Surgical Parameters Research Articles

Comprehensive Surgical Management of Thoracic Schwannomas: A Retrospective Multicenter Study on 98 Lesions.

The optimal surgical management of thoracic schwannomas (TSs) remains contentious, with various approaches proposed. Video-assisted thoracoscopic surgery (VATS) and combined VATS with neurosurgical procedures have shown promise, particularly for Eden type IV and III lesions. However, unanimous consent on the most effective surgical intervention and understanding of prognostic factors for tumor recurrence needs to be improved. The aim of this study was to elucidate the optimal surgical approach according to the Eden type and investigate predictive factors for TS recurrence. This retrospective, multicentric, observational study analyzed 98 surgically treated patients with TS from 2011 to 2023, assessing preoperative and 6-month follow-up clinical (recurrences, pain, and myelopathy recovery) and surgical parameters (operative time, intraoperative blood loss, extent of resection). Surgical procedures included thoracic laminectomy or hemilaminectomy for type I, laminectomy or thoracic transpedicular (TPD) approach for type II, laminectomy alone or combined laminectomy with VATS for type III, and VATS or thoracotomy (open thoracotomy [OT]) for type IV. Descriptive and deductive analyses were conducted between and within the 4 cohorts, with multivariate analysis assessing the contribution of predictor variables. No significant differences were found between hemilaminectomy and laminectomy for all analyzed parameters for type I. Type II lesions treated with TPD exhibited similar outcomes to laminectomy, albeit with longer procedure times. Type III lesions benefited from combined approaches compared with neurosurgical-only approaches. Video-assisted thoracoscopic surgery emerged as more favorable than OT for type IV lesions. Multivariate analysis revealed that patient sex, tumor location, extent of resection, and pathology significantly influenced recurrence rates. For Eden type III TSs, neurosurgical and VATS combined surgery achieved better outcomes than neurosurgery alone; for Eden type IV TSs, VATS achieved better results than OT. For Eden types I and II, hemilaminectomy and bilateral laminectomy and laminectomy and TPD achieved similar outcomes, respectively.

Aortic Stent Graft Treatment in a Medium-Size Aortic Center Performed by a Cardiac Surgeon Only—The 9 Years Experience in Poland

Background: The incidence of thoracic aortic aneurysms is estimated at 3.0–8.3/100,000 persons per year. There is a lack of reports in the literature on the outcomes of small- and medium-sized thoracic endovascular aortic repairs. The aim of this study is to present the results of thoracic endovascular aortic repairs at a single medium-sized center performed exclusively by a cardiac surgeon. Methods: Ninety patients who had undergone aortic stent graft implantations for the treatment of thoracic aortic anomalies were comprehensively, retrospectively evaluated. The detailed preoperative, surgical, and postoperative parameters of the patients, including the survival rate up to five years, were recorded and further analyzed. Results: The patients’ Euroscores were four (2.1–9). The 30-day mortality rate was 8.9%, the 1-year mortality rate was 15.6%, and the 5-year mortality rate was 38.9% for all causes. Postoperative complications were observed in 10% of the patients. Statistically significant differences were observed between the urgency of surgery at 30 days and survival at one year, but not at five years. The most common complications were related to respiratory (4.4%), renal (3.3%), and neurological (3.3%) dysfunction. Conclusions: Thoracic endovascular aortic repair can be safely performed in small- and medium-sized centers with optimal long-term results.

Stratification risk computation of primary graft gysfunction in heart transplant recipients on a smartphone application

