Surgical Innovation最新文献

Background: In surgical simulation, evaluation tools are necessary to allow the overall and specific level of each gesture to be assessed for learners, to allow active feedback and follow-up. The aim of this study was to create and validate a scale for the assessment of competences for neck dissection (ND) and total laryngectomy (TL) in head and neck surgical oncology simulation specific for revascularized cadavers' models.

Methods: Two independent scales were created for ND and TL based on a two-round Delphi method. The scales were used during ND and TL simulation sessions on SimLife® (Symedis, Poitiers, France) model. Surgical steps were scored by 2 independent observers. To assess its ease of use, a questionnaire was answered by senior surgeons (SS) at the end of the sessions.

Results: Fifteen items were included in the final version for ND scale and 20 for TL scale. The results of 14 lateral ND and 8 TL were included. The mean score was higher for SS (69 ± 6.4; 87.5 ± 8.5) than for residents (36.5 ± 11; 57.5 ± 13.2) for ND (P = 0.0006) and TL (P = 0.028) respectively. Six SS strongly agreed that this tool had a positive impact on resident training with stepwise feedback and accurately represented their competences.

Conclusion: We developed a pedagogic tool built to assess surgical competence for head and neck surgical oncology on revascularized cadaver models. This tool has a good construct validity thanks to the expert reviewing with Delphi method and appears to have fine acceptability by the SS.

Purpose: This study sought to compare screw placement accuracy and outcomes between freehand (FH) and AR-guided pelvic fixation. While pelvic fixation is a critical technique in spinal deformity surgery, S2-alar iliac (S2AI) screw placement poses challenges.

Methods: We conducted a case-control study of 50 consecutive patients who underwent spinopelvic fixation at a single institution. AR guidance was performed using a head-mounted display (Xvision, Augmedics). Patient demographics, surgical characteristics, spinopelvic parameters, and screw breach grade were compared using univariate and multivariate statistics.

Results: Pelvic fixation was performed FH in 21 patients (median age, 64; female, 38.1%; median BMI 32.3 kg/m²) and AR-guided in 29 patients (median age, 66; female, 51.7%; median BMI 28.4 kg/m²). Mean follow-up was longer in the FH group (28 mos vs 11 mos, P < 0.001). Pelvic fixation in the FH group was performed using either S2AI (90.5%) or dual S2AI (9.5%) screws. There were no significant differences in length of surgery (FH, 439 minutes; AR, 490 minutes; P = 0.1) or estimated blood loss (FH, 2.1L; AR, 1.9L; P = 0.7). Accuracy of FH pelvic fixation was 95.6% (43/45 screws) and accuracy of AR pelvic fixation was 96.5% (55/57 screws). Multivariable logistic regression for screw breach revealed no significant association with AR guidance when controlling for age, BMI, osteoporosis, and smoking.

Conclusions: We present the first case-control study of AR-guided spinopelvic fixation, with findings suggesting parity between FH and AR-guidance, serving as foundation for prospective controlled studies with longitudinal follow-up to interrogate the benefits of AR-guidance in spinal deformity surgery.

Background: Intrahepatic cholangiocarcinoma (ICC) presents a significant clinical challenge due to its high fatality rate and limited surgical candidacy. With only 30-40% of patients eligible for surgery upon diagnosis, alternative therapies are imperative. This study assesses the efficacy of Yttrium-90 (Y-90) radioembolization for unresectable ICC patients in a non-university tertiary care center (NUTCC).

Methods: A retrospective analysis of 15 unresectable ICC patients treated with Y-90 radioembolization was conducted. Tumor response, survival, and adverse events were evaluated using RECIST criteria.

Results: 60% of patients exhibited partial response, and 20% showed stable disease, with notable tumor size reduction and a median survival of 14 months. Minimal adverse effects were observed, indicating Y-90's favorable safety profile.

Conclusion: Y-90 radioembolization shows potential in reducing tumor burden and enhancing survival rates with minimal adverse effects for unresectable ICC. Larger prospective studies are needed to confirm its efficacy and define its role in ICC treatment protocols.

Background: In difficult colorectal cases, surgeons may opt for a hand-assisted laparoscopic (HALS) colectomy or attempt a laparoscopic surgery that may require an unplanned conversion to open (LCOS). We aimed to compare the clinical outcomes of these 2 types of surgeries.

