Frontiers in Surgery最新文献

Objective: The aim of this study was to describe the surgical technique of endoscopy-assisted anterior cervical discectomy and fusion (ACDF), to evaluate the advantages, efficacy, and safety of this procedure for the treatment of cervical spondylotic myelopathy (CSM).

Methods: The clinical data of patients with CSM treated with endoscopy-assisted ACDF from January 2023 to December 2023 were retrospectively reviewed. And 35 patients, including 13 females and 22 males, were included in this study. Endoscopic assisted ACDF surgery was described step by step in detail, and clinical and imageological assessment were performed before and after operation and follow-up.

Results: All 35 patients underwent endoscopy-assisted ACDF surgery successfully, and were followed up for 12.9 ± 2.1 months (range 9∼18 months). The operation time was 74.4 ± 10.7 min (range 60∼100 min). Postoperative drainage volume was 14.1 ± 5.8 mL (range 5∼25 mL). No complications were observed. There were no complications, aggravation of neurological symptoms after operation, and the JOA score at the last follow-up was significantly improved compared with that before operation (15.7 ± 0.8 vs. 10.3 ± 1.9, P < 0.001). At the last follow-up, the C2-C7 Cobb angle was significantly higher than that before operation (P < 0.001), and Δ Cobb angle was 7.4 ± 2.5˚, and all patients achieved bony fusion.

Conclusions: Endoscopy-assisted ACDF, which combined the uniaxial spinal endoscopy with traditional ACDF, achieved satisfactory short-term clinical efficacy and safety in the treatment of CSM.

Objective: This study aims to evaluate the clinical value of combining 3D printing technology with customized metal plates in the treatment of long-segment femoral shaft comminuted fractures.

Methods: A retrospective study was conducted on 36 patients with long-segment femoral shaft comminuted fractures who were treated at our hospital between September 2020 and September 2023. Patients were divided into two groups: the conventional group (18 patients), treated with limited open reduction and intramedullary nailing, and the 3D printing group (18 patients), which utilized 3D-printed models and customized metal plates for assisted internal fixation. Intraoperative evaluation metrics included surgical time, number of fluoroscopy exposures, and intraoperative blood loss. Postoperative evaluation metrics included the time to weight-bearing initiation, time to full weight-bearing, and fracture healing time. At 3 months post-operation and at the final follow-up, evaluations were conducted on the knee flexion-extension range of motion (ROM), hospital for special surgery (HSS) score, hip flexion-extension ROM, Harris score, visual analogue scale (VAS) score, and the occurrence of complications. At the final follow-up, lateral displacement, angular deformity, shortening deformity, and the modified radiographic union score for tibia (mRUST) score of the fracture site were evaluated.

Results: The 3D printing group had significantly shorter surgical time and fewer fluoroscopy exposures (both P < 0.001), while intraoperative blood loss was higher but not statistically significant (P = 0.252). The 3D printing group also showed faster initiation of partial weight-bearing, full weight-bearing, and fracture healing (P < 0.001, P < 0.001, P = 0.009). At 3 months and final follow-up, the 3D printing group showed significantly better knee flexion-extension ROM, HSS score, hip flexion-extension ROM, and Harris score than the conventional group (all P < 0.001), while VAS scores showed no significant difference (all P > 0.05). At the final follow-up, the 3D printing group demonstrated better results in terms of lateral displacement, angulation deformity, shortening deformity, and mRUST score (all P < 0.001).

Conclusion: Combining 3D printing technology with customized metal plates in treating long-segment femoral shaft comminuted fractures improves surgical efficiency, fracture reduction and healing quality, and promotes functional recovery.

Giant gallbladder is a rare clinical condition characterized by abnormal gallbladder enlargement, typically defined as a longitudinal diameter exceeding 14 cm or a volume surpassing 1.5 L. The most common pathological etiologies are cholelithiasis and chronic cholecystitis, followed by neoplastic factors, while congenital developmental anomalies and other causes are relatively uncommon. Herein, we report a case of giant gallbladder-induced pyloric obstruction in a patient who presented with nausea and vomiting for two weeks-symptoms that recurred after initial resolution of diabetic ketoacidosis. Abdominal computed tomography (CT) revealed a giant gallbladder with cholelithiasis, and gastroscopy demonstrated an extrinsic compressive bulge in the gastric antrum plus narrowing at the second and third part of duodenum (D2 & D3).The patient was diagnosed with cholelithiasis and chronic cholecystitis leading to giant gallbladder, which caused pyloric obstruction via compression. Management involved initial ultrasound-guided percutaneous gallbladder drainage, followed by laparoscopic cholecystectomy (LC) one week later, and the postoperative course was uneventful. This case highlights that giant gallbladder may present with atypical gastrointestinal symptoms (e.g., isolated nausea and vomiting) and is prone to misdiagnosis, especially in middle-aged and elderly females with comorbidities. Confirmation of the compressive mechanism requires integration of imaging and endoscopic findings; for patients with giant gallbladder complicated by severe adhesions or underlying comorbidities, a two-stage surgical approach (initial decompressive drainage followed by laparoscopic excision) is a safe and effective option.

