Traditional Surgery Group Research Articles

Manifestation of Urinary Tract Injury during Cervical Cancer Surgery Based on CT Urography Secretion Phase Images.

Methods We grouped the patients who had undergone cervical cancer surgery in a hospital in this article and compared the nanodrug carrier system under CT imaging with traditional laparoscopy. The postoperative physical parameters of surgical patients are collected from cervical cancer patients of different degrees, and the parameters and prognostic health of patients after different operations are compared. Results The results of the study show that the postoperative patient's body parameters of the nanodrug delivery system under the CT imaging technology used in this article are better than those of the traditional surgery group, and the average intraoperative blood loss is about 20% less than that of the traditional surgery. Postoperative complications occur. The situation is even lower, more than 30% lower than traditional surgery. Conclusion This shows that the operation of the nanodrug delivery system based on CT imaging technology has broken through some of the limitations of the development of laparoscopic technology and has played an important role in the surgical treatment of cervical cancer.

Clinical observation of arthroscopic single channel treatment of carpal tunnel syndrome with self-made instruments

To investigate the efficacy of self-made arthroscopic single channel in the treatment of carpal tunnel syndrome. Sixty patients with primary carpal tunnel syndrome treated from January 2014 to December 2019 were divided into arthroscopic group and traditional open operation group. There were 30 cases in arthroscopic group, including 12 males and 18 females, aged (47.5±4.5) years and the course of disease was (6.6±4.2) months. There were 30 cases in the traditional operation group, including 10 males and 20 females, aged (48.5±3.5) years, and the course of disease was (5.6±4.4) months. Both groups were unilateral. According to the anatomy of wrist joint and the characteristics of transverse carpal ligament and arthroscopy, the instruments including cannula, inner heart and hook knife were designed. The patients in two groups were treated with decompression of transverse carpal ligament using arthroscopy combined with self-made instruments and traditional open sergery. The incision length, operation time, intraoperative bleeding, hospitalization cost, hospitalization time and recovery time of the two groups were observed and compared. Boston Carpal Tunnel Questionnaire (BCTQ) score was used to evaluate the clinical efficacy of arthroscopy combined with self made instruments in the treatment of carpal tunnel syndrome. Compared with the traditional group, the arthroscopic group had significant advantages in incision length, operation time, intraoperative bleeding and hospital stay, but the total cost of hospitalization was increased. The Boston score was significantly higher in the arthroscopic group than that in the traditional group at 1 month after operation, but not at 3 and 6 months after operation. Arthroscopy combined with self-made instruments in the treatment of carpal tunnel syndrome is more reliable, minimally invasive and simplified than open surgery, but the patients should be clearly diagnosed and appropriately selected before operation to achieve satisfactory clinical effect.

Short-Term Efficacy and Quality of Life of Gastric Cancer Patients Undergoing Radical Gastrectomy Assisted by External Vision.

Objective To evaluate the clinical effects and survival prognosis of radical gastrectomy assisted by external vision in gastric cancer. Methods A total of 60 hospitalized gastric cancer patients from June 2016 to December 2018 were selected and divided into the observation group and control group according to different surgical procedures. The control group was treated with traditional open radical gastrectomy, while the observation group was treated with radical gastrectomy assisted by an external vision microscope. Relevant surgical indicators, visual analogue scale (VAS), postoperative complications, and life quality assessment were analyzed and compared between the two groups. Results The incision length and intraoperative blood loss in the observation group were smaller than those in the control group, and the difference was statistically significant (P < 0.05); compared with the control group, the observation group had significantly shorter hospital stay, earlier postoperative first exhaust time, and lower gastric fluid volume at the 3rd day after surgery (P < 0.05). The pain scores of the observation group at 1, 4, and 12 weeks after surgery were lower than those of the control group (P < 0.05), and the difference was significant. The quality of life scores at the 1st week and 12th week after surgery showed that the dysphagia symptom scores of the observation group and the control group were significantly reduced but the two groups had significant differences in fatigue, physical function, pain score, postoperative pain, and overall quality of life. The observation group was significantly better than the control group (P < 0.05). Follow-up studies showed no significant difference between mortality and cancer recurrence (P > 0.05); the patients recovered well at postoperation, and the diet of the observation group was better than that of the control group (P < 0.05); gastric reflux and knife pain were less than those of the control group (P < 0.05). Conclusion Radical gastrectomy assisted by external vision for gastric cancer yields clinical benefits for gastric cancer patients, which not only dramatically shortened the length of hospital stay but also effectively ameliorated the quality of life of patients, all indicating that external vision-assisted surgery was significantly better than traditional gastrectomy in improving the postoperative quality of life of gastric cancer patients in the absence of increasing the risk of adverse events.

