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Isolated limb perfusion (ILP) is a well-established surgical procedure for the administration of high dose chemotherapy to a limb for the treatment of advanced extremity malignancy. Although the technique of ILP was first described over 60 years ago, ILP is utilised in relatively few specialist centres, co-located with tertiary or quaternary cancer centres. The combination of high dose cytotoxic chemotherapy and the cytokine tumour necrosis factor alpha (TNFα), mandates leakage monitoring to prevent potentially serious systemic toxicity. Since the procedure is performed at relatively few specialist centres, an ILP working group was formed with the aim of producing technical consensus guidelines for the procedure to streamline practice and to provide guidance for new centres commencing the technique. Between October 2021 and October 2023 a series of face to face online and hybrid meetings were held in which a modified Delphi process was used to develop a unified consensus document. After each meeting the document was modified and recirculated and then rediscussed at subsequent meeting until a greater than 90% consensus was achieved in all recommendations. The completed consensus document comprised 23 topics in which greater than 90% consensus was achieved, with 83% of recommendations having 100% consensus across all members of the working group. The consensus recommendations covered all areas of the surgical procedure including pre-operative assessment, drug dosing and administration, perfusion parameters, hyperthermia, leakage monitoring and theatre logistics, practical surgical strategies and also post-operative care, response evaluation and staff training. We present the first joint expert-based consensus statement with respect to the technical aspects of ILP that can serve as a reference point for both existing and new centres in providing ILP. [ABSTRACT FROM AUTHOR]

Abstract: This paper provides a summary of the 49 trauma and related papers published in British Journal of Oral and Maxillofacial Surgery during the period January 2008 to December 2009. 16/49 (32%) of these publications were full length articles, which covered areas such as epidemiology, service provision, materials and operative surgery. In addition there were other articles including short communications, technical notes, letters to the editor and interesting cases. Whilst fewer full length articles were published compared to the other sub-specialties, it was reassuring to see that the studies represent all aspects of trauma. More basic science and randomized control studies relating to trauma need to be encouraged. [ABSTRACT FROM AUTHOR]

Abstract: This paper provides a review of articles relating to deformity, orthognathic surgery, and distraction osteogenesis published in the British Journal of Oral and Maxillofacial Surgery during 2008 and 2009. A total of 42 papers (26 full length articles, 5 technical notes, and 11 short communications or letters to the editor) were published. It was pleasing that 62% were full length articles; this is encouraging as such papers have a high educational value and are likely to be cited in future publications. [Copyright &y& Elsevier]

Abstract: Background: Highly comminuted intra-articular fractures are complex and difficult injuries to treat. Once emergent care is rendered, the definitive treatment objective is to restore the original anatomy while minimizing surgically induced trauma. Operations that use limited or percutaneous approaches help preserve tissue vitality, but reduced visibility makes reconstruction more difficult. A pre-operative plan of how comminuted fragments would best be re-positioned to restore anatomy helps in executing a successful reduction. Methods: In this study, the methods for virtually reconstructing a tibial plafond fracture were developed and applied to clinical cases. Building upon previous benchtop work, novel image analysis techniques and puzzle solving algorithms were developed for clinical application. Specialty image analysis tools were used to segment the fracture fragment geometries from CT data. The original anatomy was then restored by matching fragment native (periosteal and subchondral) bone surfaces to an intact template, generated from the uninjured contralateral limb. Findings: Virtual reconstructions obtained for ten tibial plafond fracture cases had average alignment errors of 0.39 (0.5 standard deviation) mm. In addition to precise reduction planning, 3D puzzle solutions can help identify articular deformities and bone loss. Interpretation: The results from this study indicate that 3D puzzle solving provides a powerful new tool for planning the surgical reconstruction of comminuted articular fractures. [Copyright &y& Elsevier]

To promote global equity in research, innovation, and care, sharing knowledge and grasping current benchmarks is crucial. Despite LIC/LMIC constituting around 80% of the global population, their contribution to neurosurgery research is less than 5%. This study aims to assess the status of neurosurgical oncology in LIC/LMIC using published data, offering strategic insights for progress. Conducting a retrospective bibliometric analysis via PubMed and Scopus databases, we documented reports published (2015–2021) by neurosurgical department-affiliated investigators in LICs/LMICs. World Bank classifications identified LIC and LMIC. Reviewed papers underwent further scrutiny based on independent and associated keyword lists. Our systematic approach revealed 189 studies from LMIC in 10 neurosurgery journals. Of these, 53% were case reports, with 88% focusing on brain pathologies and 12% on the spine. Intra-axial brain tumors (45.8%), extra-axial/skull base (38.4%), and metastasis (3.68%) were prominent. Among noncase report publications, surgical technique and outcome were common themes. India, Egypt, and Tunisia led in publications, with 94% appearing in journals with an impact factor below 5. No papers originated from LIC. This study reinforces existing findings that data from LMIC inadequately represent their populations, impeding a comprehensive understanding of their neurosurgical oncology landscape. Language barriers and data collection difficulties contribute to this gap. Addressing these challenges could significantly enhance progress in shaping the future of neurosurgical oncology in these regions. [ABSTRACT FROM AUTHOR]

