Standard Surgical Treatment Research Articles

Free gingival graft for augmenting peri-implant keratinized mucosa

Insufficient keratinized mucosa is a common clinical problem. Although there is no consistent data on the long-term success of implant restorations relative to the presence or absence of peri-implant keratinized mucosa, it is widely accepted that the presence of keratinized mucosa width<2 mm is associated with increased biofilm accumulation, soft-tissue inflammation, and mucosal recession. Free gingival graft (FGG) is the standard surgical intervention for augmenting the width of keratinized gingiva. However, the clinical application of FGG is technique-sensitive. Therefore, this article describes the significance and efficacy, surgical timing, conventional procedures and techniques, common complications, as well as some modified approaches of the FGG, aiming to provide guidelines for its clinical application.

Inception of novel equations for estimation of differential renal function changes after successful pyeloplasty in children

ABSTRACT Introduction Ureteropelvic junction obstruction is the most common cause of pediatric hydronephrosis. Anderson Hynes dismembered pyeloplasty as the standard surgical treatment in such cases. Purpose To evaluate and detect factors that affect renal function changes (improvement) after successful pyeloplasty using Tc-99 m Diethylenetriaminepentaacetic (DTPA) renography in children and to predict renal scan changes after successful pyeloplasty. Methods This retrospective study was conducted on children ≤ 18 years of age who underwent successful pyeloplasty from May 2018 to May 2022. Pelvic-abdominal ultrasonography and radioisotope scan Tc-99 m DTPA were performed in all patients. Results Postoperative group showed a significant increase in renal parenchyma thickness, split renal function, and glomerular filtration rate with a decreased renal pelvis anteroposterior diameter (p < 0.05). There was a significant correlation between each postoperative decrease in the anteroposterior diameter of the renal pelvis and the postoperative increase in parenchyma thickness with the postoperative increase in split renal function. The equation used to detect postoperative split renal function and glomerular filtration rate had a high detection rate. Conclusions Pyeloplasty resulted in significant improvements in hydronephrosis, and renal parenchymal changes in association with renal pelvis diameter can predict Postoperative increase in split renal function and glomerular filtration rate.

Study protocol for a single-centre non-inferior double-blinded randomised controlled trial in China comparing the efficacy and safety of high-frequency irreversible electroporation with transurethral resection of the prostate in treating lower urinary tract symptoms and benign prostatic obstruction (the GIANT trial)

IntroductionTransurethral resection of the prostate (TURP) is the gold standard surgical treatment to lower urinary tract symptoms and benign prostatic obstruction (LUTS/BPO). Although it has been proven to have substantial...

Perspectives on Cervical Cancer Prevention Strategies and a Combination Treatment for Cervical Precancer in South African Women Living with HIV and Male Partners.

Cervical cancer remains the second most common cancer among women worldwide, with 85% of cases occurring in low-and middle-income countries (LMIC). Women living with HIV (WLWH) are at a particularly high risk of developing for high-grade cervical intraepithelial neoplasia (CIN2/3) and cervical cancer, and the standard surgical treatment is far less effective in this population. Thus, research on medical therapies and combination treatment options remain a priority. In preparation for a clinical trial involving adjuvant intravaginal 5-fluorouracil (5FU) cream following surgical treatment for CIN2/3, we explored the acceptability of our proposed intervention among WLWH and male partners. We conducted qualitative interviews with WLWH and male partners in Johannesburg, South Africa between April 2022 and September 2022. We invited WLWH to participate in semi-structured focus group discussions (FGDs), while male partners were invited to participate in semi-structured in-depth interviews (IDIs). The analysis utilized a rapid, deductive approach in which quotations were identified and categorized into relevant domains: factors affecting cervical cancer screening, the initiation of 5FU vaginal cream, and adherence to 5FU. We conducted 9 FGDs comprising 48 WLWH and 18 IDIs with male partners. The mean age of participants was 43 years, and the majority (75%) had completed secondary education. Most women (75%) had also undergone Pap smear screening and 50% had a prior abnormal Pap smear. Qualitative analysis revealed that education on HPV and cervical cancer, prior experience with the health system, and social perceptions/stigma influenced cervical cancer screening uptake and were important factors in the initiation of and adherence to 5FU. Men's knowledge about cervical cancer was extremely limited. Overall, participants' perceptions of the proposed trial intervention were positive, with most participants expressing confidence that women would be able to use and adhere to the intravaginal 5FU cream. Concerns raised included possible effects of 5FU on fertility, contraceptive requirements, and the recommendation for brief periods of abstinence following cream use to prevent partner side effects. Although participants had some cervical cancer knowledge, misperceptions about HPV and cervical cancer were common and prevented follow-up for abnormal Pap results. Participants emphasized the need for thorough counseling about 5FU, citing this as integral for uptake. Utilizing stakeholder input to design the clinical trial is necessary to promote acceptability and adherence to the trial intervention.

