Single Incisions Research Articles

Surgical approaches to correct corneal astigmatism at time of cataract surgery: a mini-review.

Among refractive errors, astigmatism is the most common optical aberration, where refraction changes in different meridians of the eye. It causes blurred vision at any distance and includes corneal, lenticular, and retinal astigmatism. Cataract surgery used to cause a progressive increase in the pre-exisiting corneal astigmatism because of creating a surgically induced astigmatism, for example, a large size surgery incision. The development of surgical techniques during last decades has made cataract surgery interchange to treat preoperative corneal astigmatism at time of surgery. Nowadays, three surgical approaches can be used. By placing a sutureless clear corneal incision on the steep meridian of the cornea, a preoperative corneal astigmatism less than 1.0 D can be corrected. Single or paired peripheral corneal relaxing incisions (PCRIs) provide 1.0-3.0 D corneal astigmatism correction. PCRIs are typically used for treating 1.0-1.5 D of regular corneal astigmatism, if more than 2.0 D, the risk of overcorrection and irregular astigmatism is increased. When toric intraocular lenses (IOLs) are unavailable in markets, PCRIs are still a reasonable option for patients with up to 3.0 D of pre-existing corneal astigmatism. Toric IOLs implantation can correct 1.0-4.5 D of corneal astigmatism. Several IOLs are approved to correct a high degree of corneal astigmatism with cylinder power up to 12.0 D. These approaches can be used alone or in combination.

Minimal Access in Pediatric Surgery: An Overview on Progress towards Dedicated Instrument Developments and Anesthesiologic Advances to Enhance Safe Completion of Procedures.

Surgical techniques are evolving in Pediatric Surgery, especially in the area of minimal access surgery (MAS) where indications for applications are expanding. Miniaturization of instruments, using natural orifices, single incisions, or remotely controlled robot-assisted procedures, promises to increase the benefits of MAS procedures in pediatrics. Many pediatric pathologies are rare, and specialized surgical and anesthesiologic instruments are necessary to manage them, defined as "orphan devices", for which development and dissemination on the market are slowed down or sometimes hindered by regulatory standards and limiting financial conflicts of interest. In pediatric surgery, it is of utmost importance to work in a multidisciplinary way to offer a surgical path that is safe and supported by technological advances. For this reason, optimizing pediatric anesthesia is also a crucial factor where technological advances have made monitoring more precise, thereby enhancing safety in the operative room. The development of customized instruments and technologies should be supported by pediatric research and should be adapted to the individualities of the small patient. This overview outlines the importance of dedicated instruments developed for the safe completion of MAS procedures in pediatrics.

Clinical Analysis of 76 Cases of Second Branchial Cleft Fistula.

Objective: To provide the experience of diagnosis and treatment of second branchial cleft fistula in children. Methods: The clinical data of 76 children with second branchial cleft fistulas admitted to Beijing Children's Hospital affiliated with Capital Medical University from January 2016 to December 2020 were retrospectively analyzed. All patients underwent cervical ultrasonography and resection of the second branchial cleft fistula, and their clinical manifestations, surgical methods, complications, recurrence condition, and lesion appearance of the patients were analyzed. Results: Among the 76 cases, the lesions of 43 cases were on the right side, 20 were on the left side, and 13 were bilateral, for a total of 89 lesions. There were 49 type I lesions, 28 type II lesions, 8 type III lesions, and 4 type IV lesions. Type I and type II cases underwent complete excision of the fistula through a small incision in the neck; 2 cases of type III branchial cleft fistulas were treated with trapezoidal incision; 2 cases of type III branchial cleft fistulas underwent single transverse incisions; single small incision-assisted endoscopic resection was adopted in 4 cases of type III and 4 cases of type IV branchial cleft fistulas. During the follow-up period of 6 to 60 months, only 3 cases developed postoperative infection, the others had no postoperative complications, and no cases had recurrence during postoperative follow-up. Conclusion: The incision of the second branchial fistula should be selected according to imaging examination to achieve removal of the fistula while maintaining esthetics.

