Frontiers in Surgery最新文献

Background: Suprascapular nerve entrapment is a cause of shoulder pain and dysfunction, often complicated by symptomatic overlap with other shoulder pathologies. Entrapment most commonly occurs at two anatomical constrictions: the suprascapular notch and the spinoglenoid notch. Compression of the nerve's inferior branch at the spinoglenoid notch by a paralabral cyst, leading to isolated infraspinatus weakness and atrophy, is a relatively common pattern. Diagnosis relies on a detailed physical examination, multimodal imaging evaluation including MRI and ultrasound, and confirmation by electromyography. For patients who do not respond to conservative management or who have definitive space-occupying compression, surgical decompression is an effective treatment option.

Case presentation: This is the case of a 27-year-old man presenting with progressive right shoulder weakness and pain over just one month, already demonstrating isolated infraspinatus atrophy. Imaging revealed the etiology to be a paralabral cyst that, notably, occupied both the suprascapular and spinoglenoid notches, creating a "double-crush" compression on the suprascapular nerve. This case clearly illustrates how a strategically located space-occupying lesion can lead to rapid and characteristic neurologic deficit, even within a short clinical course.

Conclusion: This case clearly illustrates the classic presentation of an isolated spinoglenoid notch cyst causing suprascapular nerve compression, underscoring that this diagnosis must be considered in patients with isolated external rotation weakness even without a clear traumatic etiology, and highlighting that early recognition and systematic evaluation are key to successful management and neurological recovery.

Background: To evaluate the feasibility, safety, and short-term clinical outcomes of robot-assisted partial splenectomy (RAPS) in the treatment of benign splenic lesions (BSLs).

Methods: A retrospective analysis was conducted on nine patients with BSLs who underwent RAPS in the Department of Hepatobiliary, Pancreatic, and Splenic Surgery at Mianyang Central Hospital between January 2024 and September 2025. Clinical data, including demographic characteristics, lesion features, intraoperative parameters, postoperative recovery, and complications, were collected. All patients underwent preoperative contrast-enhanced abdominal computed tomography, magnetic resonance imaging, and three-dimensional (3D) reconstruction to delineate the anatomical relationship between the lesion and splenic vasculature. All procedures were performed by the same surgical team.

Results: All nine procedures were successfully completed without conversion to open surgery. The cohort comprised three men and six women, with a mean age of 49.0 ± 10.3 years. Lesions were located in the lower pole in seven cases and in the upper pole in two, with a mean diameter of 4.34 ± 0.8 cm. The mean operative time was 179.4 ± 15.5 min, the mean intraoperative blood loss was 71.1 ± 19.6 mL, and the mean postoperative hospital stay was 6.4 ± 0.9 days. No cases of splenic infarction, pancreatic fistula, hemorrhage, or severe infection were observed. Pathological diagnoses included splenic hemangioma (n = 3), non-parasitic splenic cyst (n = 5), and splenic lymphangioma (n = 1). During follow-up, no recurrence, new lesions, or splenic dysfunction were detected, and hematologic parameters remained within normal ranges.

Conclusion: RAPS is a safe, feasible, and minimally invasive spleen-preserving procedure. Preoperative 3D reconstruction facilitates precise surgical planning, and when combined with the high-precision maneuverability of robotic technology, enables complete lesion removal while preserving functional splenic tissue. This approach aligns with the principles of modern precision and minimally invasive surgery.

Objective: This study aimed to systematically identify independent risk factors for chronic postsurgical pain (CPSP) in patients undergoing minimally invasive pulmonary surgery, thereby providing an evidence-based foundation for the early identification of high-risk patients and the development of targeted preventive strategies.

Methods: A case-control study design was employed. A total of 280 patients who underwent minimally invasive thoracic surgery between January 2022 and June 2024 were enrolled and categorized into a CPSP group (n = 48) and a non-CPSP group (n = 232) based on the presence of CPSP at 3 months postoperatively. Baseline characteristics, surgical features, and perioperative pain indicators-including visual analog scale (VAS) scores for pain at rest, during coughing, and during shoulder abduction assessed daily from postoperative day 1 to day 6-were prospectively collected. The occurrence of CPSP was evaluated at the 3-month follow-up. Univariate and multivariate logistic regression analyses were used to screen for independent factors influencing CPSP, and the predictive performance of these factors was assessed using receiver operating characteristic (ROC) curve analysis.