Low-cost male urogenital simulator for penile implant surgery training:a 3D printing approach.

Penile implant surgery is the standard surgical treatment for end-stage erectile dysfunction. However, the growing complexity of modern high-tech penile prostheses has increased the demand for more practical training opportunities. The most advanced contemporary training methods involve simulation training using cadavers, with costs exceeding $5,000 per cadaver, inclusive of biohazard fees. This study introduces an innovative and cost-efficient male urogenital simulator designed to enhance penile implant surgery training. Utilizing image segmentation of patient pre-operative computed tomography (CT) scans, combined with three-dimensional (3D) printing and silicone molding techniques, we developed a high-fidelity simulator replicating the anatomical structures of the male urogenital system. The simulator incorporates an innovative double-layer structural design encompassing the corpus spongiosum and glans, corpora cavernosa, testes, epididymides, and pelvic bones. Additionally, it utilizes a two-stage skin manufacturing process tailored for different skin regions. The simulator was produced at a low material cost of £10, with an average production time of 3h. To evaluate its training efficacy, we conducted a penile implant surgery training session involving 15 urology trainees and surgeons ranging from specialty training levels ST3 to ST6. The session began with a demonstration of penile implant surgery and error detection. Trainees, averaging three per simulator, practiced corporotomy, dilation, measurement, penile prosthesis, and scrotal pump placement under expert guidance. Participants' feedback was collected using a Likert scale questionnaire, assessing learning, satisfaction, and anatomical accuracy. Quantitative analysis of the questionnaire responses indicated highly positive feedback from the participants. Satisfaction rates surpassed 96% in learning effectiveness, over 89% in overall satisfaction, and 86% in anatomical accuracy demonstration. The simulator was favourably reviewed by both urology trainees and experienced surgeons, highlighting its utility as a practical training tool. Its low production cost and high precision make it a viable alternative to current training models. The development of this cost-efficient, anatomically accurate urogenital simulator through advanced imaging and additive manufacturing techniques represents a significant advancement in penile implant surgical training. This state-of-the-art simulator not only provides a realistic and practical training experience but also underscores the potential for 3D printing technologies to revolutionize medical education and training.

Evaluation of the impact of a comprehensive rehabilitation program on improving nutritional status, psychoemotional signs and adverse events in patients with melanoma after surgical treatment

