Surgical technology international最新文献

Introduction: The purpose of this study is to prospectively evaluate differences in post-arthroscopic partial meniscectomy patients based upon the use of a small-bore needle arthroscope or traditional arthroscope for intraoperative visualization.

Materials and methods: Sixty-eight patients were randomized in a 1:1 fashion to have the visualization for arthroscopic partial meniscectomy performed with either a needle arthroscope or traditional arthroscope. Prior to surgery and one-week post procedure, patients underwent peak torque isometric knee extension testing using a handheld dynamometer and Visual Analog Scale (VAS) score collection. The intraoperative arthroscopic fluid volume used was collected. Exclusion criterion included: age under 18, non-English speaking, Kellen-Lawrence Grade 3 or higher, previous ipsilateral knee surgery within six months, and any patient in which arthroscopic partial meniscectomy (APM) was not considered the primary surgical procedure. Tourniquet was not utilized for either study group.

Results: Two group comparisons were performed between patients in the needle arthroscope (NA) group (n=34) and patients in the traditional arthroscope (TA) group (n=34). For the operated knee, patients in the NA group had greater postop leg strength (lbs) (24.7 vs. 18.5, t=3.76, p<0.001) and a smaller decrease in leg strength after surgery (-2.8 vs. -8.7, t=9.96, p<0.001). In contrast, results also showed that the leg strength of the non-operated leg was higher postop in both the NA group (0.6, p<0.001) and TA (0.8, p<0.001) arthroscopy group. Significantly less arthroscopic fluid was required for completion of the procedure in the NA group (479 ml) compared to patients in the TA group (2,568ml t=-38.51, p<0.001). Mean VAS score was significantly lower in the NA group (2.5) versus the TA (M=3.1, t=-3.25, p=0.002). The reduction in VAS pain scores was lower in the NA group (M=-1.8) versus the TA group (M=-1.1, t=-3.45, p=0.001).

Conclusion: The use of a small-bore needle arthroscope for visualization during arthroscopic partial meniscectomy is associated with improved retention of quadriceps function and less postoperative pain in the early postoperative period compared to a traditional arthroscope.

Introduction: When wounds do not respond to standard treatments, advanced therapies are recommended. One such therapy, a proprietary synthetic peptide, self-assembles into a wound matrix when applied to a wound to provide a physical-mechanical barrier that mitigates contamination, modulates inflammation, and becomes a scaffold for cell proliferation and growth. This study evaluated the safety and performance of the AC5 ® Advanced Wound System (Arch Therapeutics Inc. Framingham, Massachusetts) in the management of long-duration, non-healing, and challenging acute and chronic wounds that failed prior therapy.

Materials and methods: Fifteen participants were assigned to receive treatment with AC5 ® weekly or every other week. AC5 ® was evaluated for ease of use, and participants were evaluated for wound condition, healing progress, and local and systemic adverse reactions.

Results: 64% of participants treated weekly had a >50% reduction in wound area at four weeks and 73% had a >60% reduction at eight weeks. For patients treated every other week, 25% achieved 50% wound area reduction at four weeks and 50% had a >50% reduction at eight weeks. The product was easy to apply contiguously to uneven wound geometry. There were no adverse events.

Conclusion: The synthetic self-assembling peptide wound matrix was shown to be safe, effective, and simple to use in the treatment of hard-to-heal wounds. Because AC5® is easy to apply, has an unusual ability to self-assemble into a wound matrix in vivo, and affixes itself contiguously to the interstices of the tissue, AC5 ® may be particularly useful for undermined and tunneled wounds, whether acute or chronic. The results of this study imply that a once-weekly application may result in the best outcome. Further studies are suggested to confirm optimal application frequency for different wound types.

Introduction: Despite advances in perioperative care and immunosuppressive therapy in liver transplantation (LT), and the broadening of eligibility criteria and indications for LT, the complexity of this procedure makes the configuration of a textbook outcome (TO) rather difficult to define an optimal postoperative follow up. In this article, we evaluate and summarize the data in the literature concerning textbook outcome in liver transplantation (TOLT).