Abstract Introduction There are no standardized guidelines for helping graft allocation in heart transplant (HTx) and accepting transplants from marginal donors and donors after circulatory arrest make decision making even more complex and time consuming than ever. The organ allocation process should include a risk analysis for primary graft dysfunction (PGD) that represents the most dreadful complication of HTx. There are 3 score systems validated to predict PGD but none has clear superior predictive capability compared to the others and the complexity of score computation potentially discourage their clinical use. A score integrating all the variables presented in a user-friendly format should improve efficacy and safeness of the organ allocation process. Methods Severe PGD defined as need for temporary mechanical circulatory support (ECMO) in the first 24 hours following HTx was considered the end-point for risk stratification computation. As a derivation cohort we used meta-analytic approach for identifying variables that are independently associated to severe PGD. The overall prevalence of each variable was determined to define the absolute risk increase value in presence of each factor. We then created a scoring system applying multivariate logistic regression model. As a validation cohort we studied the performance of the score in a retospective series of HTx performed at our institution from 2013 to 2022. We used C statistic equivalent to the area under a receiver-operating characteristic curve for dichotomous outcomes. Values above 0.7 were considered acceptable. We eventually developed an application for smartphone for risk computation. Results On 64 papers screened, 5 studies were considered eligible for the derivation cohort definition. Cumulative number of patients considered was 10’175 with an incidence of severe PGD of 7.1% (CI 5.3 - 10.4) and a 30-day mortality of 41%. 13 variables were identified (table 1). The ROC curve predicted the use of ECMO with the specificity and the sensitivity of 0,81 and 0,92 respectively. We have included in the validation cohort 128 out of 150 transplanted patients, excluding pediatric and double organs transplants. The mean donor age was 45 +/- 12,4 years, 72 (54%) were men. The mean recipient age was 57 +/- 9,3; 92 were men; 32 recipients (25%) needed ECMO support within 24 hours post-transplant; 75% of the donors in the ECMO group were > 40 y.o.; 30 days mortality was 3.1% and 6,2% in the non-ECMO and ECMO group respectively. We validated the model on our cohort defying a binary outcome (ECMO yes/no). Conclusion Clinicians fill donor, recipient and surgical parameters in user-friendly smartphone application identifying patients that are most likely to need ECMO support post HTx. The decision-making process during organ allocation evolves from what was once little more than personal experience and intuition to a reliable evidence-based method based on personalized risk prediction.Table 1

Short-term outcomes and quality of life of esophagogastrostomy versus the double-tract reconstruction after laparoscopic proximal gastrectomy

BackgroundThere is no optimal reconstruction technique after proximal gastrectomy. The esophagogastrostomy (EG) is a rather simple procedure technically, but the incidences of reflux esophagitis and anastomotic stricture are higher. While the double-tract reconstruction (DTR) can lessen postoperative reflux esophagitis, it is technically complex with a long operation time. The purpose of this study was to evaluate the quality of life (QoL) and short-term outcomes of the two reconstruction techniques.MethodsWe retrospectively collected consecutive patients with upper-third gastric adenocarcinoma and adenocarcinoma of the esophagogastric junction (AEG) at our center between 2019 June and 2023 May. Patients who underwent laparoscopic proximal gastrectomy (LPG) with EG or DTR were included in this study. A comparison was made between the clinical and pathological characteristics of patients and their surgical parameters, postoperative complications, and its 1-year QoL in two groups. The QoL of the two groups was assessed by Visick grading, the European Organization for Research and Treatment of Cancer (EORTC) QLQ-C30 and EORTC QLQ-STO22 scales at 1 year after operation. The nutritional status of the two groups was evaluated by BMI, hemoglobin and serum albumin.ResultsAII the qualified patients were divided EG group (n = 63) and DTR group (n = 93). Compared to the DTR group, the blood loss volume of EG group was more (p = 0.001). There were no significant differences in operation duration, number of lymph nodes dissected, and postoperative length of stay between the two groups(p > 0.05). No statistical differences were observed in terms of the incidence of early complications and Clavien-Dindo classification as well(p > 0.05). After one year, the Visick grade of the DTR group was better than EG group (p = 0.040). The multivariable logistic regression analysis showed the only independent risk factor for reflux esophagitis was the reconstruction method. According to the EORTC QLQ-C30 questionnaire, patients in the DTR group had a better global health status(p = 0.001) and complained less about nausea and vomiting(p = 0.033), and appetite loss (p = 0.022). Patients in the DTR group complained less about reflux (p = 0.030) based on the EORTC QLQ-STO22 questionnaire. The multiple linear regression analysis revealed that the reconstruction method, reflux esophagitis and age had a linear relationship with the global health status score. Regarding nutritional status, BMI of the two groups both decreased 1 year after operation, and BMI decline value of the DTR group was lower than EG group (p = 0.001). There is no statistically significant difference between the two groups as for postoperative change in hemoglobin and serum albumin.ConclusionOur findings suggest that it is possible for skilled surgeons to achieve minimal blood loss volume without significantly increasing operation duration when performing DRT, which does not raise risk. In terms of anti-reflux, postoperative QoL and BMI maintenance, 1-year postoperative follow-up outcomes reveal the DTR is superior to EG, which deserve further research and promotion.

