Operative Technique Research Articles

Incisionless Otoplasty: Current State of the Art.

Prominent ears, also known as prominauris, inflict psychological distress and suffering on both children and adults. Otoplasty has become one of the most common aesthetic operations due to its high prevalence and significant impact on patients. Various surgical techniques for otoplasty have been documented and developed over time. While complications are rare, open and cartilage-resection techniques may result in hemorrhage, hematomas, contour deformities, hypertrophic scarring, and keloid formation. Incisionless otoplasty has been demonstrated in the literature to be an effective method, when correctly indicated, to correct prominauris with a shorter recovery time and reduced morbidity. A thorough preoperative evaluation, awareness of the different techniques, and assessment of their appropriate application minimize potential risks and unpleasant results.

Qualitative study on the ability of neurological nurses to manage patients with indwelling gastrointestinal canal

Aim and objectivesThis study aims to assess the proficiency of nurses in the neurology department in managing patients with indwelling gastrointestinal canal.BackgroundMany critically ill patients in neurology departments require the placement of nasoenteric tubes to provide enteral nutrition. However, in clinical practice, there exists considerable variability in nurses’ competencies regarding the management of patients with nasoenteric tubes. A thorough understanding of the challenges nurses face throughout the entire process of nasoenteric tube care and the development of targeted improvement measures are crucial for delivering enhanced patient care and facilitating patient recovery.DesignA qualitative interview study.MethodsFrom August to October 2023, 11 neurological nurses were recruited offline in three hospitals for semi-structured and in-depth interviews. The data analysis uses the KJ method to summarize and classify the themes from the semi-structured interview results, and then organize the themes into a coherent visual and logical path. The COREQ list is used.ResultsThe researchers conducted semi-structured interviews with 11 neurology nurses from three hospitals using a purposive sampling method, of which 64% of the participants were female and 36% were male; the average age was 38.27 ± 7.85 years; 27% from the Department of Neurology, 73% from the Department of Neurosurgery; junior professional titles accounted for 18%, intermediate professional titles accounted for 64%, senior professional titles accounted for 18%; 27% of the subjects were head nurses and 73% were nurses. The study identified 5 themes: (1) Preparation and evaluation before intubation; (2) Enhancement of intubation success rates; (3) Prevention of complications; (4) Management of complications and emergencies; (5) The acquisition of relevant knowledge and experience. In clinical practice, the bedside blind insertion technique is random and has not yet formed a unified standard, and the specific operation details and techniques need to be further improved.ConclusionDisparities exist in the nursing capabilities of neurology nurses due to variations in their knowledge and experience regarding gastrointestinal canal management.

Comparable postoperative outcomes in patients treated with either open or arthroscopic trochleoplasty for patella dysplasia

BackgroundThe aim of this study was to compare the clinical and radiologic results of the arthroscopic and the open trochleoplasty techniques.MethodsA total of 83 trochleoplasties in 83 patients were performed between 2014 and 2021 in one institution. Surgical indications for trochleoplasty were recurrent patellofemoral instability and a lateral trochlear inclination angle (LTI) ≤ 11˚ and a trochlear depth ≤ 6 mm. Of the trochleoplasties, 40 were done by open technique (OT) and 43 by arthroscopic technique (AT). In every case an additional medial patellofemoral ligament (MPFL) reconstruction was performed. Additional tuberosity tibia transfer and/or de-rotation of the femur were done when indicated. Pre- and postoperative magnetic resonance imaging (MRI) were analyzed in respect to LTI, trochlear depth, and lateralization of the patella. Postoperative subjective clinical assessment was done using the Kujala Score, Banff II Score, Tegner Score, and Marx Score.ResultsOf the patients, 15 with OT and 20 with AT were available for follow-up. The mean follow-up was 29.9 months in the OT group and 12.7 months in the AT group. No re-dislocation was observed in either groups. A significant reduction of LTI, increase of trochlear depth, and a reduction of lateralization of the patella was observed between the pre- and postoperative MRI scans in both groups. No significant difference in the observed MRI parameters was found between the two groups. Neither was there a difference in the postoperative Kujala Score, Banff II Score, Tegner Score, and Marx Score between the two groups. Length of stay was on average 6.2 days in the AT group and 8.1 days in the OT group. The surgical time was on average 141 min in the OT group and 160 min in the AT group.ConclusionWe found that patients undergoing an arthroscopic trochleoplasty had a comparable outcome with respect to clinical and radiological parameters compared with patients treated by open trochleoplasty.

