Frontiers in Surgery最新文献

Introduction: This study evaluated the efficacy and learning curve of a maxillofacial surgical robotic system (MSRS) guided by electromagnetic navigation for mandibular angle ostectomy (MAO), compared to traditional surgical methods.

Methods: The study utilized a controlled experiment involving thirty rabbits, paired divided into experimental and control groups. The experimental group underwent MAO using the MSRS, while the control group was treated with conventional surgical techniques. The surgeons performing the procedures were inexperienced in robotic surgery and MAO to assess the learning curve and the impact of robotic assistance. Key parameters measured included the accuracy of ostectomy, setup time, and ostectomy efficiency, with data analyzed through a paired-t test to compare the performance between the two groups.

Results: The study indicated a significant reduction in ostectomy time for the experimental group, with improved accuracy and efficiency in ostectomy. The study found that robotic assistance could decrease the risk of complications and enhance surgical outcomes. It also highlighted the presence of an initial learning curve when adopting new robotic technologies, which could be mitigated through adequate training and simulation practices.

Discussion: Using MSRS for MAO could lead to faster early learning curves and increased ostectomy efficiency compared to traditional surgical methods. It demonstrated the potential benefits of integrating robotic systems into craniofacial surgery, suggesting a promising direction for future surgical practices.

Congenital nephrogenic diabetes insipidus (NDI) primarily arises from an X-linked recessive inheritance caused by mutations in the AVPR2 gene, which is responsible for approximately 90% of cases. This condition has an incidence rate of 4-8 per million male live births, with females being much less frequently affected. Symptoms typically manifest shortly after birth, predominantly in males. The key clinical features of NDI include excessive urination (polyuria), compensatory excessive thirst (polydipsia), cognitive impairment, consistently low urine specific gravity, dehydration, and imbalances in electrolyte levels. This case study highlights an unusual occurrence of NDI in a 50-year-old Chinese woman attributed to a mutation in the AVPR2 gene. For more than a year, she had been suffering from excessive urination and severe thirst. The patient, who had undergone surgery for cervical cancer, developed polyuria and hypernatremia postoperatively. Initial laboratory analyses revealed normal blood sodium and chloride levels but reduced urine osmolality and specific gravity. Imaging assessments revealed no irregularities. To validate the diagnosis of NDI, she participated in a water deprivation and vasopressin test. Subsequent genetic tests revealed a thymine (T) to adenine (A) mutation, leading to a missense mutation in the AVPR2 gene. As part of her treatment, she was placed on a low-sodium diet and prescribed oral hydrochlorothiazide and indomethacin for 1 month, resulting in a marked improvement in her symptoms. To the best of our knowledge, this is the first documented case of NDI diagnosed postoperatively in an older female patient with AVPR2 heterozygosity. This case highlights an unusual instance of an X-linked recessive clinical presentation of NDI in an elderly female patient. This study also underscores the importance of conducting water deprivation, vasopressin tests, and genetic testing in establishing the underlying cause for individuals diagnosed with NDI.

Objective: Acute aneurysmal rupture can be treated with endovascular therapy or surgical clipping. For patients with concurrent acute hydrocephalus, the placement of an external ventricular drainage (EVD) is required. This study aims to investigate the impact of pre-treatment EVD placement on rebleeding in ruptured aneurysms and to examine the influence of dual antiplatelet therapy and the sequencing of dual antiplatelet therapy with EVD placement on EVD-related hematomas.

Methods: We reviewed the clinical data of 83 patients with ruptured aneurysms who underwent EVD placement from a total of 606 aneurysm patients consecutively admitted between January 2018 and January 2023. The analysis focused on the impact of pre-treatment EVD placement on aneurysmal rebleeding and the effect of dual antiplatelet therapy and its sequencing with EVD placement on EVD-related hematomas.

