Surgical Innovation最新文献

Introduction: Anastomotic leak (AL) represents a significant complication following gastrointestinal (GI) surgery, contributing to increased morbidity and mortality. pH monitoring has emerged as a potential diagnostic tool for the early detection of AL, but its effectiveness and clinical utility remain to be fully elucidated. This review aims to summarise the evidence regarding perianastomotic pH monitoring for AL detection.

Methods: A systematic search of relevant databases was conducted to identify pre-clinical and clinical studies investigating pH monitoring for AL detection following GI surgery. Studies were screened by two independent reviewers based on predefined inclusion and exclusion criteria. Data were extracted and presented as a narrative synthesis.

Results: A total of 10 studies were included in the review, comprising animal studies (n = 2), and human studies in upper GI (n = 3) and colorectal (n = 5) patients. Consistent findings of lower pH values in patients with AL across various postoperative time points were demonstrated. There was diversity in the pH detection method, in addition to variable frequency and timing of pH monitoring. Four studies reported a shorter time for AL detection with pH monitoring vs conventional methods, although no statistical comparisons were used. No standard pH cut-off value for AL detection was identified.

Conclusion: pH monitoring shows potential as a diagnostic tool for the early detection of AL following GI surgery. While the existing evidence supports its potential utility, further research is required to establish standardised protocols and assess its clinical impact.

Background: Although there is evidence that indocyanine green angiography (ICGA) can predict mastectomy skin flap necrosis during breast reconstruction, consensus on optimal protocol is lacking. This study aimed to evaluate various technical factors which can influence ICG fluorescence intensity and thus interpretation of angiograms.

Method: Single institution retrospective study (2015-2021) of immediate implant-based breast reconstructions postmastectomy using a standardized technique of ICGA, controlling for modifiable factors of ambient lighting, camera distance and ICG dose. "Time to perfusion" assessment was defined as elapsed time from ICG administration to perfusion assessment. Intraoperative "absolute" and "relative" IGCA perfusion values of mastectomy flaps, taken at different time points (30, 60 and 90 seconds), were correlated with postoperative flap outcomes.

Results: There were 260 breast reconstructions with a 3.1% necrosis rate. ICGA perfusion values, when measured at 60 and 90 seconds, were significantly lower for cases that developed necrosis compared to cases that did not, and were both good predictors of necrosis (area under ROC curves, 0.84 and 0.85, respectively). Fluorescence intensity increased as "time to perfusion" assessment increased for flaps that did not develop necrosis (correlation coefficient, 0.9, P < 0.001). Perfusion value cut-off thresholds for predicting necrosis were higher for a longer "time to perfusion" assessment.

Conclusions: A standardized ICGA protocol is recommended as ICG fluorescence intensity increased with "time to perfusion" assessment, and ≤30 seconds did not allow for accurate perfusion analysis. Using a perfusion recording of 60 or 90 seconds, and the corresponding perfusion value cut-off, may optimize reliability of perfusion assessments.

Objective: The Thunderbeat (TB) is a new surgical device that combines ultrasonic and bipolar energy. The objective of this study is to examine how the combined ultrasonic and bipolar shears affect surgical outcomes when compared to other methods.

Data sources and review methods: Using the PRISMA guidelines, the researchers used broad search terms in PubMed, Embase, and Web of Science, which produced a total of 2823 initial results, with years ranging from 1955 to June 2024. After applying inclusion and exclusion criteria, 8 final studies were included in this systematic review and meta-analysis.

Results: This meta-analysis analyzes energy-based devices used on patients into 2 major groups: (1) thyroidectomy group and (2) neck dissection group. The researchers found that the use of the TB in thyroidectomies reduces operative time when compared to the Harmonic scalpel (HS) and Ligasure (LS). The pooled mean difference in thyroidectomy operation time for the TB vs HS was -5.77 min (95% CI: -11.07 to -.48, P-value: .03) and for the TB vs LS was -4.41 min (95% CI: -8.86 to .04, P-value: .05). We also found reduced operative time with the use of the TB vs standard electrocautery for neck dissection, where the mean difference was -39.76 min (95% CI: -63.00 to -16.51, P-value: .00). No significant differences were seen in blood loss or postoperative complications when comparing TB to other methods.

