Pub Date : 2024-04-16DOI: 10.52198/24.STI.44.GS1760
Alice Moynihan, Patrick Boland, Ronan A Cahill
Transanal minimally invasive surgery (TAMIS) is an effective procedure that plays an important role in the care of patients with significant rectal neoplasia and polyps including early-stage cancers. However, it is perhaps underutilised and under threat from both advanced flexible endoscopic procedures and proceduralists (who often act as gatekeepers for referral to colorectal surgeons), as well as from robotic surgery proponents. TAMIS advocates can learn and adopt practice insights from both these fields and incorporate available technological innovations building on the huge accomplishments already delivered in this area. Evolved practice through technology has the potential to offset current limitations regarding technical constraints and indeed patient selection (via artificial intelligence methods). Potential target areas for advances are considered in this review from different perspectives: (1) Access (2) Insufflation (3) Visualisation (4) Disease Characterization in situ, and (5) Tissue Handling and Suturing. While a bundle approach may be most useful, the advances for each component are potentially useful in their own right and could be applied without depending on the other practices detailed so that more accurate (and perhaps even numerically more) TAMIS procedures can be performed globally to improve patient care.
{"title":"Twenty First Century Technological Toolbox Innovation for Transanal Minimally Invasive Surgery (TAMIS).","authors":"Alice Moynihan, Patrick Boland, Ronan A Cahill","doi":"10.52198/24.STI.44.GS1760","DOIUrl":"10.52198/24.STI.44.GS1760","url":null,"abstract":"<p><p>Transanal minimally invasive surgery (TAMIS) is an effective procedure that plays an important role in the care of patients with significant rectal neoplasia and polyps including early-stage cancers. However, it is perhaps underutilised and under threat from both advanced flexible endoscopic procedures and proceduralists (who often act as gatekeepers for referral to colorectal surgeons), as well as from robotic surgery proponents. TAMIS advocates can learn and adopt practice insights from both these fields and incorporate available technological innovations building on the huge accomplishments already delivered in this area. Evolved practice through technology has the potential to offset current limitations regarding technical constraints and indeed patient selection (via artificial intelligence methods). Potential target areas for advances are considered in this review from different perspectives: (1) Access (2) Insufflation (3) Visualisation (4) Disease Characterization in situ, and (5) Tissue Handling and Suturing. While a bundle approach may be most useful, the advances for each component are potentially useful in their own right and could be applied without depending on the other practices detailed so that more accurate (and perhaps even numerically more) TAMIS procedures can be performed globally to improve patient care.</p>","PeriodicalId":22194,"journal":{"name":"Surgical technology international","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2024-04-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140870063","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-04-08DOI: 10.52198/24.STI.44.OS1784
Daniel Hameed, Jeremy A Dubin, Ignacio Pasqualini, Viktor Krebs, Nicolas S Piuzzi, Michael A Mont
Revision total hip arthroplasty (THA) presents a formidable challenge when addressing extensive acetabular defects, particularly in severe cases classified under Paprosky types 3A and 3B and American Academy of Orthopaedic Surgeons types 3 and 4. Traditional methods often fall short, prompting the potential use of custom triflange acetabular components or patient-specific acetabular implants (PSAIs). These implants are specifically designed to conform to an individual's anatomy, aiming to enhance defect reconstruction and pelvic stabilization. This case series describes the utilization of advanced 3-dimensional printing and rapid prototyping technologies to construct customized acetabular components, which can be instrumental in enabling precise preoperative planning and surgical execution for these difficult acetabular cases and potentially leading to improved surgical outcomes.
