Surgical Innovation最新文献

Background: Joseph Pancoast (1805-1882), a prominent figure in 19th-century surgery and medical education, introduced several innovative surgical techniques during his careerPurpose: While he made significant contributions to various areas of surgery, including plastic surgery and anatomy, his techniques were particularly notable for their precision and efficacy.Results: Some of his surgical innovations are the facial grafting especially in rhinoplasty either by using a forehead graft or by using a graft from the cheeks. He introduced his own operation for Staphyloplasty by dissecting two flaps of mucous membrane having a triangular shape and contributed also in taliacotian operation, blepharoplasty, otoplasty, cheiloplastic operation in case of lip cancer, amputations at the hip-joint, ocular deformities and tongue cancer restoration. In ocular surgery he had produced a fine needle turned into a hook in order to be inserted behind the cornea to cut deeply the soft parts of the lens and withdraw any hardened nucleus.

Background: Robotic thyroidectomy is gaining popularity, yet its role in completion thyroidectomy remains unclear. We aimed to compare robotic vs conventional completion thyroidectomy for thyroid nodules.

Methods: This retrospective study analyzed patients undergoing completion thyroidectomy from 2010-2020, either by conventional open technique (n = 87) or a robotic remote-access approach (n = 44). Outcomes were compared between groups.

Results: A total of 131 patients were included. The robotic cohort was younger (45.3 ± 14.0 vs 55.5 ± 14.5 years, P < 0.001) with a lower BMI (25.9 ± 5.5 vs 33.7 ± 7.8 kg/m², P < 0.001). Operative time was longer for robotic procedures (139 min vs 99 min, P < 0.001). Hospital stay was shorter after robotic surgery, with 25% discharged the same day as compared to 5.7% in the open thyroidectomy cohort (P = 0.006). Overall rates of complication were comparable (P = 0.65). Transient recurrent laryngeal nerve palsy occurred in 4.6% of patients, which was similar between both cohorts (P = 0.66).

Conclusion: Robotic completion thyroidectomy appears safe and effective, achieving shorter hospitalization than conventional open approaches despite longer operative times. Appropriate patient selection and surgical technique optimization are key. Larger prospective studies should investigate costs and long-term patient-reported outcomes.

Background: Surgical reconstruction is a crucial stage in various surgeries, including pancreaticoduodenectomy, as it can significantly affect the surgical results. The objective was to design a suture force feedback (SFF) device that can precisely measure the suture force during surgical closures. Afterward, the device was used to train junior surgeons in surgical closure techniques.

Methods: The SFF was used to capture the suture force data of experienced surgeons. This data was utilized to train and assess junior surgeons. The SFF device had 2 tactile-based force sensors that measured the applied force. Whenever the applied force was not within the optimal force range, the device provided feedback to the surgeon. A workshop was conducted to train junior surgeons in surgical closure techniques to improve their suturing skills.

Results: Thirty-seven junior surgeons were enrolled in this training, of whom only 24 completed the 30-day training program. The pre-assessment results revealed that the force exerted by junior surgeons during suture knot-tying was uneven compared with that of the experienced surgeons, with a significant difference in the force exerted per knot throw (P = 0.005. Before the training program, junior surgeons applied a force of 3.89 ± 0.43 N, which was more than twice the force applied by experienced surgeons (1.75 ± 0.12 N). However, after completing the 30-day training program, their force improved to 2.35 ± 0.13 N.

Conclusions: The SFF device was shown to be an encouraging training tool for improving the surgical closure dexterity and technique of the participating junior surgeons.

Background: Plastic surgeons use loupes or operative microscope to aid in tissue dissection and anastomosis of structures. These devices have their own limitations in areas of visualization and weight. Current uses of augmented and virtual reality in surgery have been limited to operative planning and simulation. We present a proof of concept that harnesses video passthrough AR technology to augment the capabilities of loupes.