Aim: To better predict the central lymph node metastasis (CLNM) of patients with isthmic papillary thyroid microcarcinoma (IPTMC) before surgery, we developed a new predictive nomogram based on clinical and ultrasound features and validate its reliability.

Methods: Our study included 160 patients who were hospitalized from January 2016 to December 2024, underwent thyroidectomy with lymph node dissection, and were pathologically diagnosed with IPTMC. These patients were randomly divided into a training group of 112 cases and a validation group of 48 cases. Clinical and ultrasound characteristic data of the patients were collected. Univariate and multivariate logistic regression analyses were conducted on the training group to determine the independent risk factors for CLNM, and a nomogram was established based on these factors to predict the risk of CLNM in patients with IPTMC. The predictive performance of the nomogram was verified using the validation group.

Results: Among the clinical and ultrasound features in the training cohort, we identified four independent risk factors for CLNM: age, tumor size, multifocality, and calcification. A predictive nomogram was developed based on the above four risk factors. The predictive nomogram showed excellent calibration in predicting CLNM, with an area under the curve (AUC) of 0.811 and a concordance index (C-index) of 0.783. The calibration curve of the nomogram was close to the ideal diagonal. In addition, decision curve analysis (DCA) proved that the model had significantly greater net benefits. The validation group verified the reliability of the prediction nomogram.

Conclusions: The nomogram model developed in this study can effectively predict the risk of CLNM in patients with IPTMC before surgery and provide a reference for selecting surgical procedures.

Introduction: Blunt thoracic aortic injury (BTAI) is one of the leading causes of death among trauma patients who sustain high impact thoracic trauma with rapid deceleration. Thoracic endovascular aortic repair (TEVAR) is indicated in high grade injuries and requires a management strategy for the left subclavian artery (LSA). Gore TAG thoracic branch endoprosthesis (TBE) is a newly approved TEVAR device for to maintain LSA patency utilizing a side branch with reported use in acute indications. The anatomic suitability of this device for a population of BTAI patients and optimal inventory for off-the-shelf emergent repairs has not been reported.

Methods: A retrospective analysis of 66 patients admitted to a Level 1 Trauma Center who sustained BTAI between January 2011 and December 2023 and underwent TEVAR was performed. Computed tomography imaging was analyzed on all patients to determine the suitability for repair according to instructions for use (IFU) criteria of the manufacturer.

Results: The distance between the LSA and the injury was less than 2 cm in 59% of patients, representing a possible indication for TBE. The average injury distance in this cohort was 9 mm from the LSA, with 82% of these patients meeting IFU requirements for TBE and 18% requiring standard TEVAR. For patients who met TBE graft requirements, 28 mm, 31 mm, and 34 mm aortic components fit 76% of patients and 10 mm and 12 mm subclavian branches fit 87% of patients. Patients who did not meet IFU requirements for TBE were sized for standard TEVAR with 26 mm, 31 mm, and 34 mm grafts treating 66% of patients.

Conclusions: This study demonstrates key anatomic considerations and models the suitability and optimal TBE inventory drawn from a real-world population of BTAI patients. Despite a vast device catalog for TEVAR, this study demonstrates that carrying three TBE aortic components, two TBE subclavian components, and three standard TEVAR sizes would treat 71% of BTAI patients.

Introduction: Laparoscopic Heller Myotomy with Dor fundoplication is the most effective therapeutic option for Achalasia cardia, with fewer complications. We present the outcomes of this procedure with long-term follow-up in patients with Achalasia cardia.

Methods: A single institution prospectively maintained data of Laparoscopic Heller Myotomy with Dor fundoplication between January 2014 and January 2024 was reviewed. Eckardt scores at three-time points (preoperative, 3-month, and long-term follow-up) were used to assess treatment efficacy.

Results: A total of 16 patients had a median age of 34 years. Megaesophagus was observed in 8 (50%) patients, and 5 patients had sigmoid esophagus. The mean operative time was 162 ± 41 min. The mean myotomy length was 6.1 cm and 2.19 cm, respectively, for the esophagus and the stomach. Following the surgery, there was significant improvement in the Eckardt score from a median preoperative score of 9 (5-12) to a median postoperative score of 2(0-4) in 3 months (p = 0.001) and a median Eckardt score of 1.5 (0-3) in long-term follow-up (P < 0.001). The median long-term follow-up was 32 months (12-60 months). Overall, two treatment failure was observed, and one required endoscopic balloon dilatation. The gastroesophageal reflux (uncomplicated) was observed in 5 (31.2%) patients. The symptoms were mild, and none had reflux-related complications at the last follow-up.

