Pub Date : 2024-10-03eCollection Date: 2024-01-01DOI: 10.3389/fsurg.2024.1396897
Yang Yang, Fang Chen, Yiguo Chen, Wei Wang
Objective: To investigate the efficacy of comparing tibia transverse transport (TTT) and periosteal distraction in treating diabetic foot ulcers.
Methods: A retrospective analysis of 19 patients with diabetic foot ulcers treated with both procedures between February 2020 and November 2022, 8 of whom were treated with the tibial transverse transfer technique (transfer group) and 11 with the osteochondral distraction technique (distraction group), was performed to compare and analyze the clinical efficacy of the two methods.
Results: All wounds were healed in both groups, and the healing time ranged from 15 to 41days with a mean of 28d. The limb preservation rate was 100%. The operative time, intraoperative bleeding, and pain score in the operative area were significantly less in the distraction group than in the removal group, with statistically significant differences (P < 0.05). Intra-group comparison between the two groups of patients after surgery revealed that the skin temperature, ABI, TcPO2, SWM and VAS of the affected limb were significantly improved compared with those before surgery, and the difference was statistically significant (P < 0.05). The expression levels of VEGF, bFGF, EGF and PDGF were significantly higher than before surgery in both groups, and the difference was statistically significant (P < 0.05). No statistically significant differences were found in skin temperature, ABI, TcPO2, SWM, VAS, VEGF, bFGF, EGF and PDGF between the two groups at the corresponding time points preoperatively and postoperatively (P > 0.05).
Conclusions: The Periosteal distraction technique can significantly promote the healing of diabetic foot ulcers. It has the same efficacy as TTT in promoting the healing of diabetic foot ulcer wounds and improving the peripheral circulation of affected limbs. In addition, the periosteal distraction technique has the advantages of small trauma, simple operation, few complications, and convenient nursing care.
目的比较胫骨横向转移术(TTT)和骨膜牵引术治疗糖尿病足溃疡的疗效:回顾性分析2020年2月至2022年11月期间接受两种手术治疗的19例糖尿病足溃疡患者,其中8例采用胫骨横向转运技术(转运组),11例采用骨软骨牵引技术(牵引组),比较分析两种方法的临床疗效:结果:两组所有伤口均愈合,愈合时间从15天到41天不等,平均为28天。保肢率为 100%。牵引组的手术时间、术中出血量和术区疼痛评分明显少于切除组,差异有统计学意义(P P P P > 0.05):结论:骨膜牵引技术能明显促进糖尿病足溃疡的愈合。结论:骨膜牵引技术可明显促进糖尿病足溃疡的愈合,在促进糖尿病足溃疡伤口愈合和改善患肢末梢循环方面与 TTT 具有相同的疗效。此外,骨膜牵引技术还具有创伤小、操作简单、并发症少、护理方便等优点。
{"title":"Comparison of the efficacy of tibial transverse transfer and periosteal distraction techniques in the treatment of diabetic foot refractory ulcers.","authors":"Yang Yang, Fang Chen, Yiguo Chen, Wei Wang","doi":"10.3389/fsurg.2024.1396897","DOIUrl":"https://doi.org/10.3389/fsurg.2024.1396897","url":null,"abstract":"<p><strong>Objective: </strong>To investigate the efficacy of comparing tibia transverse transport (TTT) and periosteal distraction in treating diabetic foot ulcers.</p><p><strong>Methods: </strong>A retrospective analysis of 19 patients with diabetic foot ulcers treated with both procedures between February 2020 and November 2022, 8 of whom were treated with the tibial transverse transfer technique (transfer group) and 11 with the osteochondral distraction technique (distraction group), was performed to compare and analyze the clinical efficacy of the two methods.</p><p><strong>Results: </strong>All wounds were healed in both groups, and the healing time ranged from 15 to 41days with a mean of 28d. The limb preservation rate was 100%. The operative time, intraoperative bleeding, and pain score in the operative area were significantly less in the distraction group than in the removal group, with statistically significant differences (<i>P</i> < 0.05). Intra-group comparison between the two groups of patients after surgery revealed that the skin temperature, ABI, TcPO2, SWM and VAS of the affected limb were significantly improved compared with those before surgery, and the difference was statistically significant (<i>P</i> < 0.05). The expression levels of VEGF, bFGF, EGF and PDGF were significantly higher than before surgery in both groups, and the difference was statistically significant (<i>P</i> < 0.05). No statistically significant differences were found in skin temperature, ABI, TcPO2, SWM, VAS, VEGF, bFGF, EGF and PDGF between the two groups at the corresponding time points preoperatively and postoperatively (<i>P</i> > 0.05).</p><p><strong>Conclusions: </strong>The Periosteal distraction technique can significantly promote the healing of diabetic foot ulcers. It has the same efficacy as TTT in promoting the healing of diabetic foot ulcer wounds and improving the peripheral circulation of affected limbs. In addition, the periosteal distraction technique has the advantages of small trauma, simple operation, few complications, and convenient nursing care.</p>","PeriodicalId":12564,"journal":{"name":"Frontiers in Surgery","volume":null,"pages":null},"PeriodicalIF":1.6,"publicationDate":"2024-10-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11484059/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142462772","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-10-03eCollection Date: 2024-01-01DOI: 10.3389/fsurg.2024.1441346
Thomas J On, Yuan Xu, Nicolas I Gonzalez-Romo, Gerardo Gomez-Castro, Oscar Alcantar-Garibay, Marco Santello, Michael T Lawton, Mark C Preul
Background: Surgical approaches that access the posterior temporal bone require careful drilling motions to achieve adequate exposure while avoiding injury to critical structures.
