Surgical Innovation最新文献_第9页

Tumor Segmentation in Intraoperative Fluorescence Images Based on Transfer Learning and Convolutional Neural Networks 基于迁移学习和卷积神经网络的术中荧光图像肿瘤分割技术

IF 1.5 4区医学 Q3 SURGERY

Surgical Innovation

Pub Date : 2024-04-15 DOI: 10.1177/15533506241246576

Weijia Hou, Liwen Zou, Dong Wang

ObjectiveTo propose a transfer learning based method of tumor segmentation in intraoperative fluorescence images, which will assist surgeons to efficiently and accurately identify the boundary of tumors of interest.MethodsWe employed transfer learning and deep convolutional neural networks (DCNNs) for tumor segmentation. Specifically, we first pre-trained four networks on the ImageNet dataset to extract low-level features. Subsequently, we fine-tuned these networks on two fluorescence image datasets (ABFM and DTHP) separately to enhance the segmentation performance of fluorescence images. Finally, we tested the trained models on the DTHL dataset. The performance of this approach was compared and evaluated against DCNNs trained end-to-end and the traditional level-set method.ResultsThe transfer learning-based UNet++ model achieved high segmentation accuracies of 82.17% on the ABFM dataset, 95.61% on the DTHP dataset, and 85.49% on the DTHL test set. For the DTHP dataset, the pre-trained Deeplab v3 + network performed exceptionally well, with a segmentation accuracy of 96.48%. Furthermore, all models achieved segmentation accuracies of over 90% when dealing with the DTHP dataset.ConclusionTo the best of our knowledge, this study explores tumor segmentation on intraoperative fluorescent images for the first time. The results show that compared to traditional methods, deep learning has significant advantages in improving segmentation performance. Transfer learning enables deep learning models to perform better on small-sample fluorescence image data compared to end-to-end training. This discovery provides strong support for surgeons to obtain more reliable and accurate image segmentation results during surgery.

目标提出一种基于迁移学习的术中荧光图像肿瘤分割方法，帮助外科医生高效、准确地识别感兴趣肿瘤的边界。方法我们采用迁移学习和深度卷积神经网络（DCNN）进行肿瘤分割。具体来说，我们首先在 ImageNet 数据集上预训练了四个网络，以提取低级特征。随后，我们分别在两个荧光图像数据集（ABFM 和 DTHP）上对这些网络进行微调，以提高荧光图像的分割性能。最后，我们在 DTHL 数据集上测试了训练好的模型。结果基于迁移学习的 UNet++ 模型在 ABFM 数据集上实现了 82.17% 的高分割准确率，在 DTHP 数据集上实现了 95.61% 的高分割准确率，在 DTHL 测试集上实现了 85.49% 的高分割准确率。在 DTHP 数据集上，预训练的 Deeplab v3 + 网络表现出色，分割准确率达到 96.48%。此外，在处理 DTHP 数据集时，所有模型的分割准确率都超过了 90%。结论据我们所知，本研究首次探索了术中荧光图像上的肿瘤分割。结果表明，与传统方法相比，深度学习在提高分割性能方面具有显著优势。与端到端训练相比，迁移学习能让深度学习模型在小样本荧光图像数据上表现得更好。这一发现为外科医生在手术过程中获得更可靠、更准确的图像分割结果提供了有力支持。

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引用次数: 0

Reconstruction Strategy for Upper Extremity Defects After Bone Tumor Resection Based on 3D Customized Bone Cement Mold 基于三维定制骨水泥模型的骨肿瘤切除术后上肢缺损重建策略

IF 1.5 4区医学 Q3 SURGERY

Surgical Innovation

Pub Date : 2024-04-12 DOI: 10.1177/15533506241244493

Song Ke, Bokai Zhang, Yongqin He, Yuanyuan Zhou, Xu Hu, Yubo Fan, Min Wang, Yuan Zhang, Chao Wang

