Surgical technology international最新文献

Introduction: Preventing staple line bleeding (SLB) is still a main issue in bariatric surgery procedures, especially after laparoscopic sleeve gastrectomy (LSG). Staple line reinforcements (SLR), mattress sutures, or titanium clip application did not show any statistical superiority compared to other methods. In this randomized controlled trial, we tested hemostatic powder (HP) in order to assess a possible role in the prevention of active bleeding, hematoma formation, the need for transfusions, and the increased risk for hospitalization.

Materials and methods: Centers involved started the enrollment of patients from September 2023 to August 2024. Two groups of 96 and 98 patients were created after randomization and application of the inclusion and exclusion criteria. Patients in the first group underwent LSG with application of HP, while the second group went with standard hemostasis with bipolar coagulation and titanium clip application.

Results: There was no difference between the two groups. Overall bleeding was found to be similar between the two groups (p=1.00). Diffuse bleeding was superior in group 2 (p=0.02), while large hematoma formation was superior in group 1 (p=0.02).

Conclusion: The use of HaemoCer™ (BioCer Entwicklungs, GmbH, Bayreuth, Germany) does not reduce staple line bleeding but helps reduce the incidence of hemoperitoneum as well as the reoperation rate, even though hospitalization was similar between the two groups.

Introduction: Abdominal wall closure in postoperative burst abdomen remains challenging. Different techniques vary between definitive closure and temporary closure. The aim of this study was to examine the short-term outcomes for different closure techniques.

Materials and methods: A multicenter single-arm observational retrospective cohort study examined all patients who underwent emergency operative repair for burst abdomen between January 2010 and May 2020 in two hospitals situated in the Netherlands. Patients underwent definitive closure, static closure with inlay mesh, or dynamic closure with negative pressure wound therapy (NPWT). We evaluated patient and treatment characteristics, length of stay, complications, and survival.

Results: 119 patients were assessed. Definitive closure was performed in 68 patients (57%), with mesh augmentation in 23 (33%). When temporary closure was performed, 45 patients (88%) underwent mesh bridging. Six patients underwent dynamic closure with NPWT. Mesh bridging resulted in a shorter hospital stay (29 ± 16 days vs. 93 ± 46 days; p<0.001), less severe complications (46% vs. 100%; p=0.001), and less reoperations (20% vs. 100%; p<0.001) when compared to NPWT. There was no significant difference in 30-day and one-year mortality between all patient groups.

Conclusion: Definitive closure of the burst abdomen should be performed if possible, depending on intraoperative findings. Our data suggest that mesh bridging for burst abdomen is a valuable alternative in terms of hospital stay, severe complications, and reoperations when compared to NPWT. It can be considered in cases where definitive closure is not feasible.

Modern plasma medicine is a field of medical research combining plasma physics, life sciences, and clinical medicine. It aims to achieve direct application of physical plasma on or in the human body for therapeutic purposes. In medical contexts, the term plasma denotes the liquid component of blood, while in the physical sciences, it refers to ionized gas-also known as the fourth state of matter alongside solid, liquid, and gas. The biological effects of plasma are based on various mechanisms, involving synergistic actions of reactive species such as ionized argon gas molecules and ultraviolet light. Cold-atmospheric plasma (CAP), a specific subtype of plasma, maintain temperatures below 104°F/40°C at the application point, allowing plasma treatment on living tissue at tissue tolerable temperatures. The invention of CAP generating devices has expanded the possibilities for clinical application of plasma in medicine, with growing evidence supporting its efficacy in bacterial load reduction and potential biofilm eradication through debridement. Its antimicrobial effect, coupled with minimal adverse effects on healthy cells, positions it as a promising alternative or additional therapy option. This review provides an overview of current clinical applications of plasma medicine and explores potential roles for plasma application in orthopaedic surgery.

Introduction: Our aim is to investigate the face validity and the construct validity of the ArthroSim™ virtual reality shoulder arthroscopy simulator (Touch of Life Technologies, Inc., Aurora, Colorado).

