Surgical Tools Research Articles

Evaluation of ASA, SORT, and ACCI Scores in Predicting the Need for Postoperative Intensive Care Unit Admissions After Hip Surgery.

We aimed to investigate the effectiveness of the American Society of Anesthesiologists (ASA), the Surgical Outcome Risk Tool (SORT), and age-adjusted Charlson Comorbidity Index (ACCI) scores in determining the requirement for intensive care unit (ICU) admissions in patients aged 65 years and older who underwent hip surgery. The study population consisted of 450 patients who underwent orthopedic hip surgery. The patients who were admitted to the ICU were either monitored in the postoperative ICU (Group 1) or transferred to the ward (Group 2). SORT and ACCI scores of all patients were recorded. The patients of Group 1 were significantly older than those in Group 2. SORT scores of both groups were comparable. The diagnostic sensitivity and specificity of ACCI scores were determined as 42.1% and 70.8%, respectively. As a conclusion, ACCI scores can predict the need for ICU admissions in patients undergoing hip surgery. Besides, the traditionally used ASA scores are generally higher in this patient group. Determinative criteria for predicting the need for ICU admissions include older age of the patients, presence of comorbidities as hypertension and diabetes mellitus, as well as a long preoperative waiting period.

Interactive pipeline for mandible reconstruction surgery planning using fibula free flap.

Mandible reconstruction surgery using fibula free flap is a long and expensive process requiring extensive surgical experience. Indeed, the planning stage, mandible shaping, and therefore osteotomy positioning on the fibula are tedious, often done by hand, and can take months. This delay is unacceptable when mandible deterioration is caused by a time-sensitive disease such as cancer. In this paper, we propose an interactive pipeline for an easy-to-use and time-efficient surgical planning tool tailored to be used directly by the surgeon. From CT scans of patient's mandible and fibula, we propose to register a cutting structure to the mandible and to segment and mesh the fibula; then, respecting anatomical constraints (mandible curvature, flap size, vessel preservation, etc.), we generate a surgery plan. Next, in a 3D interactive environment, the surgeon can intuitively shape the mandible by cutting, moving, and modifying bone fragments nondestructively. This stage allows surgeons to express their expertise, and the resulting cutting plane positions are then sent to a robot serving as a cutting guide for the surgery. We demonstrate the efficiency of our method through patient-specific surgery planning for two different pathologic cases. We show our results are comparable to a commercial solution away from cutting guides design. Our proposed pipeline allows for a patient-specific precise planning and to cut down the preoperative planning phase of the mandible reconstruction surgery from days to minutes.

The History of Nonlaser Energy-Based Devices in Dermatology.

From the initial development of radiofrequency devices to new technologies such as micro-coring, there has been tremendous growth of nonlaser energy-based devices in dermatology over the past few decades. To review the origins and development of energy-based devices in dermatology and dermatologic surgery. A literature search was conducted on PubMed from inception to February 1, 2025 to identify critical publications on energy-based devices within dermatology. Since the initial research surrounding radiofrequency-based surgical tools in the 1990s, numerous dermatologists have pioneered the development of energy-based devices to target skin laxity and texture, enhance body contouring, and improve muscle tone. The rise of these energy-based devices has allowed for minimally invasive treatments to address patients' aesthetic concerns with less pain and downtime. Dermatologists have played a critical role in the advancement behind the rise of energy-based devices for a variety of aesthetic indications. Dermatologic Surgery has published many of the landmark studies behind these devices and continues to be at the forefront of innovation for further research and clinical trials.

