Surgery Techniques Research Articles

Laparoscopic antegrade spleen-preserving distal pancreatectomy with conservation of the splenic vessels: A prospective multicenter case series (with Video)

Introduction: Laparoscopic spleen-preserving distal pancreatectomy (LSPDP) with conservation of the splenic artery and vein (Kimura’ technique) is considered a technically challenging procedure that requires a high level of expertise in laparoscopic and pancreatic surgery. Methods: A prospective descriptive study on 18 patients with laparoscopic “antegrade” spleen-preserving distal pancreatectomy with Kimura’ technique from 2018 to 2023. The perioperative indications, clinical data, intra-operative index, pathological postoperative specimens, postoperative complications, and follow-up results were retrospectively evaluated. Results: The mean age was 39.4±13.3. Only 2 male patients accounted for 11.1%. The average operating time is 171±23 minutes. The average blood loss is 65.7±43 ml. The average tumor size is 4.1cm. The average hospitalization is 9.4 days. The rate of pancreatic fistula is 66.7%. There is no case of transferring open surgery or blood transfusion during surgery. The results of pathological after surgery, there were 8 cases of solid pseudopapillary tumors, 4 cases of mucinous cystadenoma, 6 cases of neuroendocrine tumors. Conclusion: Kimura’s technique for laparoscopic spleen-preserving distal pancreatectomy is safe and feasible, which can be applied to benign tumors in the body and tail of pancreas. However, this is a difficult technique in laparoscopic surgery that requires surgeons to have a lot of experience and equipment need to be adequate.

Evaluation of the effect of sleeve gastrectomy versus Roux-en-Y gastric bypass in patients with morbid obesity: multicenter comparative study

IntroductionRoux-en-Y gastric bypass (RYGB) and sleeve gastrectomy (SG) are the two most performed techniques in bariatric surgery. The aim of this study is to compare two surgical procedures in terms of weight loss and the development of comorbidities such as type II diabetes mellitus T2D, arterial hypertension, sleep apnea (OSAS), and gastroesophageal reflux disease (GERD).MethodsData from the German Bariatric Surgery Registry (GBSR) from 2005 to 2021 were used. 1,392 RYGB and 1,132 SG primary surgery patients were included. Minimum age 18 years; five-year follow-up data available. Tests were performed with a 5% significance level.ResultsLoss of follow-up 95.41% within five years. Five years after surgery, the RYGB showed significant advantages in terms of excess weight loss (%EWL 64.2% vs. 56.9%) and remission rates of the studied comorbidities: hypertension (54.4% vs. 47.8%), OSAS (64.5% vs. 50.1%), and GERD (86.1% vs. 66.9%). Compared to the pre-test, individuals diagnosed with insulin-dependent T2D showed significant improvements with RYGB over a five-year period (remission rate: 75% vs. 63%). In contrast, non-insulin-dependent T2D showed no significant difference between the two approaches (p = 0.125).ConclusionBoth surgical procedures resulted in significant weight loss and improved comorbidities. However, the improvement in comorbidities was significantly greater in patients who underwent RYGB than in those who underwent SG, suggesting that the RYGB technique is preferable.Nevertheless, RYGB requires a high degree of surgical skill. Therefore, acquiring expertise in the technical facets of the surgery is essential to achieving favorable outcomes.

Complete Laparoscopic Type C2 Radical Surgery for Cervical Stump Cancer: No-Look and No-Touch Techniques.