Assessment of Robot-Assisted Mandibular Contouring Surgery in Comparison With Traditional Surgery: A Prospective, Single-Center, Randomized Controlled Trial.

Few clinical studies on robot-assisted surgery (RAS) for mandibular contouring have been reported. The aim of this study was to follow the long-term effectiveness and safety of RAS for craniofacial bone surgery. This small-sample, early-phase, prospective, randomized controlled study included patients diagnosed with mandibular deformity requiring mandibular contouring surgery. Patients of both genders aged 18 to 30 years without complicated craniofacial repair defects were enrolled and randomly assigned in a 1:1 ratio by a permuted-block randomized assignments list generated by the study statistician. The primary outcomes were the positioning accuracy and accuracy of the osteotomy plane angle 1 week after surgery. Surgical auxiliary measurement index, patient satisfaction scale, surgical pain scale, perioperative period, and complications at 1 week, 1 month, and 6 months after surgery were also analyzed. One patient was lost to follow-up, resulting in a total of 14 patients in the traditional surgery group and 15 in the robot-assisted group (mean [standard deviation] age, 22.65 [3.60] years). Among the primary outcomes, there was a significant difference in the positioning accuracy (2.91 mm vs 1.65 mm; P < 0.01) and angle accuracy (13.26º vs 4.85º; P < 0.01) between the 2 groups. Secondary outcomes did not significantly differ. Compared to traditional surgery, robot-assisted mandibular contouring surgery showed improved precision in bone shaving, as well as higher safety.

Advances in the surgical treatment of cholesteatoma of the middle ear

Middle ear cholesteatoma, as a common ear disease, has been further understood in terms of its molecular mechanism, classification and staging, and it is generally believed that surgical treatment is the first choice, but there is no final conclusion on its surgical choice. Microscopic surgery includes complete or open radical mastoidectomy with or without reconstruction of the middle ear cavity, and their pros and cons have been debated for decades. In the past decade, a variety of surgical methods have been developed, including various improvements and combined operations that combine the advantages of traditional open radical mastoidectomy and complete mastoidectomy. On the other hand, the emergence of ear endoscopic surgery has opened up new surgical methods, as well as the use of laser and other new technologies to improve the surgical effect and prognosis, but also can not avoid their limitations and shortcomings. The purpose of this paper is to summarize the advantages and disadvantages of various surgical treatments for middle ear cholesteatoma in order to provide guidance and help for otologists in the treatment of middle ear cholesteatoma.

Comparison of Acute and Chronic Surgical Complications Following Robot-Assisted, Laparoscopic, and Traditional Open Radical Prostatectomy Among Men in Taiwan

Few studies have evaluated long-term surgical complications in patients with prostate cancer (PC) who receive open radical prostatectomy (ORP), laparoscopic radical prostatectomy (LRP), or robot-assisted radical prostatectomy (RARP). To examine the perioperative and postoperative surgical complications among patients with PC who underwent ORP, LRP, or RARP. This cohort study included patients who received a diagnosis of resectable PC and underwent RP between January 1 and December 31, 2015. Participants were enrolled in the Taiwan Cancer Registry. The index date was the date of surgery, and the follow-up duration was the period from the index date to December 31, 2018. Data analysis was performed in September 2020. ORP, LRP, or RARP. Two multivariate mixed models accounting for hospital clusters were fitted to ascertain the association of RARP with treatment outcomes (ie, hospital stay, blood transfusion, postoperative pain, erectile dysfunction, urinary incontinence, and hernia); general linear regression models were used for continuous outcomes, the amount of blood transfused, and hospital stay, and logistic regression models were used for analyzing postoperative outcomes and surgical complications. Of the 1407 patients included in this study, 315 (22.4%) received ORP (mean [SD] age, 66.4 [6.8] years), 276 (19.6%) received LRP (mean [SD] age, 66.8 [6.4] years), and 816 (58.0%) received RARP (mean [SD] age, 66.1 [6.7] years). Mean (SD) follow-up in the full cohort was 36.7 (4.6) months. No statistically significant differences were observed in age, clinical tumor stage, pathological tumor stage, Gleason score, Gleason grade group, preoperative prostate-specific antigen concentration, D'Amico risk classification, and hospital level. A shorter hospital stay was observed for patients undergoing RARP vs those undergoing ORP (mean [SE] difference, -1.64 [0.22] days; P < .001) and LRP (mean [SE] difference, -0.57 [0.23] days; P = .01). Patients undergoing RARP had lower odds of receiving a blood transfusion (RARP vs ORP: adjusted odds ratio [aOR], 0.25; 95% CI, 0.17-0.36; RARP vs LRP: aOR, 0.58; 95% CI, 0.37-0.91). For postoperative pain, RARP was associated with a decrease in the odds of moderate to severe postoperative pain for as long as 12 weeks compared with both ORP and LRP (eg, RARP vs LRP at week 12: aOR, 0.40; 95% CI, 0.19-0.85; P = .02). The aORs for RARP vs those for ORP and LRP in the third year after RP were, for erectile dysfunction, 0.74 (95% CI, 0.45-0.92) and 0.60 (95% CI, 0.36-0.98), respectively; for urinary incontinence, 0.93 (95% CI, 0.65-0.99) and 0.60 (95% CI, 0.42-0.86), respectively; and for hernia, 0.51 (95% CI, 0.31-0.84) and 0.82 (95% CI, 0.46-0.92), respectively. In this study, undergoing RARP was associated with fewer acute and chronic postoperative complications than undergoing ORP or LRP.