{"title":"Custom Triflange Acetabular Implants for Complex Hip Revisions: A Case Series.","authors":"Daniel Hameed, Jeremy A Dubin, Ignacio Pasqualini, Viktor Krebs, Nicolas S Piuzzi, Michael A Mont","doi":"10.52198/24.STI.44.OS1784","DOIUrl":"10.52198/24.STI.44.OS1784","url":null,"abstract":"<p><p>Revision total hip arthroplasty (THA) presents a formidable challenge when addressing extensive acetabular defects, particularly in severe cases classified under Paprosky types 3A and 3B and American Academy of Orthopaedic Surgeons types 3 and 4. Traditional methods often fall short, prompting the potential use of custom triflange acetabular components or patient-specific acetabular implants (PSAIs). These implants are specifically designed to conform to an individual's anatomy, aiming to enhance defect reconstruction and pelvic stabilization. This case series describes the utilization of advanced 3-dimensional printing and rapid prototyping technologies to construct customized acetabular components, which can be instrumental in enabling precise preoperative planning and surgical execution for these difficult acetabular cases and potentially leading to improved surgical outcomes.</p>","PeriodicalId":22194,"journal":{"name":"Surgical technology international","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2024-04-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140871975","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Joshua P Rainey, Jeremy M Gililland, Kevin Marchand, Kelly Taylor, Michael A Mont, Robert C Marchand
Background: Shorter, metaphyseal-filling collared stems have become popular with the direct anterior approach (DAA), based on their ease of broaching and insertion through less invasive surgical exposures. To aid with the DAA, robotic-assisted technology provides three-dimensional computed tomography (CT) preoperative planning and intraoperative guidance to accurately assess stem version. With other femoral stems, this has been shown to provide more accurate implant planning and improved patient outcomes. The purpose of this study was to understand femoral stem placement predictability and patient outcomes for a newly designed metaphyseal-filling collared stem system through a DAA in combination with a robotic-assisted system during a single surgeon's initial cases.
Materials and methods: A single high-volume surgeon, experienced with robotic-assisted DAA total hip arthroplasty (THA), adopted the use of a metaphyseal-filling collared stem. Intraoperative data and patient outcomes up to six months postoperative were collected prospectively during the surgeon's first 123 cases. Student's t-tests (α=0.05) were used for statistical comparisons. Intraoperative and radiographic assessments were performed for all 123 cases.
Results: The estimated version with neck-cut view of the robotic-assisted system was 13.81 ± 3.81°. The final version measurement captured with the robotic-assisted system was 16.56 ± 6.61°. The difference between the estimated version and robotic-assisted measured version was, on average, 2.68 ± 5.7° (p<0.001). The femoral stem sat at the level of the calcar in all but five cases. There were no intraoperative or postoperative periprosthetic fractures. Patients reported significant improvements in reduced Hip dysfunction and Osteoarthritis Outcome Score for Joint Replacement (HOOS-JR), Patient-Reported Outcomes Measurement Information System (PROMIS 10), and Western Ontario and McMaster Universities Arthritis Index (WOMAC) scores throughout their six-month recovery process with no patients reporting a periprosthetic joint infection, fracture, or dislocation.
Conclusion: The use of a metaphyseal-filling collared stem with robotic-assisted DAA resulted in adequate stem version when assessed visually and with CT scan assessments. Version estimation values were improved upon over visual assessments when using the robotic system that maps out the proximal femur and the improvement was also demonstrated when compared to the prior literature. This may also be related to the stem's collar providing a visual guide during stem placement posterior fill of this triple-tapered stem design. Although further follow up is needed to assess longer-term outcomes, at six months postoperatively, patients had significant improvements in patient-reported outcomes with all patients reporting minimal to no restrictions with their THA.