BackgroundReconstructing bone defects in the upper extremities and restoring their functions poses a significant challenge. In this study, we describe a novel workflow for designing and manufacturing customized bone cement molds using 3D printing technology to reconstruct upper extremity defects after bone tumor resection.MethodsComputer tomography data was acquired from the unaffected upper extremities to create a detachable mold, which can be customized to fit the joint precisely by shaping the bone cement accordingly. Fourteen patients who underwent reconstructive surgery following bone tumor resection in the proximal humerus (13 cases) or distal radius (1 case) between January 2014 and December 2022 were retrospectively evaluated. The medical records of this case series were reviewed for the demographic, radiological, and operative data. Metastasis, local recurrence, and complication were also reviewed. Additionally, Musculoskeletal Tumor Society Score (MSTS) and Visual Analogue Scale (VAS) were used to assess clinical outcomes.ResultsThe mean follow-up period was 49.36 ± 15.18 months (range, 27-82 months). At the end of follow-up, there were no cases of metastasis or recurrence, and patients did not experience complications such as infection, dislocation, or implant loosening. Two cases complicated with subluxation (14.3%), and 1 case underwent revision surgery for prosthetic fracture (7.1%). The average MSTS score was 23.2 ± 1.76 (77.4%, range, 66.7%-86.7%), and the postoperative VAS score was 1.86 ± 1.03 (range, 1-4), which was significantly lower than that before surgery (average preoperative VAS score was 5.21 ± 2.00 (range, 2-8)) ( P < .001).ConclusionCustomized 3D molds can be utilized to shape bone cement prostheses, which may serve as a potential alternative for reconstructing the proximal humerus and distal radius following en bloc resection of bone tumors. This reconstruction strategy offers apparent advantages, including precise matching of articular surfaces and comparatively reduced costs.

背景重建上肢骨缺损并恢复其功能是一项重大挑战。在这项研究中，我们介绍了一种利用 3D 打印技术设计和制造定制骨水泥模具的新型工作流程，以重建骨肿瘤切除术后的上肢缺损。方法从未受损伤的上肢获取计算机断层扫描数据，以创建可拆卸的模具，该模具可通过相应的骨水泥塑形进行定制，以精确地适合关节。研究人员对2014年1月至2022年12月期间接受肱骨近端（13例）或桡骨远端（1例）骨肿瘤切除后重建手术的14例患者进行了回顾性评估。对该系列病例的病历进行了审查，以了解人口统计学、放射学和手术数据。此外，还审查了转移、局部复发和并发症。结果平均随访时间为（49.36 ± 15.18）个月（27-82 个月）。随访结束时，无转移或复发病例，患者未出现感染、脱位或种植体松动等并发症。2例患者并发了半脱位（14.3%），1例患者因假体骨折接受了翻修手术（7.1%）。平均 MSTS 评分为 23.2 ± 1.76（77.4%，范围为 66.7%-86.7%），术后 VAS 评分为 1.86 ± 1.03（范围为 1-4），明显低于术前（术前平均 VAS 评分为 5.21 ± 2.结论定制的三维模具可用于塑造骨水泥假体，这可能成为骨肿瘤整体切除术后重建肱骨近端和桡骨远端的潜在替代方案。这种重建策略具有明显的优势，包括关节面的精确匹配和相对较低的成本。

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引用次数: 0

Test-Only Learning via Virtual Patients to Improve Surgical Illness Scripts of Preclinical Medical Students as a Preparation for Clinical Clerkships: An Experimental Study 通过虚拟病人进行纯测试学习，改进临床前医科学生的外科疾病脚本，为临床实习做准备：一项实验研究