Patient reported outcomes and decision regret scores in redo-paraesophageal hernia repair.

Recurrent paraesophageal hernia (PEH) repair presents significant technical challenges, with limited data weighing the benefit to the operative risk. This study aims to describe our experience with recurrent PEH repair, including long-term surgical and patient reported outcomes(PROs). We conducted a retrospective review of recurrent PEH repairs from June 2018-March 2023 using our institutional database. A blinded review of post-operative imaging was conducted to assess for recurrence. Quality of life (QOL) and decision regret were measured using the GERD Health-Related Quality-of-Life (GERD-HRQL) questionnaire and Decision Regret Scale (DRS) at maximum follow up. Eighty-eight patients underwent recurrent PEH repair at our institution for PEH, classified as type II (13.6%), type III (72.7%) and type IV (13.6%). There was significant heterogeneity in operative techniques used: one-third of patients had mesh placed at the hiatus, 11.4% had a Collis gastroplasty, and one-third of patients underwent fundoplication. Intraoperative complications included gastric (5.7%), esophageal (2.3%), vascular (1.1%) and pulmonary (1.1%) injuries. Follow up was available for 73 patients with median follow up of 35.2months. Of patients with radiographic follow up, 20 (35.7%) had a radiographic recurrence: 12 (21.4%) were 2-5cm and 8 (14.3%) were > 5cm. Patients reporting PROs (53 patients; 60.2%) reported low symptom severity (mean GERD-HRQL 13.1 ± 12) and low decision regret (mean DRS 13.3 ± 19.4) with 75.5% scoring in the lowest quartile (DRS < 25). Radiographic recurrence was associated with worse QOL (p < 0.05), but no significant difference in decision regret (p = 0.125). We found significant heterogeneity amongst recurrent PEH repair techniques with continued high recurrence rate during follow up. Radiographic recurrence was correlated with worse QOL, yet patients reported low symptom severity and low decision regret, suggesting continued value in these challenging operations. Future studies should aim to identify more effective techniques to reduce recurrence rates in this patient population.

Fixing detailed balance in ancilla-based dissipative state engineering

Dissipative state engineering is a general term for a protocol which prepares the ground state of a complex many-body Hamiltonian using engineered dissipation or engineered environments. Recently, it was shown that a version of this protocol, where the engineered environment consists of one or more dissipative qubit ancillas tuned to be resonant with the low-energy transitions of a many-body system, resulted in the combined system evolving to reasonable approximation to the ground state. This potentially broadens the applicability of the method beyond nonfrustrated systems, to which it was previously restricted. Here we argue that this approach has an intrinsic limitation because the ancillas, seen as an effective bath by the system in the weak-coupling limit, do not give the detailed balance expected for a true zero-temperature environment. Our argument is based on the study of a similar approach employing linear coupling to bosonic ancillas. We explore overcoming this limitation using a recently developed open quantum systems technique called pseudomodes. With a simple example model of a one-dimensional quantum Ising chain, we show that detailed balance can be fixed, and a more accurate estimation of the ground state obtained, at the cost of two additional unphysical dissipative modes and the extrapolation error of implementing those modes in physical systems. Published by the American Physical Society 2024

Advances and Challenges in Zone 2 Flexor Tendon Repairs.

Flexor zone 2 is the area between the A1 pulley at the distal palmar crease to the insertion of the flexor digitorum superficialis tendon at A4 pulley. Termed "no man's land," primary repair at zone 2 had notoriously high rate of complications such as adhesions, contractures, and tendon rupture. Improved understanding of tendon healing, stronger suture materials, novel operative techniques, judicious pulley venting, and early active rehabilitation have helped improve outcomes. This review examines current methodologies and postoperative considerations for zone 2 flexor tendon repair.

