Smaller Incision Size Research Articles

Comparison of diagnostic yields, operative times, and post-operative hemorrhage between twist drill versus burr hole craniotomy approaches for stereotactic needle brain biopsy.

Stereotactic frameless needle brain biopsy is a common neurosurgical procedure performed via twist drill or open burr hole approaches. We aim to compare diagnostic yields and surgical outcomes to delineate the safety and efficacy of both approaches. A retrospective database of all stereotactic needle biopsy procedures performed at a single institution over 30 months was conglomerated. Demographics, medical comorbidities, operative details/complications, immediate post-operative imaging, and pathology were abstracted. Two hundred and twenty-five needle biopsies were identified, of which 165 (73.3%) were open, and 60 (26.7%) were twist drill. Diagnostic pathology yield rates between open (84.8%) and twist drill (93.3%) approaches were similar (p = 0.15), with a median of 4 cores taken in each (p = 0.30). Diagnostic tissue yields with an intra-operative pause for pathology confirmation was 90.4% compared to 79.1% without pause (p = 0.036, OR 2.49). Median operative times for open versus twist drill procedures were 68.0min (IQR 49-83) versus 35.5min (IQR 26-54), respectively (Wilcoxon p < 0.001), which remained significant after controlling for awaiting intraoperative pathology using bivariable linear modeling (p < 0.001). Intraoperative bleeding through the needle cannula was noted in 22 patients (9.8%), including eight twist drill (13.3%) and 14 open needles (8.5%). Of 197 cases (87.6%) with post-operative cranial imaging (CT/MRI), 90 (45.7%) demonstrated some degree of post-operative hemorrhage characterized as superficial (n = 10, 11.1%), deep/intralesional (n = 64, 71.1%) bleeding, or both (n = 16, 17.9%). Bleeding rates between open (46.7%) and twist drill (43.3%) approaches were similar (p = 0.78). Post-operative clinical decline or neurological change was noted in 9 patients (4.0%), including one twist drill (1.7%) and eight open needles (4.8%), among which 7 (78%) had deep blood products identified on post-operative imaging. Stereotactic needle biopsy via twist drill approach has similar diagnostic yield rates, asymptomatic bleeding rates, and post-operative complications with significantly shorter operative time and smaller incision size than conventional open burr hole needle biopsy. Using intra-operative frozen histopathology for presumed sufficient diagnostic tissue may improve final pathologic diagnostic rates regardless of approach technique.

SMALL INCISION LENTICULE EXTRACTION – SMILE

SMALL INCISION LENTICULE EXTRACTION – SMILE

Manoeuvring Distal Tibial Shaft Fractures with Ender’s Nailing: Case Series

Fractures of the tibial shaft are the most common fractures to occur in the human body. Number of motor vehicle high-velocity injuries has increased in recent years. Various modalities used for treatment range from immobilization with the cast to open reduction and plating, closed reduction and nailing, and external fixator application. In our study, we have preferred fixation with multiple Ender’s nails in a series of three cases with different modes of injury. We found that closed reduction along with internal fixation with Ender’s nailing is a better modality in terms of easy technique, cost-effectiveness, small incision size, no soft-tissue damage or stripping, and complication. Ender’s nailing is an excellent alternative.

Design of the Novel Single Incision, Free Motion Laparoscopic Surgical System

Abstract Laparoscopic surgery is a common minimally invasive surgery that uses specialized tools to access the abdominal cavity and pelvic regions via small incisions called ports. Compared to open surgery, laparoscopy's small incision size better protects a patient's health and reduces recovery time. However, restricted rotation of the tools around chosen port locations can limit a surgeon's mobility while operating. To address this, the novel single incision, free motion (SIFM) laparoscopic surgical system was created, and its design was explored through three experiments. Experiment 1 analyzed different permanent magnetic configurations to optimize the magnetic force between a tool on the inside of the abdominal wall and an external tool. The chosen configuration was a single-pole external magnet, coupled to an axially magnetized internal magnet. Experiment 2 analyzed the experimental and theoretical forces applied by the internal tool. The tool was able to provide sufficient cutting forces at 26.1 mm of separation between the tools. Experiment 3 measured the precision of the tool's end effector which was controlled by a stepper motor-powered cable system. The tool's end effector rotates no more than 1 deg about the y-axis and no more than 2 deg about the x-axis. The SIFM system combines the health benefits of minimally invasive laparoscopic surgery, with the free motion and ease of open surgery.

