Frontiers in Surgery最新文献

Iliac vein rupture (IVR) is a rare but critical clinical condition often presenting with nonspecific symptoms such as acute abdominal pain and hemorrhagic shock, leading to significant diagnostic challenges. This case report illustrates the complexity of IVR through the clinical course of an elderly female patient with multiple comorbidities, who was ultimately diagnosed with spontaneous IVR following surgical intervention. The case emphasizes the necessity of a multidisciplinary approach involving surgical, vascular, and critical care teams to facilitate timely diagnosis and management. The patient's presentation, characterized by severe pain and hypotension, was initially suggestive of retroperitoneal hemorrhage, yet definitive diagnosis was elusive until surgical exploration was conducted, highlighting the limitations of imaging modalities in certain instances. Furthermore, this case underscores the importance of considering individual risk factors, such as previous pelvic surgeries and underlying venous pathology, in formulating patient-specific care strategies. The successful management of this case not only contributes valuable insights to the existing literature but also advocates for heightened awareness and education among healthcare professionals regarding IVR. Although the rarity of IVR poses challenges to generalizability, it underscores the need for standardized diagnostic protocols and innovative management strategies tailored to high-risk populations. In conclusion, this case serves as a reminder of the critical role of prompt recognition and intervention in improving patient outcomes for those affected by iliac vein rupture.

This case report presents the clinical course and management of an 11-year-old boy who was diagnosed with undifferentiated embryonal sarcoma of the liver (UESL), a rare and aggressive pediatric malignancy. The patient was admitted with a 20-day history of right upper quadrant pain. Imaging studies revealed a large cystic-solid mass in the right hepatic lobe, suggestive of UESL, with involvement of major hepatic vessels and the diaphragm. The patient underwent a successful extended right hepatectomy (right trisectionectomy) via an anterior approach. The postoperative course was complicated by bile leakage, which resolved with conservative management. Adjuvant chemotherapy was subsequently administered. The patient recovered fully and was disease-free at follow-up. This case highlights the critical importance of a multidisciplinary approach, meticulous surgical planning, and the utility of the anterior approach for resecting large liver tumors. It also underscores the necessity of considering UESL in the differential diagnosis of pediatric liver masses and the role of multimodal therapy in achieving a favorable outcome. Clinical lessons from this case are discussed in the context of current management strategies, with emphasis on complete resection and organized post-discharge surveillance.

Objective: To evaluate the safety and clinical performance of an F21 multipurpose cystoscope equipped with a continuous irrigation system in routine urologic procedures.

Methods: This single-center retrospective study consecutively enrolled 150 patients undergoing F21 multipurpose cystoscope-assisted procedures (50 double-J stent removals, 50 retrograde 5-Fr ureteral catheterizations, and 50 BPH patients receiving PVP).BPH patients had bladder outlet obstruction (Qmax <10 mL/s), and major exclusions included prostate cancer and prostate volume >80 mL.Outcomes included procedure-related complications; IPSS and Qmax were assessed preoperatively and at 3 and 6 months in the PVP cohort.

Results: All double-J stent removals and retrograde catheterizations were completed successfully under local anesthesia with a consistently clear operative field, and no postoperative complications were observed. All 50 PVP procedures were completed successfully; mean operative time was 65.1 ± 16.9 min, blood loss was <60 mL, postoperative irrigation averaged 17 h, and catheter removal occurred on postoperative days 3-5. In the PVP group, Qmax increased from 6.314 preoperatively to 21.716 at 3 months and 21.006 at 6 months, while IPSS decreased from 23.540 to 4.700 and 4.420, respectively (all p < 0.001). At the 3-month and 6-month postoperative follow-up time points, none of the patients developed complications such as urinary incontinence, urethral stricture, bladder neck contracture, or voiding dysfunction.

Conclusion: The F21 multipurpose cystoscope with continuous irrigation provides stable visualization and supports both routine cystoscopic interventions and PVP in a small-caliber platform, demonstrating favorable safety and functional outcomes.

Subcutaneous emphysema (SE) is a recognized but rare complication of laparoscopic surgery, and orbital involvement is particularly unusual. We report a rare case of unilateral orbital SE following laparoscopic hiatal hernia repair with Nissen fundoplication. A 49-year-old hypertensive woman with gastroesophageal reflux disease (GERD) underwent elective laparoscopic hiatal hernia repair. Intraoperatively, she developed sudden-onset left orbital emphysema. Imaging revealed mild left pneumothorax and bilateral pleural effusions. Orbital swelling was identified intraoperatively, prompting multidisciplinary evaluation including anesthesiology, surgery, and ophthalmology. Conservative management resulted in rapid and complete resolution within 48 h, without visual or respiratory sequelae. Orbital SE following laparoscopy is uncommon but clinically significant. Risk factors include high insufflation pressure, previous abdominal surgeries, and prolonged operative time. Prompt clinical and radiological assessment ensures early diagnosis and prevents complications such as orbital compartment syndrome. Surgeons must remain vigilant for rare SE presentations after laparoscopy. Conservative management is effective in mild cases, but early multidisciplinary intervention is essential to prevent vision loss.