{"title":"Evaluation of an Initial Robotic-Assisted Direct Anterior Approach Cohort Receiving a New Short Metaphyseal Filling Collared Femoral Implant.","authors":"Joshua P Rainey, Jeremy M Gililland, Kevin Marchand, Kelly Taylor, Michael A Mont, Robert C Marchand","doi":"","DOIUrl":"","url":null,"abstract":"<p><strong>Background: </strong>Shorter, metaphyseal-filling collared stems have become popular with the direct anterior approach (DAA), based on their ease of broaching and insertion through less invasive surgical exposures. To aid with the DAA, robotic-assisted technology provides three-dimensional computed tomography (CT) preoperative planning and intraoperative guidance to accurately assess stem version. With other femoral stems, this has been shown to provide more accurate implant planning and improved patient outcomes. The purpose of this study was to understand femoral stem placement predictability and patient outcomes for a newly designed metaphyseal-filling collared stem system through a DAA in combination with a robotic-assisted system during a single surgeon's initial cases.</p><p><strong>Materials and methods: </strong>A single high-volume surgeon, experienced with robotic-assisted DAA total hip arthroplasty (THA), adopted the use of a metaphyseal-filling collared stem. Intraoperative data and patient outcomes up to six months postoperative were collected prospectively during the surgeon's first 123 cases. Student's t-tests (α=0.05) were used for statistical comparisons. Intraoperative and radiographic assessments were performed for all 123 cases.</p><p><strong>Results: </strong>The estimated version with neck-cut view of the robotic-assisted system was 13.81 ± 3.81°. The final version measurement captured with the robotic-assisted system was 16.56 ± 6.61°. The difference between the estimated version and robotic-assisted measured version was, on average, 2.68 ± 5.7° (p<0.001). The femoral stem sat at the level of the calcar in all but five cases. There were no intraoperative or postoperative periprosthetic fractures. Patients reported significant improvements in reduced Hip dysfunction and Osteoarthritis Outcome Score for Joint Replacement (HOOS-JR), Patient-Reported Outcomes Measurement Information System (PROMIS 10), and Western Ontario and McMaster Universities Arthritis Index (WOMAC) scores throughout their six-month recovery process with no patients reporting a periprosthetic joint infection, fracture, or dislocation.</p><p><strong>Conclusion: </strong>The use of a metaphyseal-filling collared stem with robotic-assisted DAA resulted in adequate stem version when assessed visually and with CT scan assessments. Version estimation values were improved upon over visual assessments when using the robotic system that maps out the proximal femur and the improvement was also demonstrated when compared to the prior literature. This may also be related to the stem's collar providing a visual guide during stem placement posterior fill of this triple-tapered stem design. Although further follow up is needed to assess longer-term outcomes, at six months postoperatively, patients had significant improvements in patient-reported outcomes with all patients reporting minimal to no restrictions with their THA.</p>","PeriodicalId":22194,"journal":{"name":"Surgical technology international","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2024-04-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140872177","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-03-29DOI: 10.52198/24.STI.44.WH1752
Allegra L Fierro, Carolyn Foley, Tomer Lagziel, John C Lantis
Autologous blood-derived therapies have emerged as a unique and promising treatment option for chronic wounds. From whole blood clots to spun-down clot constituents, these therapies are highly versatile and tend to have a lower cost profile, allow for point-of-service preparation, and inherently carry minimal to no risk of rejection or allergic reaction when compared to many alternative cellular and matrix-like products. Subsequently, a diversity of processing systems, devices, and kits have surfaced on the market for preparing autologous blood-derived products (ABDPs) and many have demonstrated preclinical and clinical efficacy in facilitating chronic wound healing. However, not all ABDPs are created equal, and the lack of standardization among product formulations and cell concentrations as well as varying complexities in preparation protocols has led to unreliable substrate viabilities and overall inconsistent conclusions on efficacy. Additionally, external factors, such as the ease of drawing blood, the health of a patient's blood, and the reimbursement landscape have dissuaded some practitioners from incorporating ABDPs into an algorithm of care for recalcitrant wounds. Here, we attempt to categorize ABDPs into "classes" and examine their efficacy, advantages, and limitations when used as both a primary therapy and an adjunct for treating chronic wounds as well as comment on some potential considerations that may help gear future product development and application.
