BackgroundCastleman disease (CD) is a rare lymphoproliferative disorder that can occur anywhere along the lymphatic pathway. Retroperitoneal unicentric Castleman disease (UCD) is an extremely rare manifestation. This study aims to explore the clinical features and surgical treatment of retroperitoneal UCD.MethodsWe retrospectively reviewed patients who underwent retroperitoneal tumor surgery and were diagnosed with CD based on postoperative pathology before December 31, 2022. Data from these patients were collected and analyzed.ResultsA total of 15 patients were included in the final analysis. All patients underwent radical resection under general anesthesia. Two out of 15 patients (13.3%) experienced serious complications but recovered well. There were no perioperative deaths. The median follow-up time was 78.5 months (range: 18–107.5 months), and no deaths or recurrences occurred during this period.ConclusionsSurgical treatment for retroperitoneal UCD is safe. Patients with retroperitoneal UCD can achieve long-time survival through complete resection.
{"title":"Clinical features and outcomes of retroperitoneal unicentric Castleman disease resected as sarcomas: insights from a high-volume sarcoma center","authors":"Haicheng Gao, Wenjie Li, Boyuan Zou, Shibo Liu, Chengli Miao","doi":"10.3389/fsurg.2024.1371968","DOIUrl":"https://doi.org/10.3389/fsurg.2024.1371968","url":null,"abstract":"BackgroundCastleman disease (CD) is a rare lymphoproliferative disorder that can occur anywhere along the lymphatic pathway. Retroperitoneal unicentric Castleman disease (UCD) is an extremely rare manifestation. This study aims to explore the clinical features and surgical treatment of retroperitoneal UCD.MethodsWe retrospectively reviewed patients who underwent retroperitoneal tumor surgery and were diagnosed with CD based on postoperative pathology before December 31, 2022. Data from these patients were collected and analyzed.ResultsA total of 15 patients were included in the final analysis. All patients underwent radical resection under general anesthesia. Two out of 15 patients (13.3%) experienced serious complications but recovered well. There were no perioperative deaths. The median follow-up time was 78.5 months (range: 18–107.5 months), and no deaths or recurrences occurred during this period.ConclusionsSurgical treatment for retroperitoneal UCD is safe. Patients with retroperitoneal UCD can achieve long-time survival through complete resection.","PeriodicalId":12564,"journal":{"name":"Frontiers in Surgery","volume":"282 1","pages":""},"PeriodicalIF":1.8,"publicationDate":"2024-09-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142214110","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}
Pub Date : 2024-09-05DOI: 10.3389/fsurg.2024.1424262
Yu Yu
ObjectivesMinimally invasive transforaminal lumbar interbody fusion (Mis-TLIF) and oblique lumbar interbody fusion (OLIF) are increasingly replacing traditional approaches. This study aimed to compare the clinical outcomes of OLIF and Mis-TLIF in treating single-level degenerative lumbar diseases.MethodsPatients with single-level degenerative lumbar diseases underwent either OLIF (30 patients) or Mis-TLIF (30 patients). Surgical data, including operation time, blood loss, postoperative drainage, and postoperative bed rest duration, were collected. Clinical outcomes were assessed using the Oswestry disability index, the visual analog scale scores for low back pain and leg pain, and Japanese Orthopaedic Association scores for daily ability, along with monitoring of complications.ResultsThe OLIF group showed significantly shorter operative times, less blood loss, reduced postoperative drainage, and shorter bed rest durations than the Mis-TLIF group. At the 1-month follow-up, OLIF patients also demonstrated significantly better clinical outcome scores than Mis-TLIF patients. No significant differences were observed between OLIF and Mis-TLIF patients before surgery and after 3 months. Furthermore, lumbar lordosis and disc height were significantly greater in the OLIF group at the final follow-up.ConclusionsBoth OLIF and Mis-TLIF achieved satisfactory and effective long-term clinical outcomes for single-level lumbar degenerative diseases. However, OLIF resulted in less tissue damage, reduced bleeding, better short-term clinical outcomes, and improved recovery of segmental lordosis compared to Mis-TLIF. Therefore, OLIF appears to be the preferable option over Mis-TLIF.