Objective: We assessed a deep learning hand motion detector to potentially refine hand motion and precision during power drill use in a cadaveric mastoidectomy procedure.
Methods: A deep-learning hand motion detector tracked the movement of a surgeon's hands during three cadaveric mastoidectomy procedures. The model provided horizontal and vertical coordinates of 21 landmarks on both hands, which were used to create vertical and horizontal plane tracking plots. Preliminary surgical performance metrics were calculated from the motion detections.
Results: 1,948,837 landmark detections were collected, with an overall 85.9% performance. There was similar detection of the dominant hand (48.2%) compared to the non-dominant hand (51.7%). A loss of tracking occurred due to the increased brightness caused by the microscope light at the center of the field and by movements of the hand outside the field of view of the camera. The mean (SD) time spent (seconds) during instrument changes was 21.5 (12.4) and 4.4 (5.7) during adjustments of the microscope.
Conclusion: A deep-learning hand motion detector can measure surgical motion without physical sensors attached to the hands during mastoidectomy simulations on cadavers. While preliminary metrics were developed to assess hand motion during mastoidectomy, further studies are needed to expand and validate these metrics for potential use in guiding and evaluating surgical training.
{"title":"Detection of hand motion during cadaveric mastoidectomy dissections: a technical note.","authors":"Thomas J On, Yuan Xu, Nicolas I Gonzalez-Romo, Gerardo Gomez-Castro, Oscar Alcantar-Garibay, Marco Santello, Michael T Lawton, Mark C Preul","doi":"10.3389/fsurg.2024.1441346","DOIUrl":"https://doi.org/10.3389/fsurg.2024.1441346","url":null,"abstract":"<p><strong>Background: </strong>Surgical approaches that access the posterior temporal bone require careful drilling motions to achieve adequate exposure while avoiding injury to critical structures.</p><p><strong>Objective: </strong>We assessed a deep learning hand motion detector to potentially refine hand motion and precision during power drill use in a cadaveric mastoidectomy procedure.</p><p><strong>Methods: </strong>A deep-learning hand motion detector tracked the movement of a surgeon's hands during three cadaveric mastoidectomy procedures. The model provided horizontal and vertical coordinates of 21 landmarks on both hands, which were used to create vertical and horizontal plane tracking plots. Preliminary surgical performance metrics were calculated from the motion detections.</p><p><strong>Results: </strong>1,948,837 landmark detections were collected, with an overall 85.9% performance. There was similar detection of the dominant hand (48.2%) compared to the non-dominant hand (51.7%). A loss of tracking occurred due to the increased brightness caused by the microscope light at the center of the field and by movements of the hand outside the field of view of the camera. The mean (SD) time spent (seconds) during instrument changes was 21.5 (12.4) and 4.4 (5.7) during adjustments of the microscope.</p><p><strong>Conclusion: </strong>A deep-learning hand motion detector can measure surgical motion without physical sensors attached to the hands during mastoidectomy simulations on cadavers. While preliminary metrics were developed to assess hand motion during mastoidectomy, further studies are needed to expand and validate these metrics for potential use in guiding and evaluating surgical training.</p>","PeriodicalId":12564,"journal":{"name":"Frontiers in Surgery","volume":null,"pages":null},"PeriodicalIF":1.6,"publicationDate":"2024-10-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11484057/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142462774","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-10-02eCollection Date: 2024-01-01DOI: 10.3389/fsurg.2024.1436176
Lei Dai, Xiang Tan, Mingwu Chen, Huajian Peng, Yongyong Wang
Background: Although mediastinal drainage may lower the risk of anastomotic leakage, the incident rate of anastomotic leakage is still high. The current study aimed to compare the effects of mediastinal drainage combined with upper mediastinal re-tunneling with mediastinal drainage only on anastomotic leakage after McKeown esophagectomy for esophageal cancer.
Methods: From October 2018 to March 2021, 52 patients diagnosed as esophageal carcinoma were included in the study. 21 patients received mediastinal drainage combined with upper mediastinal re-tunneling (re-tunneling group) and 31 received mediastinal drainage only (standard group) after McKeown esophagectomy. The incidence rate of anastomotic leakage, mediastinal infection, chylothorax, thoracic infection, the peak value of leukocyte count and the mortality related to anastomotic leakage were compared between the two groups.
Results: One (4.8%) patient in the re-tunneling group developed anastomotic leakage, and no patient experienced mediastinal infection or thoracic infection. Four (12.9%) patients in the standard group developed anastomotic leakage, and all these patients experienced mediastinal infection and thoracic infection (p < 0.05). The drainage volumes of patients in the re-tunneling group and the standard group were (170 ± 60) ml and (155 ± 45) ml, respectively, with no significant difference between the two groups (p > 0.05). The peak values of leukocyte count and temperature in the re-tunneling group were (14.28 ± 1.12) × 109/L and (38.6 ± 1.1) °C, both lower than that of the standard group[ (16.48 ± 1.15) × 109/L and (38.9 ± 1.2) °C, respectively]. But the difference was not statistically significant (p > 0.05). No anastomotic leakage related death occurred in both groups.
