Surgical Innovation最新文献

BackgroundDelays between diagnosis and definitive treatment in early-stage lung cancer can lead to disease progression and patient anxiety. Recent advances in robotic-assisted bronchoscopy and surgery provide opportunities to streamline care and reduce treatment timelines.To evaluate the feasibility, safety, and diagnostic performance of an integrated Fast Track protocol combining ION robotic-assisted bronchoscopy with radioactive marker placement and subsequent robotic surgical resection in patients with small or indeterminate pulmonary nodules.MethodsA retrospective cohort study was conducted on consecutive patients undergoing ION-guided bronchoscopy with technetium-99m-labeled marker placement, followed by robotic resection, from December 1, 2024, to March 31, 2025. The protocol included preoperative imaging (Day 1), bronchoscopy with biopsy and marker placement (Day 2), and robotic surgery (Day 3). Primary outcomes included diagnostic yield and need for preliminary wedge resection; secondary outcomes assessed localization accuracy, perioperative results, and procedural complications.ResultsTen patients were included, with a median age of 59 years and a median nodule diameter of 14.0 mm. Diagnostic yield from bronchoscopy was 90%, and localization success was 100%. Robotic resection (lobectomy in 9 cases, segmentectomy in 1) was performed the day after bronchoscopy. No procedural complications occurred, and the median hospital stay was six days.ConclusionsThis integrated Fast Track pathway is feasible, safe, and effective in expediting diagnosis and treatment for early-stage lung cancer. However, the small sample size of this initial series (n = 10) limits the generalizability of these findings, which should be interpreted in the context of our institutional case selection, favoring nodules accessible by the ION system and patients with good performance status. The protocol enhances clinical efficiency by consolidating diagnostic and therapeutic steps while maintaining high diagnostic accuracy. Broader validation is warranted in larger multicenter studies.

BackgroundAccurate localisation of rib fractures is crucial for successful surgical stabilisation of rib fractures (SSRF). Mixed reality (MR) technology can overlay anatomical imaging onto a patient in real-time, which may facilitate the visualisation of rib fractures, allowing accurate skin surface markings for incision. This pilot study assessed the feasibility of using mixed reality (MR) for rib fracture localisation in SSRF.MethodsThis study involved a pre-clinical phase with two healthy patients and a clinical phase with six patients undergoing SSRF in a single tertiary trauma centre. CT scans were transformed into patient-specific 3D holographic models, which were projected through Microsoft HoloLens2TM (HL2) onto the patient after anatomical calibration. The study assessed hologram projection, number of fractures identified, time taken, and distance from skin marking to the fracture site. Iterative improvements to the MR system were implemented throughout the study.ResultsStable and accurate hologram projection was achieved in both phases. In the clinical portion, MR identified 54 rib fractures, including subscapular fractures, compared to 30 identified by US. The mean time to mark all fractures was 9.07 minutes for MR and 10.02 minutes for US. The mean displacement from skin marking to the fracture site was 2.89 cm for MR and 2.04 cm for US. Technical challenges included distorted surface anatomy and positional variations.ConclusionMR technology in the setting of SSRF is feasible and facilitates de-novo visualisation of rib fractures. Technical limitations must be addressed before widespread clinical use.

BackgroundLaparoscopic surgery has become widely accepted in gynecological practice due to its clinical benefits for patients. However, it introduces significant ergonomic challenges for surgeons, often resulting in musculoskeletal discomfort and occupational injury.ObjectiveThis study aims to assess the level of knowledge on ergonomic principles among postgraduate trainees in obstetrics and gynecology, and to highlight the necessity of formal ergonomic training to prevent work-related injuries.MethodsA structured questionnaire was distributed among postgraduate trainees of post graduate institute of Medicine, Sri Lanka. Data on surgical experience, training background, ergonomic awareness, and prevalence of physical discomfort were collected and analyzed.Results40 post graduate trainees participated in the survey. A significant proportion of trainees demonstrated limited awareness of fundamental ergonomic concepts. The mean knowledge score was as low as 25.00 ± 21.36. The majority reported musculoskeletal symptoms during or after laparoscopic surgery. Knowlegde score was not significantly correlated with discomfort severity (Spearman's ρ = -0.212,P = 0.190), indicating that ergonomic knowledge alone may not mitigate musculoskeletal strain.ConclusionThe findings underscore the urgent need for formal ergonomic education and the implementation of ergonomic guidelines in surgical training to improve surgeon well-being and operating efficiency.