The Clinical Application of Robot-Assisted Ventriculoperitoneal Shunting in the Treatment of Hydrocephalus.

BackgroundThis work aims to assess the effectiveness and safety of robotic assistance in ventriculoperitoneal shunting and to compare the results with data from traditional surgery.MethodsWe retrospectively analyzed 60 patients who had undergone ventriculoperitoneal shunting, of which shunts were implanted using a robot in 20 patients and using traditional surgical methods in the other 40 patients. Data related to surgery were compared between the two groups, and the accuracy of the drainage tube in the robot-assisted group was assessed.ResultsIn the robot-assisted surgery group, the operation duration was 29.75 ± 6.38 min, intraoperative blood loss was 10.0 ± 3.98 ml, the success rate of a single puncture was 100%, and the bone hole diameter was 4.0 ± 0.3 mm. On the other hand, the operation duration was 48.63 ± 6.60 min, intraoperative blood loss was 22.25 ± 4.52 ml, the success rate of a single puncture was 77.5%, and the bone hole diameter was 11.0 ± 0.2 mm in the traditional surgery group. The above are statistically different between the two groups (P < 0.05). Only one case of surgery-related complications occurred in the robot-assisted group, while 13 cases occurred in the traditional surgery group. There was no significant difference in the hospitalization time. In the robot-assisted surgery group, the average radial error was 2.4 ± 1.5 mm and the average axial error was 1.9 ± 2.1 mm.ConclusionIn summary, robot-assisted implantation is accurate, simple to operate, and practical; the duration of surgery is short; trauma to the patient is reduced; and fewer postoperative complications related to surgery are reported.

A New Modified Hysteroscopic-Laparoscopic Surgery for Cesarean Scar Pregnancy of Stable Type III.

ObjectiveTo introduce a modified hysteroscopic-laparoscopic operation for cesarean scar pregnancy (CSP) of stable type III.Patients and MethodsWe retrospectively studied the case notes of 31 patients with stable type III cesarean scar pregnancy who underwent hysteroscopic-laparoscopic surgery in our hospital. Thirteen patients received the modified hysteroscopic-laparoscopic surgery (modified surgery group), and eighteen patients received traditional hysteroscopic-laparoscopic surgery (traditional surgery group).ResultsThere was no significant difference in patients’ age, gestational age, number of previous cesarean sections, the serum human chorionic gonadotropin (hCG) level before surgery, gestational sac diameter, myometrium thickness between the two groups. In the modified hysteroscopic-laparoscopic surgery, the mean surgical time was 50.45±24.45 mins, the mean length of stay in hospital was 4.50±0.50 days, which was significantly shorter than the traditional surgery group (84.75±33.28 mins and 5.50±0.75 days, respectively). And the intraoperative hemorrhage in the modified group was also less than that in the traditional group (40.50±12.25 mL vs 75.33±25.45mL). Whereas the time for hCG normalization, postoperative vaginal bleeding and menstrual recovery had no significant difference between the modified surgery group and the traditional surgery group. There was no recurrence of CSP in both groups.ConclusionThe modified hysteroscopic-laparoscopic surgery had shorter operation time, less blood loss, and sooner recovery time after surgery compared to traditional hysteroscopic-laparoscopic surgery, which could be more beneficial to our patients and should be applied in clinics generally.