[Display omitted] The majority of surgical training is conducted in real-world operations. High-fidelity surgical simulators may provide a safer environment for surgical training. However, the extent that it reflects real-world operations and surgical ability is often poorly characterized. (1) Assess the validity and fidelity of a surgical simulator; (2) Examine the quantitative relationship between simulation performance and markers of real-world ability; (3) Establish thresholds for surgical expertise, and estimate their external validity and accuracy. A cohort study of surgeons at a British neurosurgical center. Ten early-career "novice" surgeons and 8 board-certified "expert" neurosurgeons. (1) Face and content validity, and visual and haptic fidelity; (2) Construct validity; (3) Predictive and discriminative utility of quantitative performance thresholds. Participants performed unilateral lumbar decompressions on high-fidelity spinal simulators that replicate the bony and soft tissue anatomy along with physiological processes such as bleeding and CSF leaks. Operating times, measured from first surgical action to either self-perceived satisfactory decompression or the end of allocated time, were recorded. The performance was also assessed independently by 2 blinded spinal subspecialist neurosurgeons using OSATS, a validated surgical assessment tool that utilizes 5-point scales on a variety of technical domains to grade the overall technical proficiency. Validity and fidelity were assessed by expert neurosurgeons using quantitative questionnaires. Construct validity was assessed by ordinal regression of simulation performance against real-world surgical grade and portfolio. Thresholds of expert status by simulation performance was established, and their predictive and discriminative utility assessed by crossvalidation accuracy and AUC-ROC. Operating time and expert assessments of simulation performance (OSATS) were strong and significant prdictors of surrogate markers of real-world surgical ability. The thresholds for expert status were operating time of 15 minutes and modified OSATS score of 15/20. These thresholds predicted expert status with 84.2% and 71.4% accuracy respectively. Strong discriminative ability was demonstrated by AUC-ROC of 0.95 and 0.83 respectively. All expert surgeons agreed that RealSpine simulators demonstrate high face validity, and high visual and haptic fidelity, with overall scores showing statistically significant agreement on these items (all scores at least 4/5, p<.0001). There was less consensus on content validity, but with still significant overall agreement (average score: 3.75/5, p=.023). Real-world surgical ability and experience can be accurately predicted by defining objective quantitative thresholds on high-fidelity simulations. The thresholds established here, along with other data presented in this paper, may inform objectives and standards to be established in a spinal surgical training curriculum. [ABSTRACT FROM AUTHOR]

There has been substantial progress in orthognathic surgery over the last 20 years, propelled by developments in 3D technology. These have led to enhanced predictability and precision, and simplified surgical planning. This transformative shift has introduced patient-specific implants (PSI) and cutting guides as viable alternatives to conventional techniques, elevating the overall effectiveness of surgical procedures. Nevertheless, the adoption of such hardware has been linked to the requirement for extensive incisions and approaches, particularly in the maxilla. Addressing this limitation, the current paper introduces an innovative cutting guide design that facilitates a minimally invasive approach to Le Fort I osteotomy. [ABSTRACT FROM AUTHOR]

the aim of this paper, is to propose a new reference line: the Frontozygomatic-Infraorbital Line (FZ-IOL). This reference line can guide the surgical team planning mandibular angle harmonization, based on the patient's skeletal proportion. The Frontozygomatic-Infraorbital Line has been adopted for symmetrization surgery, masculinization surgery, and in unsatisfactory results of previous orthognathic surgery. From March 2021 to December 2022, 3 patients were treated for severe facial asymmetry affecting mainly the lower third of the face. All cases were planned with the reference FZ-IOL. Patients were treated in the same center, at the Orthognathic Surgery Department of the Instituto Portugues da Face, Lisbon, Portugal. The Frontozygomatic-Infraorbital Line is designed virtually using software to reconstruct a 3D image from a digital imaging and communications in medicine (DICOM) file obtained from a cone beam computer tomography (CBCT). , connecting the two orbital rims. Then, a vertical line, the frontozygomatic line perpendicular to the IOL and passing through the outmost lateral portion of the frontozygomatic suture is drawn. The proposed line demonstrated how establishing appropriate reference lines is crucial for the success of the surgery. The selection of reference lines should be based on the patient's anatomy, the symmetrization process's complexity, and the surgery's desired outcome. The Frontozygomatic-Infraorbital Line represents an adequate reference line for managing mandibular angle lateral projection, improving lower third of the face symmetrization. [ABSTRACT FROM AUTHOR]