Failure of an expandable lumbar interbody spacer - a critical analysis of secondary collapse, pseudoarthrosis and revision rates after thoracolumbar fusion.

To report on the failure rates of an expandable interbody spacer, used for spinal instrumented transforaminal lumbar interbody fusion (TLIF) or posterior thoracolumbar interbody fusion (PLIF). In this retrospective, single-center observational cohort study we reviewed consecutive PLIF/TLIF patients using the Catalyft™ PL and PL40 expandable titanium interbody implant (Medtronic, Minneapolis (USA)) between 07/2022 and 11/2023. We recorded patient demographics, surgical parameters, adverse events, radiological parameters and clinical outcomes according to the MacNab criteria. We identified 53 patients (mean age 68.6 ± 11.5 years; 49.1% female; mean BMI 25.7 ± 4.4kg/m2), in which 92 Catalyft™ spacers were implanted, mostly at L4/5 (n = 35; 38.0%) and L5/S1 (n = 31; 33.7%) for degenerative (n = 44; 83.0%), deformity (n = 7; 13.2%) or other indications (n = 2; 3.8%). We noticed secondary collapse of 20 (21.7%) spacers in 11 patients (20.7%) occurring after a mean time of 4.0 ± 4.1 months postoperatively. Age < 70 years was identified as risk factor for secondary collapse (OR 3.71, 95% CI 1.31-10.5, p = 0.014), but no association was found regarding other patient-specific or surgery-related variables. Pseudarthrosis was evident in seven patients (13.2%), of which four (7.6%) required revision surgery. Clinical outcome at last follow-up (mean 6.4 ± 4.2 months) was excellent/good in 29 (54.7%), fair in 14 (26.4%) and poor in six patients (11.3%). We provide a critical analysis of our series of patients with use of a specific type of expandable interbody spacer. We noticed failure and secondary collapse in an unacceptably high number of implants, some of which required revision surgery.

Minimalist Approach for HoLEP with A Low-Power Holmium Source: A Retrospective Study.

To assess the efficacy and safety of very low-power Holmium Laser Enucleation of the Prostate (HoLEP) on a 30-W holmium laser source. With the approval of the local ethics committee, we retrospectively analysed 60 patients treated with HoLEP. There were 30 patients in the low-power (LP) group and 30 patients in the very low-power (VLP) group. For the LP group, we used a 60-W holmium laser machine. Throughout the en bloc process, we used laser settings of 2 J and 20 Hz. We used a 30-W low-power holmium source in the VLP group. We used laser settings of 2 J and 10 Hz. All patients were operated on by an experienced surgeon. We evaluated the surgical parameters and practicality of the low-power laser vs. the very low-power laser. All patients underwent successful HoLEP in the very low-power group; it was not necessary to increase the output of the laser in any case. Mean preoperatively estimated prostate volume was 88.1 mL (range, 30-300 mL). Mean enucleation time and enucleation efficiency were 67.9 min (range, 25-150 min) and 0.99 gm/min (range, 0.8-1.8 gm/min), respectively. No patient required blood transfusion postoperatively. No stress urinary incontinence (SUI) was observed in the 3rd month postoperative follow-up. The use of a low-power laser source is encouraging for the learning curve of new surgeons who will begin HoLEP surgery; it can facilitate the adoption of HoLEP in developing countries, where the initial capital investment may be a major obstacle.

Robotic spine systems: overcoming surgeon experience in pedicle screw accuracy: a prospective study.