Due to previous surgical history and subsequent adhesions between pelvic organs, surgery for cervical stump cancer (CSC) is technically more challenging than surgery for cervical cancer with an intact uterus.1 We aimed to illustrate the related anatomy, surgical steps and techniques of complete laparoscopic type C2 radical surgery (CLRS) for early-stage CSC. CLRS for six patients with CSC was performed from January 2021 to January 2022. We demonstrated the detailed skills of parametrial management during CLRS for CSC in case 5 by means of a video. A 58-year-old woman diagnosed with International Federation of Gynecology and Obstetrics (FIGO) 2018 stage IIA1 CSC received CLRS through five operative ports (Fig.1). The magnetic resonance imaging (MRI) scans and gross appearance of the specimen are shown in Fig.2. The median age and body mass index (BMI) of the six patients were 53 years and 23.8, respectively. The median blood loss was 275mL; the median time of operation was 218min; the median length of hospitalization was 15 days; and the median time to recover urinary function was 12 days. One patient underwent postoperative radiation for pathologically proven adenocarcinoma with deep stromal invasion,2 while the other five did not. After a median follow-up of 24 months, no patients experienced complications, recurrence, or death (Table 1). This study details the skills of CLRS for CSC, especially space development and the 'no-look, no-touch' tumor-free principle. It is helpful for clinicians to perform safe and standardized surgery on patients with early-stage CSC. Fig.1 Trocar placement of complete laparoscopic type C2 radical surgery for early-stage CSC. CSC cervical stump cancer, S superior, I inferior, R right, L left, U umbilicus Fig.2 MRI scans and gross appearance of the specimen for case 5 with CSC at FIGO 2018 stage IIA1. The tumor lesion on the cervical stump is indicated by yellow arrows. a Axial T2-weighted image; b DKI image; c ADC map; d sagittal T2-weighted image; e sagittal T1-weighted image; f gross appearance of the surgical specimen. MRI magnetic resonance imaging, CSC cervical stump cancer, FIGO International Federation of Gynecology and Obstetrics, DKI diffusional kurtosis imaging, ADC apparent diffusion coefficient Table 1 Clinicopathological characteristics, operative details, and outcomes of patients with cervical stump cancer Patient no. Age at diagnosis (years) BMI Reasons for subtotal hysterectomy FIGO 2018 stage Histology Operation Operation time (mins) Blood loss (mL) Urinary catheter (days) Hospital stay (days) Complications Depth of invasion LVSI LNs dissected TNM stage Tumor size (mm) Postoperative radiotherapy Follow-up (months) Recurrence Death 1 50 25.9 Uterine myoma IIA1 ASC CLRS+PLND 221 360 10 12 No Middle one-third N 13 T2a1N0M0 16 No 30 No No 2 55 17.3 Uterine myoma IB1 AC CLRS+PLND 191 270 20 12 No Deep one-third N 24 T1b1N0M0 10 Yes 20 No No 3 50 24.8 Uterine myoma IB1 SC CLRS+PLND 295 310 13 15 No Superficial one-third N 21 T1b1N0M0 15 No 25 No No 4 63 30.1 Uterine myoma IB1 SC CLRS+PLND 213 180 6 16 No Superficial one-third N 25 T1b1N0M0 15 No 19 No No 5 58 20.2 Postpartum hemorrhage IIA1 SC CLRS+PLND 220 100 11 14 No Middle one-third N 21 T2a1N0M0 15 No 24 No No 6 46 22.7 Uterine myoma IB1 SC CLRS+PLND 215 120 14 17 No Superficial one-third N 26 T1b1N0M0 12 No 23 No No BMI body mass index, FIGO International Federation of Gynecology and Obstetrics, ASC cervical adenosquamous carcinoma, AC cervical adenocarcinoma, SC cervical squamous carcinoma, CLRS+PLND complete laparoscopic radical surgery and pelvic node dissections, LVSI lymphovascular space invasion, N negative, LNs lymph nodes, TNM tumor node metastasis.

Cleft Lip and Palate Repairs in Togo, “Sourire de l’Espoir” Humanitarian Missions’ Experience: A Retrospective Study of 201 Consecutive Cases

