Surgical technology international最新文献

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.

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.