Observations were conducted on 148 patients diagnosed with melanoma of various localizations, who were divided into two groups by simple randomization: study (n=77) and control (n=71). The study group received surgical treatment in combination with rehabilitation programs (psychotherapy, nutritional support, general magnetic therapy), while the control group received only standard surgical treatment. In the study group, there is a significant improvement in the quality of life, as well as an improvement in the general condition against the background of the addition of comprehensive rehabilitation programs. According to the results of the analysis, it was noted that adverse events in the study group against the background of the use of comprehensive rehabilitation programs were less common in 41 (53%) patients than in patients in the study group in 54 (76%), where only surgical treatment was performed. After treatment, in the study group, there was a reliably significant decrease in the risk of nutritional deficiency in 16 patients (none), compared with the control group in 12 patients, respectively, (p<0.05). In the study group, a significant decrease in complaints was recorded for the indicators "Emotional functioning" (by 13.4%, in the control group a decrease of 4.9%, p<0.05), "Role functioning" (by 15.1%, in the control group by 3.4%, p<0.05), "Cognitive functioning" (by 13.7%, in the control group by 5.6%, p<0.05) and "Social functioning" (by 14.2%, in the control group by 4.0%, p<0.05). The use of a multidisciplinary rehabilitation approach, including nutritional support, magnetic therapy and psychological assistance, demonstrates a significant improvement in symptom management and quality of life in patients with melanoma after surgical treatment.

COLOR IV: a multicenter randomized clinical trial comparing intracorporeal and extracorporeal ileocolic anastomosis after laparoscopic right colectomy for colon cancer.

Right-sided colon cancer is a prevalent malignancy. The standard surgical treatment for this condition is laparoscopic right hemicolectomy, with ileocolic anastomosis being a crucial step in the procedure. Recently, intracorporeal ileocolic anastomosis has garnered attention for its minimally invasive benefits. However, there remains a paucity of rigorously designed, large-scale, international multicenter randomized controlled trials to definitively assess the safety and efficacy of intracorporeal ileocolic anastomosis in laparoscopic right hemicolectomy for right-sided colon cancer. This study is an international, multicenter, randomized, controlled, open-label, non-inferiority trial designed to compare the safety and efficacy of intracorporeal versus extracorporeal ileocolic anastomosis in patients with right-sided colon cancer undergoing right hemicolectomy. The primary endpoint is the anastomotic leakage rate within 30days post-surgery. The main secondary endpoint is the 3-year disease-free survival rate post-surgery. A comprehensive quality assurance protocol will be established before the trial begins, including CT review, pathological evaluation, and the standardization and assessment of surgical techniques. This study aims to evaluate the safety and efficacy of intracorporeal ileocolic anastomosis following right hemicolectomy in patients with right-sided colon cancer. The anticipated outcome is that intracorporeal ileocolic anastomosis will show an anastomotic leakage rate and a 3-year disease-free survival rate comparable to those of extracorporeal anastomosis, while offering the added benefit of faster postoperative recovery.

Effect of Epidermos Barrier Cream on Postoperative Parotidectomy Incision Scar.

Introduction: The modified Blair incision is commonly used for superficial and deep lobe lesions of the parotid gland. The most common complication of the parotidectomy procedure is the postoperative surgical scar. Epidermos barrier cream is a type of cream that helps in wound healing by covering the wound. Objective: The purpose of this study was to evaluate the effect of epidermos barrier cream on postoperative incision scars. Methods: Forty-six patients scheduled for surgery due to benign parotid masses were included in the study. Patients were called for a follow-up appointment to remove sutures 1 week after standard surgical intervention. In the study group, epidermos cream was used on the wound site until complete healing was achieved after suture removal, while wound healing in the control group was monitored without any medication. The patients were evaluated in the first, second, and fourth postoperative weeks using a wound site assessment questionnaire and surgical wound assessment for wound healing evaluation. Results: There were no statistically-significant differences between the groups in the evaluation results in the first week. On examination of the data in the second week, a difference was only observed in terms of the presence of hyperemia at the edges of the wound between the groups (P = .005), with no statistically-significant differences found in any other assessment tools. In the 4-week wound healing evaluation, a statistically-significant difference was observed in favor of the study group both in the patient's evaluation of the wound site (P < .001) and in the surgeon's evaluation of the wound site (P = .029). Conclusion: Epidermos cream was found to significantly improve postoperative scar healing in parotidectomy incisions considered challenging in terms of healing. Epidermos barrier cream was found to be beneficial for wound healing in wound sites.