Methods: We first evaluated methods of gaze-based eye tracking to enable digital magnification. Using the Varjo XR-1 mixed reality headset, we compared discrete zoom through displayed pop-up menu vs continuous zoom through eye winking. Six participants were recruited to perform skin suturing simulation and completed a survey and interview. Next we assessed the performance and limitations of AR digital magnification. Varjo XR-3 was utilized to address the hardware limitations. Participants performed anastomotic suturing tasks with progressively finer suture, then completed a survey and interview.

Findings: There was no strong preference between zoom methods, although participants felt the discrete zoom was easier to use. Participants had difficulty determining depth and visualizing the suture due to limitations of digital magnification. Using Wilcoxon rank sum test to examine differences in system usability scale, the Phase 2 user experience had significant difference in percentile distribution (P 0.0390).

Conclusion: Virtual loupes may be a valuable tool for plastic surgeons, with potential for variable magnification and advanced visualization. Improvements in the hardware yielded higher ratings of system usability and user experience. Further development is needed to address the limitations of existing devices.

Purpose: Femoral hernia accounts for 22% of groin hernia operations in women and for 1.1% in men. Numerous surgical approaches have been reported but there is no consensus. Many of the recurrence rates are reported in old literature, while recent reports are scarce. The aim of the present study was to review rates of recurrences in patients who underwent open repair of a primary femoral hernia.

Methods: We conducted a systematic search in the electronic literature, using the search terms "femoral hernia" and "recurrence". We included studies published from 2002 that had as primary or secondary endpoint to evaluate the recurrence after surgery. Risk of bias was assessed by the Cochrane risk of bias tool for RCT and by the Newcastle-Ottawa Scale for cohort studies.

Results: Fifteen eligible articles were included in our systematic review. A total of 1087 procedures were performed according to the defined criteria. The metanalytic evaluation highlighted a higher probability of recurrence for non-mesh than mesh repairs (6.5% vs 1.9%; RR 0.924, 95% CI: 0.857 - 0.996). In patients treated in emergency settings the rate of recurrences was 3.7%; in patients who received elective repairs it was 0.71%. Six studies reported that most of recurrences occurred within the first post-operative year.

Conclusion: We found that crude recurrence rate after open repair of a primary femoral hernia is about 4%. This rate is higher in case of non-mesh techniques and in emergency surgery. Our results support the recommendation that femoral hernias should be repaired with mesh techniques.

Background: Operation with a 3D exoscope has recently been introduced in clinical practice. The exoscope consists of two cameras placed in front of the operative field. Images are shown on a large 3D screen with high resolution. The system can be used to enhance precise dissection and provides new possibilities for improved ergonomics, fluorescence, and other optical-guided modalities.

Methods: Initial experience with the ultra-high-definition (4K) 3D exoscope in thyroid and parathyroid operations. The exoscope (OrbEye^TM) was mounted on a holding system (Olympus).

Results: We used the exoscope in parathyroidectomy (N = 6) and thyroidectomy (N = 6). Immediate advantages and disadvantages were discussed and recorded. The learning curve for use of the exoscope may be shorter for surgeons with training in endoscopic or robotic procedures. There may be improved ergonomics compared with normal open-neck operations. Further, the optical guided operations can be used with fluorescence and have potential for different on-lay techniques in the future. The 4 K 3D image quality is state-of-art and is highly appreciated during fine surgical dissection and eliminates the need for loupes.

Conclusion: In several ways, using the ORBEYE™ in thyroid and parathyroid surgery provides the surgical team with a new and enhanced experience. This includes improved possibility for teaching, surgical ergonomics, and a 4K 3D camera with a powerful magnification system. However, it is not clear if utilization of these features would improve surgical outcomes. Furthermore, the ORBEYE™ lacks incorporation of parathyroid autofluorescence, and the current costs for the system do not facilitate general access to exoscope assisted operations.

Background: The effectiveness of laparoscopic nephroureterectomy (LNU) vs open nephroureterectomy (ONU) for upper tract urothelial carcinoma (UTUC) is unclear.