Comparison of two cable configurations in 3D printed steerable instruments for minimally invasive surgery.

In laparoscopy, a small incision size improves the surgical outcome but increases at the same time the rigidity of the instrument, with consequent impairment of the surgeon's maneuverability. Such reduction introduces new challenges, such as the loss of wrist articulation or the impossibility of overcoming obstacles. A possible approach is using multi-steerable cable-driven instruments fully mechanical actuated, which allow great maneuverability while keeping the wound small. In this work, we compared the usability of the two most promising cable configurations in 3D printed multi-steerable instruments: a parallel configuration with all cables running straight from the steerable shaft to the handle; and a multi configuration with straight cables in combination with helical cables. Twelve participants were divided into two groups and asked to orient the instrument shaft and randomly hit six targets following the instructions in a laparoscopic simulator. Each participant carried out four trials (two trials for each instrument) with 12 runs per trial. The average task performance time showed a significant decrease over the first trial for both configurations. The decrease was 48% for the parallel and 41% for the multi configuration. Improvement of task performance times reached a plateau in the second trial with both instruments. The participants filled out a TLX questionnaire after each trial. The questionnaire showed a lower burden score for the parallel compared to multi configuration (23% VS 30%). Even though the task performance time for both configurations was comparable, a final questionnaire showed that 10 out of 12 participants preferred the parallel configuration due to a more intuitive hand movement and the possibility of individually orienting the distal end of the steerable shaft.

Use of Cannulated Reamers to Facilitate Thoracic Diskectomy Using a Minimally Invasive Retropleural Thoracotomy Approach-Surgical Technique.

The surgical treatment of symptomatic thoracic disk herniations is technically challenging. In the past decade, a minimally invasive retropleural thoracotomy approach has become more popular to treat this pathology. However, efficient bone removal to safely perform the diskectomy and spinal cord decompression is difficult with this technique because of the small incision size and long working distance in the thoracic cavity and the proximity of the compressed thoracic cord. To describe a novel surgical technique for performing a thoracic diskectomy using a minimally invasive lateral approach using cannulated reamers to facilitate bone removal. This technique was used in 7 consecutive patients who presented with thoracic myelopathy from a thoracic disk herniation. First, a standard lateral minimally invasive retropleural approach to the thoracic spine was performed. Partially threaded guide wires were placed in the posterior aspect of the vertebral bodies adjacent to the affected disk space, and sequential cannulated reamers were passed over the guidewires to perform partial corpectomies. The posterior annulus, posterior longitudinal ligament, and herniated disk material were then resected using Penfield dissectors and Kerrison rongeurs to complete the decompression. All 7 patients who underwent thoracic diskectomy using this approach had stable or improved neurologic function postoperatively. There were no complications related to the use of the cannulated reamer technique. The use of cannulated reamers provides a simple and efficient method for safe bone removal to facilitate minimally invasive thoracic diskectomy using a lateral approach. This is an easily reproducible technique using commonly available equipment.

The impact of endoscopic sphincterotomy incision size on common bile duct stone recurrence: A propensity score matching analysis.