{"title":"Clinical values of oblique lumbar interbody fusion on the treatment of single-level degenerative lumbar diseases","authors":"Yu Yu","doi":"10.3389/fsurg.2024.1424262","DOIUrl":"https://doi.org/10.3389/fsurg.2024.1424262","url":null,"abstract":"ObjectivesMinimally invasive transforaminal lumbar interbody fusion (Mis-TLIF) and oblique lumbar interbody fusion (OLIF) are increasingly replacing traditional approaches. This study aimed to compare the clinical outcomes of OLIF and Mis-TLIF in treating single-level degenerative lumbar diseases.MethodsPatients with single-level degenerative lumbar diseases underwent either OLIF (30 patients) or Mis-TLIF (30 patients). Surgical data, including operation time, blood loss, postoperative drainage, and postoperative bed rest duration, were collected. Clinical outcomes were assessed using the Oswestry disability index, the visual analog scale scores for low back pain and leg pain, and Japanese Orthopaedic Association scores for daily ability, along with monitoring of complications.ResultsThe OLIF group showed significantly shorter operative times, less blood loss, reduced postoperative drainage, and shorter bed rest durations than the Mis-TLIF group. At the 1-month follow-up, OLIF patients also demonstrated significantly better clinical outcome scores than Mis-TLIF patients. No significant differences were observed between OLIF and Mis-TLIF patients before surgery and after 3 months. Furthermore, lumbar lordosis and disc height were significantly greater in the OLIF group at the final follow-up.ConclusionsBoth OLIF and Mis-TLIF achieved satisfactory and effective long-term clinical outcomes for single-level lumbar degenerative diseases. However, OLIF resulted in less tissue damage, reduced bleeding, better short-term clinical outcomes, and improved recovery of segmental lordosis compared to Mis-TLIF. Therefore, OLIF appears to be the preferable option over Mis-TLIF.","PeriodicalId":12564,"journal":{"name":"Frontiers in Surgery","volume":"12 1","pages":""},"PeriodicalIF":1.8,"publicationDate":"2024-09-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142213852","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}
Pub Date : 2024-09-05DOI: 10.3389/fsurg.2024.1418314
Di Zeng, Yaoqun Wang, Ningyuan Wen, Jiong Lu, Bei Li, Nansheng Cheng
BackgroundRe-resection is recommended for patients with incidental gallbladder carcinoma (iGBC) at T1b stage and above. It is unclear whether continuation of laparoscopic re-resection (CLR) for patients with intraoperatively detected iGBC (IDiGBC) is more beneficial to short- and long-term clinical outcomes than with conversion to radical extensive-resection (RER).MethodsThis single-centre, retrospective cohort study of patients with iGBC was conducted between June 2006 and August 2021. Patients who underwent immediate reresection for T1b or higher ID-iGBC were enrolled. Propensity score matching (PSM) was used to match the two groups (CLR and RER) of patients, and differences in clinical outcomes before and after matching were analyzed.ResultA total of 102 patients with ID-iGBC were included in this study. 58 patients underwent CLR, and 44 underwent RER. After 1:1 propensity score matching, 56 patients were matched to all baselines. Patients in the RER group had a lower total postoperative complication rate, lower pulmonary infection rate, and shorter operation time than those in the CLR group did. Kaplan-Meier analysis showed that the overall survival rate of patients who underwent CLR was significantly lower than that of patients who underwent RER. Multivariate analysis showed that CLR, advanced T stage, lymph node positivity, and the occurrence of postoperative ascites were adverse prognostic factors for the overall survival of patients.ConclusionPatients with ID-iGBC who underwent RER had fewer perioperative complications and a better prognosis than those who underwent CLR. For patients with ID-iGBC, conversion to radical extensive-resection appears to be a better choice.