Results: Among the 503 patients with ruptured aneurysms, 83 required EVD placement. EVD was placed before aneurysm treatment in 63 patients and after treatment in 20 patients. The number of aneurysmal rebleeding cases in the pre-treatment EVD group and non-EVD group was 1 (1.6%) and 20 (4.8%), respectively (p = 0.406). 31 patients (37.3%) underwent stent-assisted embolization or flow diversion requiring dual antiplatelet therapy, while 52 patients (62.7%) underwent simple embolization or surgical clipping without antiplatelet therapy. EVD-related hematomas occurred in 14 patients (16.9%), with 10 cases (32.3%) in those receiving dual antiplatelet therapy and 4 cases (7.7%) in those not receiving antiplatelet therapy (p = 0.01). Among 16 patients who had EVD placed before dual antiplatelet therapy, 4 (25%) developed EVD-related hematomas. Of the 15 patients who had EVD placed after dual antiplatelet therapy, 6 (40%) developed EVD-related hematomas (p = 0.458).

Conclusion: In patients with aneurysmal subarachnoid hemorrhage (aSAH) and acute hydrocephalus, the placement of EVD before aneurysm treatment does not increase the risk of rebleeding. However, dual antiplatelet therapy increases the risk of EVD-related hematoma, and the sequence of EVD placement relative to dual antiplatelet therapy does not appear to significantly affect the outcome of EVD-related hematoma.

Background: Tunneled peripherally inserted central catheters (PICC) have potential to reduce complications compared to non-tunneled PICC in previous studies. Which is better is debatable. Thus, the aim to compare the effect of tunneled and non-tunneled PICC for cancer patients undergoing chemotherapy.

Methods: Embase, PubMed, Cochrane Library database, and CNKI were searched from inception to March 15, 2024. Odds ratios (ORs) with 95% confidence intervals (95% CIs) was calculated to assess the complications of tunneled and non-tunneled PICC for cancer patients undergoing chemotherapy using random- or fixed-effects models.

Results: A total of 12 articles were retrieved. Meta-analysis showed that tunneled PICC significantly decreased the risk of wound oozing (OR: 0.29, 95% CI: 0.20-0.41), infection risk (OR: 0.41, 95% CI: 0.20-0.85), thrombosis risk (OR: 0.26, 95% CI: 0.15-0.44), phlebitis risk (OR: 0.23, 95% CI: 0.13-0.40), and catheter dislodgement risk (OR: 0.33, 95% CI: 0.22-0.50) compared to non-tunneled PICC.

Conclusions: The subcutaneous tunneling technology has advantages over normal technique in decreasing PICC-related complications for cancer patients undergoing chemotherapy.

Systematic review registration: PROSPERO (CRD42024522862).

Introduction: The assessment of segmental fusion after Lateral Lumbar Interbody fusion (LLIF) using 3D-printed porous titanium cage is still not well studied. Various criteria, such as the presence of bone bridges (BB) between adjacent vertebrae, serve as indicators for anterior fusion. However, limited radiological studies have investigated zygapophyseal joints (ZJ) status following LLIF with porous titanium cages vs. conventional titanium threaded cages. The porous design of the latest titanium intervertebral cages is thought to enhance the bone-to-implant fusion rate. This radiological study aimed to compare the fusion patterns post-LLIF using 3D-printed porous titanium cages against those using threaded titanium cages. This radiological study aimed to compare the fusion patterns after LLIF using 3D-printed porous titanium cages against those using threaded titanium cages.

Material and methods: This retrospective, single-center radiological study involved 135 patients who underwent LLIF and posterior percutaneous screw fixation for degenerative spondylolisthesis. The study included 51 patients (Group A) with the novel porous titanium cages and 84 patients (Group B) with conventional threaded titanium cages. Inclusion criteria mandated complete radiological data and a minimum follow-up period of 24 months. The study evaluated intervertebral bone bridges (BB) for anterior fusion and zygapophyseal joints (ZJ) ankylotic degeneration, based on Pathria et al., as evidence of posterior fusion and segmental immobilization.

Results: Two years after surgery, intervertebral BB were identified in 83 segments (94.31%) in Group A and in 87 segments (88.77%) in Group B. ZJ Pathria grade I was observed in 2 segments (2.27%) of Group A and in 4 segments (4.08%) of Group B. Grade II was seen in 5 segments (5.68%) of Group A and in 6 segments (6.12%) of Group B. Posterior fusion, classified as grade III, was found in 81 segments (92.04%) of Group A and 88 segments (89.79%) of Group B. Subsidence incidence was 5.88% (3 segments) for the novel cage and 9.88% (8 segments) for the conventional cage.

Conclusions: The architecture of porous titanium cages offers a promising solution for increasing bone ingrowth and bridging space, supporting successful spinal fusion while minimizing the risk of subsidence.