{"title":"Autologous Blood-Derived Products (ABDPs) for the Treatment of Chronic Wounds.","authors":"Allegra L Fierro, Carolyn Foley, Tomer Lagziel, John C Lantis","doi":"10.52198/24.STI.44.WH1752","DOIUrl":"10.52198/24.STI.44.WH1752","url":null,"abstract":"<p><p>Autologous blood-derived therapies have emerged as a unique and promising treatment option for chronic wounds. From whole blood clots to spun-down clot constituents, these therapies are highly versatile and tend to have a lower cost profile, allow for point-of-service preparation, and inherently carry minimal to no risk of rejection or allergic reaction when compared to many alternative cellular and matrix-like products. Subsequently, a diversity of processing systems, devices, and kits have surfaced on the market for preparing autologous blood-derived products (ABDPs) and many have demonstrated preclinical and clinical efficacy in facilitating chronic wound healing. However, not all ABDPs are created equal, and the lack of standardization among product formulations and cell concentrations as well as varying complexities in preparation protocols has led to unreliable substrate viabilities and overall inconsistent conclusions on efficacy. Additionally, external factors, such as the ease of drawing blood, the health of a patient's blood, and the reimbursement landscape have dissuaded some practitioners from incorporating ABDPs into an algorithm of care for recalcitrant wounds. Here, we attempt to categorize ABDPs into \"classes\" and examine their efficacy, advantages, and limitations when used as both a primary therapy and an adjunct for treating chronic wounds as well as comment on some potential considerations that may help gear future product development and application.</p>","PeriodicalId":22194,"journal":{"name":"Surgical technology international","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2024-03-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140336870","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-03-28DOI: 10.52198/24.STI.44.OS1780
Sean B Sequeira, Matthew F Myntti, Jeanne Lee, Michael A Mont
Periprosthetic joint infection (PJI) is a serious postoperative complication in joint arthroplasty procedures that carries substantial morbidity and mortality associated with it. Several strategies have been developed both in the preoperative, perioperative, and postoperative periods to both combat and prevent the development of this devastating complication. Intraoperative irrigation is an important modality used during arthroplasty procedures prior to the implantation of final components that seeks to eradicate any biofilm formation. In this updated review, we discuss the XPERIENCE™ Advanced Surgical Irrigation solution (Next Science, Jacksonville, Florida) and the various completed, ongoing, and planned basic science and clinical investigations associated with it. Although there is already an impressive body of literature supporting its widespread utilization, future basic and clinical trials will continue to be performed to comprehensively characterize the effect this antimicrobial solution has on eliminating the risk of PJI following arthroplasty procedures.
{"title":"An Overview of Research for the Application of a Novel Biofilm-Preventing Surgical Irrigation System for Total Joint Arthroplasty Procedures in Order to Reduce the Risk of Periprosthetic Infection.","authors":"Sean B Sequeira, Matthew F Myntti, Jeanne Lee, Michael A Mont","doi":"10.52198/24.STI.44.OS1780","DOIUrl":"10.52198/24.STI.44.OS1780","url":null,"abstract":"<p><p>Periprosthetic joint infection (PJI) is a serious postoperative complication in joint arthroplasty procedures that carries substantial morbidity and mortality associated with it. Several strategies have been developed both in the preoperative, perioperative, and postoperative periods to both combat and prevent the development of this devastating complication. Intraoperative irrigation is an important modality used during arthroplasty procedures prior to the implantation of final components that seeks to eradicate any biofilm formation. In this updated review, we discuss the XPERIENCE™ Advanced Surgical Irrigation solution (Next Science, Jacksonville, Florida) and the various completed, ongoing, and planned basic science and clinical investigations associated with it. Although there is already an impressive body of literature supporting its widespread utilization, future basic and clinical trials will continue to be performed to comprehensively characterize the effect this antimicrobial solution has on eliminating the risk of PJI following arthroplasty procedures.</p>","PeriodicalId":22194,"journal":{"name":"Surgical technology international","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2024-03-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140319190","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-03-22DOI: 10.52198/24.STI.44.WH1770
Arthur Evensen, Jodi Walters, James Dancho, Valarie Samoy, David Jolley
Synthetic extracellular matrices are artificial polymers that are elongated and deposited as a matrix of nanofibers which mimic the native extracellular matrix. RenovoDerm® Anthem™ Wound Matrix (Columbus, Ohio) is comprised of polyglycolic acid and poly (L-lactide-co-caprolactone) which degrade by hydrolysis into a-hydroxy and fatty acids, lowering the pH and promoting regenerative cellular activity including angiogenesis. Amniotic allografts contain growth factors, cytokines, amino acids, extracellular matrix proteins, and hyaluronic acid which are recognized as intrinsic to the wound healing process. Synthetic extracellular matrices alone or in combination with amnio allografts do not have large bodies of evidence which demonstrate their effectiveness in the treatment of wounds. Presently, no prior studies have been performed to assess what impact these therapies may have on wound healing when used concurrently. The aim of this investigation was to assess whether a synergistic effect is produced with combination therapy using synthetic extracellular matrix and amniotic allografting. In this article, we present four cases of diabetic foot ulcerations treated with combination therapy. An amniotic fluid allograft, and/or membrane amniotic allograft, was implanted with a synthetic extracellular matrix dressing over top of the graft(s) at weekly intervals. All wounds demonstrated a greater than 80% decrease in wound size within four applications and achieved more than 95% wound closure after six applications.