{"title":"Incidental gallbladder cancer detected during laparoscopic cholecystectomy: conversion to extensive resection is a feasible choice","authors":"Di Zeng, Yaoqun Wang, Ningyuan Wen, Jiong Lu, Bei Li, Nansheng Cheng","doi":"10.3389/fsurg.2024.1418314","DOIUrl":"https://doi.org/10.3389/fsurg.2024.1418314","url":null,"abstract":"BackgroundRe-resection is recommended for patients with incidental gallbladder carcinoma (iGBC) at T1b stage and above. It is unclear whether continuation of laparoscopic re-resection (CLR) for patients with intraoperatively detected iGBC (IDiGBC) is more beneficial to short- and long-term clinical outcomes than with conversion to radical extensive-resection (RER).MethodsThis single-centre, retrospective cohort study of patients with iGBC was conducted between June 2006 and August 2021. Patients who underwent immediate reresection for T1b or higher ID-iGBC were enrolled. Propensity score matching (PSM) was used to match the two groups (CLR and RER) of patients, and differences in clinical outcomes before and after matching were analyzed.ResultA total of 102 patients with ID-iGBC were included in this study. 58 patients underwent CLR, and 44 underwent RER. After 1:1 propensity score matching, 56 patients were matched to all baselines. Patients in the RER group had a lower total postoperative complication rate, lower pulmonary infection rate, and shorter operation time than those in the CLR group did. Kaplan-Meier analysis showed that the overall survival rate of patients who underwent CLR was significantly lower than that of patients who underwent RER. Multivariate analysis showed that CLR, advanced T stage, lymph node positivity, and the occurrence of postoperative ascites were adverse prognostic factors for the overall survival of patients.ConclusionPatients with ID-iGBC who underwent RER had fewer perioperative complications and a better prognosis than those who underwent CLR. For patients with ID-iGBC, conversion to radical extensive-resection appears to be a better choice.","PeriodicalId":12564,"journal":{"name":"Frontiers in Surgery","volume":"117 1","pages":""},"PeriodicalIF":1.8,"publicationDate":"2024-09-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142214109","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}
Pub Date : 2024-09-04DOI: 10.3389/fsurg.2024.1440042
Attill Saemann, Sina Schmid, Maria Licci, Marek Zelechowski, Balazs Faludi, Philippe C. Cattin, Jehuda Soleman, Raphael Guzman
BackgroundCraniosynostosis is a type of skull deformity caused by premature ossification of cranial sutures in children. Given its variability and anatomical complexity, three-dimensional visualization is crucial for effective teaching and understanding. We developed a VR database with 3D models to depict these deformities and evaluated its impact on teaching efficiency, motivation, and memorability.MethodsWe included all craniosynostosis cases with preoperative CT imaging treated at our institution from 2012 to 2022. Preoperative CT scans were imported into SpectoVR using a transfer function to visualize bony structures. Measurements, sub-segmentation, and anatomical teaching were performed in a fully immersive 3D VR experience using a headset. Teaching sessions were conducted in group settings where students and medical personnel explored and discussed the 3D models together, guided by a host. Participants’ experiences were evaluated with a questionnaire assessing understanding, memorization, and motivation on a scale from 1 (poor) to 5 (outstanding).ResultsThe questionnaire showed high satisfaction scores (mean 4.49 ± 0.25). Participants (n = 17) found the VR models comprehensible and navigable (mean 4.47 ± 0.62), with intuitive operation (mean 4.35 ± 0.79). Understanding pathology (mean 4.29 ± 0.77) and surgical procedures (mean 4.63 ± 0.5) was very satisfactory. The models improved anatomical visualization (mean 4.71 ± 0.47) and teaching effectiveness (mean 4.76 ± 0.56), with participants reporting enhanced comprehension and memorization, leading to an efficient learning process.ConclusionEstablishing a 3D VR database for teaching craniosynostosis shows advantages in understanding and memorization and increases motivation for the study process, thereby allowing for more efficient learning. Future applications in patient consent and teaching in other medical areas should be explored.
{"title":"Enhancing educational experience through establishing a VR database in craniosynostosis: report from a single institute and systematic literature review","authors":"Attill Saemann, Sina Schmid, Maria Licci, Marek Zelechowski, Balazs Faludi, Philippe C. Cattin, Jehuda Soleman, Raphael Guzman","doi":"10.3389/fsurg.2024.1440042","DOIUrl":"https://doi.org/10.3389/fsurg.2024.1440042","url":null,"abstract":"BackgroundCraniosynostosis is a type of skull deformity caused by premature ossification of cranial sutures in children. Given its variability and anatomical complexity, three-dimensional visualization is crucial for effective teaching and understanding. We developed a VR database with 3D models to depict these deformities and evaluated its impact on teaching efficiency, motivation, and memorability.MethodsWe included all craniosynostosis cases with preoperative CT imaging treated at our institution from 2012 to 2022. Preoperative CT scans were imported into SpectoVR using a