Materials and methods: Fifteen doctors participated, with five from each of the following levels: novice with no arthroscopies performed, intermediate with less than 50 arthroscopies performed, and expert with over 100 arthroscopies performed. They first undertook a simulation task on the ArthroSim™ simulator, with the simulation and their body movements recorded. Each participant then completed a Likert scale questionnaire after their simulation task evaluating the face validity of the machine. The video recordings were rated by two shoulder surgeons independently using the Global Rating Scale for Shoulder Arthroplasty (GRSSA), Arthroscopic Surgical Skill Evaluation Tool (ASSET), and Imperial Global Arthroscopy Rating Scale (IGARS) scoring systems for construct validation.

Results: All three scales demonstrated high internal consistency GRSSA (0.976 ), ASSET (0.980), and IGARS (0.979). The intraclass correlation coefficient demonstrated high agreement between the assessors: GRSSA (0.88), ASSET (0.90), and IGARS (0.89). Construct validity was evaluated using Kruskal-Wallis one-way analysis of variance: GRSSA (chi square test: 19.828; p<0.001); ASSET (chi square test: 19.62; p<0.001); and IGARS (chi square test: 19.63; p<0.001). This demonstrates that the three scoring systems distinguish significantly between participants with different levels of experience utilizing a virtual reality simulator.

Conclusion: Our study has shown that the ArthoSim™ simulator can accurately distinguish between experience level of the participants. It is more effective in reproducing a training environment as reality for less experienced surgeons. All participants agreed that it is valuable in developing surgical training for the novice and intermediate skill level.

Introduction: Pancreaticoduodenectomy after proximal gastrectomy (PG) presents technical challenges owing to the need to preserve blood flow in the remnant stomach. Considering the oncological factors and preservation of the remnant stomach blood supply, it is crucial to preserve or reconstruct the right gastric artery (RGA) and/or right gastroepiploic artery (RGEA). In cases where the RGEA is preserved, technical considerations for reconstruction arise owing to the poor motility of the remnant stomach.

Case presentation: A 79-year-old man was diagnosed with pancreatic head cancer and underwent pylorus-preserving pancreatoduodenectomy (PPPD) three years after PG for gastric cancer. The second patient, a 64-year-old man with a history of PG for esophagogastric junction cancer two years prior, was diagnosed with distal cholangiocarcinoma and underwent PPPD. In both cases, preserving the RGEA while ensuring adequate oncological resection margins was considered feasible. We were able to safely preserve the RGA, RGEA, and remnant stomach. The jejunum was mobilized from the right mesocolon, and all anastomoses (pancreatojejunostomy, choledochojejunostomy, and duodenojejunostomy [D-J]) were performed on the proximal side of the transverse mesocolon to minimize the tension on the D-J anastomosis.

Conclusion: Pancreatoduodenectomy after PG requires careful consideration of curability and surgical invasiveness. It is crucial to devise reconstruction techniques that minimize tension on the D-J anastomosis.

Introduction: Acetabular component placement is critical for total hip arthroplasty (THA) stability and clinical outcomes. We investigated cup placement with robotic-arm assisted (RA) and conventional manual (CM) THA and compared patient-reported outcome measures (PROMs) and dislocations.

Materials and methods: Thirty-seven patients were randomized to undergo RA or CM primary THA. Computed tomography scans were completed preoperatively and at three months. Component version and inclination were analyzed with target anteversion of 20° and inclination of 40°. PROMs were collected to assess early clinical outcomes.

Results: Seventeen RA and 20 CM THAs were performed. Overall, 1/17 RA and 8/20 CM components fell outside the Lewinnek safe zone. No RA components fell outside the safe zone for inclination and one did for version. Three CM components were outside the inclination safe zone and six were outside for version. There were no dislocations in either group. Improvements in all Hip Disability and Osteoarthritis Outcome Score (HOOS) subtype scores reached substantial clinical benefit thresholds in both groups. One-year HOOS symptom and sports score improvements were significantly higher in the RA group. PROMIS-10 mental health improvement was significantly higher in the CM group at six months, but not at one year.