Using Masked Image Modelling Transformer Architecture for Laparoscopic Surgical Tool Classification and Localization

Artificial intelligence (AI) has shown its potential to advance applications in various medical fields. One such area involves developing integrated AI-based systems to assist in laparoscopic surgery. Surgical tool detection and phase recognition are key components to develop such systems, and therefore, they have been extensively studied in recent years. Despite significant advancements in this field, previous image-based methods still face many challenges that limit their performance due to complex surgical scenes and limited annotated data. This study proposes a novel deep learning approach for classifying and localizing surgical tools in laparoscopic surgeries. The proposed approach uses a self-supervised learning algorithm for surgical tool classification followed by a weakly supervised algorithm for surgical tool localization, eliminating the need for explicit localization annotation. In particular, we leverage the Bidirectional Encoder Representation from Image Transformers (BEiT) model for tool classification and then utilize the heat maps generated from the multi-headed attention layers in the BEiT model for the localizing of these tools. Furthermore, the model incorporates class weights to address the class imbalance issue resulting from different usage frequencies of surgical tools in surgeries. Evaluated on the Cholec80 benchmark dataset, the proposed approach demonstrated high performance in surgical tool classification, surpassing previous works that utilize both spatial and temporal information. Additionally, the proposed weakly supervised learning approach achieved state-of-the-art results for the localization task.

Validation of the Perioperative Mortality Risk in Adults with Congenital Heart Disease (PEACH) Score in a US Cohort.

The PErioperative ACHd (PEACH) score is a mortality risk assessment tool for adult congenital heart disease (ACHD) patients created to address the unique surgical risks in this population. Evaluation of the PEACH score's validity in a US cohort is needed. This paper sought to assess the PEACH score's performance in ACHD patients undergoing cardiac surgery. Secondary objectives included comparison of the PEACH score to other surgical risk assessment tools, score association with post-operative morbidities, and exploration of additional variables that may improve the score. A retrospective cohort study was conducted in ACHD patients who underwent cardiac surgery at the University of Colorado Hospitals between 2010 and 2022. Patients were identified by the institutional STS database. Components of the PEACH score and additional risk factors were evaluated by univariable analysis and subsequent logistic regression. A ROC curve compared the PEACH score to existing risk models. 516 patients were included with a median age of 30years and 51% male. There were 9 (1.7%) deaths. Zero of 240 low-risk patients died, 6 of 229 intermediate-risk patients died (2.6%), and 3 of 41 high-risk patients died (7.3%). Model comparison revealed PEACH score AUC 0.832, ACHS score AUC 0.869, and STAT AUC 0.769. The addition of platelet level (< 150,000) improved the PEACH score (AUC 0.843, 95% CI 0.747-0.939). The PEACH score provided strong predictive ability for perioperative mortality in this ACHD cardiac surgery cohort and was associated with increased morbidity. The addition of platelet level to the score may improve its accuracy.

CLEANSurgiTip: A Contamination Limiting, Expendable, and Novel Surgical Tool Tip for Robot-Assisted Minimally Invasive Surgery

Abstract Over the last two decades, Robot-Assisted Minimally Invasive Surgery (RAMIS) has become more accessible and has contributed to improved patient outcomes. However, its adaptation in resource-constrained environments is limited due to the cost of the consumables, such as surgical instruments and access to sterilization facilities. These surgical instruments often have a tooltip with intricate geometry, making it difficult to sterilize and reuse for multiple surgeries. This research introduces a novel MIS instrument, the CLEANSurgiTip, which features a disposable grasper designed to address biofouling while reducing overall costs through minimized waste. Unlike traditional tendon-driven systems that suffer reliability issues and require frequent replacements, the CLEANSurgiTip utilizes rigid shafts to transmit motion to a distal 2+1 degrees of freedom grasper (pitch, yaw, grasp). These rigid shafts ensure a consistent cross-section, simplifying the sealing process against bodily fluids. The transmission mechanism is simplified using an elbow mechanism and flexible shafts in place of conventional gears for orthogonal motion transmission. The flexible shaft aids in decoupling the pitch and the yaw motion. The tooltip design promotes a simplified interface between the disposable grasper and the reusable shaft, facilitating easy detachment. The paper also presents a novel reusable tool shaft to drive the proposed tooltip.

Chamber design and intensity-modulated ultraviolet-C LEDs for advanced pulsed photonic disinfection.