_Objective_: To describe “Sourire de l’Espoir” humanitarian missions on cleft lip and palate (CLP) repair and how it shaped the future of CLP repair in Togo. _Design_: Retrospective. _Patients_: Clinical files of patients operated on for CLP during humanitarian missions from October 2008 to May 2013 in Lome, the capital of Togo, were reviewed in a nine-month postoperative assessment from June to December 2020. Demographics, clinical, and therapeutic patterns were assessed. We also assessed the Zwisch method used for the training of local surgeons during the missions. Statistical analysis was performed with Epi Info (CDC version 7.1.3.3-2013). _Results_: CLP repair was performed in 201 patients during 10 missions. Patients’ mean age was 7.05 (SD 9.22) years (range: 3 months-50 years); the sex ratio (male/female) was 1.05. Distribution of cases was as follows: Cleft lip (CL) 109/201 (54.23%); cleft palate (CP) 53/201 (26.23%), and CLP 39/201 (19.40%). The Tennison-Borde-Bedouelle-Malek technique was used for the repair of CL in 119/148 patients (80.41%); the Onizuka technique (modified Millard technique) for the revision surgery of CL in 19 patients previously operated in other settings. The Kriens and Sommerlad palatoplasty technique was performed for primary and revision surgeries for all CP in 89/92 (96.73%) patients. The postoperative course was uneventful in 199/201 (99.00%) patients. One patient presented with an infection on the lip that healed with local wound care, and two patients with palatal fistula were treated by revision surgery. Two patients died in post-operative period. Three surgeons of the local team were trained as per the Zwisch method: in the first two missions, show and tell (60/201 cases), the third and fourth missions, smart help step (48/201 cases); from the seventh mission onwards, passive assistance (51/201 cases) by the local surgeons with no help. _Conclusion_: The “Sourire de l’Espoir” humanitarian missions provided primary and revision surgery to children and adults with CLP while three local surgeons were trained to build a local capacity.

Allotendoplasty in Treatment of Habitual Patella Dislocation in Adults

Background. Habitual dislocation of patella is a congenital disease that manifests in early childhood or adolescent age and requires surgical treatment. In case this condition has not been rectified timely, the congenial patellar luxation develops the properties of a habitual dislocation accompanied by pain syndrome and osteoarthrosis development in the patellofemoral and knee joints. In most cases reconstructive surgery is used for this disease treatment; it is aimed at the strengthening of the knee joint interval compartment, with the formation of a fibrous graſt or a vertical strip of it, which are moved to the knee joint outside compartment and fixed to adjacent tissues with sutures. However, such surgery is possible only in case of preserved anatomic structures of the knee medial compartment. In adult patients, aſter multiple patellar dislocations, the interval joint capsule and medial aponeurosis lose their normal structure, become weakened, strained, and loose. That is why the patient’s own tissues from that area cannot be used for reconstructive surgery.The purpose of the study is to develop the new low-traumatic method of treatment for habitual dislocation of kneecap in adult patients to ensure its reliable stabilization as related to the joint surface on distal femoral epimetaphys, and to prevent patella dislocation relapse.Material and methods. Surgery technique consists of the lateral release of knee joint, mobilization of patellar ligament and its excision together with the fragment of tibial tuberosity osseous. On 1.5–2.0 cm medially from the area of own patellar ligament harvesting in tibia epimetaphys, the new bed with the similar form and shape is formed, and the excised tibial tuberosity fragment with patellar ligament is introduced there and fixed with a Cancellous screw.The area of own patellar ligament harvestingis filled up with autogenous osseous tissue taken from the medial part of tibia epimetaphys when forming the new bed for the excised tibial tuberosity fragment. Transversal tunnelis formedin the quadriceps tendon above the patella; allotendonis pulledvia this tunnel. The allotendon ends are sutured together, thus forming the duplication, analogous to the ligament, and fixit, stretched to “pes anserinus” of the shin onits anterior-interior surface.Conclusion. The new technology of allotendoplasty for the treatment of habitual kneecap dislocation in adult patients facilitates the surgical technique, additionally strengthens medial compartment tissues of the knee, reliably stabilizes the patella as related to its joint surface on distal femoral epimetaphys, eliminates patella dislocation relapse, normalizes the knee and patellofemoral joints functioning by preventing osteoarthrosis progression in them.

[Analysis of the application effect and safety of transnasal humidified rapid insufflation ventilatory exchange technique in hysteroscopic diagnostic and therapeutic surgery].