Prospective single-center study. To compare the accuracy of pedicle screws placed by freehand and under fluoroscopy and robotic assistance with intraoperative image acquisition. Pedicle screws are the most commonly used spinal anchors owing to their ability to stabilize all three spinal columns. Various techniques such as freehand, fluoroscopy-assisted, and navigation-assisted pedicle screw placements have been used with varying degrees of accuracy. Most studies on robotic-assisted pedicle screw placement have utilized preoperatively acquired computed tomography scans. To our knowledge, this is the only study in the literature that compared freehand with fluoroscopy-guided and robotic-assisted pedicle screw insertion with freehand and fluoroscopy. In this prospective study, a total of 1,120 pedicle screws were placed in the freehand group (n=175), 1,250 in the fluoroscopyassisted group (n=172), and 1,225 in the robotic-assisted group (n=180). Surgical parameters and screw accuracy were analyzed between the three groups. The preoperative plan overlapped with the postoperative O-arm scan to determine if the screws were executed as planned. The frequency of clinically acceptable screw placement (Gertzbein-Robbins grades A and B) in the freehand, fluoroscopy-assisted, and robotic-assisted groups were 97.7%, 98.6%, and 99.34%, respectively. With robotic assistance, an experience-neutralizing effect implied that surgeons with varying levels of experience achieved comparable pedicle screw accuracy, blood loss, O-arm time, robot time, and time per screw. No significant difference in these parameters was found between surgeries commencing before and after 2 PM. No significant differences were noted between the planned and executed screw trajectories in the robotic-assisted group irrespective of surgical experience. The third-generation robotic-assisted pedicle screw placement system used in conjunction with intraoperative threedimensional O-arm imaging consistently demonstrates safe and accurate screw placement with an experience-neutralizing effect.

Enhancing parathyroid preservation in papillary thyroid carcinoma surgery using nano-carbon suspension

This study evaluates the clinical significance of nano-carbon suspension in total thyroidectomy with cervical lymph node dissection for papillary thyroid carcinoma (PTC). The objective of this study was to assess the efficacy of nano-carbon suspension in enhancing parathyroid gland preservation, reducing postoperative complications, and improving surgical precision. A retrospective analysis on 219 PTC patients who underwent total thyroidectomy with cervical lymph node dissection between March 2014 and March 2018 was conducted. Patients were divided into two groups: an experimental group (n = 107) that received nano-carbon suspension and a control group (n = 112) that did not. Comparative analyses included demographics, surgical parameters, postoperative calcium and parathyroid hormone (PTH) levels, the number of dissected lymph nodes, and the incidence of complications. Baseline characteristics, including age, sex, and BMI, showed no statistically significant differences between the experimental and control groups. Postoperative calcium levels were significantly more stable in the experimental group, with median levels of 2.22 mmol/L on day 1 versus 2.06 mmol/L in the control group (P < 0.001), and 2.29 mmol/L at week 1 versus 2.22 mmol/L (P < 0.001). PTH levels were higher in the experimental group (35 pg/mL on day 1 versus 28 pg/mL, P < 0.001; 37 pg/mL at week 1 versus 30 pg/mL, P < 0.001). The experimental group had a greater median number of dissected lymph nodes (median 11.00 versus 7.00, P < 0.001) and a lower pathological parathyroid gland count (6.5% versus 23.2%, P < 0.001). Postoperative numbness and twitching were significantly reduced (4.7% versus 16.1%, P = 0.006), and the recurrence rate at 12 months was lower (4.7% versus 12.5%, P = 0.040). The use of Nano-carbon suspension in thyroidectomy and cervical lymph node dissection for PTC enhances parathyroid gland preservation, improves surgical precision, and reduces specific postoperative complications, supporting its standard adoption in thyroid cancer surgeries to optimize patient outcomes.

Risk factors for relaparotomy after cesarean delivery.

To identify and analyze risk factors associated with relaparotomy following cesarean delivery (CD), focusing on obstetric and surgical parameters. Retrospective case-control study conducted at a high-volume tertiary obstetric center. We reviewed all women who underwent CD between 2013 and 2023. Patients who required a relaparotomy, defined as the reopening of the fascia, were included in the study group. Patient data were systematically reviewed to identify potential risk factors contributing to the need for post-CD relaparotomy, compared with a control group that did not undergo a relaparotomy. Out of 11 465 women underwent CD, 59 (0.5%) required relaparotomy. Using a multivariate model for independent risk factors, we found the following to be associated with relaparotomy: emergency CD (adjusted odds ratio [aOR] 3.09, 95% confidence interval [CI] 1.78-5.38, P < 0.01), placenta previa (aOR 4.66, 95% CI 1.54-14.11, P < 0.01), and multiple gestation as indications for the CD (aOR 4.61, 95% CI 2.10-10.12, P < 0.01); estimated intraoperative blood loss of more than 1 L (aOR 5.98, 95% CI 2.79-12.80, P < 0.01); and intraoperative adhesions (aOR 7.12, 95% CI 4.06-12.48, P < 0.01). Our study underscores the multifactorial nature of relaparotomy after CD, emphasizing the significance of considering a broad array of risk factors. By identifying and understanding these factors, clinicians can optimize patient care and potentially reduce morbidity, particularly the need for subsequent surgical interventions.

