The concept of a digital or virtual patient represents a paradigm shift in implant dentistry, transforming treatment planning into a data-driven, prosthetically guided, and patient-specific workflow. This article outlines the comprehensive process of constructing a digital patient by integrating multiple datasets: cone-beam computed tomography (CBCT) for volumetric bone representation, intraoral surface scans for dental and soft tissue geometry, facial scans for esthetic harmony, and jaw-motion tracking data for functional analysis. These datasets are merged through precise registration protocols using fiducial markers and AI-assisted alignment to create an accurate three-dimensional model reflecting both anatomical and functional dynamics. The resulting virtual patient enables prosthetically driven implant positioning, real-time occlusal simulations, and seamless communication between the surgical, prosthetic, and laboratory teams. Moreover, advances in artificial intelligence, cloud computing, and blockchain-based data security promise to expand the digital patient’s role from static documentation to a dynamic, continuously updated virtual twin. This integrated workflow enhances surgical precision, esthetic predictability, and clinical efficiency, marking a significant step toward fully digitized, personalized implant rehabilitation.

Avoiding prophylactic tracheostomies in head and neck surgeries with reconstructive free flaps: An institutional shift in practice.

There is a paucity of contemporary population-based studies on temporal trends in incidence and early complications after open thoracic aortic surgery. This study aimed to assess temporal trends in incidence and early complications of open aortic surgery for ascending aortic aneurysm or dissection in Sweden. All open thoracic aortic operations for aortic aneurysm or dissection involving the ascending aorta, in Sweden from 2001 to 2020 were included in a nationwide, population-based, observational cohort study. Individual patient data were collected from the SWEDEHEART registry, the National Patient Registry, and the National Cause of Death Register. The incidences of surgery, early postoperative mortality, and stroke rates over time were compared using generalized additive models, separately for patients operated for aneurysms and dissections. A total of 10,089 procedures in 9829 patients were included. In total, 6429/10,089 operations were performed for aneurysms (63.7%) and 3660/10,089 for dissections (36.3%). The annual incidence of open thoracic aortic operations increased from 26.7 per million inhabitants in 2001 to 64.0 in 2020 (p for trend <0.001). Crude 30-day mortality after first-time surgery was 2.4% (95% confidence interval (CI) 2.0-2.9) for aneurysms and 14.6% (95% CI 13.4-15.8) for dissections. The age- and sex-adjusted 30-day mortality risk for first-time surgery for aneurysm decreased over time (adjusted odds ratio (aOR) 0.33, 95% CI 0.14-0.77) while stroke risk showed a tendency toward decrease (aOR 0.42, 95% CI 0.17-1.06). For first-time surgery for dissections, adjusted 30-day mortality risk decreased significantly (aOR 0.40, 95% CI 0.25-0.64), whereas stroke risk did not change (aOR 1.05, 95% CI 0.64-1.72). The incidence of open thoracic aortic surgery in Sweden for aneurysm and dissection involving the ascending aorta, more than doubled over two decades. Survival after aneurysm and dissection surgery improved during the study period. This study was supported by the Örebro University Hospital Research Foundation and Nyckelfonden Research Foundation.

Dupuytren's disease is a chronic fibroproliferative disorder characterized by progressive thickening and contracture of the palmar fascia, leading to nodules, cord formation, and varying degrees of digital flexion deformity. Although the disease most commonly affects the longitudinal fibers of the palmar aponeurosis, it can also involve distal transverse fibers, natatory ligaments, and digital fascial extensions, including Grayson's and Cleland's ligaments. Its clinical presentation is highly heterogeneous, ranging from slowly evolving, stable nodules to rapidly progressive forms associated with aggressive phenotypes such as Garrod's knuckles or spiral cords that may compromise neurovascular structures. Current evidence suggests a multifactorial etiology involving genetic predisposition, aberrant Wnt/β-catenin signaling, biomechanical stimulation, and metabolic factors such as diabetes. While open surgery (limited fasciectomy) has long been considered the gold standard for advanced contractures, its associated morbidity has prompted increasing interest in minimally invasive or adjunctive non-surgical treatments. Collagenase Clostridium histolyticum (CCH) injections have demonstrated rapid functional recovery and acceptable safety, although recurrence rates remain higher than those of open surgery. Percutaneous needle aponeurotomy offers a simple, low-cost outpatient alternative with excellent short-term correction but significant long-term recurrence, particularly in PIP joints. Radiotherapy has been proposed for early nodular disease and may stabilize progression in selected patients, yet current evidence is methodologically weak and insufficient to support routine use. Pharmacologic approaches-including antifibrotic agents, tyrosine kinase inhibitors, intralesional corticosteroids, and emerging biologics such as anti-TNF therapies-remain experimental, with limited clinical validation to date. Rehabilitation, including supervised exercises and nighttime orthoses, is frequently used following minimally invasive interventions, although high-quality evidence supporting their long-term efficacy is lacking. Overall, non-surgical therapies expand the spectrum of management options for patients with Dupuytren's disease, particularly those presenting with early-stage nodular disease or mild-to-moderate contractures who seek less invasive alternatives to open surgery. However, these treatments vary considerably in durability, recurrence rates, and level of supporting evidence. Consequently, therapeutic decisions must be individualized, taking into account disease stage, anatomical involvement, patient expectations, risk tolerance, and clinician expertise. Continued research is needed to refine patient selection criteria, optimize treatment combinations, and evaluate emerging molecular therapies targeting the disease's underlying pathobiology.