IF 1.5 4区医学 Q3 SURGERY

Surgical Innovation

Pub Date : 2024-04-10 DOI: 10.1177/15533506241246333

Yavuz Selim Kıyak, Işıl İrem Budakoğlu, Özlem Coşkun

ObjectiveThe aim was to determine whether preclinical medical students can develop their illness scripts to a level comparable to that of clerkship students through test-only learning using repeated formative online testlets.MethodsIn this experimental study, participants were 52 preclinical and 53 clinical medical students. The intervention group consisted of preclinical medical students, and the control group consisted of clinical medical students. The intervention group responded to online testlets containing feedback, an innovative formative assessment method called ContExtended Questions, on general surgery for 8 days by spending no more than 30 minutes each day. The control group completed the general surgery clerkship. The performances were assessed using 20 Key-Feature Question items. The intervention group was assessed twice: immediately after the intervention (the immediate test), and again 1 month later (the delayed test). The control group was assessed once, immediately after the clerkship. All performance tests were identical.ResultsThe preclinical students had a significantly higher mean score on the immediate test (83.1 ± 9.6) compared to the clinical students (75.4 ± 8.9), P < .001. The effect size (Cohen’s d) was .83. However, the mean score in the delayed test (76.9 ± 13.6) was not significantly different from clinical students’ mean score (75.4 ± 8.9), P > .05.ConclusionsTest-only learning as a spaced repetition of online formative testlets is effective in preparing preclinical medical students to the clinical clerkship. Through using this approach in preclinical period, they can prepare themselves for the clinical environment to optimize the benefits derived from clerkships.

方法在这项实验研究中，参与者包括52名临床前医学生和53名临床医学生。干预组由临床前医科学生组成，对照组由临床医科学生组成。干预组在 8 天时间里，每天花不超过 30 分钟的时间对包含反馈信息的在线测试卷（一种名为 ContExtended Questions 的创新型形成性评估方法）进行回复，内容涉及普通外科。对照组完成了普通外科实习。使用 20 个关键特征问题项目对他们的表现进行评估。干预组接受了两次评估：干预结束后立即进行（即时测试），一个月后再次进行（延迟测试）。对照组在实习结束后立即进行一次评估。结果临床前学生在即时测试中的平均得分（83.1 ± 9.6）明显高于临床学生（75.4 ± 8.9），P < .001。效应大小（Cohen's d）为 0.83。然而，延迟测试的平均得分（76.9 ± 13.6）与临床学生的平均得分（75.4 ± 8.9）没有显著差异，P >.05.结论纯测试学习作为间隔重复的在线形成性测试单元，能有效帮助临床前医学生为临床实习做好准备。通过在临床前阶段使用这种方法，他们可以为临床环境做好准备，从而最大限度地从实习中获益。

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引用次数: 0

Evaluation of the Efficacy and Safety of Pedicled Perforator Flap Technique for Salvage Nipple Reconstruction in Breast Cancer Patients: A Pilot Study 乳腺癌患者乳头重建术的有效性和安全性评估：一项试点研究

IF 1.5 4区医学 Q3 SURGERY

Surgical Innovation

Pub Date : 2024-04-04 DOI: 10.1177/15533506241242906

Shuanglong Chen, Qingmo Yang, Shaoluan Zheng, Chenxi Chen, Lujuan Gao, Jiaqi Liu

ObjectiveWe propose a pedicled perforator flap technique for salvage nipple reconstruction after initial nipple reconstruction fails in breast cancer patients.MethodsThis is a pilot study. A total of 21 female breast cancer patients who underwent nipple reconstruction following initial nipple reconstruction fails were enrolled, and salvage nipple reconstruction based pedicled perforator flap were performed between 2016 and 2020. Operative time, perforator design, postoperative complications, follow-up duration, projection of nipple, as well as patient-reported outcomes measured by the BREAST-Q and visual analogue scale (VAS) were assessed.ResultsSixteen patients underwent fifth lateral intercostal artery perforator reconstruction, while 5 patients underwent fifth anterior intercostal artery perforator flap reconstruction. The surgeries were successful without intraoperative complications, with a mean operative time of 67 minutes. Postoperative complications were absent. The mean follow-up duration was 18 months. The mean nipple projection was 8 mm (range, 6-10 mm) with a shrinkage of 20% at 6 months after surgery. The average scores for psychosocial well-being, satisfaction with breasts, and satisfaction with nipples domains of the BREAST-Q significantly increased ( P < .01) at 6 months post-reconstruction. Sexual well-being subdomain showed no statistical difference ( P = .9369). The VAS scores for cosmesis and patient satisfaction with surgery were 9 and 9.3, respectively.ConclusionThe pedicled perforator flap technique for salvage nipple reconstruction is a safe and effective approach.