Objective: To investigate the effect and safety of transnasal humidified rapid insufflation ventilatory exchange (THRIVE) technique in hysteroscopic diagnostic and therapeutic surgery. Methods: This study was a randomized controlled trial. A total of 100 female patients undergoing hysteroscopy surgery at Beijing Tongren Hospital from September to December 2023 were selected and randomly divided into two groups by the random number table method: the THRIVE group and the mask oxygen group, with 50 patients in each group. Patients in both groups were given total intravenous anesthesia with propofol combined with remifentanil and preserved spontaneous respiration. The THRIVE group was given oxygen by the THRIVE device with an oxygen flow rate of 50 L/min, while the mask oxygen group was given oxygen by the mask with an oxygen flow rate of 5 L/min; the oxygen concentration of both groups was set at 100%. The general condition of the patients, vital signs during the operation, the amount of anesthesia drugs used and the operation time were recorded. The primary observation index was the incidence of hypoxic events in the two groups; the secondary observation indexes were the incidence and time of intraoperative apnea as well as the corresponding oxygenation interventions and the incidence of non-hypoxic adverse events. Results: The age of the THRIVE group was (42±14) years, and the age of the mask oxygen group was (43±15) years. The duration of surgery in the THRIVE group was (15.9±3.4) min, which was statistically lower than that of the mask oxygen group (16.3±4.5) min (P=0.041), and there were no differences observed in the duration of awakening time and anesthesia time (both P>0.05). There was no significant difference in the dosage of propofol, remifentanil, and intraoperative vasoactive drugs between the two groups (all P>0.05). The SpO2 of the patients in the THRIVE group at the end of the operation was (99.7±1.1) %, which was higher than that of the mask-oxygen group (99.1±1.1) % (P<0.05). There was no difference in SpO2 of the two groups at the other time points (all P>0.05). There were no differences in HR and MAP of two group patients at each time point (all P>0.05). The incidence of hypoxic events in the THRIVE group was 12.0% (6/50), which was lower than that of 28.0% (14/50) in the mask oxygen group (P=0.045). The difference in the incidence and duration of apnea between the two groups was not statistically significant (all P>0.05). There were no cases of temporary need for laryngeal mask or tracheal intubation during surgery in both groups. There was no statistically significant difference in the incidence of intraoperative body movement, dizziness, nausea and vomiting between the two groups (all P>0.05), and no cardiac, cerebral, renal or other important organ insufficiency occurred in the two weeks after surgery. Conclusion: THRIVE technology can provide effective oxygenation for patients undergoing hysteroscopic diagnosis and treatment, maintain patients' circulatory stability, and improve the safety and efficiency of surgery.

Management of renal sinus angiomyolipoma: modified robotic nephron-sparing surgery in a single center

BackgroundRenal sinus angiomyolipoma (RSAML) is a rare and typically complex renal tumor. The objective is to present our single-center experience with a modified technique of robotic nephron-sparing surgery (NSS) for treating RSAML.MethodsWe retrospectively evaluated 15 patients with RSAMLs who were treated with robotic NSS at the Department of Urology of Tongji hospital, ranging from November 2018 to September 2022. Renal vessels and ureter were dissected. The outer part of RSAML was resected. The rest of tumor was removed by bluntly grasp, curettage and suction. Absorbable gelatin sponges were filled in the renal sinus. The preoperative parameters, operative measures and postoperative outcomes were all collected. Follow-up was performed by ultrasonography and estimated glomerular filtration rate (eGFR).ResultsRobotic NSS was successfully performed in all the patients, without any conversion to open surgery or nephrectomy. The mean operation time was 134.13 ± 40.56 min. The mean warm ischemia time was 25.73 ± 3.28 min. The median estimated blood loss was 100 [50, 270] ml and 1 patient required blood transfusion. The mean drainage duration was 5.77 ± 1.98 days. The median postoperative hospital stay was 6.90 [5.80, 8.70] days. Two patients experienced postoperative urinary tract infection (Clavien-Dindo Grade II). During the median follow-up of 25.53 ± 15.28 months, patients received 91.18% renal function preservation. No local recurrence occurred in all the patients.ConclusionsRobotic NSS for RSAML is a complicated procedure that demands technical expertise and a well-designed strategy is critical in the operation. Treating RSAML with modified robotic NSS is safe, effective and feasible.

Commentary on: "A New Technique in Facial Reanimation Surgery for Moebius Syndrome" by Simmons et al.

Commentary on: "A New Technique in Facial Reanimation Surgery for Moebius Syndrome" by Simmons et al.