IntroductionAcute appendicitis is a common cause of acute abdomen in secondary care. Despite advancements in diagnostics, misdiagnosis and negative appendectomies remain significant. Artificial Intelligence (AI), particularly machine learning (ML) and deep learning, shows promise in improving diagnostic accuracy.Materials and MethodsA literature review using PubMed and Cochrane databases included studies on AI's role in diagnosing and prognosing appendicitis. Studies relying solely on clinical or radiology reports were excluded.ResultsAI models, particularly random forest (RF), logistic regression (LR), and neural networks (NN), demonstrated high diagnostic accuracy, with RF outperforming others. Machine learning methods like SVM and XGBoost (XGB) were effective in predicting appendicitis prognosis, especially in distinguishing complicated cases. AI models outperformed traditional diagnostic scores, such as the Alvarado score.ConclusionAI has significant potential to enhance the diagnosis and prognosis of acute appendicitis, but challenges in data requirements and standardisation must be addressed for widespread clinical use.

BackgroundRobotic-assisted surgery (RAS) is widely adopted, and understanding the learning curve (LC) is crucial for surgeons self-assessment and credentialling. We characterised the transition from laparoscopy to robotic approach for three experienced surgeons based on analysis of colectomies performed for malignancy.MethodsWe analysed retrospectively all consecutive robotic colon cancer surgeries performed between February 2020 and April 2025. We excluded rectal cancer resections, palliative, multivisceral and beyond TME cases. The cumulative summation (CUSUM) methodology was utilised to graphically represent the colectomy LC based on total operative time.ResultsOur analysis included 184 colectomies: 75 performed by surgeon 1, 65 by surgeon 2, and 44 by surgeon 3. Demographics data and tumour characteristics were comparable between surgeons, exempt from operative time and previous abdomino-pelvic surgery (P < .05). The CUSUM curve revealed a three-phase pattern: a learning phase (cases 1-16), a competence phase (cases 17-29), and a proficiency phase (beyond case 30). The median total operative time trended downward from the learning phase (240 min) to the proficiency phase (218 min), though this was not statistically significant (P = .13). We also observed a trend towards reduced estimated blood loss (109 mL to 86 mL, P = .066) and a decrease in 30-day re-admission rates from 14% to 4% (P = .11) in the proficiency phase.ConclusionWe present our department LC with the DaVinci Xi Robot for surgical treatment of colonic cancer. Based on our calculations, it is necessary for a surgeon to perform 30 robotic cases to reach the proficiency part of the LC of RAS for colonic resections.

BackgroundThe ergonomic design of surgical instruments plays a pivotal role in the efficiency, safety, and comfort of surgeons. Studies confirm that poorly designed instruments can lead to physical discomfort, premature fatigue, and decreased dexterity. This study aims to assess the current usability of surgical instruments to identify problematic designs and highlight areas for ergonomic improvements.MethodsAn anonymized online questionnaire with 18 questions was distributed via email to various surgical societies, professional associations, and the mailing lists of surgical departments at the University Hospital Leipzig. Data on gender, glove size, clinical background, surgical subspecialty, and experience were collected. Participants were asked about physical discomfort, fatigue, precision, and safety issues when using surgical instruments and devices.ResultsA total of 459 surgeons participated, most of whom specialized in orthopedics and trauma surgery (81.48%). Gender differences were noted in glove sizes and frequency of complaints. Women reported significantly more difficulties, such as fatigue and imprecise handling, compared to men. Overall, 88.1% of women and 59.9% of men considered the development of ergonomic instruments important. Only 13% had experience using ergonomic instruments, with nearly half of the participants reporting significant improvements.ConclusionsThe study demonstrates that surgical instruments with inadequate ergonomics, particularly for users with smaller glove sizes, result in physical strain, fatigue, and reduced precision. The findings underscore the necessity for ergonomic modifications to meet the physical requirements of surgeons, ensuring a more efficient and safer surgical workflow.