Methods: Colectomies for acute diverticulitis with a HALS or LCOS surgery were selected from the American College of Surgeons (ACS) National Surgical Quality Improvement Program (NSQIP) 2022 Targeted Colectomy Database. After confirming a difference in propensity scores between the cohorts, they were matched using propensity score matching (PSM) based on preoperative factors. RStudio was utilized for filtering and performing the PSM, while Minitab was used for statistical analysis.

Results: We identified 804 HALS colectomies and 284 LCOS colectomies. After PSM, both cohorts contained 284 patients. Absolute standardized mean errors for all matched factors were less than 0.1, confirming well-balanced cohorts. Following PSM, preoperative and perioperative factors were similar between both colectomy groups. Postoperatively, HALS surgeries had a shorter average length of stay (7.67 ± 0.38 vs 10.57 ± 0.41, P < 0.001) as well as lower rates of ileus (13.73% vs 22.54%, P = 0.007) and superficial surgical site infection (2.11% vs 5.28%, P = 0.045).

Conclusion: To the best of our knowledge, this is the first national database study comparing HALS and LCOS colectomies. After accounting for confounding variables, our PSM analysis showed the benefits of HALS colectomies for acute diverticulitis. Future studies may use single-center data containing risk adjustment profiles to create an even more uniform comparison.

Background: Transabdominal pre-peritoneal inguinal hernia repair using the da Vinci Single-Port robot (SP-TAPP) is currently performed in few centers. We aimed to define the learning curve for SP-TAPP by analyzing operative times.

Methods: The operative times of 122 SP-TAPP performed between 2019 and 2024 were retrospectively analyzed. The following phases were analyzed: docking time (DT); pre-robot time (PRT, from skin incision to side cart placement); flap closure time (FCT); console time (CT), and overall time (OT). Cumulative sum analysis (CUSUM) was used to analyze learning curves. Surgical and 30-day outcome were analyzed.

Results: The DT has remained constant over time (P > 0.9). PRT was divided into 3 phases with n1 = 5, n2 = 95 and n3 = 4, in which there was a progressive decrease in time (14.8 vs 11.9 vs 6.8 min; P = 0.08). In FCT and CT, 3 phases were identified in which times remained stable (P > 0.9 and P = 0.7). CUSUM analysis of OT identified 3 phases consisting of n1 = 13, n2 = 100 and n3 = 9 in which there was a progressive decrease in times (82 vs 72 vs 62 min; P = 0.3). Analysis of complications and early surgical outcomes did not differ except for estimated blood loss, although this was a clinically insignificant finding.

Conclusions: The learning curve for SP-TAPP is rapid and it shows how the technical skills are transferable between the multiport platform and the da Vinci Single Port robotic system for an experienced surgeon. An improvement is evident in PRT and OT, also compared to multiport systems, showing a potential for the platform to increase surgical activity.

Background: This study evaluates the feasibility of Apple Vision Pro goggles as an augmented reality (AR) surgical navigation tool for laparoscopic-assisted ultrasound-guided radiofrequency ablation (RFA) of liver tumors. Traditional RFA is effective but challenging due to the integration of multiple imaging modalities.Purpose: The primary aim of this research is to assess how Vision Pro goggles can enhance the surgical navigation process during RFA, improving tumor localization and the overall effectiveness of the procedure.Research Design: A feasibility study design was used to analyze the implementation of AR technologies in surgical navigation, focusing specifically on their application in laparoscopic surgeries.Study Sample: Participants included patients undergoing laparoscopic-assisted ultrasound-guided RFA, with pre-operative imaging workups involving CT and MRI scans followed by intraoperative laparoscopic sonography.Data Collection and/or Analysis: Data were collected through observations during surgical procedures using the Vision Pro goggles, which displayed various imaging inputs (MRI, 3D reconstruction, and laparoscopic sonography) in the surgeon's field of view. Image manipulation was assessed based on accuracy and effectiveness of tumor ablation.Results: The goggles enhanced tumor localization accuracy and facilitated real-time image manipulation, resulting in effective tumor ablation. Initial results show promising outcomes in the precision and efficiency of the RFA procedure.Conclusions: While the initial results are promising, larger studies are necessary to validate the technology's efficacy and safety. Future research should compare outcomes with traditional methods and explore its applicability to other surgeries, aiming to refine the system further. The Vision Pro goggles potentially represent a significant advancement in surgical technology by improving RFA precision and efficiency.

