Surgical technology international最新文献

Introduction: While dual mobility systems in total hip replacements have demonstrated reduced dislocation and revision occurrences, concerns persist about the potential elevation of metal ions in the bloodstream, leading to negative tissue reactions. Notably, there's a scarcity of research spanning over five years post-surgery that examines cobalt and chromium levels after such implants. This study aimed to delve into these metal ion concentrations after a five-year period, building on previous metal-ion findings. We focused on: (1) cobalt concentrations in blood and urine; (2) chromium concentrations in blood and urine; (3) cobalt variations based on follow-up duration and specific implant metrics (e.g., offset, cup dimension, stem, and neck inclination); and (4) chromium variations based on the same parameters.

Materials and methods: We tracked 57 individuals who received THA using modular dual mobility systems from January 1, 2011, to December 31, 2016, for an average span of six years (ranging from five to 10 years). At the final check-up, we measured cobalt and chromium levels in serum, plasma, blood, and urine. We also evaluated parameters like head composition and dimension, stem offset, cup dimension, and stem-neck inclination.

Results: Cobalt concentrations remained minimal, with average blood and urine values being 0.8+0.6mcg/L (standard <1.8mcg/L) and 1.2+1.0mcg/L (standard <2.8mcg/L), respectively. Two individuals exhibited a slight increase in blood cobalt concentration by 0.1 and 0.2mcg/L. Chromium averages in blood and urine were also minimal, with readings of 0.9+0.2mcg/L (standard <1.2mcg/L) and 1.3 + 0.5mcg/L (standard <2mcg/L), respectively. One individual had a marginally increased blood chromium concentration of 1.3mcg/L. Evaluations considering ceramic or cobalt-chrome heads, up to a decade of follow up, or varying implant metrics showed negligible variations in metal ion concentrations.

Conclusion: The findings reveal that over a minimum of five years (average = six years; span, five to 10 years), cobalt and chromium concentrations in patients' systems remained within normal limits and were clinically insignificant, irrespective of the follow-up duration, head material, or implant specifications. This underscores the efficacy of dual mobility systems in ensuring minimal metal ion presence.

Ultrasound-guided minimally invasive thermoablative (MIT) therapies are a therapeutic option for selected patients with large, hypoenhancing, benign thyroid nodules that cause compression disorders or aesthetic discomfort. MIT, which does not require general anaesthesia, causes thermal necrosis of the treated nodule, which is reduced in size by 50 % without functional consequences, and is indicated for patients who are not too young or in the presence of anaesthesia-related risk factors or recurrence following thyroidectomy or refusal of surgery. For the above indications, MIT complements surgery but does not replace it; it must always be performed in centres and by surgeons with proven technical skills and clinical experience. Subject to appropriate informed consent, the treatment is short-duration, well-tolerated by the patient, safe, and non-invasive. It does not require anaesthesia and complications are rare and transient. MIT, and in particular laser-based procedures (TAL), can also be effective and safe for the treatment of potentially destructible papillary microcarcinoma, as shown by the limited but sufficient literature, including the most recent guidelines, which consider it to be a therapeutic alternative that requires a better understanding of its efficacy and safety.

The advent of robotic bronchoscopy coupled with electromagnetic navigation bronchoscopy (EMN) and shape-sensing technology have increased diagnostic yields for peripheral pulmonary nodules compared to traditional bronchoscopy. Yet, diagnostic yields from these bronchoscopic platforms still fall short of where they should be. This shortfall is in large part due to a lack of advanced imaging during peripheral bronchoscopy and computed tomography (CT)-to-body divergence (CTBD). Digital lung tomosynthesis (DLT) is an advanced imaging modality that helps overcome CTBD during bronchoscopic biopsies of lung nodules. DLT is a quasi-3D imaging technique, which reconstructs tomographic images of the lung from a series of 2D fluoroscopic projection images. These images can be acquired either using a digital flat panel fluoroscopy machine or a fluoroscopy machine with a more traditional image-intensifier present in most standard bronchoscopy suites. This review aims to explain the mechanisms of both CTBD and DLT to help diagnose early-stage lung cancer more effectively.