Influence of Surgical Approach and Fixation on Complications in Talus Fractures: A Multicenter Review

Fractures of the talus are infrequent injuries often associated with substantial morbidity and imperfect outcomes. We undertook a retrospective review of talus fractures at multiple level 1 trauma centers in order to identify common treatment patterns and potential predictors of complications. All cases of talar fractures meeting inclusion criteria at our institution were reviewed. 54 of 103 talus fractures met inclusion criteria. 33 (61.1%) involved the talar neck, 13 (24.1%) the talar body, and 6 (9.2%) involved the lateral process. The most common etiology was motor vehicle accidents, accounting for 27 (50.0%). Mean follow up was 13.6 months (range 8-52 months). 37 (68.5%) fractures were fixated with screws, and 17 (31.5%) were fixated with a plate construct. Single and dual incisions were used in 63.0% and 25.9% of cases, respectively. Complications were seen in 46.3% of cases, with post-traumatic osteoarthritis being the most common complication (35.1%). Avascular necrosis occurred in 4 (7.4%) patients. No independent variables met the statistical threshold to be associated with complications. The present data alludes to possibility of over-reporting complications due to historical literature and the need for further studies.

Single and dual limbal relaxing incisions in correcting corneal astigmatism during cataract surgery

Introduction: Correcting astigmatism during cataract surgery to achieve optimal visual outcomes is important. Various techniques, such as limbal relaxing incisions (LRIs), are used to correct astigmatism. LRIs are effective for mild to moderate astigmatism but have limitations in correcting larger astigmatism. This study aimed to review the effectiveness of single and dual LRI in correcting astigmatism during cataract surgery. Methods: This literature review utilized databases from 2010 until 2022. The keywords “corneal astigmatism”, “limbal relaxing incision”, and “cataract surgery” were used to collect 12 journals that had relevant topics. Results: LRIs are a form of partial-thickness keratotomy used to correct astigmatism during cataract surgery. The incisions for LRIs are made in the peripheral cornea, following a nomogram based on the patient's astigmatism, age, and the location of the steep axis of astigmatism. LRIs can be performed as single or dual incisions, with dual LRIs offering greater astigmatism correction. In the case of irregular astigmatism, LRIs can be adjusted to the topography of the cornea because the lengths of coupled incisions can vary. Conclusion: The effectiveness between single and dual LRIs was the same, but paired LRIs have a superior effect in correcting greater astigmatism. LRIs remain a valuable tool for cataract surgeons to manage astigmatism and improve visual outcomes in cataract surgery patients.

Complications, Implant Survivorships, and Functional Outcomes of Conversion Total Knee Arthroplasty With Prior Hardware

BackgroundEnd-stage knee osteoarthritis with retained periarticular hardware is a frequent scenario. Conversion total knee arthroplasty (TKA) leads to excellent outcomes, but poses unique challenges. The evidence supporting retention versus removal of hardware during TKA is controversial. MethodsPatients who underwent TKA with prior hardware between January 2009 and December 2019 were identified. A total of 148 patients underwent TKA with prior hardware. The mean follow-up was 60 months (range, 24-223). Univariate and multivariable analyses were used to study correlations among factors and surgical-related complications, prosthesis failures, and functional outcomes. ResultsThe complication rate was 28 of 148 (18.9%). The use of a quadriceps snips in addition to a medial parapatellar arthrotomy was associated with a higher complication (odds ratio: 20.7, P < .05), implant failures (odds ratio: 13.9, P < .05), and lower the Veterans Rand 12 Mental Score (VR-12 MS) (−14.8, P < .05). Hardware removal versus retention and use of single versus multiple incisions were not associated with complications or prosthesis failures. Removal of all hardware was associated with significantly higher (+7.3, P < .05) VR-12 MS compared to retention of all hardware. ConclusionsTKA with prior hardware was associated with more complications, implant failures, and lower VR-12 MS when a more constrained construct or quadriceps snip was performed. This probably reflects the level of difficulty of the procedure rather than the surgical approach used. Hardware removal or retention was not associated with complications or implant failures; however, removal rather than retention of all prior hardware is associated with increased general health outcomes. Level of evidenceIV, cohort without control.

Single incision simultaneous liver kidney transplantation: Feasibility and outcomes.