The aim of this study is to clarify the relation between the incision size for endoscopic sphincterotomy (EST) and common bile duct stone (CBDS) recurrence. Patients who underwent elective endoscopic treatment for CBDS between January 2013 and December 2017 were enrolled, excluding those who met the exclusion criteria. The clinical characteristics were investigated using propensity score matching analysis. A total of 243 patients were investigated. Propensity scores were calculated using multinomial logistic regression with five relevant variables (age, gender, follow-up time, maximum stone size, and bile duct diameter), which led to extraction of 188 cases to compose cohorts of the small and medium EST incision groups. The CBDS recurrence rate was 17.0% in the small incision group and 6.4% in the medium incision group. Multivariate analysis identified the medium incision as an independent predictor of CBDS recurrence (hazard ratio 0.350, 95% confidence interval 0.133-0.922, P=.034). The CBDS non-recurrence rate of the medium incision group was significantly higher than that of the small incision group (log-rank test P=.019). Our findings suggest that the CBDS recurrence rate was lower in EST with medium incision size than with small incision size.

Minimally invasive removal of deep contraceptive implants under continuous ultrasound guidance is effective, quick, and safe

ObjectivesThe aim of this study was to assess the feasibility, performance, and complications of a non-surgical, minimally-invasive procedure of deep contraceptive implant removal under continuous ultrasound guidance.MethodsThe ultrasound-guided procedure consisted of local anesthesia using lidocaine chlorhydrate 1% (10 mg/mL) with a 21-G needle, followed by hydrodissection using NaCl 0.9% (9 mg/mL) and implant extraction using a Hartmann grasping microforceps. The parameters studied were the implant localization, success and complication rates, pain throughout the intervention, volumes of lidocaïne and NaCl used, duration of the procedure, and size of the incision. Between November 2019 and January 2021, 45 patients were referred to the musculoskeletal radiology department for ultrasound-guided removal of a deep contraceptive implant and were all retrospectively included.ResultsAll implants were successfully removed en bloc (100%). The mean incision size was 2.7 ± 0.5 mm. The mean duration of the extraction procedure was 7.7 ± 6.3 min. There were no major complications (infection, nerve, or vessel damage). As a minor complication, 21 patients (46.7%) reported a benign superficial skin ecchymosis at the puncture site, spontaneously regressing in less than 1 week. The procedure was very well-tolerated, with low pain rating throughout (1.0 ± 1.5/10 during implant extraction).ConclusionsMinimally invasive removal of deep contraceptive implants under continuous ultrasound guidance alone is feasible, effective, and safe. In the present cohort, all implants were successfully removed, whatever the location, with short procedural time, small incision size, low pain levels, and no significant complications. This procedure could become a gold standard in this indication.Key Points• Minimally invasive removal of deep contraceptive implants under continuous ultrasound guidance alone is feasible, which led to a success rate of 100% whatever the location (even close to neurovascular structures), with only a small skin incision (2.7 ± 0.5 mm).• The procedure was safe, quick, without any major complications, and very well tolerated in terms of pain.• This minimally invasive ultrasound-guided procedure could become the future gold standard for the removal of deep contraceptive implants, as an alternative to surgical extraction, even for implants in difficult locations such as subfascial ones or those close to neurovascular structures.