Conclusion: Mediastinal drainage combined with upper mediastinal re-tunneling after McKeown esophagectomy for esophageal cancer may decrease the risk of anastomotic leakage, mediastinal and thoracic infection, reduce the inflammatory response of patients, but did not increase the mortality related to anastomotic leakage.
Trial registration: The study was retrospectively registered.
{"title":"Mediastinal drainage combined with upper mediastinal re-tunneling vs. mediastinal drainage alone in McKeown esophagectomy of esophageal cancer: a retrospective study.","authors":"Lei Dai, Xiang Tan, Mingwu Chen, Huajian Peng, Yongyong Wang","doi":"10.3389/fsurg.2024.1436176","DOIUrl":"https://doi.org/10.3389/fsurg.2024.1436176","url":null,"abstract":"<p><strong>Background: </strong>Although mediastinal drainage may lower the risk of anastomotic leakage, the incident rate of anastomotic leakage is still high. The current study aimed to compare the effects of mediastinal drainage combined with upper mediastinal re-tunneling with mediastinal drainage only on anastomotic leakage after McKeown esophagectomy for esophageal cancer.</p><p><strong>Methods: </strong>From October 2018 to March 2021, 52 patients diagnosed as esophageal carcinoma were included in the study. 21 patients received mediastinal drainage combined with upper mediastinal re-tunneling (re-tunneling group) and 31 received mediastinal drainage only (standard group) after McKeown esophagectomy. The incidence rate of anastomotic leakage, mediastinal infection, chylothorax, thoracic infection, the peak value of leukocyte count and the mortality related to anastomotic leakage were compared between the two groups.</p><p><strong>Results: </strong>One (4.8%) patient in the re-tunneling group developed anastomotic leakage, and no patient experienced mediastinal infection or thoracic infection. Four (12.9%) patients in the standard group developed anastomotic leakage, and all these patients experienced mediastinal infection and thoracic infection (<i>p</i> < 0.05). The drainage volumes of patients in the re-tunneling group and the standard group were (170 ± 60) ml and (155 ± 45) ml, respectively, with no significant difference between the two groups (<i>p</i> > 0.05). The peak values of leukocyte count and temperature in the re-tunneling group were (14.28 ± 1.12) × 10<sup>9</sup>/L and (38.6 ± 1.1) °C, both lower than that of the standard group[ (16.48 ± 1.15) × 10<sup>9</sup>/L and (38.9 ± 1.2) °C, respectively]. But the difference was not statistically significant (<i>p</i> > 0.05). No anastomotic leakage related death occurred in both groups.</p><p><strong>Conclusion: </strong>Mediastinal drainage combined with upper mediastinal re-tunneling after McKeown esophagectomy for esophageal cancer may decrease the risk of anastomotic leakage, mediastinal and thoracic infection, reduce the inflammatory response of patients, but did not increase the mortality related to anastomotic leakage.</p><p><strong>Trial registration: </strong>The study was retrospectively registered.</p>","PeriodicalId":12564,"journal":{"name":"Frontiers in Surgery","volume":null,"pages":null},"PeriodicalIF":1.6,"publicationDate":"2024-10-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11480071/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142462777","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Background: This retrospective study aimed to evaluate the short-term recovery and cost-effectiveness of bilateral unicompartmental knee arthroplasty (UKA) compared to staged unilateral UKA. The study analyzed postoperative pain scores, medical costs, and complications in patients with knee osteoarthritis who underwent these procedures.
Methods: A total of 226 patients who received either unilateral UKA (Group A, n = 170) or bilateral UKA (Group B, n = 56) using the mobile-bearing UKA were included in the study. Patient demographics, surgical details, postoperative pain scores, knee range of motion, length of hospital stay, self-controlled analgesic use, total medical costs, and complications were retrospectively collected from medical records.
Results: The demographic characteristics were comparable between the groups. Group B had a longer surgical time and higher medical costs than Group A. However, there were no significant differences in hospital stay, pain scores, or knee range of motion between the two groups. Complications were infrequent and not significantly different. Insert dislocation and loosening were the most common complications. Patient-controlled analgesia effectively reduced pain scores in Group A but not in Group B.
Conclusion: Bilateral UKA does not significantly affect hospital stay, postoperative pain, or complications compared to unilateral UKA. Although bilateral UKA requires longer surgical time and incurs higher costs, it offers the potential benefit of reducing anesthesia-related complications and overall health insurance expenditures. This study recommends bilateral UKA as a suitable option for patients with bilateral knee osteoarthritis, given its comparable short-term outcomes and potential cost-saving advantages.
