Use Of Intraoperative Ultrasonography Research Articles

Ultrasound assessment of the distal resection margin during robotic rectal surgery.

Ensuring an adequate distal resection margin (DRM) is a key factor in achieving the gold standard in surgical treatment for rectal surgery. The aim of this article is to describe our surgical technique and the usefulness of intraoperative ultrasonography (IOUS) for evaluating the DRM during robotic rectal surgery (RRS). Prospective data on five consecutive patients with rectal cancer who underwent RRS between January 2023 and December 2023 were collected. IOUS was utilized to evaluate the DRM in all patients. The mean time for the IOUS examination ranged from 5 to 10 min. There were no intraoperative complications or conversions to open surgery. The median length of hospital stay was 6.4 days (±1.67 days). During hospitalization, one patient experienced a Grade II complication according to the Clavien-Dindo classification, specifically postoperative ileus. Furthermore, one patient experienced a delayed anastomotic fistula, which was conservatively treated without readmission. At definitive pathology, the median distance of the tumour from the DRM was 29 mm (±1.41 mm) and all patients had an R0 resection. IOUS is a reproducible and helpful modality for identifying the distal margin of the cutting line during robotic resection of rectal cancers. It does not affect the operating time compared with other methods and could be an alternative method for assessment of the DRM during RRS.

The utility of intraoperative ultrasonography for spinal cord surgery.

Intraoperative ultrasonography (IOUS) offers the advantage of providing real-time imaging features, yet it is not generally used. This study aims to discuss the benefits of utilizing IOUS in spinal cord surgery and review related literature. Patients who underwent spinal cord surgery utilizing IOUS at a single institution were retrospectively collected and analyzed to evaluate the benefits derived from the use of IOUS. A total of 43 consecutive patients were analyzed. Schwannoma was the most common tumor (35%), followed by cavernous angioma (23%) and ependymoma (16%). IOUS confirmed tumor extent and location before dura opening in 42 patients (97.7%). It was particularly helpful for myelotomy in deep-seated intramedullary lesions to minimize neural injury in 13 patients (31.0% of 42 patients). IOUS also detected residual or hidden lesions in 3 patients (7.0%) and verified the absence of hematoma post-tumor removal in 23 patients (53.5%). In 3 patients (7.0%), confirming no intradural lesions after removing extradural tumors avoided additional dural incisions. IOUS identified surrounding blood vessels and detected dural defects in one patient (2.3%) respectively. The IOUS can be a valuable tool for spinal cord surgery in identifying the exact location of the pathologic lesions, confirming the completeness of surgery, and minimizing the risk of neural and vascular injury in a real-time fashion.

P410 Intraoperative Ultrasonography of the Small Bowel in the evaluation of resection margins during surgery for Crohn's Disease

Abstract Background Histological involvement of surgical resection margins in Crohn’s Disease (CD) is considered an important risk factor for disease recurrence after surgery. The extent of resection is currently left to preoperative investigations and surgeon's experience. Aim of the study is to evaluate usefulness of intra-operative ultrasonography (IOUS) of the small bowel to best identify the surgical site of resection and reduce the risk of histological involvement of resection margins. Methods Consecutive patients who underwent surgery for CD (ileocaecal or ileal resections for first or repeated surgery) from April 2022 to April 2023 were prospectively enrolled (IOUS group). All patients underwent to IOUS through a small mini-laparotomy with a linear wireless probe performed by an expert gastroenterologist and the location of the proximal ileal resection was decided considering the absence of intraoperative small bowel ultrasonographic signs of CD (wall thickness, mucosal, submucosal and muscular layer thickness, echogenicity of the wall stratification and mesenteric fat). A control group from the historical cohort of patients undergoing the same surgical procedures was included; for whom the site of the proximal ileal resection was decided only on the basis of the absence of macroscopic signs of disease as usually assessed. To minimize the selection bias, a propensity score analysis was performed identifying a subgroup of the historical cohort (non-IOUS group) matched for location of disease and repeated surgery. The primary endpoint was histological involvement of the resection margins, judged positive in case of granulomas or signs of active ulcerative inflammation. Results 27 patients (59% male, mean age 39.3 y [SD 16.5], mean BMI 21.24 [SD 2.03]) were consecutively enrolled in the IOUS group. A 1:1 propensity score matching analysis was performed identifying 27 patients included in the non-IOUS group . The two groups were homogeneous in terms of gender, age, smoking, BMI, behavior of disease and surgical technique (laparoscopic or open technique). IOUS group presented a lower rate of histological positive margins compared to the non-IOUS group (18.5% vs 48.1% p = 0.021). No significant differences were found in terms of mean duration of surgery between the two groups (254.2 min vs 225 min [49.3-77.8]; p = 0.11) or in terms of mean length of surgical specimen (24.1 cm vs 34.1 cm [SD 13.5 -23.1]; p = 0.058) Conclusion IOUS of the small bowel appears to be a useful tool for IBD-surgeon in order to obtain a lower rate of histologically positive margins with a comparable duration of the surgery and no significant difference in length of the intestinal specimen.

