Surgical Precision Research Articles

Innovations in Minimally Invasive Gynecologic Surgery: Improving Outcomes and Recovery Gynecology

A paradigm change has occurred in minimally invasive gynecologic surgery (MIGS), which uses improved techniques and technology to improve patient care and recovery after surgery. This review paper provides a thorough analysis of current advancements in MIGS, emphasising its significant influence on surgical results and patient recovery. This research examines significant technical developments, procedural improvements, and their effects on how gynecologic surgery is evolving.
 The accuracy and effectiveness of MIGS have been redefined by technological advancements such as augmented reality, robotic-assisted surgery, sophisticated imaging modalities, and specialty equipment. By reducing invasiveness and revolutionising the surgical technique, these advancements provide improved visibility, surgical precision, and manoeuvrability. The paper goes into detail on how important these developments are for streamlining complex procedures and enhancing patient outcomes.
 The study also explores the development of improved recovery pathways in MIGS, highlighting early mobilisation, individualised care plans, multimodal pain management techniques, and psychological support. When these tactics are included into perioperative treatment, they greatly speed up patients' recuperation and enhance their general health.
 When comparing MIGS advancements to open operations, a critical examination shows that patients have less blood loss, shorter hospital stays, fewer complications, better pain management, and a speedier return to regular activities. Promising findings are also shown in long-term patient outcomes and safety profiles after MIGS treatments.

Improving Visualization of Intramuscular Perforator Course: Augmented Reality Headsets for DIEP Flap Breast Reconstruction.

Augmented reality (AR) technology, exemplified by devices such as the Microsoft HoloLens 2, has gained interest for its potential applications in preoperative guidance. This study explores the use of AR technology for perforator identification during deep inferior epigastric artery perforator (DIEP) flap breast reconstruction. A case series of five patients where an AR device was used to identify perforators during DIEP flap breast reconstruction is presented. The device was utilized to recognize preoperative perforators and map their extra- and intramuscular routes. Sound and/or color Doppler confirmation was used to verify the findings. In all five cases, the AR device successfully identified preoperative perforators and delineated their extra- and intramuscular routes. AR technology in perioperative visualization of vasculature offers the potential to enhance surgical precision and reduce operative times. By providing an augmented three-dimensional overlay of patients' vascular structures, AR can facilitate a more comprehensive understanding of individual anatomy, ultimately improving surgical outcomes. AR technology shows promise in enhancing perforator identification efficiency and deepening understanding of perforator trajectories during preoperative planning. Nonetheless, additional research is needed to establish whether the advantages of AR technology warrant its widespread adoption for perforator identification.

407 Robotic Assisted Cholecystectomy and Common Bile Duct Exploration for Single Stage Management of Complex Gallstone Disease

Abstract Aim Laparoscopic cholecystectomy and common bile duct exploration (LC-CBDE) is an alternative to endoscopic retrograde cholangiopancreatography (ERCP) for treatment of choledocholithiasis. The ‘Achilles heel’ of LC-CBDE is the choledochotomy incision and closure following duct clearance. Robotic assisted surgery (RAS) aspires to overcome these technical challenges by providing improved views (3D enhancement) and articulated instruments potentially improving surgical precision. We aim to scrutinise the outcomes of an early series of robotic assisted cholecystectomy and common bile duct exploration (RC-CBDE) cases performed at our institution. Method Retrospective analysis from a specialist benign pancreatico-biliary unit in the United Kingdom was undertaken from April 2022 – December 2022 inclusive. All patients who underwent RC-CBDE for complicated gallstone disease were included. Collated data included patient demographics, perioperative investigations, intraoperative approach, and postoperative outcomes. Results 10 patients were identified. Median (IQR) age was 51 (33 – 66) years. Median (IQR) BMI was 26 (21 – 32) kg/m2. Median (IQR) Charlson Co-morbidity Index (CCI) was 1 (0 – 4). 4 patients were operated on during the acute presentation, with median (IQR) bilirubin 51 (34 – 252.5). Median (IQR) operative time was 176 (124 – 222) minutes. Median (IQR) post-operative length of stay was 4 (1 – 5) days. One patient required reintervention for port site hernia repair from drain site. Conclusions RC-CBDE is a safe and effective treatment for choledocholithiasis with equivocal outcomes to LC-CBDE. Benefits of RAS include enhanced views and ergonomics aiding precise closure of choledochotomy, which may both reduce complications and promote wider uptake of common bile duct exploration – a previously underutilised, technically-challenging operative procedure.

