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Diverse surgical approaches, such as resective, reconstructive, and combined therapy, have been proposed for peri-implantitis treatment. A resective surgical approach with an adjunctive modified implantoplasty refers to the modification of the implant body into a constricted area to mimic a "waist" silhouette. This modified technique forms an adequate concave smooth area that may favor the outcomes of resective surgical therapy for soft tissue adaptation, biofilm control, and possible peri-implant bone gain over the long term. The present case series aimed to exhibit the long-term clinical and radiographic outcomes of resective surgery with adjunctive implantoplasty over a 6- to 11-year follow-up. Four patients presenting four implants (one per patient) diagnosed with peri-implantitis (according to an established case definition) were included in the present case series. Patients underwent resective surgery, a modified implantoplasty approach, and implant surface decontamination. After surgical therapy, clinical and radiographic outcomes such as bleeding on probing (BoP), suppuration on probing (SoP), probing depth (PD), marginal recession (MR), modified plaque index (mPI), and marginal bone levels (MBLs) were recorded over a long-term follow-up period. Over the 6- to 11-year follow-up, mean BoP, PD, and SoP scores amounted to 17% ± 24%, 3.2 ± 0.66 mm, and 0%, respectively. Mean BoP, PD, and SoP scores were reduced by 67% ± 24%, 2.5 ± 1.26 mm, and 100%, respectively. Radiographic analysis revealed a mean radiographic bone gain of 3.1 ± 1.84 mm. Peri-implant marginal bone loss surface area decreased by 5.7 ± 3.77 mm2 over the long-term follow-up. Resective therapy with adjunctive implantoplasty promoted favorable clinical and radiographic outcomes at treated peri-implantitis sites over a long-term period. [ABSTRACT FROM AUTHOR]

Context: Rehabilitation after an anterior cruciate ligament injury is recommended to be started soon after the injury. When surgery is required, research supports the delivery of physiotherapy before anterior cruciate ligament reconstruction (prehabilitation) to optimize recovery and positive outcomes. Individuals attending prehabilitation have never been questioned regarding their adherence to prehabilitation, perception of utility in meeting needs, upcoming events, or anticipated recovery goals. Design: Mixed methods cross-sectional study: Methods: 25 individuals before anterior cruciate ligament reconstruction (43% of eligible individuals from 12 clinics during the delivery period) were surveyed on their mindset and recovery expectancies. Semistructured interviews conducted in 9 of 25 participants assessed their lived experience of prehabilitation. Results: Participants reported that preventing a reinjury (96% of responses) and feeling confident during daily activities about their knee (92%) were the higher rating expectations at this stage of their treatment course. Three themes were developed from the interviews and analyses. (1) Participants reported that prehabilitation was a period full of challenges with memories of the injury and uncertainties. (2) They viewed prehabilitation as a step to move forward by finding support and self-motivating. (3) They believed that prehabilitation would have positive impacts on the treatment outcomes. Participants were confident that prehabilitation would accelerate the recovery of muscle volume (88%) and strength (84%). Conclusion: Participants had positive experiences of prehabilitation, aligning with the findings on functional outcomes in the existing literature on prehabilitation. [ABSTRACT FROM AUTHOR]

Purpose: To answer the following focus question: In preclinical in vivo experimental models, do oral implants placed in overdimensioned (OD) sites present greater biomechanical properties and histomorphometric parameters of osseointegration compared to implants placed in standard or undersized implant sockets? Materials and Methods: Online databases were searched for controlled animal studies reporting on OD sites up to February 2023. The relative implant-final drill discrepancy (IDD) was used to categorize the control and test groups according to surgical drilling protocol: (1) control: undersized (IDD > 0.5 mm) or standard (IDD = 0.2 to 0.5 mm); and (2) test OD: stress-free oversized (IDD = 0.0 to -0.1 mm); test GAP: friction-free oversized (IDD = -0.1 mm). Random-effects meta-analyses were performed for the outcomes of insertion and removal torque values (ITV and RTV, respectively), bone-to-implant contact (%BIC), and bone density (%BD) for short- (0 to 2 weeks), intermediate- (3 to 4 weeks), and long-term (= 5 weeks) healing periods. Results: Of the 527 records identified, 13 studies met the eligibility criteria. Histologically, the OD and GAP groups prevented ischemic necrosis and extensive bone resorption at the bone-implant interface in both the marginal cortical layer and the trabeculae. Faster and increased rates of bone formation, characterized by primary osteons and highly vascularized tissue, took place in OD sites between 1 and 5 weeks of healing. Meta-analyses indicated statistically significant benefits in favor of (1) control vs OD for short-term healing in extraoral sites, with pooled estimates (weighted mean difference) of ITV = 25.35 Ncm, %BIC = 2.10%, and %BD = 26.19%; (2) control vs OD for long-term healing in intraoral sites, with %BD = 11.69%; (3) control vs GAP for intermediate-term healing in extraoral sites, with %BD = 3.03%; and (4) control vs GAP for long-term healing in extraoral sites, with RTV = 5.57 Ncm. Conclusions: Oversized surgical preparation of the implant site does not seem to provide any additional benefit compared to standard or undersized sites regarding quantitative parameters of osseointegration. However, it does minimize marginal bone resorption and yields better-quality bone healing, despite the comparable results among different experimental animal models in the late postoperative period. [ABSTRACT FROM AUTHOR]

BACKGROUND: Following a breast cancer diagnosis, it is uncertain whether womens breast density knowledge influences their willingness to undergo pre-operative imaging to detect additional cancer in their breasts. We evaluated womens breast density knowledge and their willingness to delay treatment for pre-operative testing. METHODS: We surveyed women identified in the Breast Cancer Surveillance Consortium aged ≥ 18 years, with first breast cancer diagnosed within the prior 6-18 months, who had at least one breast density measurement within the 5 years prior to their diagnosis. We assessed womens breast density knowledge and correlates of willingness to delay treatment for 6 or more weeks for pre-operative imaging via logistic regression. RESULTS: Survey participation was 28.3% (969/3,430). Seventy-two percent (469/647) of women with dense and 11% (34/322) with non-dense breasts correctly knew their density (p

Purpose: Recovery after minimally invasive repair of pectus excavatum (MIRPE) is prolonged. The purpose of this prospective study was to enhance our understanding of post-MIRPE recovery by following patients' recovery through postoperative day (POD) 60 using wearable devices and determine if recovery rate is impacted by PE severity and preoperative physical activity (PA) level. Methods: Children ≤ 18 years who underwent MIRPE with cryoablation between 8/2023 and 1/2024 wore a Fitbit™ for ≥ 3 days preoperatively to determine preoperative PA and through POD 60. The recovery trajectory, defined by postoperative daily step count divided by mean preoperative daily step count, was fit by power function through POD 60 among patients with uncomplicated recovery. Subgroup analyses were performed to compare recovery by PE severity and preoperative PA level. Results: Sixteen patients met criteria (68.8% male, mean [SD] age 15.4 [1.6] years). Recovery trajectory analysis demonstrated recovery on POD 60 was 84.8% (95CI 79.0–90.6%). On subgroup analysis, patients with Correction Index > 40% and preoperative mean steps/day ≥ 10,000 had faster recovery. Conclusions: Patients undergoing MIRPE with cryotherapy who are more active preoperatively or have higher Correction Indices were found to have accelerated recovery trajectories. These results may provide insight for preoperative counselling and interventions to optimize post-MIRPE recovery. [ABSTRACT FROM AUTHOR]

Purpose Minimally invasive surgery (MIS) with integrated enhanced recovery pathways (ERPs) helps reduce length of stay and improve surgical outcomes. As these procedures have become more prevalent over time, pharmacists are in key positions to manage medications in the perioperative space to help optimize transitions of care and reduce safety events. Here we identify several clinical areas across phases of care for these procedures in which the knowledge and guidance of pharmacists, as members of the interprofessional team, are paramount. Summary Perioperative pharmacy expertise is often required for MIS procedures in the areas of acid suppression, antithrombotic management, blood glucose control, drug formulation, immunosuppressant optimization, pain mitigation, and postoperative nausea and vomiting prevention and treatment. For each MIS procedure, pharmacists should identify and consider diet and anatomical changes as well as patient- and surgery-specific risk factors. Pharmacists can then utilize their knowledge of the pharmacokinetics and pharmacodynamics of individual medications along with evidence-based medicine to recommend selection of appropriate agents. Conclusion Pharmacist contributions to perioperative medication management for MIS procedures can improve care as surgical patients navigate transitions through the perioperative setting. Pharmacists can further incorporate medication expertise through development and implementation of institutional MIS protocols within the context of ERPs. As such, any pharmacist should feel empowered to aid in the care of surgical patients. [ABSTRACT FROM AUTHOR]

The increasing incidence of surgical site infections (SSIs) following caesarean sections highlights the necessity for updated protocols that address risk factors throughout the preoperative, intraoperative, and postoperative stages. Negative Pressure Wound Therapy (NPWT) and hydrocolloid dressings have demonstrated potential for improving wound management and reducing complications, particularly by enhancing dressing integrity. Nevertheless, the application of NPWT requires careful consideration and adherence to local trust guidelines to ensure both its safety and efficacy. [ABSTRACT FROM AUTHOR]

This article provides an overview of the wound healing process, outlining the four distinct phases of the healing cascade: haemostasis, inflammation, proliferation, and maturation. The different types of closure method are described and, specifically, the various types of surgical suture that can be used for wound closure, as well as the strengths and limitations of each. The article explains aspects of patient care that need to be considered such as obtaining informed consent, and the importance of nurses maintaining appropriate clinical skills. It concludes with a step-by-step outline of best practice on how to remove sutures. [ABSTRACT FROM AUTHOR]