transfer function to visualize bony structures. Measurements, sub-segmentation, and anatomical teaching were performed in a fully immersive 3D VR experience using a headset. Teaching sessions were conducted in group settings where students and medical personnel explored and discussed the 3D models together, guided by a host. Participants’ experiences were evaluated with a questionnaire assessing understanding, memorization, and motivation on a scale from 1 (poor) to 5 (outstanding).ResultsThe questionnaire showed high satisfaction scores (mean 4.49 ± 0.25). Participants (<jats:italic>n</jats:italic> = 17) found the VR models comprehensible and navigable (mean 4.47 ± 0.62), with intuitive operation (mean 4.35 ± 0.79). Understanding pathology (mean 4.29 ± 0.77) and surgical procedures (mean 4.63 ± 0.5) was very satisfactory. The models improved anatomical visualization (mean 4.71 ± 0.47) and teaching effectiveness (mean 4.76 ± 0.56), with participants reporting enhanced comprehension and memorization, leading to an efficient learning process.ConclusionEstablishing a 3D VR database for teaching craniosynostosis shows advantages in understanding and memorization and increases motivation for the study process, thereby allowing for more efficient learning. Future applications in patient consent and teaching in other medical areas should be explored.","PeriodicalId":12564,"journal":{"name":"Frontiers in Surgery","volume":"28 1","pages":""},"PeriodicalIF":1.8,"publicationDate":"2024-09-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142213854","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}
Pub Date : 2024-09-04DOI: 10.3389/fsurg.2024.1467940
Savvas Lampridis, Marco Scarci, Robert J. Cerfolio
Interprofessional education, an approach where healthcare professionals from various disciplines learn with, from, and about each other, is widely recognized as an important strategy for improving collaborative practice and patient outcomes. This narrative review explores the current state and future directions of interprofessional education in cardiothoracic surgery. We conducted a literature search using the PubMed, Scopus, and Web of Science databases, focusing on English-language articles published after 2000. Our qualitative synthesis identified key themes related to interprofessional education interventions, outcomes, and challenges. The integration of interprofessional education in cardiothoracic surgery training programs varies across regions, with a common focus on teamwork and interpersonal communication. Simulation-based training has emerged as a leading modality for cultivating these skills in multidisciplinary settings, with studies showing improvements in team performance, crisis management, and patient safety. However, significant hurdles remain, including professional socialization, hierarchies, stereotypes, resistance to role expansion, and logistical constraints. Future efforts in this field should prioritize deeper curricular integration, continuous faculty development, strong leadership support, robust outcome evaluation, and sustained political and financial commitment. The integration of interprofessional education in cardiothoracic surgery offers considerable potential for enhancing patient care quality, but realizing this vision requires a multifaceted approach. This approach must address individual, organizational, and systemic factors to build an evidence-based framework for implementation.
跨专业教育是各学科医护人员相互学习、相互借鉴和相互了解的一种方法，被广泛认为是改善合作实践和患者治疗效果的重要策略。这篇叙述性综述探讨了心胸外科跨专业教育的现状和未来发展方向。我们使用 PubMed、Scopus 和 Web of Science 数据库进行了文献检索，重点检索 2000 年以后发表的英文文章。我们的定性综述确定了与跨专业教育干预、成果和挑战相关的关键主题。不同地区心胸外科培训项目中的跨专业教育整合各不相同，但共同的重点是团队合作和人际沟通。基于模拟的培训已成为在多学科环境中培养这些技能的主要方式，研究显示，模拟培训可提高团队绩效、危机管理和患者安全。然而，巨大的障碍依然存在，包括职业社会化、等级制度、刻板印象、对角色扩展的抵制以及后勤限制。该领域未来的工作应优先考虑更深入的课程整合、持续的师资发展、强有力的领导支持、有力的成果评估以及持续的政治和财政承诺。心胸外科跨专业教育的整合为提高患者护理质量提供了巨大的潜力，但实现这一愿景需要采取多方面的方法。这种方法必须考虑到个人、组织和系统因素，以建立一个以证据为基础的实施框架。
{"title":"Interprofessional education in cardiothoracic surgery: a narrative review","authors":"Savvas Lampridis, Marco Scarci, Robert J. Cerfolio","doi":"10.3389/fsurg.2024.1467940","DOIUrl":"https://doi.org/10.3389/fsurg.2024.1467940","url":null,"abstract":"Interprofessional education, an approach where healthcare professionals from various disciplines learn with, from, and about each other, is widely recognized as an important strategy for improving collaborative practice and patient outcomes. This narrative review explores the current state and future directions of interprofessional education in cardiothoracic surgery. We conducted a literature search using the PubMed, Scopus, and Web of Science databases, focusing on English-language articles published after 2000. Our qualitative synthesis identified key themes related to interprofessional education interventions, outcomes, and challenges. The integration of interprofessional education in cardiothoracic surgery training programs varies across regions, with a common focus on teamwork and interpersonal communication. Simulation-based training has emerged as a leading modality for cultivating these skills in multidisciplinary settings, with studies showing improvements in team performance, crisis management, and patient safety. However, significant hurdles remain, including professional socialization, hierarchies, stereotypes, resistance to role expansion, and logistical