This study evaluates the clinical outcomes of contemporary total ankle arthroplasty (TAAs) to primarily establish the current benefits and risks to facilitate informed decision making to secondarily establish if improvements are seen between subsequent generations of implants, bearing philosophy, and associated surgical technique. A systematic review and meta-analysis of published data from January 2000 to January 2020 was conducted following PRISMA guidelines. Inclusion criteria: English language papers, adult population, ≥20 ankles with a minimum follow up ≥24 months, pre- and post-operative functional scores available. Ankle implants were characterised by generations, which were determined from the original studies and confirmed based on literature set definitions. A total of 4642 TAAs in 4487 patients from 51 studies were included. The mean age was 61.9-years and follow up 57.8-months. Overall, 10-year survivorship rates were 77.63 %, with mobile bearing designs showing a small but significant advantage. Improved survivorship favoured the most modern implants at both two (p < 0.05), and 10-years (p < 0.01). The relative risk of a complication occurring improved with the evolution of implants e.g., nerve injury, and post-operative complications such as fracture, wound complications (e.g., dehiscence or heamatoma) and radiological abnormalities (e.g., radiolucencies, heterotopic bone formation and aseptic loosening). However, surgical site infection, and intra-operative fracture rates remain implant independent. Modern TAA offers improved survivorship, even with a trend to lower mean implantation age, similar complexity and ever changing indications. It would appear that implant evolution has reduced risks, especially those associated with revision, without affecting functional outcomes. • TAA offers an alternative to fusion for ankle arthritis in carefully selected patients. • TAA's are classified based on generation or type of bearing (fixed/mobile). • We evaluate outcomes – complications & revision rates for informed decision making. [ABSTRACT FROM AUTHOR]

Automatic recognition of surgical phases in surgical videos is a fundamental task in surgical workflow analysis. Previous works on automated recognition of surgical phases utilized popular methods in computer vision but failed to consider the sequential nature of surgical procedures. In this paper, we propose a method that utilizes calibrated confidence scores to dynamically switch between two Transformer-based models, viz., baseline and a separately trained binary classifier model, depending on the calibrated confidence level. Our method outperforms the baseline model on the publicly available Cholec80 dataset and can be readily applied to a variety of phase recognition methods and applications. [ABSTRACT FROM AUTHOR]

To review the literature and report the incidence of vaginal stenosis (VS) after vaginoplasty and compare the incidence rates by surgical technique and follow-up duration. We performed a systematic literature review according to PRISMA guidelines. Original research on primary vaginoplasty was included. Exclusion criteria included non-English studies, mixed cohorts without subgroup analysis, revision vaginoplasty, and papers without stenosis rates. The search was ran in Pubmed, Embase, Scopus, and Cochrane on September 9, 2022. Stenosis rates were compared with descriptive statistics using SPSS. Fifty-nine studies with a cumulative 7338 subjects were included. The overall incidence of VS was 5.83% (range 0%-34.2%). Combining VS with introital stenosis (IS) and contracture results in a cumulative incidence of 9.68%. The rate of VS in the penile inversion vaginoplasty subgroup (PIV) was 5.70%, compared to 0.20% in primary intestinal vaginoplasty. The rate of IS in the PIV group was 3.13% and 4.7% in the intestinal vaginoplasty subgroup. The overall rate of VS was 5.83%, which is lower than previously documented. This may be related to the inclusion of more recent studies and analysis limited to primary vaginoplasty. The similar rate of IS in PIV and intestinal vaginoplasty subgroups may be secondary to multiple suture lines and the need for dilation through this anastomosis. Our research demonstrates a need for a standardized definition of VS. [ABSTRACT FROM AUTHOR]

The paper describes a modification of the surgical technique for temporomandibular joint arthroscopy, using an exchange guide to replace the 2.2 mm cannula with one of 2.9 mm to better facilitate osteoplasty of the medial wall. The procedure is a simple and safe manoeuvre that reduces complications such as fluid extravasation into soft tissues, damage to the articular eminence, and bleeding into the superior joint space. Every oral and maxillofacial surgeon could benefit from this novel method, which reduces the chances of failure when exchanging the working cannulas, the potential morbidity of re-entry, and the duration of surgery. [ABSTRACT FROM AUTHOR]

