Surgical technology international最新文献

Periprosthetic joint infections (PJI) are devastating complications following total hip arthroplasty (THA) and are the most common reason for revision following primary arthroplasty. Although several devices, techniques, and procedures have been developed to combat this serious complication, there is little consensus as to how to prevent the development of PJI at the time of index arthroplasty. This article reviews the concept and implementation of a novel antimicrobial agent to substantially reduce the incidence of PJI. The regular implementation of this infection prophylaxis should be successful in drastically reducing the rate of PJI following primary THA.

Background: Female cosmetic genital surgery is becoming increasingly sought after by women who are concerned with the appearance of their vulva. Labiaplasty for the labia minora is undoubtedly the most commonly performed female cosmetic genital surgery. However, an increasing number of patients seen in our clinics in both Brazil and the United States are presenting with clitoral hypertrophy, specifically clitoral elongation. The elongated clitoris will usually protrude beyond the labia minora and majora and from the patient's perspective will give a less feminine appearance as they will often describe the protruding clitoris as feeling like they have a small penis. The surgical technique described here, Batalha Clitoropexy, is a minimally invasive surgical technique for clitoral length-reduction that does not require amputation or debulking. This technique is presented in the form of the detailed sequential steps needed to achieve satisfactory results. Photos taken before and after the procedure in a representative case show that the clitoral length has been shortened from 5.0 cm to 1.5 cm without the need of an invasive amputation or debulking clitoroplasty. Many patients with clitoromegaly or an elongated protruding clitoris do not need to undergo an invasive clitoroplasty. Specifically, patients with clitoral elongation or clitoral ptosis can be surgically treated with a less-invasive clitoropexy surgical procedure which can restore normal anatomic position to treat a protruding clitoris.

The Ross procedure is often considered the best option for a small group of patients. Some critics argue that harvesting the pulmonary artery again can cause problems, such as exposing the native pulmonary autograft to systemic pressures and requiring further intervention. However, the pulmonary autograft is a living tissue that can adjust to growing conditions and undergo remodelling. The pathophysiology of living tissue, harvesting techniques, indications for use of pulmonary autograft in aortic valve disease, contraindications, and variations of pulmonary autograft as an aortic conduit are discussed in this seminar. Following recent updates from high-volume centres, the indications, contraindications, techniques, and variations of pulmonary autograft as an aortic conduit and, in the absence of substantial well-designed randomised controlled trials, areas where the Ross procedure needs to be reaffirmed as part of the surgical armamentarium are also discussed. Furthermore, increasing evidence suggests that the Ross procedure produces better long-term results than traditional aortic valve replacement in young and middle-aged adults. To enable cardiologists and surgeons to make appropriate decisions for their patients with aortic valve disease, the author provides a complete review of the most recent published studies on the Ross procedure.

Introduction: Ampulla of Vater carcinoma (AVC) with para-aortic node (PAN) metastasis is considered unresectable and is equivalent to distant metastasis, contributing to poor outcomes.

Case presentation: A 60-year-old man was referred to our hospital and was diagnosed with an unresectable ampulla of Vater carcinoma that had metastasized to the para-aortic nodes. The patient received a systemic chemotherapy regimen comprising a combination of gemcitabine and cisplatin. Following five cycles of treatment, imaging studies revealed a significant reduction in the primary tumor and para-aortic node metastasis, rendering detection difficult. Pancreatoduodenectomy with para-aortic node dissection was performed as a radical surgery. Upon pathological examination, no residual tumors were identified in the resected specimen, indicating that the systemic chemotherapy achieved a complete pathological response. The postoperative course of the patient was uneventful, and he was discharged on the 25th postoperative day. The patient was followed up as an outpatient and remained stable without any recurrence for two months after surgery.

Conclusion: Neoadjuvant chemotherapy with gemcitabine and cisplatin was useful for downstaging the ampulla in patients with Vater carcinoma. This finding may help physicians manage patients with similar presentations.

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.

Annuloplasty should always accompany mitral valve repair in order to achieve proper annular remodeling and stabilization. Numerous types of annuloplasty rings-that differ from rigid to semi-rigid and flexible devices, from complete to partial, and from flat to saddle-shaped rings-are clinically available. A deeper understanding of mitral valve function, in conjunction with several recent studies, suggest it is advisable to prefer annuloplasty rings that mimic the physiological mitral annulus shape and three-dimensional (3D) dynamic changes in order to reduce haemodynamic stress on valve components and optimize leaflet coaptation, perhaps improving valve repair durability too. This paper aims to focus on 3D annuloplasty rings, with dynamic features: MEMO 3D™ and MEMO 4D™ (Sorin Medical, New York, New York), as well as Physio Flex (Edwards Lifesciences, Irvine, California).