目的我们提出了一种带蒂穿孔皮瓣技术，用于乳腺癌患者初次乳头重建失败后的挽救性乳头重建。共纳入 21 例初次乳头再造失败后接受乳头再造的女性乳腺癌患者，并于 2016 年至 2020 年期间进行了基于带蒂穿孔器皮瓣的挽救性乳头再造术。对手术时间、穿孔器设计、术后并发症、随访时间、乳头投影以及通过 BREAST-Q 和视觉模拟量表（VAS）测量的患者报告结果进行了评估。结果 16 名患者接受了第五肋间外侧动脉穿孔器重建术，5 名患者接受了第五肋间前动脉穿孔器瓣重建术。手术成功，无术中并发症，平均手术时间为 67 分钟。术后无并发症。平均随访时间为 18 个月。术后6个月时，乳头的平均凸度为8毫米（范围为6-10毫米），缩小了20%。重建手术后 6 个月，BREAST-Q 心理社会幸福感、对乳房的满意度和对乳头的满意度的平均得分显著增加（P < .01）。性健康子域无统计学差异（P = .9369）。患者对手术的外观和满意度的 VAS 评分分别为 9 分和 9.3 分。

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引用次数: 0

Transcatheter Aortic Valve Replacement and Coronary Protection Guided by Deep Learning and 3-Dimensional Printing 深度学习和三维打印引导下的经导管主动脉瓣置换术和冠状动脉保护术

IF 1.5 4区医学 Q3 SURGERY

Surgical Innovation

Pub Date : 2024-04-03 DOI: 10.1177/15533506241244571

Yu Mao, Guangyu Zhu, Mengen Zhai, Yanyan Ma, Lanlan Li, Ping Jin, Yang Liu, Jian Yang

ObjectiveIn this case report, the auxiliary role of deep learning and 3-dimensional printing technology in the perioperative period was discussed to guide transcatheter aortic valve replacement and coronary stent implantation simultaneously.Case presentationA 68-year-old man had shortness of breath and chest tightness, accompanied by paroxysmal nocturnal dyspnea, 2 weeks before presenting at our hospital. Echocardiography results obtained in the outpatient department showed severe aortic stenosis combined with regurgitation and pleural effusion. The patient was first treated with closed thoracic drainage. After 800 mL of pleural effusion was collected, the patient’s symptoms were relieved and he was admitted to the hospital. Preoperative transthoracic echocardiography showed severe bicuspid aortic valve stenosis combined with calcification and aortic regurgitation (mean pressure gradient, 42 mmHg). Preoperative computed tomography results showed a type I bicuspid aortic valve with severe eccentric calcification. The leaflet could be seen from the left coronary artery plane, which indicated an extremely high possibility of coronary obstruction. After preoperative imaging assessment, deep learning and 3-dimensional printing technology were used for evaluation and simulation. Guided transcatheter aortic valve replacement and a coronary stent implant were completed successfully. Postoperative digital subtraction angiography showed that the bioprosthesis and the chimney coronary stent were in ideal positions. Transesophageal echocardiography showed normal morphology without paravalvular regurgitation.ConclusionThe perioperative guidance of deep learning and 3-dimensional printing are of great help for surgical strategy formulation in patients with severe bicuspid aortic valve stenosis with calcification and high-risk coronary obstruction.

