Surgical Advances Research Articles

The acceptance of robots in the orthopedic joint replacement operating room.

Robotic surgery has seen substantial growth over the years and continues to show promise, with recent implementation into orthopedic surgery. There is limited literature available on patient attitudes and comfort level with robotic compared with conventional surgery. We aimed to develop an understanding of patient views on robot-assisted knee replacement to help the development of patient education materials and facilitate successful implementation. A qualitative, descriptive methodology was used. Included participants were those who had undergone total knee replacement in the last 5 years. Participants completed an online semistructured interview assessing their past experiences and their fears and assumptions about robotic surgery. An inductive thematic analysis was completed to organize and present the major themes. Four overarching themes described the areas patients focused on: advancements in surgery, perception of robotic surgery and surgeons, reliability, and patient education materials. Major subthemes included the proven reliability of robots, safety fears, and efficacy. Some participants' fear centred around robot autonomy. Greater comfort with the use of robots would occur if patients were given information about the role of the robot before surgery. Patient education materials can help alleviate fears and prevent misperceptions about robot-assisted knee replacement. Materials should include themes of surgical advancements and how surgeons interact with these advancements, level of robot autonomy, and the reliability and safety of the robot.

Patients with DCIS Seen at a Specialized High-Risk Breast Clinic Run by Surgical Advanced Practice Providers Have High Rates of Preventive Medication Uptake.

Preventative medication (PM) uptake is low among patients at an elevated risk of breast cancer, largely due to fears of intolerance. This study aimed to investigate whether a new, surgical advanced practice provider (APP)-run clinic was effectively prescribing PM. We hypothesized equivalent rates of PM uptake compared to consultation with medical oncologists (MD). The APP-run clinic and accompanying database were initiated 01/2023, including patients with benign breast complaints and/or an elevated risk of invasive breast cancer. A historic single-institution surgical database and this prospective database were queried for patients with ductal carcinoma in situ between 04/2007-05/2023 and 01/2023-01/2024, respectively. Patients with invasive breast cancer within the prior 5years were excluded. Chart review abstracted PM type/dose. Chi square analysis compared PM uptake rates and dose. A total of 523 patients met study criteria; the MD sample and APP sample were relatively well balanced except fewer hormone receptor positive patients in the MD sample (266/309 [86.1%] versus 202/214 [94.4%] APP, p < 0.01). PM uptake was lower in the MD sample (96/309 [31.1%] compared to the APP sample (86/214 [40.2%], p = 0.03). There was significantly more tamoxifen prescribed among the APP sample (58.2% vs. 35.6% among MD, p = 0.02), and low-dose tamoxifen prescribing increased significantly (47.3% vs. 9.8% MD, p < 0.01). Our surgical APP-run breast health clinic has demonstrated equivalent PM uptake as compared to patients seen previously by medical oncologists. This model should be considered broadly. Additionally, low-dose tamoxifen has become the prescription of choice; thus, long-term studies of tamoxifen 5 mg are warranted.

Clarity unveiled: A journey through time in cataract surgery.

This historical research article offers a comprehensive examination of the evolution of cataract surgery from ancient practices to modern innovations. The historical trajectory of cataract treatment will be explored, beginning with ancient techniques such as couching in ancient civilisations and progressing through critical milestones in surgical advancement. The research delves into the challenges faced by early practitioners, the emergence of novel techniques and the pivotal contributions of pioneering surgeons throughout history. From the rudimentary procedures of antiquity to the sophisticated technologies of the present day, the journey through time reveals medical professionals' remarkable ingenuity and perseverance in their quest to restore vision and improve the quality of life for patients afflicted by cataracts. Drawing upon historical sources, medical texts and scholarly research, this article provides insights into the social, cultural and technological factors that shaped the development of cataract surgery over millennia. It also examines the impact of crucial innovations such as extracapsular and intracapsular extraction, the advent of intraocular lens implants and the introduction of minimally invasive surgical techniques. Moreover, this research highlights the transformative effect of cataract surgery on individuals and societies from the ancient to the modern era. Hopefully, this research offers a compelling narrative of human ingenuity, scientific progress and the quest for clarity in treating cataracts.