Contaminated apparatus and surgical tools pose serious health risks. For such purpose, disinfection chambers are employed. However, these systems rely on mercury-based UV lamps which comes with various drawbacks. These limitations have driven interest in Ultraviolet-C Light Emitting Diode (UV-C LED) technology as a safer and more efficient alternative. However, existing studies have not thoroughly explored the impact of varying intensities of pulse width modulation (PWM) on disinfection efficacy. To addess this, the present study designed and tested a LED-based disinfection chamber by employing 4-W 275 nm Surface Mount Device (SMD) LEDs against frequently isolated bacteria. By following prior approach, irradiation time was alternated at 30-s intervals and antibacterial efficacy was assessed through various parameters. Additionally, scanning electron microscopy (SEM) was performed to examine the morphological changes. Results indicated that the reduction was significantly influenced (p<0.05) with varying PWM levels (60-100 %), achieving 2.05-log10 and 1.54-log10 inactivation against Escherichia coli and Staphylococcus aureus, respectively, upon exposure to 51.24 mJ/cm2 under maximum exposure settings. Moreover, complete cellular damage leading to bleb protrusion and cell-leakage confirmed the disruption of bacterial DNA. In conclusion, UV-LEDs show great potential for disinfection, with efficiency influenced by PWM and dosage.

Does cross-sectional imaging diminish the utility of surgical handover for trainee assessment?

Does cross-sectional imaging diminish the utility of surgical handover for trainee assessment?

The medial antebrachial cutaneous nerve in thoracic outlet syndrome: A systematic review and meta-analysis.

The medial antebrachial cutaneous nerve in thoracic outlet syndrome: A systematic review and meta-analysis.

Adoption of Endoscopic Spine Surgery: A 6-Year National Utilization Analysis.

Descriptive study. To determine national trends in utilization of endoscopic spine surgery from 2017 to 2022. Endoscopic spine surgery (ESS) has emerged as a potential, minimally invasive approach to treat certain symptomatic spinal pathology. The benefits of ESS have not been well established; however, small case series suggest possible improvement in postoperative complications rates, decreased length of stay, and improved outcomes in comparison to traditional techniques. Despite this, adoption of ESS is not widespread in the United States. Patients undergoing ESS were identified using the CPT code 62380 in the PearlDiver M165Ortho database from 2017 to 2022. Demographic factors extracted included: (1) age, (2) sex, (3) Elixhauser comorbidity index (ECI), (4) Charlson comorbidity index (CCI), (5) geographic region of surgery, (6) type of insurance plan (Commercial, Medicaid, Medicare), and (7) timing of the surgery. A total of 1886 patients who have undergone ESS were identified from 2017 to 2022. The utilization of ESS peaked in 2018 but reached a plateau after. The largest proportion of patients receiving ESS were over the age of 70 (30%) with 51% female (n=968). In addition, the majority of ESS were performed in the South (47.8%), and most payers utilized commercial health insurance (70.9%). Comorbidity indices for ESS patients were tracked: mean ECI +/- SD: 5.04+/-3.68; median ECI: 4 and mean CCI: 2.06; median CCI: 2. The limited widespread adoption of ESS can be multifactorial. As with all new technologies, there is hesitation for early adoption, additionally the lack of standardized surgeon education, limited scope of procedure, and need for advanced surgical tools serve as possible reasons contributing to the trends in usage.

Advancements and Applications of Plastics: A Comprehensive Review

A family of thermoplastic materials known as plastics has remarkable mechanical, thermal, electrical, and chemical qualities that make them ideal for a variety of industrial uses. Plastics, as opposed to commodity plastics, are made to be more resilient to environmental elements including moisture, chemicals, and UV light. They also have more strength and stiffness. A few common examples include acrylonitrile butadiene styrene (ABS), polyethylene terephthalate (PET), polyamide (nylon), polycarbonate (PC), polyethylene (PE), and polypropylene (PP). The automotive, aerospace, electrical and electronic, construction and consumer goods sectors all make substantial use of these materials because of their adaptability, durability, and capacity for precision engineering to suit certain performance needs. Technological developments in plastics have transformed a number of sectors by providing improved functionality, robustness, and adaptability. Recent years have seen major advancements in these materials, opening up new possibilities in a variety of industries. The creation of innovative polymer blends, nanocomposites, and additive manufacturing techniques which enable customized characteristics to fulfill particular application requirements are important breakthroughs. Because of their high strength-to-weight ratio, corrosion resistance, and lightweight nature, plastics are gradually taking the place of conventional materials like metals in the automotive and aerospace sectors. Furthermore, developments in thermoplastic composites provide enhanced thermal stability and impact resistance, which makes them perfect for interior parts and structural components Because of their superior electrical insulating qualities, flame retardancy, and tolerance to high temperatures, engineering polymers like polycarbonate and polyphenylene sulfide (PPS) are frequently used in electronics and electrical engineering. These materials maintain safety and dependability while helping to reduce the size and improve the performance of electrical equipment. Furthermore, because of their chemical resistance, sterilizability, and biocompatibility; plastics are used in the medical industry to make surgical tools, implants, and housings for medical devices. Plastics are essential for constructing complicated shapes with great accuracy and strength in additive manufacturing (3D printing). The spectrum of printable polymers has increased due to developments in material compositions and printing technology, allowing for quick prototyping and customized manufacture of end-use parts.