Introduction: The introduction of flexible fiber technology in the early 2000s revitalized the interest in the CO2 laser for neurosurgical applications, making it suitable for microsurgical procedures. Despite its widespread use, specific indications for the CO2 laser in neurosurgery remains undefined. This study evaluates the efficacy and limitations of the CO2 laser in brain tumor surgery.

Materials and methods: This retrospective observational single-center study analyzed the use of the CO2 laser in intracranial neoplasm surgeries from 2011 to 2021. A total of 94 patients were assessed, focusing on demographics, tumor characteristics, surgical duration, complications, and laser-specific issues. We used a five-tiered scoring system to assess laser effectiveness in both debulking and dissection tasks; with resection extent assessed following established guidelines.

Results: The CO2 laser was highly effective in debulking solid tumors, achieving a 76.5% gross total resection rate, while being less effective in softer, highly vascularized tumors. The average effectiveness scores for dissection (2.6±0.8) were significantly lower than for debulking (3.2±1.2). Two major complications were directly associated with laser use. Effectiveness improved over time, particularly in the latter half of the study, and varied across tumor types, with notable utility in meningiomas and vestibular schwannomas but lower scores in glial tumors.

Conclusions: The CO2 laser is a valuable tool in neurosurgery, especially for solid tumors in specific anatomical locations. Careful patient selection is crucial, and the laser complements rather than replaces conventional surgical tools. Ongoing technological advancements suggest broader future applications in neurosurgery.

Purpose: Rib fixation procedures are being performed more frequently as they have shown multiple advantages over traditional non-operative management in well-selected patients. We have developed a rib-fixation simulation on cadavers for use by surgical residents in attempt to improve their comfort, knowledge and ability to use this new technology.

Methods: Residents in years 3 through 5 of training attended a rib-fixation simulation course with cadavers. Trauma faculty and representatives of manufacturers of rib-fixation hardware participated. The simulation consisted of groups of residents reviewing anatomy and creating adequate exposure for the entire procedure. Each group created rib fractures in the cadaver, determined which materials were needed, and then performed the rib-fixation procedure. Following the simulation, we surveyed the residents to determine the impact of the structured cadaveric rib fixation-based course on their comfort level. The survey was performed using a four- and five-level Likert questionnaire. The results were analyzed using paired t-tests.

Results: Of the participating residents, 72% of residents had performed five or fewer rib-fixation procedures in their training in the first cohort, while in the cohort for the following year, 65% had performed 5-10 procedures. The simulation had a statistically significant benefit to the residents' comfort level with rib plating (2.5 versus 3.6, p-value: 0.003). The greatest impact on the comfort level was seen in year 3 of training (2 versus 4, p-value 0.02). One hundred percent of residents found that having faculty and representatives present for the simulation was very helpful. The survey demonstrated that most residents gained new knowledge regarding the anatomy and technical dissection. In 20 of 25 encounters, residents strongly agreed that this simulation was beneficial for their surgical education, when used in addition to real operative experience. Every resident reported that they would recommend the simulation to younger resident classes.

Conclusion: Rib-fixation simulations on cadavers were beneficial for surgical residents' self-assessed comfort level. The simulation increased residents' knowledge, comfort, and ability to perform rib-fixation procedures. We have seen a significant increase in resident participation in these cases after simulation training. Based on these findings, we will continue to incorporate these simulations into our program's curriculum.

Introduction: Utilization of the direct anterior approach (DAA) for total hip arthroplasty (THA) has been steadily increasing in recent years. While the DAA may offer some benefits compared to other approaches, there are still risks involved including relatively higher rates of periprosthetic femur fractures, especially when combined with cementless femoral stem use. The purpose of this study is to evaluate the early postoperative femoral complications with a short triple-wedge tapered stem used in primary THA via a DAA.