A review of robotic-assisted total hip arthroplasty.

Total hip arthroplasty (THA) is a successful surgical method for hip replacement but still poses challenges and risks. Robotic-assisted THA (rTHA) using new generation robotic systems has emerged to improve surgical precision and outcomes. The purpose of this paper is to review the literature on rTHA, with a focus on its advantages, such as individualized preoperative planning, intraoperative assistance, and improved accuracy in implantation, especially in complex cases. Additionally, it aims to explore the disadvantages associated with the use of rTHA, including high costs, the learning curve, and prolonged operation time compared to manual THA (mTHA), which are critical drawbacks that require careful consideration and efforts for minimization. Some financial analyses suggest that rTHA may offer cost-effectiveness and reduced postoperative costs compared to mTHA. While technological advancements are expected to reduce technical complications, there are still debates surrounding long-term outcomes. Practical limitations, such as limited availability and accessibility, also warrant attention. Although the development of rTHA shows promise, it is still in its early stages, necessitating critical evaluation and further research to ensure optimal patient benefits.

A New Lighting System for Surgical Vision Optimization in Barbed Pharyngoplasty for OSA.

Obstructive sleep apnea (OSA) surgery is now a viable solution in selected patients and the "remodeling" palatopharyngeal surgery is the most common one. Recently, it has become less invasive with the introduction of barbed sutures (BS). An optimization of surgical techniques is represented by barbed pharyngoplasty (BP), which requires surgical precision and needs efficient and precise oropharyngeal visualization. Consequently, the lighting system is of pivotal importance in BP. The aim of this work is to describe the first experience on the use of a new lighting system, called KLAROTM in BP for OSA. We evaluated the KLARO™ system in 15 consecutives BP for OSA in comparison with conventional headlamp illumination. The visualization of palatopharyngeal muscle in the bottom of the tonsillar fossa, entry and exit needle, such as needle tip, were statistically better with KLAROTM than headlamp illumination for both the surgeon and resident (p < 0.05). No significant differences for the visualization of the posterior pharyngeal wall and uvula were reported. The KLAROTM lighting system allows a satisfied illumination of oral cavity and oropharynx in the majority of cases. We encourage the use of KLAROTM not only in BP for OSA, but in all oral and pharyngeal surgeries, including tonsillectomy and oncological surgery.

The molecular diagnostic yield of frame-based stereotactic biopsies in the age of precision neuro-oncology: a cross-sectional study

PurposeWith the increasing role of molecular genetics in the diagnostics of intracranial tumors, delivering sufficient representative tissue for such analyses is of paramount importance. This study explored the rate of successful diagnosis after frame-based stereotactic biopsies of intracranial lesions.MethodsConsecutive patients undergoing frame-based stereotactic biopsies in 2020 and 2021 were included in this retrospective analysis. Cases were classified into three groups: conclusive, diagnosis with missing molecular genetics (MG) data, and inconclusive neuropathological diagnosis.ResultsOf 145 patients, a conclusive diagnosis was possible in n = 137 cases (94.5%). For 3 cases (2.0%), diagnosis was established with missing MG data. In 5 cases (3.5%), an inconclusive (tumor) diagnosis was met. Diagnoses comprised mainly WHO 4 glioblastomas (n = 73, 56%), CNS lymphomas (n = 23, 16%), inflammatory diseases (n = 14, 10%), and metastases (n = 5, 3%). Methylomics were applied in 49% (n = 44) of tumor cases (panel sequencing in n = 28, 30% of tumors). The average number of specimens used for MG diagnostics was 5, while the average number of specimens provided was 15. In a univariate analysis, insufficient DNA was associated with an inconclusive diagnosis or a diagnosis with missing MG data (p < 0.001). Analyses of planned and implemented trajectories of cases with diagnosis with missing MG data or inconclusive diagnosis (n = 8) revealed that regions of interest were reached in almost all cases (n = 7).ConclusionAlthough stereotactic frame-based biopsies deliver a limited amount of tissue, they bear high histopathological and molecular genetic diagnostic yields. Given the proven surgical precision of the planned biopsy trajectories, optimizing surveyed lesion regions could help improve the rate of conclusive diagnoses.