Materials and methods: Four studies discussing TOLT were included and evaluated in our literature review. Three studies had, as inclusion criteria, adult patients who had undergone elective primary LT, without association with another organ transplant, with a deceased donor. The fourth study included patients who had undergone an enhanced recovery after surgery (ERAS) protocol prior to their LT during the study period, with no other selection criteria.

Results: The frequency of TOLT in the four studies described ranged from 31 to 37.5%. The definition of TOLT was variable between the different authors, with an "all or nothing" rule. Three criteria were rather predominant: length of hospital stay, mortality, and need for hospital readmission, with variability in the times adopted by the authors for each criterion.

Conclusion: Our systematic review summarizes the international experience regarding the conceptualization of the TOLT to date. The impact of TOLT on graft and patient survival is debated, especially with the complexity of this surgery and its postoperative follow up. Multicenter studies are needed to achieve a standardization of TOLT on a global scale.

In minimally invasive procedures, one of the surgeon's goals is finalizing the surgery safely while using the minimum number and size of trocars. In this article, we present the "fishing technique" which helps to avoid using an extra 10mm trocar in order to deploy specimen retrieval bags.

Introduction: The objective of this article is to compare outcomes of robotic-assisted partial nephrectomy (RAPN) versus laparoscopic partial nephrectomy (LPN) for surgical management of renal tumours by performing a systematic review.

Materials and methods: Prospective randomised controlled trials comparing robotic to laparoscopic partial nephrectomy were included in this analysis. No date or language restriction was imposed. Studies on paediatric patients (<16 years old) were excluded. No specific outcomes were required for inclusion in the analysis. The authors independently extracted data and assessed the risk of bias using the risk of bias tool (RoB 1). Meta-analysis was performed using ReviewManager (RevMan) Software (Cochrane Collaboration, London, United Kingdom).

Results: Two prospective randomised controlled trials involving 190 participants were included. A comparative analysis of 190 patients undergoing partial nephrectomy showed no significant difference in overall complication rates. However, RAPN was associated with a reduced risk of minor complications (Clavien-Dindo grade 1-2). Operatively, LPN demonstrated a marginally shorter duration; whereas, RAPN showed a slight advantage in warm ischemia time. Regarding renal function, RAPN resulted in a less pronounced increase in serum creatinine levels six months postoperatively. In contrast, changes in estimated glomerular filtration rate did not significantly differ between the groups. Length of hospital stay and positive surgical margin rates were comparable between approaches.

Conclusion: There is limited low-quality evidence in small-scale trials that may indicate robotic partial nephrectomy is comparable to laparoscopic partial nephrectomy. RAPN has lower minor complication rates, with potential advantages in warm ischemia time and complication rates.

The prevalence of deep endometriosis invading the bowel is unknown but has been estimated to affect between 3.8% and 37% of women with endometriosis. The most common locations of bowel endometriosis are the sigmoid colon and rectum. Endometriosis affecting the small bowel is exceedingly rare. Laparoendoscopic single-site port surgery (LESS) and robotic-assisted LESS (R-LESS) offer potential advantages in cosmesis and surgical recovery while safely and effectively treating disease. R-LESS is an effective and safe technique for surgical excision of deep endometriosis of the small bowel while utilizing the same access incision as a retrieval site for the surgical specimen. We present a case of a surgical excision of double nodules of deep endometriosis of the small bowel, that was managed using the R-LESS technique, and discuss the proposed advantages and technical challenges.

Introduction: The objective of this study is to determine the structural changes in endometriosis throughout the menstrual cycle.

Materials and methods: This retrospective comparative study was undertaken in a gynaecological unit of a university teaching hospital and looked at the immunohistochemical appearances of epithelial cells of the endometrium and endometriosis in 17 cases at various stages of the menstrual cycle, particularly during menstruation.

Results: The epithelium in endometriosis lesions undergoes the same cyclical morphologic changes that are observed in eutopic endometrium. In particular, each of the six cases of endometriosis observed during the active bleeding phase showed evidence of epithelial shedding of the terminally differentiated secretory-phase epithelial cells and their almost immediate replacement by small undifferentiated cells.

Conclusion: The cyclical shedding/regeneration of endometriotic epithelium during menstruation has not previously been recognised, and it may have significant implications for the understanding of the aetiology and best management of endometriosis.