Long-Term Results after Autologous Matrix-Induced Chondrogenesis for Osteochondral Lesions of the Talus: A 10-Year Cohort Study.

A gold standard surgical treatment for osteochondral lesions (OCLs) of the talus still needs to be established. Still, autologous matrix-induced chondrogenesis (AMIC) is a commonly applied 1-stage procedure that has achieved good short- and mid-term results. The present cohort study aimed to assess whether the long-term, 10-year results can confirm the previous findings. All patients underwent an open AMIC procedure using a collagen type I/III bilayer matrix for a talar OCL. General demographic data, preoperative magnetic resonance imaging findings, intraoperative details, and German version of the Foot Function Index (FFI-D) scores preoperatively and at 1, 5, and 10 years as well as European Foot and Ankle Society (EFAS) and American Orthopedic Foot & Ankle Society (AOFAS) scores at 10 years after surgery were analyzed. The primary outcome variable was the procedure's longitudinal effect, and several variables' influence on the outcome was tested. Of 47 consecutive patients, 18 (38%) were included. Of the 18 patients, 6 (33%) were female, and 12 (67%) were male, with a mean age of 39 ± 15 (range = 15-62) and an average body mass index (BMI) of 26 ± 5 (range = 20-38) kg/m². The mean defect size was 1.4 ± 0.9 (range = 0.2-4) cm². The FFI-D total score showed a significant decrease from preoperatively to 1 year postoperatively (56 ± 19 to 34 ± 27; P = 0.001) with a further nonsignificant decrease to the 5-year (34 ± 27 to 21 ± 20; P = 0.16) and 10-year follow-up (21 ± 20 to 15 ± 13; P = 1.00). All the single items decreased significantly from preoperatively to the 5- and 10-year mark. Although not significant, most items improved from 5 to 10 years postoperatively. Age positively correlated with the preoperative, 5-year, and 10-year follow-up FFI-D total score. AMIC, as a single-step surgical intervention, is a viable long-term treatment option. Patient selection regarding symptoms and findings is vital to achieve satisfying results.

Phase I-IIa clinical trial to evaluate the safety, feasibility and efficacy of the use of a palate mucosa generated by tissue engineering for the treatment of children with cleft palate: the BIOCLEFT study protocol

IntroductionThe current gold standard treatment for patients with orofacial clefts is surgical repair of the palatal defect (uranostaphylorrhaphy), which is associated with growth defects and hypoplasia of the maxillofacial structures....

Restoration of physiologic loading after engineered disc implantation mitigates immobilization-induced facet joint and paraspinal muscle degeneration.

Intervertebral disc degeneration is commonly associated with back and neck pain, and standard surgical treatments do not restore spine function. Replacement of the degenerative disc with a living, tissue-engineered construct has the potential to restore normal structure and function to the spine. Toward this goal, our group developed endplate-modified disc-like angle-ply structures (eDAPS) that recapitulate the native structure and function of the disc. While our initial large animal studies utilized rigid internal fixation of the eDAPS implanted level to ensure retention of the eDAPS, chronic immobilization does not restore full function and is detrimental to the spinal motion segment. The purpose of this study was to utilize a goat cervical disc replacement model coupled with finite element modeling of goat cervical motion segments to investigate the effects of remobilization (removal of fixation) on the eDAPS, the facet joints and the adjacent paraspinal muscle. Our results demonstrated that chronic immobilization caused notable degeneration of the facet joints and paraspinal muscles adjacent to eDAPS implants. Remobilization improved eDAPS composition and integration and mitigated, but did not fully reverse, facet joint osteoarthritis and paraspinal muscle atrophy and fibrosis. Finite element modeling revealed that these changes were likely due to reduced range of motion and reduced facet loading, highlighting the importance of maintaining normal spine biomechanical function with any tissue engineered disc replacement. STATEMENT OF SIGNIFICANCE: : Back and neck pain are ubiquitous in modern society, and the gold standard surgical treatment of spinal fusion limits patient function. This study advances our understanding of the response of the spinal motion segment to tissue engineered disc replacement with provisional fixation in a large animal model, further advancing the clinical translation of this technology.