Percutaneous isometric reconstruction of medial collateral and posterior oblique ligaments offers similar outcomes to open techniques with reduced complication rates at a medium-term follow-up: A retrospective comparative study

BackgroundKnee Injuries involving the superficial medial collateral ligament (sMCL) and posterior oblique ligament (POL) can cause severe instability. The open surgical technique involves larger incisions. A percutaneous technique may offer similar outcomes with reduced morbidity and a shorter recovery time. The purpose of this study was to compare the clinical and functional outcomes of percutaneous and open reconstruction using isometric allografts. MethodsA retrospective comparative analysis was conducted on 21 patients between 2010 and 2021. Eleven patients underwent open surgery, while 10 underwent percutaneous surgery. The subjective IKDC, Lysholm, and Tegner scores, and valgus laxity were evaluated. Complications were also recorded. ResultsBoth the groups demonstrated significant improvements in functional scores and a reduction in valgus laxity postoperatively, with no significant differences. The mean improvements were 32.3 for the IKDC score and 37.9 for the Lysholm score. The average reduction in the Tegner score was 1.1 points. Postoperative radiographic measurements of medial joint opening were < 2 mm in all patients. The percutaneous group had fewer complications, with arthrofibrosis being significantly less frequent (0 vs. 4 in the open group). The mean follow-up was 3.5 years. ConclusionPercutaneous reconstruction of the medial side of the knee with an isometric technique is a safe and effective procedure that provides results similar to those of open reconstruction. The advantages of percutaneous reconstruction include smaller incisions, less pain and scarring, shorter recovery time, and lower risk of complications. Allografts are preferred over autografts to avoid donor site morbidity and weakening of the medial stabilizers.

Closed Reduction Followed by Percutaneous Fixation of Acute Femoral Neck Fractures in Young Adults: A Retrospective Cohort Study

OBJECTIVES: To evaluate the surgical outcomes of femoral neck fractures (FNF) in young adults treated with a closed reduction technique because it pertains to reduction quality, rates of union, and risk factors for complication. METHODS: Design: Retrospective cohort study with radiograph and electronic medical record review. Setting: Level 1 Swiss Trauma Center. Patient Selection Criteria: Between 2012 and 2021, young adults with isolated FNF (AO/OTA 31-B1) treated with percutaneous internal fixation were selected. Exclusion criteria were open reduction technique, age older than 65 years or younger than 16 years, pathologic fractures, and associated femoral head or shaft fractures. Outcome Measures and Comparisons: Primary outcome was quality of reduction, as assessed by 3 experienced trauma surgeons' evaluation of intraoperative and/or first postoperative radiographs using the overall impression, the Garden alignment index, and Lowell criteria. In addition, clinical outcomes, conversion to arthroplasty, and complications after closed reduction and fixation of femoral neck fractures were reviewed. RESULTS: A total of 54 patients with a median interquartile range age of 57.5 (48–60) years were included. Among them, 22 (41%) were women and 32 (59%) were men. The closed reduction technique demonstrated satisfactory reduction results in up to 87% of cases. Major complications occurred in 19%, with 17% requiring conversion to total hip arthroplasty. Unacceptable or borderline acceptable reduction quality correlated significantly with the need for later conversion (P = 0.03). CONCLUSIONS: The study supported the use of the closed reduction technique for acute FNF in patients younger than 65 years, achieving satisfactory reduction results in up to 87% of cases with comparable complication rates to treatment of young femoral neck fractures with open reduction. Furthermore, it underscored the significance of the surgeon's overall impression of reduction quality, alongside the established reduction criteria, the Garden alignment index, and Lowell criteria, in evaluating the quality of the reduction. In addition, risk of conversion to total hip arthroplasty was associated with worse closed reduction quality. LEVEL OF EVIDENCE: Therapeutic Level III. See Instructions for Authors for a complete description of levels of evidence.

Patient-Specific Implant for Anatomic Restoration of Lateral Femoral Condyle Contour After Impaction Fracture Associated With an ACL Tear

Impaction fractures of lateral femoral condyle (LFC-IF) are challenging entities following anterior cruciate ligament tears. Anatomic reduction and restoration of the native LFC curvature is crucial in their treatment, because if they are neglected, it may potentially lead to incongruence in the lateral knee compartment with subsequent cartilage deterioration or damage to other intra-articular structures. Previously established operative techniques seem to achieve these milestones, yet there is still a potential risk of cartilage breakage or nonanatomical reduction. The presented technique addresses those weak points by the use of patient-specific implants, which provides the opportunity to closely restore the anatomical LFC curvature with minimal risk of osteochondral fracture of the LFC-IF site.

Identifying modifiable factors and their joint effect on brain health: an exposome-wide association study.