{"title":"Impact of Synthetic Extracellular Matrices in Combination Therapy with Amniotic Allografting in the Treatment of Diabetic Foot Wounds: A Case Series.","authors":"Arthur Evensen, Jodi Walters, James Dancho, Valarie Samoy, David Jolley","doi":"10.52198/24.STI.44.WH1770","DOIUrl":"10.52198/24.STI.44.WH1770","url":null,"abstract":"<p><p>Synthetic extracellular matrices are artificial polymers that are elongated and deposited as a matrix of nanofibers which mimic the native extracellular matrix. RenovoDerm® Anthem™ Wound Matrix (Columbus, Ohio) is comprised of polyglycolic acid and poly (L-lactide-co-caprolactone) which degrade by hydrolysis into a-hydroxy and fatty acids, lowering the pH and promoting regenerative cellular activity including angiogenesis. Amniotic allografts contain growth factors, cytokines, amino acids, extracellular matrix proteins, and hyaluronic acid which are recognized as intrinsic to the wound healing process. Synthetic extracellular matrices alone or in combination with amnio allografts do not have large bodies of evidence which demonstrate their effectiveness in the treatment of wounds. Presently, no prior studies have been performed to assess what impact these therapies may have on wound healing when used concurrently. The aim of this investigation was to assess whether a synergistic effect is produced with combination therapy using synthetic extracellular matrix and amniotic allografting. In this article, we present four cases of diabetic foot ulcerations treated with combination therapy. An amniotic fluid allograft, and/or membrane amniotic allograft, was implanted with a synthetic extracellular matrix dressing over top of the graft(s) at weekly intervals. All wounds demonstrated a greater than 80% decrease in wound size within four applications and achieved more than 95% wound closure after six applications.</p>","PeriodicalId":22194,"journal":{"name":"Surgical technology international","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2024-03-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140289041","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-03-22DOI: 10.52198/24.STI.44.GS1765
Carla R Edgley, Jorge G Zarate Rodriguez, Chet W Hammill
Background: Pancreatoduodenectomy is a highly complex surgical procedure associated with high postoperative morbidity and mortality. Treatment of postoperative pain is crucial to preventing chronic pain and further complications. Opioids are the leading treatment modality for acute postoperative pain for all surgical procedures in the US, contributing to the opioid epidemic, a crisis causing death and lifelong impairment in many patients. Multimodal analgesia techniques, such as the transversus abdominis plane (TAP) block, are suggested to reduce perioperative opioid usage. This exploratory literature review aims to investigate the use of TAP block in postoperative pain and opioid use in patients undergoing pancreatoduodenectomy.
Materials and methods: A search strategy developed from Cochrane best practice recommendations was applied to a comprehensive search of PubMed, Scopus, and PsycINFO databases, yielding three articles of relevance in patients having pancreatic surgery.
Results: Previous research demonstrates TAP block efficacy in decreasing opiate consumption after major abdominal surgery; however, there is a paucity of data regarding opioid consumption in pancreatoduodenectomy patients.
Conclusion: Research in relation to TAP block analgesia is varied given the variety of approaches, techniques, and timing of the TAP block procedure. Future research should seek to elucidate the role of TAP blocks in reducing postoperative pain and opioid consumption in pancreatoduodenectomy patients.