Short- and Medium-Term Outcomes Assessment of Urethral Prostatic Lift (UroLift) as a Minimally Invasive Treatment for Benign Prostatic Hyperplasia in a Tertiary Care Centre.

Benign prostatic hyperplasia (BPH) is the enlargement and overgrowth of the prostate leading to the compression of the urethra and resulting in obstruction to the outflow of urine. Prostatic urethral lift (UroLift) is a budding minimally invasive technique that utilises mechanical manipulation of the prostate tissue so that the urethra is free from compression, thereby creating a channel for the outflow of urine. The aim of the audit was to assess the short-to medium-term outcomes in our centre in terms of improvement in symptoms, quality of life (QoL) and complication rates. A retrospective observational study was employed. All patients who had UroLift procedure between December 2021 and December 2022 were included. Sixty-four patients were found for the chosen period. Age ranged between 48 and 91 with a mean age of 73. The average prostate size was 48.63 g (31-50 g). Of the patients,64% (n=41) had the procedure performed under general anaesthesia, whilst the rest had either regional or local anaesthesia or entonox. Two to eight clips were used per patient, with four being the median number of clips. Furthermore, 53.13% (n=34) had a catheter post-procedure, with 52.94% (n=18) of these achieving trial without catheter (TWOC) in less than seven days. Of the patients, 67.18% (n=43) had no complications, 7.8% (n=5) went into acute urinary retention requiring short-term catheterisation, 1.56% (n=1) had bleeding requiring blood transfusion and 6.25% (n=4) had infection. Overall, 17.18% (n=11) had failure of procedure requiring other forms of intervention for BPH at two years post-operatively. The median improvement in post-void residual scan and quality of life (QoL) scores were 58 mL and 1.5, respectively. Although transurethral resection of the prostate (TURP) remains the gold standard surgical treatment for BPH, UroLift offers a less minimally invasive approach with better short-term recovery, preservation of sexual function and low complication profile. The failure rate from UroLift from previous studies falls within the range of 7%-22%, and the figures attained in our centre are comparable to these.

Rhegmatogenous Retinal Detachment Secondary to Type I Stickler Syndrome: Diagnosis, Treatment and Long-Term Outcomes.

This study aimed to clarify the genetic diagnosis of rhegmatogenous retinal detachment (RRD) secondary to type I Stickler syndrome (STL1) and evaluate the anatomical and functional outcomes of surgical treatment. This retrospective study included 11 patients with RRD secondary to STL1. Familial and sporadic cases of STL1 were diagnosed at the Eye & ENT Hospital, Fudan University, between 2017 and 2023. To clarify the genetic diagnosis, next-generation sequencing was performed in suspected STL1 cases. Further, standard ocular examinations and surgical treatment were performed. Nine variants of COL2A1, including four novel mutations (c.394G>T, c.2977G>T, c.3003+2dup, and c.3853G>C), were screened and identified. The pathogenicity of all variants was conclusively demonstrated. Among patients who underwent vitrectomy, the mean age at RRD was 11.5 years, and the mean follow-up was 32.9 months. The average number of surgical procedures required during the follow-up was two; 90.9% of eyes achieved final attachment, and best corrected visual acuity (BCVA) significantly improved in 81.8% of the eyes, with a middle postoperative logMAR BCVA of 0.52 compared with the preoperative value (p = 0.0148). High intraocular pressure (81.8%) and cataract (72.7%) were the most common complications. Our study expands the spectrum of COL2A1 mutations and provides a novel diagnostic strategy for STL1. By combining clinical manifestations with genetic testing, STL1 could be accurately diagnosed. With proper surgical treatment and long-term follow-up, the prognosis of RRD in patients with STL1 could be improved.