Artificial Intelligence in Neurosurgery: A State-of-the-Art Review from Past to Future.

In recent years, there has been a significant surge in discussions surrounding artificial intelligence (AI), along with a corresponding increase in its practical applications in various facets of everyday life, including the medical industry. Notably, even in the highly specialized realm of neurosurgery, AI has been utilized for differential diagnosis, pre-operative evaluation, and improving surgical precision. Many of these applications have begun to mitigate risks of intraoperative and postoperative complications and post-operative care. This article aims to present an overview of the principal published papers on the significant themes of tumor, spine, epilepsy, and vascular issues, wherein AI has been applied to assess its potential applications within neurosurgery. The method involved identifying high-cited seminal papers using PubMed and Google Scholar, conducting a comprehensive review of various study types, and summarizing machine learning applications to enhance understanding among clinicians for future utilization. Recent studies demonstrate that machine learning (ML) holds significant potential in neuro-oncological care, spine surgery, epilepsy management, and other neurosurgical applications. ML techniques have proven effective in tumor identification, surgical outcomes prediction, seizure outcome prediction, aneurysm prediction, and more, highlighting its broad impact and potential in improving patient management and outcomes in neurosurgery. This review will encompass the current state of research, as well as predictions for the future of AI within neurosurgery.

OrthopedVR: clinical assessment and pre-operative planning of paediatric patients with lower limb rotational abnormalities in virtual reality

Rotational abnormalities in the lower limbs causing patellar mal-tracking negatively affect patients’ lives, particularly young patients (10–17 years old). Recent studies suggest that rotational abnormalities can increase degenerative effects on the joints of the lower limbs. Rotational abnormalities are diagnosed using 2D CT imaging and X-rays, and these data are then used by surgeons to make decisions during an operation. However, 3D representation of data is preferable in the examination of 3D structures, such as bones. This correlates with added benefits for medical judgement, pre-operative planning, and clinical training. Virtual reality can enable the transformation of standard clinical imaging examination methods (CT/MRI) into immersive examinations and pre-operative planning in 3D. We present a VR system (OrthopedVR) which allows orthopaedic surgeons to examine patients’ specific anatomy of the lower limbs in an immersive three-dimensional environment and to simulate the effect of potential surgical interventions such as corrective osteotomies in VR. In OrthopedVR, surgeons can perform corrective incisions and re-align segments into desired rotational angles. From the system evaluation performed by experienced surgeons we found that OrthopedVR provides a better understanding of lower limb alignment and rotational profiles in comparison with isolated 2D CT scans. In addition, it was demonstrated that using VR software improves pre-operative planning, surgical precision and post-operative outcomes for patients. Our study results indicate that our system can become a stepping stone into simulating corrective surgeries of the lower limbs, and suggest future improvements which will help adopt VR surgical planning into the clinical orthopaedic practice.

Artificial intelligence in colorectal cancer: a review

The study objective: the study objective is to examine the use of artificial intelligence (AI) in the diagnosis, treatment, and prognosis of Colorectal Cancer (CRC) and discuss the future potential of AI in CRC. Material and Methods. The Web of Science, Scopus, PubMed, Medline, and eLIBRARY databases were used to search for the publications. A study on the application of Artificial Intelligence (AI) to the diagnosis, treatment, and prognosis of Colorectal Cancer (CRC) was discovered in more than 100 sources. In the review, data from 83 articles were incorporated. Results. The review article explores the use of artificial intelligence (AI) in medicine, specifically focusing on its applications in colorectal cancer (CRC). It discusses the stages of AI development for CRC, including molecular understanding, image-based diagnosis, drug design, and individualized treatment. The benefits of AI in medical image analysis are highlighted, improving diagnosis accuracy and inspection quality. Challenges in AI development are addressed, such as data standardization and the interpretability of machine learning algorithms. The potential of AI in treatment decision support, precision medicine, and prognosis prediction is discussed, emphasizing the role of AI in selecting optimal treatments and improving surgical precision. Ethical and regulatory considerations in integrating AI are mentioned, including patient trust, data security, and liability in AI-assisted surgeries. The review emphasizes the importance of an AI standard system, dataset standardization, and integrating clinical knowledge into AI algorithms. Overall, the article provides an overview of the current research on AI in CRC diagnosis, treatment, and prognosis, discussing its benefits, challenges, and future prospects in improving medical outcomes.