背景:胰十二指肠切除术是一种高度复杂的外科手术,术后发病率和死亡率都很高。术后疼痛的治疗对于预防慢性疼痛和进一步的并发症至关重要。在美国,阿片类药物是所有外科手术急性术后疼痛的主要治疗方式,导致了阿片类药物的流行,这场危机造成了许多患者的死亡和终身残疾。有人建议采用腹横肌平面(TAP)阻滞等多模式镇痛技术来减少围手术期阿片类药物的使用。本探索性文献综述旨在研究 TAP 阻滞在胰十二指肠切除术患者术后疼痛和阿片类药物使用中的应用:在对PubMed、Scopus和PsycINFO数据库进行全面检索时,采用了根据Cochrane最佳实践建议制定的检索策略,共检索到三篇与胰腺手术患者相关的文章:以往的研究表明,TAP阻滞能有效减少腹部大手术后阿片类药物的用量;但有关胰十二指肠切除术患者阿片类药物用量的数据却很少:鉴于 TAP 阻滞术的方法、技术和时机多种多样,有关 TAP 阻滞镇痛的研究也多种多样。未来的研究应致力于阐明 TAP 阻滞在减轻胰十二指肠切除术患者术后疼痛和阿片类药物消耗方面的作用。
{"title":"Decreasing Perioperative Opiate Use During Pancreaticoduodenectomy Using Transversus Abdominus Plane Blocks: A Review of the Literature.","authors":"Carla R Edgley, Jorge G Zarate Rodriguez, Chet W Hammill","doi":"10.52198/24.STI.44.GS1765","DOIUrl":"10.52198/24.STI.44.GS1765","url":null,"abstract":"<p><strong>Background: </strong>Pancreatoduodenectomy is a highly complex surgical procedure associated with high postoperative morbidity and mortality. Treatment of postoperative pain is crucial to preventing chronic pain and further complications. Opioids are the leading treatment modality for acute postoperative pain for all surgical procedures in the US, contributing to the opioid epidemic, a crisis causing death and lifelong impairment in many patients. Multimodal analgesia techniques, such as the transversus abdominis plane (TAP) block, are suggested to reduce perioperative opioid usage. This exploratory literature review aims to investigate the use of TAP block in postoperative pain and opioid use in patients undergoing pancreatoduodenectomy.</p><p><strong>Materials and methods: </strong>A search strategy developed from Cochrane best practice recommendations was applied to a comprehensive search of PubMed, Scopus, and PsycINFO databases, yielding three articles of relevance in patients having pancreatic surgery.</p><p><strong>Results: </strong>Previous research demonstrates TAP block efficacy in decreasing opiate consumption after major abdominal surgery; however, there is a paucity of data regarding opioid consumption in pancreatoduodenectomy patients.</p><p><strong>Conclusion: </strong>Research in relation to TAP block analgesia is varied given the variety of approaches, techniques, and timing of the TAP block procedure. Future research should seek to elucidate the role of TAP blocks in reducing postoperative pain and opioid consumption in pancreatoduodenectomy patients.</p>","PeriodicalId":22194,"journal":{"name":"Surgical technology international","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2024-03-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140289040","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-03-19DOI: 10.52198/24.STI.44.GS1773
Prachi Rojatkar, Anil K Nalagatla, Crystal D Ricketts, Jeffrey W Clymer, Emily Yosh
Surgical stapling has evolved significantly over time, with the primary goal of improving patient outcomes. This study describes the technological advancements in surgical stapling from the perspective of staple and cartridge design, assessing the impact of staple design when it changes from the traditional B form (also known as 2D staple form) to a three-dimensional form (known as 3D staple form). The change in configuration helps compress a larger surface area of the tissue. The 3D configuration is designed to optimize compression not only underneath each staple but also across staples and multiple staple lines, including both stapled and unstapled regions of the tissue. By achieving more evenly distributed compression throughout the staple line, there is potential for reduced leak paths. The study demonstrates that the 3D staple form in surgical stapling results in more evenly distributed compression. In the future, this advanced technology should seamlessly integrate into emerging systems such as the surgical robot, enabling continued progress in surgical instrumentation and ultimately in surgical care.
