Surgical Instruments Research Articles

The Use of Nanosecond Pulsed Fibre Laser Treatment to Improve the Corrosion Resistance of 316L SS Utilised as Surgical Devices

The nanosecond pulsed fibre laser (NsPFL) treatment is extensively employed to distinguish hospital surgical instruments (micro-surgical forceps, surgical blades, orthopaedic drills, and high-precision laparoscopic tools), which are generally composed of stainless steel. Nevertheless, if the laser parameters are not properly optimised, this process may unintentionally provoke corrosion. Maintaining the structural integrity of these materials is essential for ensuring patient safety and minimising long-term costs. This work aims to optimise the laser scanning parameters for marking 316L stainless steel (316L SS), seeking to improve its corrosion resistance. The corrosion behaviour was assessed by using open circuit potential (OCP), potentiodynamic polarisation curves (PPc), and electrochemical impedance spectroscopy (EIS) techniques, conducted in 0.9% wt NaCl solution at a controlled temperature of 25 ± 1 °C. A comprehensive study employing optical profilometry has significantly enhanced our understanding of the corrosion micromechanisms of 316L SS, comparing specimens both with and without NsPFL treatment. Considering applications involving environments rich in chloride ions, the results indicated that the NsPFL-316L SS samples demonstrated markedly enhanced performance compared to the untreated base material after 48 h of immersion in 0.9% wt NaCl solution. This improvement is particularly noteworthy given the widespread utilisation of 316L SS in the manufacturing of surgical instruments, where corrosion resistance is of paramount importance.

Splash Basins in the Operating Room: Clean or Contaminated? A Study on Bacterial Contamination in Splash Basins Used to Rinse Surgical Instruments During Surgery

Background: Preventing postoperative infection and promoting patient safety are essential responsibilities of the operating room nurse. In some hospitals, splash basins are used to rinse instruments during surgery, although previous studies emphasise the risk of bacterial contamination. A recent systematic review calls for further investigation into surgical teams’ use of splash basins. Objectives: Our objective was to investigate bacterial contamination in splash basins and to identify the variables that may have an influence on this contamination. Methods: This prospective observational pilot study involved collecting, cultivating, and analysing water samples obtained from splash basins during operations performed in the thoracic and neurosurgical departments. The ventilation systems, length of surgery, number of instruments in the splash basin, number of persons present in the operating room, frequency of door openings during surgery, and type of bacteria were observed. Results: Bacterial growth was found in 44% of the final water samples: 41% from the thoracic surgical department, which had laminar airflow ventilation systems/unidirectional airflow ventilation, and 47% from the neurosurgical department, which had conventional ventilation systems/turbulent mixing ventilation. However, the binary logistic regression analysis revealed no significant correlation between bacterial growth and the ventilation systems, length of surgery, number of instruments in the splash basin, number of people in the operating room, or frequency of door openings. The most common types of bacteria found were coagulase-negative staphylococci and Micrococcus luteus. Conclusions: Splash basins become contaminated with bacteria during surgery. Therefore, using splash basins with sterile water is not recommended. Further research is needed to determine the best evidence-based practice for rinsing instruments perioperatively.

Neural fields for 3D tracking of anatomy and surgical instruments in monocular laparoscopic video clips

Neural fields for 3D tracking of anatomy and surgical instruments in monocular laparoscopic video clips

A review of wrist mechanism design and the application in gastrointestinal minimally invasive surgery of multi-degree-of-freedom surgical laparoscopic instruments.