Performance of anew 7 mm intraocular lens with follow-up over 1.5years

Good visibility over the entire fundus is mandatory for optimal diagnostics and treatment of retinal pathologies. If an IOL implantation is planned in the context of retinal pathologies, amodel with an enlarged optic diameter offers various advantages. The two most important benefits are an enhanced view at the fundus periphery and an improvement of the IOL positional stability especially with combined vitrectomy and the use of gas or silicone oil tamponades. The purpose of this study was to evaluate the performance and positional stability of anew 7 mm IOL. This prospective study included 55eyes of 39patients who were scheduled for standardized cataract surgery and received amonofocal 7.0 mm optic IOL (Aspira-aXA, HumanOptics). An incision size of 2.0 mm was chosen. Follow-up visits were performed 1 week (1W), 1 month (1M), 4 months (4M) and 1.5years (1.5J) postoperatively. Measurements included subjective refraction, uncorrected and corrected distance visual acuity (UDVA and CDVA) as well as IOL stability regarding decentration, tilt and rotation (IOLs had apseudomarking on the periphery of the optics). Except for the postoperative occurrence of an Irvine-Gass syndrome in one eye, no intraoperative or postoperative complications were reported. The CDVA did not change significantly (p = 0.40) within the postoperative course from 1month (median 0.00 logMAR; -0.10 to 0.22 logMAR) to 1.5years (median 0.00 logMAR; -0.10 to 0.10 logMAR). The IOL was found to be stable over the postoperative course as decentration was < 0.02 mm and tilt < 5.5°. There was amedian rotation of 1.8° (0.0-13.4°) within the first postoperative week, which was not significantly different from the rotation between surgery and 1.5years (median 1.4°; 0.0-10.9°). With comparable functional performance and the same small incision size as with usual 6.0 mm IOLs, the Aspira-aXA offers the advantages of a7.0 mm optic in the diagnostics and treatment of peripheral retinal pathologies. In addition, the lens shows good position stability in the capsular bag.

Transposition of brachiobasilic arteriovenous fistulas: One-stage or two-stage technique and factors affecting the early maturation.

The brachiobasilic transposition (BBT) arteriovenous fistula (AVF) is a valuable option especially for dialysis patients with previously failed vascular access. We aim to report factors affecting the maturation of BBT-AVF created with either one-stage or two-stage technique. BBT-AVF procedures between January 2015 and May 2019 by a dedicated vascular access team were investigated retrospectively. A total of 122 patients (63 males, 59 females), with 6 to 12 weeks of follow-up after the BBT-AVF procedure were included in the study. Patients of one-stage and two-stage techniques were compared for maturation rates. Patients with successful and failed maturation were compared for baseline characteristics and anatomic factors. Of 122 BBT-AVF procedures, 54 were created with the one-stage and 68 were created with the two-stage technique. The mean age of the patients was 58.2 ± 13.8, the mean brachial artery and basilic vein diameters were 3.91 ± 1.02 mm, and 3.39 ± 1.16 mm. Of 122 included patients, 88 (72.1%) had mature AVFs at follow-up. The AVF maturation rates were similar between the one- and two-stage groups (70.4% vs 73.5%; P=.699). Lower age (62.8 ± 12.5 vs 56.5 ± 13.9; P=.023) and greater brachial artery diameter (3.09 ± 0.84 mm vs 4.23 ± 1.76 mm; P < .048) were the only factors affecting the AVF maturation in univariate analysis. Gender, extremity side, diabetes mellitus, hypertension, and targeted vein diameter were not found to affect the AVF maturation (P=.301, P=.084, P=.134, P=.858, P=.127). Target artery diameter (P=.049) was the only significant factor affecting BBT-AVF maturation in multivariate analysis. One-stage and two-stage BBT-AVFs are similar in terms of maturation rates. Targeted artery diameter was the only factor important in BBT-AVF maturation in our study group. The two-stage technique can be preferred considering smaller incision size and lower complication rate in patients with suitable anatomy.

Efficacy of minimally invasive video-assisted thyroidectomy for completion thyroidectomy