Revolutionizing surgery: AI and robotics for precision, risk reduction, and innovation.

Artificial intelligence and robotics are revolutionizing surgical practices by enhancing precision, efficiency, and patient outcomes. With global healthcare systems increasingly adopting AI-driven technologies, the integration of robotics in surgery addresses critical challenges such as surgical accuracy, minimally invasive techniques, and healthcare accessibility. However, disparities in access and ethical concerns regarding automation persist globally, necessitating a balanced discourse on these advancements. The primary objective of the review is to explore the intersection of AI and robotic technologies in surgical practices, highlighting key innovations, their impact on precision medicine, and future trajectories. The novelty of the review lies in synthesizing findings across diverse surgical specialties, including urology, plastic surgery, ophthalmology, and pediatric surgery, to provide a comprehensive understanding of AI's transformative role. The systematic review evaluates the integration of AI and robotics in surgery, synthesizing studies published in 2024. It follows PRISMA guidelines for study selection, data extraction, and synthesis. The review assesses surgical specialties, AI technologies, and outcomes like accuracy, recovery, and complications, ensuring methodological rigor and transparency. The findings indicate substantial advancements in AI-driven surgical systems, improving decision-making, reducing surgical errors, and facilitating personalized treatment strategies. Notable breakthroughs include AI-enhanced imaging, real-time data analysis, and automated robotic instruments, which collectively improve procedural efficiency and patient safety. The discussion emphasizes the critical implications of these innovations, particularly in advancing minimally invasive techniques and expanding surgical capabilities in complex procedures. However, challenges such as cost, ethical considerations, and the need for rigorous training protocols are highlighted as barriers to widespread adoption. The review underscores the implications for policymakers, healthcare institutions, and technology developers to address these barriers and promote equitable access to AI-driven surgical solutions. Limitations include the reliance on recent studies, necessitating long-term evaluations of clinical outcomes. Future research should focus on integrating AI with emerging technologies like augmented reality, fostering interdisciplinary collaboration, and addressing socio-ethical dimensions to fully realize the potential of AI in surgical advancements.

Review of Surgical Interventions in the Thyroid Gland: Recent Advances and Current Considerations.

The thyroid gland, located at the base of the neck, regulates metabolism and hormone balance through hormones like T4 and T3, which are essential for growth, neurological development, and energy production. Thyroid diseases affect 10% of the global population, making accurate and up-to-date information on surgical interventions and advancements crucial for improving clinical outcomes. Thyroid gland surgery is a dynamic field that has experienced remarkable advances in diagnosis, surgical techniques, and postoperative management. These include new advances in surgical techniques that improve precision, reduce surgical trauma, and speed up patient recovery, identification of biomarkers, and understanding of the molecular characteristics of tumors that allow for more targeted therapeutic strategies, and incorporation of advanced technologies that improve diagnostic accuracy and efficacy. This review aims to guide healthcare professionals and lay the groundwork for future research and innovative treatments in thyroid surgery.

Comprehensive Analysis of the Clinical Outcomes, Lifestyle Impacts, and Family Satisfaction in Hirschsprung's Disease: A Retrospective Cohort Study from a Single Pediatric Surgery Unit