AIM: The "2024 AHA/ACC/ACS/ASNC/HRS/SCA/SCCT/SCMR/SVM Guideline for Perioperative Cardiovascular Management for Noncardiac Surgery" provides recommendations to guide clinicians in the perioperative cardiovascular evaluation and management of adult patients undergoing noncardiac surgery. METHODS: A comprehensive literature search was conducted from August 2022 to March 2023 to identify clinical studies, reviews, and other evidence conducted on human subjects that were published in English from MEDLINE (through PubMed), EMBASE, the Cochrane Library, the Agency for Healthcare Research and Quality, and other selected databases relevant to this guideline. STRUCTURE: Recommendations from the "2014 ACC/AHA Guideline on Perioperative Cardiovascular Evaluation and Management of Patients Undergoing Noncardiac Surgery" have been updated with new evidence consolidated to guide clinicians; clinicians should be advised this guideline supersedes the previously published 2014 guideline. In addition, evidence-based management strategies, including pharmacological therapies, perioperative monitoring, and devices, for cardiovascular disease and associated medical conditions, have been developed. [ABSTRACT FROM AUTHOR]

The management of adenomyosis has undergone significant evolution, moving from traditional surgical interventions like hysterectomy to more conservative methods aimed at preserving fertility. Essential roles have been played by uterine-sparing surgeries and uterine artery embolization. Despite these advancements, there is a growing interest in less invasive alternatives. This review delves into the potential of high-intensity focused ultrasound (HIFU). HIFU employs focused ultrasound waves for precise ablation of adenomyotic lesions. The review conducts a thorough analysis of HIFU principles, safety, efficacy, and its possible synergies with other therapies. HIFU seems to be effective for adenomyosis treatment, demonstrating a favorable adverse effect profile and suitability for fertility preservation. Combining HIFU with hormonal treatment appears to enhance long-term symptom control, presenting a promising and comprehensive approach for managing adenomyosis. The goal of this article is to develop a comprehensive understanding of HIFU's role in contemporary adenomyosis management and to explore areas requiring further research. [ABSTRACT FROM AUTHOR]

Background: Chronic pain, defined as pain persisting for more than 3–6 months, has a mean one‐year prevalence in the United States of 25.8% and is one of the most frequent reasons adults seek medical care. Treatment options include physical therapy, analgesics, anticonvulsants, exercise, and muscle relaxants. Even with conventional treatment modalities, in a subset of patients, pain may persist. Cooled radiofrequency ablation (c‐RFA), a minimally invasive therapy, employs thermal energy generated by electrical currents to disrupt the transmission of pain stimuli along nociceptive pathways. This leads to an attenuation of pain impulses, primarily through nerve tissue necrosis. The potential of c‐RFA to alleviate chronic pain for patients who struggle to find relief elsewhere accentuates the importance of rigorously investigating its outcomes. This study investigates whether patients receiving c‐RFA for relief of chronic neck pain caused by cervical facet joint arthropathy experience a reduction in pain scores, the length of this reduction in pain scores, and the magnitude of this reduction in pain. Methods: This study was a retrospective analysis of data extracted from UW‐Health Electronic Medical Health records (EMR), encompassing cervical c‐RFA procedures performed from 2015 through 2022. Patient data were obtained, including diagnosis, pre‐operative pain score, post‐operative pain score, duration of relief, patient age, sex, and BMI. A two‐tailed paired t‐test was used to statistically analyze the pre‐operative and post‐operative pain scores, in which a p‐value ≤0.05 was considered significant. Results: A total of 450 cervical c‐RFA procedures were reviewed, 152 were excluded due to absent pre‐ or post‐op pain scores. 298 were included in the analysis, comprising 203 unique patients: 129 females and 74 males with an average age of 56.03 ± 12.76 and a BMI of 28.76 ± 6.05. Improvement of pain symptoms was reported in 85.23% (n = 263), 6% (n = 19) reported complete pain remission, 8.72% (n = 26) reported no change, and 3.02% (n = 9) reported worsening symptoms. Patients reported an average pre‐operative pain score of 6.15 (M = 6.15, SD = 1.55) and an average post‐operative pain score of 3.64 (M = 3.64, SD = 2.09) this achieved significance (p < 0.0001). Of the 85.23% (n = 263) charts that noted improvement, there is an average of 48.04% ± 26.53 reduction from their pre‐operative pain scores. The average duration of relief lasted 6.67 ± 4.84 months. Conclusion: This study supports the potential efficacy of c‐RFA as a minimally invasive treatment for chronic neck pain secondary to cervical facet joint arthropathy refractory to conventional treatment measures, demonstrating significant relief for a substantial length of time. Due to chronic pain's detrimental effect on one's quality of life, finding effective treatment options is essential, especially for those refractory to conventional treatments. [ABSTRACT FROM AUTHOR]

Introduction: In high‐frequency spinal cord stimulation anatomic placement targeting of the T9‐10 disc space is based on "empiric" results that are best replicated with coverage broadly from T8 to T10. This study contains the largest cohort of patients evaluating low thoracic morphology and seeks to address the lack of MRI morphological analysis in literature. Methods: This study was a retrospective review of a database of 101 consecutive patients undergoing permanent implant of thoracic SCS for chronic pain. Measurements were carried out on preoperative MRI imaging. Anteroposterior (AP) and lateral dimensions of the spinal cord as well as dural sac were measured. In addition, dorsal cerebrospinal fluid thickness and paddle depression distance were also measured. Results: When comparing morphological dimensions by level, dorsal CSF thickness was smaller at T9‐10 than T7‐8 (p = 0.018). In addition, lateral dural and spinal cord diameters were larger at T10‐11 than T9‐10, contributing to larger dural surface area at T10‐11 (p = 0.028). While trends of dorsal CSF thickness tend to decrease with lower thoracic levels, the ratio of surface area of spinal cord to dural sac appeared to remain relatively constant. Conclusions: Dorsal CSF thickness is smaller at T9‐10 than T7‐8 in chronic pain patients in this cohort. More ellipsoid, cord, and spinal canal diameter measurements were noted at lower levels of the thoracic spinal cord, particularly at T10‐11. This may correlate with anatomical SCS placement. Future studies should evaluate efficacy of SCS therapy for pain based on these anatomical considerations. [ABSTRACT FROM AUTHOR]

Background: Older adults with severe aortic stenosis (AS) may receive care in a nursing home (NH) prior to undergoing transcatheter aortic valve replacement (TAVR). NH level of care can be used to stabilize medical conditions, to provide rehabilitation services, or for long‐term care services. Our primary objective is to determine whether NH utilization pre‐TAVR can be used to stratify patients at risk for higher mortality and poor disposition outcomes at 30 and 365 days post‐TAVR. Methods: We conducted a retrospective cohort study among Medicare beneficiaries who spent ≥1 day in an NH 6 months before TAVR (2011–2019). The intensity of NH utilization was categorized as low users (1–30 days), medium users (31–89 days), long‐stay NH residents (≥ 100 days, with no more than a 10‐day gap in care), and high post‐acute rehabilitation patients (≥90 days, with more than a 10‐day gap in care). The probabilities of death and disposition were estimated using multinomial logistic regression, adjusting for age, sex, and race. Results: Among 15,581 patients, 9908 (63.6%) were low users, 4312 (27.7%) were medium users, 663 (4.3%) were high post‐acute care rehab users, and 698 (4.4%) were long‐stay NH residents before TAVR. High post‐acute care rehabilitation patients were more likely to have dementia, weight loss, falls, and extensive dependence of activities of daily living (ADLs) as compared with low NH users. Mortality was the greatest in high post‐acute care rehab users: 5.5% at 30 days, and 36.4% at 365 days. In contrast, low NH users had similar mortality rates compared with long‐stay NH residents: 4.8% versus 4.8% at 30 days, and 24.9% versus 27.0% at 365 days. Conclusion: Frequent bouts of post‐acute rehabilitation before TAVR were associated with adverse outcomes, yet this metric may be helpful to determine which patients with severe AS could benefit from palliative and geriatric services. [ABSTRACT FROM AUTHOR]

Background: This paper evaluates endoscopic stapedotomy from the perspectives of a group of 3 surgeons, each of whose experience in endoscopic and microscopic stapedotomy is 3 years and more than 12 years, respectively. Methods: Thirty-four patients clinically diagnosed with stapedial otosclerosis were alternately assigned for unilateral, microscope- and endoscope-assisted stapedotomy following the selection criteria given. Results were evaluated with predetermined epidemiologic, preoperative, perioperative, and postoperative outcome parameters. Results: The microscope group had 12 ears with otosclerosis and the endoscope-assisted group 14. Ears found to have conditions other than otosclerosis at surgery, and patients lost to follow-up were excluded. Apart from the operative time, the difference in the results of none of the parameters was statistically significant in the two groups. The average operative times for microscope- and endoscope-assisted stapedotomy were 63 minutes and 86.5 minutes, respectively, the difference being statistically significant (P <.001). Conclusions: From the perspectives of otologists in differential positions in the learning curve for microscope- and endoscope-assisted stapedotomy, there were no statistically significant differences between the two procedures in the execution of the steps to achieve "adequate surgical exposure" and in postoperative outcomes, except for operative time. [ABSTRACT FROM AUTHOR]