Cervical cancer ranks as the fourth most common malignancy in women globally.1 For early stage disease, radical hysterectomy with pelvic lymphadenectomy remains the standard surgical approach. The LACC trial revealed that minimally invasive surgery (MIS) was associated with inferior oncologic outcomes compared with open surgery,2 with this discrepancy largely attributed to the compromise of tumor-free principles during MIS-particularly through the use of uterine manipulators that may cause mechanical tumor compression and dissemination.3 While open surgery is generally preferred, MIS may be considered in selected cases, such as tumors ≤ 2cm according to Chinese guidelines.4 PATIENTS AND METHODS: To address these concerns, we developed a tumor-free technique incorporating Ma's suspending band and tumor-shielded vaginal closure, adapted for robotic single-site radical hysterectomy using the da Vinci Xi platform. Key features include: (1) ergonomic single-site access through a 3-4cm umbilical incision accommodating a quad-channel port, enabling simultaneous operation of three robotic arms while preserving a dedicated assistant channel for traction, suction, and irrigation; (2) optimized pneumoperitoneum management through strategic robotic arm positioning that elevates the abdominal wall, ensuring consistent surgical exposure at reduced intra-abdominal pressures (8-10mmHg versus conventional 12-14mmHg); (3) minimal parietal trauma through a single-incision approach that improves cosmetic outcomes and potentially reduces port-related complications. This video article details the technical execution of our procedure, highlighting its reproducibility and adherence to oncological safety principles. Prospective data collection and follow-up are ongoing to evaluate long-term oncologic outcomes.

Mastery of Operative Suturing/Stapling in Intestinal Surgery (MOSIS) Development of a Military General Surgery Resident Education Simulation Curriculum.

36. The “Semi-Inclusion” Ross Modification: Surgical Technique and Mid-to-Long Term Outcomes

Does surgical technique matter? Comparing intraoperative outcomes and hemodynamic stability between classical and piggyback liver transplantation

Video article retrorectal endometriotic lesion involving sacral roots: Surgical technique for nerve-sparing excision and pain relief.

Tonsillectomy, with or without adenoidectomy, is the most common major surgical procedure performed in children. The risk and incidence of primary and secondary post-tonsillectomy hemorrhage (PTH) have been well described. The goal of this scoping review is to analyze the incidence and risk factors for recurrent PTH, and to map existing evidence to identify knowledge gaps. CINAHL, Cochrane Library, Embase, Google Scholar, and Ovid Medline. The study followed PRISMA-ScR guidelines. Three reviewers independently screened studies, including those reporting the incidence of PTH and recurrent PTH in children. There were 229 recurrent PTH episodes described in the 11 manuscripts included in this analysis, with 7.1% of initial PTH cases re-bleeding (0.33% of total tonsillectomy cases). Management of recurrent PTH involved surgical intervention and observation. Oropharyngeal findings at the time of the initial PTH and management strategy for the initial PTH were not associated with increased recurrence rates. The indication for tonsillectomy, NSAID usage, and surgical technique were not associated with recurrent PTH when reported. Across studies, there was wide heterogeneity in how recurrent bleeding was defined, and inconsistent reporting of timing and outcomes. The predictive value of laboratory screening for occult coagulopathies in children with multiple bleeds was unclear. No clear risk factors for recurrent PTH were identified from the pooled analysis. This scoping review highlights major research gaps, including the need for standardized definitions and severity grading, prospective multicenter data to clarify predictors of recurrence, and systematic evaluation of hematologic screening protocols.