SURG-08. A PHASE III RANDOMIZED TRIAL OF GROSS TOTAL RESECTION VERSUS POSSIBLE RESECTION OF FLAIR HYPERINTENSITY LESION ON MR IMAGE FOR NEWLY DIAGNOSED SUPRATENTORIAL GLIOBLASTOMA (JCOG2209)

Abstract BACKGROUND Complete resection of contrast-enhanced lesion (gross total resection: GTR) without severe neurological deficits has been generally accepted as the goal of surgery. However, it remains unclear if additional resection of surrounding FLAIR hyper-intense lesion combined with GTR (FLAIRectomy) has survival advantage of primary glioblastoma patients. Purpose: Multicenter, open-label, randomized phase III trial was commenced to confirm the superiority of FLAIRectomy to GTR alone followed by radiotherapy with concomitant and adjuvant temozolomide in terms of overall survival (OS) for primary glioblastoma IDH-wildtype patients. This trial investigates not only survival but also postoperative neurological and neurocognitive deficits in detail. METHODS We assumed a 2-year OS of 50% in the GTR arm and expected a 15% improvement in the FLAIRectomy arm. A total of 130 patients is required with a one-sided alpha of 5%, power of 70%, and will be accrued from 49 Japanese institutions in 4 years and follow-up will last 2.5 years. Patients 18-75 years of age will be registered and randomly assigned to each arm with 1:1 allocation. The primary endpoint is OS, and the secondary endpoints are progression-free survival, frequency of adverse events, proportion of Karnofsky performance status preservation, proportion of National Institutes of Health stroke scale preservation, proportion of mini-mental state examination preservation and proportion of health-related quality of life preservation. The Japan Clinical Oncology Group Protocol Review Committee approved this study protocol in May 2023. Ethics approval was granted by the National Cancer Center Hospital Certified Review Board. Patient enrollment began in July 2023. DISCUSSION If FLAIRectomy is superior to GTR alone, aggressive surgery will become a standard surgical treatment for glioblastoma with resectable contrast-enhanced lesion. Trial registration: Registry number: jRCT1031230245. Date of registration: 19/July/2023. Date of first participant enrollment: 28/July/2023. Funding for this study is provided by National Cancer Center Research and Development Fund (2023-J-03).

Outcome Through the Years of Left-Ventricular Assist Devices Therapy for End-Stage Heart Failure: A Review.

Heart transplantation remains the gold standard surgical treatment for advanced heart failure. Over time, medical therapies have achieved remarkable outcomes in terms of survival and quality of life, yet their results may be insufficient, even when maximized. The limited availability of organ donors and the selective criteria for heart transplant eligibility have led to a significant rise in the utilization of long-term mechanical circulatory support, including left ventricular assist devices. Patients receiving LVADs often present with multiple comorbidities, constituting a highly vulnerable population. Individuals living with LVADs may experience various long-term complications, such as bleeding, driveline infections, neurological events, and right ventricular dysfunction. Fortunately, the development of increasingly biocompatible LVAD devices in recent years has resulted in a notable reduction in these complications. This review aims to summarize the principal complications encountered by patients with LVADs throughout their treatment and the associated daily management strategies.

Is Cervical Disc Arthroplasty an Effective Treatment Option for Patients with Cervical Spondylotic Myelopathy?: A Matched Cohort Analysis Compared to Anterior Cervical Discectomy and Fusion

