Frontiers in Surgery最新文献

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.

[This corrects the article DOI: 10.3389/fsurg.2025.1708113.].

Background: Cervical disc herniation with radiculopathy is a common cause of neck and arm pain. While anterior cervical discectomy and fusion (ACDF) remains the standard treatment, it sacrifices motion and may cause adjacent segment degeneration. Uniportal non-coaxial spinal endoscopic surgery (UNSES) offers a motion-preserving alternative. This case presents the first application of UNSES with endoscopic annular suture repair and ligamentum flavum suspension in the cervical spine, demonstrating its technical feasibility.

Case presentation: A 54-year-old male presented with progressive neck and right right arm pain, numbness and triceps weakness, due to right paracentral C6/C7 disc herniation compressing the C7 nerve root. The patient underwent full-endoscopic posterior cervical discectomy using a uniportal non-coaxial endoscopic system, with ligamentum flavum preservation via suture suspension. The annular defect was repaired intraoperatively using an endoscopic annular suture device under direct visualization. Postoperative imaging confirmed complete neural decompression and successful annular closure without residual disc or dural compromise. Postoperative MRI confirmed complete decompression and annular closure. At 3 months, visual analog scale (VAS) improved from 7 to 1, the Japanese Orthopaedic Association (JOA) score increased from 13 to 16, and the Neck Disability Index (NDI) decreased from 42% to 14%, with no recurrence or instability.

Conclusions: UNSES combined with annular suture repair enables safe, motion-preserving decompression for cervical disc herniation. This novel approach may enhance biomechanical integrity, reduce recurrence, and represent a minimally invasive alternative to fusion in selected patients.

Intracranial aneurysms (IAs) are uncommon in children, with an incidence of 1%-5%. However, intracranial dissecting aneurysms (IDA) account for a higher proportion (20%-50%) of all aneurysms in this age group. Pediatric IDAs typically result from vascular wall injury, potentially associated with genetic predisposition, congenital defects, or trauma. These lesions most commonly present with ischemic stroke, while subarachnoid hemorrhage (SAH) is relatively rare. Early symptoms include headache and vomiting, with severe cases potentially leading to neurological deficits. Digital subtraction angiography (DSA) remains the gold standard for diagnosis. Timely diagnosis and intervention are critical for improving prognosis. Treatment options include pharmacological therapy, endovascular intervention, and microsurgical repair. This report details a case of a 14-year-old male diagnosed with a dissecting aneurysm in the communicating segment of the left internal carotid artery (ICA). Emergency endovascular intervention with coil occlusion of the parent artery was performed. Short-term follow-up demonstrated favorable outcomes without new neurological deficits. The clinical characteristics of this condition are briefly reviewed in the context of this case.

This report presents a case of hepatic encephalopathy (HE) induced by a spontaneous splenorenal shunt (SSRS). A 73-year-old male patient was admitted to our medical facility due to loss of consciousness. Laboratory analyses revealed elevated blood ammonia levels and varying degrees of reduction in erythrocyte, leucocyte, and platelet levels. Portal vein imaging utilizing 320-slice CT demonstrated enlargement of the portal and splenic veins, splenomegaly, multiple varicose veins at the splenic hilum, and local protrusion of the left renal vein. An initial diagnosis of HE with SSRS and hypersplenism was established. A multi-disciplinary treatment approach was implemented, incorporating a patient-doctor collaborative decision-making model. Two treatment options were presented to the patient, who opted for surgical intervention over interventional treatment. Subsequently, a combined splenectomy and splenorenal shunt vessel ligation procedure was performed. Postoperatively, the patient's condition exhibited significant improvement compared to his pre-operative state, with no recurrence of HE observed. This article reports a case of recurrent hepatic encephalopathy and severe hypersplenism related to SSRS, which was successfully treated by combined splenectomy and vascular disconnection.

Objective: Bladder neck contracture (BNC) is a challenging postoperative complication of transurethral resection of the prostate (TURP), especially in patients with small-volume prostates (<40 mL) who are at high risk. This retrospective study aimed to evaluate the efficacy and safety of local betamethasone injection in preventing BNC following TURP in this specific population.