The utility of intraoperative ultrasonography for spinal cord surgery.

Intraoperative ultrasonography (IOUS) offers the advantage of providing real-time imaging features, yet it is not generally used. This study aims to discuss the benefits of utilizing IOUS in spinal cord surgery and review related literature. Patients who underwent spinal cord surgery utilizing IOUS at a single institution were retrospectively collected and analyzed to evaluate the benefits derived from the use of IOUS. A total of 43 consecutive patients were analyzed. Schwannoma was the most common tumor (35%), followed by cavernous angioma (23%) and ependymoma (16%). IOUS confirmed tumor extent and location before dura opening in 42 patients (97.7%). It was particularly helpful for myelotomy in deep-seated intramedullary lesions to minimize neural injury in 13 patients (31.0% of 42 patients). IOUS also detected residual or hidden lesions in 3 patients (7.0%) and verified the absence of hematoma post-tumor removal in 23 patients (53.5%). In 3 patients (7.0%), confirming no intradural lesions after removing extradural tumors avoided additional dural incisions. IOUS identified surrounding blood vessels and detected dural defects in one patient (2.3%) respectively. The IOUS can be a valuable tool for spinal cord surgery in identifying the exact location of the pathologic lesions, confirming the completeness of surgery, and minimizing the risk of neural and vascular injury in a real-time fashion.

Patient with multifocal pancreatic insulinoma: a rare presentation of functional pancreatic neuroendocrine neoplasm

Insulinoma is a type of neuroendocrine tumour with an incidence of 1—4 cases per million. Multiple insulinomas constitute less than 10% of all insulinomas. Surgery is the treatment of choice for insulinoma. The operation can be done with an open or laparoscopic approach, with cure rates ranging from 77% to 100%. Pancreatic resection is recommended for tumours larger than 2 cm in size, while enucleation is advised for lesions smaller than 2cm if the tumour is at least 2—3 mm away from the main pancreatic duct to prevent the formation of a fistula. For better intraoperative localization of lesions, bimanual palpation together with intraoperative ultrasonography (IOUS) is advised. Palpation alone has 70% sensitivity, but together with IOUS, it reaches 85—95%
 A young female patient in her late 20s with non‑specific complaints and a medical history of epilepsy dating back to the age of 17 underwent a physical examination. Blood test results indicated severe hypoglycemia, and magnetic resonance imaging (MRI) revealed an 11‑mm neoplasia in the body of the pancreas. A 72‑hour fasting test confirmed the diagnosis of insulinoma, and the patient underwent laparoscopic surgery. IOUS was done for the precise localization of the lesion, and another tumour in the pancreatic tail was found. A spleen‑preserving laparoscopic distal pancreatectomy was performed. Histologic reports confirmed multifocal Grade 1 insulinoma. The postoperative course was uneventful. After 4 months of follow‑up, computed tomography (CT) was done, and there were no signs of recurrence of insulinoma, pancreatic pseudocysts, or other signs of postoperative complications. Since the operation, the patient has not had any episodes of hypoglycemia or seizures.
 The wide spectrum of symptoms, which are not specific to insulinomas, in particular seizures, can make it difficult to establish a correct diagnosis and can be mistaken for other psychiatric or neurologic disorders. This case clearly shows the advantages of IOUS‑guided surgery in achieving better visualization and outcomes. After enucleation of the smaller lesion without the use of IOUS, other insulinomas would be missed and left in place because they were located deeply in the parenchyma. Simple visualization and palpation would not be enough.