Surgical management of thoracolumbar burst fractures by three different posterior techniques: A prospective comparative study

Study designProspective Comparative Study. ObjectivesThis study aims to study the outcome of thoracolumbar burst fractures by comparison of 3 different posterior constructs groups of patients treated by the posterior approach. SettingUniversity level Tertiary care Centre of Northern India. MethodsSingle centre study conducted from September 2020 to April 2022, the study included patients aged 18–50 years with burst fractures in the thoracolumbar region, TLICS score ≥4, and injury surgery duration <3 weeks. Sixty patients were divided into three groups: Group I (short segment with index screw(s) in the fractured vertebrae), Group II (short segment with interbody cage fusion), and Group III (long segment without index screw or interbody cage). Clinical and radiological assessments were performed over a 6-month follow-up period. Outcome measures included the Visual Analog Scale (VAS) for pain, Oswestry Disability Index (ODI), American Spinal Injury Association (ASIA) impairment scale, and radiological parameters. ResultsAmong 60 patients, 38 were male, and 22 were female, with a mean age of 33.37 ± 12.26 years. The most common injury mechanisms were falls from heights (85 %). Group I had the lowest estimated blood loss (395 ± 36.20 ml) and shortest surgery duration (140 ± 26.56 min), while Group III had the highest blood loss (744.25 ± 113.69 ml) and longest surgery duration (203.50 ± 23.40 min). No statistically significant differences were observed in kyphosis correction, canal clearance, or fusion status among the groups. Neurological and functional outcomes improved across all groups, with no significant intergroup differences. ConclusionAll three posterior instrumentation constructs provided effective management of thoracolumbar burst fractures, demonstrating high rates of fusion, significant kyphosis correction, and minimal loss of alignment. Despite variations in surgical parameters such as estimated blood loss and surgery duration, the clinical and radiological outcomes were comparable. Level of evidenceIII.

Using mobile EEG to study auditory work strain during simulated surgical procedures

Surgical personnel face various stressors in the workplace, including environmental sounds. Mobile electroencephalography (EEG) offers a promising approach for objectively measuring how individuals perceive sounds. Because surgical performance does not necessarily decrease with higher levels of distraction, EEG could help guide noise reduction strategies that are independent of performance measures. In this study, we utilized mobile EEG to explore how a realistic soundscape is perceived during simulated laparoscopic surgery. To examine the varying demands placed on personnel in different situations, we manipulated the cognitive demand during the surgical task, using a memory task. To assess responses to the soundscape, we calculated event-related potentials for distinct sound events and temporal response functions for the ongoing soundscape. Although participants reported varying degrees of demand under different conditions, no significant effects were observed on surgical task performance or EEG parameters. However, changes in surgical task performance and EEG parameters over time were noted, while subjective results remained consistent over time. These findings highlight the importance of using multiple measures to fully understand the complex relationship between sound processing and cognitive demand. Furthermore, in the context of combined EEG and audio recordings in real-life scenarios, a sparse representation of the soundscape has the advantage that it can be recorded in a data-protected way compared to more detailed representations. However, it is unclear whether information get lost with sparse representations. Our results indicate that sparse and detailed representations are equally effective in eliciting neural responses. Overall, this study marks a significant step towards objectively investigating sound processing in applied settings.

Deep Neuromuscular Block with Low Pressure Pneumoperitoneum in Laparoscopic Abdominal Surgeries: A Randomized Controlled Trial