There are several approaches used for surgical treatment of neurogenic thoracic outlet syndrome (n-TOS). The posterior upper rib excision and decompression technique is a novel technique that was developed and used by the author for the past 8 years. The purpose of this paper is to report clinical outcomes of patients treated with this approach. All patients with n-TOS operated by single surgeon from 2015 to 2023 were retrospectively analyzed. Demographic, clinical, radiologic, surgical, and postoperative data were collected and reported with emphasis on efficacy and complications. The surgical success was evaluated subjectively as excellent, good, fair, poor, and bad. Radiologic data were analyzed to assess the extent of accessory/first rib removal. Eighty procedures were performed in 61 patients with a mean follow-up of 1153 (87-3048) days. The majority (60.7%) of patients were women, with 39.3% being men. In 11 cases (18%) causative factor was bone abnormality. Two patients were previously operated at another centers (3.3%). Total mean subjective improvement rate was 91.5%. More than half (55) of the patients reported "excellent" (>75%) and 6 "good" improvements (50%−75%); no fair, poor, and worse outcomes were reported. Patients reporting "good" outcome had statistically significant shorter follow-ups than the "excellent" group (P < 0.001). Complications included pleural opening, Horner syndrome, and apical hematoma, none of which were permanent. The posterior upper rib excision and decompression approach provides excellent clinical outcomes in patients with n-TOS. It allows better intraoperative visualization and removal of the first rib and full decompression of the neurovascular bundle. [ABSTRACT FROM AUTHOR]

Pancreatic resection for pancreatic ductal adenocarcinoma (PDAC) is one of the most complex procedures in abdominal surgery due to the technical and oncological challenges given by its local aggressive growth. The improvement of new multidrug chemotherapy regimens and surgical techniques has increased the caseload of "borderline resectable" (BR) or even "locally advanced" (LA) PDAC candidates for surgical resection. As a result, the increased heterogeneity of surgical scenarios has made it essential to utilize a tailored surgical strategy for each individual case. Notably, the strategy employed to approach and assess the peripancreatic vessels should be weighted according to tumor's location and the site of suspected vascular infiltration. The aim of this paper is to describe the open surgical approach for "BR" or "LA" PDAC used at our Institution and summarizes a "step-up approach" to manage vascular infiltration. [ABSTRACT FROM AUTHOR]

In this paper, we propose a control framework for intelligent surgical robots under the Remote Center of Motion (RCM). The goal of a surgical robot is to assist surgeons in performing complex surgeries. RCM constraint implies that the surgical tip attached to the end-effector of the surgical robot does not slide away from the point of the incision while performing surgery. Implementation of a control algorithm to comply with RCM constraints is a complicated task because of the nonlinear model of the surgical robots and stringent conditions of accuracy imposed by the patient's safety. This paper proposes an optimization-driven approach to perform the surgical maneuver under RCM constraints. We then applied a bio-inspired optimization algorithm to solve the problem efficiently. For testing the performance of ZNNBAS, we used MATLAB to simulate a surgical procedure. A 7-DOF surgical robot (KUKA LBR IIWA 7) was used as a test bench for running the simulations. The simulation results show that the ZNNBAS is comparable with BAS, PSO, and GA and efficiently and robustly performed the task commanded maneuvers while enforcing the RCM constraints. [ABSTRACT FROM AUTHOR]

Imaging plays a crucial role in the postoperative monitoring of thoracic aortic repairs. With the development of multiple surgical techniques to repair the ascending aorta and aortic arch, it can be a daunting challenge for the radiologist to diagnose potential pathologies in this sea of various techniques, each with their own normal postoperative appearance and potential complications. In this paper, we will provide a comprehensive review of the postoperative imaging in the setting of thoracic aortic repairs, including the role of imaging, components of thoracic aortic repairs, the normal postoperative appearance, and potential complications. • Imaging plays a critical role in the postoperative management of thoracic aorta repairs. • Diverse surgical techniques for thoracic aorta repair can pose challenges for radiologists diagnosing pathologies. • This is a review of postoperative imaging, including the role of imaging, normal postoperative appearance, and complications. [ABSTRACT FROM AUTHOR]

For nearly a century, orthodontists have mainly focused on occlusion as the primary objective of orthodontic therapy. The introduction of the soft tissue paradigm has shifted treatment planning from hard tissue to soft tissue and reinforced the key role of facial esthetics in orthodontic diagnosis and treatment planning. Whereas occlusion is rooted in measurable definitions of Class I and other "keys to occlusion", esthetics is more subjective, based not only on the orthodontist's assessment but also on personal and cultural preferences rather than rigid norms. The aim in this paper is to demonstrate that orthognathic surgery potentially narrows the gap between esthetics and function, even though surgery may have its own limitations. Three reports are presented on patients whose clinical examination, records evaluation and treatment planning have focused on facial and smile esthetics, and treatment approaches that combined orthodontics, orthognathic surgery and appropriate adjunct procedures to enhance the overall esthetic outcome. [ABSTRACT FROM AUTHOR]

