Surgical technology international最新文献

Pelvic Venous Disorder (PEVD) and May-Thurner syndrome (MTS) represent relatively understudied vascular issues that can significantly impact patients' quality of life. This study aims to evaluate the efficacy of surgical treatment for PEVD and MTS, conduct a comparative analysis of outcomes, and determine the practical significance of different therapeutic approaches. The study was conducted from 2019 to 2022 in Moscow, Russia, encompassing two outpatient clinics. A total of 132 patients diagnosed with pelvic venous disorder and/or May-Thurner syndrome (MTS) participated in the research. Diagnostic confirmation relied on ultrasound, transrectal ultrasound, and magnetic resonance imaging. Surgical treatment methods included angioplasty and stenting of the iliac veins. Evaluation of outcomes was based on a comparison of symptoms and additional investigations before and after treatment. It was found that 36% of patients had a history of previous varicocelectomies, with 21% of them having undergone prior surgical interventions. Comorbidities included chronic prostatitis, sexual dysfunction, haemorrhoids, and the presence of varicose veins in the legs, with these pathologies observed in more than 50% of cases. Following the surgical intervention (placement of stents on the left common iliac vein, LCI), a significant improvement in condition was observed in 91% of cases. The obtained results confirm the high efficacy of surgical intervention in the case of PEVD and MTS. The research findings can assist physicians in making more informed decisions when choosing treatment methods for patients with these conditions.

Thermal or burn injuries cause coagulative necrosis of the epidermis and underlying tissues and the resultant wounds can be long lasting and highly painful. Depending on the depth of a burn, management ranges from local wound care to surgical intervention. When presented with deep-partial thickness and full-thickness burns, autologous skin grafting has been the mainstay of management to prevent scarring and promote healing. However, since the early 2000s, there has been increasing interest in reducing, if not eliminating, the need for autologous grafting considering the morbidity and pain associated with donor site harvesting, lack of appropriate donor sites in the case of larger burns, and to improve overall cosmetic outcomes. In this article, we discuss the available products on the market for the treatment of thermal burn injuries, explore the data advocating for their use and discuss their limitations, and highlight the unique efficacy of intact fish skin grafts, in particular, in this specific patient population.

Accurate acetabular component positioning is crucial for the success of total hip arthroplasty (THA). Malplacement of the acetabular component increases the risk of post-surgery complications, most notably dislocation.1 Furthermore, malposition can also result in wear of the polyethylene liner, limited range of motion, and osteolysis.2,3 These complications have led to controversy regarding the optimal acetabular component position. The historic Lewinnek "safe zone" defines the ideal acetabular placement as within 40° +/- 10° abduction and 15° +/- 10° anteversion.4 However, recent controversy has emerged regarding the ideal placement of the acetabular component with one systematic review showing acetabular components placed within the Lewinnek parameters having no significant difference in dislocation rate to those components placed outside the "safe zone."5 Callanan et al. found that a range of 30-45° of abduction and 5-25° of anteversion was the ideal target zone while other studies have argued that the historic safe zone, while useful, should not be considered completely protective against dislocations.6,7 In addition, the spinopelvic relationship as it relates to changes in acetabular cup orientation from a standing to seated position may alter cup placement from the "ideal" position to accommodate reduced spinopelvic junction motion and limit the risk of postoperative instability.8 Secondary to risk of acetabular cup malposition during THA, fluoroscopically aided enabling technology (FET) has gained popularity recently, secondary to proposed benefits of improved accuracy of intraoperative component positioning over standard landmark identification or the use of fluoroscopy alone (FA), as well as minimizing the risk of significant postoperative leg length discrepancies.9,10 In addition, further factors such as not needing special preoperative imaging, minimal change to workflow or surgical approach, and the possibility of reduced operative times have made the use of this technology appealing.11 In addition to the debate regarding ideal acetabular component position to reduce postoperative complications, there has been ongoing discussion regarding the potential detrimental effects of cumulative radiation dose to the surgeon, patient, and operating room personnel when using fluoroscopy for placement of the acetabular component in direct anterior approach total hip arthroplasty (DAA-THA). Prior studies have shown that during DAA- THA, average radiation time was 15.1 seconds (secs), and exposure was 2.00mGy with increasing exposure seen as patient body mass index (BMI) increased.12,13 In theory, FET may help to reduce radiation exposure through less use of intraoperative fluoroscopy for confirmation of acetabular component position. The questions proposed in this study are: 1) Does FET improve the accuracy of acetabular component position versus FA in DAA-THA? and 2) Does FET reduce fluoroscopy time and radiation exposure compared to FA in

Thermal or burn injuries cause coagulative necrosis of the epidermis and underlying tissues and the resultant wounds can be long lasting and highly painful. Depending on the depth of a burn, management ranges from local wound care to surgical intervention. When presented with deep-partial thickness and full-thickness burns, autologous skin grafting has been the mainstay of management to prevent scarring and promote healing. However, since the early 2000s, there has been increasing interest in reducing, if not eliminating, the need for autologous grafting considering the morbidity and pain associated with donor site harvesting, lack of appropriate donor sites in the case of larger burns, and to improve overall cosmetic outcomes. In this article, we discuss the available products on the market for the treatment of thermal burn injuries, explore the data advocating for their use and discuss their limitations, and highlight the unique efficacy of intact fish skin grafts, in particular, in this specific patient population.

Functional and aesthetic aberrations of labia majora are poorly described in scientific literature, and there is a lack of standardization and algorithms for treatment. The labia majora differs from the labia minora in that it has transitional epithelium, fascia, erectile tissue, and adipose components connected to crural, pelvic, and perineal structures. Non-surgical treatments, such as radiofrequency and light-based therapy, must match the symptoms and target these unique structures to have an effect. Our aim is to propose an algorithmic approach to the anatomical variants of the labia majora that are most bothersome to women and describe a step-by-step process to improve vulvar appearance and function.

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.