Analysis of influence of surgical instruments on accuracy of magnetic navigation system for craniofacial surgery robots

IntroductionIn craniofacial surgery, magnetic navigation systems can effectively extend the doctor’s limited visual range, improve their surgical precision, shorten the operation time, and reduce the incidence of surgical complications. Owing to the ease of magnetic navigation, the accuracy of the magnetic navigation system is affected by various equipment in the operating room. Therefore, its large-scale application is lacking because the navigation accuracy requirement can be extremely high during craniofacial surgery. Therefore, the accuracy of magnetic navigation systems is crucial. Various surgical instruments have been evaluated to effectively reduce the interference of magnetic navigation systems with surgical instruments. In craniofacial surgery, magnetic navigation systems can effectively extend the doctor’s limited visual range, improve their surgical precision, shorten the operation time, and reduce the incidence of surgical complications. Owing to the ease of magnetic navigation, the accuracy of the magnetic navigation system is affected by various equipment in the operating room. Therefore, its large-scale application is lacking because the navigation accuracy requirement can be extremely high during craniofacial surgery. Therefore, the accuracy of magnetic navigation systems is crucial. Various surgical instruments have been evaluated to effectively reduce the interference of magnetic navigation systems with surgical instruments. In the surgical environment, the use of surgical instruments during mandibular surgery was simulated by selecting several conventional surgical instruments to record errors in the magnetic navigation system. The fluctuation values of the magnetic navigation errors were subsequently estimated and changes in its accuracy measured. MATLAB was used to calculate and analyze the fluctuations of the magnetic navigation errors. As results, the high-frequency electrosurgical system caused the greatest interference with the magnetic navigation system during surgery while powered on, with a maximum fluctuation error value of 1.8120 mm, and the maximum fluctuation error values of the stitch scissors, teeth forceps, and a needle holder were 1.3662, 1.3781, and 0.3912 mm, respectively. The closer the instrument is to the magnetic field generator or navigation target, the greater its impact. In conclusion, stitch scissors, teeth forceps, a needle holder, and the high-frequency electrosurgical system all affect magnetic navigation system accuracy. Therefore, it is necessary to avoid magnetic navigation system use and surgical instrument disturbances during surgery or select surgical instruments that do not interfere with the system. Surgical instruments must be evaluated for electromagnetic interference before they can be used in surgery with a magnetic navigation system.

Does practice make perfect? Laparoscopic training mainly improves motion efficiency: a prospective trial

Training improves skills in minimally invasive surgery. This study aimed to investigate the learning curves of complex motion parameters for both hands during a standardized training course using a novel measurement tool. An additional focus was placed on the parameters representing surgical safety and precision. Fifty-six laparoscopic novices participated in a training course on the basic skills of minimally invasive surgery based on a modified Fundamentals of Laparoscopic Surgery (FLS) curriculum. Before, twice during, and once after the practical lessons, all participants had to perform four laparoscopic tasks (peg transfer, precision cut, balloon resection, and laparoscopic suture and knot), which were recorded and analyzed using an instrument motion analysis system. Participants significantly improved the time per task for all four tasks (all p < 0.001). The individual instrument path length decreased significantly for the dominant and non-dominant hands in all four tasks. Similarly, both hands became significantly faster in all tasks, with the exception of the non-dominant hand in the precision cut task. In terms of relative idle time, only in the peg transfer task did both hands improve significantly, while in the precision cut task, only the dominant hand performed better. In contrast, the motion volume of both hands combined was reduced in only one task (precision cut, p = 0.01), whereas no significant improvement in the relative time of instruments being out of view was observed. FLS-based skills training increases motion efficiency primarily by increasing speed and reducing idle time and path length. Parameters relevant for surgical safety and precision (motion volume and relative time of instruments being out of view) are minimally affected by short-term training. Consequently, surgical training should also focus on safety and precision-related parameters, and assessment of these parameters should be incorporated into basic skill training accordingly.