Background: Hirschsprung's disease (HD) is a congenital condition causing functional bowel obstruction. Despite surgical advancements, long-term impacts on patients' quality of life, family dynamics, and satisfaction remain underexplored. This study evaluates the clinical outcomes, lifestyle impacts, and family satisfaction in HD management. Methods: A retrospective cohort study analyzed 127 HD cases managed in a single pediatric surgery unit (2004–2020). Data from medical records, surveys, and structured interviews assessed surgical outcomes, postoperative bowel function, school attendance, dietary adjustments, social anxiety, and family satisfaction. The quantitative analysis utilized SPSS v25.0, with p-values &lt;0.05 considered statistically significant. Results: Patients had a mean age at surgery of 10.6 months; 72.4% were male. Surgical interventions included one-stage pull-through (51.2%) and staged procedures (48.8%). Complications like persistent constipation (26.8%), enterocolitis (15.0%), and redo surgeries (6.3%) were common. Functional outcomes showed that 81.1% achieved good bowel function, while 14.2% required occasional medication. Rural patients faced higher absenteeism (45% vs. 30%) and restrictive dietary changes (50% vs. 35%). Family satisfaction was high (73.2%), with concerns about long-term bowel management (65%), psychosocial impact (38%), and financial burdens (21%). Conclusions: This study highlights the multifaceted challenges of HD management, including disparities in rural vs. urban care, persistent complications, and psychosocial impacts. Recommendations include multidisciplinary care, genetic counseling, family-centered support, and public health interventions tailored to regional needs. These findings advocate for enhanced strategies to improve surgical outcomes, address long-term care challenges, and elevate family satisfaction.

Surgical advances in the stone age: Unveiling the art of healing.

Surgical advances in the stone age: Unveiling the art of healing.

Managing Lead Fractures in Deep Brain Stimulation for Movement Disorders: A Decade-Long Case Series from a National Neurosurgical Centre.

Background: Deep brain stimulation (DBS) is an effective treatment for movement disorders, but its long-term efficacy may be undermined by hardware complications such as lead fractures. These complications increase healthcare costs and necessitate surgical revisions. The frequency, timing, and clinical factors associated with lead fractures remain poorly understood. Objective: This study aimed to determine the incidence, timing, and clinical factors associated with lead fractures in a large cohort of DBS patients over a 10-year period. Methods: This retrospective study analyzed data from 325 patients who underwent bilateral DBS implantation at the National Centre for Neurosurgery from 2013 to 2023. The analysis specifically focused on 17 patients who experienced lead fractures during the long-term follow-up period. Results: Among the 325 patients, lead fractures were identified in 17 patients (5.23%), affecting 18 electrodes. The majority of cases involved patients with Parkinson's disease (76.5%) or dystonia (23.5%), with an average age of 59.17 ± 8.77 years. Nearly all patients with lead fractures had a history of trauma. Additionally, two cases were associated with active engagement in sports, particularly activities involving movements like pulling up on a horizontal bar, while Twiddler's Syndrome was identified in two other cases. All electrode fractures required surgical revision. Conclusions: Lead fractures, while rare, remain a significant complication in DBS systems. Precise surgical techniques, early detection, and advancements in DBS hardware design may help to mitigate this risk. Future innovations, such as durable leads or wireless systems, may improve long-term outcomes in DBS therapy for movement disorders.

Effectiveness of contemporary surgical approaches and prosthetic rehabilitation in the management of ameloblastoma: a narrative review of functional and aesthetic outcomes

Ameloblastoma, a benign yet aggressive odontogenic tumour poses significant challenges in management due to its potential for recurrence and impact on oral functionality and aesthetics. Effective treatment necessitates a combination of surgical resection, bone reconstruction, and prosthetic rehabilitation. This review aims to evaluate contemporary surgical approaches and prosthetic rehabilitation strategies for managing ameloblastoma, focusing on functional and aesthetic outcomes to enhance patient recovery and quality of life. A narrative review was conducted using scholarly databases, incorporating articles published in English from 2013 to 2023. Studies were selected based on their focus on surgical approaches and prosthetic rehabilitation outcomes. A systematic framework categorized surgical techniques (radical, conservative) and prosthetic methods (fixed, removable, or implant-supported). Radical segmental resection with sufficient safety margins emerged as the preferred surgical approach to minimize recurrence. Immediate reconstruction using autogenous bone grafts, particularly vascularized fibula free-flaps, demonstrated high success rates and improved quality of life. Implant-supported prosthetics showed enhanced functional and aesthetic recovery, with immediate implants yielding better survival rates. Technological advancements such as CAD/CAM and 3D printing improved surgical precision and patient outcomes. Contemporary surgical and prosthetic advancements significantly enhance the management of ameloblastoma. Integrating innovative techniques with long-term follow-up ensures optimal functional and aesthetic results, contributing to improved patient satisfaction and recovery.