{"title":"A comparative study of single-stage bilateral vs. unilateral medial unicompartmental knee arthroplasty on complications, clinical outcomes, and costs.","authors":"Kao-Chang Tu, Han-Ting Shih, Shun-Ping Wang, Kun-Hui Chen","doi":"10.3389/fsurg.2024.1470421","DOIUrl":"https://doi.org/10.3389/fsurg.2024.1470421","url":null,"abstract":"<p><strong>Background: </strong>This retrospective study aimed to evaluate the short-term recovery and cost-effectiveness of bilateral unicompartmental knee arthroplasty (UKA) compared to staged unilateral UKA. The study analyzed postoperative pain scores, medical costs, and complications in patients with knee osteoarthritis who underwent these procedures.</p><p><strong>Methods: </strong>A total of 226 patients who received either unilateral UKA (Group A, <i>n</i> = 170) or bilateral UKA (Group B, <i>n</i> = 56) using the mobile-bearing UKA were included in the study. Patient demographics, surgical details, postoperative pain scores, knee range of motion, length of hospital stay, self-controlled analgesic use, total medical costs, and complications were retrospectively collected from medical records.</p><p><strong>Results: </strong>The demographic characteristics were comparable between the groups. Group B had a longer surgical time and higher medical costs than Group A. However, there were no significant differences in hospital stay, pain scores, or knee range of motion between the two groups. Complications were infrequent and not significantly different. Insert dislocation and loosening were the most common complications. Patient-controlled analgesia effectively reduced pain scores in Group A but not in Group B.</p><p><strong>Conclusion: </strong>Bilateral UKA does not significantly affect hospital stay, postoperative pain, or complications compared to unilateral UKA. Although bilateral UKA requires longer surgical time and incurs higher costs, it offers the potential benefit of reducing anesthesia-related complications and overall health insurance expenditures. This study recommends bilateral UKA as a suitable option for patients with bilateral knee osteoarthritis, given its comparable short-term outcomes and potential cost-saving advantages.</p><p><strong>Level of evidence: </strong>III.</p>","PeriodicalId":12564,"journal":{"name":"Frontiers in Surgery","volume":null,"pages":null},"PeriodicalIF":1.6,"publicationDate":"2024-10-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11480034/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142462769","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-10-01eCollection Date: 2024-01-01DOI: 10.3389/fsurg.2024.1273843
Yooseok Ha, Donghyun Kim, Hyeokjae Kwon, Sunje Kim, Seung Han Song, Sang-Ha Oh, Joo-Hak Kim, Ho Jik Yang, Hyunwoo Kyung
The free flap is a versatile option for reconstruction of soft tissue defects around the ankle. In patients with poor lower leg circulation, arterial insufficiency is one of the complications that can occur immediately after vessel anastomosis during free flap surgery. The authors were able to improve blood circulation in the flap by using modified turbocharging method in which another perforator was anastomosed to the distal end of the main pedicle.
{"title":"Anterolateral thigh free flap using modified turbocharging method: a case report.","authors":"Yooseok Ha, Donghyun Kim, Hyeokjae Kwon, Sunje Kim, Seung Han Song, Sang-Ha Oh, Joo-Hak Kim, Ho Jik Yang, Hyunwoo Kyung","doi":"10.3389/fsurg.2024.1273843","DOIUrl":"https://doi.org/10.3389/fsurg.2024.1273843","url":null,"abstract":"<p><p>The free flap is a versatile option for reconstruction of soft tissue defects around the ankle. In patients with poor lower leg circulation, arterial insufficiency is one of the complications that can occur immediately after vessel anastomosis during free flap surgery. The authors were able to improve blood circulation in the flap by using modified turbocharging method in which another perforator was anastomosed to the distal end of the main pedicle.</p>","PeriodicalId":12564,"journal":{"name":"Frontiers in Surgery","volume":null,"pages":null},"PeriodicalIF":1.6,"publicationDate":"2024-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11473491/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142462770","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-09-30eCollection Date: 2024-01-01DOI: 10.3389/fsurg.2024.1482120
María Teresa Gómez-Hernández, Cristina E Rivas Duarte, José María Fernández García-Hierro, Marta G Fuentes, Oscar Colmenares, Clara Forcada Barreda, Francisco Gómez Valle, Irene Jiménez García, Marcelo F Jiménez
Background: Intraoperative identification of subsolid or small pulmonary nodules during minimally invasive procedures is challenging. Recent localization techniques show varying success and complications. Hybrid operating rooms (HORs), equipped with radiological tools, facilitate intraoperative imaging. This study compares the accuracy and safety of marking pulmonary nodules using electromagnetic navigation bronchoscopy (ENB) combined with Cone Beam Computed Tomography (CBCT) vs. CBCT-guided percutaneous marking (PM).
Methods: This retrospective cohort study included patients with pulmonary nodules scheduled for minimally invasive resection in a HOR. Marking techniques included ENB assisted by CBCT and PM guided by CBCT. The study compared the success rate, procedure time, intraoperative complications and radiation dose of both techniques.
Results: A total of 104 patients with 114 nodules were included (October 2021-July 2024). Thirty nodules were marked using ENB, and 84 with PM. One case used both techniques due to ENB failure. No differences among groups were found in nodule characteristics. Success rates were similar (93.3% in ENB group vs. 91.7% in PM group, p = 1). Marking took significantly longer time in the ENB group (median 40 min) compared to PM group (25 min, p = 0.007). Five (6%) patients in the PM group experienced intraoperative complications compared to none in the ENB (p = 0.323). Radiation dose was significantly higher in the ENB group (p = 0.002).
Conclusions: ENB assisted by CBCT is a safe and effective technique, with success rates comparable to CBCT-guided PM, though it may result in longer procedural times and higher radiation doses.