Lumbar disc herniation (LDH) is a prevalent condition that severely impacts patients' quality of life and work capacity. Traditional surgical treatments like laminectomy, while effective, involve significant invasiveness and potential complications, including long-term spinal instability and recurrent symptoms. With the advancement of minimally invasive techniques, percutaneous endoscopic lumbar discectomy (PELD) has become a popular option due to its reduced trauma and faster recovery. However, PELD, while beneficial, carries risks, including complications that may not be immediately evident. This report presents the case of a 60-year-old female patient who underwent PELD for L4/5 disc herniation but experienced significant postoperative complications, including increased pain and neurological symptoms. Initial conservative management failed, and further investigations suggested possible postoperative infection, though this was later ruled out through surgical exploration and bacterial cultures. The patient subsequently underwent open surgical exploration, which revealed extensive tissue damage and required additional interventions, including a minimally invasive lateral anterior approach for stabilization and fusion (MIS-OLIF). Postoperative recovery was successful, with complete symptom resolution and stable spine alignment at a six-month follow-up. This case highlights the complexity of managing PELD-related complications and underscores the importance of thorough diagnostic evaluation and the potential need for additional surgical interventions to ensure long-term patient outcomes.

Introduction: This study presents the development and validation of a Deep Learning Convolutional Neural Network (CNN) model for estimating acetabular version (AV) from native hip plain radiographs.

Methods: Utilizing a dataset comprising 300 participants with unrelated pelvic complaints, the CNN model was trained and evaluated against CT-Scans, considered the gold standard, using a 5-fold cross-validation.

Results: Notably, the CNN model exhibited a robust performance, demonstrating a strong Pearson correlation with CT-Scans (right hip: r = 0.70, p < 0.001; left hip: r = 0.71, p < 0.001) and achieving a mean absolute error of 2.95°. Remarkably, over 83% of predictions yielded errors ≤5°, highlighting the model's high precision in AV estimation.

Discussion: The model holds promise in preoperative planning for hip arthroplasty, potentially reducing complications like recurrent dislocation and component wear. Future directions include further refinement of the CNN model, with ongoing investigations aimed at enhancing preoperative planning potential and ensuring comprehensive assessment across diverse patient populations, particularly in diseased cases. Additionally, future research could explore the model's potential value in scenarios necessitating minimized ionizing radiation exposure, such as post-operative evaluations.

Introduction: Implant-based breast reconstruction (IBR) is the predominant breast reconstruction technique post-mastectomy, with bacterial infections being a significant complication affecting patient recovery and quality of life. The following study aimed to determine the microbiological features of the causative agents responsible for breast implant infections, with more attention paid to the comparative analysis of Gram-positive and Gram-negative bacteria and their presentation.

Methods: We conducted a retrospective analysis of 214 patients who presented with periprosthetic infection and underwent implant removal following implant-based breast reconstruction at Humanitas Research Hospital and Istituto Europeo di Oncologia between January 2018 and March 2024.

Results: The study revealed that Gram-positive bacteria were more prevalent, with Staphylococcus species, particularly Staphylococcus aureus, being the most isolated pathogen in both institutions (∼39.96%). In contrast, Gram-negative bacteria were less frequent, with a higher proportion of these pathogens being multi-resistant strains. A significant difference was observed (p = 0.007), indicating that individuals with normal BMI have a higher prevalence of Gram-positive infections (88.46%), whereas obese and overweight patients had higher proportions of Gram-negative infections (23.53% and 28.89%, respectively). In addition, smoking status was also significantly associated with pathogen distribution (p = 0.032), with active and past smokers being related to higher percentages of polymicrobial infections. Furthermore, positive prophylactic MSSA/MRSA swabs were significantly more associated with Staphylococcus aureus infections compared to those with negative results (p = <0.001).

Conclusions: Gram-positive bacteria, especially Staphylococcus species, dominate the microbiological landscape of implant-based breast reconstruction (IBR) infections. Our findings provide insights into this critical issue, facilitating a more precise choice of empiric antibiotic treatment and prevention strategies. This analysis underscores the necessity for prophylactic protocols and therapeutic approaches tailored to the predominant bacterial groups. Further research is needed to explore long-term trends and resistance mechanisms to improve patient management.