Osteotomy Le fort I as a Treatment option for class III Dentoskeletal Problem

Introduction: Orthognathic surgery is surgery to correct the jaw relation and which aim to correct dentoskeletal deformities and a treatment option for severe deformity that cannot be corrected by orthodontic treatment alone. Le fort I osteotomy is a technique in orthognathic surgery that aims to correct the maxilla. In its management, it is possible for correction of the maxilla and mandible to achieve an optimal jaw relation, function and esthetics. Case report: This case report explained a patient with maxilla retrognathism accompanied by function and aesthetic problems. This patient was diagnosed with class III dysgnathy and was performed orthognathic surgery treatment with le fort I osteotomy technique under general anesthesia at Central Operating Theater at Hasan Sadikin General Hospital, Bandung, and was evaluate periodically after the surgery. Conclusion: In this case, the patient's function and aesthetic problems was corrected without causing any postoperative complications. Careful planning with a good calculation and treatment plans are important for obtaining a good result. Keywords: Le fort I osteotomy, class III disgnathy, dentoskeletal deformity

Techniques for Penile Augmentation Surgery: A Systematic Review of Surgical Outcomes, Complications, and Quality of Life

The increase in practices related to enhancing penile size can be attributed to the belief that an improved genital appearance contributes to a man’s virility, coupled with an altered self-perception of his body. It is crucial to tailor interventions to meet the genuine needs of patients by thoroughly assessing their history, psychological state, and potential surgical benefits, all while considering the associated risks of complications. This systematic review aims to summarize the available evidence on outcomes, complications, and quality of life after penile augmentation surgery, examining both minimally invasive and more radical techniques. A search of the PubMed and Scopus databases, focusing on English-language papers published in the last 15 years, was performed in December 2023. Papers discussing surgery in animal models and case reports were excluded from the present study unless further evaluated in a follow-up case series. The primary outcomes were changes in penile dimensions, specifically in terms of length and girth, as well as the incidence of surgical complications and the impact on quality of life. A total of 1670 articles were retrieved from the search and 46 were included for analysis. Procedures for penile length perceived enhancements include lipoplasty, skin reconstruction plasty, V-Y and Z plasty, flap reconstruction, scrotoplasty, ventral phalloplasty, and suspensory ligament release; techniques for increasing corporal penile length include penile disassembly, total phalloplasty, and sliding elongation. Finally, penile girth enhancement may be performed using soft tissue fillers, grafting procedures, biodegradable scaffolds, and Penuma®. In conclusion, while penile augmentation surgeries offer potential solutions for individuals concerned about genital size, the risks and complexities need to be accounted for.

3D bioprinting: a review and potential applications for Mohs micrographic surgery.

Mohs Micrographic Surgery (MMS) is effective for treating common cutaneous malignancies, but complex repairs may often present challenges for reconstruction. This paper explores the potential of three-dimensional (3D) bioprinting in MMS, offering superior outcomes compared to traditional methods. 3D printing technologies show promise in advancing skin regeneration and refining surgical techniques in dermatologic surgery. A PubMed search was conducted using the following keywords: "Three-dimensional bioprinting" OR "3-D printing" AND "Mohs" OR "Mohs surgery" OR "Surgery." Peer-reviewed English articles discussing medical applications of 3D bioprinting were included, while non-peer-reviewed and non-English articles were excluded. Patients using 3D MMS models had lower anxiety scores (3.00 to 1.7, p < 0.0001) and higher knowledge assessment scores (5.59 or 93.25% correct responses), indicating better understanding of their procedure. Surgical residents using 3D models demonstrated improved proficiency in flap reconstructions (p = 0.002) and knowledge assessment (p = 0.001). Additionally, 3D printing offers personalized patient care through tailored surgical guides and anatomical models, reducing intraoperative time while enhancing surgical. Concurrently, efforts in tissue engineering and regenerative medicine are being explored as potential alternatives to address organ donor shortages, eliminating autografting needs. However, challenges like limited training and technological constraints persist. Integrating optical coherence tomography with 3D bioprinting may expedite grafting, but challenges remain in pre-printing grafts for complex cases. Regulatory and ethical considerations are paramount for patient safety, and further research is needed to understand long-term effects and cost-effectiveness. While promising, significant advancements are necessary for full utilization in MMS.

