BMC Surgery最新文献

Background: Intraoperative preservation of parathyroid glands (PGs) remained a significant challenge in thyroidectomy. Recently, deep learning has demonstrated considerable potential in medical applications. We proposed a novel intraoperative method for PG identification.

Methods: We developed a localization subnet based on YOLOX and a novel semantic segmentation model termed Trans-U-HRNet, collectively termed PG-AI. The dataset included 976 images from 121 patients undergoing open thyroidectomy, with images from 101 patients randomly split 8:2 for training and internal validation. PG detection was quantified using PG-AI, and its performance was visually compared with near-infrared autofluorescence (NIRAF) imaging and assessments by surgeons with varying experience levels.

Results: PG-AI achieved an accuracy of 91.1% and a recall rate of 86.5% on the internal validation set. The recognition rates of PG-AI were 88.7% and 85.0% on the internal and external validation sets, respectively, in visualization. PG-AI showed 72.1% agreement with NIRAF imaging, and the combined approaches successfully identified all PGs. In external validation, PG-AI significantly outperformed junior surgeons in recognition rate (p = 0.004).

Conclusion: PG-AI generated accurate segmentation masks of PGs in real-time intraoperative images, providing reliable visual guidance to surgeons during identification.

Background: Congenital cervicothoracic scoliosis (CTS) caused by hemivertebra poses surgical challenges. Evidence regarding the efficacy and safety of one-stage posterior-only radical hemivertebra resection in this region remains limited.

Method: A retrospective cohort study was carried out. Patients who had undergone one-stage, posterior-only radical hemivertebra resection for congenital CTS between January 2018 and March 2022, with a minimum follow-up period of 2 years, were included, and these patients had CTS resulting from cervicothoracic hemivertebra. Data on Demographic characteristics, radiological measurements, surgical details, health-related quality of life, as well as postoperative complications were collected.

Results: This study included 19 CTS patients undergoing one-stage posterior-only hemivertebra resection with short fusion. Mean surgical age was 11.47 ± 3.91 years, with 33.79 ± 15.12 months' follow-up. Preoperative local Cobb angle significantly decreased after surgery (50.20°±15.97°to 20.87°±11. 89°, P < 0.001). Segmental kyphosis reduced from 31.21°±9.99° to 16.40°±7.99° (P < 0.001). Cervical balance parameters (T1 tilt, clavicle angle, radiographic shoulder height, neck tilt, head shift) and distal compensatory curve showed significant improvement (P < 0.001). Postoperative C2-C7 angle increased, while thoracic kyphosis (TK) and lumbar lordosis (LL) decreased significantly. SRS-22 scores improved in "pain", "self-image", and "satisfaction with the management" domains. Five complications occurred, including fever, Pleural effusion, and distal curve progression.

Conclusion: One-stage posterior-only radical hemivertebra resection demonstrated efficacy in correcting both the cervicothoracic and compensatory thoracic curves, mitigating neurological complications, and enhancing patients' quality of life, thereby further substantiating its value in optimizing spinal alignment.

Trial registraction: Registration was not applicable as this study retrospectively analyzed medical records generated during routine clinical practice.

Background: With increasing pressure on operating room capacity due to growing surgical demand and constraints in cost, workforce, and sustainability, real-world scenarios such as the COVID-19 pandemic offer valuable insights. This study assessed the pandemic's impact on surgical care for patients with gallstone disease or inguinal hernia, focusing on disease-related and surgical complications.

Methods: This multicenter historical cohort study included patients treated in 2019 and 2020 at three Dutch hospitals. Data were collected from hospital systems and patient records. The COVID period (March-December 2020) was compared to a reference period (March-December 2019). The primary outcome of this study was the rate of disease-related complications. Secondary outcomes included surgery rates, hospital presentations and admissions, time to surgery, surgical complications, length of hospital stay, and readmissions.

Results: In total, 1572 patients with gallstone disease and 1511 with inguinal hernia were included. During the COVID period, fewer cholecystectomies were performed (59.8% vs. 67.7%, p = 0.001), and complicated gallstone disease increased (28.5% vs. 21.6%, p = 0.002). No significant differences were found in the rate of inguinal hernia repairs (61.6% vs. 63.5%, p = 0.46) or hernia-related complications (5.4% vs. 3.7%, p = 0.139). Surgical complication rates were similar across both periods for both conditions.

Conclusions: Limited surgical availability during the COVID-19 period was linked to reduced cholecystectomy rates and more complicated gallstone disease, without affecting inguinal hernia outcomes or surgical complication rates.