Results: Univariate analysis revealed that preoperative anxiety, preoperative pain, surgical approach, intercostal suture, scar length, and postoperative shoulder abduction pain were significantly associated with CPSP development (P < 0.05). Multivariate logistic regression analysis ultimately identified postoperative shoulder abduction pain (OR = 1.893, 95% CI: 1.432-2.502, P < 0.001), scar length (OR = 1.240, 95% CI: 1.049-1.466, P = 0.011), and preoperative anxiety (OR = 3.089, 95% CI: 1.201-7.943, P = 0.019) as independent risk factors for CPSP, while intercostal suture (OR = 0.234, 95% CI: 0.074-0.736, P = 0.013) was an independent protective factor. Predictive performance analysis showed that postoperative shoulder abduction pain had the best predictive value [Area Under the Curve (AUC) = 0.821], with an optimal cut-off value of >3.5 points.

Conclusion: For patients undergoing minimally invasive thoracic surgery, higher early postoperative (within 6 days) shoulder abduction pain scores, greater scar length, and the presence of preoperative anxiety are significant independent risk factors for developing CPSP at 3 months, whereas the use of the intercostal suture technique demonstrates a protective effect. Clinical practice should emphasize enhanced monitoring and management of postoperative shoulder abduction pain, the proactive adoption of protective surgical techniques, and attention to patients' preoperative psychological state to effectively reduce the risk of CPSP.

Purpose: To compare the perioperative efficacy and safety of ultramini-percutaneous nephrolithotomy (ultramini-PCNL) combined with flexible ureteroscopic lithotripsy (FURL) vs. standard-channel PCNL in patients with complex renal calculi, with a focus on evaluating the impacts of the two procedures on postoperative oxidative stress responses, inflammatory factor levels, and renal hemodynamic parameters.

Methods: A retrospective analysis was conducted on the clinical data of 135 patients with complex renal calculi admitted to our hospital from January 2023 to December 2024. According to different surgical approaches, the patients were divided into a study group (SG, n = 72) and a control group (CG, n = 63). The CG underwent standard-channel PCNL, while the SG received ultramini-PCNL combined with FURL. Surgical parameters, pain conditions, stone-free rate, oxidative stress markers, inflammatory factors, renal function, renal blood flow levels before and after surgery, as well as postoperative complications, were compared between the two groups.

Results: Compared with the CG, perioperative blood volume, time to out of bed activity and hospital stay were shorter in the SG (P < 0.05); Postoperative pain scores were lower in the SG than in CG at 12 h, 24 h and 72 h (P < 0.05), postoperative stone-free rate was higher in the SG (P < 0.05); Postoperative Cor and MDA levels were lower while SOD levels were higher in SG (P < 0.05); Postoperative CRP, IL-6 and the complication rate were lower in SG than in CG (P < 0.05). Postoperatively, compared with the preoperative values, both groups showed slight fluctuations in serum urea and creatinine (Cr) levels; however, the differences were not statistically significant (P > 0.05). After surgery, the renal artery Vmax in the SG was significantly higher than that in the CG (P < 0.05). No significant differences were observed between the two groups regarding the RI index (P > 0.05).

Conclusion: Ultramini-PCNL combined with FURL demonstrates superior efficacy in the treatment of complex renal calculi. This approach effectively improves stone-free rate, reduces stress responses, ameliorates inflammatory factor levels, and provides a high level of safety, supporting its broader clinical application.

Objective: This study aimed to compare the outcomes of direct suturing (Method 1) and pericranium-assisted suturing (Method 2) for U-shaped dural incisions, with a specific focus on site-specific differences in cerebrospinal fluid (CSF) leak and postoperative infection.

Methods: In this retrospective cohort, 172 patients undergoing repair of U-shaped dural incisions were analyzed. Based on intraoperative feasibility, patients underwent either Method 1 (n = 94) or Method 2 (n = 78). Primary and secondary outcomes were CSF leak and postoperative infection rates, respectively. Subgroup analyses were stratified by surgical site (supratentorial vs. infratentorial).