{"title":"Intraoperative marking of pulmonary nodules in a hybrid operating room: electromagnetic navigation bronchoscopy versus percutaneous marking.","authors":"María Teresa Gómez-Hernández, Cristina E Rivas Duarte, José María Fernández García-Hierro, Marta G Fuentes, Oscar Colmenares, Clara Forcada Barreda, Francisco Gómez Valle, Irene Jiménez García, Marcelo F Jiménez","doi":"10.3389/fsurg.2024.1482120","DOIUrl":"https://doi.org/10.3389/fsurg.2024.1482120","url":null,"abstract":"<p><strong>Background: </strong>Intraoperative identification of subsolid or small pulmonary nodules during minimally invasive procedures is challenging. Recent localization techniques show varying success and complications. Hybrid operating rooms (HORs), equipped with radiological tools, facilitate intraoperative imaging. This study compares the accuracy and safety of marking pulmonary nodules using electromagnetic navigation bronchoscopy (ENB) combined with Cone Beam Computed Tomography (CBCT) vs. CBCT-guided percutaneous marking (PM).</p><p><strong>Methods: </strong>This retrospective cohort study included patients with pulmonary nodules scheduled for minimally invasive resection in a HOR. Marking techniques included ENB assisted by CBCT and PM guided by CBCT. The study compared the success rate, procedure time, intraoperative complications and radiation dose of both techniques.</p><p><strong>Results: </strong>A total of 104 patients with 114 nodules were included (October 2021-July 2024). Thirty nodules were marked using ENB, and 84 with PM. One case used both techniques due to ENB failure. No differences among groups were found in nodule characteristics. Success rates were similar (93.3% in ENB group vs. 91.7% in PM group, <i>p</i> = 1). Marking took significantly longer time in the ENB group (median 40 min) compared to PM group (25 min, <i>p</i> = 0.007). Five (6%) patients in the PM group experienced intraoperative complications compared to none in the ENB (<i>p</i> = 0.323). Radiation dose was significantly higher in the ENB group (<i>p</i> = 0.002).</p><p><strong>Conclusions: </strong>ENB assisted by CBCT is a safe and effective technique, with success rates comparable to CBCT-guided PM, though it may result in longer procedural times and higher radiation doses.</p>","PeriodicalId":12564,"journal":{"name":"Frontiers in Surgery","volume":null,"pages":null},"PeriodicalIF":1.6,"publicationDate":"2024-09-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11471733/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142462776","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-09-26eCollection Date: 2024-01-01DOI: 10.3389/fsurg.2024.1428545
Ting An, Jie Liu, Liwei Feng
The control of bleeding during laparoscopic liver resection (LLR) is still a focus of research. However, the advantages of the main bleeding control methods, including total hepatic inflow occlusion (TIO) vs. hemihepatic inflow occlusion (HIO), during LLR remain controversial. The purpose of this meta-analysis was to compare the clinical outcomes of patients who received TIO and patients who received HIO. This meta-analysis searched the Medline, PubMed, Web of Science, Embase, Ovid, and Cochrane Library databases. The language of the studies was restricted to English, and comparative studies of patients treated with TIO and HIO during LLR were included. The primary outcome was to compare the intraoperative details, such as the operative time, occlusion time, and volume of blood loss, between the two groups. Secondary outcomes included conversion, overall complications, liver failure, biliary leakage, ascites, pleural effusion, and hospital stay. Five studies including 667 patients, 419 (62.82%) of whom received TIO and 248 (37.18%) of whom received HIO, were included in the analysis. The demographic data, including age, sex, hemoglobin, total bilirubin, albumin, and alpha-fetoprotein, were comparable. No significant differences noted in operative time, occlusion time, volume of blood loss, conversion, overall complications, liver failure, biliary leakage, hemorrhage, ascites, or pleural effusion. The hospital stay in patients who received HIO was significantly shorter than that for patients who received TIO [mean difference (MD), 0.60; 95% confidence interval (CI), 0.33-0.87; p < 0.0001; I2 = 54%]. The blood loss of patients with liver cirrhosis in the TIO group was significantly less than that in the HIO group (MD, -107.63; 95% CI, -152.63 to -62.63; p < 0.01; I2 = 27%). Both the TIO and HIO methods are safe and feasible for LLR. Compared with HIO, TIO seems to have less blood loss in cirrhotic patients. However, this result demands further research, especially multicenter randomized controlled trials, for verification in the future. Systematic Review Registration: https://www.crd.york.ac.uk/, Identifier PROSPERO (CRD42022382334).