OUTCOMES OF PRIMARY TOTAL HIP ARTHROPLASTY IN PATIENTS OVER 80 YEARS OF AGE: DATA FROM THE SCOTTISH ARTHROPLASTY PROJECT

There is an increasing demand worldwide for total hip arthroplasty in patients over 80 years old. This study is the largest of its kind reporting long term outcomes and clinical survivorship of patients over 80 years old undergoing THR.13171 patients 80 years or older who underwent THR between 2000 and 2019 were included. Demographic and operative data was collected including age, sex, laterality, date of surgery and operative technique. Presence and date of complications were collected. Data was also collected for the same time period on 80910 patients aged 51–79 years undergoing THR for comparison.4103 (31.2%) male and 9068 female (68.8%) patients were included in the 80year old cohort. Median age was 83 (IQR 81–83, range 80–98). 32682 (40.4%) male and 48227 (59.6%) females were included in the 50–79year old cohort. Median age was 68 (IQR 62–73, range 50–79).The 80 cohort was more likely to sustain post operative complications in the 6 months following surgery including DVT (81/13171 vs 364/80910, P&lt;0.05), myocardial infarction (177/13171 vs 341/80910, P&lt;0.05), acute renal failure (371/12800 vs 812/80910 P&lt;0.05).The 50–79year old cohort was over twice as likely to undergo revision surgery than the 80 year old cohort (HR 2.55, 95% CI 2.216–2.932, p&lt;0.001). Of those requiring revision surgery, the elderly cohort were more likely to undergo earlier revision surgery (378days, 95%CI 236–519d vs 1586days, 95%CI 1471–1700d, p&lt;0.001). In those undergoing revision surgery, a higher proportion were done for infection in the 80 year old cohort (39/219 (17.8%) vs 215/2809 (7.7%), p&lt;0.05.This study demonstrates good outcomes in terms of medical complications and a low overall risk of requiring revision surgery in patients 80years old undergoing THR. Patients over the age of 80 should be counselled on the relatively increased risk of medical complications post operatively.

Abstract PO5-18-12: Can we cure de novo oligometastatic stage IV HER2+ breast cancer with multimodality therapy? (CHLOE)

Abstract Background: The current standard of care is to treat all patients with metastatic breast cancer with palliative intent, regardless of extent of disease. However, in real world practice patients with oligometastatic disease are sometimes treated with surgery and/or radiation/ablation in combination with systemic therapy to render them as having no evidence of disease. Previous randomized clinical trials have not shown a benefit to adding surgery or radiation in metastatic breast cancer, however, these trials had a small number of HER2+ patients. HER2+ patients are uniquely responsive to combination of chemotherapy and targeted HER2 therapy and therefore may have different outcomes with a multimodality approach. The goal of this project is to use a novel, user friendly, on-line clinical study platform that registers patients and enables follow-up data collection to test the hypothesis that de novo stage IV oligometastatic HER2+ patients treated with multimodality therapy may result in improved long-term distant metastasis free survival and overall survival. Trial design: This is a prospective, nationwide registry study that will enroll newly diagnosed (de novo) oligometastatic (operationally defined by local tumor boards as disease where all metastatic lesions can be ablated) HER2+ breast cancer. A secure online portal has been created by the Yale IT team in accordance with HIPPA and cybersecurity guidelines. Data will be directly entered into the online portal by participating investigators and information regarding what treatment the patient received, if they completed treatment, and survival data will be collected. All treatment decisions will be at the discretion of the treating provider. Eligibility criteria: Patients with de novo oligometastatic HER2+ breast cancer in whom local treatment of all metastatic sites by either surgery, radiation, or ablative techniques is feasible as determined by multidisciplinary discussion or local tumor board. Specific aims: Primary: To estimate the 3 year distant metastasis free survival in patients with de novo oligometastatic HER2+ breast cancer treated with a multi-modality treatment plan. Secondary: To estimate 3 year overall survival and to monitor QOL. Statistical methods: The major analysis will occur after at least 3 years following the last subject’s enrollment in a cohort, to ensure that the objective of distant metastasis free survival at 3 years will be analyzed. It will include: tabulation of all cases entered, number and location of metastases, if treatment plan was implemented, compliance rate of treatment delivery, observed results with respect to the primary endpoint. Kaplan-Meier estimates will be presented for the analysis of survival endpoints together with a summary of associated statistics (median survival time if reached, landmark survival rate estimates and estimates for every 6 months thereafter if applicable), including the corresponding two-sided 95% confidence intervals. The 95% exact Clopper Pearson confidence intervals will be presented for binary endpoints. Paired t-test or Wilcoxon signed rank test will be used to assess the difference of continuous variables measured at different time points. The secondary clinical outcome is overall survival at 3 years, defined as the percentage of patients without an event at the 3-year follow-up time point measured from the study registration date. An event is considered death from any cause. OS time will be measured from the date of randomization to the date of first OS failure or last follow-up. OS will be estimated by the Kaplan-Meier method with OS failure defined as: death from any cause. Present accrual and target accrual: 4/42 patients Contact information for people with a specific interest in the trial: Mariya.Rozenblit@yale.edu https://chloe.yalepathaws.org Citation Format: Mariya Rozenblit, Nathalie Wiesendanger, Kelly Shanahan, Christine Hodgdon, Peter Gershkovich, Mehra Golshan, Meena Moran, Maryam Lustberg, Lajos Pusztai. Can we cure de novo oligometastatic stage IV HER2+ breast cancer with multimodality therapy? (CHLOE) [abstract]. In: Proceedings of the 2023 San Antonio Breast Cancer Symposium; 2023 Dec 5-9; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2024;84(9 Suppl):Abstract nr PO5-18-12.

