Surgery Research Articles

The protocol for BROWSE-P (breast reconstruction outcomes with Strattice™ or Artia™ – pre-pectoral): a cohort study to assess long-term outcomes of immediate pre-pectoral implant based breast reconstruction with Strattice™ or Artia™

Introduction: Techniques in implant-based breast reconstruction (IBBR) have evolved over the last 15 years due to the introduction of mesh or acellular dermal matrices (ADMs). Traditionally, total submuscular coverage progressed to upper pole muscle cover with lower pole ADM and now total or anterior ADM cover in the pre-pectoral plane. Data is scarce to support the pre-pectoral technique but, it is suggested to result in less postoperative pain, more natural cosmesis and avoidance of animation deformity. The BROWSE study concluded that subpectoral with Strattice™ IBBR resulted in better cosmesis and lower rates of capsular contracture when compared to the total submuscular technique. The BROWSE-P study aims to assess the safety profile of Artia™ a porcine derived ADM and review the long-term outcomes of pre-pectoral IBBR with Strattice™ and Artia™. Methods and analysis: BROWSE-P is a single center cohort study. Consecutive patients who have undergone immediate pre-pectoral IBBR with Strattice™ or Artia™ from January 2017 to December 2022 will be included. Demographic, operative, oncology, complication, and further surgery data with be collected to assess the rate of revision surgery and safety profile of Artia™. Those who have their implant reconstruction in situ will be invited for clinical assessment to assess for capsular contracture. Participants will also be asked to complete a BREAST-Q post-reconstruction module, to assess patient satisfaction and quality of life, and have medical photographs taken for an assessment of aesthetic outcome by a blinded panel using the 10-point Visser scale. We aim to collect data on 500 reconstructions and complete clinical assessment, patient reported outcomes and aesthetic assessment for 250 patients.

Percutaneous sacroiliac screw fixation with a 3D robot-assisted image-guided navigation system

Abstract Objective Presentation and description of percutaneous sacroiliac (SI) screw fixation with the use of a 3D robot-assisted image-guided navigation system and the clinical outcome of this technique. Indications Pelvic fractures involving the posterior pelvis. Contraindications Patients not suited for surgery. Surgical technique Planning the screws on the diagnostic computer tomogram (CT). Matching with a low-dose CT in the operating room. Lateral incision. Verify the guidewire position with the personalized inlet and outlet views. After correct positioning, place a cannulated screw over the guidewire. For fragility fractures, augmentation is recommended. Finish the surgery with a final 3D scan to confirm correct placement of the screws and cement. Postoperative management Direct postoperative mobilization with pain-adapted full weight-bearing. Results Data of 141 patients between January 2018 and August 2022 were analyzed (average age 82 ± 10 years, 89% female). Most of the fractures were type II fragility fractures of the pelvis (FFP; 75%). The median hospital stay was 12 ± 7 days and the median surgery duration for a unilateral SI screw was 26 min. In total 221 S1 screws and 17 S2 screws were applied. No screws showed signs of loosening or migration. Of the five suboptimally placed screws, one screw was removed due to sensory impairment. All patients with cement leakage remained without symptoms. Conclusion The surgical technique with the use of a 3D robot-assisted image-guided navigation system is a technique for safe fixation of dorsal fragility fractures of the pelvis and is associated with fewer complications.

Perceived work-related stress and associated factors among the surgical workforce in a Nigerian tertiary health facility: A cross-sectional study