Materials and methods: A retrospective review was conducted of the arthroplasty registry of our institution from April 2022 to August 2023 to identify patients who underwent a primary THA via a DAA with the Short Medacta Stem (SMS) (Medacta International, Castel San Pietro, Switzerland). Patients were excluded if the stem was used for a revision surgery, they were within 90 days of surgery, or they refused research consent. Inclusion criteria was met in 262 patients (302 hips). Data was collected after reviewing the chart, and reports and radiographic measurements, including Dorr type and canal fit ratios, were obtained from preoperative and postoperative radiographs, respectively.

Results: A total of 302 total hips were included, 161 patients were male (53.3%) and 141 were female (46.7%), with an average age of 66.5 years (27-88, +/- 10.7 years). Average follow up was 0.3 years (range, 0.05-1.71 years). The majority of patients had a Dorr B femur (81.7%). The Median stem size used was an 8 (range, 2-15), and 89.4% of those had a collar. Average canal fill ratio was 0.83 (range, 0.43-0.98, +/- 0.07). Overall, there were two Vancouver B2a periprosthetic femoral shaft fractures (0.66%) that required revision surgery to a modular stem. In addition, there were two Vancouver Ag greater trochanteric fractures (0.66%) with acceptable alignment that did not require revision surgery. Demographic information about the patients with femoral complications is summarized in Table I. Average age of patients with femoral complications was 69.5 years, with an average canal fit ratio of 0.88.

Conclusion: We found that the triple-wedge implant had a low rate of early femoral complication in primary THA from an anterior approach and is safe for use in THA from a DAA. More follow up is needed to evaluate continuing implant survivorship and patient outcomes.

Introduction: Femoral-popliteal bypass (FPB) surgery is a common lower extremity revascularization procedure. As the population continues to age, this procedure is being performed increasingly on older patients. This study investigated whether outcomes differ in this population.

Materials and methods: Patients over and less than 80 years old who underwent FPB between 2009-2013 were queried using an existing hospital registry. Demographics, comorbidities, intraoperative complications, perioperative outcomes, and two-year patencies were compared.

Results: Twenty-four patients in the octogenarian cohort (OC) and 72 patients in the non-octogenarian cohort (NOC) were identified. There was a lower prevalence of smoking (p=0.018) and higher prevalence of hypertension (p=0.021) among octogenarians. Other medical characteristics were similar (p<0.05). There were no differences in use of vein versus PTFE (p=0.002) as a conduit, or above (OC 20.0% vs. NOC 36.7%), versus below knee (OC 80.0% vs. NOC 63.3%) distal anastomosis (p>0.05) between the groups. There was a difference (p<0.01) in indication for procedure (OC/NOC): claudication (0%/44%), limb salvage (71%/31%), and rest pain (29%/25%). There were no differences in 30-day readmissions (17% vs. 21%; p=0.59) or incidence of postoperative (25% vs. 19%; p=0.56) or intraoperative complications (8.3% vs. 4.2%; p=0.52). Length of stay (LOS) was longer and statistically significant in octogenarians (12 days vs. 7 days; p=0.032) and remained significant after multivariate linear regression (p=0.015). Patencies in OC were lower and dropped faster after six months; however, there were no statistically significant differences in patencies at any time interval (p>0.05). The position of the distal anastomosis relative to the knee, conduit type, and indication were not independently predictive of patency outcomes (p>0.05).

Conclusion: The safety and efficacy of FPB in octogenarians is similar to the general population despite LOS in octogenarians being 5.98 days longer. While the difference in indication suggests that vascular surgeons are more conservative in treating octogenarians, our analysis did not reveal significant differences between populations and suggests that lower extremity bypass can be performed safely with comparable results in this cohort. A larger cohort is needed to validate these results.