Background: The solid pattern is a highly malignant subtype of lung adenocarcinoma. In the current era of transitioning from lobectomy to sublobar resection for the surgical treatment of small lung cancers, preoperative identification of this subtype is highly important for patient surgical approach selection and long‐term prognosis. Methods: A total of 1489 patients with clinical stage IA1‐2 primary lung adenocarcinoma were enrolled. Based on patient clinical characteristics and lung imaging features obtained via deep learning, highly correlated diagnostic factors were identified through LASSO regression and decision tree analysis. Subsequently, a logistic model and nomogram were constructed. A restricted cubic spline (RCS) was used to calculate the optimal inflection point of quantitative data and the differences between the groups. Results: The three‐dimensional proportion of solid component (PSC), sex, and smoking status was identified as being highly correlated diagnostic factors for solid predominant adenocarcinoma. The logistic model had good prediction efficiency, and the area under the ROC curve was 0.85. Decision curve analysis demonstrated that the application of diagnostic factors can improve patient outcomes. RCS analysis indicated that the proportion of solid adenocarcinomas increased by 4.6 times when the PSC was ≥72%. A PSC of 72% is a good cutoff point. Conclusion: The preoperative diagnosis of solid‐pattern adenocarcinoma can be confirmed by typical imaging features and clinical characteristics, assisting the thoracic surgeon in developing a more precise surgical plan. [ABSTRACT FROM AUTHOR]

Purpose: Thrombolysis in Cerebral Infarction (TICI) 3 represents the optimal angiographic outcome following mechanical thrombectomy (MT) for acute ischemic stroke (AIS). Although it is known to yield better outcomes than TICI 2b, the influence of preprocedural cerebral hemodynamics on the clinical advantage of TICI 3 over TICI 2b remains unexplored. Methods: This single-center retrospective analysis involved patients with anterior circulation AIS who underwent successful recanalization during MT at the Comprehensive Stroke Center, University Hospital, Krakow between January 2019 and July 2023. We assessed the benefit of achieving TICI 2c/3 over TICI 2b on the basis of preprocedural computed perfusion imaging results, primarily focusing on early infarct volume (EIV) and tissue-level collaterals indicated by hypoperfusion intensity ratio (HIR). Good functional outcome (GFO) was defined as a modified Rankin Score < 3 on day 90. Results: The study comprised 612 patients, of whom 467 (76.3%) achieved TICI 2c/3. GFO was more frequent in the TICI 2c/3 group (54.5% vs 69.4%, p < 0.001). There was interaction between the recanalization status and both HIR (Pi = 0.042) and EIV (Pi = 0.012) in predicting GFO, with disproportionately higher impact of HIR and EIV in TICI 2b group. The benefit from TICI 2c/3 over TICI 2b was insignificant among patients with good collaterals, defined by HIR < 0.3 (odds ratio:1.36 [0.58–3.18], p = 0.483). Conclusion: TICI 2c/3 improves patient functional outcomes compared to TICI 2b regardless of EIV. However, such angiographic improvement may be clinically futile in patients with good tissue-level collateralization. Our findings suggest that preprocedural HIR should be considered when optimization of recanalization is considered during MT. [ABSTRACT FROM AUTHOR]

Background: To evaluate 5-year effect of laparoscopic vertical sleeve gastrectomy (LVSG) versus laparoscopic roux-en-Y gastric bypass (LRYGB) on gastroesophageal reflux disease (GERD) solely based on randomized controlled trials (RCTs). Methods: A systematic review and meta-analysis of 5-year postoperative GERD data comparing LVSG and LRYGB in adults were undertaken. Electronic databases were searched from January 2015 to March 2024 for publications meeting inclusion criteria. The Hartung–Knapp–Sidik–Jonkman random effects model was applied to estimate pooled odds ratio where meta-analysis was possible. Bias and certainty of evidence were assessed using the Cochrane Risk of Bias Tool 2 and GRADE. Results: Five RCTs were analysed (LVSG n = 554, LRYGB n = 539). LVSG was associated with increased adverse GERD outcomes compared to LRYGB at 5 years. The odds for revisional surgery to treat GERD in LVSG patients were 11 times higher compared to LRYGB (OR 11.47, 95% CI 1.83 to 71.69; p = 0.02; I2 = 0% High level of certainty). Similarly pharmacological management for increasing GERD was significantly more frequent in LVSG patients compared to LRYGB (OR 3.89, 95% CI 2.31 to 6.55; p ≤ 0.01; I2 = 0% Moderate level of certainty). Overall, LVSG was associated with significantly more interventions (both medical and surgical) for either worsening GERD and/or development of de novo GERD compared to LRYGB (OR 5.98, 95% CI 3.48 to 10.29; p ≤ 0.01; I2 = 0%) Moderate level of certainty). Conclusions: The development and worsening of GERD symptoms are frequently associated with LVSG compared to LRYGB at 5 years postoperatively requiring either initiation or increase of pharmacotherapy or failing that revisional bariatric surgery. Appropriate patient/surgical selection is crucial to reduce these postoperative risks of GERD. [ABSTRACT FROM AUTHOR]

Objective: To explore the decision-making factors for defunctioning ileostomy (DI) after rectal cancer surgery and to analyze the impact of the DI on perioperative outcomes. Methods: A retrospective case–control study was conducted that included rectal cancer patients who underwent low anterior resection from January 2013 to December 2023. Among them, 33 patients did not undergo DI but with anastomotic leakage (AL) after surgery, and 1030 patients were without AL. Preoperative, operative and tumor factors between these two groups were compared to explore the decision-making factors for DI. Meanwhile, the differences of perioperative outcomes between the DI group of 381 cases and non-DI group of 701 cases were compared. Results: For preoperative factors, the proportions of male patients and preoperative chemoradiotherapy (CRT) in the AL with non-DI group were greater than those in the non-AL group (p < 0.05); for operative factors, the proportion of patients in the AL with non-DI group with a surgical time > 180 min were greater (p < 0.05); for tumor factors, the proportion of T3-4 stage was higher in the AL with non-DI group (p < 0.05). Multiple regression analysis revealed that male sex and preoperative CRT were the independent risk factors affecting DI. For perioperative outcomes, the DI did not reduce the incidence of all and symptomatic AL and non-AL postoperative complications (p > 0.05) but with 12.07% stoma-related complications, and increase hospitalization costs (p < 0.05); however, it can shorten the postoperative hospital stay, pelvic drainage tube removal time, and reduce the anal tube placement rate and readmission rate (all p < 0.05). Conclusion: Male patients and preoperative CRT were the independent risk factors affect the decision of DI in our study, and DI can shorten the postoperative hospitalization, pelvic drainage tube removal time, and decrease the anal tube placement rate and readmission rate during the perioperative period but with a higher economic cost. [ABSTRACT FROM AUTHOR]

Background: The modern wound dressing is produced to absorb fluid and protect against external contamination. The choice of which wound dressing to apply after surgery is usually based on local tradition. There are various impervious dressings on the market. Even if the wound is sterile before application, there will be subsequent recolonisation of skin microbiota. Previous studies suggest that a high bacterial load on the skin hampers wound healing and might be a risk for SSI. Aim: The aim was to compare bacterial recolonisation on the shoulder under three different wound dressings, 48 h after sterile preparation of the skin as in preparation for surgery. Method: In 25 healthy volunteers, a standard pre-surgical skin disinfection for a deltopectoral incision was made on the left shoulder with 0.5% chlorhexidine solution in 70% ethanol. Three different wound dressings were then placed on the shoulder, and 48 h later the skin beneath each dressing was swabbed, subsequently cultured and bacterial density analysed using viable count. Results: The bacterial recolonisation under air-dry (gauze) dressing was significantly lower (p =.0001) compared to semipermeable and occlusive wound dressings. Conclusion: Choosing a less permeable wound dressing may lead to an increased bacterial load on the skin during the first 48 h after surgery. [ABSTRACT FROM AUTHOR]

The Neck Disability Index (NDI), a common Patient-Reported Outcome Measure (PROM) for neck pain, lacks sufficient study on its psychometric properties in preoperative patients with cervical spondylotic myelopathy (CSM). This study aims to address these gaps by conducting an exploratory factor analysis of the Japanese NDI. The objectives are 2-fold: (1) to scrutinize the psychometric properties and internal consistency of the Japanese NDI, and (2) to explore the specific regions of pain and numbness influencing the NDI. A single-center observational study. A total of 100 preoperative patients with CSM. The NDI and Numerical Rating Scale (NRS) were employed to assess preoperative neck disability and pain and numbness in various body regions. Demographic and clinical characteristics were collected, encompassing age, sex, body mass index, American Society of Anesthesiologists classification, smoking status, comorbidities, pain and numbness at various sites using the NRS, and NDI. For evaluating the psychometric properties and internal consistency of the NDI, exploratory factor analysis (EFA) and Cronbach's α coefficient were utilized. Furthermore, the impact of pain and numbness on NDI factors was examined through multivariable regression analysis. EFA identified 2 factors—Physical and Mental—highlighting the dual nature of neck-related disability. Physical factors (std.β=0.724, p<.001) exerted a stronger impact on NDI scores compared to Mental factors (std.β=0.409, p<.001). Cronbach's α coefficient was 0.831 for physical factors and 0.723 for mental factors, indicating a high level of internal consistency. Numbness in the hand (std.β=0.338, p<.001) and pain in the neck (std.β=0.202, p=.035) were significant variables influencing Physical factor, while numbness in the hand (std.β=0.485, p<.001) and pain in the head (std.β=0.374, p<.001) impacted mental factor. This study contributes valuable insights into the psychometric properties of the NDI in preoperative patients with CSM. The identified factors emphasize the importance of addressing both physical and sensory symptoms in preoperative care. [ABSTRACT FROM AUTHOR]