This paper aims to comprehensively review current designs of Multi-degree-of-freedom (Multi-DOF) wrist mechanisms and the applications of Multi-DOF surgical instruments in gastrointestinal minimally invasive surgery (MIS). By reviewing the advantages and limitations of traditional laparoscopic and robotic surgical instruments, we present the development of Multi-DOF surgical instruments. Then, we summarize the Multi-DOF wrist mechanisms, delineating their pros and cons. Finally, the surgical outcomes and efficiency of Multi-DOF surgical instruments are reviewed. The utilization of Multi-DOF surgical instruments for both benign and malignant gastrointestinal diseases demonstrates perioperative outcomes comparable to traditional laparoscopic and robotic surgeries. In certain aspects, it exhibits advantages such as shorter operative times and faster gastrointestinal function recovery. Further research is needed to effectively combine these driving mechanisms to achieve a new type of transmission mechanism with high rigidity and precision, ample working space, and decoupled degrees of freedom. Multi-DOF surgical instruments offer the advantages of high flexibility and lower costs, displaying good feasibility and safety in practical clinical applications within gastrointestinal surgery. Their promotion in primary care hospitals could benefit a larger patient population. However, more extensive sample-sized multicenter studies are still warranted to elucidate such surgical instruments' advantages further.

Impact of PDCA Cycle Combined with Instrument Mapping on Sterilization and Supply of Surgical Instruments

Objective: To explore the effect of applying the Plan-Do-Check-Act (PDCA) cycle combined with instrument mapping to manage surgical instruments in a hospital sterilization supply center. Methods: A total of 600 surgical instruments in a hospital’s surgical instrument sterilization and supply management center were sampled and grouped based on the introduction of the PDCA cycle combined with instrument mapping. The control group included 300 surgical instruments subject to routine sterilization management from November 2023 to January 2024. The observation group included 300 surgical instruments managed with the PDCA cycle combined with instrument mapping from February 2024 to April 2024. The quality of surgical instrument management, incidence of adverse events, and other indicators were compared between the two groups. Results: The observation group demonstrated significantly higher scores in management quality indices compared to the control group, with scores for disassembly and assembly (93.28 ± 1.57 vs. 87.41 ± 1.48), cleaning (95.04 ± 2.08 vs. 90.23 ± 2.12), disinfection and sterilization (95.33 ± 1.27 vs. 91.95 ± 1.39), waste disposal (93.26 ± 1.24 vs. 89.65 ± 1.18), packaging and traceability (94.35 ± 1.74 vs. 92.23 ± 1.65), and issuance and recycling (95.79 ± 1.72 vs. 90.22 ± 1.81) (all P < 0.05). The observation group reported two adverse events (one incomplete instrument specification and one case of instrument package overweight) with an incidence rate of 0.67%. Conversely, the control group reported six adverse events (including shortages, incomplete specifications, unqualified sterilization, defective instruments, untimely or incorrect delivery, and overweight instrument packages) with an incidence rate of 3%, demonstrating statistically significant differences between groups (P < 0.05). Conclusion: Applying the PDCA cycle combined with instrument mapping for surgical instrument management in hospital sterilization supply centers significantly improves management quality and reduces adverse events. Its application is recommended for wider adoption in hospital sterilization supply centers.

Kidney stone disease: Practice patterns among urologists in Canada.

Despite kidney stone disease (KSD) guidelines, high-quality evidence for KSD management in Canada is lacking. We aimed to assess Canadian urologists' practice patterns, preferences, and barriers in managing KSD. A cross-sectional survey was distributed to Canadian urologists via the Canadian Urological Association (CUA), Quebec Urological Association (QUA), and Canadian Endourology Group (CEG), as well as directly to urology departments nationwide. Descriptive statistics were used to analyze the results. Of 93 respondents, 47% were from academic centers, 43% from community hospitals, and 10% from mixed/private settings. Most performed over 75 ureteroscopies and fewer than 25 percutaneous nephrolithotomies (PCNLs) annually (67% and 58%, respectively). Holmium:YAG (Ho:YAG) lasers were available in 85% of hospitals, thulium fiber laser (TFL) in 70%, and Ho:YAG with Moses effect lasers in 28%. Preferred surgical devices included the TFL (74.5%), followed by the Ho:YAG laser (24.2%) and Ho:YAG with Moses effect laser (21.7%). Endourology fellowship-trained urologists (53%) were more likely to perform their own PCNL access (90% vs. 23%, p<0.001), metabolic workup (73% vs. 48%, p=0.02), and felt more comfortable prescribing prophylactic and medical treatment for KSD (86% vs. 50%, p<0.01) compared to non-endourology fellowship-trained colleagues. Metabolic workup was delegated to nephrologists or specialized clinics by 38%, mainly due to lack of time (25%) and expertise (25%). Additionally, 71% lacked access to multidisciplinary KSD clinics, with 76% believing such clinics would be beneficial. The study highlights variability in KSD management practices and barriers. Addressing these issues could improve KSD care in Canada and inform future guidelines.