Considerable uncertainty remains regarding the associations of multiple factors with brain health. We aimed to conduct an exposome-wide association study on neurodegenerative disease and neuropsychiatry disorders using data of participants from the UK Biobank. Multivariable Cox regression models with the least absolute shrinkage and selection operator technique as well as principal component analyses were used to evaluate the exposures in relation to common disorders of central nervous system (CNS). Restricted cubic splines were conducted to explore potential nonlinear correlations. Then, weighted standardized scores were generated based on the coefficients to calculate the joint effects of risk factors. We also estimated the potential impact of eliminating the unfavorable profiles of risk domains on CNS disorders using population attributable fraction (PAF). Finally, sensitivity analyses were performed to reduce the risk of reverse causality. The current study discovered the significantly associated exposures fell into six primary exposome categories. The joint effects of identified risk factors demonstrated higher risks for common disorders of CNS (HR = 1.278 ~ 3.743, p < 2e-16). The PAF varied by exposome categories, with lifestyle and medical history contributing to majority of disease cases. In total, we estimated that up to 3.7 ~ 64.1% of disease cases could be prevented.This study yielded modifiable variables of different categories and assessed their joint effects on common disorders of CNS. Targeting the identified exposures might help formulate effective strategies for maintaining brain health.

Optimization of Motion Planning for Quadrotor-Equipped Robotic Manipulators

The focus of the work is on optimizing motion planning for quadcopter-equipped robotic manipulators by integrating quadcopter design, modeling, and path planning for a robotic arm mounted on a quadcopter through MATLAB. Recently, quadcopters have also been used in many application fields with increased viability. This paper will attempt at bringing a complete framework that enhances the operational capabilities of quadcopters through optimized path planning algorithms. The approach will rely on obstacle avoidance techniques for safe operation with satisfactory efficiency in unstructured environments. Advanced algorithms such as Rapidly-exploring Random Trees and dynamic window approaches provide solutions to this challenge of redundancy in the path followed and adaptability in its surroundings. Simulations prove that the proposed optimization methods strongly improve the accuracy and efficiency of the path planned by the robotic arm as it adheres to the dynamic constraints imposed. This work can apply practical insight into many real-world fields such as logistics, surveillance, and search-and-rescue applications aside from contributing to the theoretical understanding of quadcopter dynamics.

Laparoscopic management of variant ductal and vascular anatomy in children with choledochal cysts.

Variations in biliary ductal and hepatic vascular anatomy increase the complexity of surgery for choledochal cysts (CDC). The laparoscopic approach for the management of paediatric CDCs with variant anatomy is underreported. This study aimed to describe anatomical variations, operative techniques and early outcomes of laparoscopic hepaticojejunostomy (HJ) in children with CDCs and variant anatomy. We conducted a retrospective review of 40 children who underwent laparoscopic CDC excision with HJ between 2019 and 2024 in a single surgical unit. Patients were divided into Group I (with anatomical variations, n = 20) and Group II (without variations, n = 20). Data on demographic details, clinical presentation, imaging findings, pre-operative interventions, ductal and vascular anatomical variations, surgical techniques, intraoperative variables, post-operative complications and outcomes were collected and analysed. Ductal variations were found in 10 patients, with aberrant right posterior sectoral duct being the most common. Vascular variations were identified in 12 patients, with anteriorly crossing the right hepatic artery (RHA) being the most frequent. Group I had a higher mean age (7.32 vs. 3.57 years, P = 0.014) and longer operative times (415 vs. 364 min, P < 0.0001). Conversion to laparotomy was necessary in 10% of Group I and 15% of Group II patients ( P = 0.634). Post-operative complications, primarily minor (Clavien-Dindo Grade I or II), occurred in 40% of Group I and 30% of Group II ( P = 0.495). Group I had a significantly shorter time to full feeds (72 vs. 80 h, P = 0.015). Both groups had similar post-operative hospital stays and follow-up durations. At the last follow-up, all patients, except one with liver failure in Group II, were asymptomatic with no significant biliary dilatation or liver function abnormalities. Laparoscopic management of CDCs with variant ductal and vascular anatomy in children is feasible, safe and effective. Detailed pre-operative imaging, meticulous intraoperative assessment and tailored surgical techniques are crucial for successful outcomes.