While metastatic extension to the cardiophrenic lymph nodes (CPN) is relatively rare, cardiophrenic lymphadenectomy may be performed for diagnostic and/or therapeutic purposes. The subxiphoid approach is appropriate, especially for CPN in the prepericardiac area, offering adequate exposure while avoiding the morbidity associated with pleural or pericardial breach. In this article, we describe the surgical technique-detailing the retrosternal liberation section of the tranversus abdominis muscle, followed by cardiophrenic dissection and lymphadenectomy.

Introduction: Accurate pre-resection assessment of gap measurements during total knee arthroplasty (TKA) may reduce the need for thicker polyethylene inserts or those with higher constraint by allowing the surgeon to address potential imbalance through guiding bony resections and implant position. This study aimed to determine whether robotic assistance with pre-planning allowed for the use of thinner and less-constrained polyethylene inserts compared to conventional methods.

Materials and methods: Records were retrospectively reviewed for 408 patients who underwent primary TKA. Patients were divided into cohorts based on the technique utilized-conventional, manual methods with a jig-based system (CM-TKA, 169 knees) versus robotic-assisted TKA (RA-TKA, 237 knees). Operative notes were reviewed for implant brand, thickness of the polyethylene insert, degree of constraint of the polyethylene insert, and whether robotic assistance was used to complete the operation. Statistical analysis was performed using Chi-square tests for categorical and t-tests for continuous variables.

Results: There were no significant differences in demographic characteristics between the RA-TKA and CM-TKA groups. Statistically significant differences were observed between cohorts in mean polyethylene insert thickness (11.0mm ± 1.3mm vs. 11.7mm ± 1.7mm, p<0.0001), rate of use of the thinnest 10mm insert (43% vs. 34%, p=0.048), rate of "outlier" insert sizes ≥14mm (5% vs. 18%, p<0.0001), and rate of constrained insert use (4% vs. 18% of knees, p<0.0001).

Conclusion: In a review of 408 consecutive TKA patients, use of robotic-assisted techniques allowed for the use of thinner polyethylene inserts, fewer "outlier" polyethylene sizes, and reduced need for constrained inserts compared to conventional, manual methods.

Introduction: Complex abdominal wall defects (CAWD) requiring complex abdominal wall reconstruction (CAWR) represent an important surgical challenge in the presence of significant comorbidities. We aimed to report the results on a large patient cohort and identify independent outcome predictors.

Materials and methods: All patients who underwent CAWR with biologic mesh (Strattice™; Reconstructive Tissue Matrix ®, a porcine-derived acellular dermal matrix; Allergan plc, Branchburg, New Jersey) between July 2016 and November 2021 at the tertiary academic center were studied using univariable and multivariable regressions.

Results: During the study period, 287 patients that underwent CAWR emergently and electively were included. The mean age was 59.1±13.4 years, 45.3% were female, and the mean body mass index (BMI) was 32.4±8.3 kg/m2. Elderly patients (≥65 years) represented 35.5%, and 36.6% of patients were operated for recurrent incisional/ ventral hernia. Mean hospital length of stay was 17.7±22.4 days. During the median follow up of two years, the hernia recurrence rate was 3.5%, similar to deaths within 90 days that occurred in 3.5% patients. The most frequent specific adverse outcomes were surgical site infection (22.6%), reoperation (20.9%), seroma (10.1%) and wound necrosis (9.4%). On multivariable regression, the most consistent independent predictors of adverse outcomes were emergency operation requiring damage control laparotomy, extensive lysis of adhesions, obesity, contaminated The Centers for Disease Control and Prevention (CDC) wound class, loss of abdominal domain, and delayed wound closure.

Conclusions: Overall, most patients undergoing CAWR electively or in emergency settings have excellent outcomes with a recurrence rate of 3.5% at two years. High-risk patients for recurrence and mortality are those requiring damage control laparotomy (DCL) during the index emergency operation, fistula take-down, intestinal resection, patient undergoing extensive lysis of adhesions and have a BMI >35kg/m2. Furthermore, patients who have a CDC wound class of III/IV have higher rates of perioperative complications, including the need for reoperation and increased hospital length of stay.