Background ContextCervical spondylotic myelopathy (CSM) is a progressive condition characterized by spinal cord compression secondary to disc degeneration. While anterior cervical discectomy and fusion (ACDF) has long been considered the standard surgical treatment for CSM, loss of motion segments after this procedure may lead to sequelae, including adjacent segment disease (ASD), further propagating loss of function and the potential requirement for revision procedures. More recently, cervical disc arthroplasty (CDA) has been introduced as a motion-preserving alternative to ACDF in CSM. PurposeThis study compares ACDF to CDA in patients with preoperative CSM. Study Design/SettingA matched cohort retrospective study Patient Sample110 patients were included in the final analysis; 55 underwent ACDF, and 55 underwent CDA. Outcome MeasuresComplication rates, myelopathic severity measured by the Nurick scale, and patient-reported outcomes measured by VAS-neck, VAS-arm, and NDI scores MethodsWe examined patients who underwent either one or two-level ACDF or CDA with a minimum follow-up of two years. Patients were matched for age, sex, comorbid conditions, preoperative myelopathy severity, and the number of indicated operative levels. Demographics, perioperative data, and complication rates were compared between the two cohorts of patients. Patient-reported outcome measures were assessed at multiple follow-up intervals. ResultsNo significant differences were observed in demographics or perioperative data. Overall complication rates were similar between the two cohorts (p=0.167). Rates of dysphagia (p=1.00), dysphonia (p=0.157), infection (p=1.00), construct failure (p=0.154), heterotopic ossification (p= 0.132), and ASD (p=0.315) were similar between the two groups. Furthermore, revision rates were similar between the two groups (p=0.315). No significant differences were observed in median postoperative Nurick scores between the two cohorts (p=1.00). NDI improvements were greater in the CDA cohort (p=0.040). ConclusionsACDF and CDA had statistically similar complication rates and improvements in myelopathic symptoms. However, patients who underwent CDA had superior PROMs to those who had undergone ACDF.

057. The Comparative Efficacy of Robot-Assisted Versus Laparoscopic Surgery for Rectal Cancer: A Systematic Review and Meta-Analysis

Background: Background: Total mesorectal excision (TME) is the gold standard surgical intervention for rectal cancer, associated with effective local recurrence management and improved overall survival rates. Laparoscopic surgery for colon cancer is primarily recognised as a curative treatment. Nonetheless, laparoscopic surgery for rectal cancer presents technological limitations. Robot-assisted laparoscopic total mesorectal excision (TME) surgery for rectal cancer was established to address these technical difficulties. Our objective was to assess the clinical and oncological outcomes of robot-assisted surgery compared to laparoscopic surgery for rectal cancer. Methods: We searched PubMed, ScienceDirect, and CENTRAL to identify studies and trials published between 2014 and 2023. The outcomes of our study encompass operational duration, duration of hospital admission, and intra-operative haemorrhage. We employed Revman 5.4.2 to do the meta-analysis. Results: Seven trials were analysed, encompassing 1,231 patients, including 545 patients who underwent robotic-assisted surgery and 686 patients who received laparoscopic surgery. Our results demonstrate that robot-assisted surgery significantly reduced operation time (MD 74.04, 95% CI [28.12, 119.97], p = 0.002), hospital stay (MD -1.86, 95% CI [-2.68, -1.05], p &lt; 0.00001), and intra-operative blood loss (MD 36.83, 95% CI [23.55, 50.11], p &lt; 0.00001). Our study identified robot-assisted surgery as a viable option for rectal cancer treatment. Conclusion: Our study revealed that robot-assisted surgery correlated with decreased intra-operative blood loss, operative duration, and length of hospital stay. Further research is needed to corroborate these findings

Laparoscopic Robotic-Assisted Restorative Proctocolectomy and Ileal J-Pouch-Anorectal Anastomosis in Children: Shifting to a Two Stage-Approach.

