Surgical Process Research Articles

Psychiatric evaluation and support for the elderly undergoing elective surgery

Providing evaluation and support for individuals who choose to undergo surgery is an essential aspect of comprehensive healthcare. With the global population aging, it's becoming more common for elderly individuals to opt for surgeries. This requires understanding how health impacts surgical outcomes in this vulnerable group. This study delves into the presentation and management of factors throughout the entire surgical process, including before, during, and after surgery. The clinical presentation covers existing health conditions, cognitive issues, emotional responses, and ethical considerations related to decision-making abilities. Recognizing these factors is crucial in order to provide tailored interventions that promote the well-being of patients and improve overall outcomes. Clinical management involves measures before surgery, collaborative care models during the period and strategies to prevent or address psychiatric complications after surgery. Ethical considerations are consistently important throughout this process, especially concerning decision-making abilities. This comprehensive approach involves psychiatrists, geriatricians, anesthetists and other healthcare professionals who work together to enhance the well-being of surgical patients. As our population continues to age, further research and attention on aspects of care within this demographic are vital for providing comprehensive and patient-centered healthcare.

EDL Induced Electro-magnetized Modified Hybrid Nano-blood Circulation in an Endoscopic Fatty Charged Arterial Indented Tract.

The electrokinetic process for streaming fluids in magnetic environments is emerging due to its immense applications in medical and biochemical industrial domains. In this context, our proposed model seeks to inquire into the hemodynamic characteristics of electro-magnetized blood blended with trihybrid nanoparticles circulation induced by electro-osmotic forces in an endoscopic charged arterial annular indented tract. This steaming model also invokes the consequences of variable Lorentz attractive force, buoyancy force, heat source, viscous and Joule warming, arterial wall properties, and sliding phenomena for featuring more realistic problems in blood flows. Different shapes of suspended trihybrid nanoparticles, such as spheres, bricks, cylinders, and platelets, are included in the model formation. Electro-magnetized modified hybrid nano-blood is an electro-conductive solution comprising blood as base fluid and magnetized trihybrid nanoparticles (copper, gold, and alumina). Closed-form solution in terms of Bessel's functions is gotten for electro-osmotic potential due to the electric double layer (EDL). The homotopy perturbation methodology is implemented in order to track down the convergent series solutions of non-linear coupled flow equations being elicited. The physical attributes of distinct evolving parameters on the different dimensionless hemodynamic profiles and quantities of interest are elucidated evocatively via a sort of graphs and charts. The ancillary outcomes proved that the Debye-Hückel parameter and Helmholtz-Smoluchowski velocity have a dual impact on the ionized bloodstream. The bloodstream rapidity is alleviated/boosted for the assisting/opposing electroosmosis process. Cooling of ionized blood in the endoscopic arterial conduit is achieved with lower Hartmann numbers. Copper-gold-alumina/blood exhibits a superior heat transmission rate across the arterial wall than copper-gold-blood, copper-blood, and pure blood. Additionally, the contour topology for the bloodstream in the flow domain is briefly elaborated. The contour distribution is significantly amended due to the variant of the Debye-Hückel parameter. The model's new findings may be invaluable in electro-magneto-endoscopic operation, electro-magneto-treatment for cancer, surgical process, etc.

Experiences of robot assisted thrombectomy with 2-year follow-up.

No consensus has been reached on operative procedures since a limited case series of robot-assisted inferior vena cava thrombectomy (RA-IVCT) and robot-assisted radical nephrectomy (RA-RN) have been described. The clinical data of 21 patients who underwent RA-IVCT and RA-RN were retrieved from the database. Preoperative preparation was used for assessment of the tumour. Surgical procedures were recorded, and operative skills were summarised. The median IVC clamping time was 23min, and IVC wall invasion was pathologically found in 2 cases. The mean postoperative hospital stay was 8.4days and most patients recovered to full ambulation and oral feeding on the fourth day. None of the patients had liver or kidney dysfunction at the last follow-up (median, 24months). RA-IVCT presents technical challenges to surgeons. IVC control is an important part of the surgical process and different sides require different techniques.