A Comparative Study of Laparoscopic Skills Between Novices and Experts: How to Steepen the Learning Curve.

Introduction and aim Laparoscopic surgery has revolutionized the field of surgery over the past few decades. The learning curve in laparoscopy is known to be slow, flat, and complex. This study aims to conduct a comparative analysis of laparoscopic skills, specifically focusing on suturing, knot tying, and needle handling, between novices and experts. The purpose is to objectively quantify the disparities in skill proficiency, identify specific areas needing improvement in training curricula, and contribute to the development of more effective training methodologies for emerging laparoscopic surgeons. Methods Residents from different specialties and institutions had their laparoscopic training and evaluation sessions recorded during their curriculum and compared with the performance of experienced surgeons from the Hôtel-Dieu de France University Hospital (Beirut, LBN) during live surgeries. This comparative study was based on the universally recognized Global Operative Assessment of Laparoscopic Skills (GOALS) score and an assessment of a detailed set of laparoscopic skills and techniques used during needle handling and knot tying. Results Twenty-one tasks performed by novices and 11 tasks performed by experts were considered. A significant difference was found in the GOALS score between the two groups (experts: 23.4/25; novices: 15.9/25). Moreover, a statistically significant difference was found to be present in favor of the experts in the following skills/techniques: using thread handling and forceps rotation for needle manipulation, laying the needle on a fixed driver arm before grasping it, using needle curvature for knot tying, using upward-facing forceps convexity when tying, using an open thread loop before tying, thread handling capacity, knot tying capacity, and number of needle skills performed per task. Conclusion This study demonstrates that many micro-steps in laparoscopic suturing are more prevalent among expert surgeons than among trainees. Incorporating these micro-steps into training could significantly accelerate learning curves, enabling trainees to refine their skills more efficiently and keep pace with the latest surgical advancements in their specialties.

Bone-marrow-based augmentation in rotator cuff repair—from microfracture to bone marrow aspirate concentrate

AbstractRotator cuff tears are a major cause of shoulder dysfunction, and relatively high rates of rotator cuff re-tear persist despite surgical advancements, particularly in patients with poor biological healing potential. Bone-marrow-based augmentation techniques, specifically bone marrow stimulation (BMS) and bone marrow aspirate concentrate (BMAC), have been introduced to enhance the biological environment at the repair site, potentially improving outcomes. Bone marrow stimulation, commonly achieved through microfracture, stimulates the release of growth factors and mesenchymal stem cells (MSCs) from the bone marrow to promote tendon-to-bone integration. Although simple and cost-effective, clinical results for BMS augmentation in rotator cuff repair (RCR) are mixed, with most recent meta-analyses not demonstrating a clinically significant superiority over conventional RCR. Augmentation with BMAC offers a more sophisticated approach, concentrating MSCs and anti-inflammatory cytokines to directly enhance the healing process. Preclinical studies have shown promising results with BMAC augmentation, demonstrating improved tendon integrity and biomechanical strength. The existing clinical studies suggest BMAC may reduce re-tear rates and enhance tendon healing, although outcomes are not yet universally optimal. The current evidence highlights the potential of these techniques, particularly as a potential treatment option in biologically challenging cases. However, the variability in clinical outcomes underscores the need for further research to refine these methods and establish their role in routine clinical practice.

Racial disparities in early postoperative proximal humerus fracture outcomes: Do minorities face longer operative times, extended hospital stays, and higher risks?