The design method of the digital sequential tooth-sectioning guide for the extraction of mandibular impacted third molars

Objective: To explore a method for digitally designing and fabricating a sequential tooth-sectioning guide that can assist in the extraction of mandibular horizontal impacted third molars, preliminarily evaluate its feasibility and provide a reference for clinical application. Methods: Twenty patients with mandibular low level impacted third molars who visited the Department of General Dentistry, Peking University School and Hospital of Stomatology from March 2021 to January 2022 were selected. Cone-beam CT showed direct contact between the roots and mandibular canal, and full range impressions of the patients' intraoral teeth were taken and optical scans of the dental model were performed. The patients' cone-beam CT data and optical scan data were reconstructed in three dimensions, anatomical structure extraction, registration fusion, and the design of the structure of the guide (including crown-sectioning guide and root-sectioning guide) by Mimics 24.0, Geomagic Wrap 2021, and Magics 21.0 software, and then the titanium guide was three dimension printed, and the guide was tried on the dental model. After confirmation, the guide was used to assist the dentist in the operation. We observed whether the guide was in place, the number of tooth splitting, the matching of tooth splitting with the preoperative design, the operation time, and whether there were any complications. Results: In this study, 20 sectioning guides were successfully printed, all of them were well fitted in the patients' mouth, the average number of section was 3.4 times, the tooth parts was better matched with the preoperative design, and the average operative time of the guides was (29.2±9.8) minutes without complications such as perforation of the bone cortex. Conclusions: The use of sequential sectioning guides to assist in the extraction of mandibular impacted third molars was initially validated to accurately replicate the preoperative sectioning design, and is expected to provide a digital solution to improve surgical precision and ensure safety. Further studies with larger sample sizes are needed to evaluate its accuracy and safety.

Usability Of Three-dimensional Printing in Maxillofacial Surgery: A Narrative Review

Purpose: The three-dimensional (3D) printing method is a modern approach in which different custom designs are fabricated with high complexity according to the patient’s need. This narrative review aimed to highlight the materials used in 3D printers for medical use, especially in the field of oral and maxillofacial surgery. Methods: PubMed, Web of Sciences, and Google Scholar were searched for the relevant studies, and after meeting the inclusion criteria, articles were studied, and focused points were highlighted. Results: s: Synthetic and natural materials used in 3D printing include hydroxyapatite, tricalcium phosphate, bicalcium phosphate, apatite–wollastonite glass ceramics, stem cells, and collagen. The most frequent clinical applications include dental implants, maxillofacial trauma, facial cosmetics, orthognathic surgery, maxillofacial oncology, and maxillofacial reconstruction. Anatomical models and surgical instructions were the most often printed objects. The key benefits were increased surgical precision and a shorter operating time. The cost of the items, the length of the manufacturing process when printed by the industry, and legal concerns were the main drawbacks. Conclusion: The 3D models are beneficial for surgeons as they can save time and even human life. In the future, additional research should be done on the modeling, efficacy, and safety of natural materials, and systematic reviews and meta-analyses should be conducted for a better understanding.