constraints. Future efforts in this field should prioritize deeper curricular integration, continuous faculty development, strong leadership support, robust outcome evaluation, and sustained political and financial commitment. The integration of interprofessional education in cardiothoracic surgery offers considerable potential for enhancing patient care quality, but realizing this vision requires a multifaceted approach. This approach must address individual, organizational, and systemic factors to build an evidence-based framework for implementation.","PeriodicalId":12564,"journal":{"name":"Frontiers in Surgery","volume":"1 1","pages":""},"PeriodicalIF":1.8,"publicationDate":"2024-09-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142213857","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}
Pub Date : 2024-09-03DOI: 10.3389/fsurg.2024.1440418
Jinfu Zuo, Rong Wang, Xiaoting Fan, Haixia Zhang, Zhaohui Zhai, Huachang Sun
The aim of this report was to evaluate the efficacy of nasal reconstruction using auricular cartilage combined with auricular full-thickness skin graft and a local flap from the right nasal ala for correcting complex nasal defects, and its impact on the patient's quality of life and psychological well-being. We present the case of a 50-year-old female with a severe nasal deformity due to a car accident, characterized by a missing right alar flap and an exposed right nostril. The patient underwent nasal reconstructive surgery using auricular cartilage combined with an auricular full-thickness skin graft and a local flap from the right nasal ala. Detailed records of the patient's postoperative recovery, surgical outcomes, and satisfaction were made at follow-up. The survival rate of the grafted skin and flaps on the nasal ala, septum, and dorsum was high. The reconstructed right nasal ala closely resembled the left, and the patient was very satisfied. In patients with complex nasal deformities, nasal reconstruction using ear cartilage combined with auricular full-thickness skin grafts and local flaps can achieve satisfactory aesthetic and functional outcomes. The high level of postoperative satisfaction suggests that this technique significantly improves patients’ quality of life and psychological well-being.
{"title":"Frontiers | Total words: 2377, Figures: 2 Clinical Effect of Combining Auricular Cartilage, Full-Thickness Auricular Skin Graft, and Local Flap from the Right Nasal Ala in Complex Nasal Defect Reconstruction","authors":"Jinfu Zuo, Rong Wang, Xiaoting Fan, Haixia Zhang, Zhaohui Zhai, Huachang Sun","doi":"10.3389/fsurg.2024.1440418","DOIUrl":"https://doi.org/10.3389/fsurg.2024.1440418","url":null,"abstract":"The aim of this report was to evaluate the efficacy of nasal reconstruction using auricular cartilage combined with auricular full-thickness skin graft and a local flap from the right nasal ala for correcting complex nasal defects, and its impact on the patient's quality of life and psychological well-being. We present the case of a 50-year-old female with a severe nasal deformity due to a car accident, characterized by a missing right alar flap and an exposed right nostril. The patient underwent nasal reconstructive surgery using auricular cartilage combined with an auricular full-thickness skin graft and a local flap from the right nasal ala. Detailed records of the patient's postoperative recovery, surgical outcomes, and satisfaction were made at follow-up. The survival rate of the grafted skin and flaps on the nasal ala, septum, and dorsum was high. The reconstructed right nasal ala closely resembled the left, and the patient was very satisfied. In patients with complex nasal deformities, nasal reconstruction using ear cartilage combined with auricular full-thickness skin grafts and local flaps can achieve satisfactory aesthetic and functional outcomes. The high level of postoperative satisfaction suggests that this technique significantly improves patients’ quality of life and psychological well-being.","PeriodicalId":12564,"journal":{"name":"Frontiers in Surgery","volume":"12 1","pages":""},"PeriodicalIF":1.8,"publicationDate":"2024-09-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142213855","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}
Pub Date : 2024-09-03DOI: 10.3389/fsurg.2024.1395518
Junyi Gao, Qing Zhao, Yi Cheng
BackgroundAn intra-aortic balloon pump (IABP) is a mechanical circulatory device frequently used in patients undergoing coronary artery bypass grafting (CABG). As a treatment for perioperative haemodynamic instability, IABP insertion often implicates an adverse outcome. This study aimed to investigate the age- and sex-related disparity in risk factors for perioperative IABP insertion in CABG patients.MethodsA total of 2,460 CABG patients were included and divided into subgroups by age (elderly subgroup, ≥65 years; young subgroup, <65 years) and sex. Basic characteristics were compared between IABP and non-IABP patients in the overall patient group and the subgroups. Multivariate logistic analysis was used to investigate the significant risk factors for perioperative IABP application, and interaction effects among the potential risk factors were analysed. Combined receiver operating characteristic analysis was used to evaluate the prediction value of combined risk factors.ResultsThe overall patient group had a mean age of 