An innovative approach to assess spinal canal expansion following French-door cervical laminoplasty by intraoperative ultrasonography.

To investigate the feasibility and effectiveness of applying intraoperative ultrasound (IOUS) to evaluate spinal canal expansion in patients undergoing French-door cervical laminoplasty (FDCL). Twenty-five patients who underwent FDCL for multilevel degenerative cervical myelopathy were prospectively recruited. Formulae describing the relationship between laminoplasty opening angle (LOA) and laminoplasty opening size, the increase in sagittal canal diameter and the spinal canal area were deduced with trigonometric functions. The LOA was measured with IOUS imaging during surgery, and other spinal canal parameters were assessed. Actual spinal canal enlargement was verified on postoperative CT images. Linear correlation analysis and Bland‒Altman analysis were used to evaluate correlation and agreement between the intraoperative and postoperative measurements. The LOA at C5 measured with IOUS was 27.54 ± 3.12°, and it was 27.23 ± 3.02° on postoperative CT imaging. Linear correlation analysis revealed a significant correlation between IOUS and postoperative CT measurements (r = 0.88; p < 0.01). Bland-Altman plots showed good agreement between these two methods, with a mean difference of 0.30°. For other spinal canal expansion parameter measurements, correlation analysis showed a moderate to a high degree of correlation (p < 0.01), and Bland-Altman analysis indicated good agreement. In conclusion, during the French-door cervical laminoplasty procedure, application of IOUS can accurately evaluate spinal canal expansion. This innovative method may be helpful in improving surgical accuracy by enabling the operator to measure and determine canal enlargement during surgery, leading to ideal clinical outcomes and fewer postoperative complications. The use of intraoperative ultrasonography to assess spinal canal expansion following French-door cervical laminoplasty may improve outcomes for patients undergoing this procedure by providing more accurate measurements of spinal canal expansion. • Spinal canal expansion after French-door cervical laminoplasty substantially influences operative prognosis; insufficient or excessive lamina opening may result in unexpected outcomes. • Prediction of spinal canal expansion during surgery was previously impracticable, but based on this study, intraoperative ultrasonography offers an innovative approach and strongly agrees with postoperative CT measurement. • Since this is the first research to offer real-time canal expansion guidance for cervical laminoplasty, it may improve the accuracy of the operation and produce ideal clinical outcomes with fewer postoperative complications.

Endoscopically Assisted Percutaneous Harvesting of the Flexor Hallucis Tendon in Zone 2: An Anatomical Study.

Flexor hallucis longus (FHL) transfer is a well-established method for treating chronic Achilles tendon ruptures and tendinopathy. Harvesting of the FHL tendon in zone 2 results in greater length but is also associated with an increased risk of injury to the medial plantar nerve and requires an additional plantar incision. Because of the anatomic proximity of the FHL tendon to the tibial neurovascular bundle in zone 2, the purpose of this study was to investigate the risk of vascular or nerve injury with arthroscopic assisted percutaneous tenotomy in zone 2 of the FHL tendon. Endoscopically assisted percutaneous FHL transfer was performed on 10 right lower extremities from 10 cadaveric human specimens. The FHL tendon lengths and the relationship between FHL tendon and the tibial neurovascular bundle at zone 2 was analyzed. We observed a complete transection of the medial plantar nerve in 1 case (10%). The mean length of the FHL tendon was 54.7 ± 9.5 mm and the mean distance from the distal stump of the FHL tendon to local neurovascular structures was 1.3 ± 0.7 mm. There is a risk of neurovascular injury after endoscopic FHL tenotomy in zone 2. The tenotomy site is within 2 mm of the local neurovascular structures in the majority of cases. The additional length gained from this technique is unlikely to be required for the majority of FHL tendon transfer procedures. If additional length is needed, we would recommend the use of intraoperative ultrasonography or a mini-open approach to minimize injury risk. Level V, expert opinion.