A Novel Method to Treat Progressive Desmoid Tumors Involving Neurovascular Bundles: A Retrospective Cohort Study.

BACKGROUNDMore effective therapies are needed to treat progressive desmoid tumors when active surveillance and systemic therapy fail.OBJECTIVETo assess the efficacy and safety of sandwich isolation surgery on the local control of progressive desmoid tumors involving neurovascular bundles.METHODSA total of 27 patients with progressive desmoid tumors at extremities involving neurovascular bundles who received surgery at our hospital between August 2014 and August 2018 were identified. A total of 13 patients received sandwich isolation surgery, in which R2 resection was performed in neurovasculature-involving regions, and a biomaterial patch was used to envelop involved neurovascular structures and isolate residual tumors. In non-neurovasculature-involving regions, wide resection was performed without isolation. A total of 14 patients received traditional surgery, which included tumor resection without isolation procedure.RESULTSIn sandwich isolation group, tumor progressions and local recurrences occurred in 3 patients outside the isolated neurovasculature-involving regions. However, no progressions or recurrences occurred in any patients in the isolated neurovasculature-involving regions where R2 resection was performed. Sandwich isolation surgery group and traditional surgery group shared similar baseline clinical characteristics. The estimated 3-yr event-free survival rate was 76.9% after sandwich isolation surgery, and 32.7% after traditional surgery (P = .025). Patients who received sandwich isolation surgery were less likely to have local recurrence (hazard ratio: 0.257, P = .040). No complications were noted except intermittent mild pain in operative regions (2 cases).CONCLUSIONSandwich isolation surgery is effective and safe for local control of desmoid tumors involving neurovascular bundles.

Latest Comprehensive Medical Resource Consumption in Robot-Assisted versus Laparoscopic and Traditional Open Radical Prostatectomy: A Nationwide Population-Based Cohort Study.

Simple SummaryFew studies have evaluated long-term medical monetary cost in patients with prostate cancer (PC) receiving open radical prostatectomy (ORP), laparoscopic radical prostatectomy (LRP), or robot-assisted radical prostatectomy (RARP). To the best of our knowledge, this is the largest and longest follow-up study to examine medical monetary cost in patients with PC undergoing ORP, LRP, or RARP. After adjustment for confounders, the medical monetary cost in the RARP group was the least compared with that in the ORP and LRP groups.Background: Few studies have evaluated long-term medical monetary cost in patients with prostate cancer (PC) receiving open radical prostatectomy (ORP), laparoscopic radical prostatectomy (LRP), or robot-assisted radical prostatectomy (RARP). To the best of our knowledge, this is the largest and longest follow-up study to examine medical monetary cost in patients with PC undergoing ORP, LRP, or RARP. After adjustment for confounders, the medical monetary cost in the RARP group was the least compared with that in the ORP and LRP groups. Purpose: To estimate long-term medical resource consumption among patients with prostate cancer (PC) receiving open radical prostatectomy (ORP), laparoscopic radical prostatectomy (LRP), or robot-assisted radical prostatectomy (RARP). Patients and Methods: Participants were men enrolled in the Taiwan Cancer Registry with localized PC diagnosis who received radical prostatectomy. After adjustment for confounders, a generalized linear mixed model was used to determine significant differences in the number of urology outpatient clinic visits required, proportion of patients being hospitalized for urinary diseases or surgical complications, and medical reimbursement for urinary diseases or surgical complications following ORP, LRP, or RARP in the first, second, and third years. Results: No differences were observed in the median number of urology outpatient clinic visits between the three types of surgical modalities up to the second year after ORP, LRP, and RARP (median: 15, 10, and seven visits, respectively; p < 0.001), but significant differences were observed in the third year. Similarly, with RARP (10.9% versus 18.7% in ORP and 9.8% in LRP; p = 0.0014), the rate of hospitalization for urinary diseases or surgical complications decreased in the third year. Medical reimbursement for urinary diseases or surgical complications reduced after RARP compared with that for ORP and LRP, with approximately 22% reduction in the first year (p = 0.0052) and 20–40% reduction in the third year (p value = 0.0024). Conclusions: Medical resource consumption in the RARP group was less compared with those in the ORP and LRP groups.