Conclusion: This meta-analysis demonstrated that TB can be equivalent to other energy-based devices and shows potential advantages over traditional electrocautery.

In recent days, bone cancer is a life-threatening health issue that can lead to death. However, physicians use CT-scan, X-rays, or MRI images to recognize bone cancer, but still require techniques to increase precision and reduce human labor. These methods face challenges such as high costs, time consumption, and the risk of misdiagnosis due to the complexity of bone tumor appearances. Therefore, it is essential to establish an automated system to detect healthy bones from cancerous ones. In this regard, Artificial intelligence, particularly deep learning, shows increased attention in the medical image analysis process. This research presents a new Golden Search Optimization along with Deep Learning Enabled Computer Aided Diagnosis for Bone Cancer Classification (GSODL-CADBCC) on X-ray images. The aim of the GSODL-CADBCC approach is to accurately distinguish the input X-ray images into healthy and cancerous. This research presents the GSODL-CADBCC technique that leverages the bilateral filtering technique to remove the noise. This method uses the SqueezeNet model to generate feature vectors, and the GSO algorithm efficiently selects the hyperparameters. Finally, the extracted features can be classified by improved cuckoo search with a long short-term memory model. The experimental results demonstrate that the GSODL- CADBCC approach attains highest performance with an average accuracy of 95.52% on the training set data and 94.79% on the testing set data. This automated approach not only reduces the need for manual interpretation but also minimizes the risk of diagnostic errors and provides a viable option for precise medical imaging-based bone cancer screening.

Background: Intraportal pancreatic islet transplantation is a treatment option for patients with severe beta cell failure and unstable glycemic control. However, this procedure is associated with loss of beta cells after intrahepatic transplantation. Islet delivery devices (IDDs) implanted at extrahepatic sites may support engraftment and improve survival of pancreatic islets. We assessed the surgical feasibility, tolerability and safety of implantation of open microwell devices at subcutaneous sites with varying friction in pigs.

Methods: Open, non-immunoisolating microwell islet delivery devices were made from polyvinylidene fluoride (PVDF). Empty (n = 26) and islet-seeded devices (n = 8) were implanted subcutaneously in 6 immunocompetent pigs in low-friction sites (abdomen and lateral hip) and high-friction sites (anterior neck) for 3 months. Retrieved grafts were analyzed histologically with haematoxylin and eosin, and Masson's Trichrome staining.

Results: Islet-seeding and transportation of IDDs was free from complications with minimal islet spillage. IDDs were implanted subcutaneously using standard surgical equipment, without complications during the surgeries. IDDs implanted in the neck and IDDs co-transplanted with human islets were expelled and retrieved after 10 days. Empty IDDs were removed after 3 months. The abdominal site showed reduced signs of inflammation as compared to the neck region, while similar tissue ingrowth and vascularization of devices were found in the two locations.

Conclusions: Open microwell IDDs can safely be implanted with standard surgical equipment and successful islet-loading can be performed. Low-friction sites are preferable over high-friction sites for subcutaneous implantation in the porcine model since these lead to the least amount of foreign body reaction.

Background: Gynecomastia, the enlargement of male breast tissue, significantly impacts both physical and psychological health. Surgical intervention is often necessary, utilizing various techniques to reduce glandular and fatty tissue. This paper introduces an innovative surgical method combining power-assisted liposuction with the stab-flatten technique to enhance precision and cosmetic results. We present our clinical experience and evaluate its effectiveness in gynecomastia treatment.