Objectives: Surgical management of calcaneal tuberosity fractures is challenging, as patient outcomes can be compromised by skin flap necrosis and implant failure. We propose a technique utilizing a prefabricated L-shaped hook plate, which represents an innovative clinical orthopedic surgical approach.

Methods: In this retrospective study, patients with Beavis type II calcaneal tuberosity fractures underwent internal fixation using a preformed "L-shape" hook plate (2015-2020). Data on operative time, complications, and healing time were recorded. Functional outcomes were evaluated using the Ankle Society Ankle-Hindfoot (AOFAS-AH) and Visual Analog Scale (VAS) pain scores.

Results: This study included 15 patients (6 females/9 males; mean age 52.9 ± 11.2 years) with calcaneal tuberosity fractures who underwent internal fixation with a preformed "L-shape" hook plate. At a mean follow-up of 17.1 ± 6.0 months, no postoperative complications-including wound issues, infection, nerve injury, or fixation failure-were observed in any patient. All 15 cases achieved clinical healing at an average of 10.5 weeks (range: 8-13). Functional outcomes improved significantly, with the AOFAS-AH score increasing from 24.0 ± 9.9 preoperatively to 93.8 ± 5.2 postoperatively, and the VAS score decreasing from 5.7 ± 0.6 to 1.3 ± 0.5 (p < 0.001 for both).

Conclusions: Emergency open reduction and internal fixation is recommended for calcaneal avulsion fractures to prevent flap necrosis. For Beavis type II fractures, the preformed L-shaped hook plate represents a novel and promising alternative, demonstrating favorable early clinical outcomes in this initial series.

The objective of this video is to show the feasibility of secondary cytoreductive surgery for recurrent high-grade serous ovarian cancer. The procedure targets recurrences in the cardiophrenic lymph nodes and the right diaphragm involving the right basal pleura. Using video-assisted thoracoscopy, the thoracic recurrences were dissected and removed. Minimally invasive thoracic secondary cytoreductive surgery proved to be safe and feasible and facilitated rapid post-operative recovery, ensuring timely access to subsequent second-line adjuvant chemotherapy.

Introduction: Mixed reality (MR) technology has emerged as a promising technology to endoscopic spine surgery by enhancing surgeon visualization. This early feasibility study introduces the Apple Vision Pro (Apple Inc., Cupertino, CA) Head Mounted Display (AVP HMD) as an intraoperative visualization tool during biportal endoscopic spine surgeries. The SURG-TLX is an established workload assessment tool specifically tailored for surgical procedures and is a specialized modification of the NASA-TLX, a widely established multidimensional measure for cognitive workload.

Methods: Adult patients undergoing biportal endoscopic lumbar surgery using the AVP HMD were prospectively followed. SURG-TLX Scores were recorded immediately after each operation to document the cognitive workload of using the AVP HMD during surgery. Demographics, intraoperative, and postoperative complications were collected and assessed. Patient reported outcomes (PROs) were recorded with visual analogue scores (VAS) Back and Leg pain, as well as Oswestry Disability Index (ODI).

Results: Forty patients were included in this study. Patients were followed for 3 months after surgery. The mean age of the population was 62.78 ± 16.12 years, with a BMI of 27.90 ± 5.86, with 47.5% being female. Preoperative average VAS Back score was 5.4 ± 3.26, VAS Leg scores was 6.85 ± 2.43, ODI score was 44% ± 18.67%. Average SURG-TLX score was 22.24 ± 7.46. There were 2 intraoperative dural tears with no clinical sequelae, otherwise there were no perioperative complications. At 3 months follow-up, the average post-operative VAS Back was 2.71 ± 3.29, VAS Leg was 2.11 ± 3.19, and ODI was 21.0% ± 22.74, which were significant reductions as compared to the preoperative scores (p < 0.05).

Conclusion: This early feasibility study introduced the use of the AVP HMD during biportal endoscopic spine surgeries and showed that the AVP HDM did not increase the operating surgeon's perceived cognitive workload. The intraoperative use of AVP HMD did not worsen early clinical outcomes and did not increase the risk of complications. We describe the feasibility of incorporating MR technology such as the Apple Vision Pro for surgical visualization during endoscopic spine surgery.