Background: Postoperative pain management remains a challenge in laparoscopic abdominal surgeries. Objectives: The purpose of this research was to determine the effects of deep neuromuscular blockade (NMB) in conjunction with low-pressure pneumoperitoneum )PP) on postoperative pain, surgical parameters, and recovery outcomes. Methods: This randomized controlled double-blind study included 44 participants undergoing laparoscopic abdominal surgery. Patients were randomized equally into two groups (22 each): Group D received deep NMB, while group M received moderate NMB using cis-atracurium, through the utilization of computer-generated random numbers enclosed within sealed, opaque envelopes, following a parallel approach. Regarding deep NMB, following an initial dose of 0.15 mg/kg, a continuous infusion of 0.06 - 0.12 mg/kg/hr was administered to maintain a post-tetanic count between 1 and 2, with low PP pressure of 10 - 12 mmHg. Conversely, for moderate NMB, after the same initial dose of 0.15 mg/kg, the continuous infusion commenced upon the train-of-four count returning to 2, with the rate adjusted to sustain a count between 1 and 3, and standard PP pressure of 15 mmHg. The primary outcome was postoperative pain intensity as measured by Numerical Rating Scale (NRS) scores in the post-anesthesia care unit (PACU). The secondary outcomes included postoperative pain intensity measured by NRS scores from 2 hours to 48 hours post-surgery, time to first analgesic administration, cumulative opioid consumption within the initial 48-hour postoperative period, and patient-reported satisfaction with postoperative pain management. Statistical analysis using SPSS v26 included tests for normality (Shapiro-Wilks), with parametric data analyzed by t-test, non-parametric data by Mann-Whitney, and qualitative data by chi-square/Fisher's test. Results: Group D experienced a considerably longer time until the first analgesic rescue compared to group M (9.82 ± 1.5 hours vs. 7.23 ± 1.19 hours, P &lt; 0.001). Morphine consumption in the first 24 hours was lower in Group D (10.77 ± 1.51 mg vs. 13.09 ± 1.74 mg, P &lt; 0.001). At 6, 8, and 12 hours postoperatively, group D exhibited significantly lower pain scores (P &lt; 0.05). Surgical duration, surgical field quality, complication rates, and patient satisfaction were comparable between groups. Conclusions: Deep NMB combined with low-pressure PP provided superior postoperative analgesia without compromising surgical field quality or increasing complications in laparoscopic abdominal surgeries.

Effect of design and surgical parameters variations in mobile-bearing versus fixed-bearing unicompartmental knee arthroplasty: A finite element analysis.

Unicompartmental knee arthroplasty (UKAs) are available in the market as fixed- and mobile-bearing (FB and MB) and can be characterised by a different set of design parameters in terms of geometries, materials and surgical approaches, with overall good clinical outcomes. However, clear biomechanical evidence concerning the consequences of variations of these features on knee biomechanics is still lacking; therefore, the present study aims to perform a sensitivity analysis to see which outcomes are affected by these variations. For both MB-UKA and FB-UKA, five design and surgical parameters were defined (bearing insert thickness, tibial component material, implant components friction coefficient, antero-posterior slope angle and level of tibial bone resection). Two control models were defined based on standard configurations for both implants. Finite element analysis was chosen to perform this study, and different parameter combinations (216 models in total) were implemented and tested at both 0° and 90° of flexion, using a previously validated finite element knee model. The results were then evaluated in terms of bone and polyethylene Von Mises stress and tibio-femoral contact area. Bearing thickness, tibial bone cut and slope angle were found to be the most sensitive parameters for both types of UKAs. Specifically, changes in these parameters in the FB-UKA appeared to induce more significant variations in the polyethylene insert (both in terms of polyethylene stress and contact area), while in the MB-UKA, these changes influenced bone stress distribution more. Surgical parameters returned to have a more significant influence than material and friction variations; furthermore, the outcomes most affected by parameter variations were the insert-related ones for FB-UKA while for the MB-UKA were the ones regarding tibial bone stresses. Not Applicable.

Do Obese Patients Have Worse Outcomes in Adult Spinal Deformity Surgeries? A Meta-Analysis.