Introduction: This study aimed to identify the blood transfusion rates for several surgical procedures in a single district general hospital and assess the value of preoperative blood type and antibody screen across all relevant surgical procedures. We hypothesized that there was an overuse of blood type and antibody screen in our general surgical population. Methods: A database containing transfusions of patients who underwent elective‐ or emergency surgery from January 2015 to September 2020 was matched to a database of preoperative type‐and‐screen performed in the same period. Registered procedures where the incidence of transfusion is deemed low were excluded. The included procedures were assessed for the intraoperative usefulness of type‐ and‐screen testing. Results: In the included 68.892 surgeries, 36.134 (52.0%) blood samples were preoperatively tested for the blood type and screened for antibodies according to the hospital's routine. Overall 3.517 (5.1%) of surgeries had patients that received a transfusion in the perioperative period and 1.2% (n = 850) during the surgery. Conclusion: Most surgeries had a very low incidence of transfusion. Despite this, type‐and‐screen tests were widely used. This suggests the need for a more focused pre‐surgery type‐and‐screen approach, and a more data driven approach to local guidelines in collaboration with surgical specialties. [ABSTRACT FROM AUTHOR]

The importance of osteoporosis assessment before lumbar surgery is well recognized. The MRI-based Vertebral Bone Quality (VBQ) score is introduced to evaluate bone quality; however, its diagnostic value has not been well documented. The purpose of this meta-analysis was to summarize the diagnostic value of the VBQ score for osteoporosis or osteopenia in patients undergoing lumbar surgery. We comprehensively searched electronic databases for studies exploring the diagnostic accuracy of the VBQ score for osteoporosis/osteopenia in patients with lumbar disease following the PRISMA guidelines. The quality of the included studies was assessed. The VBQ scores were compared between the groups, and the pooled sensitivity, specificity, and summary receiver operating characteristic (ROC) were calculated. Publication bias was assessed, and meta-regression was conducted. We included 17 studies with a total of 2815 patients, with a mean age of 66.4 years and a percentage of females of 72.5%. According to the QUADAS-2 tool, the quality of the included studies was relatively high. The results showed a significantly higher VBQ score in the osteoporosis/osteopenia group compared with the control group. According to the mean VBQ cutoff value of 3.02 ± 0.38 for the diagnosis of osteoporosis, the pooled sensitivity and specificity were 0.76 and 0.74, respectively, and the AUC was 0.81. According to the mean VBQ cutoff value of 2.31 ± 0.18 for the diagnosis of osteopenia, the pooled sensitivity and specificity were 0.78 and 0.58, respectively, and the AUC was 0.76. The MRI-based VBQ score could provide useful information for identifying patients with low bone mass who need further evaluation. Future prospective studies are still needed to evaluate the complementary role of the VBQ score. [ABSTRACT FROM AUTHOR]

Pancreatic neuroendocrine tumours (PNETs) are a rare subset of pancreatic tumours that have historically comprised up to 3% of all clinically detected pancreatic tumours. In recent decades, however, advancements in imaging have led to an increased incidental detection rate of PNETs and imaging has played an increasingly central role in the initial diagnostics and surgical planning of these tumours. Cinematic rendering (CR) is a 3D post-processing technique that generates highly photorealistic images through more realistically modelling the path of photons through the imaged volume. This allows for more comprehensive visualization, description, and interpretation of anatomical structures. In this 2-part review article, we present the first description of the various CR appearances of PNETs in the reported literature while providing commentary on the unique clinical opportunities afforded by the adjunctive utilization of CR in the workup of these rare tumours. This second instalment focuses on the applications of CR in optimizing preoperative planning of PNETs. [ABSTRACT FROM AUTHOR]

Purpose: A routine preoperative assessment is considered both ineffective and inefficient. Despite the widespread application of lean thinking in healthcare, there is little evidence of successful experiences in preoperative admissions in order to reduce "No value added" activities. A conceptual framework reporting the drivers (clinic, tools, innovation, organization, and governance) and impacts (patient, efficiency, sustainability, time, learning and growth) was developed. Methodology: Drawing on the experience of an Italian high complexity hospital, this paper analyzes the case study by reporting evidence on how to implement lean in preoperative assessment and how to evaluate the positive results obtained. Results: Applying lean principles, the identification of value improved the appropriateness of care by creating 40 personalized pathways; the value stream resulted in a reduction of "No Value Added Time" from 37% to 28%, chest X-rays from 41% to 14% and cardiac visits from 49% to 37%; the pursuit of continuous flow through innovation contributed to increase the use of digitalization; the new pull organization helped to reduce the average time spent per year by 1.5 h; the continuous improvement was ensured through the governance of results. Conclusion: The proposed framework should be used to improve the quality of care in preoperative admissions by adopting the lean drivers for successful implementation and reporting the impacts. [ABSTRACT FROM AUTHOR]

Aim: Presurgical Nasoalveolar molding (PNAM) is a technique used for cleft lip and palate patients prior to cheiloplasty. However, concerns exist regarding its negative impact on maxillary arch growth.This study aimed to assess the effect of selective trimming in NAM on maxillary arch growth in patients with unilateral cleft lip palate. Methodology: The retrospective observational study analyzed the study casts of 30 patients before and after undergoing nasoalveolar molding treatment. Study casts which were repositories of the institute were analyzed and segregated as Group A: NAM given with selective trimming of the appliance, and Group B: NAM without selective trimming of the appliance. Pre and post‐treatment casts were assessed digitally at L‐L' (Intercleft segment width), C‐C' (Intercanine width), T‐T' (Alveolar arch width), L‐TT' (Alveolar arch length from major cleft segment), and L'‐TT' (Alveolar arch length from minor cleft segment) Results: A notable significant difference between Group A's and B's mean Alveolar arch width and Intercleft segment width was seen. Whereas parameters such as intercanine width, and alveolar arch length as functions from major and minor segments showed no significant variance. Conclusion: Although NAM has been known to affect the growth of the maxillary arch, this study proposes that techniques such as selective trimming can help counteract this drawback. [ABSTRACT FROM AUTHOR]

Background & Objective: In situations where misoprostol is not available or its use is contraindicated, hyoscine can be an alternative option. The present study was conducted with aim to compare the effect of vaginal hyoscine butyl bromide and versus vaginal misoprostol on cervical ripening before hysteroscopy. Materials & Methods: This double-blind randomized clinical trial study was conducted on 150 patients who were candidates for diagnostic or therapeutic hysteroscopy and were divided into two groups. In group one, 75 patients received 20 mg of Hyosin vaginally 4 hours before surgery, and in group 2, 200 micrograms of misoprostol was administered vaginally 4 hours before surgery. The two groups were compared in terms of passage of Hegar dilator number 5, amount of cervical dilatation, operation length, postoperative pain and drug side effects. Results: The passage rate of Hegar dilator number 5 in the misoprostol group was 51 (68%) and in the hyoscine group was 44 (58.7%). Also, the mean pain in the misoprostol group was 5.32±2.16 and in the hyosin group was 5.68±1.61. The mean operation length in the misoprostol group was 38.36±6.14 minutes and the in the hyosin group was 40.23±6.41 minutes. The mean amount of cervical dilatation in the misoprostol group was 5.43±1.53 cm and in the hyosin group was 4.97±1.44 cm. Conclusion: Hyoscine for cervical ripening for diagnostic and therapeutic hysteroscopy had no significant difference with misoprostol. Also, there was no significant difference between the two groups in surgical complications, duration of surgery, postoperative pain, and the amount of cervical dilatation. Therefore, considering the low cost and availability of hyoscine, its use for ripening the cervix before hysteroscopy seems logical. [ABSTRACT FROM AUTHOR]

Background: In this study, we aimed to assess the efficacy of surgical treatment in children with drug-refractory infantile epileptic spasms syndrome (IESS) and examine the factors influencing the post-surgical outcomes. Methods: The clinical data of 30 children (18 males and 12 females) with epileptic spasms (ES) who underwent surgery at the Epilepsy Center of Shenzhen Children's Hospital between June 2018 and June 2020 were retrospectively analyzed. Post-surgical outcomes were evaluated using the Engel Epilepsy Surgery Outcome Scale. Scalp electroencephalography and developmental quotient were assessed preoperatively and postoperatively. Univariate analysis and exact logistic regression analyses were used to identify the factors affecting the postoperative efficacy. Results: Of the 30 patients who underwent surgical resection, 22 (73.3%) achieved Engel's class I–II outcomes. Additionally, motor and cognitive functions improved in 14 patients (46.7%). The development of 12 (40%) patients remained at the preoperative development level. The median number of antiseizure medications taken preoperatively was 5.27 (range 2–10), which decreased to 1.90 (range 0–4) at the last follow-up. Seizure duration, etiology, positive positron emission tomography-magnetic resonance imaging (PET-MRI), surgery type, and lesion location were significantly correlated with the postoperative efficacy (P < 0.05). Positive PET/MRI findings and lesion location predicted independently the postoperative outcomes. Permanent impairments of motor or language function were rare, with only two cases reporting hydrocephalus and one reporting hemiplegia. Conclusions: Surgery is an effective treatment option for children with IESS. Early referral and comprehensive preoperative evaluation are essential for identification of surgically treatable structural lesions. The primary surgically treatable cause is cortical malformation, followed by perinatal brain injury. Hemispheric disconnection is a preferred surgical approach. Positive PET/MRI findings and lesion location predicted the postoperative outcomes. [ABSTRACT FROM AUTHOR]