ObjectiveMinimally invasive video-assisted thyroidectomy (MIVAT) is among the most common alternatives to conventional open thyroidectomy. Previous reports have shown it to be safe and effective in patients without neck surgery history. However, this contraindication has been called into question in more recent small series. This study aims to evaluate the efficacy and safety of MIVAT in patients with prior neck surgery. MethodsWe retrospectively reviewed the data of 178 patients who underwent completion thyroidectomy in the Department of Otolaryngology-Head and Neck Surgery at Loma Linda University Medical Center between July 2004 and July 2017. Patients were divided into MIVAT group and Conventional group based on method of surgery, and analysis with two sample tests of proportions was carried out as appropriate. ResultsPatients in MIVAT group had significantly shorter operative time (74.1 ± 26.4 min vs. 99.0 ± 49.3 min, p < 0.001), less estimated blood loss (19.5 ± 15.0 mL vs. 39.0 ± 65.9 mL, p = 0.002), smaller incision size (3.5 ± 1.1 cm vs. 6.2 ± 2.2 cm, p < 0.001), and a lighter thyroid weight (7.5 ± 5.2 g vs. 20.5 ± 31.1 g, p < 0.001). The average length of stay was a half day longer, and post-operative admission was higher (78.8% vs. 51.7%, p = 0.005) in MIVAT group, while most was for routine 23-hour observation (63.6% vs. 35.9%, p = 0.009). There were no differences in complications. ConclusionMIVAT is feasible for re-operative patients with equivalent or superior outcomes to those of conventional thyroidectomy, and no significant difference in the incidences of common postoperative complications.

Comparative study of anterior cervical discectomy and fusion by anterior cervical plate and stand-alone cervical cage

&lt;p class="abstract"&gt;&lt;strong&gt;Background:&lt;/strong&gt; Anterior cervical discectomy (ACD) was used for management of degenerative cervical disc disorders (DCDD) in previous days. Further research and developments in management of DCDD led to evolution of standard and widely used operative technique as anterior cervical discectomy and fusion (ACDF) by either anterior cervical plate (ACDF-ACP) with bone grafting or stand-alone cage (ACDF-SAC). There is less data available in literature regarding when and where to use ACDF-ACP and ACDF-SAC.&lt;/p&gt;&lt;p class="abstract"&gt;&lt;strong&gt;Methods:&lt;/strong&gt; The study was conducted on 20 patients operated in Government Medical College and Hospital and Pacific Hospital and Research Centre, Aurangabad from June 2018 to March 2020. These patients divided into group A - 10 patients, operated by ACDF-SAC which are further divided as group Aa - 6 patients - operated for single level ACDF-SAC and group Ab - 4 patients - operated for two level ACDF-SAC, group B - 10 patients, operated by ACDF-ACP which are further divided as group Ba - 5 patients - operated for single level ACDF-ACP and group Bb - 5 patients - operated for two level ACDF-ACP. Patients evaluated preoperatively and postoperatively using X-ray cervical spine anteroposterior (AP) and lateral views, MRI cervical spine, visual analogue scale (VAS) for pain, Robinson’s criteria and Cobb’s angle.&lt;strong&gt;&lt;/strong&gt;&lt;/p&gt;&lt;p class="abstract"&gt;&lt;strong&gt;Results:&lt;/strong&gt; In our study we found, ACDF-SAC has small incision size, less intraoperative time, easy to carry out for surgeons, less intraoperative complications and better clinical outcome as compared to ACDF-ACP. Whereas only radiological results were better in ACDF-ACP than ACDF-SAC.&lt;/p&gt;&lt;p class="abstract"&gt;&lt;strong&gt;Conclusions:&lt;/strong&gt; ACDF-SAC is superior to ACDF-ACP for appropriately selected patients and in well experienced hands.&lt;/p&gt;

Patient Willingness to Pay for Faster Return to Work or Smaller Incisions.