61.5 years. The application rate of perioperative IABP was 8.0%. A left ventricular ejection fraction (LVEF) <50% significantly correlated with perioperative IABP application in the overall patient group and the subgroups. Traditional factors such as myocardial infarction history, atrial fibrillation history, and intraoperative estimated blood loss were significant risk factors in certain subgroups. Small dense low-density lipoprotein levels were significantly associated with IABP insertion in the male subgroup and young subgroup. The area under the curve of combined risk factors was significantly higher than that of LVEF <50% alone in the overall patient group and subgroups.ConclusionAge- and sex-related differences were present in the risk factor distribution for perioperative IABP insertion in CABG patients.
{"title":"Age- and sex-related differences in risk factors for perioperative intra-aortic balloon pump application in patients undergoing coronary artery bypass grafting","authors":"Junyi Gao, Qing Zhao, Yi Cheng","doi":"10.3389/fsurg.2024.1395518","DOIUrl":"https://doi.org/10.3389/fsurg.2024.1395518","url":null,"abstract":"BackgroundAn intra-aortic balloon pump (IABP) is a mechanical circulatory device frequently used in patients undergoing coronary artery bypass grafting (CABG). As a treatment for perioperative haemodynamic instability, IABP insertion often implicates an adverse outcome. This study aimed to investigate the age- and sex-related disparity in risk factors for perioperative IABP insertion in CABG patients.MethodsA total of 2,460 CABG patients were included and divided into subgroups by age (elderly subgroup, ≥65 years; young subgroup, &lt;65 years) and sex. Basic characteristics were compared between IABP and non-IABP patients in the overall patient group and the subgroups. Multivariate logistic analysis was used to investigate the significant risk factors for perioperative IABP application, and interaction effects among the potential risk factors were analysed. Combined receiver operating characteristic analysis was used to evaluate the prediction value of combined risk factors.ResultsThe overall patient group had a mean age of 61.5 years. The application rate of perioperative IABP was 8.0%. A left ventricular ejection fraction (LVEF) &lt;50% significantly correlated with perioperative IABP application in the overall patient group and the subgroups. Traditional factors such as myocardial infarction history, atrial fibrillation history, and intraoperative estimated blood loss were significant risk factors in certain subgroups. Small dense low-density lipoprotein levels were significantly associated with IABP insertion in the male subgroup and young subgroup. The area under the curve of combined risk factors was significantly higher than that of LVEF &lt;50% alone in the overall patient group and subgroups.ConclusionAge- and sex-related differences were present in the risk factor distribution for perioperative IABP insertion in CABG patients.","PeriodicalId":12564,"journal":{"name":"Frontiers in Surgery","volume":"117 1","pages":""},"PeriodicalIF":1.8,"publicationDate":"2024-09-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142213856","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}
Pub Date : 2024-09-03DOI: 10.3389/fsurg.2024.1449838
Yun Xu, Yang Liu, Din Ding, Bin Ru, Quan Wan, Zhongwei Ji, Wenlong Liu, Ran Guo, Jiaqi Hu, Nannan Zhang, Langhai Xu, Shun Li, Wenjun Cai
ObjectiveTo assess the clinical impact of unilateral laminotomy for bilateral decompression (ULBD) in managing patients with adjacent vertebrae following lumbar fusion.MethodsA retrospective analysis was conducted on 21 patients, with a mean age of 67.4 years, who underwent ULBD for adjacent vertebra disease at our department from January 2021 to November 2023. We reviewed demographic data, surgical techniques, imaging studies, and patient-reported outcomes. The study compared Visual Analog Scale (VAS) scores, Numeric Rating Scale (NRS) scores, Japanese Orthopaedic Association (JOA) scores, Short Form-36 (SF-36) scores, and imaging outcomes before surgery, immediately post-surgery, and at 1 month, 6 months, and 12 months post-surgery.ResultsEvaluation of 21 patients with adjacent segment disease (ASD) (13 males, 8 females; mean age 67.42 years) was performed with follow-ups at various intervals post-surgery. Postoperative VAS, NRS, JOA, and SF-36 scores showed significant improvements compared to preoperative scores. Immediately after surgery, there were significant improvements in NRS score (2.76 ± 0.70 vs. 3.71 ± 0.85, P < 0.05) and JOA score (15.38 ± 1.02 vs. 9.29 ± 1.01, P < 0.05) compared to preoperative scores. Similarly, at 12 months post-surgery, significant improvements were observed in NRS score (1.52 ± 0.51 vs. 3.71 ± 0.85, P < 0.05) and JOA score (25.0 ± 1.10 vs. 9.29 ± 1.01, P < 0.05) compared to preoperative scores. The clinical satisfaction rate was 95.0% among all patients, with postoperative imaging examinations revealing a significant decompression effect. No complications were reported among the surgical patients.ConclusionsThis study suggests that endoscopic ULBD can be a safe and effective technique for managing symptomatic ASD, providing satisfactory clinical outcomes for patients with ASD. Endoscopic ULBD may serve as an alternative treatment option for ASD with lumbar stenosis.