Cortical resting motor threshold difference in asleep-awake craniotomy for motor eloquent gliomas: WHO grading influences motor pathway excitability.

Developing neurophysiological tools to predict WHO tumor grade can empower the treating teams for a better surgical decision-making process. A total of 38 patients with supratentorial diffuse gliomas underwent an asleep-awake-sedated craniotomies for tumor removal with intraoperative neuromonitoring. The resting motor threshold was calculated for different train stimulation paradigms during awake and asleep phases. Receiver operating characteristic analysis and Bayesian regression models were performed to analyze the prediction of tumor grading based on the resting motor threshold differences. Significant positive spearman correlations were observed between resting motor threshold excitability difference and WHO tumor grade for train stimulation paradigms of 5 (R = 0.54, P = 0.00063), 4 (R = 0.49, P = 0.002), 3 (R = 0.51, P = 0.001), and 2 pulses (R = 0.54, P = 0.0007). Kruskal-Wallis analysis of the median revealed a positive significant difference between the median of excitability difference and WHO tumor grade in all paradigms. Receiver operating characteristic analysis showed 3mA difference as the best predictor of high-grade glioma across different patterns of motor pathway stimulation. Bayesian regression found that an excitability difference above 3mA would indicate a 75.8% probability of a glioma being high grade. Our results suggest that cortical motor excitability difference between the asleep and awake phases in glioma surgery could correlate with tumor grade.

Prevalence of co-morbidities and referral patterns in routine preoperative evaluation: A retrospective observational analysis in a tertiary care government hospital

The initial interaction between patients and anaesthesiologists during pre-anaesthesia check-ups (PAC) is a crucial opportunity to diagnose and pre-optimize co-morbidities that might go unnoticed. This proactive approach contributes to safe anaesthesia administration, uneventful intra-operative experiences, and smooth post-operative recovery. Our study assesses the prevalence of diverse co-morbidities within a tertiary care centre's PAC. After analysing data from 3 months involving 905 patients, 624 individuals exhibited co-morbidities, with 217 cases being newly identified within the PAC clinic. Among female patients, anaemia emerged as the most prevalent anomaly (219 cases), while hypertension dominated among male patients (171 cases). Overall, anaemia constituted the most common co-morbidity (362 cases). A comprehensive clinical assessment during the Pre-Anaesthetic Clinic empowers formulation strategies for pre-optimization and treatment of co-morbidities. Timely intervention is pivotal, not only to prevent surgery delays but also to avert potentially catastrophic outcomes arising from untreated conditions. This approach translates into expedited patient recovery, minimizing anaesthesia-related complications. The Pre-Anaesthetic Clinic plays a pivotal role in diagnosing and intervening in patient co-morbidities. Beyond diagnosis, it is a crucial early intervention and treatment platform, significantly enhancing the overall surgical recovery process.

Unilateral Biportal Endoscopy for the Treatment of Lumbar Disc Herniation.

Unilateral biportal endoscopy (UBE) is a minimally invasive spinal surgery technique increasingly employed in treating degenerative lumbar diseases, such as lumbar disc herniation, lumbar spinal stenosis, and spondylolisthesis. In UBE, two independent yet interconnected surgical channels are established-one for the endoscope and the other for surgical instruments-providing a broad and clear surgical field of view. UBE offers several advantages over traditional open surgery, including reduced tissue damage, shorter hospital stays, and faster recovery times. Additionally, it combines the benefits of microscopic surgery and interlaminar endoscopy, enhancing flexibility, accuracy, and reliability during the procedure. The learning curve for UBE is shorter than that for transforaminal endoscopy, as the surgical processes closely resemble those of conventional open surgery. Despite its favorable clinical outcomes, such as reduced blood loss and shorter hospitalization, UBE carries potential complications, including epidural hematoma, dural injury, and compression of the outlet nerve root. To mitigate these risks, it is crucial to ensure appropriate patient selection, apply the correct surgical technique, and engage in careful postoperative monitoring. This article provides a detailed summary of the step-by-step surgical techniques used in UBE for treating lumbar disc herniation. It serves as a comprehensive guide to enhance practitioners' understanding of UBE. The presentation also underscores the importance of rigorous training and expertise to ensure optimal patient outcomes.