Clinical effect of minimally invasive surgery for inguinal cryptorchidism

BackgroundThe purpose of this study was to investigate the clinical effect of minimally invasive surgery for inguinal cryptorchidism.MethodsThe patients were divided into the minimally invasive surgery group (n = 100) and the traditional surgery group (n = 58). In the minimally invasive surgery group, patients with low inguinal cryptorchidism (n = 54) underwent surgery with a transscrotal incision, and patients with high inguinal cryptorchidism (n = 46) underwent laparoscopic surgery.ResultsThere was no difference in the hospital stay duration or cost between the minimally invasive surgery group and the traditional surgery group (P > 0.05). As for the operative time, minimally invasive surgery of low inguinal cryptorchidism was shorter than traditional surgery (P = 0.033), while minimally invasive surgery of high inguinal cryptorchidism was comparable to traditional surgery (P = 0.658). Additionally, there were no cases of testicular atrophy, testicular retraction, inguinal hernia or hydrocele in either group. There was no significant difference in the incidence of poor wound healing between the two groups (P > 0.05). Although there was no significant difference in the incidence of scrotal hematoma between the two groups (P > 0.05), the incidence in the minimally invasive surgery group was higher than that in the traditional surgery group.ConclusionsMinimally invasive surgery including a transscrotal incision for low inguinal cryptorchidism and laparoscopic surgery for high inguinal cryptorchidism is as safe and effective as traditional surgery, and could also provide a good cosmetic effect for children.

Ligation-free single scrotal incision orchiectomy with ultrasonic scalpel: Xinhua Zhang Procedure

Background: To explore the efficacy and safety of a new type of testicular excision with ultrasonic dissector. Methods: A retrospective analysis was performed on 69 patients with advanced prostate cancer undergoing orchiectomy in our hospital between June 2017 and June 2019. All patients were divided into a traditional surgery group (n = 27) and an ultrasonic scalpel surgery group (n = 42). The operation time, intraoperative blood loss, postoperative hospital stay and postoperative complication rates were compared. Results: The ultrasonic scalpel surgery group had significantly shorter operation times and less intraoperative blood loss than the traditional surgery group (each P &lt; 0.01). Moreover, the incidence of postoperative complication differed significantly between the traditional surgery group (18.52%) and the ultrasonic scalpel surgery group (0%) (P &lt; 0.01). However, there was no significant difference in postoperative hospital stay between the two groups (P &gt; 0.05). Conclusions: The surgery time for testicular excision using the ultrasonic knife is short, the operation is simple and the complications are few and thus it may become a form of replacement for traditional testicular excision.

The Prospective, Single-Center, Randomized Controlled Trial: Assessment of Craniofacial Robot-Assisted Surgery in Comparison With Traditional Surgery

Background: The clinical research reports on robot-assisted surgery (RAS) in mandibular contouring surgery are lacking. Our objective was to follow up on the effectiveness and safety of RAS for craniofacial bone surgery over a long period of time. Methods: This small sample early phase prospective randomized controlled study included patients diagnosed with mandibular deformity requiring mandibular contouring surgery. Patients of both genders aged 18-30 years who did not have complicated craniofacial repair defects were enrolled and were randomly assigned in a 1:1 ratio by a permuted-block randomized assignments list that was generated by the study statistician. The control group was treated with traditional mandibular contouring surgery, while the experimental group was treated with robot-assisted mandibular contouring surgery. This was an open trial, but patients and evaluators did not know the grouping of patients. The primary outcomes were the position accuracy and angle accuracy of the osteotomy plane. We conducted third-party measurement and evaluation on the accuracy of outcomes 1 week after surgery. Surgical auxiliary measurement index, patient satisfaction scale, surgical pain scale, perioperative period, and complications at 1 week, 1 month, and 6 months after surgery were also analyzed. Findings: From July 11, 2017 to August 20, 2019, 30 patients, 15 in the RAS group and 15 in the traditional surgery group, were enrolled in the study. One patient was lost to follow-up in the final experiment (controlled group), resulting in a total of 14 patients in the traditional surgery group and 15 in the robot-assisted group, whose data were used for statistical analysis. Among the primary outcomes, there was a significant difference in the position accuracy and angle accuracy between the preoperative design and the actual postoperative osteotomy CT between the traditional surgery group and the robot-assisted group. Among the secondary outcomes, apart from the deviation distance of inferior alveolar nerve to the mandibular cutting plane and bone cutting volume compared with the surgical simulation, there was no significant difference in terms of other surgical auxiliary measurement index, patient satisfaction scale, surgical pain scale, perioperative period, and complications. Interpretation: Compared to traditional surgery, robot-assisted mandibular contouring surgery showed obviously improved precision in bone cutting. What’s more, this technology did not increase the risk of patients. However, this technology needs further clinic trial for effectiveness and safety with more cases according to the findings of this early-phase trial. Trial Registration: The Trial was registered in the Chinese Clinical Trial Registry with the registration number chicTR-Inr17011795. Funding Statement: This work was supported by National Natural Science Foundation of China (No. 61672341，61973211，51911540479); The project of Science and Technology Commission of Shanghai Municipality (No. 17441903800, 18DZ2201900, 19441912300); The project of Science and Technology Commission of Fujian Province (No. 2018H0032); The project Science and Technology Department of Hainan Province (ZDYF2018022); The project of Science and Technology Commission of Quanzhou municipality (No. 2018Z028); The project of SJTU Medical and Engineering Cross Fund (No. YG2017ZD03); the project of Interdisciplinary Program of Shanghai Jiao Tong University (ZH2018QNB31)；and the project of Shanghai Jiao Tong University School of Medicine Two-hundred Talent (No. 20161420). Declaration of Interests: All authors declare no competing interests. Ethics Approval Statement: This study was approved by the Independent Ethics Committee of Shanghai Ninth People’ s Hospital affiliated with the Shanghai Jiao Tong University, School of Medicine. The clinical study was conducted according to the requirements of the ethics committee.