Background: Value-based health care models such as bundled payments and accountable care organizations can penalize health systems and physicians for excess costs leading to low-value care. Health systems can minimize these extra costs by constraining diagnostic (eg, magnetic resonance imaging utilization) or treatment options with debatable necessity in the setting of clinical equipoise. Instead of restricting more expensive treatments, it is plausible that health systems could instead recoup the extra costs of these treatments by charging patients supplementary out-of-pocket charges (cost sharing). The primary aim of this exploratory study was to assess hand surgery patient willingness to pay supplementary out-of-pocket charges for a procedure that theoretically leads to an earlier return to work or smaller incisions when there are 2 procedures that lead to similar results (clinical equipoise). Methods: A total of 122 patients completed a questionnaire that included demographic information, a financial distress assessment, a series of scenarios asking patients the degree to which they are willing to pay extra for the procedure choice, as well as their perspective of how much insurers should be responsible for these additional costs. Results: Patients were willing to pay out-of-pocket to some degree for a procedure that leads to earlier return to work and smaller incision size when compared with a similar alternative procedure, but noted that insurers should bear a greater burden of costs. Approximately 10% of patients were willing to pay maximum amounts ($2500+) for earlier return to work (3, 7, and 14 days earlier) and smaller incision sizes of any length. Conclusions: Some patients may be willing to pay out-of-pocket and cost share for procedures that lead to earlier return to work and smaller incisions in the setting of clinical equipoise. As such, when developing and implementing alternative payment models, health systems could potentially offer services with debatable necessity in the setting of equipoise for a supplementary out-of-pocket charge.

Outcomes of Isolated Peroneal Tendoscopy for Treatment of Peroneal Tendon Disorders

Category:ArthroscopyIntroduction/Purpose:Peroneal tendoscopy may be used to treat patients with peroneal tendinopathy. It is typically used for diagnostic purposes and to address tendinopathy in the absence of large tendon tears. Its value includes preservation of the superior peroneal retinaculum, small incision size, and faster postoperative recovery compared to open treatment. The goal of this study is to explore the functional outcomes of patients who have undergone isolated peroneal tendoscopy.Methods:Consecutive adult patients who underwent isolated peroneal tendoscopy between January 2010 and January 2018 at a single Foot and Ankle center were identified. The electronic medical record and operative notes were reviewed to identify patients with a minimum 12-month follow-up. Those undergoing open tendon repair, tendon transfer, peroneal groove deepening, and any other concurrent foot or ankle procedure were excluded from the study. Eligible patients were administered the PROMIS Physical Function-Short Form 10A (PF SF10A), Foot and Ankle Ability Measure (FAAM), and the Visual Analog Scale (VAS).Demographic information was also collected. Data was pooled, and descriptive analyses and unpaired T-tests were conducted.Results:Thirty patients met inclusion criteria and 22/30 patients (73%) were able to be reached. Our patient cohort was predominantly female (90.9%), had a mean age of 46.4 years, and an average BMI of 27.6. The mean pre-operative FAAM and PROMIS PF SF10A for patients were 58.3 and 39.7, while the mean post-operative FAAM and PROMIS PF SF10A were 83.3 and 50.5, respectively. There was a statistically significant improvement between the mean pre-operative and post-operative FAAM and PROMIS PF SF10A scores for patients (p =0.0050 and 0.0025, respectively) with a mean improvement of 25.0 in FAAM and 10.8 for PROMIS PF SF10A scoring. At an average of 33.4 month follow-up, the mean VAS for pain was 20.9 out of 100.Conclusion:Isolated peroneal tendoscopy is an effective treatment for patients who have peroneal pain in the absence of frank tears or tendon instability. The improvement in FAAM and PF SF10A scores was statistically significant and exceeds published MCIDs for both FAAM and PROMIS PF SF10A. Additional research is required to further evaluate the effectiveness of peroneal tendoscopy as compared to other methods of treating peroneal tendinopathy, such as open peroneal tenosynovectomy.

Single-tunnel ureteroscope-assisted technique for peritoneal dialysis catheter placement: a comparison with open surgery