The current review paper was written in collaboration with breast cancer surgeons from the European Breast Cancer Research Association of Surgical Trialists (EUBREAST), a breast pathologist from the Danish Breast Cancer Group (DBCG), and representatives from the European SocieTy for Radiotherapy & Oncology (ESTRO) breast cancer course. Herein we summarize the different mastectomies and reconstruction procedures and define high-risk anatomical areas for breast cancer recurrences, to further specify the challenges in the surgical procedure, histopathological evaluation, and target volumes in case of postmastectomy irradiation, as recommended by the ESTRO guidelines according to the surgical procedure. The paper has original figures and illustrations for all disciplines for in-depth understanding of the differences between the procedures. • Mastectomy techniques and reconstruction evolved to improve cosmetic outcomes. • Different techniques maybe associated with different amount of residual breast tissue. • More data is needed to estimate who are the patients at risk for residual disease or recurrence. • Multidisciplinary work needed to individualise treatment for optimal oncological outcomes while maintaining the significant improvements in achieving better cosmesis for these patients. [ABSTRACT FROM AUTHOR]

Percutaneous screw fixation has recently gained popularity as an alternative to conservative treatment to avoid prolonged immobilization. The placement of a screw in the central axis of the scaphoid has been shown to be biomechanically superior to its eccentricity. Still, it poses difficulties in performing percutaneous screw fixation via both palmar and dorsal approaches. We describe a palmar percutaneous screwing of corporal fractures of the scaphoid by a simple palmar transtrapezial approach allowing an optimal centering of the screw. We selected patients operated on by the same surgeon using the palmar transtrapezial approach between January 2015 and January 2019 based on the coding used for these fractures and the operative reports. In addition, pre- and postoperative data were collected from the patient's computer and paper records and by telephone contact with the patients. Thirty-three patients were included. Percutaneous screw fixation of the scaphoid was performed under locoregional anesthesia in the operating room with one arm in the supine position on the arm table. No hyper-extension of the wrist was performed. The Kirchner guidewire passed through the anterior horn of the trapezium and then into the trapezium-scaphoid joint. A screw replaced it after satisfactory centering in the axis of the scaphoid. Management took place on average within 12 days after the trauma. 75.8% were A2 fractures, according to Herbert's classification. The average operating time was 16.63 minutes, and in 91% of the cases, the patient was hospitalized for one day. The variation of the scapholunate angle on the preoperative profile radiographs with the angle defined by the axis of the scaphoid screw and the lunate postoperatively was on average 2.94°. One patient presented nonunion, and four showed an undersized screw with a screw overhang requiring revision surgery. The transtrapezial approach to fixation of acute scaphoid fractures facilitates precise percutaneous screw placement in the central axis of the scaphoid. A study of long-term complications, including the degenerative impact on the scaphotrapezial joint, is needed to assess the safety of passage through the anterior horn of the trapezium. [ABSTRACT FROM AUTHOR]

Minimally invasive techniques in spine surgery have continued to advance as robotic technology has evolved over several generations. Although traditional techniques for placing pedicle screws are still widespread in practice, newer technology has increased the reliability of accurately placing instrumentation with smaller incisions and subsequent decreased length of stay. Additionally, advancements in planning software have improved the ability to align posterior instrumentation to assist with rod placement on multilevel constructs. This paper describes the surgical techniques and operative workflow for placing pedicle screws with the latest robotic technology. The robotic platform, registration, surgical planning, and placement of instrumentation are discussed in detail. Advantages of the Mazor X Stealth Edition compared with the previous generation robot include obviating the need for K wires and eliminating the need for a percutaneous pin, as navigation is integrated into the robot. Our use of this new technology has been encouraging. Using the techniques described in this paper, the first 90 pedicle screws placed with the Mazor X Stealth Edition robot yielded 100% grade A accuracy on the Gertzbein-Robbins scale confirmed on immediate postoperative CT. There were no complications experienced in any case. In our experience, this robotic technology has the potential to improve patient outcomes and is associated with advanced surgical planning compared with more traditional techniques. [ABSTRACT FROM AUTHOR]