Technical advances in the surgical management of Wilms tumors in children.

Surgery is one of the cornerstones of Wilms tumor treatment. In this article, we present technical advancements that are finding their way into the armamentarium of pediatric cancer surgeons. We discuss the current approaches, challenges, opportunities, and future directions of minimally invasive surgery (laparoscopic and robotics), image-guided surgery, and fluorescence-guided surgery. Furthermore, we discuss the use of intraoperative ultrasonography, as well as the use of new techniques to improve the quality of lymph node sampling.

Complication Avoidance in Neurosurgery with Use of Intraoperative Ultrasonography.

Intraoperative ultrasonography is an extremely valuable tool for avoidance of complications during neurosurgical procedures, including resection of intracranial and spinal cord tumors, removal of spontaneous intracerebral hemorrhages and arteriovenous malformations, and ventricular access for shunt placements. Nevertheless, application of this highly useful technique may be accompanied by some challenges and difficulties, as well as human errors; thus, it requires specific knowledge and continuous training.

Use of intraoperative ultrasonography in deciding the extent of surgical decompression for Chiari Malformation Type I

Introduction: The optimal surgical treatment for Chiari Malformation Type I continues to be controversial with procedures ranging from posterior fossa bone decompression alone to release or resection of the cerebellar tonsils. Intraoperative ultrasonography can be a useful tool in deciding the least invasive procedure so as to reduce the complications and improve the efficacy of the procedure. Methods: A retrospective study over a period of seven years of patients who underwent surgery for Chiari Malformation type I under the guidance of intraoperative ultrasonography was done. The patients underwent three types of surgery based on the adequacy of decompression seen as free flow of CSF through foramen of magendie and free movement of cerebellar tonsils on intraoperative ultrasonography placed over the duramater: Group 1: foramen magnum decompression alone, Group 2: foramen magnum decompression and lax duraplasty and Group 3: foramen magnum decompression with lax duraplasty and release or resection of cerebellar tonsils. Outcome of the types of surgery were determined by the clinical outcome at post-operative six months and two years. Result: A total of 10 patients: four males and six females were included in the study. The mean age of the population was 32.7 +/- 14.57 years with range of 42 years. There were three patients in group 1, two patients in group 2 and five patients in group 3. 100% of the patients in group 1, 50% of patients in group 2 and 60% of the patients in group 3 had improved outcome as evidenced by resolution of symptoms and resolution of syrinx at six months and one year postoperative period. Conclusion: Intraoperative ultrasonography is an effective tool in deciding the extent of surgical decompression for Chiari Malformation Type I. A larger multicentre study would help statistically validate the findings.

Enucleation of Pancreatic Insulinomas with the use of Intraoperative Ultrasonography

Tumor-induced hypoglycaemia is very rare, usually caused by a pancreatic beta cell tumor (insulinoma). Symptoms caused by inappropriate insulin secretion usually occur during fasting periods, they can be neurogenic or neuroglycopenic. The diagnosis usually takes up to 2-years, this is biochemical with imaging support. The only curative treatment for an insulinoma is surgical resection (enucleation or partial pancreatectomy).

The use of intraoperative ultrasonography in surgical treatment of patients with lumbosacral lipomas of different types