Indicadores clínicos nutricionais da nanda internacional em pacientes no pós-operatório

Aim: to describe the nutritional clinical indicators of post operatory patients based on the nutrition field of NANDA International. Method: cross-sectional descriptive study conducted in a university hospital from October to December2012. Astructured script was used to investigate sociodemographic and clinical indicators. The sample consisted of 80 individuals. A descriptive statistical analysis and data were arranged in tables. Results: Eight diagnoses were identified with a predominance of: unbalanced nutrition: lower than body requirements (00002) (58.8%); Excessive volume of liquid (00026) (43.8%) and risk of impaired hepatic function (00178) (42.5%). Conclusion: the individual nutritional status is an important parameter in the surgical process, either for the procedure or after it. Thus, care and nursing actions must prioritize and meet the needs of diagnoses identified in order to avoid postoperative complications.

Designing a Log-Logistic-Based EWMA Control Chart Using MOPSO and VIKOR Approaches for Monitoring Cardiac Surgery Performance

This study aims to develop a risk-adjusted Exponentially Weighted Moving Average (EWMA) control chart for computer-based performance monitoring in cardiac surgery. Patients have distinct risk factors that impact the surgical process before it even begins. As a result, risk adjustment is carried out utilizing the Accelerated Failure Time (AFT) model to consider these factors. Before using the risk-adjusted EWMA chart, the optimal parameter design should be established, considering the required statistical and economic factors. A model for Multi-Objective Decision Making (MODM) with multiple assignable causes has been proposed to accomplish this. The model is solved using a two-stage methodology based on the Multi-Objective Particle Swarm Optimization (MOPSO) method and the VIekriterijumsko KOmpromisno Rangiranje (VIKOR) method. An actual case study for cardiovascular patients has been undertaken to demonstrate the performance and effectiveness of the suggested model. The multi-objective and pure economic models have been thoroughly compared. The economic model with statistical constraints and the multi-objective model have also been compared again. The findings suggest that the multi-objective design of the risk-adjusted EWMA chart exhibits higher statistical performance in both cases against a small augment in cost.

Digital consent in gynecology: an evaluation of patient experience

IntroductionThe surgical consent process is a crucial discussion between patient and surgeon, which is predominantly documented utilizing hand-written forms. The exchange of individualized information allows the patient to make a truly informed decision. Digital consent (also known as electronic consent or e-consent) has been shown to improve accuracy of information provided without increasing the time taken to consent patients. We aimed to evaluate patient experience and effectiveness of digital consent in a gynecology department in a tertiary London Teaching Hospital.MethodsA questionnaire was designed and completed by 100 patients undergoing gynecological surgery: 50 consented using paper and 50 consented digitally. The questionnaire included 8 statements, with five possible answers to select, ranging from strongly agree to strongly disagree, on a standard five-point Likert Scale. Patients were all female and categorized into age groups (deciles) and asked whether consent was taken digitally or on paper. Data were collected between January and July 2021.ResultsMost responses were positive with 87% (694/800) of responses to the questions being either strongly agree or agree. Patients who were consented using paper selected ‘strongly agree’ 43.5% (174/400) of the time in comparison to 64.8% (259/400) of the time when they were consented digitally. The majority, 86% (43/50), of digitally consented patients received a copy of the consent form in comparison to 18% (9/50) of those consented using paper. On average, the patients consented digitally were older than their paper-consented counterparts (49–58 and 59–68 respectively). The mean scores for the questions relating to the ease of reading the form, ease of understanding the form, understanding of the potential complications, and overall satisfaction were higher in those digitally consented (p < 0.05).DiscussionOverall, patients were satisfied with both methods of consent. However, individuals who were consented digitally reported higher levels of satisfaction throughout the consent process, compared to paper consent. These data suggest that digital consent is an acceptable alternative to paper consent for patients and facilitates adherence to national consent guidance, which stipulates patients should be given the information they request.