Objective To compare the treatment of single-tunnel ureteroscope (STU) technique and open surgery (OP) for peritoneal dialysis placement. Methods We retrospectively reviewed 139 consecutive cases of peritoneal catheters insertion, 63 patients for OP and 76 patients for STU group from May 2013 to June 2017. Both methods on their operation-related data, early catheter-related complications, and initial catheter survival were compared. Results The STU group was significantly associated with shorter operation time, hospital stay, smaller incision size, and lesser dose of anesthesia than the OP group(P<0.05). the rate of catheter obstruction in the STU group (33.3%) was significantly lower than that in the OP group (3.9%, P=0.032). Catheter migration occurred at a significantly higher rate in OP group (14.9%), than MPT group (2.6%, P=0.014). Two incisional hernia and six fluid leakage cases occurred in OP group, but none in STU group. After median two years of follow-up, catheter survival rate was significantly higher in STU group than in OP group, with one year survival rates of 96% and 83%, and two year survival rates of 86% and 63%, respectively (P=0.023). Conclusions The ureteroscopy-assisted technique for peritoneal dialysis catheter placement is a safe and reliable. Compared with traditional open surgery, it decreases operation time, postoperative complications, less catheter-related complications, and increases catheter survival. It deserves clinical using regularly. Key words: Peritoneal Dialysis; Catheters; Ureteroscopy; Surgical Procedures, Operative

Percutaneous endoscopic discectomy: Gold standard technique for single level intervertebral disc prolapse

Introduction: DISC prolapse is a common problem seen in general population and 10% patients may require surgical intervention. Objective: To determine functional outcome of patients operated by percutaneous endoscopic discectomy. Methodology: Study Area: New Civil Hospital Surat. Sample Size: 40 Scores used: VAS and Oswestry Disability Index Results: Patients operated for Disc Herniation by percutaneous discectomy were followed up 1 month 3 months and 6 months postoperatively showing immediate pain relief, smaller incision size, almost no blood loss and earlier return to daily activities. Conclusion: Endoscopic discectomy is a newer technique which is practised now a days for PIVD and it shows better results than conventional discectomy in terms of post op pain the amount of blood loss, post op ambulation and anesthesia given. It can now be said that percutaneous endoscopic discectomy is the GOLD standard surgical technique for single level disc prolapse.

Astigmatism in Straight and Frown Incision in Small Incision Cataract Surgery: A Comparative Study

ABSTRACT Introduction Blindness due to cataract presents an enormous problem especially in developing countries like India, not only in terms of human morbidity but also in terms of economic loss and social burden. The cataract surgeon of today is challenged to control the sphere as well as the cylinder of the refraction after surgery. Small incision cataract surgery (SICS) is now the method of choice in many parts of the world. This present study has been carried out with the aim to compare the postoperative corneal astigmatism between the two groups of patients undergoing SICS with posterior chamber intraocular lens (PCIOL) implantation with two difference types of incisions, i.e., frown and straight. Material and methods A prospective study was carried out in 60 patients enrolled from the Department of Ophthalmology of Pondicherry Institute of Medical Sciences who underwent SICS with superiorly placed straight and frown incision with PCIOL (each group consisting of 30 patients) during the period from May 2005 to October 2006. Results In this study, 60 patients having senile cataract in the age group of 50 to 75 years were studied. Out of these, the majority were in the age group of 60 to 64 (28.33%) years and only 26.66% were more than 70 years. The male:female ratio was 1:1. In our study, we found that frown incision had significantly better (p &lt; 0.001) mean net astigmatism as compared with the straight incision. Conclusion We conclude that small incision size and absence of suture are the most important factors that contribute to less astigmatism and faster stabilization of SICS, where phacoemulsification cannot be performed. The duration for stabilization of postoperative astigmatism in straight incision group is 6 weeks, whereas it is 3 weeks in frown incision. Frown superior incision has got added advantage of early wound stabilization than straight incision, allowing the patient to resume their daily activities at an early stage. Superior incision group (both frown and straight) had increased amount of with-the-rule (WTR) astigmatism which later shifted to against-the-rule. There was a significant difference in net astigmatism between frown and straight. Postoperative astigmatism also depends on preoperative astigmatism. Patients with preoperative WTR benefited from superior incision cataract surgery. How to cite this article Tripathi S, Srinivasan M, Gupta S. Astigmatism in Straight and Frown Incision in Small Incision Cataract Surgery: A Comparative Study. Int J Adv Integ Med Sci 2017;2(3):111-116.