<h3>ОБОСНОВАНИЕ</h3> Интраоперационная ультрасонография (ИОУСГ) является одним из набирающих популярность методов нейровизуализации в современной нейрохирургической практике. Широкое распространение этого метода обусловливает быстрое прогрессирование аппаратных систем, в частности, мобильных ультрасонографических аппаратов, а также ультрасонографических датчиков, в том числе специализированных интраоперационных. Все эти факторы снижают порог доступности ИОУСГ, в связи с чем возникает потребность в информации о ее применении при хирургическом лечении отдельных патологий. Люмбосакральная липома (ЛСЛ) — объемное образование пояснично-крестцовой области дизэмбриогенетического происхождения, исходящее из конуса спинного мозга и имеющее различные типы роста и взаимоотношения с окружающими структурами, проявляющееся подкожным опухолевидным образованием, постепенным нарастанием неврологического, урологического и ортопедического дефицита. В статье отражены основные аспекты применения ИОУСГ в хирургическом лечении пациентов с ЛСЛ различных типов. <h3>ЦЕЛЬ ИССЛЕДОВАНИЯ</h3> Оценить применимость ИОУСГ в лечении пациентов с ЛСЛ различных типов, разработать алгоритм действий хирурга для применения ИОУСГ при операциях резекции ЛСЛ. <h3>МАТЕРИАЛ И МЕТОДЫ</h3> Изучена техника проведения ИОУСГ по результатам применения данного метода интраоперационной нейровизуализации в хирургическом лечении 145 пациентов с ЛСЛ различных типов, прооперированных проф. А.А. Суфиановым. В исследование включены 34 пациента из общей группы, прооперированные с целью резекции ЛСЛ с периодом послеоперационного наблюдения более 5 лет. <h3>РЕЗУЛЬТАТЫ</h3> Приведены основные достоинства и недостатки ИОУСГ в сравнении с иными методами нейровизуализации. Представлены описания интраоперационных ультрасонографических картин ЛСЛ различных типов. Представлен алгоритм действий хирурга для применения ИОУСГ в хирургическом лечении пациентов с ЛСЛ. <h3>ВЫВОДЫ</h3> ИОУСГ может считаться методом, наиболее удачно применимым при операциях резекции ЛСЛ различных типов ввиду визуализации всех необходимых анатомических структур на определенных этапах операции. По нашему мнению, ИОУСГ является методом выбора интраоперационной нейровизуализации при хирургическом лечении ЛСЛ.

Intraoperative Use of Ultrasonography in the Reduction of Zygomatico-Maxillary Complex Fractures.

A single blind randomized controlled study. The aim of this study is to evaluate the use of ultrasonography intraoperatively to assess the reduction of unilateral zygomatic complex fractures with a control group using the conventional blind digit palpation. The study comprised of a sample size of 24 patients with 21 male and 3 female patients. Patients of all age groups diagnosed with unilateral displaced zygomatic complex fracture with or without mandible fracture were included in the study. The subjects were randomized into study and control groups based on a standard protocol with a total of 24 patients. Imaging was in the form of a preoperative and postoperative 3D computed tomography scan with reconstruction of the maxilla and mandible to interpret the diagnosis for all subjects. The inter-fracture distance of the fractured infraorbital rim were measured in 3 dimensions (antero-posterior, medio-lateral and supero-inferior) and compared pre and postoperatively. Preoperative, intraoperative and postoperative ultrasonographic examination was performed and recorded on all patients at the frontozygomatic region, infraorbital rim and zygomatic buttress to assess the proximity of the fractured margins pre reduction, post reduction and post fixation of the fracture segments. Statistical analytic results were significant in all 3 dimensions when measured postoperatively using computed tomography. Ultrasonography is an effective screening and intraoperative tool in the armamentarium of oral and maxillofacial surgery to assess zygomatic complex fractures, avoiding incisions in aesthetic areas of the maxillofacial region.

Fourth ventricle tumors in children: complications and influence of surgical approach.

