Surgical technology international最新文献

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.

Introduction: In the United States, intestinal fistulas accounts for $500 million (USD) of healthcare expenditures and 28,000 admissions annually. They are also associated with significant morbidity and mortality. Despite the high prevalence of intestinal fistulas, risk factors of mortality have yet to be fully elucidated. The aim of this study was to identify risk factors of mortality in emergently admitted patients with fistulas of the intestine, excluding the rectum and anus.

Materials and methods: Adult and elderly patients emergently admitted with intestinal fistulas, between 2004-2014 were investigated using the National Inpatient Sample Database, ICD-9-CM code 569.81. Clinical outcomes, therapeutic management, demographics, and comorbidities were collected. Associations between mortality and all other variables were established via univariable and multivariable logistic regression models. The final multivariable regression model elucidated the odds ratios (95% confidence interval, p-value) of pertinent mortality risk factors.

Results: A total of 7,377 patients were included, of which the average adult and elderly ages were 48.9 and 74.6 years, respectively. Of these patients, 4,241 (57.5%) were female and 3,136 (42.5%) were male. Elderly patients demonstrated a higher mortality rate than adult patients-4.5% and 1.7%, respectively. In the adult group, the odds ratio for mortality was 1.020 for hospital length of stay in days (95% CI: 1.015-1.026, p<0.001), 1.035 for age (95% CI: 1.011-1.060, p=0.004), and 1.033 for days to the first procedure (95% CI: 1.021-1.044, p<0.001), among others. For the elderly group, the odds ratio for mortality was 1.012 for hospital length of stay in days (95% CI: 1.005-1.019, p=0.001), 1.075 for age (95% CI: 1.050-1.101, p<0.001), and 1.026 for days to the first procedure (95% CI: 1.009-1.043, p=0.002), among others.

Conclusion: In adult and elderly patients emergently admitted for intestinal fistulas, multiple comorbidities were risk factors for in-hospital mortality. In the elderly cohort, increased age and increased days to operation were additional risk factors for in-hospital mortality.

Introduction: The purpose of this article is to examine the risk of early clinical rotator cuff repair failures in high-risk patients who were augmented with a reinforced bio-inductive implant (RBI).

Materials and methods: A retrospective chart review was performed identifying full-thickness rotator cuff repairs (RCR) augmented with an RBI. Inclusion criteria for "high risk of retear" were: large (>3cm) and massive (>5cm, >/= 2 tendons) tears, anterior to posterior (AP) tear >2.5cm, infraspinatus fatty atrophy (Goutalier >/= 2), recurrent tears, and at least one comorbidity (diabetes, hypertension, active smoker). ROM, VAS, and ASES scores were collected at preoperative, three-month, six-month, and 12-month visits. Clinical failures were defined as complete retear based upon imaging, repeat rotator cuff surgery, VAS score >5 at one-year postoperative, and ASES MCID <27-point improvement.

Results: Forty-nine patients were found to have undergone RCR with an RBI augmentation. Mean follow up was 26.1 months. Clinical healing rate was 94% (46/49). The need for surgical intervention post RCR was 8.2% (4/49). The complication rate was 14.3% (7/49). VAS scores at three, six, and 12 months compared to preop revealed statistically significant decreases at all timepoints (D-3.9, D-4.6, D-5.2, respectively, p<0.001). ASES scores at three, six, and 12 months compared to pre-surgical scores met the MCID and were found to have statistically significant improvements at all timepoints (D30.7, D40.8, D49.8, respectively, p<0.001). Shoulder ROM (forward flexion/abduction) at three, six, and 12 months compared to preop was found to be statistically significant at all timepoints (p<0.01).

Conclusion: The addition of an RBI to RCR in patients at high risk of failure demonstrated favorable outcomes in terms of range of motion, pain, and functional outcome scores with a low rate of clinical retear at a minimum of one-year follow up.

Clinical relevance: Many risk factors have been attributed to high retear rates and poor clinical outcomes in patients undergoing RCR. Numerous variations to RCR have been explored to aid in outcomes and decrease failures. This manuscript is the first to examine the use of an RBI as an RCR augment. The implant's bio-inductive properties and strength profile demonstrate promising benefits at early timepoints in this study, indicating that it can improve patient-reported outcomes while decreasing clinical failures in patients at high risk of retear.