Traditionally, simultaneous liver kidney transplantation (SLK) has been performed using a subcostal incision for the liver allograft and a lower abdominal incision for kidney transplantation (dual incision, DI). At our institution, we performed SLK using a single subcostal incision (SI). The aim of this study was to report the outcomes of single versus dual incisions for SLK. A retrospective cohort study of consecutive SLK procedures performed at our center from January 2015 to April 2021 was performed. The demographic characteristics, complications, intraoperative findings, and complications after SI and DI were statistically compared. A total 37 SLK were performed (19 DI and 18 SI). The age and indications for transplantation were comparable between the two groups. Patient in SI group had significantly higher MELD score (27.0±1.5vs. 31.7±1.5, p=.038). The cold ischemic time of kidney transplantation (599±26min vs. 447±27min, p<.001) and the total surgical time (508±21min vs. 423±22min, p=.008) were significantly shorter in the SI group. The incidence of complications and post-transplant kidney function was comparable between the groups. A slightly higher incidence of surgical site complications was noted in the DI group without any statistically significance (p=.178). Single-subcostal incision SLK is technically feasible and has comparable outcomes to dual-incision SLK. SI was associated with shorter cold ischemic time for kidney transplant, as well as shorter overall operative time.

Single versus dual incision approaches for dual plating of bicondylar tibial plateau fractures have comparable rates of deep infection and revision surgery

ObjectivesThe use of one midline incision versus dual medial/lateral incisions for dual plating of bicondylar tibial plateau (BTP) fractures is controversial. This study aimed to compare rates of infection and secondary surgery in patients treated with dual plating for a BTP fracture using a single versus double incisions. DesignRetrospective cohort study. SettingTwo Level-1 trauma centers. Patients/ParticipantsPatients > 18 years with a closed AO/OTA 41-C BTP fracture without compartment syndrome treated with a single midline or dual incision (lateral with medial or posteromedial) approach for dual plating. InterventionDual plating through either a single anterior incision, or dual medial/lateral incisions. Main outcome measurementsRates of deep infection and reoperation were compared using Chi-square analysis (p-value of < 0.05). Results and conclusionsIn total 636 AO/OTA 41-C BTP fractures treated between 1/1/01 and 12/31/18 were identified and assessed. After exclusions for limited follow up, other techniques, open fracture and the need for fasciotomies, 346 patients were studied. Of these 254 had been treated with a single plate / single approach technique while 92 had been dual plated, 41 through a single anterior incision while 51 had dual plating through separate lateral and medial or posteromedial incisions. For these 92 fractures, there was no significant difference in the rate of deep infection (22.0% vs 23.5%, s=0.858) or reoperation (31.7% vs 31.4%, p=0.973) between the single and dual incision groups. Injuries that had been treated with single plating via a single incision had comparably lower rates of deep infection (10.2% vs. 22.8%, p=0.003) and reoperation (12.2% vs. 31.5%, p<0.001). There were no significant differences in any demographic parameters between patients undergoing single versus dual plating. Although retrospective, not randomized and subject to single surgeon bias these data suggest that these complications are more based on injury than the approach. Level of evidenceIII

The Paired T-Fastener Technique: A Bolster-Free Gastropexy for Laparoscopic Gastrostomy Tube Placement.

Purpose: Gastropexy during laparoscopic gastrostomy tube (GT) insertion can be technically challenging. T-fasteners are an effective method of gastropexy. However, the use of external bolsters requires an additional procedure for removal and may cause skin complications due to pressure necrosis. We describe our experience utilizing T-fasteners in a novel way that eliminates external bolsters during laparoscopic GT placement. Methods: Pediatric patients requiring enteral access who underwent gastrostomy at a single institution using the paired T-fastener technique were reviewed. Gastropexy was achieved by passing pairs of T-fasteners, under laparoscopic and/or endoscopic guidance, through single stab incisions into the stomach in a square configuration, allowing the suture from one T-fastener to be tied subcutaneously to its paired suture. This eliminates the need for external bolsters. Operative time and 30-day postoperative complications, including local wound infection, granulation tissue formation, bleeding, and tube replacement, are reported. Results: Thirty patients underwent gastrostomy placement using the paired T-fastener technique. Mean age was 9.2 years (standard deviation [SD] 6.9) and mean weight 29.9 kg (SD 21.0). Mean tube length was 2.2 cm (SD 0.71). Eight patients underwent an additional procedure at the time of gastrostomy. Mean operative time was 74.4 minutes (SD 39.7). Five patients developed a local wound infection requiring antibiotics. Five developed granulation tissue. Seven patients underwent tube replacement within 30 days for dislodgment or stem upsize. Conclusion: The paired T-fastener technique is a safe and efficient method for primary button gastrostomy placement. This method eliminates the need for additional trocars or external bolsters and may be helpful in patients with thick abdominal walls.