The goal of this study was to characterize the complications and morbidity related to the surgical management of pediatric fourth ventricle tumors. All patients referred to the authors' institution with posterior fossa tumors from 2002 to 2018 inclusive were screened to include only true fourth ventricle tumors. Preoperative imaging and clinical notes were reviewed to extract data on presenting symptoms; surgical episodes, techniques, and adjuncts; tumor histology; and postoperative complications. Three hundred fifty-four children with posterior fossa tumors were treated during the study period; of these, 185 tumors were in the fourth ventricle, and 167 fourth ventricle tumors with full data sets were included in this analysis. One hundred patients were male (mean age ± SD, 5.98 ± 4.12 years). The most common presenting symptom was vomiting (63.5%). The most common tumor types, in order, were medulloblastoma (94 cases) > pilocytic astrocytoma (30 cases) > ependymoma (30 cases) > choroid plexus neoplasms (5 cases) > atypical teratoid/rhabdoid tumor (4 cases), with 4 miscellaneous lesions. Of the 67.1% of patients who presented with hydrocephalus, 45.5% had an external ventricular drain inserted (66.7% of these prior to tumor surgery, 56.9% frontal); these patients were more likely to undergo ventriculoperitoneal shunt (VPS) placement at a later date (p = 0.00673). Twenty-two had an endoscopic third ventriculostomy, of whom 8 later underwent VPS placement. Overall, 19.7% of patients had a VPS sited during treatment.Across the whole series, the transvermian approach was more frequent than the telovelar approach (64.1% vs 33.0%); however, the telovelar approach was significantly more common in the latter half of the series (p < 0.001). Gross-total resection was achieved in 70.7%. The most common postoperative deficit was cerebellar mutism syndrome (CMS; 28.7%), followed by new weakness (24.0%), cranial neuropathy (18.0%), and new gait abnormality/ataxia (12.6%). Use of intraoperative ultrasonography significantly reduced the incidence of CMS (p = 0.0365). There was no significant difference in the rate of CMS between telovelar or transvermian approaches (p = 0.745), and multivariate logistic regression modeling did not reveal any statistically significant relationships between CMS and surgical approach. Surgical management of pediatric fourth ventricle tumors continues to evolve, and resection is increasingly performed through the telovelar route. CMS is enduringly the major postoperative complication in this patient population.

ANALYSIS OF THE INTRAOPERATIVE ULTRASOUND RESULTS IN THE SURGICAL TREATMENT OF RENAL TUMORS

Purpose . To evaluate the effectiveness of intraoperative ultrasonography (IOUS) in the surgical treatment of kidney tumors. Patients and methods . Possibilities of IOUS application in the surgical treatment of kidney tumor according to the results of examination and surgical treatment of 145 patients (95 men and 50 women) diagnosed with kidney cancer were evaluated. The patients were divided into 2 groups: group 1 (comparisons) — 76 patients; during the examination and treatment, the IOUS method was not used, group 2 (basic) — 69 patients, who during the surgical treatment used the IOUS method to further clarify the localization, the size and boundaries of the tumor formation. Results . The use of IOUS helped to reduce the frequency of nephrectomy (11.9% in the comparison group and 8.7% in the main group), and reduce the frequency of intraoperative complications, which amounted to (8.7% against 13.2%). The frequency of damage to the spleen and the transition to open surgery did not differ. The use of IOUS allowed to characterize in detail the anatomical features of the tumor, its vascularization and to implement the RENAL prognosis: favorable — in 50.7% of patients, unfavorable — in 15.9%. Conclusion .When performing kidney tumor surgery, it is recommended to perform IOUS of the affected kidney in order to further clarify the boundaries of the tumor lesion to improve the effectiveness of the operation.

Application of image-guided navigation system for laparoscopic hepatobiliary surgery.

To achieve safety of the operation, preoperative simulation became a routine practice for hepatobiliary and pancreatic (HBP) surgery. The use of intraoperative ultrasonography (IOUS) is essential in HBP surgery. There is a limitation in the use of IOUS in laparoscopic surgery (LS), for which a new intraoperative system is expected. We have developed an image-guided navigation system (IG-NS) for open HBP surgery since 2006, and we have applied our system to LS. The aim of this study is to evaluate the results of clinical application of IG-NS in LS. Eight patients underwent LS using IG-NS; LS consisted of cholecystectomy and hepatectomy in four patients each. After registration, the 3D models were superimposed on the surgical field. We performed LS while observing the navigation image. Moreover, we developed a support system for operations. The average registration error was 8.8 mm for LS. Repeated registration was effective for organ deformation and improved the precision of IG-NS. By using various countermeasures, identification of the tumor's position and the setting of the resection line became easy. As IG-NS provided real-time detailed and intuitive information, this intraoperative assist system may be an effective tool in LS.