Results: The incidence of CSF leak was low and comparable between the two methods, regardless of surgical site (Method 1: 7.14% supratentorial vs. 7.69% infratentorial, P = 1.00; Method 2: 4.17% vs. 3.33%, P = 1.00). Re-repair rates were similarly low across all groups. However, Method 2 was associated with a significantly higher overall infection rate in the infratentorial compartment compared to supratentorial surgeries (23.33% vs. 6.25%, P = 0.039). Sub-analysis revealed this was primarily driven by a higher incidence of incision infection/delayed healing in the infratentorial group (16.67% vs. 2.08%, P = 0.028), whereas meningitis rates were comparable. Multivariable analysis confirmed the surgical site itself was not an independent risk factor for infection.

Conclusion: Both direct and pericranium-assisted suturing are effective in preventing CSF leak for U-shaped dural incisions. However, the pericranium-assisted technique carries a significantly increased risk of incision-related infections in the infratentorial region. Clinical decision-making must therefore balance the reliable sealing capability of pericranium-assisted repair against its site-specific infection profile, particularly in complex posterior fossa surgeries.

Purpose: Rotator cuff tears (RCTs) are a prevalent source of shoulder disability, frequently accompanied by pathologies of the long head of the biceps tendon (LHBT). While both tenotomy and tenodesis are established procedures for managing LHBT lesions during rotator cuff repair, their comparative efficacy remains a subject of debate. This study aimed to compare the clinical outcomes of isolated tenotomy vs. tenotomy with tenodesis in patients undergoing arthroscopic RCTs in a retrospective study.

Methods: All surgical procedures involved arthroscopic rotator cuff repair performed by a single surgeon. Patients were divided into isolated biceps tenotomy and tenotomy with tenodesis using a suture anchor. Postoperative rehabilitation was standardized. Outcomes were assessed preoperatively and at 3, 6, 12 months, and final follow-up using ASES and Constant-Murley scores, VAS pain scale, operative time, and complications.

Results: A total of 63 patients (mean age 67.3 years) were retrospectively reviewed and divided into two groups: isolated tenotomy (n = 28) and tenotomy with tenodesis (n = 35). Preoperative demographics and functional scores (ASES, Constant-Murley, VAS) were comparable between groups. Both techniques resulted in significant and sustained improvements in all functional and pain outcomes at 3, 6, and 12 months postoperatively compared to baseline. In the early postoperative period (3 months), the tenotomy group demonstrated a statistically superior improvement in VAS pain scores. However, these differences in functional and pain scores between the two groups were no longer significant at the 6 and 12-month follow-ups. The operative time was significantly shorter for the tenotomy group. The only significant complication difference was the occurrence of Popeye deformity in two patients (14%) in the tenotomy group, with no cases in the tenodesis group.

Conclusion: In conclusion, both isolated tenotomy and tenodesis provide equivalent, excellent functional improvements and pain relief at the 12-month follow-up. Tenotomy offers the advantages of a shorter operative time and better early pain control, at the cost of a higher risk of Popeye deformity. Tenodesis effectively prevents this cosmetic complication but requires a longer surgery.

Aim: The adrenal gland is a vital endocrine organ responsible for maintaining physiological homeostasis. Bilateral adrenalectomy results in adrenal insufficiency, requiring lifelong hormone replacement therapy. This study aimed to establish a reproducible experimental model for vascularized adrenal gland transplantation in rats.

Materials and methods: Twenty male Wistar Albino rats (180-220 g) were randomly assigned into two equal groups (n = 10 each): control and transplantation. The control group underwent bilateral total adrenalectomy. In the transplantation group, vascularized adrenal grafts-including the adrenal artery and vein with attached aortic and inferior vena cava segments-were anastomosed end-to-side to the recipient's femoral artery and vein using 10-0 nylon sutures under general anesthesia. On postoperative day 15, all recipients underwent bilateral adrenalectomy. On day 100, animals were sacrificed for macroscopic and histopathological evaluation of graft viability.

Results: All control rats died within 15 days, whereas all transplanted rats survived throughout the 100-day observation period. Macroscopic inspection revealed viable grafts without vascular compromise. Histopathological analysis demonstrated preserved cortical and medullary architecture, confirming the long-term viability of the transplanted adrenal glands.

Conclusion: This study presents a technically feasible and reproducible model for vascularized adrenal gland transplantation in rats. The model provides a reliable experimental platform for future research on adrenal physiology and transplantation surgery.