Racial disparities in orthopedic surgery outcomes have been extensively documented, highlighting systemic biases in care. Proximal humerus fractures (PHFs), about 6% of all fractures, are rising, especially among the elderly. Despite the prevalence of PHFs, a research gap exists regarding racial disparities in postoperative complications and outcomes. Data from the American College of Surgeons NSQIP database from 2006 to 2021 were analyzed, including 41,285 patients with PHFs. CPT and ICD codes guided inclusion and exclusion criteria. Propensity-score matching balanced a cohort of 17,052 patients. Demographic variables, comorbidities, and outcomes were analyzed using univariate statistics, chi-square tests, and Fisher's exact tests. Post propensity-score matching, significant demographic disparities emerged between white and minority patients. Minority patients had longer operative times (p < .001) and hospital stays (p = .001) than white patients. Minority patients also exhibited higher rates of mortality (p = .04) and unplanned re-intubation (p = .04). This study revealed significant racial disparities in early postoperative outcomes for PHFs. Despite surgical advancements, minorities have prolonged operative times, extended hospital stays, and heightened risks of adverse events. Action is needed to ensure healthcare equity and justice and to address disparities in PHF surgical management across diverse demographics. III.

Outcome Variation of CO 2 Laser and MicrodrillAssisted Stapedotomy in Otosclerosis

Background: CO2 laser and microdrill-assisted stapedotomy are widely performed procedures in otolaryngology practice. However, definite information regarding surgical advances, postoperative results, complications and how and in which patients these surgical techniques should be exclusively used is a source of continuous discussion. Aim: To compare the outcome of CO2 laser and microdrill-assisted stapedotomy in patients with otosclerosis. Methodology: We enrolled 26 cases as study sample on the basis of selection criteria. All these patients were evaluated by a complete clinical head and neck examination, preoperative oto-microscopic evaluation,pure tone audiometry (PTA) and a high-resolution CT scan.One group of patientswere treated by CO2 laser stapedotomy, and another group by microdrill-assisted stapedotomy. Fisher’s Exact test and Student’s t-test were done as appropriate, and a p-value &lt;0.05 was considered as the level of significance. Results: Maximum patients 9(69.2%) and 7(53.8%) were in the age group of 20-30 years in Group A (CO2 laser stapedotomy) and Group B (Microdrill assisted stapedotomy), respectively. The difference in the mean postoperative air–bone gap was not statistically significant (p=0.679) between the groups. All surgical procedures compared in our study showed the surgical success of &gt; 90%. In present study, 8(61.5%) and 9(69.2%) of the study subjects presented with tinnitus in the CO2 and Microdrill groups, respectively. 1(7.7%) and 1(7.7%) of the study subjects presented with dizziness in both groups, respectively. At 3 months postoperative follow-up, only 1(7.7%) case in the CO 2 laser group and 4(30.8%) cases in the Microdrill group developed complications. Among them, 1 (7.7%) and 2(15.4%) cases developed permanent vertigo in CO2 and Microdrill groups, respectively. 1(7.7%) case developed chorda tympani injury, and 1(7.7%) case developed worsened tinnitus in the Microdrill group. No significant (p&gt;0.05) difference was observed between the groups regarding postoperative complications at 3 months. Conclusion: After analyzing the results of the present study, it can be concluded that there is no significant difference between CO2 laser and microdrill-assisted stapedotomy in terms of hearing outcome and complication. Bangladesh J Otorhinolaryngology 2024; 30(1): 15-23

The learning curve and outcomes of 1038 endoscopic endonasal transsphenoidal pituitary tumor surgeries - A single surgical team experience.