Methods: From June 2021 to January 2023, 128 gynecomastia patients underwent power-assisted liposuction and the stab-flatten method via a single axillary incision. We collected demographic and clinical data, including surgery duration, complications, and patient satisfaction regarding physical appearance, mental state, and social interactions. The BODY-Q questionnaire was used preoperatively and 3 months postoperatively for assessment.

Results: The study included 128 male patients, treating 252 breasts, with an average age of 35 years and a mean BMI of 27.7 kg/m². Most procedures were bilateral (96.9%), with an average fat removal of 224.5 mL and a surgery duration of 147 minutes. The complication rate was low at 2.0%, with bruises in 5 breasts. The average hospital stay was 2 days. Significant improvements were noted in BODY-Q scores for appearance satisfaction and health-related quality of life, with increased appearance satisfaction and reduced appearance-related distress.

Conclusion: Since June 2021, the combined use of power-assisted liposuction and the stab-flatten technique has been effective in managing gynecomastia. This synergistic approach not only achieves aesthetically pleasing outcomes but also minimizes the surgical risks associated with traditional methods.

Background: The use of prophylactic closed-incisional negative pressure wound therapy after colorectal procedures has been shown to reduce postoperative wound complications and surgical site infection. We present our experience with a novel, closed-incision, mechanically powered negative pressure (MP-NPD) dressing after colorectal procedures.

Methods: This was a prospective, single-center, single-arm observational study assessing patient reported and wound healing outcomes of colorectal surgical incisions dressed with a MP-NPD. Consecutive patients, 18 years and older, that met inclusion criteria were enrolled between May 2021 and December 2021.

Results: Thirty patients were included (13 male/17 female) with a mean age of 62.7 ± 11.8 years and mean body mass index of 25.5 ± 4.4 kg/m². The mean incision length covered was 3.0 ± 1.8 cm. The median number of manual pinches required to initially activate the dressing with negative pressure within -75 to -125 mmHg was 12 (range 7-20). Four dressings were changed (13.3%) after drainage was noted inside the pump; not including these, 88.5% (23/26) of dressings held pressure consistently without any re-pinching during the 72-h period since they were first applied in the operating room. 75.9% of patients reported the dressing was "very comfortable" and none reported the dressing restricted mobility. 79.3% of patients reported the dressing was "very easy" to use. There were no cases of major wound complication or surgical site infection within 30 days.

Conclusion: The use of MP-NPD appears to be feasible on primarily-closed colorectal incisions. Further randomized controlled study is warranted to ascertain its clinical efficacy.

Background: Liver retraction management in laparoscopic sleeve gastrectomy (LSG) is challenging for surgeons, especially in patients with enlarged livers. Traditional methods, such as the Nathanson retractor (NR), often necessitate additional incisions, potentially increasing liver enzymes and increasing the risk of complications. The aim of this study was to evaluate the efficacy of the use of a Veress needle (VN), an alternative liver retraction technique, in LSG surgery compared with NR.

Materials and methods: This study was conducted at a university-affiliated hospital between May 2022 and December 2022. Patients who underwent LSG were divided into two groups: one utilizing the NR and the other employing the VN for liver retraction. Parameters such as operation duration, retraction time, liver laceration, trocar-induced hemorrhage, subxiphoid trocar site infections, pain scores measured via the visual analog scale (VAS) at various time points, pre- and postoperative liver enzyme levels (AST, ALT, GGT, ALP) and CRP levels were analyzed.

Results: Data from 151 patients were analyzed. The AST/ALT elevations (P < 0.001) were significantly lower in the VN group (73 patients) than in the NR group (78 patients), while there was no significant difference in GGT/ALP levels. Retraction-related bleeding was significantly greater in the NR group than in the VN group (6.4% vs 0%, P = 0.035). Postoperative infection rate was lower in the VN group but not statistically significant (0% vs 3.8%, P = 0.135). CRP differences were significant on the first postoperative day (P < 0.001). Postoperative VAS scores were significantly lower in the VN group at all measured time points except at the 48th hour and 10th day.