腹腔镜肝脏切除术(LLR)期间的出血控制仍是研究重点。然而,腹腔镜肝切除术中主要出血控制方法(包括全肝血流闭塞(TIO)与半肝血流闭塞(HIO))的优势仍存在争议。本荟萃分析旨在比较接受 TIO 和接受 HIO 患者的临床结果。该荟萃分析检索了 Medline、PubMed、Web of Science、Embase、Ovid 和 Cochrane Library 等数据库。研究语言仅限于英语,并纳入了在 LLR 期间接受 TIO 和 HIO 治疗的患者的对比研究。主要结果是比较两组患者的术中细节,如手术时间、闭塞时间和失血量。次要结果包括转归、总体并发症、肝衰竭、胆漏、腹水、胸腔积液和住院时间。五项研究共纳入了 667 名患者,其中 419 人(62.82%)接受了 TIO,248 人(37.18%)接受了 HIO。包括年龄、性别、血红蛋白、总胆红素、白蛋白和甲胎蛋白在内的人口统计学数据具有可比性。在手术时间、闭塞时间、失血量、转归、总体并发症、肝衰竭、胆漏、出血、腹水或胸腔积液等方面均无明显差异。接受 HIO 的患者的住院时间明显短于接受 TIO 的患者[平均差异 (MD),0.60;95% 置信区间 (CI),0.33-0.87;P I 2 = 54%]。TIO组肝硬化患者的失血量明显少于HIO组(MD,-107.63;95% CI,-152.63至-62.63;P I 2 = 27%)。TIO 和 HIO 方法对于 LLR 都是安全可行的。与 HIO 相比,TIO 在肝硬化患者中的失血量似乎更少。不过,这一结果还需要进一步研究,尤其是多中心随机对照试验,以便在未来进行验证。系统综述注册:https://www.crd.york.ac.uk/,标识符为 PROSPERO (CRD42022382334)。
{"title":"Total hepatic inflow occlusion vs. hemihepatic inflow occlusion for laparoscopic liver resection: a systematic review and meta-analysis.","authors":"Ting An, Jie Liu, Liwei Feng","doi":"10.3389/fsurg.2024.1428545","DOIUrl":"https://doi.org/10.3389/fsurg.2024.1428545","url":null,"abstract":"<p><p>The control of bleeding during laparoscopic liver resection (LLR) is still a focus of research. However, the advantages of the main bleeding control methods, including total hepatic inflow occlusion (TIO) vs. hemihepatic inflow occlusion (HIO), during LLR remain controversial. The purpose of this meta-analysis was to compare the clinical outcomes of patients who received TIO and patients who received HIO. This meta-analysis searched the Medline, PubMed, Web of Science, Embase, Ovid, and Cochrane Library databases. The language of the studies was restricted to English, and comparative studies of patients treated with TIO and HIO during LLR were included. The primary outcome was to compare the intraoperative details, such as the operative time, occlusion time, and volume of blood loss, between the two groups. Secondary outcomes included conversion, overall complications, liver failure, biliary leakage, ascites, pleural effusion, and hospital stay. Five studies including 667 patients, 419 (62.82%) of whom received TIO and 248 (37.18%) of whom received HIO, were included in the analysis. The demographic data, including age, sex, hemoglobin, total bilirubin, albumin, and alpha-fetoprotein, were comparable. No significant differences noted in operative time, occlusion time, volume of blood loss, conversion, overall complications, liver failure, biliary leakage, hemorrhage, ascites, or pleural effusion. The hospital stay in patients who received HIO was significantly shorter than that for patients who received TIO [mean difference (MD), 0.60; 95% confidence interval (CI), 0.33-0.87; <i>p</i> < 0.0001; <i>I</i> <sup>2</sup> = 54%]. The blood loss of patients with liver cirrhosis in the TIO group was significantly less than that in the HIO group (MD, -107.63; 95% CI, -152.63 to -62.63; <i>p</i> < 0.01; <i>I</i> <sup>2</sup> = 27%). Both the TIO and HIO methods are safe and feasible for LLR. Compared with HIO, TIO seems to have less blood loss in cirrhotic patients. However, this result demands further research, especially multicenter randomized controlled trials, for verification in the future. <b>Systematic Review Registration:</b> https://www.crd.york.ac.uk/, Identifier PROSPERO (CRD42022382334).</p>","PeriodicalId":12564,"journal":{"name":"Frontiers in Surgery","volume":null,"pages":null},"PeriodicalIF":1.6,"publicationDate":"2024-09-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11467754/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142462779","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-09-24eCollection Date: 2024-01-01DOI: 10.3389/fsurg.2024.1426170
Abdullah D Alotaibi, Bashayr N Alsuwayt, Rana N Raghib, Rahaf S Alsayer, Sarah M Albarrak, Abdullah N Alrasheedi, Mohd Saleem, Sheeba Afreen, Oren Friedman
Introduction: This study explores the profound impact of nasal structure on individuals' self-image and emotional well-being, emphasizing the increasing popularity of rhinoplasty in Saudi Arabia, influenced by societal beauty standards portrayed on social media. The investigation aims to unravel the complex interplay between demographic factors, such as gender and age distribution, and prevalent nasal deformities in a cohort of 293 participants.
Material and methods: This retrospective study at the University of Hail and King Khalid Hospital, Saudi Arabia, investigated nasal deformities in 293 participants aged 15-54. Ethical approval was obtained, and data, including bio-demographics and nasal deformities, were retrospectively reviewed. Statistical analyses, utilizing chi-square and Fisher exact tests, assessed associations, enhancing internal validity. The study targeted a diverse population, emphasizing ethical guidelines and systematic sampling.
Results: Our study of 293 participants revealed a prevalence of common nasal deformities. Dorsal hump deformity (59.0%) was the most prevalent, followed by external nasal deviation (54.6%). Significant gender differences were observed, with males more prone to external nasal deviation (65.6%), while decreased nasal tip rotation was more common in females (40.6%). Variations in nasal tip shape were statistically significant, with broad nasal tip shape more prevalent in females (35.2%).