Comparative Efficacy of Three Methods of Lumbar Interbody Fusion for Lumbar Degenerative Diseases in a Tertiary Public Hospital.

To evaluate the clinical efficacy of large-channel endoscope-assisted posterior lumbar interbody fusion (Endo-PLIF), minimally invasive transforaminal lumbar interbody fusion (MIS-TLIF), and open posterior lumbar interbody fusion in the treatment of degenerative diseases of the lumbar spine. The data of 110 patients with degenerative diseases of the lumbar spine were analyzed retrospectively: 31 cases had Endo-PLIF, 36 patients received MIS-TLIF, and 43 cases underwent modified-TLIF. We compared several parameters among the three groups: operative duration; intraoperative blood loss; latent blood loss; intraoperative radiation dose; visual analog scale (VAS) score; Oswestry Disability Index (ODI); anterior protrusion angle of the intervertebral space; postoperative ambulatory time; postoperative duration of hospital stay; complications. The prevalence of interbody fusion was observed at follow-up. The operative duration of Endo-PLIF was longer than that of MIS-TLIF and modified-TLIF (P <0.05). In terms of intraoperative blood loss, latent blood loss, and recovery time, Endo-PLIF and MIS-TLIF had clear advantages (P <0.05). The VAS score and ODI of the three groups were satisfactory, but the low-back pain of patients in the Endo-PLIF group and MIS-TLIF group was less than that in the modified-TLIF group (P <0.05). In terms of complications and prevalence of interbody fusion, there were no significant differences among the three groups (P >0.05). All three operative methods had satisfactory efficacy. Endo-PLIF can be employed to treat lumbar degenerative diseases more precisely and in a minimally invasive fashion, but a learning curve and improvement in surgical instruments are needed.

Broken Drill Bits During Surgical Procedures: A Review of 156 Patient Safety Events

Background Broken surgical drill bits pose a risk to patient safety. A routine review of event reports submitted to the Pennsylvania Patient Safety Reporting System (PA-PSRS) uncovered an increase in the number of event reports related to broken drill bits, prompting an exploration to better understand patterns of drill bit breakage in Pennsylvania. Methods We queried the PA-PSRS database to identify event reports describing a broken drill bit during surgery submitted between January 1, 2021, and December 31, 2023. Event reports were manually coded to identify the procedure, anatomic location of breakage in the patient’s body, timing of discovery, and fragment fate. Results A total of 156 relevant event reports were identified. The procedure being performed was determined in 64 of 156 event reports. Fracture repair procedures were most commonly reported to encounter a broken drill bit (27 of 64; 42.2%). We were able to determine the anatomic location in the patient’s body where the drill bit breakage occurred in 108 of 156 event reports. The most commonly reported anatomic location was the femur (27 of 108; 25.0%). We were able to determine the fate of the broken drill bit in 141 of 156 event reports, and most drill bits were retained in the patient (99 of 141; 70.2%). Conclusion This data analysis provides insight into broken drill bits in Pennsylvania facilities. Because drill bits are commonly broken pieces of equipment and the fragments from these broken pieces are frequently retained, it is important to prevent drill bit breakage to improve patient safety. Table 2 (251188) outlines prevention strategies established by equipment manufacturers and previous research. Implementing these strategies can address breakage across multiple procedures and patients. Plain Language Summary While a rare occurrence, surgical instruments may break during a procedure. In the case of drill bits, which are one of the most frequently broken surgical instruments, pieces that are left inside of a patient could cause harm, and may migrate to other parts of the body. When Patient Safety Authority researchers noted an increased number of events involving broken and retained drill bits during surgery, they analyzed data from the Pennsylvania Patient Safety Reporting System (PA-PSRS) to help decrease the risk of broken drill bits in surgery. In studying cases involving a drill bit breaking during surgery, researchers learned that most of these events occurred during fracture repair procedures and joint replacement surgery, and drill bits most frequently broke in the femur (thigh bone). In most event reports, the broken drill bit was discovered during the procedure, but in 2.6% of event reports (4 out of 156 reports) it was discovered after the operation. Removing drill bit fragments is recommended; however, surgeons may decide to leave them in place if removal risks damage to the surrounding area, and in many event reports broken drill bits were retained following the surgery with no further intervention. Hospitals and surgical facilities should look to existing literature and device manufacturers’ guidelines for prevention strategies, such as recommended surgical techniques; drill bit sterilization, reprocessing, and storage; and general safety measures, some of which are summarized in the article.