Neoadjuvant Immunotherapy Increases Event-Free Survival in Melanoma

Neoadjuvant Immunotherapy Increases Event-Free Survival in Melanoma

Using synaptic connections to dissect neural microcircuitry

There are a number of methods used to study synapses through selective labeling and control. However, these techniques are often cytotoxic, difficult to implement, or lack the selectivity required to most effectively study microcircuits. We aim to create two novel techniques for studying how the brain is wired – a method for transsynaptic genetic labeling and a method for selectively destroying synapses. For synaptic labeling we are using the C. elegans orthologs for the Notch-Delta signaling system, Glp-1 and Lag-2. Glp-1 was modified by replacing the intracellular portion of the protein with cre recombinase, a site directed DNA recombination enzyme. It is hypothesized that when a cell expressing the chimeric Glp1-Cre protein comes in close contact with a cell expressing Lag-2, cre recombinase will be released allowing for the selective expression of a fluorescent molecule based on cell proximity. In vitro testing via confocal microscopy indicates that the labeling mechanism performs as expected, labeling cells based on contact in HEK 293T cells.To selectively destroy synapses, we have developed a chimeric protein, CadPlexin, that will activate repulsion signals through homophilic binding between two cells connected by a synapse. CadPlexin is composed of the extracellular domain of fruit fly DE-Cadherin and the transmembrane and intracellular domains of mouse plexin-B2. Cadherins bind to one another homophillically, acting to bind cells with one another. Plexins, when dimerized and activated by their usual ligand, Semaphorin, will cause a downstream signaling cascade that induces cell-cell repulsion. We hypothesize that, when two cells expressing CadPlexin are in close contact (i.e. at a synapse), CadPlexin will selectively destroy the synapse, as the extracellular domains from DE-Cadherin will bind together and mimic semaphorin binding and clustering required to activate plexin signaling. Preliminary results from in vitro experiments suggest that CadPlexin performs as expected, seen through stress fibers in the actin cytoskeleton of Cos7 cells transfected with CadPlexin – a characteristic cytoskeletal change induced through Plexin signaling. Together, these techniques will allow us to label synaptically connected neurons and destroy synapses with surgical precision. Funding Sources: Murchison Summer Research Fellowship, Trinity University Start-Up Funds, McNair Scholars Program, the Brain and Behavior Research Foundation NARSAD Young Investigator Award, Mary E. Groff Foundation, Women in STEM Program. This is the full abstract presented at the American Physiology Summit 2023 meeting and is only available in HTML format. There are no additional versions or additional content available for this abstract. Physiology was not involved in the peer review process.

USE OF THE NUCLEUS SMARTNAV® SYSTEM IN INTRAOPERATIVE TELEMETRY OF COCHLEAR IMPLANT

Tests performed intraoperatively are routine tools in cochlear implant (CI) programs worldwide. Recently, Cochlear™ launched the Nucleus Smartnav® system that describes new parameters measured during insertion of the electrode array into the cochlea, verifies its position, tests impedance and AutoNRT. Objective: To describe the use of the Cochlear™ Nucleus SmartNav® system as an intraoperative measurement tool in cochlear implant surgery. Material and Methods: Patient with bilateral and congenital profound prelingual deafness. He has been using an individual sound amplification device (PSAD) bilaterally since childhood, has reasonable speaking skills and good understanding of others’ speech. Although IC was previously indicated, he chose to keep the hearing aid. However, given the inefficient gain, mainly in the left ear, a bimodal adaptation was suggested: CI in the left ear and hearing aids in the right. At the age of 48, he underwent CI surgery on the left, using the Cochlear™ CI622 model with CP1001 speech processor and intraoperative measurements performed by the Nucleus® SmartNav system. The impedance test and NRT were also performed intraoperatively using the Nucleus® SmartNav system, after reviewing the insertion of the electrodes. Result: The measurements obtained during the insertion of the electrode array in the cochlea allowed greater intraoperative control by enabling fine adjustments in the surgical technique. Conclusion: The Nucleus Smartnav® system endorses technologies that aim to increase surgical precision and reduce complications.

Multifunctional anatomical prototypes (MAPs): Treatment of excessive gingival display due to altered passive eruption.

To describe a strategy using digital technologies for improving the diagnosis, treatment planning, and surgical execution of patients with excessive gingival display (EGD) due to altered passive eruption (APE). An important component for successful patient's management is to fulfill their esthetic expectations whilst delivering predictable and long-term therapeutic outcomes. To achieve this goal in patients with excessive gingival display due to altered passive eruption, it is essential to perform an accurate diagnosis and to communicate to the patient the expected customized results using digital technologies. Computer-aided designed and manufactured multifunctional anatomical prototypes (MAPs) may contribute to these purposes. Additionally, they can guide the surgical crown lengthening procedure or serve as a reference during the surgical guide fabrication providing information of the required anatomical landmarks. This novel strategy protocol for diagnosis, communication, and treatment management of patients with excessive gingival display follows functional and biological principles within the frame of a digital workflow, which improves the diagnostic capabilities, enhances communication, and guides the surgical treatment as shown in the 12 months follow-up of the reported case. Developing a virtual patient by combining multiple digital data sets including cone-beam computed tomography (CBCT), intra-oral scans and digital photography, supports the clinician and the patient to achieve a comprehensive diagnosis and to better communicate the expected results to the patient. Furthermore, this digital treatment exercise based on anatomical and biological principles will facilitate the surgical precision and the achievement of successful outcomes, thus fulfilling the patient needs and expectations.