Healthcare workers continue to experience high levels of work-related stress which continue to negatively affect their psychological, physical, and emotional well-being. This is even more prevalent among healthcare workers who work in surgical specialities, with the surgical operation room becoming a known stressor at hospitals. This study aims to assess work-related stress among surgical team members at Ahmadu Bello University Teaching Hospital in Zaria between January 2021–2022. Data analysis involved descriptive and inferential statistical approaches using the Statistical Package for Social Science (SPSS) version 23.0. The study found an overall high prevalence of work-related stress, with 65% of participants reporting moderate levels of stress. The majority of the participants have a mean age of 39.4 ± 7.8 years, most of them being physicians (66.3%), being males (59.9%), and identified with a Hausa ethnic tribe. Notably, the multiple regression analysis found that tribe (p = 0.008), professional cadres (p = 0.001) and age/years of experience (p = 0.0035) emerged as significant predictors of work-related stress. Key determinants of work-related stress among surgical team members include workload, complexity of work, and conflicting cognitive job demands that continue to subject professionals to increasing workloads and constant decision-making about their job. Organizational factors, such as job policy and procedure, communication problems, and the nature of facilities, were identified as the highest contributors to work-related stress in organizational, interpersonal, and physical/environmental dimensions. The findings lead to the conclusion that a considerable proportion of surgical team members experience a relatively high level of work-related stress, primarily attributed to workload and cognitive demands. In light of these results, urgent efforts are recommended to improve the working conditions and environment for surgical team members. Furthermore, the integration of stress management measures into the educational programs for the surgical team is emphasized to effectively address and mitigate the impact of work-related stress.

Sea food by-products valorization for biomedical applications: evaluation of their wound regeneration capabilities in an Ex vivo skin model

IntroductionThe skin is often exposed to harmful stimuli that might compromise its integrity and functionality. After an injury, the skin has a limited capability to restore its complex structure, and in the case of severe skin damage, surgical operations and rapid application of wound dressings are often required to promote optimal wound healing. Nowadays, collagen-based biomaterials are widely used in combination with bioactive molecules able to prevent excessive inflammation and possible infections. In line with a circular economy and blue biotechnology approach, it was recently demonstrated that both collagen and bioactive molecules (i.e., antioxidant compounds) can be sustainably obtained from sea food by-products and effectively used for biomaterial development. Herein, we describe and compare the application of two marine collagen-based wound dressings (CBWDs), produced with materials obtained from sea urchin food waste, for the treatment of skin lesions in a wound healing organ culture (WHOC) model.MethodsThe ex vivo WHOC model was set up starting from rat skin explants and the induced lesions were assigned into three different groups: control (CTRL) group, not treated, marine collagen wound dressing (MCWD) group, and antioxidants-enriched marine collagen wound dressing (A-MCWD) group. After 5 and 10 days, specimens were examined for organ maintenance and assessed for the healing process.ResultsImmunohistochemical results showed that both CBWDs were similarly successful in prolonging skin repair, preserving the epidermal barrier up to 5 days under static culture conditions. Histological and gene expression analysis highlighted that the A-MCWD might support and accelerate skin wound healing by exerting antioxidant activity and counteracting inflammation.DiscussionOverall, these findings underline the potential of sea urchin food waste as a novel resource for the development of functional medical devices for the treatment of skin wounds.

Static Versus Expandable Cages in Minimally Invasive Lateral Lumbar Interbody Fusion

Study Design: A meta-analysis approach to a systematic review. Objective: Perform a systematic review to identify all reports directly comparing outcomes of lateral lumbar interbody fusion (LLIF) using static versus expandable interbody cages. Specifically focusing on periprocedural complications, intraoperative morbidity, and fusion outcomes. Summary of Background Data: Minimally invasive surgical techniques, particularly LLIF, have gained popularity for their potential to reduce muscle and soft tissue dissection, leading to faster postoperative recovery. LLIF has been associated with fewer complications compared with open posterior approaches. The introduction of expandable lumbar interbody devices aims to further reduce surgical difficulty and potential complications. However, concerns include a small graft window due to the expansion mechanism and higher costs. Methods: The Web of Science, Scopus, and PubMed databases were systematically queried in accordance with PRISMA guidelines to identify articles comparing outcomes following LLIF using static and expandable interbodies. The Newcastle-Ottawa Scale (NOS) was employed to assess the risk of bias (ROB) in the selected studies. Extracted data underwent effect-size meta-analysis with the PyMARE library, using P<0.05 to define statistical significance. Results: Of the 77 identified articles, 4 studies comprising 283 patients (mean age: 67.1 y, 55.8% female) met the inclusion and exclusion criteria. A total of 150 patients (53%) were treated with static interbodies compared with 133 (47%) receiving expandable interbodies. The groups did not differ significantly with respect to operative time (P=0.59), blood loss (P=0.89), length of stay (P=0.78), subsidence (P=0.49), 24-month mean disc height (P=0.11), 24-month mean ODI (P=0.58), or 24-month mean visual analog scale (VAS) back pain (P=0.81). The expandable group saw a trend toward improved fusion rates (97% vs. 92%, P=0.06). Conclusions: The present meta-analysis suggests the use of expandable (vs. static) interbodies in LLIF surgery may result in similar surgical morbidity, subsidence, and decompression. Further prospective comparative studies are merited to validate these results.