This systematic review was undertaken to define and summarize existing, proposed quality performance indicators (QPI) for hepato-pancreatico-biliary (HPB) procedures. A systematic literature review identified studies reporting on quality indicators for cholecystectomy, hepatectomy, pancreatectomy and complex biliary surgical procedures. The databases searched were MEDLINE, EMBASE, PubMed, and SCOPUS, with all literature available until the search date of 1 May 2020 included. The reference lists of all included papers, as well as related review articles, were manually searched to identify further relevant studies. Forty-five publications report quality indicators for pancreatectomy (n = 22), hepatectomy (n = 7), HPB resections in general (n = 12), and cholecystectomy (n = 6). No publications proposed QPI for complex biliary surgery. The 45 papers used national audit (n = 18), consensus methodology (n = 5), state-wide audit (n = 3), unit audit (n = 9), review methodology (n = 9), and survey methodology (n = 1). Sixty-one QPI were reported for pancreatectomy, 22 reported for hepatectomy, and 14 reported for HPB resections in general, in domains of infrastructure, provider, and documentation. Fourteen infrastructure and provider-based QPI were reported for cholecystectomy. There are few internationally agreed QPI for HPB procedures that allow global comparison of provider performance and that set aspirational goals for patient care and experience. [ABSTRACT FROM AUTHOR]

Online surgical phase recognition plays a significant role towards building contextual tools that could quantify performance and oversee the execution of surgical workflows. Current approaches are limited since they train spatial feature extractors using frame-level supervision that could lead to incorrect predictions due to similar frames appearing at different phases, and poorly fuse local and global features due to computational constraints which can affect the analysis of long videos commonly encountered in surgical interventions. In this paper, we present a two-stage method, called Long Video Transformer (LoViT), emphasizing the development of a temporally-rich spatial feature extractor and a phase transition map. The temporally-rich spatial feature extractor is designed to capture critical temporal information within the surgical video frames. The phase transition map provides essential insights into the dynamic transitions between different surgical phases. LoViT combines these innovations with a multiscale temporal aggregator consisting of two cascaded L-Trans modules based on self-attention, followed by a G-Informer module based on ProbSparse self-attention for processing global temporal information. The multi-scale temporal head then leverages the temporally-rich spatial features and phase transition map to classify surgical phases using phase transition-aware supervision. Our approach outperforms state-of-the-art methods on the Cholec80 and AutoLaparo datasets consistently. Compared to Trans-SVNet, LoViT achieves a 2.4 pp (percentage point) improvement in video-level accuracy on Cholec80 and a 3.1 pp improvement on AutoLaparo. Our results demonstrate the effectiveness of our approach in achieving state-of-the-art performance of surgical phase recognition on two datasets of different surgical procedures and temporal sequencing characteristics. The project page is available at https://github.com/MRUIL/LoViT. • A temporally-rich spatial feature extractor to extract spatial feature. • Multi-scale temporal feature aggregation of local and global relationships. • A phase transition-aware supervision for highlighting phase transitions. [ABSTRACT FROM AUTHOR]

The ESPA Pain Management Ladder Initiative is a clinical practice advisory based upon expert consensus supported by the current literature to help ensure a basic standard of perioperative pain management for all children. In 2018 the perioperative pain management of six common pediatric surgical procedures was summarised. The current Pain Management Ladder recommendations focus on five more complex pediatric surgical procedures and suggest basic, intermediate, and advanced pain management methods. The aim of this paper is to encourage best possible pain management practice and to support institutions to create their own pain management concepts according to their financial and human resources due to the diversity of clinical settings in Europe. Furthermore, the authors underline that these recommendations are intended for inpatients only. [ABSTRACT FROM AUTHOR]

Submental intubation is a low-risk alternative to tracheostomy when nasotracheal or orotracheal intubation is not appropriate. To improve the selection of patients and clinical outcomes we have explored published papers on submental intubation in oral and maxillofacial surgery, and included a proposal for a decision pathway. Systematic searches of PubMed, Scopus, and Cochrane databases for papers published between 1986 and 2018 yielded 116 eligible articles (one randomised controlled trial, 61 case series, 40 case reports, six surgical techniques, and eight letters) that included 2 229 patients. Measured outcomes were the indications, techniques, devices used, time taken to complete the procedure, and complications. Indications were trauma (81%), orthognathic surgery (15%), disease (2%), and cosmetic surgery (1%). Technical preferences were for a one-tube (84%) over a two-tube technique (6%), and a paramedian (52%) over a median incision (33%). The preferred device was a reinforced endotracheal tube (85%). The mean (range) intubation time was 10 (2–37) minutes. The complication rate was 7% (n = 152), the most common being superficial skin infection (n = 54), hypertrophic scarring (n = 18), and damage to the tube apparatus (n = 15). Submental intubation has minimal complications, takes a short time to do, and it is a useful alternative to tracheostomy in some oral and maxillofacial operations. More robust evidence regarding the selection of patients, modifications to the technique, and a comparison of risk with that of tracheostomy, are needed for further evaluation of its feasibility. [ABSTRACT FROM AUTHOR]