Robotic surgery: current perceptions and the clinical evidence.

It appears that a discrepancy exists between the perception of robotic-assisted surgery (RAS) and the current clinical evidence regarding robotic-assisted surgery among patients, healthcare providers, and hospital administrators. The purpose of this study was to assess whether or not such a discrepancy exists. We administered survey questionnaires via face-to-face interviews with surgical patients (n=101), healthcare providers (n=58), and senior members of hospital administration (n=6) at a community hospital that performs robotic surgery. The respondents were asked about their perception regarding the infection rate, operative time, operative blood loss, incision size, cost, length of hospital stay (LOS), risk of complications, precision and accuracy, tactile sensation, and technique of robotic-assisted surgery as compared with conventional laparoscopic surgery. We then performed a comprehensive literature review to assess whether or not these perceptions could be corroborated with clinical evidence. The majority of survey respondents perceived RAS as modality to decrease infection rate, increase operative time, decrease operative blood loss, smaller incision size, a shorter LOS, and a lower risk of complications, while increasing the cost. Respondents also believed that robotic surgery provides greater precision, accuracy, and tactile sensation, while improving intra-operative access to organs. A comprehensive literature review found little-to-no clinical evidence that supported the respondent's favorable perceptions of robotic surgery except for the increased costs, and precision and accuracy of the robotic-assisted technique. There is a discrepancy between the perceptions of robotic surgery and the clinical evidence among patients, healthcare providers, and hospital administrators surveyed.

Avoidance of Wrong Level Surgery in the Lumbar Spine: A Technical Report

Study Background: Wrong level surgery remains one of the detrimental technical mistakes that can occur during a surgeon’s career. There is a higher frequency of wrong site surgery in the lumbar spine compared to the cervical spine. The authors aim to present a localization technique designed to aid in the prevention of wrong level surgery with the use of preoperative and intraoperative localization. Methods: We prospectively followed 240 patients who underwent less exposure surgery for the lumbar spine. We identified the correct operative level using a combination of a 22-guage spinal needle placed under fluoroscopy in the lamina of the vertebra of the target intervertebral disc space prior to incision and then placing a hooked dilator between the spinous processes of the intervertebral space to provide actual confirmation within the operative space. Results: Data showed that all 240 patients had surgery performed on the correct level using the described technique and the placement of the percutaneous needle assisted in minimizing the incision size to less than 5 cm for a single level fusion in all cases. Conclusion: The described technique allows for localization prior to incision, smaller incision size, consistent and accurate localization when performing lumbar spinal surgery.

Change in Central Macular Thickness after 2.2-mm Microincision Coaxial versus 2.75-mm Small Incision Cataract Surgery

Purpose: To evaluate the central macular thickness and volume changes after conventional 2.75-mm small incision cataract surgery (SICS) and 2.2-mm microincision coaxial cataract surgery (MICS). Methods: We performed a retrospective chart review of 48 eyes undergoing uneventful phacoemulsification and divided the subjects into two groups, SICS and MICS. To evaluate the central macular thickness and volume changes after cataract surgery, optical coherence tomography (OCT) was used before and at one day, one week, one month, and two months postoperatively. Results: No statistically significant difference was found in the intraoperative phacoemulsification power, phaco time, or volume of intraoperative irrigation solution between the two groups (p > 0.05). The average central macular thickness increased in the MICS group compared to the SICS group at every postoperative time point, and the difference was statistically significant at postoperative one month (p = 0.04). The average central macular volume was elevated in the MICS group; however, the difference was not significant (p > 0.05). Conclusions: Central macular thickness and volume change were greater in the MICS group compared to the SICS group, and the difference in central macular thickness between the two groups was significant at postoperative one month. Careful follow-up examinations should be performed using OCT at this postoperative time point, especially in patients who received cataract surgery with smaller incision size. J Korean Ophthalmol Soc 2014;55(10):1460-1469