Impact of preoperative pharmaceutical care consultation on medication errors in surgical patients: a comprehensive analysis

ABSTRACT Objective Assessing the impact of introducing preoperative pharmaceutical care consultations by analyzing the severity of prevented medication errors (MEs) and their potential effects on the surgical process. Methods Preoperative pharmaceutical care consultation was implemented in our hospital to assess the preoperative medication management of surgical patients between the pre-anesthesia consultation and the day of surgery. Pharmacists evaluated the appropriateness of medication management based on a consensus multidisciplinary institutional protocol. All errors identified between 2016 and 2020 were analyzed, and their severity and potential impact on surgery were standardized. A list of therapeutic groups was created to prioritize patients for consultations Results During the study period, 3,105 patients attended the consultations and 1,179 MEs were prevented. According to severity, 30.6% of MEs were classified as category E and 26.2% as D. The Number Needed to Treat to prevent a category E or higher ME (indicating potential harm to patients) was 5 patients. About 14.84% of MEs belonged to the prioritized drug groups. One hundred and thirteen errors would have resulted in a surgery delay of more than 24 h, and 175 errors were classified as G-H (irreversible damage). Conclusions This study highlights the effectiveness of pharmaceutical care consultations in preventing MEs and improving surgical outcomes.

Diagnosis of frailty and implications on surgical process in the elderly

Longevity has increased the proportion of the elderly in the population, and as a result ageing has become the leading factor for diseases such as cerebrovascular and cardiovascular disorders. It also makes surgical procedures more complex with potential life-threatening complications. In order to further investigate the role of ageing in modern healthcare, the term ‘frailty’ has been proposed to describe a condition of reduced functional reserve that leads to an increased risk of adverse health outcomes. The aim of this study was to review the pathophysiology of frailty and to highlight the most important tools to diagnose it, and their ability to predict the postoperative outcome. There are two major conceptual models that provide guidance for the detection of frailty: the Fried Phenotype Model and the Cumulative Deficit Model. These two main models have provided a base from which the assessment of frailty has developed. Two frailty assessment tools, the modified frailty index and the simplified frailty index play a key role in the preoperative setting because of their predictive power for postoperative risk quantification. Assessments of independence and/or cognitive function represent the main components that an ideal frailty tool should have to identify elderly people who are at risk of postoperative functional and cognitive deterioration. Cognitive impairment undoubtedly has a high association with frailty, but cognitive status is not included in many frailty assessments. In this regard, comprehensive geriatric assessment is a more complete evaluation tool, and it should be used whenever a frailty tool screening gives a positive result. Finally, frailty assessment is useful to explore the cumulative effect of comorbidities on the ageing patients’ functional reserves and to identify the appropriate level of in-hospital and postdischarge care.

Parental experience and understanding of parent-provider discussions of treatment for infants with ureteropelvic junction obstruction.

The purpose of the current study was to understand what families identify as necessary information to guide decision-making in the treatment of their child with UPJO. We conducted semi-structured interviews with parents of children with UPJO using phenomenological methodology. Data were systematically analyzed according to principles of thematic analysis, using a team-based inductive approach. 32 parents were interviewed. Findings are organized by three major themes including barriers to meaningful participation in decision making, logistical aspects of the decision, and psychosocial aspects of the decision. These findings suggest the need to increase parent education and understanding around medical and surgical decision-making, and the need to enhance psychosocial support for more meaningful parental engagement in the surgical decision-making process. The findings from the interviews highlight the importance of caregivers needing clear and accurate information in order to engage in meaningful discussions related to surgical decision-making for decisions around surgery for UPJO treatment.

Mini Percutaneous Nephrolithotomy vs Standard Percutaneous Nephrolithotomy: A Perioperative Decision Support System for Surgical Success Comparison.