Use of the intraoperative ultrasonography in intradural spinal tumor surgery

To review our experience gained from the use of intraoperative ultrasonography (IOUSG) in intradural spinal tumor surgery. IOUSG was used during surgery of 69 intradural spinal tumors, operated on between 2012 and 2016. A 5-8 MHz probe of IOUSG was used, before and after durotomy to perform the exact durotomy and myelotomy, and after tumor resection, to detect a residual tumor. A retrospective review of parameters including demographic data, localization and histopathology of the tumour, IOUSG findings, and the amount of tumor resection was made. In a total of 69 intradural spinal tumors (42 extramedullary, and 27 intramedullary tumors) IOUSG was used during surgery. Total excision was performed in 68 cases, and subtotal excision in one case. Pre-durotomy IOUSG showed sufficient laminectomy in 62 cases. In 7 cases, as the IOUSG failed to show all borders of the tumor, laminectomy was extended. IOUSG is an important tool, which contributes to intradural spine surgery. This modality shows the tumor appearance before durotomy, and is therefore helpful in deciding the amount of laminectomy and duratomy in addition to the exact location of myelotomy. It also provides the surgeon with information about residual tumor after excision, thereby increasing the safety and success of the surgical procedure.

Usefulness of intraoperative ultrasonography: a case report of idiopathic spinal cord herniation

Usefulness of intraoperative ultrasonography: a case report of idiopathic spinal cord herniation

An "alternative finger" in robotic-assisted thoracic surgery: intraoperative ultrasound localization of pulmonary nodules.

Robotic-assisted thoracic surgery (RATS) has become a promising treatment for pulmonary neoplasms. DuringRATS, intraoperative ultrasonography can act as an "alternative finger" to "touch" and locate lesions, especially pulmonarynodules. This study was aimed to investigate the efficacy of intraoperative ultrasonographic localization during da Vinci RATSprocedures. Patients with pulmonary nodules were randomly divided into an Experimental Group andControl Group in which nodules were respectively located using intraoperative ultrasonography or by the surgeon's anatomicknowledge. The success rates and relevant localization factors were compared between the groups and analyzed to concludethe efficacy of intraoperative ultrasonography. Additionally, the intraoperative ultrasonography learning curve was analyzedto evaluate each surgeon's ability to independently perform intraoperative ultrasonography. Thirty-four patients wereincluded in the study (n = 17/group). Respectively, the Experimental Group and Control Group comprised 41.2% and 58.9%women (p= 0.937), and had average ages of 55.5 and 55.8 years. In the Experimental group, ultrasonographic localization formixed ground-glass nodules with CT values of -500 to -100 Hounsfield units had an efficacy of 87.5%. By contrast, the localizationefficacy in Control Group was 20.0% (p=0.032).A single surgeon without prior experience performed intraoperative ultrasonography in 20 cases, and the latter 10 procedures required significantly less time relative to the former 10 procedures(p=0.000). During RATS, the use of intraoperative ultrasonography as an "alternative finger" to "touch" and findthe accurate location of pulmonary nodules, especially mixed ground-glass nodules, is warranted.

Intraoperative ultrasonography in nine dogs with intra-abdominal neoplasm suspect

ABSTRACT: Intraoperative ultrasonography (IOUS) is used in medicine for diagnosis and guidance during oncologic surgery. The aims of this study were to assess the performance, feasibility, advantages and difficulties of the IOUS technique in dogs with suspected intra-abdominal tumors. The study included nine client-owed dogs that had suspected intra-abdominal tumors (spleen, liver or bowel) based on transabdominal ultrasound examination and that were subsequently referred for exploratory laparotomy surgery. During surgery, IOUS was performed; results of preoperative transabdominal ultrasonography, inspection by the surgeon and IOUS were compared on a case-by-case basis. IOUS was helpful in determining lesion resection in all cases. Lesions detected solely by the use of IOUS were observed in seven out of nine cases. Analysis of these cases demonstrated that IOUS can be a tool to assist during oncology surgery on the liver, spleen or bowel. Dogs with hepatic tumors can have small non-palpable intraparenchymal nodules, which may be visible by IOUS.