Conclusion: In conclusion, our study highlights the prevalence of common nasal deformities, emphasizing significant gender variations. These findings contribute to a deeper understanding of nasal anatomy, essential for informed decision-making in rhinoplasty.
{"title":"Types of nasal deformities in individuals seeking rhinoplasty at governmental hospital in Saudi Arabia.","authors":"Abdullah D Alotaibi, Bashayr N Alsuwayt, Rana N Raghib, Rahaf S Alsayer, Sarah M Albarrak, Abdullah N Alrasheedi, Mohd Saleem, Sheeba Afreen, Oren Friedman","doi":"10.3389/fsurg.2024.1426170","DOIUrl":"https://doi.org/10.3389/fsurg.2024.1426170","url":null,"abstract":"<p><strong>Introduction: </strong>This study explores the profound impact of nasal structure on individuals' self-image and emotional well-being, emphasizing the increasing popularity of rhinoplasty in Saudi Arabia, influenced by societal beauty standards portrayed on social media. The investigation aims to unravel the complex interplay between demographic factors, such as gender and age distribution, and prevalent nasal deformities in a cohort of 293 participants.</p><p><strong>Material and methods: </strong>This retrospective study at the University of Hail and King Khalid Hospital, Saudi Arabia, investigated nasal deformities in 293 participants aged 15-54. Ethical approval was obtained, and data, including bio-demographics and nasal deformities, were retrospectively reviewed. Statistical analyses, utilizing chi-square and Fisher exact tests, assessed associations, enhancing internal validity. The study targeted a diverse population, emphasizing ethical guidelines and systematic sampling.</p><p><strong>Results: </strong>Our study of 293 participants revealed a prevalence of common nasal deformities. Dorsal hump deformity (59.0%) was the most prevalent, followed by external nasal deviation (54.6%). Significant gender differences were observed, with males more prone to external nasal deviation (65.6%), while decreased nasal tip rotation was more common in females (40.6%). Variations in nasal tip shape were statistically significant, with broad nasal tip shape more prevalent in females (35.2%).</p><p><strong>Conclusion: </strong>In conclusion, our study highlights the prevalence of common nasal deformities, emphasizing significant gender variations. These findings contribute to a deeper understanding of nasal anatomy, essential for informed decision-making in rhinoplasty.</p>","PeriodicalId":12564,"journal":{"name":"Frontiers in Surgery","volume":null,"pages":null},"PeriodicalIF":1.6,"publicationDate":"2024-09-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11459581/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142389654","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-09-20eCollection Date: 2024-01-01DOI: 10.3389/fsurg.2024.1410162
Sahra Nasim, Henna Nasim, Martin Kauke, Ali-Farid Safi
Background: Autologous fat grafting for temporal augmentation is increasingly popular in aesthetic surgery. However, its high absorption rate, unpredictable volume retention rate, and potential safety risks are significant drawbacks. Evaluation methods for the fat graft survival rate, especially volume retention in the temporal area, vary widely and tend to be more subjective than objective. Therefore, this systematic review aims to analyze the unpredictable volume retention rate, associated safety concerns, and the various assessment strategies following autologous fat grafting for cosmetic temporal augmentation.
Methods: We conducted a systematic review of manuscripts listed in the MEDLINE/PubMed database on autologous fat grafting for cosmetic temporal augmentation. Articles had to be available in full text and written in English. Studies not presenting human data or not discussing cosmetic indications were excluded. We adhered to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines.
Results: Eight articles were included. The average fat volume injected into each temporal region was 10.69 ml (range 6-17.5) on the right and 10.64 ml (range 5.9-17.4) on the left side. All included articles utilized photographic documentation before and after treatment, along with various questionnaires and scales (37.5% Likert Scale, 12.5% Hollowness Severity Rating Scale, 12.5% Visual Analogue Scale, 12.5% Allergan Temple Hollowing Scale). For objective assessment, one article (12.5%) used computed tomography, and another (12.5%) employed a three-dimensional scanning system to objectively evaluate fat graft survival.
Conclusion: Autologous fat grafting effectively addresses temporal hollowness, with high patient satisfaction and a favorable safety profile. However, the variability in fat retention rates highlights the need for more controlled studies to establish reliable, validated methods for evaluating fat graft survival in the temporal area, and to further assess the safety of this procedure.