Background: Multiple preoperative calculators are available online to predict preoperative mortality risk for noncardiac surgical patients. However, it is currently unknown how these risk calculators perform across different raters. The current study investigated the interrater reliability of three preoperative mortality risk calculators in an elective high-risk noncardiac surgical patient population to evaluate if these calculators can be safely used for identification of high-risk noncardiac surgical patients for a preoperative multidisciplinary team discussion. Methods: Five anesthesiologists assessed the preoperative mortality risk of 34 high-risk patients using the preoperative score to calculate postoperative mortality risks (POSPOM), the American College of Surgeons surgical risk calculator (SRC), and the surgical outcome risk tool (SORT). In total, 170 calculations per calculator were gathered. Results: Interrater reliability was poor for SORT (ICC (C.I. 95%) = 0.46 (0.30–0.63)) and moderate for SRC (ICC = 0.65 (0.51–0.78)) and POSPOM (ICC = 0.63 (0.49–0.77). The absolute range of calculated mortality risk was 0.2–72% for POSPOM, 0–36% for SRC, and 0.4–17% for SORT. The coefficient of variation increased in higher risk classes for POSPOM and SORT. The extended Bland–Altman limits of agreement suggested that all raters contributed to the variation in calculated risks. Conclusion: The current results indicate that the preoperative risk calculators POSPOM, SRC, and SORT exhibit poor to moderate interrater reliability. These calculators are not sufficiently accurate for clinical identification and preoperative counseling of high-risk surgical patients. Clinicians should be trained in using mortality risk calculators. Also, clinicians should be cautious when using predicted mortality estimates from these calculators to identify high-risk noncardiac surgical patients for elective surgery. Highlights: -Interrater reliability for POSPOM, SRC and SORT preoperative mortality risk predictors is lower than expected. -Clinicians need to use preoperative mortality risk calculators with caution when using them for identification and preoperative counseling of high-risk noncardiac surgical patients. -In this study all raters using POSPOM, SRC and SORT for preoperative mortality risk calculation, contributed to variability in risk estimates. [ABSTRACT FROM AUTHOR]

\nIntroduction: Limited information exists regarding the impact of preoperative serum creatinine changes on cardiac surgery-associated acute kidney injury (CSA-AKI). This study aimed to investigate the development of AKI in patients with a baseline estimated glomerular filtration rate of ≥60 mL/min/1.73 m2 who present with an elevation in preoperative serum creatinine. Methods: This retrospective cohort study assessed patients who underwent open-heart surgery. Preoperative serum creatinine change was calculated as the ratio of the maximum preoperative serum creatinine value to the baseline creatinine (MCR). Patients were categorized into three groups based on MCR: non-elevation (≤1.0), mild elevation (1.0 to 1.5), and pronounced elevation (≥1.5). Multivariable logistic regression was used to estimate the risk of AKI, severe AKI, and non-recovery from AKI. Results: There were significant increases in the odds of AKI (adjusted odds ratio [OR], 1.42; 95% confidence interval [CI], 1.29–1.57; per 0.1 increase in MCR), severe AKI (adjusted OR, 1.28; 95% CI, 1.15–1.41), and AKI non-recovery (adjusted OR, 1.29; 95% CI, 1.16–1.43). Pronounced elevation in preoperative serum creatinine was associated with a higher risk of AKI (adjusted OR, 15.45; 95% CI, 6.63–36.00), severe AKI (adjusted OR, 3.62; 95% CI, 1.20–10.87), and AKI non-recovery (adjusted OR, 4.74; 95% CI, 1.63–13.89) than non-elevation. Mild elevation in preoperative serum creatinine was also significantly associated with AKI (adjusted OR, 3.76; 95% CI, 1.92–7.37). Conclusions: Elevation in preoperative serum creatinine from baseline was associated with an increased risk of AKI; even mild elevation significantly increased the risk of AKI. Cardiac surgery-related acute kidney injury (CSA-AKI) is serious complication that can result in higher mortality and morbidity after cardiac surgery. Although previous studies have highlighted that preoperative kidney dysfunction is a risk factor for AKI, there is limited information of the impact of preoperative serum creatinine change preceding surgery on CSA-AKI. We found that approximately 85% of patients experienced elevation in preoperative serum creatinine. Elevation in preoperative serum creatinine was associated with CSA-AKI, even mild elevation was associated with a 3.8-fold higher risk of postoperative CSA-AKI. Furthermore, patients with pronounced elevation in preoperative serum creatinine also exhibited a higher risk of severe AKI and non-recovery from AKI. This study emphasizes the importance of extending scrutiny beyond mere preoperative serum creatinine values, highlighting the assessment of fluctuations in preoperative serum creatinine; this aids in identifying individuals at high risk, enabling clinicians to intervene more earlier and potentially improve prognosis. [ABSTRACT FROM AUTHOR]

Purpose: Patients with hypoalbuminemia, (serum albumin (SA) < 3.5 g/dL) are at greater risk for complications after surgery, including increased postoperative infection rates after total knee arthroplasty (TKA). This study aimed to analyze both preoperative and postoperative SA in patients who experienced acute periprosthetic infection within the first 4 weeks after surgery. Methods: We retrospectively analyzed data from 490 consecutive TKAs (314 patients). Five patients developed early acute infection requiring surgical treatment. SA data were collected preoperatively (SA0) and 1 week postoperatively (SA1W) to evaluate SA dynamics. Multiple patient and operative parameters that could influence SA were also analyzed. Results: No statistical differences were found in parameters expected to influence SA values between the surgically treated (STG) and non-treated groups (non-STG). None of the patients in STG had SA0 and SA1W below 3.5 g/dL. However, the amount and rate of SA reduction before and after surgery were significantly greater in STG than in non-STG. Conclusion: SA dynamics revealed a greater reduction in both the amount and rate in STG before and after surgery than in non-STG. No correlation was found between early acute periprosthetic infection after TKA and each SA0 and SA1W time point. Further evaluation of the SA value of 3.5 g/dL as a threshold for acute early acute infection is warranted. [ABSTRACT FROM AUTHOR]

Background: Peripheral intravenous catheterization is frequently performed in emergency units, but it is a procedure which is difficult for healthcare professionals and painful for patients. The primary objective of the present study was to examine the effect on venous dilation, procedure duration and pain severity of local heat, cold and vibration applications performed on the intervention area before peripheral intravenous catheterization in adults. The second objective of the study was to examine the effects of age and gender variables on the participants' pain intensity levels. Methods: A single-blinded randomized controlled trial. The study included 120 adults who were randomly selected between March and August 2023. One application group (n = 30) received local heat application, one group (n = 30) received local cold application, and one (n = 30) received local vibration using the Buzzy® device. The applications, to the site of the peripheral intravenous catheterization, lasted one minute. The control group (n = 30) received standard peripheral intravenous catheterization application. The groups' vein dilation was assessed with the vein assessment scale, pain felt during catheterization with the visual analog scale, and the duration of the procedure with a chronometer. Results: It was found that the venous dilation of the cold application group was significantly higher (p = 0.010, p = 0.015 respectively) and procedure duration was shorter (p = 0.013, p < 0.001 respectively) than that of the heat and vibration application groups, and its pain severity was significantly lower (p = 0.002, p = 0.001 and p = 0.001 respectively) than that of the control group and the heat and vibration application groups. Conclusions: It was determined that local cold application for one minute to the area of peripheral intravenous catheterization increased venous dilation, shortened application time, and reduced pain. Trial registration: ClinicalTrials.gov ID NCT06378424, retrospectively registered 20/04/2024. [ABSTRACT FROM AUTHOR]

Background: Inadvertent peri-operative hypothermia (IPH) is defined as a peri-operative core temperature less than 36°C. IPH is known to increase the risk of blood loss, prolonged and altered drug effects, post-operative shivering, and adverse cardiac events. Pre-operative warming with forced air reduces post-induction redistribution hypothermia, results in higher average intraoperative core temperature than non- pre-warmed counterparts and prevents complications associated with hypothermia. Purpose: To compare the effect of preoperative forced air warming on the incidence of perioperative hypothermia in patients undergoing general anaesthesia, who are pre-warmed versus those who are not pre-warmed Study Design: This randomised comparative prospective study was conducted in the Department of Anaesthesiology and Pain Management at Max Super speciality Hospital, Patparganj, New Delhi after approval by the institutional ethics committee. 170 patients were included in this study Methodology: 170 adult persons of either sex, ASA physical status I-III scheduled for different surgeries under general anaesthesia who met eligibility criteria were randomly assigned either to group A in which pre-operative forced air warming was done for 30 minutes or to group B in which pre-operative forced air warming was not done. Pre-warming was done in preoperative care unit with a forced air warming device with temperature setting of 45 degrees Celsius for 30 minutes. Pre-operatively, axillary temperatures of patients were recorded. After administration of general anaesthesia, nasopharyngeal core temperature was recorded every 10 minutes till the end of surgery. Intra-operatively forced air warming was done in both groups with temperature setting of 45 degrees. Incidence of hypothermia was compared between two groups. Amount of intra-operative blood loss, time of recovery from anaesthesia, postoperative shivering and incidence of adverse cardiac event were also compared between two groups. Result: Incidence of hypothermia was significantly higher in non-pre-warmed group as compared to pre-warmed group. (p<0.001) Incidence of postoperative shivering was significantly higher in non-pre-warmed group. (p<0.001). Mean recovery time from anaesthesia was also significantly higher in non-pre-warmed group (p<0.001). However, incidence of adverse cardiac event and increased blood loss were insignificant between the two groups. Conclusion: According to the observations and findings of this study, the occurrence of perioperative hypothermia was decreased in patients who underwent a 30-minute pre-warming period before receiving general anesthesia, compared to patients who did not get pre-warming. Pre-warming additionally decreased the occurrence of post-operative shivering and shortened the duration of recovery from anesthesia. Nevertheless, there was no significant difference in the occurrence of negative cardiac events and the amount of blood loss between the two groups. The study was conducted within a limited time frame, and a bigger sample size would provide more definitive results. [ABSTRACT FROM AUTHOR]