Background: Restorative proctocolectomy (RPC) with ileal pouch-anal anastomosis (IPAA) is the gold standard surgical treatment for patients with ulcerative colitis (UC) unresponsive to medical therapy and those with familial adenomatous polyposis. Robotic IPAA is a safe and feasible option for the surgical treatment of UC in children. The feasibility of IPAA without ileostomy has been demonstrated in adult in the modified two-stage approach. Aim: The aim of the study was to examine feasibility, outcomes, and complications of robotic modified two-stage approach for RPC with IPAA in pediatric patients comparing it with robotic three-stage approach. Methods: All patients aged 4-18 years who underwent operative treatment for medically refractory UC were included. Demographic and clinical features, age at colectomy and at reconstructive surgery, intraoperative details and complications, and postoperative outcomes were analyzed. Results: Thirteen patients were included in the study (6 males, 7 females). Ileostomy was fashioned in 8 patients at the time of RPC and IPAA (Group 1); in 5 patients the bowel continuity was reintegrated at the time of IPAA (Group 2). No intraoperative complications and no conversions were recorded. One patient of Group 1 had a postoperative pouch complication. The 5 patients who underwent a two-stage procedure did not show short-term complications. No statistical differences were found between the groups in short-term (P = .48) and long-term complications (P = .07). Conclusions: Modified two-stage IPAA is a safe and feasible option in pediatric patients with UC, and RALS offers advantages over other techniques for the precision of rectal dissection and ileo-anal anastomosis.

Comparative Analyses of the Outcomes Between Lobectomies and Trisegmentectomies/Lingulectomies in the Surgical Management of Clinical Stage I Left Upper Lobe Non-small Cell Lung Cancer.

Lobectomies are the standard surgical intervention for lung cancer; however, recently, surgeons have considered segmentectomies for smaller tumors, with their potential for favorable survival outcomes while preserving lung function. The surgical outcomes of trisegmentectomies/lingulectomies and lobectomies for clinical stage I left upper lobe (LUL) non-small cell lung cancers (NSCLCs) remain undetermined. Thus, our study aimed to assess the differences between the short-term surgical and long-term survival outcomes in patients with clinical stage I LUL NSCLC who underwent trisegmentectomies/lingulectomies and those who underwent lobectomies. Between 2011 and 2021, we retrospectively reviewed the data of 377 patients with clinical stage I NSCLC who had undergone LUL lobectomies or trisegmentectomies/lingulectomies. Patients were categorized into two subcohorts according to tumor size, i.e. 0-2 and 2-4 cm. To ensure preoperative demographic comparability, 1:1 propensity-score matching (PSM) was performed. This study focused on the 2-4cm subcohort. Post-PSM, patients who underwent trisegmentectomies/lingulectomies had quicker operations and shorter postoperative hospital and intensive care unit lengths of stay than those who underwent lobectomies. Post-PSM, no statistically significant differences in progression-free survival (PFS) or overall survival (OS) were observed between the segmentectomy and lobectomy groups in both the0-2 and 2-4cm subcohorts. The multivariate analysis revealed that different surgical methods were not statistically significant factors for either PFS or OS. Trisegmentectomies/lingulectomies are a feasible option for clinical stage I NSCLC, with better perioperative outcomes and similar survival rates when compared with LUL lobectomies.

Buccal fat pedicle flap with a delayed tarsoconjunctival flap for lower eyelid retraction: a new surgical methodology.

The aim of this retrospective case review is to present a novel surgical technique used in the treatment of recalcitrant lower eyelid retraction. This study was performed as a retrospective case review of 4 patients who have failed standard conservative surgical interventions for lower eyelid retraction repair. 3 patients developed lower eyelid retraction following surgical intervention for orbital trauma and 1 patient developed lower eyelid retraction in the setting of granulomatosis with polyangiitis. The surgical technique was identical in each patient and performed by an oculofacial plastic surgeon, sometimes together with an oral and maxillofacial surgeon. Follow-up results for all patients were assessed at 1 week, 1 month, and 3 months. All four patients demonstrated initial improvement in lower eyelid position, fullness, and height. A common finding was mild lateral postoperative entropion, which was easily overcome with an upper eyelid tarsoconjunctival flap. There were no surgical complications sustained in any of the cases. This retrospective case review provides a novel surgical option for the correction of recalcitrant lower eyelid retraction. The excellent vascularity provided by this flap, location, and easy access support its use. A prospective study comparing alternative solutions would be useful in comparing the buccal fat pad vascularized pedicle to alternative methods used to correct refractory and cicatricial lower eyelid retraction.