Does Utilizing IRIS, a Segmented Three-dimensional Model, Increase Surgical Precision During Robotic Partial Nephrectomy?

Preservation of renal parenchyma is a major goal when performing a partial nephrectomy. IRIS anatomical visualization software generates a segmented 3D model, allowing improved visualization of the tumor and surrounding structures. We hypothesize that using IRIS intraoperatively during partial nephrectomy on complex tumors increases the precision of surgical procedures and therefore may result in more tissue preservation. We identified 74 non-IRIS and 19 IRIS patients who underwent partial nephrectomy, with nephrometry scores of 9, 10, and 11. Propensity scores were used to match 18 pairs of patients on nephrometry score, age, and tumor volume. Pre- and postoperative imaging (MRI/CT) was obtained. Volumes of the preoperative tumor and preoperative whole kidney were obtained to calculate predicted postoperative whole kidney volume and then compared to actual postoperative whole kidney volume. Mean differences between predicted and actual postoperative whole kidney volumes were 19.2 cm3 (SD=20.2) and 32 cm3 (SD=16.1, P = .0074) for IRIS and non-IRIS groups, respectively. The mean improvement in precision for the IRIS procedure was 12.8 cm3 (95% confidence interval, 2.5 to Inf; P = .02). There was no significant change in mean glomerular filtration rate from baseline to 6 months postoperatively between IRIS and non-IRIS groups (-6.39, SD=15.8 vs -9.54, SD=13.3; P = .5). No significant differences in complication rates (0 vs 1, P = .2), worsening glomerular filtration rate staging (5 vs 4, P = 1), and >25% decrease in glomerular filtration rate (3 vs 4, P = 1) were found between IRIS and non-IRIS groups. We demonstrated that using IRIS intraoperatively when performing partial nephrectomy on complex tumors is associated with improved surgical precision.

Robot-Assisted Epiretinal Membrane Peeling: A Prospective Assessment of Pre- and Intra-Operative Times and of Surgeons' Subjective Perceptions.

The Preceyes Surgical System (PSS) is a robotic assistive device that may enhance surgical precision. This study assessed pre- and intra-operative times and surgeons' perceptions of robot-assisted epiretinal membrane peeling (RA-MP). We analyzed the time requirement of three main tasks: the preparation of the PSS (I), patient preparation (II), and surgery (III). Following surgery, the surgeons were asked questions about their experience. RA-MP was performed in nine eyes of nine patients. Task I required an average time of 12.3 min, initially taking 15 min but decreasing to 6 min in the last surgery. Task II showed a mean time of 47.2 (range of 36-65) min. Task III had a mean time of 72.4 (range of 57-100) min. A mean time of 27.9 (range of 9-46) min was necessary for RA-MP. The responses to the questionnaire revealed a trend towards increasing ease and reduced stress as familiarity with the PSS increased. A substantial reduction in pre- and intra-operative times, decreasing to a total of 115 min, was demonstrated. RA-MP was positively anticipated by the surgeons and led to no hand or arm strain while being more complex than manual MP.

Skull-Base Surgery-A Narrative Review on Current Approaches and Future Developments in Surgical Navigation.

Surgical navigation technology combines patient imaging studies with intraoperative real-time data to improve surgical precision and patient outcomes. The navigation workflow can also include preoperative planning, which can reliably simulate the intended resection and reconstruction. The advantage of this approach in skull-base surgery is that it guides access into a complex three-dimensional area and orients tumors intraoperatively with regard to critical structures, such as the orbit, carotid artery and brain. This enhances a surgeon's capabilities to preserve normal anatomy while resecting tumors with adequate margins. The aim of this narrative review is to outline the state of the art and the future directions of surgical navigation in the skull base, focusing on the advantages and pitfalls of this technique. We will also present our group experience in this field, within the frame of the current research trends.