This study aimed to rank the features that are important in terms of safety and effectiveness in choosing the surgical method and providing appropriate care to the patient by using the variables examined before and after the surgery to evaluate the success of mini percutaneous nephrolithotomy and standard percutaneous nephrolithotomy surgeries. The features evaluated before and after surgery were ranked according to their importance in the features considered, using Multivariate Adaptive Regression Splines (MARS), LASSO, Ridge, Elastic_net, and Random Forest algorithms as variable selection techniques. There are 278 samples in the relevant data set. Type of surgery (100%), intercostal access (97.75%), kidney opening procedure (94.25%), postoperative creatinine (59.22%), hydronephrosis (52.23%), the number of entries (41.61%), and pre- and post-operative hemoglobin difference (45.13%) were determined as the most critical variables. The MARS algorithm showed the most successful performance, with the lowest mean absolute error (MAE) value of 0.3622, the lowest root mean square error (RMSE) value of 0.3960, and the highest R2 value of 0.3405. Clinical decision support systems can be helpful in eliminating errors and reducing costs. It can also improve the quality of healthcare and aid in the early diagnosis of diseases. Computer-aided decision-making systems can be developed using the results of such products. These systems can provide doctors with better information about their patient's treatment options and improve decision-making. It can contribute to patients being better informed about the surgery results and taking an active role. In conclusion, this study provides essential information that should be included in the surgical decision-making process for patients using medications and with a history of percutaneous nephrolithotomy.

DATA GOVERNANCE in digital surgery

Technological and computer advances have led to a “new era” of Surgery called Digital Surgery. In it, the management of information is the key. The development of Artificial Intelligence requires “Big Data” to create its algorithms. The use of digital technology for the systematic capture of data from the surgical process raises ethical issues of privacy, property, and consent. The use of these out-of-control data creates uncertainty and can be a source of mistrust and refusal by surgeons to allow its use, requiring a framework for the correct management of them. This paper exposes the current situation of Data Governance in Digital Surgery, the challenges posed and the lines of action necessary to resolve the areas of uncertainty that have arisen in the process, in which the surgeon must play a relevant role.

Optimizing Patient Outcomes in Spinal Surgery: An Investigation Into Anesthesiologists' Case Volume.

Introduction Nearly one million patients in the United States undergo spine surgical procedures annually to seek relief from chronic back and neck pain. A multidisciplinary approach is key to ensuring the efficiency and safety of the surgical process, with the anesthesia team, nursing, surgeon, and healthcare facilities all playing a role. The purpose of this study is to capture potential associations between the anesthesiologists' case volume and patient postoperative outcomes in the early recovery period. Methods A retrospective review of anterior cervical discectomy and fusion (ACDF), lumbar decompression (LD), and lumbar fusion (LF) patients from July 2019 to June 2023 was performed. Anesthesiologists were categorized into low, medium, and high volumes of spine surgical cases. Univariate analysis was performed on patient demographics, intraoperative measures, post-anesthesia care unit (PACU) measures, and postoperative measures by anesthesiologist volume. Results This study included 545 ACDF, 815 LD, and 1,144 LF patients. There were no differences between groups in ACDF patients by anesthesiologist volume. When examining patients undergoing LD, there was a difference in patients with an American Society of Anesthesiologists (ASA) physical status classification of three or greater (low volume: 41.7% vs. medium volume: 53.7% vs. high volume: 45.0%; p=0.029). When examining patients undergoing LF, there were differences in patients with low temperatures in PACU (low volume: 2.8% vs. medium volume: 7.3% vs. high volume: 4.2%; p=0.044) and the percentage of patients with a 90-day emergency department return (low volume: 7.7% vs. medium volume: 11.9% vs. high volume: 7.0%; p=0.024). Conclusion While this study found a minimal impact of anesthesiologist volume on postoperative outcomes, recent literature has emphasized the critical role of teamwork and specialized surgical teams to enhance efficiency and patient care. Further studies are warranted to identify other variables in anesthesia, nursing, and surgical team workflow that may impact postoperative outcomes in spinal surgeries.