本病例报告探讨了深度学习和三维打印技术在围手术期的辅助作用，以同时指导经导管主动脉瓣置换术和冠状动脉支架植入术。门诊部的超声心动图结果显示主动脉严重狭窄，并伴有反流和胸腔积液。患者首先接受了胸腔闭式引流术。在收集了 800 毫升胸腔积液后，患者的症状得到缓解，并被送入医院。术前经胸超声心动图显示主动脉瓣严重双尖瓣狭窄，合并钙化和主动脉瓣反流（平均压力梯度为 42 毫米汞柱）。术前计算机断层扫描结果显示主动脉瓣为I型双尖瓣，伴有严重的偏心钙化。从左冠状动脉平面可以看到瓣叶，这表明冠状动脉阻塞的可能性极高。术前成像评估后，利用深度学习和三维打印技术进行了评估和模拟。在引导下成功完成了经导管主动脉瓣置换术和冠状动脉支架植入术。术后数字减影血管造影显示，生物假体和烟囱冠状动脉支架均处于理想位置。结论深度学习和三维打印的围手术期指导对重度双尖瓣主动脉瓣狭窄伴钙化和高危冠状动脉阻塞患者的手术策略制定有很大帮助。

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引用次数: 0

Metaverse and Telementoring: From Surgery to Workshop. Metaverse and Telementoring：从手术到工作坊

IF 1.5 4区医学 Q3 SURGERY

Surgical Innovation

Pub Date : 2024-04-01 Epub Date: 2024-02-20 DOI: 10.1177/15533506241233674

Michele Ammendola, Francesca Vescio, Mohanad Al Ansari, Jozel Hila, Laura Rizzo, Roberto Romano, Francesco Marchegiani, Nicola de'Angelis, Tullio Piardi, Davide Cavaliere, Adam E Frampton, Tamara M H Gall, Maria Luposella, Riccardo Memeo, Giuseppe Navarra, Silvia Curcio, Giuseppe Currò

Background: The Coronavirus 2019 (COVID-19) pandemic has favored the growth of telemedicine systems and in this context the idea of Metaverse was born and developed. A 3D reality in which people can interact with each other through digital reproductions of themselves. Metaverse has already been tested in numerous medical fields due to its ability to combine visual and auditory information with tactile sensations. The purpose of this study is to highlight its potential also in its ability to be used as a telementoring place where the skills and knowledge of surgeons from all over the world can be combined.

Material and methods: The first HPB Surgery Workshop was held at the "Metaverse Surgical Hospital, USA". During the workshop, surgeons located in various parts of the world reported on hepatic, pancreatic and biliary tract surgery and remotely supported the execution of a robotic liver resection.

Results: The Metaverse gave the opportunity for surgeons to meet and discuss HPB pathologies and its surgical strategies and for surgeons in training to interface with experts by participating in a moment of advanced training.

Conclusion: In the Metaverse, telementoring can be used at very low cost to improve clinical and surgical practice.

背景：冠状病毒 2019（COVID-19）大流行促进了远程医疗系统的发展，在此背景下，"元宇宙"（Metaverse）的概念应运而生。在三维现实中，人们可以通过自己的数字复制品进行互动。由于 Metaverse 能够将视觉和听觉信息与触觉相结合，因此已经在许多医疗领域进行了测试。本研究的目的是突出它的潜力，即它还可以作为一个远程教学场所，将世界各地外科医生的技能和知识结合在一起：第一届人类乳头瘤病毒手术研讨会在 "美国 Metaverse 外科医院 "举行。研讨会期间，来自世界各地的外科医生报告了肝脏、胰腺和胆道手术的情况，并远程支持了机器人肝脏切除术的实施：结果：Metaverse为外科医生提供了会面和讨论HPB病理及其手术策略的机会，也为正在接受培训的外科医生提供了通过参加高级培训与专家交流的机会：结论：在Metaverse中，远程指导可用于改善临床和手术实践，且成本极低。

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引用次数: 0

Prophylactic Intra-abdominal Drainage is Associated With Lower Postoperative Complications in Patients With Crohn's Disease: A Randomized Controlled Trial. 预防性腹腔内引流可降低克罗恩病患者的术后并发症：随机对照试验》。

IF 1.5 4区医学 Q3 SURGERY

Surgical Innovation

Pub Date : 2024-04-01 Epub Date: 2024-02-10 DOI: 10.1177/15533506241232598

Ming Duan, Lei Cao, Mengjie Lu, Tenghui Zhang, Qing Ji, Xian Guo, Zhen Guo, Qiong Wu, Yuxiu Liu, Jianfeng Gong, Weiming Zhu, Yi Li

Background: Prophylactic intraoperative drains have been shown not superior for patients underwent intestinal surgery. However, for patients with Crohn's disease (CD), this needs further exploration.