Introduction: Preoperative fasting is a standard practice aimed at minimising the risk of pulmonary aspiration during surgery. However, patients often experience prolonged fasting periods beyond the recommended duration due to unanticipated delays in the operating theatre, communication failures between teams, inadequate preoperative planning and other factors. Aim: To investigate the effects of unexpectedly prolonged fasting on intraoperative and postoperative parameters in patients undergoing elective surgery under spinal anaesthesia. Materials and Methods: This prospective observational study was conducted from October 2023 to June 2024 at the Department of Anaesthesiology, Dr. D.Y. Patil Medical College, Hospital and Research Centre, Pimpri, Pune, Maharashtra, India. The study included 70 patients undergoing elective surgery under spinal anaesthesia. Patients were divided into two groups: Group A (AM group, n=35), scheduled for surgery between 8:00 AM and 12:00 PM and Group B (PM group, n=35), scheduled for surgery after 12:00 PM or with delayed surgeries. Intraoperative parameters, including Mean Arterial Pressure (MAP), Heart Rate (HR), oxygen saturation (SpO2) and random blood glucose levels, were recorded at specific time points. Postoperative outcomes, such as nausea, vomiting and random blood glucose levels, were also assessed. Continuous and discrete variables were summarised as mean±SD and median, while categorical variables were presented as frequencies and percentages. Associations between categorical variables were tested using Pearson's Chi-square or Fisher's-exact test, with p-values<0.05 considered statistically significant. Results: The PM group exhibited higher preoperative random blood glucose levels (102.3±18.7 mg/dL) compared to the AM group (89.2±12.5 mg/dL). Postoperative nausea and vomiting were observed in 5 (14.3%) patients in the AM group and 11 (31.4%) patients in the PM group. Both groups showed a gradual decrease in MAP and HR from the preoperative period to 30 minutes after spinal anaesthesia administration, with slightly higher values noted in the PM group. No significant differences in SpO2 were observed between the groups. Conclusion: Unexpected prolonged fasting before elective surgery under spinal anaesthesia may contribute to higher preoperative blood glucose levels and an increased risk of postoperative nausea and vomiting. These findings underscore the importance of adhering to preoperative fasting guidelines and exploring potential strategies to minimise prolonged fasting periods, such as carbohydrate loading or allowing clear fluids closer to surgery. [ABSTRACT FROM AUTHOR]

OBJECTIVES CALGB140503/JCOG0802 RCTs comparing lobectomy with sublobar resection in stage IA NSCLC have confirmed the non-inferiority of segmentectomy. Additional insight is needed to improve preoperative work-up and intraoperative strategies to increase safety and promote the dissemination of minimally invasive segmentectomy (MIS). A Delphi panel study assessed the level of consensus among surgeons for the planning and management of MIS. METHODS Twenty-one expert lung surgeons represented academic institutions, major teaching hospitals, and community hospitals from Europe, North America, and Asia. A 3-round Delphi methodology was used to analyse the answers of each panellist. Recognizing that questions with fewer response options have a higher consensus probability due to limited variability, weighted consensus thresholds were modified based on the number of response options. RESULTS The 21 panellists responded to all 3 rounds of questions. Based on the most robust consensus (94.4%), 3D chest CT reconstructions are recommended only when planning complex segmentectomies. Surgeons should perform 3D reconstructions chest CT scans (consensus = 83.3%). The most effective and safest technique is image-guided VATS in a hybrid operating room (consensus = 83.3%). Dyes with intravenous administration are the safest technique for identifying the intersegmental plane during MIS (consensus = 72.2%). Augmented/mixed reality will probably not immediately help reduce perioperative complications (consensus = 72.2%). CONCLUSIONS This Delphi consensus supports 3D reconstructions and preoperative pulmonary nodule localization before complex MIS. These recommendations should be considered when allocating resources to improve MIS's safety and oncologic efficacy for patients with small, early-stage lung cancers. [ABSTRACT FROM AUTHOR]

OBJECTIVES Postoperative pain remains a burden for patients after minimally invasive anatomic lung resection. Current guidelines recommend the intraoperative placement of intercostal catheters to promote faster recovery. This trial aimed to determine the analgesic efficacy of continuous loco-regional ropivacaine application via intercostal catheter and establish this method as a possible standard of care. METHODS Between December 2021 and October 2023, patients were randomly assigned to receive ropivacaine 0.2% or a placebo through an intercostal catheter with a flow rate of 6–8 ml/h for 72 h after surgery. Patients were undergoing anatomic VATS lung resection under general anaesthesia for confirmed or suspected stage I lung cancer (UICC, 8th edition). The sample size was calculated to assess a difference in numerical rating scale associated with pain reduction of 1.5 points. RESULTS Fourteen patients were included in the ropivacaine group, whereas the placebo group comprised 18 participants. Patient characteristics and preoperative pain scores were similar in both groups. There was no statistically significant difference in postoperative pain scores and morphine consumption between the 2 groups. The mean numerical rating scale when coughing during the first 24 h postoperatively was 4.9 (SD: 2.2) in the ropivacaine group and 4.3 (SD: 2.4); P  = 0.47 in the placebo group. We were unable to determine any effect of administered ropivacaine on the postoperative pulmonary function (FEV1, PEF). CONCLUSIONS Our preliminary results suggest that continuous loco-regional ropivacaine administration via surgically placed intercostal catheter has no positive effect on postoperative pain scores or morphine requirements. CLINICAL REGISTRATION NUMBER NCT04939545 [ABSTRACT FROM AUTHOR]

OBJECTIVES The goal was to explore clinical factors and build a predictive model for the disease-free and overall survival of patients with non-small cell lung cancer (NSCLC) receiving neoadjuvant chemotherapy combined with immune checkpoint inhibitors. METHODS Inclusion criteria for patients in this multicentre study were as follows: (i) Patients who were diagnosed with stages I–III NSCLC after a bronchoscopy biopsy or puncture; (ii) patients who were examined with computed tomography/positron emission tomography-computed tomography before treatment and surgery; (iii) patients who received neoadjuvant chemotherapy combined with immune checkpoint inhibitors for 2 to 6 cycles preoperatively; (iv) patients whose peripheral blood indicators and tumour markers were assessed before treatment and preoperatively; (v) patients who underwent radical lung cancer surgery after neoadjuvant therapy. Cases were divided into high- and low-risk groups according to 78 clinical indicators based on a 10-fold Least Absolute Shrinkage and Selection Operator selection. We used Cox proportional hazards models to predict disease-free and overall survival. Then, we used time-dependent area under the curve and decision curve analyses to examine the accuracy of the results. RESULTS Data were collected continuously, and 212 and 85 cases were randomly assigned to training and testing sets, respectively. The area under the curve for the prediction of disease-free survival (training: 1 year, 0.83; 2 years, 0.81; 3 years, 0.83 versus testing: 1 year, 0.65; 2 years, 0.66; 3 years, 0.70), overall survival (training: 1 year, 0.86; 2 years, 0.85; 3 years, 0.86 versus testing: 1 year, 0.66; 2 years, 0.57; 3 years, 0.70) were determined. The coefficient factors including pathological response; preoperative tumour maximum diameter; preoperative lymph shorter diameter; preoperative tumour and lymph maximum standardized uptake value; change in tumour standardized uptake value preoperatively; and blood-related risk factors were favourably associated with prognosis (P  < 0.001). CONCLUSIONS Our prediction model, which integrated data from preoperative positron emission tomography-CT, preoperative blood parameters and pathological response, was able to make highly accurate predictions for disease-free and overall survival in patients with NSCLC receiving neoadjuvant immunity with chemical therapy. [ABSTRACT FROM AUTHOR]

Introduction: Frailty is significantly correlated with a higher incidence of medical complications during hospitalization after esophagectomy. As frailty is thought to be a reversible condition, improving the reserve capacity through preoperative physical therapy is expected to reduce the risk of postoperative pulmonary complications (PPCs). Herein, we report our experience with preoperative physical therapy in a patient with esophageal cancer who was considered to have inadequate fitness for surgery owing to poor physical performance. Case Presentation: A 72‐year‐old man (height: 169.5 cm, weight: 54.7 kg, body mass index: 18.9 kg/m2) with esophagogastric junction tumors (cStage IIIA) was hospitalized and scheduled to undergo surgery based on preoperative screening. He was categorized as frail according to the revised Japanese version of the Cardiovascular Health Study criteria and the Mini Nutritional Assessment Short‐Form indicated severe malnutrition. We focused on physical therapy to improve exercise tolerance and prevent PPCs and devised a short‐term intensive physical therapy program comprising minimal exercises that the patient could perform efficiently. The program consisted of only inspiratory muscle training and aerobic exercises. His maximal inspiratory pressure (MIP) and 6‐min walking distance improved by 30 cm H2O and 145 m, respectively, on the day before surgery compared with those on day 8. The percentage predicted value of the MIP improved from 56.6% at the start of physical therapy to 102.9% on the day before surgery. On day 43, the patient underwent subtotal esophagectomy and was able to ambulate on postoperative day 5 without respiratory complications. Conclusion: We conducted a short‐term, intensive, and minimal preoperative physical therapy program for a patient with esophageal cancer who had physical frailty. Preoperative physical therapy to increase the reserve capacity may result in a favorable postoperative course even in patients with physical frailty. [ABSTRACT FROM AUTHOR]