The ability of perfusion index and positional perfusion index variation to predict spinal anesthesia-induced hypotension in elderly patients: A prospective observational study

Background: Spinal anesthesia (SA) is a popular anesthetic technique for several surgeries; however, it is mostly associated with hypotension. The perfusion index (PI) can predict hypotension after spinal and general anesthesia. We aimed to evaluate the predictability of PI postural change, supine and sitting PI to post-SA hypotension in elderly patients.Methods: This study was conducted on 68 elderly patients aged >65 years, scheduled for elective orthopedic surgical operations under SA in supine position. PI, arterial oxygen saturation, blood pressure, and heart rate were initially recorded at sitting and supine positions then 5, 10, and 20 minutes after subarachnoid drug injection (in supine position). ΔPI=PI supine−PI sitting. The relative change in PI (rPI) =ΔPI/PI sitting× 100.Results: Hypotension occurred in 33.82% of patients. The Δ PI was 0.53±0.24, and the r PI was 14.18±6.41%. Δ PI at cut-off >0.6 and r PI at cut-off > 14%; could predict SA-induced hypotension with a sensitivity of 82.61 and 86.96%, respectively, and specificity of 88.89 and 77.78%, respectively. There was an insignificant difference between Δ PI and r PI and between r PI and baseline supine in predicting SA-induced severe hypotension. The prediction of SA-induced hypotension was higher with Δ PI than baseline sitting and baseline supine (P=0.002 and 0.027) and between r PI and baseline sitting (P=0.047).Conclusions: In elderly patients, the Δ PI has a higher predictive value for SA-induced hypotension than baseline sitting and baseline supine with comparable prediction ability between Δ PI and r PI.

Assessment of inferior pedicle therapeutic mammoplasty as apart of volume displacement techniques of oncoplastic breast surgery for early breast cancer

Assessment of inferior pedicle therapeutic mammoplasty as apart of volume displacement techniques of oncoplastic breast surgery for early breast cancer

Analysis of postoperative complications of orbital fracture.

To analyze the types and causes of complications following orbital fracture reconstruction and enhance clinicians' capacity to manage or prevent such complications. We conducted a retrospective case series analysis, retrospectively collecting and analyzing clinical data of patients with orbital fractures who received surgical treatment at the Affiliated Eye Hospital of Nanchang University from May 2012 to May 2022. Descriptive statistics were employed to document common postoperative complications, and we recorded complications persisting after a minimum 6-month follow-up period. Among the 227 patients who underwent orbital fracture surgery, they were followed up for 6 to 36 months, and complications occurred in 15 cases, resulting in an incidence rate of 6.61%. These complications included implant material infections and rejections (4 cases), persistent diplopia (3 cases), intraorbital hematomas (2 cases), epiphora (2 cases), lower eyelid eversion or retraction (2 cases), and skin scars (2 cases). The primary cause of postoperative infection was chronic inflammation in the paranasal sinuses or closed cavities within the fracture area. Postoperative complications in orbital fractures were associated with various factors, including the timing of surgery, surgical approach, repair materials, surgical skills, and auxiliary techniques. Standardizing surgical techniques and implementing precise auxiliary technologies may reduce the incidence of complications and enhance the operation's success rate.