Background: Near-infrared fluorescence (NIF)-mapping with indocyanine green dye (ICG) facilitates the identification of the intersegmental plane during minimally invasive segmentectomy. Our pilot study showed that ICG is associated with an increase in oncological margin distance from the tumour, greater than the surgeon's best judgment. We hypothesized that, with greater experience, the surgeon's judgement will improve, and the benefit of ICG will diminish.

Methods: This is a phase 2 single-arm trial of patients undergoing robotic-assisted segmentectomy for NSCLC tumours less than 3 cm. After isolating the diseased segment(s), the predicted intersegmental plane (Dp) was identified by the thoracic surgeon. After intravenous ICG injection, the true intersegmental plane (Dt) was revealed using NIF. The primary outcome was the average distance between Dt and Dp (Dt-Dp). Comparisons were performed across 3 temporal tertiles: tertile 1 (t1) comprised of the first 30 participants, and the remaining participants were divided equally for tertiles 2 (t2) and 3 (t3). Kruskal-Wallis test was used to compare differences between tertiles (α = 0.05).

Results: A total of 190 patients were enrolled from October 2016 to June 2021. The median age was 68 (interquartile range:62-72), and 57.37%(109/190) were women. ICG injection occurred in 60.53%(115/190) of the participants, and intersegmental plane visualization was achieved in 88.70%(102/115). Dt-Dp diminished significantly across tertiles: t1 = 20.65 ± 15.82 mm, t2 = 2.42 ± 15.49 mm, and t3 = 1.36 ± 9.87 mm (P = 0.0001). Locally estimated scatterplot smoothing revealed that this distance approaches zero as the surgeon performs more cases.

Conclusion: In our single-surgeon experience with robotic-assisted segmentectomy for NSCLC, the added value of NIF-mapping with ICG diminishes with surgeon experience.

Backgroud: Perirenal hematoma (PRH) is a notable complication following percutaneous nephrolithotomy (PCNL) with significant implications for patient outcomes. This study aimed to develop a nomogram predictive model for PRH after PCNL.

Methods: Retrospective data from patients who underwent PCNL were analyzed. Patient demographics, stone characteristics, and operative details were assessed for their association with PRH using univariate and multivariate analyses. A nomogram was constructed based on identified predictors.

Results: Among 1047 patients, 6.2% developed PRH. Factors significantly associated with PRH included age, urine culture, stone surface area, operative time and estimate blood loss. These factors were incorporated into the nomogram, providing a user-friendly tool for preoperative risk assessment of PRH following PCNL.

Conclusion: We developed a nomogram predictive model for PRH after PCNL, facilitating individualized risk assessment and preventive strategies. Implementation of this nomogram may enhance patient safety and optimize surgical outcomes in PCNL procedures. Further validation studies are warranted to assess its generalizability and accuracy.

Objective: The endoscopic transsphenoidal approach is commonly used for sellar and suprasellar pathologies. However, reaching above the diaphragma sella, especially for posterosuperior and retrocavernous orientation, still poses some challenges. We designed and developed a steerable tip suction cannula (STSC) that has distinct leverage for endoscopic resection of such pathologies.

Methods: The entire suction cannula is made of stainless steel. The instrument consists of a handle, vacuum tube, suction tip bed, suction tip, finger knuckle, wire path, countersunk headpin, and isolated steel wire. The working principle of the product is to enable the surgeon to move the aspiration tip in the desired direction by steering the finger knuckle. Five cadaveric specimens fixed with the saturated salt solution were used to evaluate the instrument and obtain measurements.

Results: In the straight position, the STSC aspirated 2.67% slower than the control aspirator tip and 13.24% faster than that at 30° angulation. Based on the CT measurements, the mean angulation of the instrument from the frontobasal axis was 38.3°. The mean distance from the frontobasal axis was 1.3 cm. The average angulation of the tip of the instrument in the cranium was 25.5°.

Conclusion: The designed STSC might effectively resect large to giant pituitary adenomas, especially those with supradiaphragmatic extension. Its suction capability is comparable to that of conventional suction tubes.