Effectiveness of a single burr hole as a surgical technique for the management of chronic subdural hematoma: A clinical case series study

Effectiveness of a single burr hole as a surgical technique for the management of chronic subdural hematoma: A clinical case series study

Guardian Knowledge in Primary Congenital Glaucoma: A Cross-Sectional Study

Précis: Guardian education level and frequency of surgical interventions are key determinants of knowledge in primary congenital glaucoma, highlighting the need for targeted educational strategies. Background: Management of congenital glaucoma poses unique challenges, particularly concerning the patient guardians’ understanding of the condition, which is crucial for treatment adherence and follow-up compliance. This study aimed to assess guardians’ knowledge levels and identify the influencing factors. Methods: This cross-sectional study included 103 guardians of pediatric patients with PCG. Participants with missing data were excluded from the study. The participants were assessed using a 20-question survey covering various aspects of glaucoma. Descriptive and inferential statistics were used for analysis. Results: The sample included 96 guardians, primarily females (80.2%). The children’s ages varied significantly, averaging approximately 44 months (SD = 39.8). The guardians predominantly had secondary education (34.4%) and most were housewives (77.1%). There was a positive correlation between higher education levels and the overall knowledge score of guardians (P = 0.006). Similarly, the guardian’s locality showed a positive correlation with knowledge scores, with urban guardians having higher scores than rural guardians. Additionally, there was a positive correlation between the number of surgical operations performed on the child and the guardians’ knowledge. For the subtotals, variables such as the child order among siblings and age of the child showed significant positive correlations, emphasizing the multifaceted influences on guardians’ understanding. In the multivariate analysis, the guardian’s education level showed a significant positive correlation for the Overall Score, as did the number of operations performed on the patient. Conclusions: The study revealed gaps in guardian knowledge, irrespective of educational level or other demographic factors. Guardians’ education level and the number of operations performed on the child are critical determinants of guardians’ understanding of congenital glaucoma. Traditional approaches to educational interventions may require re-evaluation, and there is a pressing need for targeted educational interventions.

Lower urinary tract symptoms in men after surgery for benign prostatic hyperplasia

BACKGROUND: The development of medical technologies has resulted into a significant increase in the number of patients undergoing minimally invasive surgeries for benign prostatic hyperplasia. However, 29.9–41% of patients after surgical treatment are not satisfied with the surgical treatment results. AIM: To assess the rate and nature of lower urinary tract symptoms in men after surgical treatment of benign prostatic hyperplasia with various surgical techniques. MATERIALS AND METHODS: A telephone survey was carried out among 6117 men aged 59.57 ± 11.11 years (48–83 years), who underwent surgical treatment for benign prostatic hyperplasia with various surgical techniques and 5960 of these patients were surveyed using the IPSS questionnaire in the period 2012–2022. Moreover, to assess urination, patients kept their voiding diaries for 72 hours, a questionnaire to evaluate the symptoms of overactive bladder; ultrasound of the bladder, prostate and upper urinary tract, uroflowmetry, and, if indicated, a urodynamic study were performed. RESULTS: The study showed that 2413 (40.5%) patients were “absolutely satisfied” with the surgical treatment results, 829 (13.9%) patients were “partially satisfied” and noted improved urination, although its quality was assessed as unsatisfactory, and 2718 (45.6%) operated men were “absolutely dissatisfied”. Lower urinary tract symptoms persisted in 2655 (47.9%) men which underwent surgery, and in 3.3% of cases (87 patients) their severity increased in the postoperative period. CONCLUSIONS: The high rate of dissatisfaction with the surgical treatment results of patients with benign prostatic hyperplasia is caused by the persistence of irritative symptoms in the postoperative period and does not depend on the surgery performed. The origin of symptoms in most patients is not associated with benign prostatic hyperplasia, and the surgery indications are overestimated.