Pituitary adenomas rank third among adult intracranial tumors, with an incidence of 3.9- 7.4 cases/per 100,000 annually. Transsphenoidal surgery has evolved to include endoscopic endonasal surgery (EEA) in many centers due to technological and surgical advancements over the past two decades. We aim to analyze a 12-year cohort of pituitary adenomas operated through EEA, highlighting the evolution of surgical techniques and outcomes. A retrospective review of patients undergoing EEA was conducted. A team of an otolaryngologist and neurosurgeon performed surgeries. The cohort was divided into three groups: Phase 1 (P1, 2012-2015), Phase 2 (P2, 2016-2019), and Phase 3 (P3, 2020-2023). Patient demographics, clinical data, and outcomes were collected from electronic medical records and compared over time. The mean age was 54.2 years, with 53.5% being female. The gross total resection rate was 75.6%, increasing from 62.3% in P1 to 76.3% in P3 (P = 0.003). The mean operative duration was 274.61 min, with no significant correlation to case number. Complication rates, excluding cerebrospinal fluid (CSF) leaks, were similar between the groups, with no statistically significant differences observed for complications such as visual deficit, cranial nerve palsy, and epistaxis. However, meningitis decreased significantly from 3.8% to 0.3% (P < 0.001). Intraoperative CSF leaks decreased from 65.1% to 55% (P = 0.003). The need for revision surgery was lower in P3 (8.5% vs. 5.4% vs. 2.1, P < 0.001). Length of hospitalization decreased from 5.3 days to 3.9 days (P < 0.001). Our experience with EEA for pituitary adenomas shows significant improvements in surgical outcomes, reduced complications, and better postoperative management, underscoring the importance of experience, technical refinement, and a multidisciplinary approach.

Paul I. Terasaki, Ph.D: a pioneer in transplant medicine and a dedicated philanthropist.

In the last five decades, remarkable surgical and medical advances ensued within the field of organ transplantation. These strides were marked by significant breakthroughs in transplant immunology, with Dr. Paul I. Terasaki standing as a true pillar of the field. This article highlights major milestones in Dr. Terasaki's life, his groundbreaking accomplishments in the field of transplant medicine, and his enduring philanthropic contributions to numerous medical and community organizations.

Hepatocellular carcinoma recurrence after liver transplantation: risk factors, targeted surveillance and management options

Hepatocellular carcinoma (HCC) represents a well-recognized indication for liver transplantation (LT), with improving graft and patient survival rates due to medical and surgical advancements over time. Despite the implementation of selection criteria to ensure the highest transplant benefit, post-LT recurrence of HCC is not uncommon and is often associated with poor outcomes. Therefore, a post-transplant surveillance strategy appears to be a cost-effective approach, particularly in the early post-surgery period when the recurrence rate is high. Although specific guidelines are still lacking, emerging strategies tailored to pre-transplant tumor history and explant pathology show promise. Moreover, new immunosuppressive therapy schemes and aggressive management of post-transplant medical complications can be implemented to reduce the risk of cancer recurrence. Finally, multimodal oncological strategies are increasingly used to improve survival even after cancer recurrence. This paper reviews the evidence on HCC recurrence after LT, providing insights into risk factors, targeted surveillance, and management strategies.

Risk Factors and Outcomes of Perioperative Extracorporeal Membrane Oxygenation in Neonates and Infants Undergoing Truncus Arteriosus Repair.

Background: Despite surgical advances, neonatal truncus arteriosus repair remains high risk and approximately 10% of patients receive perioperative extracorporeal membrane oxygenation (ECMO). We aimed to assess factors and outcomes associated with the use of perioperative ECMO in infants undergoing truncus arteriosus repair. Methods: We conducted a retrospective cohort study of patients who underwent truncus arteriosus repair between 2004 and 2019, using administrative data from the Pediatric Health Information System database. Results: We identified 1,645 neonates and infants who underwent truncus arteriosus repair at 49 centers, of which 141 (8.6%) received ECMO. Prematurity (adjusted odds ratio [aOR], 2.06; 95% CI, 1.38-3.06; P < .001), truncal valve intervention (aOR, 4.69; 95% CI, 2.56-8.59; P < .001), and interrupted aortic arch repair (aOR, 1.80; 95% CI, 0.96-3.38; P = .07) were associated with perioperative ECMO. Hospital mortality occurred in 87 of 141 (62%) patients who received ECMO compared with 77/1504 (5.1%) who did not require ECMO(aOR, 13.39; 95% CI, 8.70-20.61; P < .001). In the 1,481 patients who survived to hospital discharge, ECMO was associated with higher rates of postoperative length of stay >30 days (63% [34/54] vs 28% [400/1427]; aOR 2.65; 95% CI, 1.24-5.64, P = .012) and hospital readmission within 90 days (61% [33/54 [ vs 33% [474/1427] [; aOR, 2.66; 95% CI, 1.47-4.82; P = .001). Conclusions: Prematurity, truncal valve intervention, and interrupted aortic arch repair are important risk factors that could help predict the use of perioperative ECMO. Extracorporeal membrane oxygenation utilization is strongly associated with greater odds of hospital mortality, prolonged postoperative length of stay, and higher rates of hospital readmission in surviving patients.