Methods: In this pilot study, CD patients were randomly assigned to drain (n = 50) and no-drain (n = 50) groups. The primary endpoint was the rate of postoperative prolonged ileus (PPOI). The secondary endpoints were postoperative abdominal ascites, postoperative systemic inflammatory response syndrome (SIRS) and C-reactive protein (CRP) levels.

Results: The incidences of PPOI and postoperative abdominal ascites were significantly lower in the drain group (12% vs 44%; 0% vs 24%, both P < .05). Postoperative SIRS incidence and CRP levels were significantly increased in the no-drain group [36% vs 10%; 54.9 vs 34.3 mg/L, both P < .05]. In multivariate analysis, prophylactic drainage was the independent protective factor for PPOI and postoperative LOS.

Conclusions: Prophylactic drainage may be associated with improved clinical outcomes in CD patients.

背景：预防性术中引流被证明对接受肠道手术的患者没有优势。然而，对于克罗恩病（CD）患者来说，这一点还需要进一步探讨：在这项试验性研究中，克罗恩病患者被随机分配到引流管组（50 人）和无引流管组（50 人）。主要终点是术后回肠延长率（PPOI）。次要终点是术后腹水、术后全身炎症反应综合征（SIRS）和 C 反应蛋白（CRP）水平：结果：引流管组的 PPOI 和术后腹水发生率明显较低（12% 对 44%；0% 对 24%，均 P < .05）。无引流组的术后 SIRS 发生率和 CRP 水平明显升高 [36% vs 10%; 54.9 vs 34.3 mg/L，均 P < .05]。在多变量分析中，预防性引流是 PPOI 和术后 LOS 的独立保护因素：结论：预防性引流可改善 CD 患者的临床预后。

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引用次数: 0

Is LigaSure Alone Sufficient for the Closure of the Appendix Stump? 仅靠 LigaSure 是否足以封闭阑尾残端？

IF 1.5 4区医学 Q3 SURGERY

Surgical Innovation

Pub Date : 2024-04-01 Epub Date: 2024-02-15 DOI: 10.1177/15533506241234005

Deniz Tazeoglu, Ahmet Cem Esmer

Purposes: Closure of the appendix stump is necessary for laparoscopic appendectomy. Problems that occur during the appendix stump closure can cause severe morbidity. Several methods of stump closure have been described. This study aimed to investigate the adequacy of LigaSure alone in closing the appendix stump.

Methods: Patients who were operated on with the diagnosis of acute appendicitis between October 2021 and January 2022 were evaluated retrospectively. The patients were divided into two groups according to the closure technique of the appendix stump hemoclip(group I) and LigaSure only(group II). In addition, demographic data (age, gender), body mass index (BMI), presence of comorbid disease, perioperative appendicitis classification, operation time, postoperative hospital stay, radiological and pathological appendix size of the patients included in the study were recorded. Clavien Dindo was used for postoperative complication assessment.

Result: The study included 77 patients. 48(62.3%) of the patients were in group I, and 29(37.7%) were in group II. There was no statistical difference between the groups regarding age, gender distribution, BMI, presence of comorbid disease (P > .05). The operation time of group I was longer than group II (P < .001). There was no difference between the groups in terms of both radiological and pathological appendix size. There was no statistical difference between the groups regarding postoperative complications and severity of complications (P = .76, P = .99, respectively).

Conclusion: Appendiceal stump closure can be performed with Ligasure, but it should be noted that this procedure can be performed on selected patients, as in the study group, not on all patients.