Conclusions: LHM provides immediate and durable symptomatic relief with fewer complications.

Objective: To investigate the etiology, clinical presentation, management, and prognosis of intramuscular myxoma occurring in the submandibular region.

Methods: A case of intramuscular myxoma originating from the mylohyoid muscle was analyzed. The patient's clinical history, imaging features, surgical findings, and pathological results were reviewed. Relevant characteristics were summarized in the context of previously published literature.

Results: The patient presented with a painless mass in the submandibular area. Computed tomography revealed a cystic lesion, and postoperative histopathological examination confirmed the diagnosis of intramuscular myxoma. The patient recovered well following surgical excision.

Conclusion: Intramuscular myxoma is a rare benign soft-tissue tumor, with an estimated incidence of approximately 0.10-0.13 per 100,000 individuals. Lesions arising in the submandibular muscles are exceptionally uncommon and may be misdiagnosed as sublingual gland cysts. Due to the nonspecific clinical manifestations and potential for misdiagnosis on imaging, histopathological evaluation remains the definitive diagnostic method. Complete surgical excision is the treatment of choice and is generally associated with a favorable prognosis.

Background: Patients with vascular disease undergoing surgery face increased perioperative risks, and those scheduled for carotid endarterectomy (CEA) represent a particularly vulnerable subgroup. This study aimed to (1) estimate the prevalence and identify predictors of adverse postoperative outcomes in patients undergoing carotid endarterectomy (CEA) under local/regional anesthesia (LA), and (2) compare these outcomes with those of general anesthesia (GA) where comparative data were available.

Methods: Following PRISMA and MOOSE guidelines, PubMed, Scopus, and Web of Science were systematically searched for English-language studies published up to January 2025. Pooled prevalence estimates were obtained using random-effects models. Meta-regression explored associations of demographic and clinical variables with postoperative outcomes. In addition, pairwise random-effects meta-analyses were performed for studies reporting separate outcomes for LA and GA. Effect sizes were expressed as odds ratios (OR) with 95% confidence intervals (CIs), and heterogeneity was quantified using the I² statistic.

Results: Of 267 records identified, 14 studies met eligibility criteria, including 22,302 patients undergoing CEA under LA. The pooled prevalence was 1% for stroke (95% CI: 0.01-0.02) and 0.01% for both myocardial infarction and death (95% CI: 0.00-0.01). Meta-regressions showed that male sex was significantly associated with postoperative stroke (β = 0.010, p = 0.0002), whereas older age predicted myocardial infarction (β = 0.006, p = 0.03). No significant predictors of mortality were identified. In the comparative analysis, LA was associated with a 52% lower risk of myocardial infarction and a 30% lower risk of death compared with GA, while no significant difference emerged for postoperative stroke.

Conclusion: CEA performed under regional anesthesia is associated with low rates of adverse postoperative events, with male sex and older age emerging as relevant predictors for stroke and myocardial infarction, respectively. Comparative evidence suggests potential advantages of LA over GA in reducing myocardial infarction and mortality, while stroke risk appears similar between anesthetic modalities.

Systematic review registration: https://www.crd.york.ac.uk/PROSPERO/, PROSPERO CRD420251066377.

Robotic-assisted total knee arthroplasty (TKA) significantly enhances surgical precision and alignment accuracy. While traditional robotic systems rely on preoperative imaging, imageless technology has emerged as a viable alternative, leading to a reduction in costs, radiation exposure, and logistical challenges. This narrative review aims to evaluate the efficacy and reliability of imageless robotic-assisted TKA, specifically assessing its accuracy in component positioning, functional outcomes, and potential advantages over image-based systems. A review of current literature was conducted, comparing imageless robotic TKA with both manual and image-based techniques. The key parameters analyzed include alignment precision, joint line restoration, patient-reported outcomes, and complication rates. Notably, imageless robotic-assisted TKA demonstrated alignment accuracy and functional outcomes comparable to those of image-based systems, while providing enhancements in workflow efficiency and the elimination of radiation exposure. Although a moderate learning curve was observed, no significant differences in patient satisfaction or clinical performance were recorded. Overall, imageless robotic-assisted TKA represents a safe and effective alternative to image-based systems, achieving comparable surgical precision with additional economic and practical benefits. Further research is required to confirm long-term outcomes and to optimize intraoperative guidance strategies.