Background: Despite the growing volume of neighborhood-level health disparity research, there remains a paucity of prospective studies investigating the relationship between Area Deprivation Index (ADI) and functional outcomes for patients undergoing hip arthroscopy. Purpose: To investigate the relationship between neighborhood-level socioeconomic status and functional outcomes after hip arthroscopy. Study Design: Cohort study; Level of evidence, 3. Methods: A retrospective analysis of prospectively collected data was performed on patients aged ≥18 years with minimum 1-year follow-up who underwent hip arthroscopy for the treatment of symptomatic labral tears. The study population was divided into ADILow and ADIHigh cohorts according to ADI score: a validated measurement of neighborhood-level socioeconomic status standardized to yield a score between 1 and 100. Patient-reported outcome measures (PROMs) included the modified Harris Hip Score, Nonarthritic Hip Score, Hip Outcome Score–Activities of Daily Living, Hip Outcome Score–Sports-Specific Subscale, 33-item International Hip Outcome Tool, visual analog scale for pain, and patient satisfaction. Results: A total of 228 patients met inclusion criteria and were included in the final analysis. After patients were stratified by ADI score (mean ± SD), the ADILow cohort (n = 113; 5.8 ± 3.0; range, 1-12) and ADIHigh cohort (n = 115; 28.0 ± 14.5; range, 13-97) had no differences in baseline patient demographics. The ADIHigh cohort had significantly worse preoperative baseline scores for all 5 PROMs; however, these differences were not present by 1-year follow-up. Furthermore, the 2 cohorts achieved similar rates of the minimal clinically important difference for all 5 PROMs and the Patient Acceptable Symptom State for 4 PROMs. When controlling for patient demographics, patients with higher ADI scores had greater odds of achieving the minimal clinically important difference for all PROMs except the 33-item International Hip Outcome Tool. Conclusion: Although hip arthroscopy patients experiencing a greater neighborhood-level socioeconomic disadvantage exhibited significantly lower preoperative baseline PROM scores, this disparity resolved at 1-year follow-up. In fact, when adjusting for patient characteristics including ADI score, more disadvantaged patients achieved greater odds of achieving the minimal clinically important difference. The present study is merely a first step toward understanding health inequities among patients seeking orthopaedic care. Further development of clinical guidelines and health policy research is necessary to advance care for patients from disadvantaged communities. [ABSTRACT FROM AUTHOR]

Objective: The aim of this study was to develop an F-fluorodeoxyglucose (18F-FDG) positron emission tomography/computed tomography (PET/CT) radiomic model for predicting mediastinal lymph node metastasis (LNM) in presurgical patients with lung adenocarcinoma. Methods: The study enrolled 320 patients with lung adenocarcinoma (288 internal and 32 external cases) and extracted 190 radiomic features using the LIFEx package. Optimal radiomic features to build a radiomic model were selected using the least absolute shrinkage and selection operator algorithm. Logistic regression was used to build the clinical and complex (combined radiomic and clinical variables) models. Results: Ten radiomic features were selected. In the training group, the area under the receiver operating characteristic curve of the complex model was significantly higher than that of the radiomic and clinical models [0.924 (95% CI: 0.887-0.961) vs. 0.863 (95% CI: 0.814-0.912; p = 0.001) and 0.838 (95% CI: 0.783-0.894; p = 0.000), respectively]. The sensitivity, specificity, accuracy, and positive and negative predictive values of the radiomic model were 0.857, 0.790, 0.811, and 0.651 and 0.924, respectively, which were better than that of visual evaluation (0.539, 0.724, 0.667, and 0.472 and 0.775, respectively) and PET semiquantitative analyses (0.619, 0.732, 0.697, and 0.513 and 0.808, respectively). Conclusions:18F-FDG PET/CT radiomics showed good predictive performance for LNM and improved the N-stage accuracy of lung adenocarcinoma. [ABSTRACT FROM AUTHOR]

Objective • The goal of this study was to explore the application effect of preoperative computed tomography (CT) angiography and color ultrasound-assisted design of lower limb perforator flaps in the repair of lower limb soft tissue defects. Repair of soft tissue defects in the lower limbs is a challenging surgical task, and accurate preoperative location of vascular structures and detailed design of the surgical plan are crucial to the success of the surgery. This study aims to improve the accuracy and effectiveness of lower limb perforator flap repair surgery by introducing CT angiography and color ultrasound technology. Methods • Sixty-four patients who underwent lower limb soft tissue defect repair with perforator flaps were enrolled at our hospital from February 2020 to February 2023. According to their admission time, they were divided into two groups: 32 patients admitted before June 31, 2022, were included in the control group, and preoperative color Doppler ultrasound was used to assist in designing the lower limb perforator flap; 32 patients admitted after June 31, 2022, were included in the study group, and preoperative CT angiography and color Doppler ultrasound were used to assist in designing the lower limb perforator flap. Specifically, we conducted detailed records and analyzes of patients’ age distribution, gender ratio, and relevant medical history. This demographic information will help reveal whether there are differences in the effectiveness of preoperative CT angiography and color ultrasound-assisted lower extremity perforator flap design among different patient groups. By considering these key factors, we can more accurately assess the actual utility of new technologies in different patient groups and provide more specific guidance for clinical practice.The therapeutic effects of the two groups of patients were recorded. The differences between the preoperative CT angiography measurements and intraoperative actual measurements of the study group were compared. Clinical indicators, sensory function in the graft area, flap survival rate, flap complication rate, and donor area complication rate were compared between the two groups. The satisfaction of patients in the two groups with the recovery of the surgical area was also compared. Results • The treatment success rate of the study group was higher than that of the control group (P < .05). There was no significant difference in the preoperative CT angiography measurements (shallow branch localization, shallow branch starting diameter, shallow branch length, deep branch starting diameter) and intraoperative actual measurements of the study group (P > .05). The operation time and intraoperative blood loss of the study group were shorter than those of the control group (P < .05), and there was no significant difference in flap harvesting area and length of hospital stay between the two groups (P > .05). There was a difference in sensory function in the graft area between the two groups, with a higher proportion of S4 grade in the study group and better recovery compared to the control group (P < .05). There was no significant difference in satisfaction evaluation between the two groups (P > .05). Conclusion • Preoperative CT angiography and color ultrasound-assisted design of lower limb perforator flaps have shown significant clinical advantages in repairing lower limb soft tissue defects, improving treatment effects and surgical efficiency. In clinical practice, this technology is expected to reduce surgical complexity, shorten surgical time, reduce the risk of intraoperative bleeding, and achieve effective defect repair while maintaining or improving the patient’s sensory function. However, there are some limitations to the study, such as the relatively small sample size and single-center nature. Future research can optimize the operation process of this technology, expand the scope of research, and explore its application in the repair of soft tissue defects caused by specific causes. This technology may provide more precise and effective options for personalized treatment, especially for patients who need to preserve more sensory function. [ABSTRACT FROM AUTHOR]

Objectives To develop a simple postoperative risk stratification based on histopathologic findings from radical prostatectomy specimens. Methods This study included 3 cohorts of patients with a preoperative diagnosis of clinically localized prostate cancer: 1 derivation cohort (n = 432) and 2 validation cohorts (n = 506 and n = 720). First, a postoperative risk stratification model was developed in the derivation cohort using the factors extraprostatic extension, surgical margin status, seminal vesicle invasion, and lymph node involvement. Each of the first 3 factors was assigned 0 or 1 point for negative or positive results, respectively, and the sum of the points, ranging from 0 to 3, was scored. pN1 was not scored but was analyzed separately. Validation cohorts were then used to evaluate the predictive accuracy of the model. Additionally, we compared the model with the Cancer of the Prostate Risk Assessment (CAPRA) score. Results Because the log-rank test showed no statistically significant differences between scores 1 vs 2 or score 3 vs pN1 in the derivation cohort, the following 3-level risk stratification was created: low risk (score 0), intermediate risk (score 1-2), and high risk (score 3 or pN1). There were statistically significant differences in recurrence-free survival between any of 2 groups of 3-level risk stratification. This model similarly worked in both validation cohorts. The C indexes for the model were higher than those for the CAPRA score. Conclusions This simple postoperative risk stratification model, based on radical prostatectomy findings, has a prognostic impact that has been validated in a multicenter population. [ABSTRACT FROM AUTHOR]

Simple Summary: The optimal selection of patients with advanced high-grade serous ovarian cancer (HGSOC) who are likely to benefit from upfront cytoreductive surgery remains challenging. With the results of the TRUST trial, the fifth randomized phase III trial comparing oncologic outcomes of primary versus interval cytoreductive surgery, expected to be presented soon, there is a high unmet clinical need to define novel biomarkers to optimize pretherapeutic patient assessment and allow for more personalized clinical decision making. Building on the growing evidence of the predictive and prognostic value of fibrinogen in various solid cancers, this study is the first to observe an independent association between the "Fibrinogen–Albumin-Ratio Index" (FARI) and surgical outcomes in patients with advanced HGSOC undergoing primary cytoreductive surgery. Given that the FARI seems to act as a surrogate for intra-abdominal tumor load, the further clinical validation of this cost-effective and readily available biomarker appears promising. Background/Objectives: The present study evaluates predictive implications of the pretherapeutic Fibrinogen–Albumin-Ratio Index (FARI) in high-grade serous ovarian cancer (HGSOC) patients undergoing primary cytoreductive surgery. Methods: This retrospective study included 161 patients with HGSOC International Federation of Gynecology and Obstetrics (FIGO) stage ≥ IIb, who underwent primary cytoreductive surgery followed by platinum-based chemotherapy. Associations between the FARI and complete tumor resection status were described by receiver operating characteristics, and binary logistic regression models were fitted. Results: Higher preoperative FARI values correlated with higher ascites volumes (r = 0.371, p < 0.001), and higher CA125 levels (r = 0.271, p = 0.001). A high FARI cut at its median (≥11.06) was associated with lower rates of complete tumor resection (OR 3.13, 95% CI [1.63–6.05], p = 0.001), and retrained its predictive value in a multivariable model independent of ascites volumes, CA125 levels, FIGO stage, and Charlson Comorbidity Index (CCI). Conclusions: The FARI appears to act as a surrogate for higher intra-abdominal tumor load. After clinical validation, FARI could serve as a readily available serologic biomarker to complement preoperative patient assessment, helping to identify patients who are likely to achieve complete tumor resection during primary cytoreductive surgery. [ABSTRACT FROM AUTHOR]