Combined laparoscopic nephroureterectomy with transurethral approach to the ureter in renal tuberculosis treatment

BACKGROUND: Tuberculosis of the genitourinary system is a common cause of organ removal surgeries. Despite the improvement of medical technologies, kidney and urinary tract surgeries for urogenital tuberculosis are traditionally performed using the open method. AIM: To assess the findings of laparoscopic and open combined nephroureterectomy with transurethral resection of the distal ureter in patients with renal tuberculosis. MATERIALS AND METHODS: The findings of 61 nephroureterectomies with transurethral resection of the distal ureter performed for destructive renal tuberculosis were analyzed. Open nephroureterectomy was performed in 31 patients, and laparoscopic approach was used in 30 patients. Patients in both groups were comparable by gender and age. RESULTS: The surgery duration, volume of intraoperative blood loss, rate and severity of postoperative complications were lower in patients who had laparoscopic interventions. When examined 1 month after surgery, patients in both groups showed the improvement of clinical parameters. The following changes were reported: a significant decrease in the nighttime urination rate, a decrease in IPSS scores, and an increase in the functional bladder capacity without significant differences depending on the surgical approach. After the surgery, a significant improvement in the quality of patients’ life was observed. In patients who had laparoscopic surgery, improvements were detected in all the SF-36 questionnaire domains. However, in patients after open surgery with a positive effect on most of assessed parameters no significant improvement of parameters in section “General Physical Health” was found. CONCLUSIONS: Irrespective of the selected approach, combined nephroureterectomy with transurethral resection of the distal ureter is an effective method of surgical treatment of patients with destructive renal tuberculosis. Moreover, the laparoscopic technique has shown a number of significant advantages over open surgery.

Surgical treatment of hypospadias with lichen sclerosus: Long‐term outcomes from a single center

AbstractBackgroundHypospadias with lichen sclerosus (LS) poses surgical challenges due to lack of materials for urethral reconstruction and coverage and the limited number of reports on this clinical condition.ObjectivesTo report surgical strategies and outcomes for primary and redo hypospadias patients with LS.Materials and methodsWe conducted a retrospective observational descriptive study with 31 patients with primary/redo hypospadias and LS between 2013 and 2023. Of these patients, 9 had primary hypospadias with 7 distal types and 2 proximal types, and 22 were redo patients. Nineteen of the 31 patients underwent various surgical techniques, and 12 underwent the oral mucosa onlay procedure (OMOP). Postoperative uroflowmetry, hypospadias objective scoring evaluation (HOSE), and complications were evaluated.ResultsFor primary distal hypospadias with LS‐affected skin, five patients underwent circumcision; these patients had normal postoperative urinary flow, and only one patient had an inconspicuous penis after surgery. For the patients with primary proximal hypospadias with an LS‐affected urethra, one patient required perineal urethrostomy following a modified Koyanagi procedure for recurrent stricture; the other patient underwent two‐stage transverse preputial island flap urethroplasty with no postoperative lower urinary tract symptoms (LUTS) and satisfactory aesthetic scores. In two remaining cases of primary distal hypospadias with meatus/urethral LS, no LUTS or postoperative complications occurred following meatoplasty/circumcision and penile basal fixation. During reoperations, compared with those of patients who underwent other redo procedures, twelve patients who underwent OMOP had better Qmax and uroflowmetry (p = 0.002) and higher HOSE scores (p = 0.01).ConclusionsFor primary hypospadias patients with LS, enhanced exposure of the penile shaft and glans may benefit distal hypospadias, whereas staged surgery may be suitable for proximal hypospadias. The oral mucosa is favored for urethral augmentation in patients with redo hypospadias complicated with LS, and the OMOP can address neourethra coverage effectively.