随着时间的推移,以改善患者预后为主要目标的手术缝合技术发生了重大发展。本研究从钉书针和针筒设计的角度描述了手术钉书针的技术进步,评估了钉书针设计从传统的 B 形(也称为 2D 钉书针形式)转变为三维形式(称为 3D 钉书针形式)时所产生的影响。结构的改变有助于压缩更大的组织表面积。三维结构的设计不仅优化了每个订书钉下方的压缩,还优化了跨订书钉和多条订书钉线的压缩,包括组织的订书钉区域和未订书钉区域。通过在整个缝合线上实现更均匀分布的压缩,有可能减少渗漏路径。这项研究表明,手术缝合中的三维缝合线可实现更均匀分布的压迫。未来,这项先进技术应能无缝集成到手术机器人等新兴系统中,从而推动手术器械的不断进步,并最终促进手术护理的发展。
{"title":"The Science of Stapling: Staple Form.","authors":"Prachi Rojatkar, Anil K Nalagatla, Crystal D Ricketts, Jeffrey W Clymer, Emily Yosh","doi":"10.52198/24.STI.44.GS1773","DOIUrl":"10.52198/24.STI.44.GS1773","url":null,"abstract":"<p><p>Surgical stapling has evolved significantly over time, with the primary goal of improving patient outcomes. This study describes the technological advancements in surgical stapling from the perspective of staple and cartridge design, assessing the impact of staple design when it changes from the traditional B form (also known as 2D staple form) to a three-dimensional form (known as 3D staple form). The change in configuration helps compress a larger surface area of the tissue. The 3D configuration is designed to optimize compression not only underneath each staple but also across staples and multiple staple lines, including both stapled and unstapled regions of the tissue. By achieving more evenly distributed compression throughout the staple line, there is potential for reduced leak paths. The study demonstrates that the 3D staple form in surgical stapling results in more evenly distributed compression. In the future, this advanced technology should seamlessly integrate into emerging systems such as the surgical robot, enabling continued progress in surgical instrumentation and ultimately in surgical care.</p>","PeriodicalId":22194,"journal":{"name":"Surgical technology international","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2024-03-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140319192","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-03-12DOI: 10.52198/24.STI.44.GS1764
Adam Truong, Jino Chough, Karen N Zaghiyan, Phillip R Fleshner
Introduction: Interest in microscopic margin positivity during surgical resection of medical-refractory Crohn's disease has been renewed with multiple recent studies showing an association between microscopic margin positivity with disease recurrence. Our aim was to determine risk factors for microscopic margin disease positivity following ileocolic resection (ICR).
Materials and methods: A prospectively-maintained database of patients with Crohn's disease undergoing ICR at a tertiary-referral center was queried. Margin positivity was defined as the presence of cryptitis, erosion, transmural inflammation with lymphoid aggregates, or architectural distortion at either ileal (proximal) or colonic (distal) margins.
Results: Amongst 584 patients, 97 patients had a positive microscopic margin (17%) of which 46% had a positive proximal margin, 17% had a positive distal margin, and 13% had both positive and distal margins. Using multivariable logistic regression analysis, index ICR was associated with less odds of positive margin (odds ratio [OR] 0.46, 95% confidence interval [CI] 0.24-0.89, p=0.02), and granuloma presence was associated with increased odds (OR 2.26, 95% CI 1.23-4.21, p=0.01).
Conclusion: We found that repeat ileocolic resection and granuloma presence were predictors of microscopic margin disease.
{"title":"Risk Factors for Microscopic Disease Positivity at Ileocolic Resection Margins for Crohn's Disease.","authors":"Adam Truong, Jino Chough, Karen N Zaghiyan, Phillip R Fleshner","doi":"10.52198/24.STI.44.GS1764","DOIUrl":"10.52198/24.STI.44.GS1764","url":null,"abstract":"<p><strong>Introduction: </strong>Interest in microscopic margin positivity during surgical resection of medical-refractory Crohn's disease has been renewed with multiple recent studies showing an association between microscopic margin positivity with disease recurrence. Our aim was to determine risk factors for microscopic margin disease positivity following ileocolic resection (ICR).</p><p><strong>Materials and methods: </strong>A prospectively-maintained database of patients with Crohn's disease undergoing ICR at a tertiary-referral center was queried. Margin positivity was defined as the presence of cryptitis, erosion, transmural inflammation with lymphoid aggregates, or architectural distortion at either ileal (proximal) or colonic (distal) margins.</p><p><strong>Results: </strong>Amongst 584 patients, 97 patients had a positive microscopic margin (17%) of which 46% had a positive proximal margin, 17% had a positive distal margin, and 13% had both positive and distal margins. Using multivariable logistic regression analysis, index ICR was associated with less odds of positive margin (odds ratio [OR] 0.46, 95% confidence interval [CI] 0.24-0.89, p=0.02), and granuloma presence was associated with increased odds (OR 2.26, 95% CI 1.23-4.21, p=0.01).</p><p><strong>Conclusion: </strong>We found that repeat ileocolic resection and granuloma presence were predictors of microscopic margin disease.</p>","PeriodicalId":22194,"journal":{"name":"Surgical technology international","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2024-03-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140120678","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-03-07DOI: 10.52198/24.STI.44.OS1758
Nathalie Willems, Kevin B Marchand, Christina Esposito, Daniele De Massari, Daniel Hameed, Gavin Clark, Robert Marchand, Michael A Mont, Michael Dunbar
Introduction: Classical neutral mechanical alignment in total knee arthroplasty (TKA) has been a standard paradigm, while more recently, other alignment schemas, such as kinematic, individualized, and functional, have been explored. This study aimed to investigate the effect of three-dimensional (3D) computed tomography (CT)-based surgical robotics inputs on a classically trained surgeon's TKA component positions and alignment targets over time.