To evaluate the clinical outcomes of modified crestal and lateral approaches in maxillary sinus lift. Fifty patients with single missing posterior maxillary teeth and severe bone deficiency (residual bone height < 5 mm) requiring implant placement were selected from a tertiary hospital's dental department between January and December 2023. Patients were randomly assigned to the modified crestal sinus lift group (experimental group) or the lateral window sinus lift group (control group). Behavioural cognition was assessed using the Hospital Anxiety and Depression Scale (HADS), postoperative pain was quantified using the Visual Analog Scale (VAS). Bone gain was evaluated by Gained Bone Height (GBH), and implant success rate and complication incidence were recorded. The t-test was used for intergroup comparisons, and categorical data were analysed using the chi-square test. Statistical significance was set at p < 0.05. Significant differences were observed between the experimental and control groups in pre- and postoperative behavioural cognition, surgical time, and VAS pain scores (p < 0.05). No significant differences were found in bone gain, implant success rate, or complication incidence. The bone augmentation outcomes of the two surgical techniques were essentially comparable. However, the modified crestal approach demonstrated advantages over the lateral window technique in terms of minimal trauma, improved patient behavioural cognition, and reduced postoperative pain. These findings suggest that optimising minimally invasive sinus lift techniques may enhance clinical applications, particularly with patient-centred considerations.

Failure of the femoral stem: A case series of intra-prosthetic fractures and proposed classification system.

Surgical Management of High-Risk Prostate Cancer.

En bloc subtotal temporal bone resection (STBR) is a surgical technique used for the removal of temporal bone malignancies. However, few reports detailing resection of the most medial bone in this procedure have been published, although it is the most technically challenging aspect of en bloc STBR. In this study, we focused on the anatomical details of resection of the most medial bone in en bloc STBR, and we discuss the surgical nuances involved. Dissections were performed on 10 formalin-fixed cadaveric specimens. Following the subtemporal-infratemporal fossa and retromastoid-paracondylar approaches, resection of the medial portion to complete en bloc STBR was examined. To achieve en bloc STBR, we had to safely remove the bone within a triangular area anterior to the jugular fossa, posterior to the posterior genu of the petrous segment of the internal carotid artery, and directly above the carotid ridge on the medial side of the styloid process base. The region to be resected had mean (range) dimensions of 16 (12-25) mm anteriorly, 17 (12-25) mm posteriorly, and 10 (8-12) mm medially, with a total area of 76 (47-146) mm2. En bloc STBR is a complex and technically demanding procedure, with the medial bone being the most challenging component to resect. This study emphasizes the importance of understanding the anatomical features of the medial bone for en bloc resection. It aims to contribute to the refinement of surgical techniques for temporal bone resection.

Optimal pharmacotherapy and maintenance of thyroid hormone homeostasis following thyroidectomy are essential for effective metabolic regulation and overall endocrine balance. Surgical techniques that preserve neural integrity play a critical role in maintaining endocrine balance and ensuring stability of thyroid hormone dosage, thereby influencing the overall success of thyroid hormone replacement therapy. This study assessed the impact of intraoperative nerve monitoring (IONM) during thyroidectomy on postoperative endocrine outcomes, with prominence on thyroid hormone stability and levothyroxine dose requirements. The study includes review of 45 patients who underwent thyroid surgery from 2018 to 2023 at a tertiary care center in Turkey. The patients were subsequently allocated into two groups: The first group underwent surgery with IONM (n = 23), whereas the second group underwent surgery without IONM (n = 22). The primary outcome was levothyroxine dose stability, defined as achievement of euthyroid status (TSH 0.4-4.0 mIU/L with normal FT4 levels) without further dose adjustment over two consecutive follow-up visits. Secondary outcomes included time to euthyroid status, number of dose adjustments, postoperative hypocalcemia, RLN injury and hospital stay duration. Postoperative thyroid function tests were assessed at 2, 6 and 12 weeks. Statistical analysis was conducted using SPSS Statistics version 26.0. Patients undergoing thyroid surgery with IONM had an average hospital stay of 1.67 days, while those who did not have IONM had an average hospital stay of 1.77 days. No statistically significant difference between the two groups regarding total time in the operating room. Patients in the IONM group demonstrated a more stable pattern of postoperative thyroid hormone levels and a lower rate of endocrine-related complications compared to the non-IONM group. This study suggests that IONM was associated with postoperative hormonal stability as well as more predictable pharmacotherapy with respect to levothyroxine use. Given the retrospective design, these findings demonstrate association rather than causation and further prospective studies are required.