Abstract PS9-45: Factors causing delayed resolution of breast lymphoedema

Abstract IntroductionBreast lymphoedema impacts the quality of life and cosmesis in women undergoing breast conserving surgery for cancer. The assessment of breast lymphoedema is complex and challenging. The varied reported incidence (0-94%) is due to lack of awareness, poor reporting, subjective characterisation, absence of standardised definitions and tools for diagnosis and monitoring. Extensive research has been done on secondary limb and trunk lymphoedema following lymph node surgery and/or radiotherapy. However, there is a lack of data on breast lymphoedema. Disruption of lymphatics due to advanced oncoplastic procedures, axillary surgery, modified incisions and adjuvant radiotherapy may contribute to this problem. The objective of this study is to identify the causes of delayed resolution of breast lymphoedema. Methods A retrospective audit was carried out in women who underwent breast conserving surgery between 2011-2017.Only patients with breast oedema, seen in the lymphoedema clinic were included in the study. Data on body mass index (BMI), types of incisions, breast procedures, axillary surgery, histopathology, adjuvant treatment including the extent of adjuvant radiotherapy was collated from the hospital database. Breast lymphoedema was diagnosed by clinical examination and/or by a Delfin lymph scanner (DLS). DLS is a mobile non-invasive device which uses tissue dielectric constant (TDC) for measuring subcutaneous tissue water. A reading of 45% or higher was accepted as indicative of breast lymphoedema in our unit. Percentage water content (PWC) value was recorded only in 55 patients using DLS. ResultsDuring the study period, 1905 patients underwent breast conserving surgery, out of which 120 (6.3%) were documented as having breast lymphoedema. The median time from surgery to assessment in the lymphedema clinic was 11 months. On univariate analysis, a high BMI (&amp;gt;30) and radiotherapy with boost lead to non-resolution of breast oedema. The median time taken for resolution of symptoms was 18 months. Other factors such as lateral skin crease incisions, single incisions to perform both breast and axillary surgery, oncoplastic procedures and re-excisions were not statistically significant. Using a DLS, the median PWC value was 56% in this cohort. Conclusions Our study shows that high BMI and radiotherapy with boost leads to delayed resolution of breast lymphoedema. The Delfin lymph scanner may be a potential tool for monitoring breast oedema but further prospective studies are required for validation of this tool. Citation Format: Pragnya Chigurupati, Manoj Gowda, Rebecca Elwell, Arie Hawazie, Kirti Katherine Kabeer, Sekhar Marla, Sadaf Jafferbhoy, Soni Soumian, Sankaran Narayanan. Factors causing delayed resolution of breast lymphoedema [abstract]. In: Proceedings of the 2020 San Antonio Breast Cancer Virtual Symposium; 2020 Dec 8-11; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2021;81(4 Suppl):Abstract nr PS9-45.

A STUDY ON COMPARISON OF KERATOMETRIC CHANGES BETWEEN PREINCISION AND SINGLE-STEPPED CLEAR CORNEAL INCISION IN PHACOEMULSIFICATION SURGERY

Phacoemulsication surgery is the most widely used technique for cataract surgery nowadays. It can be done by either pre-incision or by clear corneal incisions. Clear corneal incisions are becoming more popular option for cataract surgery and IOL (intraocular lens) implantation. The availability of foldable IOL that can be inserted through small incisions has created a trend for clear corneal incisions. To compare post-operative kera to metric changes after phacoemulsication surgery between pre-incision or tunnel-based incision and single stepped clear corneal incisions. Fifty patients undergoing phacoemulsication surgery in the Dept. Of Ophthalmology, Nilratan Sircar Medical College &amp; Hospital, Kolkata, West Bengal. Both pre-incision and clear-corneal incision in phacoemulsication surgery results in surgically induced astigmatism post-operatively, but there was no signicant difference in post-operative induced astigmatism in between both techniques.