Interventions for Fluid Collections in Acute Pancreatitis: Expanding Horizon

AbstractManaging pancreatic fluid collections (PFCs) in acute pancreatitis has undergone a paradigm shift. Endoscopic and surgical advancements have led to the development of safer and more effective techniques for draining PFCs and performing necrosectomy. These techniques have been effectively incorporated into the step-up approach. Percutaneous catheter drainage remains the cornerstone for managing PFCs, although its role has changed with the advent of endoscopic ultrasound-guided techniques. PFC management relies heavily on interdisciplinary collaboration. All the techniques must be considered complementary rather than competitive. The preference for one method over the other must consider the patient factors and availability of expertise. This review entails a detailed discussion of the intervention of PFCs with the latest available evidence.

Surgical Advances in the Treatment of Acromioclavicular Joint Injury: A Comprehensive Review.

In this article, we aim to review the diagnosis, classification, and treatment of acromioclavicular joint injury by mainly describing the progress of surgical treatment for acromioclavicular joint injury, providing a reference for clinical diagnosis and treatment. Acromioclavicular joint injury is a common sports injury, which is more common in male than in female patients. The mechanism of the injury is mainly caused by direct or indirect violence, which can be clearly diagnosed by radiography. According to the time after injury, it can be divided into acute injury and chronic injury. The Rockwood classification is the most commonly used classification in research. For Rockwood types V to VI, we treat with surgery, while the treatment options for type III are controversial and no consensus has been reached. Surgical treatment can be divided into open surgery and shoulder arthroscopy. The methods of open surgery can be divided into 3 categories: direct acromioclavicular joint fixation, coracoclavicular space suspension device fixation, and coracoclavicular ligament reconstruction. The shoulder arthroscopy method involves reconstruction of the coracoclavicular ligament under arthroscopy, combined with suture-button suspension fixation. For patients with Rockwood classification III and IV-VI, who have significant movement needs, surgery is the preferred treatment for acute acromioclavicular dislocation within 3 weeks. For patients with a chronic acromioclavicular dislocation or who do not respond to nonsurgical treatment, it is recommended to use wire suspension fixation combined with ligament to repair the damage. This article aims to review advances in the management of acromioclavicular joint injury.

Preoperative Evaluation, Informed Consent and Postoperative Care in Pediatric Vitreoretinal Surgery

In childhood, vitreoretinal surgery may be required due to trauma and some congenital or developmental disorders. Pediatric vitreoretinal surgery differs from that of adults in terms of etiology, anatomical and surgical characteristics, response to treatment and follow-up. This process has many challenges that require patient follow-up over many years as the child develops. Pre-operative preparation according to the age of the patient and the nature of the pathology will make it easier for the surgeon to manage all the processes. The consent of the child must be obtained in accordance with the child's cognitive abilities, in addition to the informed consent of the family. Despite surgical and technological advances in pediatric vitrectomy, anatomical and functional outcomes are worse than in adults. This article discusses pediatric vitreoretinal surgery in terms of preoperative preparation, informed consent and follow-up.