Re-do hypospadias surgery following failed previous repair: lessons learned over two decades of experience.

To evaluate our experience with different surgical techniques and to find clinical factors that affect the outcome of treatment in cases of redo-hypospadias. We have retrospectively evaluated demographic and clinical data of children who underwent redo or cripple-hypospadias repair. Between 2004 and 2021, 76 patients met the inclusion and exclusion criteria. The median age of the first cripple-hypospadias surgery was 64.8 ± 62.9 months. Upon primary surgery 5(6.6%) patients presented with distal-hypospadias, 13(17.1%) midshaft-hypospadias, 37(48.7%) proximal-hypospadias and 21(27.6%)with an unknown initial meatal status. To correct cripple-hypospadias 3(3.9%) patients underwent meatal-advancement and meatoplasty 32(42.1%) different tubularization techniques, 25(32.9%) required flap/graft, 13(17.1%) staged procedure and in 3(3.9%) surgical technique was undefined. Fifty-four (71%) children presented with post-surgery complications: 25(32.9%) meatal retraction, 19(25.3%) meatal stenosis and 17(22.3%) developed urethro-cutaneous fistula. Thirty-six (47.4%) patients underwent additional surgeries. There was no association between surgical technique or age and the need for additional surgeries (P = 0.831, P = 0.425 respectively). There was no association between surgical technique or age and surgical complications (P = 0.514, P = 0.425 respectively). All surgical techniques except meatal-advancement might lead to urethral stricture on long term follow-up (P = 0.028). Our data show that treatment of cripple-hypospadias is challenging for both surgeon and patients alike. There is a need to tailor a surgical technique to each patient and there is no one technique which is appropriate for all patients.

Effects of ultrasound-guided external oblique intercostal plane block on the postoperative analgesia after open liver surgery: study protocol for a randomised controlled trial.

Open liver surgery remains a primary surgical approach for complex liver resections and liver transplantation. However, the postoperative pain management is still a major challenge. Ultrasound-guided external oblique intercostal (EOI) plane block is a novel approach of regional anaesthesia and has a great potential to relieve postoperative pain after upper abdominal surgeries. This study aims to investigate the efficacy and safety of ultrasound-guided EOI plane block in managing postoperative pain after open liver surgery. Seventy-four participants scheduled for open liver surgery will be randomly assigned to either the intervention group, receiving an ultrasound-guided EOI plane block with a single dose of 30ml 0.375% ropivacaine, or the control group, which will not receive this block. All participants will be provided with opioid-based patient-controlled intravenous analgesia (PCIA) postoperatively. The primary outcome is resting pain score at 3h postoperatively, assessed using numerical rating scale. Secondary outcomes include pain score at 6, 24, 48, and 72h postoperatively, perioperative opioid consumption, remedial analgesics within 72h postoperatively, PCIA usage within postoperative 72h, postoperative recovery, length of hospital stay, postoperative side effects, block-related complications, and ropivacaine plasma concentration of participants receiving the block. This study is a randomised controlled trial to evaluate the efficacy and safety of ultrasound-guided EOI plane block for postoperative analgesia after open liver surgery. As regional anaesthesia plays an important role in the multimodal pain management, EOI plane block may prove to be an effective regional technique for enhancing postoperative pain relief and contributing to enhanced recovery after open liver surgery. Chinese Clinical Trial Registry ChiCTR2200065745. Registered on November 14, 2022.

