperative complications. Weight reduction by the use of low energy diet (LED, ≤1200kcal/day) or very low energy diet (VLED, ≤800kcal/day) can reduce postoperative complications after bariatric surgery, but for most other types of surgery the evidence for its use remains uncertain. The aim of this systematic review was therefore to evaluate the scientific evidence in general for this routine. The Medline, Embase, Web of Science and Cochrane databases were searched up until November 20, 2024 using the Cochrane risk of bias assessment tool for observational studies and the NIH quality assessment of controlled intervention studies for randomized trials. Operation time, surgeon's perceived difficulty, intraoperative complications, postoperative complications and relevant efficacy measures for specific procedures were considered as endpoints. A random-effects model was used to pool effect sizes for the main analyses. A total of 7053 studies were identified. After screening by title and abstract, followed by full text, 18 studies (9 RCTs and 9 observational studies) remained for the analyses including 854 patients who received the intervention and 979 controls. Preoperative LED/VLED resulted in an overall shorter operation time (standard mean difference 0.36, 95% CI 0.14-0.59, p=0.002), and reduced risk of postoperative complications after bariatric surgery, cholecystectomy, colorectal surgery and hernia repair (pooled RR 0.63, 95%CI 0.51-0.79, p<0.001). Heterogeneity between studies was high for operation time but very low for complications. No difference was seen for intraoperative complications, while the data did not allow further analyses on perceived difficulty of surgery or efficacy outcomes. The results support the use of LED/VLED for short-term preoperative weight reduction in patients with obesity planned for bariatric surgery and for those undergoing cholecystectomy, colorectal surgery and hernia repair. Further studies including a comparable control group are needed to evaluate its routine use for other surgical procedures. The protocol of this study was preregistered at the International Prospective Register of Systematic Reviews, PROSPERO.

Retrospective comparative cohort analysis of Darn and Lichtenstein repair methods for bilateral inguinal hernias in adult males in a low-resource setting: a single-centre study in Sudan

Background: Inguinal hernias are a common surgical condition that, if untreated, can lead to severe complications. Bilateral inguinal hernias add challenges due to increased recurrence and postoperative risks. Although Lichtenstein repair, a mesh-based approach, is the gold standard for its low recurrence, Darn repair – a mesh-free technique – offers a cost-effective alternative in low-resource settings. This study assesses the applicability and effectiveness of both techniques for bilateral inguinal hernias in a resource-limited environment. Materials and methods: With Institutional Review Board (IRB) approval from Al-Waleedeen Specialized Hospital (IRB number WAD.12.01.2021), a retrospective cohort analysis was conducted on 75 adult males who underwent bilateral inguinal hernia repair from January 2021 to October 2023 in Sudan. Patients were divided into Group A (Lichtenstein, n = 30) and Group B (Darn, n = 45). Data on operative time, complications, hospital stay, return to normal activities, patient satisfaction, and economic impact were collected, with a three-month follow-up. Results: Darn repair showed fewer postoperative complications, particularly lower surgical site infections (SSI) (8% vs. 20%, P = 0.014). It also had shorter operative times (mean 30 minutes less), reduced hospital stays (1.5 vs. 2.8 days, P &lt; 0.0001), and lower costs. Recurrence rates were comparable across both groups. Conclusion: While both methods yielded similar recurrence rates, Darn repair showed advantages in resource-limited settings, with fewer complications, shorter hospital stays, and lower costs, making it a practical option when mesh is not readily available. Limitations include retrospective design, convenience sampling, and possible recall bias from phone follow-ups. The three-month follow-up may not capture long-term outcomes like chronic pain or late recurrences. Future studies should extend follow-ups and conduct prospective trials to optimize Darn repair across diverse settings

Spacer-type tibial osteotomy versus open wedge high tibial osteotomy and unicompartmental knee arthroplasty for Kellgren-Lawrence grade 3–4 medial unicompartmental knee osteoarthritis in patients younger than 65 years