Meta-Analysis. This meta-analysis evaluates the difference in surgical outcomes between obese and non-obese patients undergoing adult spinal deformity (ASD) corrective surgery. ASD encompasses a wide range of debilitating spinal abnormalities. Concurrently, obesity is on the rise globally and has been shown to influence the outcomes of ASD management. The relationship between obesity and surgical outcomes in ASD has been the focus of recent studies, yielding various results. We conducted a comprehensive search of PubMed, Cochrane, and Google Scholar (page 1-20) through June of 2024. The surgical outcomes assessed included post-operative complications, revision rates, wound infections, thromboembolic events, implant-related complications, and non-home discharge. Surgical parameters such as operative time, length of stay (LOS), and estimated blood loss (EBL), as well as functional outcomes like the Oswestry Disability Index (ODI) and pain scores were analyzed. Nine studies met inclusion criteria. Non-obese patients exhibited a lower rate of implant-related complications (OR=0.25; 95% CI: 0.12-0.52, P=0.0002) and non-home discharge (OR=0.52; 95% CI: 0.32-0.84, P=0.007). Additionally, non-obese patients had reduced LOS (MD=-0.29; 95% CI: -0.53 - -0.05, P=0.02) and EBL (SMD=-0.68; 95% CI: -1.19 - -0.18, P=0.008). No statistically significant differences were observed for the remaining outcomes. Non-obese patients undergoing ASD corrective surgery are associated with fewer implant-related complications, a lower EBL, shorter LOS, and a higher likelihood of being discharged home compared to their obese counterparts.

Risk Factors for High Repair Tension During Rotator Cuff Repair

Background: Excessively high repair tension, especially tension ≥10 N, can lead to unsuccessful rotator cuff repair. Purpose/Hypothesis: The purpose of this study was to identify the preoperative risk factors for high repair tension in rotator cuff repair. It was hypothesized was that older age, longer symptom duration, nontraumatic (ie, degenerative) tear onset, progressive fatty degeneration, and larger tear size would be among the risk factors. Study Design: Cross-sectional study; Level of evidence, 3. Methods: This retrospective study involved 80 patients (80 shoulders) diagnosed with rotator cuff tears by magnetic resonance imaging between July 2018 and August 2020. Repair tension was measured intraoperatively using a digital tension meter. Risk factors for high repair tension (≥10 N) were evaluated. The t test was used to assess the relationship of repair tension with patient characteristics and surgical parameters. Parameters with a P value of &lt;.05 in the univariate analysis were entered into a multivariate logistic regression model to determine their relationship with repair tension ≥10 N. Results: Symptom duration of ≥4 months, nontraumatic tear onset, large/massive tears, mediolateral (ML) tear length of ≥20 mm, and anteroposterior (AP) tear length of ≥18 mm were associated with high odds of repair tension ≥10 N ( P≤ .013 for all). Multivariate analysis showed that nontraumatic onset, ML tear length of ≥20 mm, and AP tear length of ≥18 mm were independent risk factors for repair tension ≥10 N ( P≤ .035 for all). Conclusion: The independent risk factors for high repair tension (≥10 N) during rotator cuff repair were nontraumatic tear onset, ML tear length of ≥20 mm, and AP tear length of ≥18 mm. Symptom duration of ≥4 months and large/massive tears were associated with high odds of repair tension ≥10 N, although they were not considered independent risk factors. Prospective cohort studies with larger sample sizes are needed to confirm the clinical value of the risk factors identified in this study.

Efficacy and safety of laminoplasty combined with C3 laminectomy for patients with multilevel degenerative cervical myelopathy: a systematic review and meta-analysis.

Laminoplasty (LP) combined with C3 laminectomy (LN) can effectively achieve spinal cord decompression while maintaining the integrity of the posterior ligament-muscle complex, thereby minimizing cervical muscle damage. However, its necessity and safety remain controversial. This study aimed to compare the safety and efficacy of LP and LP combined with C3 LN in the treatment of patients with multilevel degenerative cervical spondylotic myelopathy (DCM). A systematic review and meta-analysis of the literature was performed. A search of PubMed, Web of Science, Embase, and the Cochrane Library databases was conducted from inception through December 2023 and updated in February 2024. Search terms included laminoplasty, laminectomy, C3 and degenerative cervical spondylosis. The literature search yielded 14 studies that met our inclusion criteria. Outcomes included radiographic results, neck pain, neurologic function, surgical parameters, and postoperative complications. We also assessed methodologic quality, publication bias, and quality of evidence. Fourteen studies were identified, including 590 patients who underwent LP combined with C3 LN (modified group, MG) compared to 669 patients who underwent LP (traditional group, TG). The results of the study indicated a statistically significant improvement in cervical range of motion (WMD = 3.62, 95% CI: 0.39 to 6.85) and cervical sagittal angle (WMD = 2.07, 95% CI: 0.40 to 3.74) in the MG compared to the TG at the last follow-up (very low-level evidence). The TG had a higher number of patients with complications, especially C2-3 bone fusion. There was no significant difference found in improvement of neck pain, JOA, NDI, cSVA, T1 slope at latest follow-up. LP combined with C3 LN is an effective and necessary surgical method for multilevel DCM patients to maintain cervical sagittal balance. However, due to the low quality of evidence in existing studies, more and higher quality research on the technology is needed in the future.