目的：腹腔镜阑尾切除术必须关闭阑尾残端。阑尾残端闭合过程中出现的问题会导致严重的发病率。目前已有多种阑尾残端闭合方法。本研究旨在探讨单独使用 LigaSure 是否足以关闭阑尾残端：方法：对 2021 年 10 月至 2022 年 1 月期间诊断为急性阑尾炎并接受手术的患者进行回顾性评估。根据阑尾残端血钳（I组）和LigaSure（II组）的闭合技术将患者分为两组。此外，研究还记录了患者的人口统计学数据（年龄、性别）、体重指数（BMI）、有无合并症、阑尾炎围手术期分类、手术时间、术后住院时间、阑尾的放射学和病理学大小。Clavien Dindo用于术后并发症评估：研究共纳入 77 名患者。48（62.3%）名患者属于第一组，29（37.7%）名患者属于第二组。两组患者在年龄、性别分布、体重指数、有无合并症等方面无统计学差异（P>0.05）。第一组的手术时间长于第二组（P < .001）。两组在阑尾的放射学和病理学大小方面没有差异。在术后并发症和并发症严重程度方面，组间无统计学差异（P = .76，P = .99）：结论：阑尾残端闭合术可以使用 Ligasure 进行，但需要注意的是，这种手术只适用于部分患者，如研究组中的患者，而非所有患者。

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引用次数: 0

Single-Port Laparoscopic Extraperitoneal Repair of Pediatric Inguinal Hernias and Hydroceles by Using Hernia Crochet Needle With a Cannula. 使用带套管的疝气钩针单孔腹腔镜腹膜外修复小儿腹股沟疝和腹股沟积水。

IF 1.5 4区医学 Q3 SURGERY

Surgical Innovation

Pub Date : 2024-04-01 Epub Date: 2024-01-05 DOI: 10.1177/15533506241226497

Zhixiong Lin, Lei Yan, Zhihao Fang, Dianming Wu, Mingkun Liu, Yifan Fang

Purpose: Numerous modifications laparoscopic techniques have mushroomed in recent years. Here we describe a modified technique of extracorporeal ligation of processus vaginalis in children using a hernia crochet needle with a cannula.

Methods: Processus vaginalis repair was carried out on patients diagnosed with inguinal hernia or hydroceles using this novel technique between June 2021 and June 2022. The processus vaginalis was closed extracorporeally using a hernia crochet needle with a cannula. In the presence of patent processus vaginalis, the same procedure would be performed on the contralateral side. The primary outcomes was the safety and efficiency of this modified procedure, and the secondary outcomes was the post operative complications.

Results: A total of 212 (165 inguinal hernia and 47 hydroceles) children were corrected by this novel technique. The mean operation time was 27.49 min for unilateral inguinal hernia cases and 36.55 min for bilateral cases. The unilateral hydrocele median operation time was 27.83 min and that for the bilateral cases was 37.30 min. During the mean of 10.92 months of follow-up, there was only a boy subject to a metachronous contralateral occurrence of hernia 10 months after surgery, and no other complications (knot reactions, testicular atrophy, postoperative hydrocele or iatrogenic) have been observed yet.

Conclusion: This study shown a unique procedure with using a hernia crochet needle with a cannula to be simple, safe, and effective in managing inguinal hernias and hydroceles in the pediatric population.

目的：近年来，许多改良腹腔镜技术如雨后春笋般涌现。在此，我们介绍一种使用带套管的疝气钩针对儿童阴道前突进行体外结扎的改良技术：方法：在 2021 年 6 月至 2022 年 6 月期间，使用这种新技术对确诊为腹股沟疝或鞘膜积液的患者进行了阴道前突修补术。使用带套管的疝气钩针在体外闭合阴道突。如果存在通畅的阴道突，则在对侧进行同样的手术。主要结果是这种改良手术的安全性和效率，次要结果是术后并发症：结果：共有 212 名儿童（165 名腹股沟疝和 47 名鞘膜积液）接受了这项新技术的矫正。单侧腹股沟疝的平均手术时间为 27.49 分钟，双侧为 36.55 分钟。单侧鞘膜积液的中位手术时间为 27.83 分钟，双侧鞘膜积液的中位手术时间为 37.30 分钟。在平均 10.92 个月的随访中，只有一名男孩在术后 10 个月发生了对侧疝气，尚未发现其他并发症（结节反应、睾丸萎缩、术后鞘膜积液或先天性）：这项研究表明，使用带套管的疝气钩针进行治疗是一种简单、安全、有效的治疗小儿腹股沟疝气和鞘膜积液的独特方法。