Orthopedic Surgery in Osteogenesis Imperfecta in Adults.

Osteogenesis imperfecta is a genetic disorder, mainly characterized by bone fragility. In adult with osteogenesis imperfecta, surgical treatment may be indicated as an emergency procedure in the event of a fracture, or as a scheduled procedure in case of patient functional impairment due to many causes, such as persistent pain, complex bone deformities, and degenerative arthropathies. In all cases, a multidisciplinary approach is recommended. It is essential to consider the patient's characteristics and expectations regarding treatment, as well as the local conditions, which may be complex due to the poor bone quality, bone deformity, and the presence of hardware implanted during childhood. The procedure can be very complex and challenging and each patient is a unique case. An accurate preoperative planning is mandatory to select the appropriate surgical technique, which can be either conservative or prosthetic, and to evaluate its feasibility and the risk-benefit ratio. The aim is to improve the patient's quality of life and autonomy as long as possible.

Breast Implant-Associated Anaplastic Large Cell Lymphoma: A Case Report About a Patient with Cytology Negative for Malignancy

Breast implant-associated anaplastic large cell lymphoma (BIA-ALCL) is a rare lymphoma primarily linked to textured breast implants. Symptoms are often non-specific (e.g., breast swelling, pain, or fluid collection). When imaging detects fluid around the implant, cytological examination is the first diagnostic approach. However, this method has limited sensitivity and may yield false-negative results. In this case, a 41-year-old woman presented with swelling, pain, and itching in her left breast six years after bilateral textured breast implant placement. Ultrasonography (US) revealed peri-implant fluid collection around the left implant. A following magnetic resonance imaging (MRI) scan ruled out an implant rupture. Due to persistent pain and the peri-implant effusion on the left side, open surgery was performed. During implant removal, the seroma was drained, and multiple suspicious masses were found on the left side. The cytology of the seroma fluid was negative and intraoperative frozen sections of the excised masses were inconclusive. A complete capsulectomy was conducted due to the suspicion of malignancy. Histological examination ultimately confirmed the diagnosis of BIA-ALCL. This case highlights the diagnostic challenges associated with this rare condition. Therefore, BIA-ALCL should always be considered in the differential diagnosis of breast implant-associated seroma.

Do Surgical Oncology Multidisciplinary Team Meetings Make a Difference?

Multidisciplinary team (MDT) meetings are important but resource-expensive components of surgical and oncologic care. This cohort study investigated the effectiveness of surgical MDT meetings by assessing the predictability of MDT meeting recommendations, the degree that patient management plans are changed by discussion, and the incidence of recommendation implementation. Multidisciplinary team meetings at The Queen Elizabeth Hospital in South Australia were audited for upper gastrointestinal (UGI) and colorectal (CR) surgical units from August 2021 to June 2022. All cases referred for MDT meeting discussion were included. Prospectively obtained pre-MDT meeting management plans were compared with formal MDT meeting recommendations to assess for concordance and degree of change. Patient records were assessed after 8 months for MDT meeting recommendation implementation. Multivariable analysis of patient factors was performed to identify associations between MDT meeting recommendation predictability and implementation. In 438 patient cases, discussed during 30 MDT meetings, 317 (72.37%) were correctly predicted. Specifically, 226 (51.6%) were correct with no change, 28 (6.39%) were correct with minor changes, 40 (9.13%) were correct with moderate changes, and 23 (5.25%) were correct with major changes. The UGI and CR cohorts differed significantly in moderate changes (P = 0.0217). The female patients were 1.62 times more likely than the male patients to have pre-MDT meeting management plans predicted (P = 0.0201). Formal MDT meeting recommendations were implemented in 380 (89.62%) cases. The MDT meetings changed management for almost 1 in 2 patients discussed. Other than female sex, no identifiable patient factors increased the likelihood of predictability, and no factors predicted recommendation implementation.