Hemophilic pseudotumor is a rare complication of hemophilia in which a chronic, expanding hemorrhagic mass erodes adjacent bone; intracranial presentations are exceedingly uncommon and can mimic neoplasms. We describe a 36-year-old man with severe hemophilia A who developed a five-year, progressively enlarging left frontoparietal swelling with worsening right-sided hemiparesis. MRI demonstrated a heterogeneously enhancing extra-axial lesion destroying the left cranial vault with "mushroom-like" extracranial extension, marked mass effect, and midline shift, initially interpreted as a possible meningioma. Given progressive deficits, the patient underwent resection under intensive factor VIII replacement. Intraoperatively, a 10 × 10 × 5 cm encapsulated lesion containing organizing clot and fibrous tissue was excised en bloc; the skull defect was reconstructed in a staged procedure. Histopathology confirmed hemophilic pseudotumor. Postoperatively, hemiparesis improved markedly; a small epidural hematoma was managed conservatively. At 12 months, MRI showed no recurrence and the patient remained neurologically intact on prophylactic factor VIII. This case highlights the need to include hemophilic pseudotumor in the differential diagnosis of skull lesions in patients with hemophilia and underscores the value of early recognition and multidisciplinary management-particularly meticulous perioperative hemostatic support-to enable safe resection and excellent outcomes.

Objective: Recurrence of trigeminal neuralgia (TN) after microvascular decompression (MVD) poses a challenge for neurosurgeons. This study aimed to investigate the effect of repeat posterior fossa exploration (RPFE) and external neurolysis for TN recurrence following MVD.

Methods: Totally, 38 TN patients who experienced recurrence after MVD were included. All patients underwent RPFE and limited neurolysis. The Barrow Neurological Institute Pain Intensity Scale were utilized to evaluate preoperative pain and postoperative outcomes.

Results: The median follow-up period was 63.8 months (range: 5-112 months). Thirty-three out of the 38 patients achieved excellent outcomes, 4 had good outcomes, and 1 experienced failure. The rates of complete pain relief was 92% immediately post-surgery and 86.8% at the final follow-up. Re-exploration revealed Teflon adhesion in almost all patients (92%). Complications included new facial numbness (n = 5), temporary facial weakness (n = 3), hearing loss and tinnitus (n = 1), wound infection (n = 1), and postoperative hemorrhage (n = 1).

Conclusions: Teflon adhesion was frequently observed upon re-exploration. A substantial majority of TN patients experiencing recurrence post-MVD achieved positive outcomes via RPFE and neurolysis. Complications, particularly facial numbness attributed to premature excessive Teflon dislodgement, continue to pose challenges. However, limited neurolysis, have proven effective in minimizing these complications.

Background: Total joint arthroplasty is an effective treatment for end-stage joint diseases, with approximately 1.5 million procedures performed globally annually and a 25%-30% annual growth rate in China. However, 10%-15% of patients develop prosthetic loosening or subsidence within 15-20 years postoperatively, predominantly due to aseptic loosening (incidence >10%) caused by wear particle-induced aseptic inflammatory osteolysis. The role of autophagy in this pathogenesis remains incompletely understood.

Methods: A 61-year-old female patient developed aseptic loosening 11 months after left total knee arthroplasty. Comprehensive management included preoperative screening (including synovial cell count, differential, and alpha-defensin detection), revision surgery (debridement of necrotic/inflammatory tissue/residual cement and implantation of a new prosthesis with vancomycin-impregnated cement), synovial HE staining, quantitative immunohistochemistry (IHC; Ki67, CD3, CD20, CD68, P62, LC3II, and Beclin1), and postoperative rehabilitation.

Results: Postoperatively, pain was relieved: the patient ambulated with crutches at 3 days, achieved 90° knee flexion at 1 week, and full pain-free weight-bearing (110° flexion) at 2 months. Postoperative infection markers (C-reactive protein and erythrocyte sedimentation rate) were temporarily elevated due to surgical trauma and returned to normal during follow-up. Imaging showed a stable prosthesis without infection or recurrent loosening. Synovial HE staining revealed extensive inflammatory infiltration; quantitative IHC showed high expression of inflammatory markers and low expression of autophagy-related markers. Clinical outcomes were favorable with validated patient-reported outcome measures (Knee injury and Osteoarthritis Outcome Score: 85 points; Western Ontario and McMaster Universities Osteoarthritis Index score: 20 points) at 6 months post-revision.

Conclusion: The integrated protocol effectively treated aseptic loosening. Wear particle-induced chronic synovitis and altered autophagy-related marker expression may be involved in the pathogenesis, providing preliminary clinical and pathological evidence for further research.