BackgroundSpacer-type tibial osteotomy have been proven a novel and effective osteotomy to treat osteoarthritis, while lack of comparison with other surgical methods in younger patients. This study aims to evaluate the short-term clinical outcomes of spacer-type tibial osteotomy versus open wedge high tibial osteotomy (OWHTO) and unicompartmental knee arthroplasty (UKA) for Kellgren-Lawrence (K-L) grade 3–4 osteoarthritis (OA) in patients younger than 65 years.MethodsThis retrospective study analyzed a total of 224 patients with K-L grade 3–4 knee OA treated from March 2018 to November 2020. Three groups were created according to the operation type. The clinical outcomes recorded preoperatively and at 6, 12 and 24 months postoperatively were the range of motion (ROM), visual analogue scale (VAS), American Knee Society Score (KSS), Western Ontario and McMaster Universities Global (WOMAC) score, operation time, length of incision, relevant complications and failures. Radiographic parameters were measured to evaluate the correction of varus deformity.ResultsThe cohort comprised 224 patients; 70 underwent spacer-type tibial osteotomy, 73 underwent OWHTO, and 81 underwent UKA. The spacer group had the shortest incision (P = 0.000), least amount of bleeding (P = 0.000), and shortest operation time (P = 0.000). UKA achieved the most significant pain relief based on VAS (P = 0.014), KSS pain score (0.030), and WOMAC score (P = 0.000) at 6 months postoperatively, but there were no differences between three groups at 12 and 24 months postoperatively. The spacer and OWHTO groups achieved significantly greater ROM changes compared with the UKA group (all P = 0.000). The complication rate did not significantly differ between the three groups. No surgical failures were identified in HTO but two spacer dislocations in spacer group and three polyethylene dislocations in UKA.ConclusionFor younger patients with K-L grade 3–4 OA, OWHTO seems to be the most appropriate method through clinical comparisons. Although spacer-type tibial osteotomy offers shorter operation time and comparable clinical outcomes, it also has extended recovery phase, additional fibular incision and the risk of spacer dislocation, which did not appear to be superior to OWHTO and UKA under the indications outlined in this study.Trial registrationRetrospectively registered, QYFY WZLL 27,021.

Mucosal snare resection-endoscopic submucosal excavation for gastric submucosal tumors: a retrospective study (with video)

AimsThis study aimed to compare the clinical outcomes of patients with submucosal tumors treated with endoscopic submucosal excavation (ESE) and those treated with mucosal snare resection-endoscopic submucosal excavation (MSR-ESE).MethodsWe retrospectively analyzed clinical data from patients who underwent ESE or MSR-ESE at the Second Affiliated Hospital of Zhejiang University School of Medicine between January 2023 and January 2024. Factors such as operation time, intraoperative perforation, postoperative adverse events, postoperative fasting time, antibiotic use, hospitalization duration, costs, and pathological diagnosis were compared between the two procedures.ResultsA total of 180 patients with submucosal tumors were included in this study. The MSR-ESE group consisted of 75 patients (41.7%), while the ESE group had 105 patients (58.3%). Propensity score matching (PSM) showed no significant differences in postoperative antibiotic use, fasting time, or intraoperative perforation between the two groups (P&amp;gt;0.05). However, the MSR-ESE group demonstrated shorter operation and hospitalization times, lower hospitalization costs, and a reduced incidence of postoperative peritonitis (P&amp;lt;0.05). Multivariate logistic regression analysis identified operation time as an independent risk factor for unplanned intraoperative perforation, with the likelihood of perforation increasing significantly as operation time increased (P=0.007, OR=1.015, 95% CI, 1.004 to 1.026).ConclusionMSR-ESE outperforms ESE with shorter operation times, lower costs, and fewer postoperative complications, making it a safe and effective treatment for gastric submucosal tumors.