Recently, robotic-arm assisted total knee arthroplasties have become popular because of their promise to lead to enhanced accuracy and efficient planning of the procedure, as well as improved radiographic and clinical outcomes. One robotic system is based on computed tomography (CT) to help with preoperative planning, intraoperative adjusting, and bone cutting for these procedures. The purpose of this article is to describe the second-generation iteration of this CT-based robotic technique by describing the new features using an actual total knee arthroplasty case. This article then becomes a step-by-step guide to performing the procedure, as well as describing the new features of this upgraded system.

Introduction: In the repair of focal chondral defects, there are several patient-reported outcome measures (PROMs) that are used to assess the patient's well-being. However, the question remains as to how well one scoring system relates to another, which may restrict the comparison of results from different studies. Therefore, we examined the strength of correlations between the Lysholm and KOOS scores.

Materials and methods: The data for this analysis was obtained from the Autologous Matrix-Induced Chondrogenesis (AMIC®; Geistlich Pharma AG, Wolhusen, Switzerland) knee registry, which is an ongoing, multicentre database designed to record changes over time in knee function and symptoms. This is done using the Lysholm score, the Visual Analogue Scale (VAS) for pain, and the five domains of the Knee injury and Osteoarthritis Outcome Score (KOOS). All patients had preoperative and postoperative scores at one-year follow up. The results were evaluated using the Spearman's rank correlation test.

Results: We identified 79 patients in the registry, all of whom were treated by the co-authors and had preoperative scores and postoperative scores at one year for the Lysholm, VAS, and the KOOS domains. The Lysholm score demonstrated a significant correlation (p<0.0001) to all KOOS domains. The correlation coefficients were 0.81, 0.82, 0.83, 0.84, and 0.76 for the KOOS domains of symptoms, pain, activities of daily living (ADL), quality of life (QoL), and Sport, respectively. The correlation between VAS pain and the KOOS domain for pain was significant (p<0.0001) but notably lower, with a correlation coefficient of 0.71.

Conclusion: Our data provides evidence that the outcome of the Lysholm knee score is strongly correlated with the KOOS scores, with the KOOS domains of ADL and pain exhibiting the highest correlation. Thus, it may be possible, through formulae calculations, to predict a KOOS score from the Lysholm score. With regard to assessment of outcomes over larger numbers of studies, the pooling of substantially more data could facilitate the conduct of systematic reviews and meta-analyses pertaining to the surgical treatment of chondral injuries of the knee.

Osteonecrosis of the femoral head (ONFH) is a chronic progressive debilitating disease that often affects young and active patients. It results from vascular interruption to the femoral head and can be caused by trauma, chronic corticosteroid use, chronic alcoholism, and coagulopathies. Treatment includes core decompression, a surgical procedure that may help delay or forestall disease progression if performed at the early stages of the disease. Technological advances have made the procedure more efficient and effective. There are several core decompression systems available in the market, giving healthcare providers options for core decompression technique: (1) The PerFuse™ Percutaneous Decompression System (Zimmer Biomet, Warsaw, Indiana) offers the advantage of utilizing autologous stem cell progenitor augmentation which has been shown to provide clinical benefits to patients; (2) The Advanced Core Decompression System (Stryker, Kalamazoo, Michigan) utilizes synthetic regenerative bone grafts, and these calcium-based synthetic grafts are well-accepted as the adjuvant modality for small defects; and (3) The Avascular Necrosis/Osteonecrosis Core Decompression Expandable Reamer System (Arthrex Inc., Naples, Florida) offers the unique ability for endoscopic-assisted core decompression, which may provide increased ability to treat early-stage ONFH by identifying necrotic lesions not visible radiographically. The preferred management of ONFH remains a topic of controversy and is reliant on the disease stage. Future randomized clinical trials comparing various core decompressions systems, with or without the use of bone marrow aspirates and arthro-endoscopy, may provide insight into the true clinical benefits of each method.