{"title":"Frontiers | Clinical Efficacy of Unilateral Laminotomy for Bilateral Decompression (ULBD) in the Treatment of Adjacent Segment Disease after Lumbar Fusion","authors":"Yun Xu, Yang Liu, Din Ding, Bin Ru, Quan Wan, Zhongwei Ji, Wenlong Liu, Ran Guo, Jiaqi Hu, Nannan Zhang, Langhai Xu, Shun Li, Wenjun Cai","doi":"10.3389/fsurg.2024.1449838","DOIUrl":"https://doi.org/10.3389/fsurg.2024.1449838","url":null,"abstract":"ObjectiveTo assess the clinical impact of unilateral laminotomy for bilateral decompression (ULBD) in managing patients with adjacent vertebrae following lumbar fusion.MethodsA retrospective analysis was conducted on 21 patients, with a mean age of 67.4 years, who underwent ULBD for adjacent vertebra disease at our department from January 2021 to November 2023. We reviewed demographic data, surgical techniques, imaging studies, and patient-reported outcomes. The study compared Visual Analog Scale (VAS) scores, Numeric Rating Scale (NRS) scores, Japanese Orthopaedic Association (JOA) scores, Short Form-36 (SF-36) scores, and imaging outcomes before surgery, immediately post-surgery, and at 1 month, 6 months, and 12 months post-surgery.ResultsEvaluation of 21 patients with adjacent segment disease (ASD) (13 males, 8 females; mean age 67.42 years) was performed with follow-ups at various intervals post-surgery. Postoperative VAS, NRS, JOA, and SF-36 scores showed significant improvements compared to preoperative scores. Immediately after surgery, there were significant improvements in NRS score (2.76 ± 0.70 vs. 3.71 ± 0.85, P < 0.05) and JOA score (15.38 ± 1.02 vs. 9.29 ± 1.01, P < 0.05) compared to preoperative scores. Similarly, at 12 months post-surgery, significant improvements were observed in NRS score (1.52 ± 0.51 vs. 3.71 ± 0.85, P < 0.05) and JOA score (25.0 ± 1.10 vs. 9.29 ± 1.01, P < 0.05) compared to preoperative scores. The clinical satisfaction rate was 95.0% among all patients, with postoperative imaging examinations revealing a significant decompression effect. No complications were reported among the surgical patients.ConclusionsThis study suggests that endoscopic ULBD can be a safe and effective technique for managing symptomatic ASD, providing satisfactory clinical outcomes for patients with ASD. Endoscopic ULBD may serve as an alternative treatment option for ASD with lumbar stenosis.","PeriodicalId":12564,"journal":{"name":"Frontiers in Surgery","volume":"190 1","pages":""},"PeriodicalIF":1.8,"publicationDate":"2024-09-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142269432","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}
Pub Date : 2024-09-02DOI: 10.3389/fsurg.2024.1433273
Marco Battistelli, Federico Valeri, Manuela D’Ercole, Alessandro Izzo, Alessandro Rapisarda, Filippo Maria Polli, Nicola Montano
IntroductionThe paraspinal approach was first introduced in 1968 and later refined by Leon Wiltse to gain access to the lateral interevertebral foraminal region. However, challenges can arise due to unfamiliarity with this approach, unique patient anatomy, or in case of revision surgery, potentially elevating the risk of complications and/or poor outcome.MethodsHere we report on two cases in which the intraoperative Oarm CT neuronavigation was used during a Wiltse approach. Under general anesthesia, the spinous process near the surgical level is exposed through a midline incision. The patient's reference anchor is then attached to the exposed spinous process. Intraoperative CT is acquired and transferred to the Stealth Station S8 Surgical Navigation System (Medtronic). The Wiltse approach is now performed through a