Conclusions: Robotic-arm assistance may result in more consistent placement within the Lewinnek safe zone. There were improvements in PROMs in both groups, but there were different effects on individual PROMS between groups. Further study is necessary to determine the clinical significance of these improvements.

Introduction: This study aims to evaluate the effect of sensor-based rehabilitation (SR) on chronic knee pain (CKP) outcomes.

Materials and methods: PubMed, Embase, CINAHL, SCOPUS, Cochrane Library, grey literature, and bibliographic references were searched from inception to April 2023. Only randomized controlled trials (RCTs) and cohort studies evaluating the outcomes of SR on CKP were included. Inclusion and exclusion criteria were based on type of study, research subjects, intervention, outcome, language, and availability of data. Out of 937 studies screened, a total of 10 studies with 4347 patients met selection criteria. Comparison of outcomes following intervention was conducted across studies. Meta-analysis of KOOS subscales was also conducted. Literature retrieval and data extraction were conducted by three independent reviewers. Two reviewers performed quantitative data extraction independently before compilation and cross-referencing on Covidence with a third researcher assisting in the cross-referencing process independently to minimise judgment errors.

Results: The sensors utilized included wearable sensors, plantar-controlled sensors, embedded sensors, and optical sensors. There was a high degree of variability in the conduct of the intervention programs and timepoint of assessment. There was an improvement in the KOOS aggregate scores from baseline to post intervention with better improvements seen in studies incorporating avatar-based biofeedback. However, meta-analysis of the KOOS subscales did not show clinically significant differences between control and intervention groups.

Conclusion: There is insufficient evidence to support the routine use of SR in patients with CKP. However, there is some evidence to suggest that incorporation of SR with avatar-based biofeedback in a multi-faceted treatment approach may yield better outcomes than the use of sensors as merely activity trackers.

Progressive peripheral artery disease, especially in the tibial and pedal vessels, can severely limit the interventions that vascular surgeons and interventionalists can provide to patients. End-stage peripheral arterial disease is often described as a disease where there are no distal targets available in the foot. Traditionally, amputation has been the only option for these patients. However with advancements in surgical and endovascular technology, surgical and now peripheral deep vein arterialization (pDVA) can be utilized. In pDVA, an arteriovenous channel is created between a tibial artery and vein and reinforced with covered stent grafts in order to increase distal limb perfusion and improve amputation-free survival. Many techniques have been described, but currently the only formal device marketed and under investigation for pDVA is the LimFlow System (LimFlow SA, Paris, France). Our institution has performed pDVA for multiple vascular patients with no other available surgical interventions. We describe the technique, postoperative care, and outcomes for these patients. Additionally, we will explore updated outcomes and applicability of the LimFlow System in the current vascular practice today.

Introduction: Owing to their rarity, clinicopathologic variables and postoperative outcomes in patients with ampulla of Vater carcinoma (AVC) have not been fully elucidated.

Materials and methods: A retrospective review of the clinical records of patients who underwent surgical exploration for AVC was performed using univariate and multivariate analyses.

Results: One-, three-, and five-year overall survival rates after surgery were 97.4%, 71.8%, and 63.0%, respectively. The most frequently observed sites of recurrence were lymph nodes in 11 patients (52%), followed by the liver in eight (38%), lung in six (29%), local in three (14%), and peritoneal dissemination in three (14%). On multivariate analysis, only the presence of lymph node metastasis extending to the pancreatic head region predicted inferior relapse-free survival. A significant correlation between postoperative recurrence and pathological lymph node metastasis was observed.

Conclusions: Lymph node metastasis, especially that extends to the pancreatic head region, was clearly identified as a prognostic indicator of reduced relapse-free survival in patients with AVC.