Complex blunt traumatic abdominal wall hernias: Experience from a high-volume abdominal core health center

BackgroundTraumatic abdominal wall hernias are rare and commonly involve the lateral abdominal wall due to shearing off the oblique and transversus abdominis muscles from the iliac crest. The vast majority of the current literature focuses on the index trauma admission, includes few patients, and provides little to no detail about the hernia repair itself. We aim to report our center’s high-volume experience with a definitive repair of chronic traumatic lateral abdominal wall hernias. MethodsAll patients who underwent lateral abdominal wall hernia repair performed at our institution from January 2015 through August 2023 were identified in the Abdominal Core Health Quality Collaborative. Only patients with blunt trauma etiology were included. Hernia characteristics, operative techniques, postoperative outcomes, and long-term patient-reported outcomes were extracted from the Abdominal Core Health Quality Collaborative database and supplemented with a manual chart review. ResultsForty-three patients with traumatic lateral abdominal wall hernias underwent repair within the study period. Elective repair occurred at a median of 3 years after a traumatic event. Nearly half of the patients had a recurrent hernia (41.9%) and most had a lumbar (L4) component (79.1%). The mean hernia width was 16.2 cm, and 30.2% had concomitant midline defects. Transversus abdominis release was performed in 88.4% of patients; 74.5% had heavy-weight polypropylene mesh placed and 76.7% had mesh fixation. Superficial surgical site infection occurred in 11.6% of patients, and 7% had a surgical site occurrence. At a mean follow-up of 1.9 years, 3 patients (7%) developed a hernia recurrence, which was noted on physical examination or imaging. One patient was reoperated on for recurrence, and 1 patient underwent partial mesh removal because of a chronic mesh infection. ConclusionIn the largest series of definitive repairs of complex lateral abdominal wall post-traumatic hernias to date, elective open complex abdominal wall reconstruction is safe and associated with low morbidity and hernia recurrence rates.

Comparison of early and late term results of onlay and sublay mesh approaches in open incisional hernia surgery

Aims: Despite the increase in minimally invasive techniques, open techniques continue to be frequently used in incisional hernia repairs. In open incisional hernia surgeries, onlay and sublay techniques are the most frequently preferred depending on the area where the mesh is placed. In this study, we aimed to compare these two techniques by analyzing perioperative findings. Methods: Data from elective open incisional hernia surgeries (onlay and sublay) performed by the same surgical team in the general surgery clinic between 01.01.2023 and 31.12.2023 were retrospectively reviewed. Emergency surgeries, laparoscopic or combined surgeries, patients who did not undergo mesh repair, patients who received preoperative botulinum toxin due to “loss of domain”, patients with missing data, and patients who did not continue their follow-up were excluded from the study. Results: The data of a total of 74 patients who met the inclusion criteria were analyzed in the study. Onlay procedure was performed in 53 (71%) patients and sublay procedure was performed in 21 (19%) patients with a retromuscular approach. No intraoperative complications were detected in any of the patients. There were statistically significant differences between the groups in terms of female gender (p: 0.007), duration of surgery (p&lt;0.001) and duration of hospital stay (p&lt;0.001). There were no statistically significant differences between the groups in terms of complications (p:0.42), unexpected re-admission (p:0.779) and six-month recurrence (p: 0.779). Conclusion: Onlay or sublay techniques can be safely applied in open incisional hernia surgery because they have acceptable complication and recurrence rates. Surgical experience and patient factors are the main determinants of which technique to apply.

Influence of the orientation of constructed blood vessels during the 3D printing on the measurement of the pseudo-oxygen saturation of an artificial blood substitute using conventional oxygen sensors: a test series

BackgroundThe development of phantoms to reduce animal testing or to validate new instruments or operation techniques is of increasing importance. For this reason, a blood circulation phantom was developed to test a newly designed retractor system with an integrated oxygen sensor. This phantom was used to evaluate the impact of the 3D printed blood vessel on the measurement of the oxygen saturation.MethodsA solution of nickel sulfate and copper sulfate was prepared as a substitute for real blood. The absorption spectra of these solutions were recorded and compared with those of blood. Subsequently, the oxygen sensor used was calibrated to the blood substitute. Additionally, blood vessels with a simplified geometry were designed and manufactured using inverted vat polymerization and an elastic material (Formlabs Elastic 50 A). To determine the orientation during the printing process, various vessels were printed. Measurements to assess the effects of disturbance (rotation of the vessels during measurements) on the sensor readouts were prepared.ResultsThe impact of disturbances was verified through the rotation of the 3D printed vessels. It was demonstrated that a direct measurement on the disturbances led to outliers and higher values. An optimal orientation was determined to be a lateral placement (90° or 270°) of the sensor. Regarding the orientation of the vessels within the printing space, an orientation of 45° yielded the best results, as the individual layers had the least impact on the light emitted and received by the oxygen sensor.ConclusionThe achieved results demonstrate the influence of the orientation of the vessel during 3D printing as well as the influence of the position of the vessel during the measurement using a conventional oxygen sensor.