The clinical research of 1,470 nm laser in percutaneous nephrolithotomy.

BackgroundPercutaneous nephrolithotomy (PCNL) is the primary method for the treatment of renal calculi. The preservation of the nephrostomy tube after operation brings severe pain to the patients. We use a 1,470 nm semiconductor laser to stop bleeding after the operation, which cannot reserve the nephrostomy tube, fully reflect its safety and effectiveness, and provide a new method for clinical practice.MethodsForty-two patients with renal stones who came to our hospital from March 2016 to September 2019 were randomly divided into two groups: laser operation group (20 patients) and traditional operation group (22 patients). The stone removal rate, surgical effect, and postoperative complications were compared between the two groups.ResultsThere was no significant difference in the stone clearance rate between the two groups at the 4th week after operation (P>0.05). However, the incidence of postoperative infection, incision pain, and massive bleeding in the laser surgery group were lower than those in the traditional surgery group (P<0.05). However, there was no significant difference in urine extravasation and postoperative hematuria between the two groups (P>0.05). The average postoperative hospital stay in the laser surgery group was shorter than that in the traditional surgery group, and the difference was statistically significant (P<0.05). Simultaneously, there was no significant difference in operation time, intraoperative blood loss, and medical expenses between the two groups (P>0.05).ConclusionsThe 1,470 nm laser is safe, effective, and feasible in PCNL operation, especially in hemostasis of the renal puncture channel, and it is worth popularizing.

The application of percutaneous retrograde pubic screw implantation assisted by hollow pedicle opener in treatment of pubic branch fracture

To evaluate the effectiveness of percutaneous retrograde pubic screw implantation assisted by hollow pedicle opener in pubic branch fractures. The clinical data of 42 patients with pubic branch fractures treated by hollow screw fixation between March 2008 and March 2019 were analyzed retrospectively. According to the operation method, they were divided into the traditional operation group (20 cases in group A, fixed with traditional retrograde pubic screws) and the modified operation group (22 cases in group B, fixed with percutaneous retrograde pubic screws assisted by hollow pedicle opener). There was no significant difference ( P>0.05) between the two groups in terms of gender, age, cause of injury, fracture classification, comorbidity, and time from injury to operation. The operation time, blood loss, incision length, screw length, and complications were recorded and compared between the two groups. The fracture reduction was evaluated according to Matta standard on the next day after operation, and the function was evaluated by Majeed score at 12 months after operation. The operation was successfully completed in both groups. The operation time, blood loss, and incision length of group B were significantly less than those of group A ( P<0.05); there was no significant difference in screw length between the two groups ( t=0.793, P=0.437). All patients were followed up 8-24 months, with an average of 16.8 months. There was no complication in the two groups, such as injury of blood vessels and nerves, fracture of internal fixation, screw entering into joint cavity, and nonunion of fracture. There was no significant difference in the fracture healing time between the two groups ( t=-1.068, P=0.299). There were 2 cases of incision infection, 1 case of incision fat liquefaction, 2 cases of lower extremity deep vein thrombosis in group A, the incidence of complications was 25.0%; there was only 1 case of lower extremity deep vein thrombosis in group B, the incidence of complication was 4.5%, which was lower than that in group A, but the difference was not significant ( χ 2=2.104, P=0.147). In group A, 1 case was found to be dislocated, but in group B, there was no dislocated fracture. There was no significant difference between the two groups in the evaluation of Matta imaging on the next day after operation and the evaluation of Majeed function at 12 months after operation ( P>0.05). Percutaneous retrograde pubic screw implantation assisted by hollow pedicle opener is effect for the pubic branch fractures with the advantage of smaller incision, shorter operation time, and less bleeding compared with traditional methods.