Concept and Design of Cutting Tools for Osseodensification in Implant Dentistry

Osseodensification is an innovative surgical instrumentation technique based on additive (non-cutting) drilling using special burs. It is known from the literature, that the osseodensification burs should operate in a clockwise direction to drill holes and in a counterclockwise direction to compact the osteotomy walls. For these purposes, the burs have special design features, like conical contour shape, increased number of helical flutes, and negative rake angle on the peripheral part. However, although other parameters and features of the burs define their overall performance, they are not described sufficiently, and their influence on surgical quality is almost unknown both for clinicians and tool manufacturers. The purpose of the present research is to identify the key design features of burs for osseodensification and their functional relationship with the qualitative indices of the procedure based on an analytical review of research papers and patent documents. It will help to further improve the design of osseodensification burs and thereby enhance the surgical quality and, ultimately, patient satisfaction. Results: The most important design features and parameters of osseodensification burs are identified. Thereon, the structural model of osseodensification bur is first represented as a hypergraph. Based on the analysis of previous research, functional relationships between design parameters of osseodensification burs, osseodensification procedure conditions, and procedure performance data were established and, for the first time, described in the comprehensive form of a hypergraph. Conclusions: This study provides formal models that form the basis of database structure and its control interface, which will be used in the later developed computer-aided design module to create advanced types of burs under consideration. These models will also help to make good experimental designs used in studies aimed at improving the efficiency of the osseodensification procedure.

The effect of energy modality on tissue identification from surgical smoke by differential ion mobility spectrometry

Surgical smoke analysis offers a way to provide assisting information to the surgeon intraoperatively, which can be potentially used to assess cancer tumor margins in surgical oncology and alert the operator of accidental organ injuries caused by electrosurgical (ES) instruments. Surgical smoke content is affected by the energy instrument it is produced by. Classification of surgical smoke by differential ion mobility spectrometry (DMS) was evaluated with 6 porcine tissue types and 5 energy instruments. Instruments consisted of mono- and bipolar instruments, ultrasonic shears and a –blade. Machine learning was used to classify tissues by training binary classifier linear discriminant analysis (LDA) to distinguish a marked tissue class from the rest. The greatest binary classification accuracies were obtained with the monopolar instruments and the lowest with the bipolar instrument, 93.5 % and 77.5 % respectively. The analysis of surgical smoke with DMS is possible with a variety of energy instruments, however with varying performance. This implies that DMS based tissue identification is generalizable across different surgical instruments and surgical specialties.

Integration Models for SDC-capable Medical Devices into an Existing OR Network

Abstract The interconnection of medical devices in an operating room (OR) represents a major step in optimizing clinical processes and increasing the quality of treatment. The IEEE 11073 Service-oriented Device Connectivity (SDC) standard family constitutes the foundation for manufacturerindependent information exchange and remote control of medical devices. However, integrating new SDC-capable devices into an existing OR network poses a major challenge for medical device manufacturers. Thus, suitable integration models are required. This work focuses on the definition of three possible integration models and their comparison according to architectural design patterns. Thereby, the use case of integrating a high-frequency (HF) surgical device to interconnect with existing SDC-capable devices is pursued. One of the models, which focuses on high expandability and low coupling, was successfully applied to interconnect an HF surgical device with an OR light in the research OR of Reutlingen University. The results indicate transferability to other integration scenarios and are intended to further promote manufacturer-independent integrated ORs.