{"title":"Autologous fat grafting for cosmetic temporal augmentation: a systematic review.","authors":"Sahra Nasim, Henna Nasim, Martin Kauke, Ali-Farid Safi","doi":"10.3389/fsurg.2024.1410162","DOIUrl":"10.3389/fsurg.2024.1410162","url":null,"abstract":"<p><strong>Background: </strong>Autologous fat grafting for temporal augmentation is increasingly popular in aesthetic surgery. However, its high absorption rate, unpredictable volume retention rate, and potential safety risks are significant drawbacks. Evaluation methods for the fat graft survival rate, especially volume retention in the temporal area, vary widely and tend to be more subjective than objective. Therefore, this systematic review aims to analyze the unpredictable volume retention rate, associated safety concerns, and the various assessment strategies following autologous fat grafting for cosmetic temporal augmentation.</p><p><strong>Methods: </strong>We conducted a systematic review of manuscripts listed in the MEDLINE/PubMed database on autologous fat grafting for cosmetic temporal augmentation. Articles had to be available in full text and written in English. Studies not presenting human data or not discussing cosmetic indications were excluded. We adhered to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines.</p><p><strong>Results: </strong>Eight articles were included. The average fat volume injected into each temporal region was 10.69 ml (range 6-17.5) on the right and 10.64 ml (range 5.9-17.4) on the left side. All included articles utilized photographic documentation before and after treatment, along with various questionnaires and scales (37.5% Likert Scale, 12.5% Hollowness Severity Rating Scale, 12.5% Visual Analogue Scale, 12.5% Allergan Temple Hollowing Scale). For objective assessment, one article (12.5%) used computed tomography, and another (12.5%) employed a three-dimensional scanning system to objectively evaluate fat graft survival.</p><p><strong>Conclusion: </strong>Autologous fat grafting effectively addresses temporal hollowness, with high patient satisfaction and a favorable safety profile. However, the variability in fat retention rates highlights the need for more controlled studies to establish reliable, validated methods for evaluating fat graft survival in the temporal area, and to further assess the safety of this procedure.</p>","PeriodicalId":12564,"journal":{"name":"Frontiers in Surgery","volume":null,"pages":null},"PeriodicalIF":1.6,"publicationDate":"2024-09-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11449973/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142380496","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-09-18DOI: 10.3389/fsurg.2024.1428046
Hyder Mirghani, Amirah Alhowiti
IntroductionRemote-access scarless thyroidectomies are relatively new surgical procedures, and their uptake for cosmetic concerns is rapidly evolving. However, demographic factors, previous thyroid surgery, and culture substantially influence the patient's choice. This is the first study to assess the extensive counseling effect on the patient's preference for remote-access thyroidectomies compared to conventional transcervical approaches. We aimed to assess the same among medical students at the University of Tabuk, Saudi Arabia.MethodsThis interventional study was conducted from December 2023 to March 2024. A structured questionnaire was used to gather information about demographic factors, knowledge, and perception of the medical students regarding remote-access thyroidectomies before and after a slide presentation.ResultsOf 394 medical students (age 22.65 ± 1.62 years), 53.8% were women. Initially, the majority of the students preferred remote-access thyroidectomy over the conventional approach (85.3% vs. 14.7%, respectively); however, a substantial change toward the cervical approach was evident after extensive counseling [odds ratio, 2.59; 95% confidence interval (CI), 1.58–4.27; and P-value <0.00]. Knowledge regarding remote-access thyroidectomy was poor (26.9%). The students were anxious regarding postoperative complications (3.22 ± 1.59/5), thyroid scar appearance (3.28 ± 1.36/5), and postoperative pain (3.17 ± 1.38/5). Concerns regarding body satisfaction and cost were lower.ConclusionMedical students at the University of Tabuk, Saudi Arabia, demonstrated low knowledge. The strong preference for remote-access thyroidectomy over transcervical thyroidectomy shifted substantially toward the conventional approach after counseling. The main factors were thyroid scar appearance, pain, and complications. Further larger-scale studies involving the general public and assessing the effect of extensive counseling on surgical choice are needed.
{"title":"Knowledge and perception of medical students regarding remote-access thyroidectomy in Tabuk: the effects of extensive counseling—an interventional study","authors":"Hyder Mirghani, Amirah Alhowiti","doi":"10.3389/fsurg.2024.1428046","DOIUrl":"https://doi.org/10.3389/fsurg.2024.1428046","url":null,"abstract":"IntroductionRemote-access scarless thyroidectomies are relatively new surgical procedures, and their uptake for cosmetic concerns is rapidly evolving. However, demographic factors, previous thyroid surgery, and culture substantially influence the patient's choice. This is the first study to assess the extensive counseling effect on the patient's preference for remote-access thyroidectomies compared to conventional transcervical approaches. We aimed to assess the same among medical students at the University of Tabuk, Saudi Arabia.MethodsThis interventional study was conducted from December 2023 to March 2024. A structured questionnaire was used to gather information about demographic factors, knowledge, and perception of the medical students regarding remote-access thyroidectomies before and after a slide presentation.ResultsOf 394 medical students (age 22.65 ± 1.62 years), 53.8% were women. Initially, the majority of the students preferred remote-access thyroidectomy over the conventional approach (85.3% vs. 14.7%, respectively); however, a substantial change toward the cervical approach was evident after extensive counseling [odds ratio, 2.59; 95% confidence interval (CI), 1.58–4.27; and <jats:italic>P</jats:italic>-value &lt;0.00]. Knowledge regarding remote-access thyroidectomy was poor (26.9%). The students were anxious regarding postoperative complications (3.22 ± 1.59/5), thyroid scar appearance (3.28 ± 1.36/5), and postoperative pain (3.17 ± 1.38/5). Concerns regarding body satisfaction and cost were lower.ConclusionMedical students at the University of Tabuk, Saudi Arabia, demonstrated low knowledge. The strong preference for remote-access thyroidectomy over transcervical thyroidectomy shifted substantially toward the conventional approach after counseling. The main factors were thyroid scar appearance, pain, and complications. Further larger-scale studies involving the general public and assessing the effect of extensive counseling on surgical choice are needed.","PeriodicalId":12564,"journal":{"name":"Frontiers in Surgery","volume":null,"pages":null},"PeriodicalIF":1.8,"publicationDate":"2024-09-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142269302","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}