Advantages of subtotal gastrectomy for upper third gastric cancer: A systematic review and meta‐analysis

AbstractDistal gastrectomy with very small remnant stomach (subtotal gastrectomy, STG) is sometimes performed for upper third gastric cancer, instead of total gastrectomy (TG). However, the advantages of STG over TG remain fully unknown, in terms of survival outcomes, complication rates, nutritional status, and quality of life. Therefore, a systematic review was performed in accordance with the preferred Reporting Items for Systematic Reviews and Meta‐Analyses (PRISMA) extension statement for reporting systematic reviews. Meta‐analyses were performed regarding operation time, complication rates, body weight changes, and reflux esophagitis by using R software. Operation time was significantly shorter in STG than in TG (Mean difference: −20.79 [95% CI: −35.59 to −5.99]). We cannot conclude whether STG is better than TG in terms of survival because of inconsistency among reports. The total complication rates (≧ grade2 and 3) are significantly lower in STG than TG. Reflux esophagitis was lower in STG than in TG (0% vs. 7.7%), although the difference was not significant probably because of small sample size. Body weight change compared with preoperative value was significantly lower after STG than TG both at 6 and 12 months after the operation (6 months: mean difference −5.31% [95% CI: −6.95 to −3.67], 12 months: mean difference −6.13 [95% CI: −8.20 to −4.06]). We revealed that STG has its advantage on shorter operation time, less complication rates, and lower body weight loss by meta‐analysis. Although there are some controversies, STG can be an ideal option for patients with gastric cancer of upper third stomach.

Prediction of implant failure risk due to periprosthetic femoral fracture after primary elective total hip arthroplasty : a simplified and validated model based on 154,519 total hip arthroplasties from the Swedish Arthroplasty Register.

While cementless fixation offers potential advantages over cemented fixation, such as a shorter operating time, concerns linger over its higher cost and increased risk of periprosthetic fractures. If the risk of fracture can be forecasted, it would aid the shared decision-making process related to cementless stems. Our study aimed to develop and validate predictive models of periprosthetic femoral fracture (PPFF) necessitating revision and reoperation after elective total hip arthroplasty (THA). We included 154,519 primary elective THAs from the Swedish Arthroplasty Register (SAR), encompassing 21 patient-, surgical-, and implant-specific features, for model derivation and validation in predicting 30-day, 60-day, 90-day, and one-year revision and reoperation due to PPFF. Model performance was tested using the area under the curve (AUC), and feature importance was identified in the best-performing algorithm. The Lasso regression excelled in predicting 30-day revisions (area under the receiver operating characteristic curve (AUC) = 0.85), while the Gradient Boosting Machine (GBM) model outperformed other models by a slight margin for all remaining endpoints (AUC range: 0.79 to 0.86). Predictive factors for revision and reoperation were identified, with patient features such as increasing age, higher American Society of Anesthesiologists grade (> III), and World Health Organization obesity classes II to III associated with elevated risks. A preoperative diagnosis of idiopathic necrosis increased revision risk. Concerning implant design, factors such as cementless femoral fixation, reverse-hybrid fixation, hip resurfacing, and small (< 35 mm) or large (> 52 mm) femoral heads increased both revision and reoperation risks. This is the first study to develop machine-learning models to forecast the risk of PPFF necessitating secondary surgery. Future studies are required to externally validate our algorithm and assess its applicability in clinical practice.

Different sides of craniotomy for anteriorly superiorly projecting anterior communicating artery aneurysm clipping: outcome and long-term cognitive function: A single-center retrospective study.