Methods: Clinical data of 248 patients with small-volume benign prostatic hyperplasia (BPH) who underwent TURP at Zhuhai People's Hospital from January 2017 to December 2023 were retrospectively analyzed. Patients were divided into two groups: the betamethasone injection group (n = 128) receiving 8 mg betamethasone injected into the submucosal layer of the bladder neck (3, 6, 9, and 12 o'clock positions) during surgery, and the control group (n = 120) undergoing TURP without betamethasone injection. All procedures were performed using standardized bipolar plasma TURP without bladder neck incision. Baseline characteristics, intraoperative parameters, and postoperative outcomes were collected. The primary endpoint was the incidence of BNC within 12 months of follow-up, diagnosed based on clinical symptoms, uroflowmetry (maximal urine flow <10 ml/sec), and cystoscopy. Secondary endpoints included the incidence of other postoperative complications.

Results: The baseline characteristics of the two groups were comparable (all p > 0.05). During the 12-month follow-up, the incidence of BNC in the betamethasone injection group was significantly lower than that in the control group (2.3% vs. 10.8%, p = 0.004). Multivariate logistic regression analysis identified local betamethasone injection as an independent protective factor against BNC (OR = 0.20, 95% CI: 0.06-0.69, p = 0.011), while prostate volume ≤30 mL was an independent risk factor (OR = 3.21, 95% CI: 1.08-9.53, p = 0.036). There were no significant differences in the incidence of other postoperative complications (urinary tract infection, secondary hemorrhage, urethral stricture, urinary incontinence) between the two groups (all p > 0.05).Conclusion: Local injection of betamethasone during TURP significantly reduces the incidence of BNC in patients with small-volume prostates without increasing perioperative complications. This intervention targets the inflammatory and fibrotic mechanisms underlying BNC and serves as a safe and effective adjuvant strategy to optimize surgical outcomes in this high-risk population.

This study introduces a novel "tunnel method" for single-position laparoscopic nephroureterectomy in women with upper urinary tract urothelial carcinoma (UTUC), enabling complete resection of the kidney and entire ureter while preserving the uterine round ligament during dissection of the intramural ureter and bladder cuff excision. By creating a tunnel-like space beneath the round ligament via precise dissection of the uterine broad ligament, this technique avoids round ligament transection, thereby maintaining pelvic anatomical integrity, reducing risks of pelvic organ prolapse, minimizing postoperative adhesions, and preserving reproductive and pelvic function-particularly critical for women of childbearing age or those at risk of prolapse. This innovative approach ensures effective oncological resection while prioritizing female-specific anatomical and functional considerations, providing a more comprehensive and patient-centered treatment option for UTUC.

Purpose: To compare perioperative and oncologic outcomes between robotic surgical platforms (Si vs. Xi) in rectal carcinoma.

Methods: A retrospective cohort study of 86 robotic rectal cancer resections (Si: n = 31; Xi: n = 55) were analyzed at Tianjin Medical University Cancer Hospital between November 2019 and June 2024.

Results: Among 86 patients with comparable baseline clinicopathological variables (all p > 0.05), the Xi system showed superior perioperative efficiency: shorter operation (226.7 vs. 282.1 min, p = 0.010), console (p = 0.016) and docking times (p = 0.013), less blood loss (83.8 vs. 155.8 mL, p = 0.005), and a shorter postoperative stay (7.8 vs. 9.7 days, p = 0.016). On multivariable analyses, Xi remained independently associated with a shorter operative time (p = 0.002), reduced blood loss (p = 0.027), and decreased length of stay (p = 0.038). Complication rates, lymph node yield, and short-term oncologic quality indicators (distal resection margin [DRM], circumferential resection margin [CRM], mesorectal integrity) were comparable between two systems (all p > 0.05). In low rectal cancers (≤ 5 cm from the anal verge) with balanced baselines, Xi achieved a higher sphincter preservation rate (90.5% vs. 55.6%, p = 0.049). Survival trends numerically favored Xi (3-year DFS 79.8% vs. 73.0%; OS 92.0% vs. 83.0%), but differences were not significant (DFS: p = 0.54; OS: p = 0.26). On Cox regression, TNM stage independently predicted both DFS (p = 0.041) and OS (p = 0.029). However, the robotic platform (Xi vs. Si) showed no survival advantage (DFS: HR = 1.33, 95% CI 0.53-3.37, p = 0.548; OS: HR = 1.43, 95% CI 0.76-2.67, p = 0.267).

Conclusions: Compared with Si, the Xi platform confers measurable perioperative advantages-shorter operative time, less blood loss, and reduced hospitalization-without compromising short-term oncologic quality or survival. In low rectal tumors, Xi may facilitate sphincter preservation under comparable baselines. Long-term outcomes appear driven primarily by disease stage rather than platform generation.