New technologies in breast surgery: combined use of superparamagnetic iron oxide nanoparticles and 3D printed surgical instruments

New technologies in breast surgery: combined use of superparamagnetic iron oxide nanoparticles and 3D printed surgical instruments

Implications of compressive loading of the stomach wall: Interplay between mechanical deformation and microstructure.

During gastric surgery, the stomach wall is compressed with clamps and sutures or staple lines. These short- and long-term deformations can severely compromise the integrity of the tissue and make it difficult for the stomach wall to respond and remodel to the new loading conditions. Consequently, serious intra- and postoperative complications such as the formation of leaks during bariatric surgeries, can be associated with these immense tissue deformations. Hence, the study aimed to investigate the effects of compressive loading of the stomach wall in the radial direction. This was done by macroscopic mechanical loading of the stomach wall in each region of the stomach and evaluating the microstructural changes inflicted in the tissue. For this purpose, several imaging techniques were used, i.e., a histological analysis, second-harmonic generation microscopy, and X-ray micro-computed tomography. The combination of these three methods allowed us to investigate the gradual compression of the different stomach layers as well as the local reorientation and deformation of the main microstructural components, e.g., collagen fibers and muscle bundles. Importantly, this study found that the collagen bundles in the stomach wall straighten and reorient toward the circumferential-longitudinal plane and partially fan out with increased radial compressive deformation. The 3D scans of the stomach wall indicated a deterioration of the blood vessels and buckling of the mucosal glands due to compression. Statement of significance Unfortunately, little is known about the load transfer in the stomach wall during gastric surgery and the associated deformations on the macro- and microscale. The present study investigates the structural changes of the stomach wall, its layers and the inherent biological building blocks using histology, multi-photon microscopy, and micro-computed tomography. For the first time, the layer-specific response to stepwise radial compression of the stomach wall was studied, the related collagen fiber parameters were estimated, and a 3D sample structure was visualized. This clinically-oriented study links the structural changes within the wall to the postoperative remodel- ing process and the irreversibly altered gastric motility, thereby underscoring its relevance to the field of biomedical engineering, e.g., the development and improvement of surgical instruments.

Development of an artificial intelligence model for wire electrical discharge machining of Inconel 625 in biomedical applications

AbstractSuperalloys, particularly nickel alloys such as Inconel 625, are increasingly used in biomedical engineering for manufacturing critical components such as implants and surgical instruments due to their exceptional mechanical properties and corrosion resistance. However, traditional machining methods often struggle with these materials due to their high strength and thermal conductivity. This study investigates the application of Wire Electrical Discharge Machining (WEDM) as an advanced method for processing Inconel 625 in biomedical contexts. The authors develop an Adaptive Neuro‐Fuzzy Inference System for forecasting WEDM parameters using grey‐based data. The model's variable inputs are analysed through analysis of variance (ANOVA) and Taguchi design, aiming to optimise process performance attributes relevant to biomedical applications. Comparative studies between predicted and experimental data demonstrate a high degree of accuracy, indicating that the proposed model effectively enhances the machining process. The results suggest that this intelligent system supports decision‐making in the production of high‐quality biomedical devices and components.

A Study on the Carbon Dioxide Laser

Abstract: One of the first gas lasers to be created was the carbon-dioxide laser (CO2 laser). One of the most practical kinds of lasers, it was created in 1964 by Bell Labs' Kumar Patel [22]. The most powerful continuous-wave lasers on the market right now are carbon-dioxide lasers. Additionally, they are quite efficient; the output power to pump power ratio can reach 20%. The primary wavelength bands of the infrared light beam produced by the CO2 laser are 9.6 and 10.6 micrometers (μm). [22] In order to improve its performance, a carbon dioxide laser uses carbon dioxide as its main gain medium. Nitrogen (N2), helium (He), and occasionally hydrogen (H2), water vapor, oxygen, or xenon (Xe) are added. This laser works by energizing the gas mixture to produce laser light by promoting the emission of radiation by an electrical gas discharge. In carbon dioxide lasers, the electrical gas discharge can be powered by radio frequency (RF), direct current (DC), or alternating current (AC). The wavelength of the light emitted by these lasers is 10.6 micrometers. In dermatology, they are frequently used for operations like wrinkle reduction, scar removal, and sun damage treatment. Furthermore, for accurate cutting and tissue removal, carbon dioxide lasers are employed as surgical instruments in specialties such as neurosurgery and gynecology.[24]