Preclinical, cadaveric study of the application of da Vinci single port system in thoracic surgery.

Conventional robotic thoracic surgery has been performed with multiple robotic arms through 4 or more ports, and robotic single-site approaches have also been attempted through enlarged single incisions. The authors previously reported our experiences with robotic single-site thoracic surgery for mediastinal mass excision (1).

Episiotomy: the biomechanical impact of multiple small incisions during a normal vaginal delivery.

Childbirth-related injuries are one of the main causes of pelvic floor dysfunction. To attempt to avoid serious tears during delivery, an episiotomy can be performed. In this study, we intended to investigate the biomechanical performance of the pelvic floor muscles after performing different episiotomies using a physics-based computational model which includes the pelvic floor muscles and the fetus. Previous biomechanical studies have analysed the mechanical effects of single incisions of different lengths; in this study, we intend to analyse the implications of multiple small incisions, evaluating the reaction forces, the stress on the muscles and the loss of tissue integrity sustained by the pelvic floor. The obtained results predict that an episiotomy delivery reduces the likelihood of macroscopic levator trauma by decreasing the stress on the region of insertion of the rectal area of the levator ani in the symphysis pubis. From the mechanical point of view, multiple incisions do not bring benefits compared to larger incisions. However, nothing can be ascertained about the clinical benefit of such an approach.

130 Surgical Technique for Complex Cases of Peyronie’s Disease: Penile Prosthesis Implantation, Modified Neurovascular Bundle Release and Single or Multiple Corporeal Incisions and Grafting with Collagen Fleece

Surgery is the mainstay of treatment for Peyronie’s disease (PD), but multiple surgical approaches may be considered. We present specific surgical techniques for each individual case. We aim to demonstrate its safety and effectivity for penile curvature correction and restoring erectile dysfunction with limited complications. Data were collected from a prospective cohort of 23 consecutive patients treated in our institution with complex PD and ED, between February 2015 and May 2017. The surgical procedure consists of an implantation of penile prosthesis (malleable or inflatable) associated with single or multiple incisions of the plaque/tunica albuginea and grafting with a self-adhesive collagen fleece, and previously modified neurovascular bundle release. All patients provided informed consent and the protocol was approved by Institution Review Board (IRB). In the video attached, we described each technique, step by step. With a median follow-up of 15.3 months, the mean postsurgical penile lengthening was 2.7(1-5) cm, with an improvement of PDQ PD bother score of 4.3(2-5) points. No glans ischemia or infectious complications were recorded, but hematoma was observed in 26% patients, and the overall satisfaction was 92%.

403 Surgical management algorithm for complex cases of Peyronie’s Disease with penile prosthesis implantation, modified neurovascular bundle release and single or multiple corporeal incisions and grafting with collagen fleece

Surgery is the mainstay of treatment for Peyronie’s disease (PD), but multiple surgical approaches may be considered. We present a new algorithm for the surgical management of complex cases of PD, which suggests specific surgical techniques for each individual case. We aim to demonstrate its safety and effectivity for penile curvature correction and restoring erectile dysfunction with limited complications. Data were collected from a prospective cohort of 23 consecutive patients treated in our institution with complex PD and ED, between February 2015 and May 2017. The surgical procedure consists of an implantation of penile prosthesis (malleable or inflatable) associated with single or multiple incisions of the plaque/tunica albuginea and grafting with a self-adhesive collagen fleece, and previously modified neurovascular bundle release. Descriptive statistics were calculated for demographic data, preoperative clinical information and follow-up variables. All patients provided informed consent and the protocol was approved by Institution Review Board (IRB).