Background: Primary malignant sternal spindle cell tumors are clinically rare, and the aggressive nature leads to a large chest wall defect because of extended resection. To date, no cases of sternal malignant spindle cell tumor complicated by ankylosing spondylitis have been documented in the literature.

Case presentation: We present a case of primary sternal malignant spindle cell tumor occurring in the setting of ankylosing spondylitis. Given the high risks associated with ankylosing spondylitis and the existing pathological fracture, preoperative biopsy was withheld after MDT evaluation. Intraoperative frozen section pathology confirmed malignant spindle cell tumor, and extended resection and chest wall reconstruction with a multi-point fixation strategy were subsequently completed. Postoperative staging was Enneking IIB (G2T2M0) with wide margins. The patient declined postoperative chemotherapy and underwent regular follow-up examinations. The patient recovered uneventfully without implant-related complications.

Conclusion: This case report provides preliminary evidence that the combination of precise extended resection and chest wall reconstruction may achieve oncological radical cure in this specific patient. The procedure restored chest wall structure and function. These findings suggest the potential for favorable prognosis with this approach in similar complex cases of AS. This patient achieved 3-year disease-free survival. A complete dataset was provided including pulmonary function indices, exercise tolerance, and quality-of-life scores. These findings offer an important reference for clinical decision-making in similar complex cases.

Background: Superior labrum anterior and posterior (SLAP) lesions are a common cause of shoulder pain and instability. Developing accurate, non-invasive diagnostic tools is essential to support clinical decision-making for SLAP lesions. This study aimed to establish an automated diagnostic model for SLAP lesions using a 2.5D deep learning framework combined with ensemble learning and to evaluate its clinical utility.

Methods: In this retrospective study, 185 patients who underwent shoulder arthroscopy between January 2019 and September 2025 were included (91 SLAP lesions, 94 controls). Preoperative shoulder magnetic resonance imaging (MRI) data were analysed. Images from three consecutive slices, centred on the maximal region of interest (ROI), were processed using a Wide_ResNet101_2 network pre-trained on ImageNet for deep feature extraction and probability prediction. A decision-level fusion strategy integrated the predicted probabilities from all three layers as input features for three ensemble classifiers: AdaBoost, Random Forest, and XGBoost. Model performance was assessed with accuracy, area under the receiver operating characteristic curve (AUC), sensitivity, specificity, precision, and F1-score. The DeLong test and integrated discrimination improvement (IDI) were used to compare models.

Results: All ensemble models exhibited robust diagnostic performance. On the test set, the XGBoost model achieved the highest AUC (0.754) and sensitivity (0.933), though specificity was moderate (0.538). The Random Forest model yielded an AUC of 0.745, while the AdaBoost model achieved an AUC of 0.731. F1-scores ranged from 0.75 to 0.80. There were no statistically significant differences in AUC among the models. Feature importance analysis highlighted the central MRI slice as most contributory. Model interpretability assessments showed that the network focused predominantly on the biceps-labral complex, which is anatomically consistent with SLAP pathology.

Conclusions: The proposed automated diagnostic model, utilising a 2.5D deep learning and ensemble approach, demonstrated favourable diagnostic performance and clinical applicability for SLAP lesion detection on shoulder MRI. Among the ensemble strategies, the XGBoost model provided the highest sensitivity, rendering it particularly suitable as a clinical decision-support tool. The multi-slice information fusion framework substantially improved diagnostic accuracy, supporting its potential as a novel artificial intelligence solution to assist radiologists in diagnosing shoulder labral injuries.

Carpal tunnel syndrome (CTS) is most commonly idiopathic or associated with wrist strain, while neoplastic compression, a rare etiology, is easily overlooked. This report describes a 50-year-old male patient presenting with numbness in the 1st to 4th fingers of the right hand. Preoperative electromyography confirmed the diagnosis of CTS, but ultrasonography showed no obvious abnormalities. During single-channel endoscopic carpal tunnel release, a protruding mass was identified at the bottom of the carpal tunnel, which was resected and sent for pathological examination. Immunohistochemical and molecular testing results indicated clear cell sarcoma of soft tissue with a maximum diameter of 4 cm. No BRAF gene V600E mutation was detected, but the EWSR1/ATF1 fusion gene was positive. Following tumor resection and multimodal adjuvant therapy, the patient achieved complete relief of numbness and maintained independent daily living activities at the 12-month follow-up, with stable pulmonary disease. This study analyzes the clinical characteristics, diagnosis, and treatment of the case, combined with a literature review. It suggests that neoplastic compression should be suspected in male patients with recurrent CTS, especially when preoperative imaging is negative, and meticulous intraoperative exploration is crucial. Literature analysis shows that wrist tumors are prone to recurrent nerve compression due to anatomical space limitations, and early identification followed by surgical resection is key to improving prognosis.