A Clinical Study of Integrated Healthcare Management in Process Optimization in an Adult Inguinal Hernia Day Unit

The purpose of this study is to explore the effectiveness of the application of the integrated medical and nursing management model in the optimization of the adult inguinal hernia day ward process. 105 patients who received adult inguinal hernia day surgery treatment in a hospital of general surgery from May 2023 to April 2024 were selected and grouped according to the time node of the introduction of the medical and nursing integration day ward management mode (12 October 2023). 52 patients before the introduction of the mode were included in the control group, while the other 53 patients after the introduction were included in the observation group. A comparative analysis was made for the differences in pre-hospital examination completion rate, day surgery failure rate, average length of stay, hospitalization cost, overall satisfaction, and incidence of adverse events between the two groups under different management modes. The results showed that the prehospital examination completion rate of the observation group (100%) was higher than that of the control group (59.62%), the day surgery failure rate (1.89%) was lower than that of the control group (30.77%), the average length of stay (5.03 ± 1.58 d) was shorter than that of the control group (7.82 ± 1.64 d), and the average cost of hospitalization (8,108.2 ± 264.6 yuan) was less than that of the control group (9,235.6 ± 375.5 yuan). The differences were all statistically significant (P &lt; 0.05). The total satisfaction of patients in the observation group (98.11%) was significantly higher than that of the control group, and the differences were all statistically significant (P &lt; 0.05). In the control group, there was one case of mislabeling of the surgical site, three cases of missing medical documents, two cases of medication dosage errors, two cases of anesthesia accidents, and one case of surgical instruments or gauze left behind, with a total incidence rate of 17.31%. In the observation group, there was only 1 case of missing medical documents and 1 case of medication dosage error, with an incidence rate of 3.77%, and the difference between the groups was statistically significant (P &lt; 0.05). In conclusion, the implementation of integrated medical and nursing management for patients undergoing inguinal hernia surgery can effectively increase patients’ willingness to undergo pre-hospital examination, reduce the day surgery failure rate, shorten the hospital stay, reduce hospital expenses, and reduce the risk of adverse events such as mislabeling of the surgical site, missing medical documents, medication dosage errors, anesthesia accidents, and surgical instruments or gauze left behind, which is highly satisfactory to the patient group. Hence, it is recommended to promote and apply this procedure in other departments.

Dynamic calibration and multi-view fusion of active vision tracking system for surgical instrument

Abstract In recent years, surgical instrument tracking has gained significant attention in the field of surgical navigation. An often-overlooked problem lies in the instrument’s irregular movement conflicting with the tracking system’s fixed viewpoint, leading to line-of-sight (LOS) occlusion, marker occlusion, and sub-optimal accuracy. The active vision tracking system (which actively adjusts the camera viewpoint) is applied to address this issue. In this paper, two algorithms of multi-view fusion and dynamic calibration are proposed in multi-camera active vision to allow each camera to adjust its viewpoint independently. These algorithms are integrated into the parallel computing of the frontend and backend to implement the positioning of the instrument from multiple perspectives and real-time calibration of multiple cameras. Simulations and experiments are carried out to test the accuracy and robustness of the proposed tracking system. Results reveal that our system achieves a closer trajectory (0.12 mm) to the ground truth compared to a stereo camera tracking system (0.32 mm). The proposed tracking system is able to keep track of the instruments within the positioning volume at different surgical phases, ensuring consistent navigation and improving positioning stability and accuracy.&amp;#xD;