Correlation Between Urethral Length and Urethral Stricture After Transurethral Resection of Prostate

Aim: To show the effects of urethral length, and surgical or patient related parameters on urethral strictures after Transurethral Prostate Resection (TURP). Materials and Methods: The study included 127 patients who underwent TURP for benign prostate hyperplasia (BPH) unresponsive to medical treatment in our clinic between May XXX and February XXX. The patients were separated into two subgroups as those who underwent second surgery because of urethral stricture and those who did not. These two groups were compared in respect of age, height, weight, total prostate specific antigen, fall in hemoglobin values, increase in urine peak flow rate, decrease in the post-micturition residual volume, prostate volume, operating time, tissue amounts, resection rate, and urethral length. Results: Urethral stricture was determined in 13.4% of the patients. A statistically significant difference was determined between the two groups in respect of age and urethral length (p

Rapid and random-start endometrial preparation before outpatient hysteroscopic polypectomy in patients of perimenopausal age

Objective This study aimed to assess the efficacy of randomly started oral dienogest/ethinylestradiol (DNG/EE) for swift endometrial preparation prior to outpatient hysteroscopic polypectomy in perimenopausal women. Method A multicenter, prospective, randomized controlled trial was conducted in university hospitals. Eighty perimenopausal women scheduled for outpatient hysteroscopic polypectomy between January 2023 and March 2024 were randomly assigned to either intervention (n = 40) or control (n = 40) groups. Exclusion criteria included concomitant endometrial pathologies, recent therapy and adnexal diseases. The intervention group received oral DNG/EE 2 mg/0.03 mg/day started on any day of the menstrual cycle for 14 days. The control group underwent polypectomy between menstrual cycle days 8 and 11 without pharmacological treatment. Results Pre-procedure (p < 0.001) and post-procedure (p < 0.001) endometrial thickness were significantly reduced in the intervention group, along with a higher incidence of hypotrophic/atrophic endometrial patterns (p < 0.001). Surgical parameters also differed significantly between groups. Conclusion DNG/EE treatment offers rapid, cost-effective endometrial preparation, enhancing surgical outcomes and patient satisfaction during outpatient polypectomy. Trial registration ClinicalTrials.gov NCT06316206.

Application of different CO2 pneumoperitoneum pressure in laparoscopic pyeloplasty for infants with ureteropelvic junction obstruction.

Laparoscopic pyeloplasty is a minimally invasive approach for the therapy of infant ureteropelvic junction obstruction (UPJO), reliant on CO2 pneumoperitoneum insufflation. While the impact of CO2 insufflation on adult and older pediatric populations has been studied, its effects on infants remain less explored. This prospective randomized controlled trial included infants with UPJO undergoing laparoscopic pyeloplasty. Patients were allocated to low pneumoperitoneum pressure (LPP, 5 mmHg) or high pneumoperitoneum pressure (HPP, 8 mmHg) groups. Surgical parameters, postoperative complications, acid-base balance, stress markers, inflammatory cytokines, and oxidative stress markers were evaluated and compared. A total of 116 infants were analyzed. Preoperative characteristics were comparable between LPP and HPP groups. No significant differences in blood loss, operation time, or hospitalization time were observed. Postoperative complications were similar between groups. Acid-base balance analysis revealed a decrease in pH after pneumoperitoneum in both groups, with greater reductions in actual base excess and standard base excess in the HPP group. Stress markers, cytokines, and oxidative stress markers increased postoperatively in both groups, with higher levels in the HPP group. HPP leads to more pronounced physiological responses, including acid-base alterations, stress reactions, and inflammatory cytokine elevations.

Surgical Parameters During Reverse Shoulder Arthroplasty Predict Post-Surgical Kinematics During the Hand-to-Head Motion

Surgical Parameters During Reverse Shoulder Arthroplasty Predict Post-Surgical Kinematics During the Hand-to-Head Motion