Idiopathic normal pressure hydrocephalus: survey on current diagnostic and therapeutic procedures in clinical practice in Germany

ObjectiveCerebrospinal fluid (CSF) shunting has become the standard treatment for idiopathic normal pressure hydrocephalus (NPH). Nevertheless, there is still disagreement on diagnostic criteria for selecting patients for surgery and optimal shunt management. The primary aim of the present study was to provide an update on the status of best practice, the use of different diagnostic algorithms and therapeutic management of idiopathic NPH in an European country.Methods A standardized questionnaire with sections on the assessment of clinical symptoms and signs of NPH, diagnostic work-up, therapeutic decision making, and operative techniques was sent to 135 neurosurgical clinics in Germany that regularly perform shunt surgeries.ResultsOverall, responses were received from 114/135 (84.4%) clinics. Most responders considered gait disturbance to be the hallmark clinical sign of idiopathic NPH (96%). A lumbar tap test was utilized always/ mostly by 97 centers (86%). In 43% of the centers, 30–40 ml CSF were removed with the spinal tap test. Spinal dynamic CSF studies were used by 12 centers only occasionally, and only by 1 center always for diagnostic purposes. Ventriculo-peritoneal shunting was the most frequent type of CSF diversion (> 90%). Pressure-controlled valves were used by the majority of units (95%) Overall 102 centers (93%) always/mostly used adjustable valves, and antisiphon devices were used always/ mostly in 50% of units.ConclusionThe present survey demonstrates that there has been a remarkable change of practice and opinions on the diagnosis and treatment of idiopathic NPH over the past two decades in Germany. Remarkably, variabilities in practice among different centers are less common than previously and recommendations according to scientific publications and guidelines have been implemented more readily.

Management of Breast Cancer by Skin-Reducing Mastectomy and Immediate Breast Reconstruction by Prepectoral Implant Approach with Polypropylene Mesh for Patients with Large Breasts.

To assess the feasibility and outcomes of immediate breast reconstruction using a dermal sling and polypropylene mesh for fixation after skin-reducing mastectomy with prepectoral prosthesis placement in patients with large breasts who were diagnosed with cancer. This retrospective study included demographic and clinical data from female patients with breast cancer and large breasts, who were candidates for skin-reducing mastectomy and immediate reconstruction. Data regarding operative technique, implant size, operative duration, and intraoperative complications were retrieved. Early and late postoperative complications were recorded. Routine assessment of postoperative patient satisfaction was performed using the Breast Reconstruction Satisfaction Questionnaire. The study included data from 49 female patients with a mean (± SD) age of 40.88 ± 8.03 years; the mean follow-up was 31.5 ± 8.1 months. The operation was successful in 47 (95.9%) patients, whereas reconstruction failed in 2. Capsule contracture occurred in 9 (18.4%) patients, 4 of whom required capsulectomy. Severe wound infections occurred in 2 (4.1%) patients, 1 of whom was treated conservatively. Implant exposure occurred in 2 (4.1%) patients, 1 of which was managed using a skin rotational flap. Five (10.2%) patients experienced mildly impaired range of motion. Forty-four (90.0%) patients reported postoperative satisfaction, with 3 expressing satisfaction only when postoperative complications were treated. The prepectoral approach using a combined synthetic mesh and dermal sling yielded a good solution for patients with large breasts. The technique was associated with minimal complications, yielded good postoperative patient satisfaction, and is affordable. The results of using a synthetic mesh appeared to be equivalent to those of ADM. This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266 .