Injuries of the meniscus often lead to changes in joint biomechanics, which affect the load distribution and contact stresses. The menisci consist of a peripheral vascular region (red zone) and an inner avascular region (white zone). The blood supply plays an important role in the healing of meniscal tears. Surgical treatment of such lesions includes meniscectomy/meniscoplasty and repair, depending on the type of injury, where "meniscoplasty" refers to the treatment modality that occurs under coblation. The application of Autologous Bioactive Matrix (ABM) has been shown to promote healing in such lesions. In addition, a special type of PRF (ArthroZheal®, Vivostat A/S, Allerød, Denmark) has been demonstrated to have healing effects in extracellular matrix synthesis and cell proliferation, as well as regenerative and remodeling effects. This autologous product can be applied directly at the meniscal repair site. We performed a prospective study on meniscus repair with ArthroZheal® alone (plus meniscoplasty) and ArthroZheal® together with an all-inside suturing technique using the STAR AccurFix Meniscal Repair Device system (STAR Sports Medicine, Beijing, China), depending on the type and the site of the lesion. One hundred twenty knees (110 patients) were identified through the use of clinical examination and MRI scan. The study took place between January 2023 and August 2023. Two groups were created: GROUP A was treated only with ArthroZheal®(plus meniscoplasty) and GROUP B was treated with a combination of ArthroZheal® and an all-inside suturing technique (STAR AccurFix). Pre- and postoperative grading was performed with the International Knee Documentation Committee (IKDC) score and the Tegner Activity Level Scale (Tegner Score). The results with both treatment methods were excellent and meniscus restoration has been documented on MRIs conducted 6 months post-op. In 15 patients, 2nd-look arthroscopy was performed through a nanoscope on an outpatient basis, and showed meniscal healing and remodeling. Tegner scores and IKDC scores in both groups showed significant improvement. Meniscal repair should be performed at all costs to maintain meniscal integrity and prevent long-term degenerative changes. New treatment methods include orthobiologics and all-inside suturing techniques. The main idea is to apply an autologous biological scaffold which is able to carry cells into the meniscal lesion and to allow their differentiation, proliferation, and extracellular matrix synthesis to produce a meniscal-like tissue. Our results suggest that the application of autologous ABM (ArthroZheal®) for the treatment of such lesions by means of dry arthroscopy results in better MRI, pain management and functional results at 3 months post-op, and these improvements can persist for up to 6 months.

Introduction: This study aimed to ascertain the risk factors contributing to in-patient mortality in elderly patients 65 years and older who were admitted emergently, diagnosed with intestinal fistula, and underwent surgery.

Materials and methods: Data were extracted from the National Inpatient Sample (NIS) spanning the years 2005-2014. Multivariable logistic regression and a generalized additive model (GAM) were employed to investigate predictors of mortality. Continuous variables are presented as mean values with standard deviations (SD).

Results: The study encompassed 34,853 patients with a mean age of 77.7 years-56.5% were female and 79.4% were White. Patients were categorized into three groups based on the time elapsed between admission and surgery: less than two days (17,761), two to three days (8,407), and more than three days (4,233). Mortality rates were 2.7%, 6%, and 6.1% for patients who underwent surgery within two to three days, within two days, and after more than three days of admission, respectively. Notably, the group that operated more than three days from admission experienced nearly double the hospital length of stay (12 days, SD: 7.2) compared to the other two groups (6.3, SD: 6 and 6.1, SD: 4.8). Furthermore, the association between mortality and time to operation, as indicated by the GAM model, revealed a significant non-linear relationship after adjusting for age, gender, race, zip code, hospital location, and comorbidities (p<0.001).

Conclusion: Elderly patients diagnosed with intestinal fistula should undergo operative treatment as soon as possible, once they are resuscitated. Delaying the operation more than three days after admission substantially increases the risk of mortality.

Artificial intelligence and technology have continued to evolve over recent decades, and their utility in hip and knee arthroplasty is growing with interest and enthusiasm. A multitude of technologies are available to assist surgeons in the intraoperative execution of hip and knee arthroplasty, ranging from robotics and augmented reality to artificial intelligence-powered fluoroscopy. The purpose of this review is to provide a framework for arthroplasty surgeons to understand the concept of artificial intelligence and the advancements in technologies that impact the perioperative care of patients undergoing hip and knee arthroplasty.