Comparison of Phacoemulsification and Aspiration Parameters in Cataract Surgery: Metal Tip vs. Hybrid Tip

Various tips are available for phacoemulsification in cataract surgery. Evidence-based data can inform ophthalmologists, especially inexperienced ones, on tip selection. We retrospectively evaluated the energy efficiency and other parameters of two ultrasonic phacoemulsification and aspiration tips across different nuclear hardness grades in 342 cataract patients (342 eyes) with nuclear hardness grades II to IV. Surgical procedures, ultrasound settings, and instrumentation were standardized. All surgeries were performed by one experienced doctor. We compared the metal INTREPID® Balanced Tip (M-tip) with the INTREPID® Hybrid Tip (P-tip), which has a polymer coating. The M-tip required significantly less total ultrasound time and cumulative dissipated energy (CDE) than the P-tip for grades III and IV, while the P-tip had a shorter aspiration time and less estimated fluid aspirated for grade II. No differences in corneal endothelial cell loss were observed. Lens rupture rates were low: 0.47% for the M-tip and 0.78% for the P-tip. Multiple regression analysis showed that CDE increased with nuclear hardness. These findings suggest that the M-tip is efficient for harder lenses, while the P-tip may be advantageous for softer lenses, informing optimal tip selection in cataract surgery. Further research is suggested to elucidate their clinical significance.

Current Status and Considerations on Endoscopic Diagnosis and Treatment of Subepithelial Microlesions in the Digestive Tract

The detection rate of subepithelial lesions in the digestive tract, especially microlesions (≤ 1 cm in diameter), has significantly increased. Historically, periodic follow-up or surgical resection has been recommended by scholars. Due to the potential risk of malignancy, regular follow-up carries certain risks, while surgical resection, though effective, is highly invasive with a high risk of complications. With the rapid development of endoscopic techniques, more and more subepithelial lesions in the digestive tract have been successfully treated through endoscopic submucosal dissection and endoscopic full-thickness resection. However, these methods require a high level of skill and are associated with significant costs for surgical instruments and materials. Therefore, it is worth exploring whether a simpler and more efficient treatment can transition patients from observation to proactive treatment. A modified technique combining snare, long transparency cap, and Argon Plasma Coagulation under endoscopy has advantages over traditional methods, such as being simpler to perform, less prone to complications, and more cost-effective. This article reviews the current status and considerations of endoscopic treatment for subepithelial lesions in the digestive tract.

LigaSure versus conventional Milligan MORGAN hemorrhoidectomy in Nigerian patients with symptomatic hemorrhoids.

Hemorrhoidectomy is considered as the most effective approach for patients with grade III and grade IV hemorrhoids; the operative procedure may be associated with significant postoperative pain and other complications. Several surgical techniques and devices have been developed to overcome these postoperative problems. To compare perioperative and postoperative outcomes of hemorrhoidectomy performed with the LigaSure and the conventional Milligan-Morgan hemorrhoidectomy among Nigerian patients with symptomatic hemorrhoids. All consenting adult patients who fulfilled the inclusion criteria were randomized to either conventional Milligan-Morgan or LigaSure hemorrhoidectomy. Outcome measures were the duration of the procedure, estimated blood loss, and resolution of symptoms, which were assessed using the Sodergren hemorrhoids severity score (SHSS). Postoperative pain was evaluated using the visual analog scale (VAS), and the short-term recurrence rate was also checked at 3months. Data were analyzed using the computer software IBM SPSS version 23. Fifty-two patients were randomized equally into the two arms. The median blood loss in the LigaSure group was 10.0mL, whereas the median blood loss in the Milligan-Morgan group was 26.5mL, (p=0.0001). The median postoperative pain at 2weeks using the VAS was 5.5 in the LigaSure group, and in the Milligan-Morgan group, it was 6.0 (p=0.002). The mean duration of surgery in the LigaSure group was 18.04min and 34.19min in the Milligan-Morgan group (p=0.0001). LigaSure hemorrhoidectomy is faster and associated with less blood loss compared to conventional Milligan-Morgan hemorrhoidectomy.