Panoramic radiography is the standard imaging method for preoperative assessment before lower third molar removal. However, oral surgeons have been using cone beam computed tomography (CBCT) as an additional tool to assess detailed preoperative data, as it provides cross-sectional images. The aim of this systematic review was to determine whether the use of CBCT and the additional information provided modifies the preoperative assessment of lower third molar removal when compared to panoramic radiography and consequently results in a different surgical approach. A search of the PubMed, Embase, Web of Science, Science Direct, and Scopus electronic databases was performed on 30 June 2018, which retrieved 196 records without duplicates. The grey literature was also searched to include any other paper that might meet the eligibility criteria, which resulted in an additional five records. Among these papers, five met all of the eligibility criteria. These five studies included a total of 289 individuals and a total sample of 311 teeth. The findings showed that three-dimensional imaging does not change the surgical approach when compared to panoramic radiography; however it is considered a useful imaging method to understand the relationship between the lower third molars and the mandibular canal. [ABSTRACT FROM AUTHOR]

As training in microvascular surgery often involves the use of live animals, it is important that such a practice is regularly revisited and justified, particularly in the context of emerging training strategies such as virtual simulation. This systematic review was therefore designed to assess the ongoing need for their use over other methods. A search of PubMed and MEDLINE using the major MeSH terms: anastomosis, surgical vascular procedures, microsurgery, and training, yielded 1386 titles from which 153 abstracts were read, 70 papers analysed, and 17 included. Nine of these papers were randomised studies that compared different methods of training. Other publications were included if the use of live animals was assessed or commented upon, or both (8 publications). Only one study randomised trainees to a non-living animal model or a living model, with detailed assessment that included clinical transfer to live surgery. It showed no significant difference in the quality of training, and excellent techniques of assessment. There was much discussion on the advantage of regular training and opportunities to practise without tuition, but there was no clear advantage for the use of live animals. Our review emphasises the lack of evidence regarding the need for live animals in the training of microsurgical or microvascular skills. Although the assumption remains that the use of live rats is essential, there is a clear need for a high-quality, comparative study to justify the continued use of such models given the quality of the alternatives now available. [ABSTRACT FROM AUTHOR]

Highligths • Strategy envisaging a virtual/mock surgery on a CAD/AM model of the patient cranium. • Additive Manufacturing based intervention simulation. • Additive Manufacturing based design of implants. • Complex craniofacial defects corrected using a single-step intervention. Abstract Background and objective The purpose of the present paper is to pave the road to the systematic optimization of complex craniofacial surgical intervention and to validate a design methodology for the virtual surgery and the fabrication of cranium vault custom plates. Recent advances in the field of medical imaging, image processing and additive manufacturing (AM) have led to new insights in several medical applications. The engineered combination of medical actions and 3D processing steps, foster the optimization of the intervention in terms of operative time and number of sessions needed. Complex craniofacial surgical intervention, such as for instance severe hypertelorism accompanied by skull holes, traditionally requires a first surgery to correctly "resize" the patient cranium and a second surgical session to implant a customized 3D printed prosthesis. Between the two surgical interventions, medical imaging needs to be carried out to aid the design the skull plate. Instead, this paper proposes a CAD/AM-based one-in-all design methodology allowing the surgeons to perform, in a single surgical intervention, both skull correction and implantation. Methods A strategy envisaging a virtual/mock surgery on a CAD/AM model of the patient cranium so as to plan the surgery and to design the final shape of the cranium plaque is proposed. The procedure relies on patient imaging, 3D geometry reconstruction of the defective skull, virtual planning and mock surgery to determine the hypothetical anatomic 3D model and, finally, to skull plate design and 3D printing. Results The methodology has been tested on a complex case study. Results demonstrate the feasibility of the proposed approach and a consistent reduction of time and overall cost of the surgery, not to mention the huge benefits on the patient that is subjected to a single surgical operation. Conclusions Despite a number of AM-based methodologies have been proposed for designing cranial implants or to correct orbital hypertelorism, to the best of the authors' knowledge, the present work is the first to simultaneously treat osteotomy and titanium cranium plaque. [ABSTRACT FROM AUTHOR]

Closure of a wide-spaced multi-hole secundum atrial septal defect (MHASD) using a single occluder is difficult to accomplish. Multiple occluder implantation has risks such as incomplete endothelialisation, device embolisation, and residual shunt. Blade or balloon septotomy enables single device occlusion; however, the aforementioned may cause a short circumferential rim with subsequent device instability. This paper describes an inter-defect septal puncture technique for single device closure of different layouts of wide-spaced MHASDs via per-atrial or percutaneous approach under exclusive transoesophageal echocardiographic guidance. This technique combined with anti-tenting puncture equally befits a small caval atrial septal defect and MHASD with a floppy aneurysmal septum. [ABSTRACT FROM AUTHOR]