We explored the impact of various craniotomy approaches on the outcomes and long-term cognitive function of microsurgical clipping for superiorly projecting anterior communicating artery (ACoA) aneurysms. We retrospectively analyzed 127 superiorly projected ACoA aneurysms underwent microsurgical clipping between January 2014 and January 2022. Patients were categorized into two types: type 1 (70 patients), characterized by the posterior positioning of the ipsilateral A2 segment (open A2 plane side), and type 2 (57 patients), characterized by the anterior positioning of the ipsilateral A2 segment (closed A2 plane side). The analysis focused on clinical outcomes (modified Rankin Scale score, mRS) and long-term cognitive function (Montreal Cognitive Assessment, MoCA). No significant differences in initial attributes were observed between the two groups. No differences in mRS (P = 0.483), cognitive impairment (P = 0.190), or severe cognitive impairment (P = 0.332) between the two groups. Furthermore, no significant differences in delayed cerebral ischemia (P = 0.852), delayed bleeding (P = 0.912), or intraoperative rupture (P = 0.141) between the two groups. However, the occurrence of MoCA subcategories of postponed memory items (P < 0.05) and conceptualization items (P < 0.05) demonstrated a significant decrease on the accessible A2 plane side during a shorter operative time (P = 0.03) and reduced gyrus rectus aspiration frequency (P = 0.000). The anterior position of the A2 segment can offer better visualization of the aneurysm dome, bilateral A2, and AcoA, leading to reduced operative time and gyrus rectus aspiration frequency, potentially enhancing long-term cognitive function.

Integrated Optical and Magnetic Navigation for Simplified Percutaneous Transforaminal Endoscopic Lumbar Discectomy: A Novel Approach.

This study aims to evaluate the clinical benefits of the integrated optical and magnetic surgical navigation system in assisting transforaminal endoscopic lumbar discectomy (TELD) for the treatment of lumbar disc herniation (LDH). A retrospective analysis was conducted on patients who underwent TELD for LDH at our hospital from November 2022 to December 2023. Patients treated with the integrated optical and magnetic surgical navigation system were defined as the navigation-guided transforaminal endoscopic lumbar discectomy (Ng-TELD) group (30 cases), while those treated with the conventional X-ray fluoroscopy method were defined as the control group (31 cases). Record and compare baseline characteristics, surgical parameters, efficacy indicators, and adverse events between the two patient groups. The average follow-up duration for the 61 patients was 11.8 months. Postoperatively, both groups exhibited significant relief from back and leg pain, which continued to improve over time. At the final follow-up, patients' lumbar function and quality of life had significantly improved compared to preoperative levels (P < 0.05). The Ng-TELD group had significantly shorter total operation time (58.43±12.37 vs. 83.23 ± 25.90 min), catheter placement time (5.83 ± 1.09 vs. 15.94 ± 3.00 min), decompression time (47.17 ± 11.98 vs. 67.29 ± 24.23 min), and fewer intraoperative fluoroscopies (3.20 ± 1.45 vs. 16.58 ± 4.25) compared to the control group (P < 0.05). There were no significant differences between the groups in terms of efficacy evaluation indicators and hospital stay. At the final follow-up, the excellent and good rate of surgical outcomes assessed by the MacNab criteria was 98.4%, and the overall adverse event rate was 8.2%, with no statistically significant differences between the groups (P > 0.05). This study demonstrates that the integrated optical and magnetic surgical navigation system can reduce the complexity of TELD, shorten operation time, and minimize radiation exposure for the surgeon, highlighting its promising clinical potential.

Impact of Technological Advancements on Short-term Outcomes in Flap Reconstruction after Soft Tissue Sarcoma Resection: A Retrospective Comparative Analysis.