Methods: We conducted a meta-analysis of studies based on propensity score-matched cohorts to compare the surgical and oncological outcomes of LNU and ONU in UTUC patients. A literature search was conducted on PubMed, Embase, and Cochrane Library until July 12, 2023. The Newcastle-Ottawa Scale was utilized to assess the quality of eligible studies. Measurements of surgical and oncological outcomes were extracted and pooled including mean difference (MD), risk ratio (RR), hazard ratios (HR), and 95% confidence intervals (CI).

Results: Five high-quality retrospective studies were included, totaling 6422 patients; 2080 (32.4%) underwent LNU, and 4342 (67.6%) underwent ONU. With respect to surgical outcomes, patients in the LNU group experienced less estimated blood loss and had shorter hospital stay than those in the ONU group, but there was no significant difference in complication rates and operation time. In regard to oncological outcomes, there were no significant differences between the LNU and ONU groups in 3-year overall survival (OS) and cancer-specific survival (CSS). However, 3-year intravesical recurrence free survival (IVRFS) was worse in the LNU group compared to the ONU group.

Conclusion: LNU was associated with less estimated blood loss and shorter hospital stays than ONU, but there were no differences in OS and CSS between the surgical modalities. Nonetheless, LNU might result in poorer IVRFS than ONU.

Background: Adherence to preoperative weight loss recommendations may serve as a surrogate for the level of engagement in hiatal hernia (HH) patients. This study aims to evaluate the relationship between achieving preoperative weight loss goals and outcomes after HH repair.

Methods: A retrospective review of 235 patients undergoing laparoscopic HH repair at a single institution was performed. Patients were grouped based on the percentage of weight loss goal achieved. Low achievement was defined as the bottom quartile of goal achievement (≤75%); high achievement was defined as the top quartile (≥140%). Baseline characteristics, clinical outcomes, and patient reported outcomes (PROMs) were compared between groups.

Results: 131/235 (55.7%) achieved their weight loss goal. No differences in baseline characteristics or clinical outcomes were observed between the low and high achievement groups. While both groups experienced improvements in PROMs postoperatively, patients in the high achievement group demonstrated significantly lower symptom burden at one-month postoperatively. Further, high-achievement patients were more likely to experience complete resolution of common HH symptoms at one-month postoperatively, including no difficulty swallowing food, no breathing difficulties or choking episodes, no choking when eating food, no choking when drinking liquid, and no regurgitation of food or liquid.

Conclusions: In patients undergoing laparoscopic HH repair, patients achieving their preoperative weight loss goals experienced less overall symptom burden and lower prevalence of common symptoms one-month postoperatively than those with low levels of goal achievement. These results demonstrate that patients can take an active role in improving their own surgical outcomes and health status.

Aims & objectives: The primary aim of this paper is to determine whether smart glasses or head-mounted displays improve efficiency in a procedural or theatre setting without compromising the quality of the procedure performed. Additionally, this paper aims to qualitatively explore applications in surgical education, whilst on-call, consulting and patient observation.

Design: This paper is a systematic review of the literature available on the topic of smart glasses or head-mounted displays in surgical or procedural settings.

Methods: A search of Pubmed, Cochrane and the Wiley Online Library was performed in accordance with the PRISMA guidelines. Procedural times and adverse outcomes were compared between the smart glass and non-smart glass groups in each of the quantitative studies. A literature review of studies, including those not satisfying the primary aim was conducted and is included in this paper.

Results: 32 studies were identified that complied with the inclusion criteria of this paper. 8 of these studies focused on procedural times and adverse outcomes, with and without smart glass usage. Procedural time was reduced when smart glass technology was used, without an increase in adverse patient outcomes.

Conclusions: Surgeons should consider whether the relatively short reduction in procedural time is worth the high cost, privacy issues, battery complaints and user discomfort involved with these devices. There are promising applications of this technology in the areas of surgical education and consultation. However, more trials are necessary to assess the value of using smart glasses in these settings.