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引用次数: 0

A Matched Comparative Analysis of Type-2 Diabetes Mellitus Remission Between Roux-en-Y Gastric Bypass and Sleeve Gastrectomy. Roux-en-Y胃旁路术与袖状胃切除术对2型糖尿病缓解情况的匹配比较分析。

IF 1.5 4区医学 Q3 SURGERY

Surgical Innovation

Pub Date : 2024-04-01 Epub Date: 2024-01-22 DOI: 10.1177/15533506241229040

Karl Hage, Pearl Ma, Wissam Ghusn, Kayla Ikemiya, Andres Acosta, Robert A Vierkant, Barham K Abu Dayyeh, Kelvin D Higa, Omar M Ghanem

Objective: Multiple scores validate long-term type-2 diabetes mellitus (T2DM) remission after metabolic and bariatric surgery (MBS). However, studies comparing Roux-en-Y gastric bypass (RYGB) and sleeve gastrectomy (SG) have not adequately controlled for certain parameters, which may influence procedure selection.

Methods: We conducted a multicenter retrospective review of patients with T2DM who underwent RYGB or SG between 2008 and 2017. Data on demographics, clinical, laboratory, and metabolic values were collected annually for up to 14 years. Each eligible RYGB patient was individually matched to an eligible SG patient based on diabetes severity, weight loss, and follow-up duration.

Results: Among 1149 T2DM patients, 467 were eligible for matching. We found 97 matched pairs who underwent RYGB or SG. RYGB showed significantly higher T2DM remission rates (46.4%) compared to SG (33.0%) after matching. SG patients had higher insulin usage (35.1%) than RYGB patients (20.6%). RYGB patients also experienced greater decreases in HbA1c levels and diabetes medication usage than SG patients.

Conclusions: RYGB demonstrates higher efficacy for T2DM remission compared to SG, regardless of baseline characteristics, T2DM severity, weight loss, and follow-up duration. Further studies are needed to understand the long-term metabolic effects of MBS and the underlying pathophysiology of T2DM remission after MBS.

目的：多项评分验证了代谢和减肥手术（MBS）后2型糖尿病（T2DM）的长期缓解。然而，比较 Roux-en-Y 胃旁路术（RYGB）和袖状胃切除术（SG）的研究并未充分控制某些参数，而这些参数可能会影响手术选择：我们对2008年至2017年间接受RYGB或SG手术的T2DM患者进行了多中心回顾性研究。在长达 14 年的时间里，我们每年都会收集有关人口统计学、临床、实验室和代谢值的数据。根据糖尿病严重程度、体重减轻情况和随访时间，将每位符合条件的RYGB患者与符合条件的SG患者进行单独匹配：在 1149 名 T2DM 患者中，有 467 人符合配对条件。我们发现有 97 对配对患者接受了 RYGB 或 SG 治疗。配对后，RYGB 的 T2DM 缓解率（46.4%）明显高于 SG（33.0%）。SG 患者的胰岛素使用率（35.1%）高于 RYGB 患者（20.6%）。与 SG 患者相比，RYGB 患者的 HbA1c 水平和糖尿病药物用量的下降幅度也更大：无论基线特征、T2DM 严重程度、体重减轻程度和随访时间长短如何，与 SG 相比，RYGB 对 T2DM 缓解的疗效更高。要了解 MBS 的长期代谢效应以及 MBS 后 T2DM 缓解的潜在病理生理学，还需要进一步的研究。

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