ObjectiveThis study aimed to evaluate the safety and effectiveness of an intraluminal fecal diverting device (FDD), COLO-BT™ as an alternative to defunctioning ileostomy in patients who declined stoma formation following proctectomy.MethodsWe retrospectively reviewed the medical records of patients who underwent proctectomy followed by placement of an intraluminal FDD (COLO-BT™) as a temporary substitute for ileostomy at a single tertiary care center between September 2017 and September 2021. Safety was assessed based on postoperative and anastomotic complications, as well as endoscopic findings of colonic changes at the FDD fixation site. Effectiveness was evaluated by the rate of permanent stoma formation.ResultsAmong 91 patients, 8 (8.8%) required surgical re-intervention. Of these, five patients experienced anastomotic complications necessitating stoma formation: rectovaginal fistula (n = 2), delayed anastomotic leakage (n = 2), and rectourethral fistula (n = 1). One patient developed severe ileus requiring surgery, which also resulted in stoma formation. Overall, six patients (6.6%) underwent permanent stoma formation during a mean follow-up period of 24 months. Endoscopic follow-up identified colonic luminal deformities in 15 patients (16.5%), most of which were asymptomatic mucosal edema or erosion (n = 12). Three patients (3.3%) had non-symptomatic ulcers at the FDD fixation site. All luminal deformities had resolved on follow-up sigmoidoscopy performed 1 year later.ConclusionThe intraluminal FDD (COLO-BT™) may offer a feasible alternative to defunctioning ileostomy following proctectomy in selected patients, with acceptable rates of postoperative complications and permanent stoma formation. Further studies are needed to confirm long-term safety and efficacy.

IntroductionArthroscopic surgery demands specialized skills, traditionally acquired via supervised clinical practice. Simulators offer a controlled training alternative. This study introduces a 3D-printed knee arthroscopy simulator and evaluates its effectiveness in skill transfer and acceptance in medical education, aiming to assess its utility for real arthroscopic procedures among medical students.MethodsForty final-year medical students with no prior arthroscopy experience were randomized into a simulated training group (3D-printed simulator) and a control group (video instruction). All participants performed a supervised diagnostic arthroscopy. Performance parameters (completion time, lookdowns, instrument loss, triangulation time, interventions) and Arthroscopic Surgery Skill Evaluation Tool (ASSET) scores were analyzed. Simulator acceptance was assessed via a Likert scale. Data were analyzed using appropriate parametric (Student's t-test) and non-parametric (Wilcoxon, McNemar) tests, with a significance level of 5%."ResultsThe simulated training group outperformed controls, completing arthroscopy 39% faster (P < .001), with 60% fewer lookdowns (P = .001), 59% fewer supervisor interventions (P < .001), 35% shorter triangulation time (P = .019), and 50% fewer instrument losses (P < .001). ASSET scores were significantly higher in all domains except safety. Participants strongly endorsed the simulator's utility and supported its integration into medical education.ConclusionThis study demonstrates the effectiveness of our low-cost, reproducible 3D-printed knee arthroscopy simulator as an effective tool for skill acquisition and transfer in individuals without prior arthroscopy experience. Training with the simulator significantly improves performance in real arthroscopic procedures.

BackgroundRecurrence of pilonidal sinus disease (PSD) after minimally invasive surgery remains a significant challenge to surgeons and may be explained by incomplete obliteration of the sinus. Preoperative imaging could play an important role in addressing this problem. Magnetic resonance imaging (MRI) is considered the modality of choice but is costly and time-consuming. The objective of this study was to determine if ultrasound (US) is a feasible alternative to MRI in preoperative PSD mapping.MethodsA prospective, proof of concept study was conducted on patients treated with laser ablation in 2 Belgian hospitals between Jan 2023 and Dec 2024. The patients underwent a preoperative US and MRI. Sinus characteristics were described according to a predefined protocol. The agreement between US and MRI was quantified using the intraclass correlation coefficient (ICC) for the measurement of 3 sinus dimensions (length, depth and width) and Cohen's kappa coefficient (k) for the detection of side branches.Results30 patients were included with a median age of 27 years (IQR 20-35). Median sinus dimensions were 3.3 cm (IQR 1.5-5.6), 0.5 cm (IQR 0.3-0.8) and 0.7 cm (IQR 0.4-1.2) on US, and 1.9 cm (IQR 1.5-3.9), 0.4 cm (IQR 0.2-0.6) and 0.4 cm (IQR 0.2-0.7) on MRI for length, depth and width respectively. Side branches were detected in 6 (22%) patients on US and in ten (40%) patients on MRI. The level of agreement between US and MRI was moderate for sinus length (ICC 0.74, 95% CI 0.49-0.87, P < 0.001), and poor for sinus depth (ICC 0.30, 95% CI -0.05-0.60, P = .041) and width (ICC 0.36, 95% CI -0.03-0.66, P = .008). The level of agreement for the detection of side branches was moderate (k 0.46, 95% CI 0.11-0.82, P = .013).ConclusionPreoperative US is not suitable for the preoperative mapping of PSD when compared to MRI. MRI remains the preferred imaging technique in our clinical practice especially for complex PSD.