Frontiers in Surgery最新文献

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

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

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

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

Systematic review registration: PROSPERO (CRD42024522862).

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

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

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

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

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

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

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

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

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

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

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

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

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

Introduction: In DBS for patients with PD, STN is the most common DBS target with the sweet point located dorsal ipsilaterally adjacent to the pyramidal tract. During awake DBS lead implantation, macrostimulation is performed to test the clinical effects and side effects especially the pyramidal tract side effect (PTSE) threshold. A too low PTSE threshold will compromise the therapeutic stimulation window. When DBS lead implantation is performed under general anaesthesia (GA), there is a lack of real time feedback regarding the PTSE. In this study, we evaluated the macrostimulation-induced PTSE by electromyography (EMG) during DBS surgery under GA. Our aim is to investigate the prediction of post-operative programming PTSE threshold using EMG-based PTSE threshold, and its potential application to guide intra-operative lead implantation.

Methods: 44 patients with advanced PD received STN DBS under GA were studied. Intra-operative macrostimulation via EMG was assessed from the contralateral upper limb. EMG signal activation was defined as the amplitude doubling or greater than the base line. In the first programming session at one month post-operation, the PTSE threshold was documented. All patients were followed up for one year to assess clinical outcome.

Results: All 44 cases (88 sides) demonstrated activations of limb EMG via increasing amplitude of macrostimulation the contralateral STN under GA. Revision tracts were explored in 7 patients due to a low EMG activation threshold (<= 2.5 mA). The mean intraoperative EMG-based PTSE threshold was 4.3 mA (SD 1.2 mA, Range 2.0-8.0 mA), programming PTSE threshold was 3.7 mA (SD 0.8 mA, Range 2.0-6.5 mA). Linear regression showed that EMG-based PTSE threshold was a statistically significant predictor variable for the programming PTSE threshold (p value <0.001). At one year, the mean improvement of UPDRS Part III score at medication-off/DBS-on was 54.0% (SD 12.7%) and the levodopa equivalent dose (LED) reduction was 59.5% (SD 23.5%).

Conclusion: During STN DBS lead implantation under GA, PTSE threshold can be tested by EMG through macrostimulation. It can provide real-time information on the laterality of the trajectory and serves as reference to guide intra-operative DBS lead placement.

Background: Image-guided surgical navigation systems are widely regarded as the benchmark for computer-assisted surgical robotic platforms, yet a persistent challenge remains in addressing intraoperative image drift and mismatch. It can significantly impact the accuracy and precision of surgical procedures. Therefore, further research and development are necessary to mitigate this issue and enhance the overall performance of these advanced surgical platforms.

Objective: The primary objective is to improve the precision of image guided puncture navigation systems by developing a computed tomography (CT) and structured light imaging (SLI) based navigation system. Furthermore, we also aim to quantifying and visualize intraoperative image drift and mismatch in real time and provide feedback to surgeons, ensuring that surgical procedures are executed with accuracy and reliability.

Methods: A CT-SLI guided orthopedic navigation puncture system was developed. Polymer bandages are employed to pressurize, plasticize, immobilize and toughen the surface of a specimen for surgical operations. Preoperative CT images of the specimen are acquired, a 3D navigation map is reconstructed and a puncture path planned accordingly. During surgery, an SLI module captures and reconstructs the 3D surfaces of both the specimen and a guiding tube for the puncture needle. The SLI reconstructed 3D surface of the specimen is matched to the CT navigation map via two-step point cloud registrations, while the SLI reconstructed 3D surface of the guiding tube is fitted by a cylindrical model, which is in turn aligned with the planned puncture path. The proposed system has been tested and evaluated using 20 formalin-soaked lower limb cadaver specimens preserved at a local hospital.

Results: The proposed method achieved image registration RMS errors of 0.576 ± 0.146 mm and 0.407 ± 0.234 mm between preoperative CT and intraoperative SLI surface models and between preoperative and postoperative CT surface models. In addition, preoperative and postoperative specimen surface and skeletal drifts were 0.033 ± 0.272 mm and 0.235 ± 0.197 mm respectively.

Conclusion: The results indicate that the proposed method is effective in reducing intraoperative image drift and mismatch. The system also visualizes intraoperative image drift and mismatch, and provides real time visual feedback to surgeons.