Enhancing digital literacy in primary education through augmented reality

Currently, there is a need to develop digital competencies already because they are included in the new curriculum. This article explores the field of augmented reality (AR) and its educational potential to bolster digital literacy in primary education. The core objective is to scrutinize the suitable use of AR-integrated mobile applications in primary schooling, spotlighting widely adopted apps and their practical applications. The article underscores digital literacy as a key competence for children’s self-directed future learning. In our research we used a combination of qualitative and quantitative research approaches. It seeks to identify the impacts and benefits of AR in primary school settings. In a natural didactic context, it is conducted as action research. The methodology includes direct observation of pupils engaging with the AR app Quiver during educational tasks, complemented by discussions with their teacher as a focus group. Additionally, the study gathers insights from parents via questionnaires based on their perceptions of AR in education. The analysis of the interview data utilizes the open coding technique to interpret the findings. The relevance of the research was confirmed by the consistency of results when transitioning from onsite to online learning environments. The study showed that AR engagement helped to increase the digital literacy of the participating pupils, showing high levels of engagement, motivation and collaborative communication.

The Rochester Model for Spinal CSF Leak Repair Simulation and Scoring.

Iatrogenic spinal durotomies occur at a rate of 1% to 17%. Surgical simulation for durotomy repair is needed to provide affordable, accessible, and validated practice. This study sought to design and validate a simple 3-dimensional printed model for spinal cerebrospinal fluid (CSF) leak repair and to introduce the Rochester original objective structured assessment of technical skills (OSATS) CSF leak (ROCL) repair criteria for assessment. A spinal model was designed to mimic a lumbar laminectomy with the L3-5 lamina removed and 3-dimensional printed using Vero polymers. The model was paired with a porcine collagen "dura" that was pressurized using IV saline and overlayed with gel-molded fascial, muscle, and skin layers with an opening. Participants were provided a training model with a 1.5-cm midline durotomy, surgical microinstrument set, microscope, and 6-0 prolene suture. The 25-point ROCL repair criteria were adapted from the original OSATS principles to assess proficiency in surgical repair by 2 blinded neurosurgeons not participating in the trials. Postsimulation survey data regarding model realism were collected. Six residents and 4 attendings participated. Median operative time in minutes was 13 minutes among residents and 7 minutes among attendings. Moreover, the ROCL score was a median of 19/25 for attendings and 15/25 for residents. The suture angle was statistically more consistent among senior residents and attendings compared with junior residents. Participants agreed that the model was realistic (median 4/5), useful for improving the operative technique (median 5/5), and would increase comfort in spinal CSF leak repair procedures (median 5/5). Each reusable model had a cost of $19.99 if printed with polylactic acid and each replacement dura cost <3¢. This study presents an affordable, realistic, and educational spinal CSF leak repair model and introduces ROCL for assessment.

Standardized surgical procedure for natural orifice specimen extraction surgery of precision functional sphincter-preserving surgery for ultra-low rectal cancer (NOSES-PPS) (2024 edition)

Natural orifice specimen extraction surgery of precision functional sphincter- preserving surgery for ultra-low rectal cancer (NOSES-PPS) is an innovative surgical technique that builds upon traditional laparoscopic surgery for low rectal cancer. This method utilizes a specially designed transparent screw-thread anal dilator and associated equipment to achieve precise tumor localization and resection through direct visualization via the anus. Digestive tract reconstruction is then accomplished using a combination of a precision circular stapler and manual suturing, thereby preserving sphincter function in patients with ultra-low rectal cancer. NOSES-PPS has been widely adopted across multiple provinces and cities in China, with over 500 cases successfully performed to date. The technique and its outcomes have been published in both national and international peer-reviewed journals, receiving significant recognition from the medical community. However, as a novel approach to rectal cancer surgery, there is currently a lack of authoritative clinical practice guidelines detailing the specific procedural steps of NOSES-PPS. To address this gap, the Colorectal Tumor Committee of the Chinese Medical Association, the Colorectal Cancer Committee of the Chinese Anti-cancer Association, and the China NOSES Collaborative Group have jointly led an effort to establish standardized guidelines for NOSES-PPS. This initiative involved the collaboration of experts in colorectal oncology from numerous large medical centers across China. Through multiple rounds of consultation and discussion, these experts have developed a comprehensive set of guidelines that detail the definition of NOSES-PPS, requirements for instrumentation, indications, key operative techniques, and the management of perioperative and postoperative complications. This guideline aims to promote the standardized implementation of NOSES-PPS in clinical practice.