Diabetic foot ulcers (DFUs) are a prevalent complication of diabetes mellitus (DM) and lead to significant morbidity and mortality. Patients with DM have a lifetime risk of DFUs as high as 34%. The pathogenesis of DFUs is multifactorial, and the most common underlying causes are poor glycemic control, peripheral neuropathy, peripheral vascular disease, foot deformity, and poor foot care. Diabetic lower-extremity complications are also a significant burden in terms of healthcare costs. In the United States alone, the direct cost of diabetic foot care has been estimated to be $8,659 per patient, with total annual medical costs for managing diabetic foot disease ranging from $9 to $13 billion. Given the risk of amputation and poor wound healing, the fast, accurate diagnosis and treatment of DFUs are critical. Measures to prevent DFUs include glycemic control and annual foot inspections. For patients with DFUs, off-loading and local wound care are critical for wound healing. Debridement is the standard of care for DFU wounds, and several techniques exist. In this review, we discuss the current practices of diabetic wound care, different methods of debridement and their practical use in DFUs, and novel debridement approaches with the potential for improving wound-healing outcomes.

Introduction: Surgery for colorectal cancer (CRC) is not risk-free; therefore, preoperative evaluation must be done to predict and prevent surgical complications. Sarcopenia, a loss of muscle mass and function, was shown to be associated with surgical complications. Our study evaluates the effects of sarcopenia on short-term patient outcomes after CRC resection.

Materials and methods: Our retrospective study included patients with histologically proven CRC between 2018 and 2020 who underwent surgical resection. Skeletal muscle mass (cm2) was evaluated on a preoperative CT scan at the level of L3 vertebrae then standardized using stature (m2) to obtain the skeletal mass index (SMI) (cm2/m2). Patients received proper adjuvant care if needed and were followed up 90 days post surgery. Descriptive statistics were presented in percentage for categorical variables and in mean for continuous variables. Multivariate was made by linear regression.

Results: 113 patients were included, and 15% were sarcopenic. A statistically non-significant association was found between sarcopenia and severe complications (grade III-IV) (23.53% in sarcopenic vs. 9.38% non-sarcopenic, p=0.02, multivariate p=0.675). Sarcopenia was not associated with anastomotic leakage, infectious complications, or ileus or intra-abdominal bleeding (p>0.05). In literature, some studies showed an association between sarcopenia and postoperative complications while others showed no relationship between the two. Most studies used SMI.

Conclusion: A non-statistically significant association was found between sarcopenia and postoperative complications in CRC patients. Sarcopenia does not predict postoperative severe complications, anastomotic leakage, infectious complications, or ileus or intra-abdominal bleeding. Emergent surgeries and age >60 years were associated with more postoperative complications.

Harry Reich, MD, FACOG, FRCOG, FACS is known worldwide as a pioneer in the field of laparoscopic surgery. He performed the first laparoscopic hysterectomy, the first pelvic lymphadenectomy for cancer, and the first excision of cul-de-sac endometriosis that included rectal resection. This article explores his life and contributions. The author knew Dr. Reich from medical conferences over many years and visited Dr. Reich in Pennsylvania to observe him in the operating room. For this article, the author spoke with Dr. Reich on nearly a nightly basis over a 13-month period in 2022 and 2023. Dr. Reich's descriptions were cross-referenced with his publications and those of his peers. The author also interviewed physicians who worked closely with Dr. Reich and reviewed the trial transcript of the February 1980 Nesbitt Memorial Hospital special ad hoc investigatory committee. The result is a comprehensive review spanning from Dr. Reich's early life to his ultimate recognition as one of the most significant innovators of advanced laparoscopic surgery. The author concluded that Dr. Reich's accomplishments are rooted in his command of pelvic anatomy, his lifelong interest in surgery and his willingness to challenge existing surgical dogma. By attending medical school in Ireland, Dr. Reich benefitted from the deep study of anatomy offered there. He also had a unique background of being a Harvard-trained gynecologic surgeon practicing in Wilkes-Barre, a small Pennsylvania community that trusted him because both his parents practiced medicine there before him. Dr. Reich favored conservative surgery rather than hysterectomy for endometriosis and patiently excised deep disease, offering relief to countless women, at times without compensation. He exhibited astonishing bravery and perseverance in the face of scathing criticism. Dr. Harry Reich's empathy for his patients and willingness to challenge the status quo were pivotal in improving the lives of many thousands of women and revolutionizing gynecologic surgery.

While total hip arthroplasty (THA) is an enormously successful treatment for patients with end-stage degenerative arthritis of the hip, and surgeons have optimized existing hip implants and techniques, dislocation and instability persist as a leading cause of failure. Given the tremendous success of reverse total shoulder arthroplasty in enhancing the stability of shoulder reconstruction by reversing the anatomic seating of the ball and socket components, one manufacturer (Hip Innovation Technology, LLC, Woodstock, Georgia) has developed a novel Reverse Hip Replacement System (Reverse HRS) to address the need for greater stability in reconstruction of the arthritic hip joint. Rather than the traditional anatomic components that replace the head of the femur with a spherical ball and the acetabulum with a socket with polyethylene liner mounted into the pelvis, the Reverse HRS features a cup with polyethylene liner attached to the femoral stem and a spherical metal head attached to a central trunnion inside of the porous-coated acetabular shell fixed into the pelvis. This design provides dramatically enhanced stability and improved range of motion. This article reviews relevant published literature, including results from a Canadian clinical trial and case reports from a multicenter American clinical trial monitored by the U.S. Food and Drug Administration. It also describes the components and surgical technique of reverse THA.