Materials and methods: Data from 1,394 consecutive robotically-assisted TKAs by a single surgeon from 2016 to 2020 were analyzed. Metrics collected included pre-balance planned implant component positions, final planned implant component positions after soft tissue balancing, and constitutional alignment from CT scans. Joint line obliquity was plotted against the arithmetic hip-knee angle (aHKA) using coronal plane alignment of the knee (CPAK). Three categories of alignment strategy were defined: true mechanical alignment (tMA), adjusted mechanical alignment (aMA), and no mechanical alignment (noMA).
Results: A shift to overall varus component positioning was observed over the years. Joint line obliquity according to CPAK showed a wider spread in later years, and the distribution of tibial and femoral coronal alignment angles expanded over time.
Conclusion: The study revealed a change in alignment targets and final positioning of components away from neutral biomechanical axes in a large volume of TKAs by a single, classically trained surgeon over five years of using a robotic arm-assisted TKA system with CT-based planning. The most dominant factor for this change was the use of 3D CT planning, allowing the surgeon to assess patient-specific anatomy and plan accordingly. Outcome data is needed to determine if this change in behavior and surgical technique was beneficial. In summary, using a CT scan-based robotically assisted technique led to a gradual and complete shift from tMA to predominantly a non-mechanically aligned philosophy in TKA.
{"title":"True Confessions of Neutral Mechanical Disciple-How I Learned to Love a Patient-Specific Target.","authors":"Nathalie Willems, Kevin B Marchand, Christina Esposito, Daniele De Massari, Daniel Hameed, Gavin Clark, Robert Marchand, Michael A Mont, Michael Dunbar","doi":"10.52198/24.STI.44.OS1758","DOIUrl":"10.52198/24.STI.44.OS1758","url":null,"abstract":"<p><strong>Introduction: </strong>Classical neutral mechanical alignment in total knee arthroplasty (TKA) has been a standard paradigm, while more recently, other alignment schemas, such as kinematic, individualized, and functional, have been explored. This study aimed to investigate the effect of three-dimensional (3D) computed tomography (CT)-based surgical robotics inputs on a classically trained surgeon's TKA component positions and alignment targets over time.</p><p><strong>Materials and methods: </strong>Data from 1,394 consecutive robotically-assisted TKAs by a single surgeon from 2016 to 2020 were analyzed. Metrics collected included pre-balance planned implant component positions, final planned implant component positions after soft tissue balancing, and constitutional alignment from CT scans. Joint line obliquity was plotted against the arithmetic hip-knee angle (aHKA) using coronal plane alignment of the knee (CPAK). Three categories of alignment strategy were defined: true mechanical alignment (tMA), adjusted mechanical alignment (aMA), and no mechanical alignment (noMA).</p><p><strong>Results: </strong>A shift to overall varus component positioning was observed over the years. Joint line obliquity according to CPAK showed a wider spread in later years, and the distribution of tibial and femoral coronal alignment angles expanded over time.</p><p><strong>Conclusion: </strong>The study revealed a change in alignment targets and final positioning of components away from neutral biomechanical axes in a large volume of TKAs by a single, classically trained surgeon over five years of using a robotic arm-assisted TKA system with CT-based planning. The most dominant factor for this change was the use of 3D CT planning, allowing the surgeon to assess patient-specific anatomy and plan accordingly. Outcome data is needed to determine if this change in behavior and surgical technique was beneficial. In summary, using a CT scan-based robotically assisted technique led to a gradual and complete shift from tMA to predominantly a non-mechanically aligned philosophy in TKA.</p>","PeriodicalId":22194,"journal":{"name":"Surgical technology international","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2024-03-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140319193","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}