Diverting ileostomy for treatment of ileoanal pouch dysfunction: a technical note.

The ileal pouch-anal anastomosis (IPAA) is a restorative procedure performed after proctocolectomy to improve quality of life in patients with colorectal conditions like ulcerative colitis, familial adenomatous polyposis, and selected cases of Crohn's disease and Lynch syndrome. However, severe pouch dysfunction can occur, often necessitating further surgical intervention. This technical note aims to describe the operative approach and perioperative management for diverting ileostomy as a treatment for dysfunctional ileoanal pouches. Indications for the procedure include complications such as pelvic sepsis, pouchitis, fistulas, and Crohn's disease of the pouch. Preoperative planning involves a multidisciplinary team, stoma site marking, and imaging to assess bowel integrity. The surgical technique utilizes laparoscopic access with careful adhesiolysis to minimize bowel injury, with intraoperative pouchoscopy to identify anatomical landmarks. An ileostomy is created by selecting a tension-free small bowel segment and approximating it to a pre-marked stoma site. Attention is given to preserving bowel length to allow for potential future restorative procedures. Postoperative care focuses on stoma management and addressing ongoing pouch dysfunction symptoms. Diverting ileostomy offers symptom relief for patients with pouch dysfunction while avoiding more complex procedures like pouch excision. It is a valuable option in managing pouch failure.

Safe implementation of minimally invasive surgery in a specialized colorectal cancer unit.

In the past 30 years, minimally invasive surgery (MIS) has made remarkable progress and has become the standard of care in colorectal cancer treatment. The implementation of new techniques or platforms is, therefore, a challenge for surgical teams. This study aims to analyze the experience in the implementation of minimally invasive surgery in the colorectal unit in a specialized colorectal cancer center. We will report and compare the clinical outcomes of the patients submitted to the different surgical approaches, reflecting the importance of surgical training in the laparoscopic and robotic field for the reduction of surgical complications and improve short-term outcomes. This study involved a retrospective analysis of data collected from a prospectively maintained database at the colorectal unit of Champalimaud Foundation between 2012 and 2023. Data were collected as part of routine clinical documentation and included variables on patient's demographics, staging, short-term outcomes, and follow-up. A total of 661 patients treated at the Champalimaud Foundation between 2012 and 2023 were included, of which 389 (59%) had colon and 272 (41%) rectal cancer. Most of the patients underwent elective surgery, with a minimally invasive approach performed in 91% of cases. A complete resection (R0) was achieved in 95.1% (619) of the procedures with a pathology report staging 64.5% (409) of tumors as pT3-4. Eleven percent (70) of patients had complications classified as Clavien-Dindo (CD) ≥ 3. This study supports the safety of the implementation of minimally invasive surgery in colorectal cancer care, with improvement in postoperative outcomes and surgical quality, supporting the importance of surgical training and specialized teams.

Total Elbow Replacement in Swine: Surgical Technique and Initial Clinical Experience in a Kunekune Sow.

The aim of this study was to describe the development of a total elbow replacement (TER) technique in swine and report the outcome of TER in a Kunekune sow (61 kg) with severe elbow osteoarthritis. The technique was developed by operating on three pig cadavers (Yorkshire 40-50 kg). The TATE Elbow implant fit was confirmed with modeling to the patient's computed tomography imaging. Patient-specific instrumentation was printed for attempted use. Total elbow replacement was performed using a lateral approach, including lateral epicondylar osteotomy, careful retraction of the radial nerve, and preservation of the lateral collateral ligament. Postoperative care included controlled exercise and physical therapy. A lateral approach to the pig elbow for TATE TER was successfully developed. The bulk of the lateral head of the triceps muscle precluded use of the patient-specific instrumentation; the procedure was performed using standard instrumentation. Radiographic evidence up to 9 months postoperatively showed adequate implant alignment and satisfactory osteointegration of humeral and radioulnar components. There were not any postoperative complications and the patient's comfort was improved by 6 months and sustained at 18 months. A lateral approach for TATE TER in a pig with advanced elbow osteoarthritis proved feasible and effective. With the expansion of the TATE Elbow line, it is possible that a larger range of pigs could be treated. This report suggests that a lateral approach for TATE TER in dogs could represent a suitable alternative to the medial approach currently used.