A Conduit for a Culturally Competent Consent: Medical Interpreters' Perspectives on Surgical Informed Consent Discussions.

To understand medical interpreter's perspectives on surgical informed consent discussions and provide feedback for surgeons on improving these conversations. Informed consent is a critical component of patient-centered surgical decision-making. For patients with limited English proficiency (LEP), this conversation may be less thorough, even with a medical interpreter, leaving patients with an inadequate understanding of their diagnosis or treatment options. A semi-structured interview guide was developed with input from interpreters and a qualitative research expert. We purposively sampled medical interpreters representing multiple languages until thematic saturation was achieved. Participants discussed their experience with the surgical consent discussion and process. Interview transcripts were analyzed using emergent thematic analysis. Among 22 interpreters, there were ten languages represented and an average experience of 15 years (range 4-40y). Four major themes were identified. First, interpreters consistently described their roles as patient advocates and cultural brokers. Second, interpreters reported unique patient attributes that influence the discussion, often based on patients' cultural values/expectations, anticipated decisional autonomy, and family support. Third, interpreters emphasized the importance of surgeons demonstrating compassion and patience, using simple terminology, conversing around the consent, providing context about the form/process, and initiating a pre-encounter discussion. Finally, interpreters suggested reducing legal terminology on consent forms and translation into other languages. Experienced interpreters highlighted multiple factors associated with effective and culturally tailored informed consent discussions. Surgeons should recognize interpreters' critical and complex roles, be cognizant of cultural variations among patients with LEP, and improve interpersonal and communication skills to facilitate effective understanding.

Non-linear thermal radiation and entropy generation on MHD Casson and Williamson hybrid nanofluids across a curved stretching sheet with Cattaneo-Christov heat flux model

This entire study aims to prove the impacts of non-linear thermal radiation and entropy generation on Casson and Williamson hybrid nanofluids through a comparative analysis of the magnetohydrodynamic flow in a porous, curved stretching sheet with the Cattaneo-Christov heat flux model. We used hybrid nanofluid blood based on gold (Au) and Aluminium oxide (Al2O3) nanoparticles. The governing non-linear coupled Partial Differential Equation (PDE) are transformed into non-linear coupled Ordinary Differential Equations (ODE) using the Maple software solver using the Homotopy Perturbation Method. The Homotopy Perturbation Method (HPM) results are compared with the Numerical Method (NM) results, and HPM gives reliable results. The results are provided through the table and graphical representations for several parameters such as velocity, temperature, entropy production, Bejan number, Nusselt number, and skin friction respectively. The velocity profile decreases for Williamson and Casson hybrid nanofluids over a curved stretching sheet while the magnetic field parameters increase. Due to magnetic force associated with Lorentz force, which is known as resistive force, velocity decreases. The Magnetic field on the entropy generation for Casson and Williamson hybrid nanofluids. As the Magnetic field increases, the entropy generation increases for Williamson and Casson hybrid nanofluids. This problem is used in various biomedical situations, including resistive impedance to flow, arteria wall shear stress, and heating impact owing to radiation throughout the surgical process by altering the strength of the applied magnetic field.

First experiences with a surgery supporting computer system in regard to education, efficiency and complications