How I do it: Endoscope-assisted in situ arterial reconstruction of the lower limb

Arterial reconstruction with greater saphenous vein (GSV) is a frequently performed vascular surgery technique for revascularization of chronic limb threatening ischemia. Surgeon variations of the procedure are common and aim to balance patency, limb salvage, complications, hospital resources and technical feasibility. This paper describes a minimally invasive revascularization option using endoscope assistance for in situ GSV-arterial bypass in infrainguinal occlusive disease. It highlights patient selection, operating room set up, instrument details and procedure strategies that facilitate use of this technique. The development and refinement of minimally invasive techniques in lower extremity arterial bypass is critical to reduce wound complications and improve limb salvage outcomes in patients.

Central pedicle therapeutic mammoplasty as oncoplastic breast conservative surgery technique in moderate sized breasts with ptosis

Central pedicle therapeutic mammoplasty as oncoplastic breast conservative surgery technique in moderate sized breasts with ptosis

Oncoplastic Breast Conservation for Central Tumors: Definition, Classification, and the Analysis of Single Institution Experience.

Tumors in the central part of the breast are usually considered more aggressive and technically difficult, which limits breast conservation. The definition of central tumors from a surgical point of view, classification of the techniques for partial breast reconstruction, and conceptual algorithm of choice based on tumor and breast characteristics are proposed, along with the estimation of surgical and oncological safety. This is a retrospective analysis of the single-institution experience, with a focus on the decision-making process for choosing the oncoplastic breast-conserving surgery technique. To evaluate the safety of breast conservation for central tumors, a comparative analysis of early surgical complications and oncological long-term results of treatment in patients with central breast tumor location and other breast tumor locations was performed. A total of 940 lumpectomies were performed in 926 patients during 15 years. The central breast tumor location group included 128 patients with 130 lumpectomies (13.8%), and the other breast tumor locations group included 798 patients with 810 lumpectomies (86.2%). We did not find any significant differences in the rate of early surgical complications and involved margins, local and systemic recurrence rates, time to progression, or overall survival between the groups. Oncoplastic breast-conserving surgery is a safe procedure for the treatment of central tumors. In our opinion, the proposed classification of partial breast reconstruction techniques and an algorithm of their choice allow for effective restoration of the breast shape and volume according to the parameters of the tumor, breast, surgeon, and patient preferences.

Comparison of the Outcomes of Anterior Cervical Discectomy and Fusion and Cervical Disc Replacement for Cervical Disc Disease.

To compare the radiological outcome and development of heterotopic ossification (HO) following single-segment anterior cervical discectomy and fusion (ACDF) and cervical disc replacement (CDR) for cervical disc herniation and evaluate their impact on surgical success. Descriptive comparative study. Place and Duration of the Study: Neurosurgery Department at Bozyaka Education and Research Hospital, Izmir, Turkiye, between January 2020 and June 2022. Patients aged 18-70 years with radicular neck pain unresponsive to conventional medical treatment and an MRI-confirmed diagnosis were included. Patients with osteoporosis (OP) were excluded. Patients were randomised into two treatment groups (ACDF and CDR) and stratified by age and symptom severity. Radiographic assessments and HO classification according to McAfee were performed. Among the included patients, 56 underwent ACDF and 45 underwent CDR. The mean patient age was 48.29 ± 9.530 and 41.84 ± 7.239 years in the ACDF and CDR groups, respectively (p <0.001). The postoperative disc height increased in both groups. The T1 slope was significantly higher preoperatively and in the early postoperative period in the CDR group than in the ACDF group (p = 0.001). HO was graded as 1, 2, 3, and 4 in 28 (27.7%), 6 (5.9%), 7 (6.9%), and 4 (3%) patients, respectively. ACDF and CDR provided similar improvements in radiological measurements and pain relief. Although both procedures significantly enhanced the patient's quality of life and disability scores, HO was more prevalent following CDR during long-term follow-up. Cervical disc replacement, Anterior cervical discectomy and fusion, Spinal surgery techniques, Heterotopic ossification.