Analysis of 784 Surgically Treated Distal Biceps Tendon Ruptures

The surgical repair of distal biceps tendon ruptures has an overall low rate of serious complications, regardless of approach or technique. However, two-incision technique has a higher rate of posterior interosseous nerve palsy, heterotopic bone formation, and re-operation rate. To examine clinical and surgical outcomes for distal biceps tendon repairs in a large, multi-specialty, integrated healthcare system. Retrospective cohort study of distal biceps tendon repairs performed from January 1, 2008 through December 31, 2015. The repair methods were classified as: two-incision approach using bone tunnel-suture fixation, or anterior single incision approach. Anterior single incisions were further classified according to the fixation method: cortical button alone, cortical button and interference screw, or suture anchors alone. Patient demographics, surgeon characteristics, surgical outcomes, and complications were analyzed for all repair types. Of the 784 repairs that met our inclusion criteria, 639 (81.5%) were single incision approaches. When comparing two-incision and single incision repairs, there was a significantly higher rate of posterior interosseous nerve palsy (3.4% vs. 0.8% respectively, P: 0.010), heterotopic bone formation (7.6% vs 2.7%, respectively. P: 0.004), and re-operations (8.3% vs 2.3%, respectively. P<0.001). When excluding lateral antebrachial cutaneous nerve palsies, there was no significant difference in the overall nerve palsies between single incision and two-incision (5.8% vs. 6.9%, respectively, P: 0.612). The overall rate of tendon re-rupture was 1.9% (single incision: 1.6%, two-incision: 2.8%, P: 0.327). The overall rate of post-operative wound infection was 1.5% (single incision: 1.3%, two-incision: 2.8%, P: 0.182). The average time from surgery to release from medical care was 14.4 weeks (single incision: 14.0 weeks, two-incisions: 16.0 weeks, P: 0.286). Patients treated with cortical button + interference screw were released significantly sooner than other single incision repair types (13.1±8.01 weeks, P: 0.011). There were no significant differences in rates of motor neuropraxia, infection, re-rupture, re-operation in regards to surgeon’s years of practice, fellowship training, or case volume. The surgical repair of distal biceps tendon ruptures has an overall low rate of serious complications, regardless of approach or technique. However, two-incision technique has a higher rate of posterior interosseous nerve palsy, heterotopic bone formation, and re-operation rate. Surgeon’s years of practice, fellowship training, and case volume do not affect the rate of major complications.

Surgical Treatment of Distal Biceps Tendon Ruptures: An Analysis of Complications in 784 Surgical Repairs

Background: Distal biceps brachii tendon ruptures lead to substantial deficits in elbow flexion and supination; surgical repair restores muscle strength and endurance. Purpose: To examine clinical and surgical outcomes for distal biceps tendon repairs in a large, multispecialty, integrated health care system. Study Design: Cohort study; Level of evidence, 3. Methods: Retrospective cohort study of distal biceps tendon repairs performed between January 1, 2008, and December 31, 2015. The repair methods were classified as double-incision approach using bone tunnel–suture fixation or anterior single-incision approach. Anterior single incisions were further classified according to the fixation method: cortical button alone, cortical button and interference screw, or suture anchors alone. Patient demographics, surgeon characteristics, range of motion, and complications were analyzed for all repair types. Results: Of the 784 repairs that met the inclusion criteria, 639 (81.5%) were single-incision approaches. When comparing double-incision and single-incision repairs, there was a significantly higher rate of posterior interosseous nerve palsy (3.4% vs 0.8%, P = .010), heterotopic bone formation (7.6% vs 2.7%, P = .004), and reoperation (8.3% vs 2.3%, P < .001). The most common nerve complication encountered was a lateral antebrachial cutaneous nerve palsy (n = 162), which was significantly more common in the single-incision repairs than in the double-incision repairs (24.4% vs 4.1%, P < .001). When excluding lateral antebrachial cutaneous nerve palsies, there was no significant difference in the overall nerve palsies between single-incision and double-incision (5.8% vs 6.9%, P = .612). The overall rate of tendon rerupture was 1.9% (single incision, 1.6%; double incision, 2.8%; P = .327). The overall rate of postoperative wound infection was 1.5% (single incision, 1.3%; double incision, 2.8%; P = .182). The average time from surgery to release from medical care was 14.4 weeks (single incision, 14 weeks; double incision, 16 weeks; P = .286). Patients treated with cortical button plus interference screw were released significantly sooner than were patients with other single-incision repair types (13.1 ± 8.01 weeks, P = .011). There were no significant differences in rates of motor neurapraxia, infection, rerupture, and reoperation with regard to surgeon’s years of practice, fellowship training, or case volume. Conclusion: The surgical repair of distal biceps tendon ruptures has an overall low rate of serious complications, regardless of approach or technique. However, the double-incision technique has a higher rate of posterior interosseous nerve palsy, heterotopic bone formation, and reoperation rate. Surgeon’s years of practice, fellowship training, and case volume do not affect the rate of major complications.