Soft tissue sarcomas (STS) are rare malignancies requiring extensive surgical resection, often leading to significant soft tissue defects. Flap reconstruction is crucial for restoring function and appearance. Recent reconstructive microsurgery advancements, including high-resolution indocyanine green (ICG) imaging and ultra-high frequency ultrasonography (UHFU), have revolutionized preoperative planning and intraoperative guidance. We aimed to compare the surgical procedures and short-term outcomes of patients undergoing immediate flap reconstruction before and after our department's adoption of these technologies. We retrospectively analyzed 276 patients who underwent immediate flap reconstruction post-sarcoma resection between May 2014 and December 2023. They were categorized into pre- and post-technology groups based on the introduction of ICG angiography and UHFU in July 2019. We collected demographic, surgical, and postoperative data and compared outcomes using Fisher's exact and t-tests. The muscle preservation rate at the donor site was significantly higher in the post-Tech than in the pre-Tech group (no muscle damage: 65% vs. 37%, incision muscle damage: 25% vs. 26%, and muscle resection: 10% vs. 37%; p < 0.01). The proportions of complications (21% vs. 36%, p = 0.01), flap complications (17% vs. 30%, p = 0.01), partial flap loss (5% vs. 17%, p < 0.01), and flap dehiscence (9% vs. 25%, p < 0.01) were low in the post-Tech group. In the stratified analysis of free-flap reconstruction, the post-Tech group had a shorter operative time (7:01 vs. 8:13, p = 0.03) and fewer takebacks due to compromised flap perfusion (4% vs. 15%, p = 0.03) compared with the pre-Tech group. The introduction of ICG angiography and UHFU has improved surgical outcomes in STS flap reconstructions. These technologies facilitate precise preoperative planning and intraoperative decision-making, resulting in reduced operative times, low complication rates, and enhanced muscle preservation at the donor site.

Geometric Study and Clinical Case Series for Mandible Reconstruction With a Single-Piece Scapular Free Flap.

Virtual surgical planning (VSP) with simple cutting templates could help surgeons preoperatively plan scapula reconstructions in the vertical and horizontal orientations. Virtually, eight defects were created in ten healthy mandibles and reconstructed with the subject-specific scapula vertically and horizontally. In the clinical series, 15 single-piece scapula mandible reconstructions planned with in-house VSP and guided with simple templates were compared with 15 freehand reconstructions. Virtually, the vertical placement outperformed the horizontal placement in dice score (DSC) and Hausdorff-95 for all but one defect. Clinically, the VSP cohort had shorter operative time (386.6 ± 111.6 min vs. 268.9 ± 50.6 min, p = 0.002), fewer tracheostomies (73% vs. 15%, p = 0.002), lower length of hospital stay (16.6 ± 13.5 days vs. 12.2 ± 8.1 days, p = 0.319), and higher complete/partial union to a non-significant degree (78% vs. 100%, p = 0.471). A single-piece scapula free flap is a versatile option for mandibular reconstruction. VSP has time and cost savings potential and quality of life impact that should be further investigated.

Effects of Breast-Conserving Surgery Combined with Sentinel Lymph Node Biopsy on Breast Cosmetic Appearance and Systemic Stress of Patients with Breast Cancer

Background: We aimed to evaluate breast-conserving surgery plus sentinel lymph node biopsy in affecting breast cosmetic appearance and systemic stress of breast cancer patients. Methods: A total of 150 early breast cancer patients admitted between January 2020 and September 2022 were retrospectively analyzed. Propensity score matching was performed to minimize selection bias based on baseline characteristics, resulting in two matched groups of 55 patients each. The observation group received breast-conserving surgery and sentinel lymph node biopsy, while the control group underwent breast-conserving surgery and axillary lymph node dissection. Results: The observation group experienced shortened operation time and extubation time compared with the control group, and there were significantly different blood losses between the two groups (p &lt; 0.05). The observation group was significantly superior to the control group in terms of the postoperative quality of life (p &lt; 0.05). After treatment, the levels of plasma procalcitonin (PCT) and tumor necrosis factor-α (TNF-α) in the two groups decreased. By contrast to those in the control group, PCT, TNF-α, carcinoembryonic antigen and carbohydrate antigen 125 presented significantly reduced levels in the observation group following treatment (p &lt; 0.05). The observation group, compared to the control group, exhibited significant improvement of the breast appearance (p &lt; 0.05). No significant difference was observed between the two groups regarding human epidermal growth factor receptor-2 (HER-2) expression (p &gt; 0.05). Conclusion: Breast-conserving surgery and sentinel lymph node biopsy are simple and can reduce the complications and benefit the recovery of patients.