An Evidence-Based Approach to Indication for Remplissage.

Treatment of anterior shoulder instability (ASI) is complex with many factors contributing to surgical decision making. The remplissage is an adjunct surgical technique that can be added at the time of arthroscopic labral repair or glenoid bone block reconstruction to decrease the recurrence rate of ASI post-operatively. The purpose of this review is to highlight the history, indications, and outcomes of remplissage when used for anterior shoulder instability. Prior studies have demonstrated that remplissage, when used in addition to an arthroscopic labral repair, can significantly reduce the rate of recurrent instability in patients with both off-track and near-track Hill Sachs lesions. There remains concern that addition of remplissage will negatively affect post-operative range of motion (ROM). However, recent literature suggests no difference observed in ROM when comparing remplissage plus arthroscopic labral repair to arthroscopic labral repair alone. While the addition of a remplissage has promising rates of return to sport, these results are less favorable when a remplissage is performed in an overhead athlete. The remplissage is a powerful surgical tool to utilize in addition to an arthroscopic labral repair or glenoid bone block reconstruction in patients with anterior instability. An understanding of appropriate indications and its influence on post-operative outcomes can assist the surgeon with providing the best possible outcome for each individual patient.

The importance of the Electrode-Neural Interface in supporting long term outcomes in cochlear implantation. Expert opinion.

Background Since first introduced in the mid 1980's, cochlear implant (CI) technology has significantly evolved to reach the current state of the art. Commencing with straight, lateral wall electrode arrays, advances in the last decade led to the development of slim perimodiolar arrays that lie closer to the electrically targeted spiral ganglion. Over the years, as a consequence of improving hearing benefits, CI indications have been steadily expanded. Today, individuals with moderately severe to profound sensorineural hearing loss, many with residual hearing in the low-frequency range, may receive a cochlear implant in one or both ears. Summary Before implantation, individual recipient characteristics, such as years of auditory deprivation, hearing thresholds and speech understanding ability with conventional amplification can have an effect on CI hearing outcomes. Surgical procedures such as careful, soft surgery techniques are imperative to reduce cochlear trauma and optimize outcomes and can be supported by surgical guidance tools and drug therapies to help preserve the delicate intra-cochlear structures. Histopathological investigations provide evidence that support the design concept of slim perimodiolar electrode arrays. Modiolar proximity and scalar tympani location permit energy efficient, focused electrical stimulation of the targeted neural interface, while minimizing injury to the fine structures of the intracochlear lateral wall and its blood supply. Key Messages Modiolar electrode arrays may provide highly consistent scala tympani placement and modiolar proximity which may improve functional hearing outcomes, compared to lateral wall electrode arrays results. Modiolar proximity can result in narrower spread of excitation, reduced channel interaction, lower electrical stimulation thresholds and may improve speech understanding. Preservation of functional residual low-frequency hearing is possible with both straight and perimodiolar electrode arrays. .

Advancing Orthopedic Surgical Tools: With Global Metal Dependency Trends Shifting Toward Sustainable Bioceramic Alternatives

Advancing Orthopedic Surgical Tools: With Global Metal Dependency Trends Shifting Toward Sustainable Bioceramic Alternatives

Dynamic response of soft tissue can be disregarded during femoral stem impaction.