Application of Ultimate Oncoplastic Surgery in Breast-Conserving Surgery

ABSTRACT Objective To investigate the application of oncoplastic surgery in breast-conserving surgery. Methods We retrospectively analyzed the clinical data of 103 breast cancer patients who underwent breast-conserving surgery in the First Affiliated Hospital of Henan University. All the patients were female whose tumor volume-to-breast volume ratio was greater than 20%. Fifty-two patients were treated with oncoplastic breast-conversing surgery (observation group), and 51 patients were treated with traditional breast-conserving surgery (control group). The volume of resected tissue, subjective satisfaction with breast shape, objective score of breast shape, and follow-up were compared between the two groups. Results In the observation group, the weight of resected breast tissue was 64.2–172.1 g, with a median of 98.7 g. In the control group, the weight of resected breast tissue was 67.5–175.7 g, with a median of 102.3 g. After 12 months of follow-up, the subjective satisfaction rate and objective score of breast shape in the observation group were significantly better than those in the traditional breast-conserving surgery group (P 0.05). Conclusion Oncoplastic breast-conserving surgery leads to better cosmetic results and a more satisfactory clinical results.

Comparison of Traditional Upper Airway Surgery and Upper Airway Stimulation for Obstructive Sleep Apnea

To compare patients with moderate-severe obstructive sleep apnea (OSA) undergoing traditional single and multilevel sleep surgery to those undergoing upper airway stimulation (UAS). Case control study comparing retrospective cohort of patients undergoing traditional sleep surgery to patients undergoing UAS enrolled in the ADHERE registry. 8 multinational academic medical centers. 233 patients undergoing prior single or multilevel traditional sleep surgery and meeting study inclusion criteria were compared to 465 patients from the ADHERE registry who underwent UAS. We compared preoperative and postoperative demographic, quality of life, and polysomnographic data. We also evaluated treatment response rates. The pre and postoperative apnea hypopnea index (AHI) was 33.5 and 15 in the traditional sleep surgery group and 32 and 10 in the UAS group. The postoperative AHI in the UAS group was significantly lower. The pre and postoperative Epworth sleepiness scores (ESS) were 12 and 6 in both the traditional sleep surgery and UAS groups. Subgroup analysis evaluated those patients undergoing single level palate and multilevel palate and tongue base traditional sleep surgeries. The UAS group had a significantly lower postoperive AHI than both traditional sleep surgery subgroups. The UAS group had a higher percentage of patients reaching surgical success, defined as a postoperative AHI <20 with a 50% reduction from preoperative severity. UAS offers significantly better control of AHI severity than traditional sleep surgery. Quality life improvements were similar between groups.

Analysis of difficulties and influencing factors in treatment of appendiceal abscess in children with laparoscopic surgery

The purpose of this study was to investigate and analyze the difficulties and the influencing factors in the laparoscopic surgery for appendiceal abscess in children. Forty-six patients with appendiceal abscess receiving laparoscopic surgery (laparoscopic surgery group) in Xuzhou Children's Hospital from January 2012 to March 2017 were retrospectively analyzed. The surgery was performed using the 3-hole method, the 30° lens was placed in umbilical region, and the left lower abdomen and superior pubis were the operating holes. If the appendix was thick and big, 10 mm trocar was replaced on the superior pubis and the appendix was removed, followed by pelvic or lower abdominal drainage via the superior pubis incision. The laparoscopic surgery group was compared with 45 cases of laparotomy (traditional surgery group) for appendiceal abscess performed by the same group of operators in the past, and the perioperative period and postoperative complications between the two groups were compared. The child patients' age, history of abdominal pain and prediagnosis treatment were compared within the laparoscopic surgery group. Compared with those in traditional surgery group, the surgery time in laparoscopic surgery group had no statistically significant difference (P>0.05), the incidence rate of complications was lower, and the difference was statistically significant (P<0.05). In laparoscopic surgery group, the surgery time of child patients aged ≥6 years old with the medical history for more than 5 days and unreasonable preoperative treatment was longer than that of child patients aged <6 years old with the medical history for less than or equal to 5 days and reasonable preoperative treatment, and the difference was statistically significant (P<0.05). Compared with the traditional surgery, laparoscopic surgery for appendiceal abscess in children can significantly reduce the postoperative complications; at the same time, the history of abdominal pain and preoperative treatment are the influencing factors of surgery.