PurposeSince October 2019 a computer software named SPM (surgical process manager) is used in a Level I Trauma center. Workflows were developed for distinct surgical procedures (distal radius fractures, proximal femur fractures, ankle fractures, proximal humerus fractures and vertebral fractures). In addition, these workflows were separated in a shortened „Expert“-versions for consultants and a more detailed „Learner“- versions for residents.This investigation was intended to show, if and what kind of benefits in regard to efficiency (incision to suture and suture to incision time), education and complications a surgery supporting software can bring. MethodsSPM was used in 90 cases during October 2019 to June 2022. A control trial with 108 patients was developed, including patients of the same age, having same kind of injuries, receiving the same surgery technique without using the SPM.The software was installed on the computer in the operation room, projected on head monitors and operated by a foot pedal. Complications could also be documented using the pedal.Groups were divided in surgical procedures and fracture type, qualification of the surgeon, complications and surgery time. Surgery times were taken from the hospital computer system (SAP IS-H). A statistical analysis was performed by using the chi square and Fischer exact test with significance set at a P value <0.05. ResultsIn 51 cases the software was used for the distal radius (control group 54 patients), in 20 cases for Weber fractures (control group 21 patients), in 9 cases for the proximal femur (control group 19 patients), in 5 cases for vertebral fractures (control group 7 patients) and in 5 cases for the proximal humerus (control group 6 patients).Time from incision to closure was significant higher in the intervention group (49 vs 42 min, p- value 0,018) and wasn't significant lower in the “expert” group, fixing radius and ancle fractures (39 to 46 min, p value 0,186).Comparing the SPM and control group concerning closing to incision time, no difference could be observed (56 to 58,5 min, p value 0,828).The greatest time deviation between „Learners“und „Experts“was observed in reduction and fixation (p value 0,006) in ankle fractures. The “Expert“group also needed less time for the approach (p value 0,008) in case of distal radius fractures.Unexpected events were more often observed in the intervention group (5,5 vs 3,7 %). ConclusionsA surgery supporting computer system might be a good tool for detecting and optimizing workflows in the operation room and for improving and analyzing the training of residents and surgical assistants.In addition, it offers the opportunity to document intraoperative complications. However, a saving of time wasn't observed in this study. Further investigations with bigger number of cases and a longer follow-up are necessary to proof these findings statistically.

A Novel Endovascular Double-Disc Implant for Sealing Intimal Tears in Aortic Dissection

Postdissection thoracoabdominal aortic aneurysm incidence after thoracic endovascular aortic repair for type B aortic dissection is high, with residual distal tears being a major reason for persistent blood flow in the false lumen. The EndoPatch is an endovascular double-disc implant for sealing re-entry tears in aortic dissection, isolating blood flow in the false lumen and promoting thrombosis formation. Compared with conventional endovascular treatment techniques, this endovascular double-disc implant’s small size and minimal working space requirements may reduce the risk of spinal ischemia and offer flexible vascular access. Although several barriers still impede this endovascular device’s broad application, its innovative design, flexible vascular access, and streamlined surgical process make it a promising alternative for managing intimal tears in aortic dissection, either alone or as a supplementary method combined with conventional endovascular techniques. (Guo’s Entry Tear Repair: The First in Man Study of Endopatch System; NCT04745039)

Pirmosios Baltijos šalyse taikomos robotinės chirurgijos sistemos „Versius“ daugiadisciplinis diegimas

On June, 2023, Vilnius University Hospital Santaros Klinikos started robotic-assisted operations using VERSIUS robotic surgery system (CMR, Cambridge, UK) and performed 29 robotic surgeries within the first 3 weeks. This surgical system was purchased with funding from the European Regional Development Fund. Comprehensive three-month-long learning courses were organized for a total number of 32 persons, forming 8 independent teams, each consisting of 2 surgeons and 2 nurses. Learning courses consisted of online theoretical training modules, a one-week learning course including technical skills training with a simulator and dry runs as well as cadaveric surgical cases. Furthermore, an additional learning module included dry runs in the operating room prior to the first surgeries, following live and online proctored surgical cases. This enabled a rapid and smooth introduction of the robotic surgical system into clinical practice without putting patients at risk. Abdominal surgeons, urologists, and gynecologists have already performed surgeries using the VERSIUS surgical system and no major complications have been reported. Thoracic surgeons are underway to begin thoracic robotic-assisted surgeries, completing the multidisciplinary VERSIUS surgical system implementation process. Our goal is to share initial experience with robotic VERSIUS surgical system and evaluate its implementation in Vilnius University Hospital Santaros Klinikos.