Dynamic response of soft tissue can be disregarded during femoral stem impaction.

Evaluation of electrophysiological changes after radical prostatectomy and their relationship with erectile function recovery.

Erectile dysfunction (ED) is a common complication of radical prostatectomy (RP), mostly due to cavernous nerve (CN) injury. Despite improved surgical techniques and tools, ED rates are still high. Electrophysiological studies help to understand the functional effects of RP on CN and cavernous smooth muscles. The aim of this study is to evaluate the clinical reflection of changes on corpus cavernosum electromyography (CC-EMG) parameters caused by RP. A total of 44 patients were included in this prospective cohort study who underwent RP. The patients were divided into three groups based on nerve-sparing status: bilateral nerve-sparing (Group A) (n = 21), unilateral nerve-sparing (Group B) (n = 12), and non-nerve-sparing (Group C) (n = 11). All patients underwent CC-EMG one month before the operation and at the postoperative third month and were administered the International Index of Erectile Function (IIEF)-5 one month before the operation and at the postoperative third and 12th months. The postoperative third-month CC-EMG showed that the degree of cavernous smooth muscle relaxation in Group A was significantly higher than in Group B and Group C (p = 0.010 and p = 0.032, respectively). In the regression analysis, it was determined that patients with a postoperative IIEF-5 score of 12 or higher at the 12th month had a significantly greater degree of relaxation on the postoperative third-month CC-EMG (p = 0.034). In conclusion, a greater relaxation degree on postoperative third-month CC-EMG correlates with better long-term recovery of erectile function in patients who underwent RP.

The VELO Questionnaire as a Surgical Outcome Evaluation Tool for Cleft Palate Surgery in a Limited Resource Setting in Indonesia

Background: Evaluation of surgical outcomes after cleft palate surgeries is important; however, surgeons face challenges in directly examining patients because of geographical limitations and the coronavirus disease (COVID-19) pandemic. Material and Methods: This research uses a cohort study design. Respondents were patients with a cleft palate or the patient's parents, obtained from the screening results of our local hospital charity's clinical mission in Indonesia between 2018 and 2022. Respondents were interviewed using the VELO questionnaire twice, preoperative and 6 months postoperative. Twenty-three respondents with a cleft palate who underwent primary palatoplasty were divided into two groups: (1) patients aged 3–8 years were represented by parents in filling out the VELO-Parent, and (2) patients aged above 8 years were filling out the VELO-Youth on their own. Results: The validity and reliability scores analyzed were categorized as excellent. There was an increase in the VELO scores between pre- and postoperative in both groups (p&lt;.05). The VELO scores also significantly changed postoperatively in patients with three different cleft palate types. Conclusions: The translated VELO questionnaire was valid and reliable to use. The VELO questionnaire is practical to use as an evaluation tool of the surgical outcome of palatoplasty in Indonesia.

A Portable Ultrasound-Guided Surgical System for Breast and Thyroid Surgery

Abstract Ultrasound-guided fine needle biopsy and vacuum-assisted minimally invasive rotary cutting are favored in clinical applications due to their cost-effectiveness, minimal trauma, and lack of radiation. However, the existing spatial positioning technology for surgical instruments occupies operating room space and affects the doctor’s hand operation. This study aims to develop an integrated navigation mode by combining real-time ultrasound imaging, electromechanical guidance, and intelligent ultrasound image processing. By using a miniaturized angle detection sensor, we can accurately obtain the angle of the instrument. Combined with real-time segmentation of ultrasound images based on deep learning, the accuracy of lesion localization is significantly improved. We successfully integrated the ultrasound image acquisition, real-time lesion segmentation and navigation functions into a compact and portable embedded device, achieving the embedded platform deployment of the algorithm. This innovation not only reduces the impact of the ultrasound surgical guidance system on the surgeon’s surgical movements but also effectively reduces the space occupied in the operating room. In the future, sensors with higher precision performance can be replaced or models can be optimized to improve overall performance. The integrated navigation mode proposed in this project provides clinicians with a more comfortable, efficient, and convenient surgical assistant tool by integrating real-time ultrasound imaging, electromechanical guidance, and intelligent image processing technology.