paramedian incision under neuronavigation guidance and perfectly tailored to the patient's unique anatomy.ResultsThe first case was a patient harboring a left lumbar intraextraforaminal schwannoma and the second one was a patient with an extraforaminal lumbar disc herniation at the adjacent level of a previous lumbar instrumentation. We were able to easily identify and remove both the lesions minimizing the surgical approach with no complication and optimal clinical outcome.Discussion and ConclusionOur cases demonstrate the feasibility of application of intraoperative O-arm CT-neuronavigation to the Wiltse approach. In our opinion, this technique helps in minimizing the surgical approach and rapidly identifying the lesion of interest. Further studies are needed to address the effective utility and advantages of intraoperative CT-neuronavigation in this specific surgical scenario.
引言脊柱旁入路于1968年首次提出，后经Leon Wiltse改进，可进入椎间孔外侧区域。然而，由于对该方法不熟悉、患者解剖结构特殊或翻修手术等原因，可能会出现一些挑战，从而潜在地增加了并发症和/或不良结果的风险。在全身麻醉下，通过中线切口暴露手术水平附近的棘突。然后将患者的参考锚连接到暴露的棘突上。获取术中 CT 并将其传输到 Stealth Station S8 手术导航系统（美敦力）。第一个病例是一名患有左腰椎椎间孔内分裂瘤的患者，第二个病例是一名患有椎间孔外腰椎间盘突出症的患者。讨论与结论：我们的病例证明了将术中 O 型臂 CT 神经导航应用于 Wiltse 入路的可行性。我们认为，这项技术有助于最大限度地减少手术入路，并快速确定感兴趣的病灶。我们需要进一步研究术中 CT 神经导航在这种特殊手术情况下的有效实用性和优势。
{"title":"The use of intraoperative CT-neuronavigation in Wiltse approach. A technical note","authors":"Marco Battistelli, Federico Valeri, Manuela D’Ercole, Alessandro Izzo, Alessandro Rapisarda, Filippo Maria Polli, Nicola Montano","doi":"10.3389/fsurg.2024.1433273","DOIUrl":"https://doi.org/10.3389/fsurg.2024.1433273","url":null,"abstract":"IntroductionThe paraspinal approach was first introduced in 1968 and later refined by Leon Wiltse to gain access to the lateral interevertebral foraminal region. However, challenges can arise due to unfamiliarity with this approach, unique patient anatomy, or in case of revision surgery, potentially elevating the risk of complications and/or poor outcome.MethodsHere we report on two cases in which the intraoperative Oarm CT neuronavigation was used during a Wiltse approach. Under general anesthesia, the spinous process near the surgical level is exposed through a midline incision. The patient's reference anchor is then attached to the exposed spinous process. Intraoperative CT is acquired and transferred to the Stealth Station S8 Surgical Navigation System (Medtronic). The Wiltse approach is now performed through a paramedian incision under neuronavigation guidance and perfectly tailored to the patient's unique anatomy.ResultsThe first case was a patient harboring a left lumbar intraextraforaminal schwannoma and the second one was a patient with an extraforaminal lumbar disc herniation at the adjacent level of a previous lumbar instrumentation. We were able to easily identify and remove both the lesions minimizing the surgical approach with no complication and optimal clinical outcome.Discussion and ConclusionOur cases demonstrate the feasibility of application of intraoperative O-arm CT-neuronavigation to the Wiltse approach. In our opinion, this technique helps in minimizing the surgical approach and rapidly identifying the lesion of interest. Further studies are needed to address the effective utility and advantages of intraoperative CT-neuronavigation in this specific surgical scenario.","PeriodicalId":12564,"journal":{"name":"Frontiers in Surgery","volume":"18 1","pages":""},"PeriodicalIF":1.8,"publicationDate":"2024-09-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142213858","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}
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