Distal biceps tendon tears are relatively uncommon injuries that may result in pain and dysfunction. When these injuries are addressed acutely, healing rates, functional recovery, and patient outcomes are excellent. Despite generally good outcomes, failures do occur. Chronic tears of the distal biceps or those requiring revision surgery pose a unique challenge, as the tendons are often retracted and atrophic, requiring allograft reconstruction to bridge the gap in the repair construct. This manuscript aims to describe a safe, reproducible surgical technique and examine the clinical outcomes of distal biceps tendon reconstructions performed with allografts. A retrospective review of patient records from 2000 to 2022 to include Current Procedural Terminology code 24342 for reinsertion of biceps tendon, distal, with or without tendon graft, was performed. Operative notes were screened to determine which procedures included a distal biceps repair with an allograft. Charts were reviewed to determine a patient's most recent documented range of motion, pain score, and any postoperative complications. Patients were contacted by phone to determine their Quick Disabilities of Arm, Shoulder and Hand, Mayo Elbow Performance Score, and 12-Item Short Form Health Survey (SF-12) scores, as well as current visual analog scale for pain. Fifteen patients who underwent distal biceps repairs with allograft were identified, and we were able to contact 10 (66%) of them. Six of these patients had chronic tears, while four had recurrent ruptures of previously performed acute distal biceps repairs. None of these patients reported complications or revision procedures. The average follow-up time for patients was 54 months (range: 8-182 months). The average visual analog scale pain score was 0.4 (range: 0-2). Average final flexion-extension was documented as 3°-130°, and prono-supination as 79°-89°. Patients reported an average Mayo Elbow Performance Score of 93.5 (range: 80-100), Quick Disabilities of Arm, Shoulder and Hand score of 4.8 (range: 0-15.9), SF-12 physical score of 54.3 (range: 50-57), and SF-12 mental score of 57.6 (range: 51-62). Allograft reconstruction of distal biceps injuries for chronic and recurrent tears results in excellent patient-reported outcomes and range of motion, with no significant complications among our cohort. Future studies with larger patient populations will help further validate our results.

Lower trapezius tendon transfer for posterior-superior irreparable rotator cuff tears: a comprehensive narrative review.

To explore barriers and facilitators in implementing the Safety Climate Thermometer (SCT), a new tool designed to support team-level safety culture improvement in surgical settings. The SCT acts through visual insights into safety culture themes, acting as a conversation starter, and interdisciplinary team meetings about this topic. It aims to facilitate daily practice changes. The SCT has previously been developed using user-centered design methods, which consisted of a scoping literature review and international survey. A qualitative implementation study using semi-structured interviews and observational data, guided by the implementation outcomes framework. Three surgical teams from Dutch hospitals of varying size participated between 2021 and 2023 and used the SCT's visual input and interdisciplinary team meeting structure for 7 months. Seventeen healthcare professionals, including nurses, surgeons, and managers, took part in the SCT process and subsequent interviews. The SCT facilitated an anonymous, online assessment followed by structured interprofessional discussions and goal-setting for safety improvement. Participants reported high usability and acceptability due to the tool's intuitive design and anonymity. The SCT was adaptable to different surgical contexts, though smaller teams with motivated champions and in-person facilitation appeared most suitable. Key barriers included high turnover and work pressure, competing priorities, lack of trust, and survey fatigue. Facilitators include in-person external facilitation and "protected time." Reported positive effects included strengthened team cohesion and a greater sense of being heard. The SCT is a practice-oriented, user-friendly tool for improving safety culture through team-based reflection and dialogue. Future use should prioritize exploration of contextual factors.

Inherited metabolic disorders (IMDs) are a heterogeneous group of rare single-gene disorders caused by enzyme defects that disrupt biochemical and metabolic pathways. Acute metabolic decompensation is a medical emergency that can be fatal if untreated. It can be triggered by catabolic stressors such as fasting, infection, surgery, pain, bleeding, or exposure to anesthetic agents. Traumatic injury in particular can precipitate IMD life-threatening crises. The risks of complicating surgical interventions can be reduced by careful perioperative management of fluids, nutrition, and medications under the guidance of a biochemical genetics specialist. Management of IMD metabolic emergencies is often complex, and trauma and surgical providers may only have limited access to specific protocols. Without prompt recognition and treatment, patients with IMDs are at high risk of poor outcomes in trauma or surgical settings. Optimal management requires early consultation with a metabolic specialist and a coordinated multidisciplinary team. This review highlights key principles and resources to enhance recognition and management of IMD metabolic crises for trauma and surgical teams.

Enhancing precision or adding complexity? The impact of surgical microscope use in palatal cleft repair: A prospective comparative study.