When Would Minimally Invasive Spinal Surgery Not Be Preferable for Metastatic Spine Disease?

Metastatic spine tumor surgery (MSTS) is an important treatment modality of metastatic spinal disease (MSD). Open spine surgery (OSS) was previously the gold standard of treatment till the early 2010s. However, advancements in MSTS in recent years have led to the advent of minimally invasive spinal surgery (MISS) techniques for the treatment of MSD. The clear benefits of MISS have resulted in a current paradigm shift toward today's gold standard of MISS and early adjuvant radiotherapy in treating MSD patients. Nonetheless, despite improvements in surgical techniques and the rise of literature supporting MISS for MSD, there are still certain situations whereby MISS is not desirable or even suitable. There has also yet to be any literature describing the considerations of not using MISS in MSD in today's clinical context. A narrative review was conducted for this manuscript. All studies related to OSS and MISS in MSTS were included. A total of 54 studies were included in this review. These studies discussed various advantages of MISS for MSD in today's clinical context, including the patient profile, location of vertebrae involved with metastasis requiring treatment, tumor characteristics, as well as equipment availability. This study establishes situations in which MISS can be less applicable despite the advantages it may confer over traditional OSS. MSTS should be individualized, depending on the experience of the surgeon. OSS is a time-tested approach that still holds weight in MSTS and should be readily utilized depending on the clinical situation.

Treatment and Early Outcomes of Capitellar Osteochondritis Dissecans.

Treatment for osteochondritis dissecans (OCD) of the humeral capitellum has been predominantly guided by fragment stability and articular cartilage integrity. Nonoperative management is recommended for stable lesions, whereas surgical intervention is indicated for unstable lesions and those that fail nonoperative care. Several surgical options may be considered, although limited information is available regarding indications for specific surgical techniques and comparative postoperative results. To assess surgical outcomes of patients with capitellar OCD treated according to a decision-making approach focused on subchondral bone involvement. Cohort study; Level of evidence, 3. Patients diagnosed with capitellar OCD at a tertiary academic center were enrolled in a prospective longitudinal cohort study. Patient information was collected at the time of enrollment, and OCD lesions were classified according to the Nelson grade. Clinical and radiologic data were collected both pre- and postoperatively for those undergoing surgical treatment. Surgical procedures were performed based on an evolving treatment framework that included considerations specifically for lesion containment and depth of subchondral bone disease. Timmerman scores were obtained to assess patient functional outcomes. A total of 154 patients were prospectively enrolled, 19 of whom had bilateral disease. The mean age at presentation was 13.7 years; 39% were gymnasts and 28.5% were primary baseball or softball athletes. Surgery was performed on 145 elbows, including 43 drilling/microfracture procedures, 21 internal fixations, and 63 autologous osteochondral grafting (OG) procedures. Clinically, there were significant improvements in pain, elbow motion, and mechanical symptoms. Timmerman scores significantly improved after each type of surgical procedure. A total of 76% of patients returned to their primary sport. When stratified by the Nelson grade, patients with OG had lower revision surgery rates than those treated with drilling/microfracture and fixation. Furthermore, for Nelson grade 2 lesions, patients treated with OG had significantly better postoperative elbow motion and higher Timmerman scores compared with those treated with other procedures. Using a treatment framework incorporating lesion containment and depth of subchondral bone disease, surgery for capitellar OCD provides clinical, radiologic, and functional improvements. Patients treated with OG may have lower revision rates and better functional outcomes compared with those treated with other surgical techniques, with OG warranting consideration even for lower-grade OCD lesions.