OUTCOME OF TREATMENT IN PATIENTS RECEIVING INTRAVENOUS TRANEXAMIC ACID DURING PERCUTANEOUS NEPHROLITHOTOMY AT TERTIARY CARE HOSPITAL

Background: PCNL serves as the standard treatment for large renal stones though it typically leads to considerable blood loss from the procedure. Patients treated with the antifibrinolytic medication tranexamic acid experience decreased bleeding during surgical procedures and after surgery because this drug blocks the fibrinolytic process. Additional research studies need to explore the value of TXA for PCNL because its therapeutic potential has proved effective in other surgical specialties. Objective: This study aims to determine how intravenous administration of tranexamic acid impacts surgical bleeding amounts and transfusion rates together with post-operative hospital length of stay for patients who undergo PCNL. Methods: The study was executed as a randomized controlled trial in the Department of Urology at Liaquat National Hospital, Karachi for six months. The research enrolled 118 patients who received PCNL and distributed them randomly between two separate groups. The participants in Group A received 1g of intravenous tranexamic acid through an intravenous route exactly twenty minutes before the procedure began while Group B members got normal saline as their placebo treatment. Both pre-operative and post-operative assessments measured patients' hemoglobin and hematocrit levels while recording the need for transfusions and determining the period of hospital stay. SPSS v16 handled the data analysis while p≤0.05 indicated statistical significance. Results: The TXA-treated patients showed a minimal reduction of mean hemoglobin levels which amounted to 1.0 ± 0.4 g/dL while mean hemoglobin levels in the placebo group descended to 1.9 ± 0.6 g/dL (p&lt;0.001). The patients in Group A experienced a lower mean hematocrit loss percentage (2.8 ± 1.1%) than those in Group B (4.9 ± 1.4%) and this difference reached statistical significance (p&lt;0.001). A total of 10.2% of patients receiving TXA needed transfusion therapy whereas 28.8% of placebo group patients needed transfusion therapy (p=0.01). Patients who received TXA spent 2.7 ± 0.8 days in the hospital while patients who received placebo required 3.4 ± 1.0 days (p=0.002). Patients experienced no negative side effects or signs of thromboembolic complications during the study period. Conclusion: Clinical administration of IV tranexamic acid reduces perioperative bleeding transfusion rates and hospitalization duration in patients undergoing arbuscular nephrolithotomy procedures while maintaining good safety outcomes. The use of intravenous tranexamic acid serves as a successful surgical tool that helps improve urological medical results.

Redefining Medical Applications with Safe and Sustainable 3D Printing.

Additive manufacturing (AM) has revolutionized biomedical applications by enabling personalized designs, intricate geometries, and cost-effective solutions. This progress stems from interdisciplinary collaborations across medicine, biomaterials, engineering, artificial intelligence, and microelectronics. A pivotal aspect of AM is the development of materials that respond to stimuli such as heat, light, moisture, and chemical changes, paving the way for intelligent systems tailored to specific needs. Among the materials employed in AM, polymers have gained prominence due to their flexibility, synthetic versatility, and broad property spectrum. Their adaptability has made them the most widely used material class in AM processes, offering the potential for diverse applications, including surgical tools, structural composites, photovoltaic devices, and filtration systems. Despite this, integrating multiple polymer systems to achieve multifunctional and dynamic performance remains a significant challenge, highlighting the need for further research. This review explores the foundational principles of AM, emphasizing its application in tissue engineering and medical technologies. It provides an in-depth analysis of polymer systems, besides inorganic oxides and bioinks, and examines their unique properties, advantages, and limitations within the context of AM. Additionally, the review highlights emerging techniques like rapid prototyping and 3D printing, which hold promise for advancing biomedical applications. By addressing the critical factors influencing AM processes and proposing innovative approaches to polymer integration, this review aims to guide future research and development in the field. The insights presented here underscore the transformative potential of AM in creating dynamic, multifunctional systems to meet evolving biomedical and healthcare demands.