Conclusions: The VN technique in LSG significantly reduces liver enzyme elevation and the need for an extra trocar and incision, potentially lowering complication risk and enhancing patient outcomes.

Background: Conventional axillary lymph node dissection (ALND) is associated with significant post-operative morbidity in patients undergoing breast surgery due to increased lymphatic leakage. LigaSure, an electrothermal bipolar vessel sealing system, provides better closure of the leakage. This study aims to compare the efficacy and safety of LigaSure against conventional techniques in patients with breast cancer underwent ALND and breast surgery.

Methods: We conducted a comprehensive search across the databases to identify relevant studies. The search results were imported into Covidence for article eligibility screening, and all relevant outcomes data were synthesized using odd ratios (ORs) or standardized mean differences (SMDs) with 95% confidence intervals (CIs) in meta-analysis models using RevMan 5.4.

Results: Twelve studies with the total of 895 patients (LigaSure = 441; Conventional technique = 454) with breast cancer underwent breast surgery with ALND were included. LigaSure was associated with significantly lower post-operative drain volume (SMD: -0.39, 95% CI [-0.53, -0.24], P < 0.00001), shortened duration of drain (SMD: -0.51, 95% CI [-0.67, -0.34], P < 0.00001), and reduced hospital stay length (SMD: -0.57, 95% CI [-0.96, -0.18], P = 0.004) compared to conventional techniques. However, no difference observed in total operation time, intra-operative blood loss, seroma related outcomes and post-operative complications between the two groups.

Conclusion: LigaSure significantly reduced the lymphorrhea, duration of drain and hospital stay, however, it did not prove be effective in seroma-related outcomes.

Background: The development of emergency department (ED) triage systems remains challenging in accurately differentiating patients with acute abdominal pain (AAP) who are critical and urgent for surgery due to subjectivity and limitations. We use machine learning models to predict emergency surgical abdominal pain patients in triage, and then compare their performance with conventional Logistic regression models.

Methods: Using 38 214 patients presenting with acute abdominal pain at Zhongnan Hospital of Wuhan University between March 1, 2014, and March 1, 2022, we identified all adult patients (aged ≥18 years). We utilized routinely available triage data in electronic medical records as predictors, including structured data (eg, triage vital signs, gender, and age) and unstructured data (chief complaints and physical examinations in free-text format). The primary outcome measure was whether emergency surgery was performed. The dataset was randomly sampled, with 80% assigned to the training set and 20% to the test set. We developed 5 machine learning models: Light Gradient Boosting Machine (Light GBM), eXtreme Gradient Boosting (XGBoost), Deep Neural Network (DNN), and Random Forest (RF). Logistic regression (LR) served as the reference model. Model performance was calculated for each model, including the area under the receiver-work characteristic curve (AUC) and net benefit (decision curve), as well as the confusion matrix.

Results: Of all the 38 214 acute abdominal pain patients, 4208 underwent emergency abdominal surgery while 34 006 received non-surgical treatment. In the surgery outcome prediction, all 4 machine learning models outperformed the reference model (eg, AUC, 0.899 [95%CI 0.891-0.903] in the Light GBM vs. 0.885 [95%CI 0.876-0.891] in the reference model), Similarly, most machine learning models exhibited significant improvements in net reclassification compared to the reference model (eg, NRIs of 0.0812[95%CI, 0.055-0.1105] in the XGBoost), with the exception of the RF model. Decision curve analysis shows that across the entire range of thresholds, the net benefits of the XGBoost and the Light GBM models were higher than the reference model. In particular, the Light GBM model performed well in predicting the need for emergency abdominal surgery with higher sensitivity, specificity, and accuracy.

Conclusions: Machine learning models have demonstrated superior performance in predicting emergency abdominal pain surgery compared to traditional models. Modern machine learning improves clinical triage decisions and ensures that critically needy patients receive priority for emergency resources and timely, effective treatment.