Pregnancy success after hysteroscopic sterilization reversal.

To evaluate the effectiveness of hysteroscopic sterilization reversal by assessing pregnancy rates and identifying surgical complications. All patients at a single center undergoing elective reversal of hysteroscopic sterilization for fertility were followed from January 2009 to May 2014. Eligible patients met prespecified criteria for outpatient surgery. Patients underwent outpatient reversal using a transverse suprapubic abdominal incision with tubouterine implantation performed with either bilateral cornual or single transverse posterior-fundal uterine incisions. Patients were evaluated on postoperative day 1, called the following day, and e-mailed at 2 weeks and 12 months. Pregnancy outcomes were assessed through a 12-month questionnaire and self-reporting using an Internet-based patient portal. Univariate analysis of patient and operative characteristics was performed. Seventy patients underwent bilateral tubouterine implantation and completed at least 12 months of follow-up. All surgeries were outpatient without any immediate operative complications. Four patients had complications between 2 and 30 days, none requiring extended hospitalization. Women who became pregnant were younger (mean age 34 years) than those who did not become pregnant (mean age 38 years). Twenty-five patients (36%, 95% confidence interval [CI] 25-47%) reported a total of 31 naturally conceived pregnancies. Twenty-seven percent (19/70, 95% CI 17-37%) of those undergoing surgery subsequently reported live births. A single pregnancy complication of postpartum hemorrhage after cesarean delivery requiring transfusion was reported; no ectopic pregnancies were reported. Hysteroscopic sterilization can be reversed using tubouterine implantation and both pregnancy and live birth rates are promising.

Paired opposite Clear Corneal Incision: Time-Related Changes of its Effect and Factors on which those Changes Depend

To assess astigmatism induced by paired opposite clear corneal incision (OCCI) compared to single incisions and to investigate factors on which its effect depends. The study comprised 326 eyes from 326 patients. In patients with <1.0 D corneal astigmatism, clear corneal incision was performed (CC group, n = 245), and in those with >1.0 D preoperative corneal astigmatism, a second, opposite clear corneal incision was made (OCCI group, n = 81). Both groups consisted of superior, temporal, and oblique subgroups according to the steepest meridian. Prior to the surgery, and after surgery, repeated keratometry was performed and surgically induced astigmatism (SIA) was calculated using vector analysis. Two weeks after the surgery, the SIA was 0.67 ± 0.44 D in the CC group and 1.15 ± 0.65 D in the OCCI group; 9 weeks after the operation, it was 0.61 ± 0.43 D in the CC group and 0.99 ± 0.57 D in the OCCI group (p<0.001). The SIA showed no significant postoperative change in our groups. Opposite clear corneal incision reliably induces about 1.0 D of corneal astigmatism on the steep meridian in proportion to the rate of preoperative astigmatism. Its magnitude is independent of the location of the incisions and its effect remains unchanged during the postoperative period.

The evolving application of single‐port robotic surgery in general surgery

Advances in the field of minimally invasive surgery have grown since the original advent of conventional multiport laparoscopic surgery. The recent development of single incision laparoscopic surgery remains a relatively novel technique, and has had mixed reviews as to whether it has been associated with lower pain scores, shorter hospital stays, and higher satisfaction levels among patients undergoing procedures through cosmetically-appeasing single incisions. However, due to technical difficulties that arise from the clustering of laparoscopic instruments through a confined working space, such as loss of instrument triangulation, poor surgical exposure, and instrument clashing, uptake by surgeons without a specific interest and expertise in cutting-edge minimally invasive approaches has been limited. The parallel use of robotic surgery with single-port platforms, however, appears to counteract technical issues associated with single incision laparoscopic surgery through significant ergonomic improvements, including enhanced instrument triangulation, organ retraction, and camera localization within the surgical field. By combining the use of the robot with the single incision platform, the recognized challenges of single incision laparoscopic surgery are simplified, while maintaining potential advantages of the single-incision minimally invasive approach. This review provides a comprehensive report of the evolving application single-port robotic surgery in the field of general surgery today.