Comparative Study of Micro-Bone Window and Conventional Bone Window Microsurgery for Hypertensive Intracerebral Hemorrhage.

To compare and analyze the efficacy and safety of traditional craniotomy and small bone window craniotomy in the treatment of hypertensive cerebral hemorrhage (HICH). Fifty-four patients with HICH treated with traditional craniotomy and small bone window craniotomy were retrospectively analyzed. The operation time, hospitalization time, preoperative, and postoperative CT analysis, Glasgow coma scale (GCS) score and Glasgow outcome scale (GOS) scores were analyzed. There were no significant differences in gender, age, hematoma volume, GCS score and pre-operative time between the 2 groups (P > 0.05). The operation time and hospitalization time of the micro-bone window group were shorter than those of the traditional operation group (P < 0.05). The GCS and GOS scores of the small bone window group after 3 days and 6 months were higher than those of the traditional operation group (P < 0.05). However, there was no significant difference in hematoma clearance rate, re-bleeding rate and infection rate between the two groups (P > 0.05). For patients with GCS 8-12 HICH, micro-bone window not only has the same effect as traditional bone window, but also has the advantages of shorter operation time and less trauma.

Accuracy and Safety of Robot‐Assisted Drilling Decompression for Osteonecrosis of the Femoral Head

ObjectiveTo investigate the safety and superiority of robot‐assisted femoral head drilling decompression in the treatment of femoral head necrosis.MethodsA total of 63 patients who underwent borehole decompression of the femoral head in our hospital from January 2016 to March 2019 were recruited. Patients were divided into two groups for comparison according to surgical methods. In the robot‐assisted surgery group, there were 30 cases with 41 femoral heads. The conventional group had 33 cases and 46 femoral heads. All patients signed the consent form before the operation. The follow‐up time was 6 months. The incision lengths, operation times, intraoperative blood loss, intraoperative fluoroscopies, guide needle punctures, postoperative Harris scores, and postoperative complications of the two groups were compared.ResultsThe incision length of the robot surgery group was 5.16 ± 0.41 cm, while that of the traditional surgery group was 7.42 ± 0.50 cm. The operation time of the robot surgery group was 46.99 ± 4.94 min, while that of the traditional surgery group was 55.01 ± 6.19 min. The fluoroscopy frequency of the robot surgery group was 10.50 ± 1.78 times, while that of the traditional surgery group was 17.91 ± 2.20 times. The intraoperative blood loss in the robotic surgery group was 20.62 ± 2.52 mL, while that in the conventional surgery group was 52.72 ± 3.39 mL. In the robot operation group, each femoral head guide needle was punctured three times, and the puncture was successful one time. The number of guided needle punctures in the traditional group was 8.02 ± 1.73. The difference between the two groups was statistically significant (P < 0.05). The Harris score was 69.53 ± 7.51 in the robot surgery group and 68.38 ± 7.26 in the traditional surgery group one month after surgery, 78.52 ± 6.49 in the robot surgery group and 76.41 ± 7.95 in the traditional surgery group three months after surgery, and 83.32 ± 8.62 in the robot surgery group and 81.74 ± 6.20 in the traditional surgery group six months after surgery. There was no significant difference between the two groups (P > 0.05). In the traditional group, there was one case of incision infection and one case of femoral head collapse during follow‐up. In the robot group, there were no complications, such as incision infection and deep vein thrombosis. No collapse of the femoral head was found in the robot group during follow‐up.ConclusionThe positioning system of the orthopaedic robot is an ideal method for the treatment of femoral head necrosis. This method has the advantages of simple operation, accurate drilling, a short operation time, less surgical trauma, less radioactivity, and good recovery of hip joint function.