Simple Summary: With advances in radiological imaging and its increased use, small nodules are being detected more frequently. Surgical resection is often the final option for diagnosis and treatment; however, small nodules may be too small to be detected during surgery. The lungs are soft, deformable organs that can change shape during respiratory phases and surgical procedures. Thus, surgeons rely on preoperative or intraoperative markings for nodule identification and precise resection. Furthermore, two randomized clinical trials found that sublobar resection could be an alternative treatment for early-stage non-small-cell lung cancer. Therefore, the demand for preoperative or intraoperative marking techniques is increasing, particularly for wedge resection or segmentectomy. In this study, we provide a narrative review of the current status and future perspectives of preoperative and intraoperative markings in thoracic surgery. The widespread implementation of lung cancer screening and thin-slice computed tomography (CT) has led to the more frequent detection of small nodules, which are commonly referred to thoracic surgeons. Surgical resection is the final diagnostic and treatment option for such nodules; however, surgeons must perform preoperative or intraoperative markings for the identification of such nodules and their precise resection. Historically, hook-wire marking has been performed more frequently worldwide; however, lethal complications, such as air embolism, have been reported. Therefore, several surgeons have recently attempted to develop novel preoperative and intraoperative markers. For example, transbronchial markings, such as virtual-assisted lung mapping and intraoperative markings using cone-beam computed tomography, have been developed. This review explores various marking methods that have been practically applied for a better understanding of preoperative and intraoperative markings in thoracic surgery. Recently, several attempts have been made to perform intraoperative molecular imaging and dynamic virtual three-dimensional computed tomography for the localization, diagnosis, and margin assessment of small nodules. In this narrative review, the current status and future perspectives of preoperative and intraoperative markings in thoracic surgery are examined for a better understanding of these techniques. [ABSTRACT FROM AUTHOR]

Objective: Uterine-sparing surgery for pelvic organ prolapse (POP) repair has shown good results, but the potential negative implications of leaving the uterus in place are yet to be fully defined. We aimed to assess the risk of unanticipated abnormal gynecological pathology at the time of reconstructive pelvic surgery. Methods: A retrospective consecutive case series including women who underwent vaginal hysterectomy for POP repair at a tertiary medical center in 2006–2020. All patients were offered a free Pap smear test at the age of 65 years as part of a national screening program. Transvaginal ultrasound was routinely performed preoperatively. Standard 3 pedicle hysterectomy was performed with/without bilateral salpingo-oophorectomy (BSO). Results: The study comprised 462 women of mean age 63 ± 9.3 years without previous known malignant or premalignant pathology. Benign pathology was observed in 286 patients (61.9%). Endometrial malignancy was found in three patients (0.7%) and significant premalignant pathology in 15 patients (3.2%), including cervical intraepithelial neoplasia stage 2–3 in seven patients (1.5%) and complex hyperplasia with atypia in eight patients (1.7%). All these pathologies were found in postmenopausal women. None had preoperative clinical symptoms or endometrial thickness of ≥5 mm on preoperative ultrasound. In the 35 patients after BSO, adnexal findings were normal (77.2%) or benign (22.8%). Conclusions: Premenopausal women with uterovaginal prolapse and normal preoperative evaluation have a minimal risk of significant abnormal uterine pathology. In postmenopausal women, the risk of unanticipated malignant uterine pathology is 0.7% and 3.2% for significant premalignancy. [ABSTRACT FROM AUTHOR]

Background: Many previous studies reported that mobility did not recover to the preoperative level even several months after total knee arthroplasty (TKA). However, recent studies indicate that the time required for recovery may have been shortened. The correct information regarding the mobility improvement is very helpful in assessing a patients' progress in rehabilitation. Therefore, we evaluated the mobility early after TKA. Materials and Methods: One hundred seventy patients participated. We measured gait speed and the Timed Up and Go test (TUG) as mobility at pre-operatively and post-operatively at one, two, and three weeks. Results: Gait speed at 1 and 2 weeks after TKA was significantly lower than the preoperative value, but no significant difference was observed at 3 weeks. TUG at 1 week after surgery was significantly slower than the preoperative value, but no difference at 2 weeks, and faster than the preoperative value at 3 weeks. Approximately half of the patients (gait speed, 50%; TUG, 55%) demonstrated improvements exceeding their preoperative values. Conclusions: Our findings suggest that achieving preoperative mobility within 3 weeks after TKA may serve as a target for assessing early postoperative recovery progress. [ABSTRACT FROM AUTHOR]

Background: Ureteral injury occurs in 0.3–1.5% of colorectal cancer surgeries. Devices to visualize the ureteral course and avoid ureteral injury are required for minimally invasive surgery (MIS). The NIRC™ fluorescent ureteral catheter (FUC) is a versatile ureteral visualization device currently available in Japan that can be used in combination with a variety of laparoscopic and robotic systems. In this study, we examined the outcomes of high-risk patients who underwent colorectal cancer surgery with FUC insertion. Methods: One hundred forty-one patients who underwent MIS for colorectal cancer and colorectal cancer recurrence at our institute between January 2021 and May 2024 underwent preoperative FUC insertion because of the high risk of ureteral injury and surgical difficulty. For these patients, patient background data and short-term outcomes were examined. The results are expressed as the median and interquartile range. Results: Age, 70 [60–78]; M:F(n), 84:57; BMI, 22.1 [19.7–24.7]; T4 (TNM classification), 52 cases (36.9%); preoperative intestinal obstruction, 45 cases (31.9%); abscess formation, 30 cases (21%); surgical history, 70 cases (50%); recurrent cancer, 14 cases (9.9%); preoperative chemo-radiotherapy, 28 cases (19.9%); time required for FUC insertion, 12 [9–19] minutes; operation time, 412 [309–552] minutes; blood loss, 10 [5–30] ml; open conversion, 0 cases; postoperative hospitalization, 12 [9–17.5]; circumferential resection margins < 1 mm (rectal surgery), 4/87 cases (4.6%); comorbidities, 0 ureteral injury, 1 urethral injury during FUC insertion (0.7%) and 16 CD Grade 3 or higher cases (11%). Conclusions: FUC may improve the safety of MIS and reduce blood loss in addition to preventing ureteral injury and is expected to have oncological advantages for ensuring the margin of the tumor without fear of ureteral injury. However, the time required for and complications associated with FUC are challenging. New methods for less invasive and easier ureteral visualization may be needed. [ABSTRACT FROM AUTHOR]

A study published in the British Journal of Surgery found that there is widespread non-adherence to guidelines for the surgical management of diabetes-related foot complications. The study examined the practices and outcomes of diabetic foot surgery and found that overall compliance with recommended practices was moderate. The study suggests that the complexity of the guidelines and the low certainty of evidence may contribute to the deviation from recommended practices. The authors emphasize the need to improve guideline adherence and conduct further research to strengthen the evidence supporting international guidelines for diabetic foot management. [Extracted from the article]

Background: To evaluate the safety and efficacy of percutaneous biopsy and microwave ablation (B + MWA) in patients with pulmonary nodules (PNs) who are receiving antithrombotic therapy by rivaroxaban as bridging therapy. Methods: The study comprised 187 patients with PNs who underwent 187 B + MWA sessions from January 1, 2020, to December 31, 2021. The enrolled patients were divided into two groups: Group A, who received antithrombotic therapy five days before the procedure and received rivaroxaban as a bridging drug during hospitalization, and group B, who had no antithrombotic treatment. Information about the technical success rate, positive biopsy rate, complete ablative rate, and major complications were collected and analyzed. Results: Group A comprised 53 patients and group B comprised 134 patients. The technical success rate was 100% in both groups. The positive biopsy rates were 88.68% and 91.04%, respectively (p = 0.6211, X2 = 0.2443). In groups A and B, the complete ablative rates at 6, 12, and 24 months were 100.0% versus 99.25%, 96.23% versus 96.27%, and 88.68% versus 89.55%, respectively. There were no significant differences in bleeding and thrombotic complications between the two groups. No grade 5 complications occurred. Conclusions: It is generally considered safe and effective that patients who are on antithrombotic therapy by rivaroxaban as bridging to undergo B + MWA for treating PNs. [ABSTRACT FROM AUTHOR]

Background: Endometriosis of the distal segment of the uterosacral ligament may lead to a displaced ureter in the surgical field and must be identified before safe disease excision can be carried out. The aim of this study is to investigate the benefit of the systematic use of preoperative intraureteral indocyanine green (ICG) fluorescence injection in patients undergoing endometriosis surgery. Method: In this proof-of-concept, monocentric, observational, cohort study data were prospectively collected and retrospectively analyzed. Patients underwent laparoscopic surgery for deep infiltrating endometriosis with suspected ureteral involvement between January 2022 and December 2023. Using the propensity score matching (PSM) in a 1:1 matching ratio, patients who underwent preoperative ICG injection were compared with those who did not in terms of ureterolysis length and duration, and operative time. Results: The mean length of ureterolysis was shorter in the ICG group compared to the non-ICG group (p < 0.001). The ICG group also had shorter ureterolysis duration (p < 0.001) and operative time (p = 0.02). No complications were reported at mean 6.8-month follow-up visit. Conclusions: The systematic use of intraureteral ICG prior to uterosacral ligaments endometriosis surgery may be safe and could assist in reducing the length of ureterolysis and operative time. Larger prospective studies are needed to confirm our findings. [ABSTRACT FROM AUTHOR]