Upper limb amputation is a widespread problem worldwide, leading to massive loss of functionality for the victims. While a few solutions exist, these are often very expensive and involve expensive and dangerous surgical procedures. In this paper, we propose a low-cost, highly functional upper limb prosthesis controlled via Electroencephalogram (EEG) signals captured in real-time, classified into upper limb motion intention using a novel Genetic Algorithm (GA) optimized Long Short-Term Memory (LSTM) deep learning model to rehabilitate amputees. The proposed 3D-printed prosthetic arm has 3 Degrees-of-Freedom (DOF), which allows it to perform complex movements that can accurately emulate an actual human arm. The results discussed later in this paper conclude that our approach, while being low-cost, is highly accurate and functional. [ABSTRACT FROM AUTHOR]

Persistence of the left superior vena cava is often an incidental finding during cardiac surgical procedures. In minimally invasive valvular surgery, it may jeopardise venous drainage and myocardial protection. This How-To-Do-It paper describes the cannulation strategy in a case of minimally invasive mitral surgery in a patient with persistence of the left superior vena cava and absence of the anonymous vein detected with preoperative multimodality imaging. [ABSTRACT FROM AUTHOR]

The removal of lower third molar teeth is one of the most common surgical procedures performed worldwide, but many concepts in this surgery have been unclear and have engendered different opinions. This paper aims to review current thinking in certain pertinent aspects of this surgery to update the reader on the most current research and synthesise it to make clinical recommendations. Topics covered include preoperative imaging, timing of removal, flap design, lingual retraction, coronectomy, lingual split, closure techniques, and use of antibiotics, steroids, and drains. [ABSTRACT FROM AUTHOR]

Laparoscopic surgery techniques are complex and impose postural and communication constraints on the surgeon that may affect surgery outcomes. This paper explores the possibilities of designing intraoperative AR interfaces for laparoscopy surgery. We suggest that the laparoscopic video be displayed on an AR headset and that surgeons consult preoperative image data on that display. Interaction with these elements is necessary. Thus, we propose a head-gaze and hand clicker approach that is effective and minimalist, as well as the implementation of a prototype. We conduct a user study to evaluate the prototype and to comprehend the impact and improvements that headgaze average filtering and the scale method can bring to perform annotations in the laparoscopy video feed on a virtual monitor positioned straight in front of the user. The user experiment was performed in a between-subject protocol with 32 volunteers from the Institute of Informatics, and the proposed task involves communication in the interface through drawing annotations with proposed interaction approaches: A hand device for input confirmations and the head-gaze stabilization methods to pointing and selection. The study found that the users were confident about their performance and demonstrated low physical and temporal demand. The proposed head-gaze methods showed that independent of the stabilization applied, the difference between the error sensibility of the axis of the head-gaze in annotation positioning is significant. The vertical axis presented a higher error rate than the horizontal axis. When we compared other variables, we found some differences in specific circumstances, but overall, the interaction with HL1 is very distributed. [Display omitted] • Laparoscopy imposes posture strain and poor preoperative data access to surgeons. • AR technology may solve these issues if an appropriate interaction is available. • We propose an AR UI with panels to see lap-video and preoperative images. • Interaction is centered on head gaze pointing and a ring under the surgical glove. • An experiment with 32 users characterizes usability and user experience with our UI. [ABSTRACT FROM AUTHOR]

The literature (2012-4) describing experimental pig surgery was reviewed to estimate the extent to which neuromuscular block (NMB) is used, to examine methods for ensuring unconsciousness, and to identify the rationale for use of NMB and establish the anaesthetist's training. In the first stage of a two-stage review, NMB use was estimated using Web of Knowledge to identify articles describing NMB during pig surgeries. In the second stage, PubMed and Google Scholar were used to increase the number of articles for determining measures taken to prevent accidental awareness during general anaesthesia (AAGA). The corresponding authors of screened articles were emailed four times to establish the reason for using NMB and the anaesthetists' backgrounds (medical, veterinary, or technical). The first search revealed NMB use in 80 of 411 (20%) studies. Of the 153 articles analysed in the second stage, two described strategies to reduce AAGA. Some (6%) papers did not provide information on anaesthetic doses; citations supporting anaesthetic efficacy were found in only 13. Five of 69 papers using inhalation agents measured end-tidal anaesthetic concentrations based on human, not porcine, minimal alveolar concentrations. The methods in 13% of articles reporting anaesthetic depth assessment were incomplete or questionable, or both; four described using somatic motor reflexes. Corresponding authors of 121 articles reported that the principal reason for NMB was improved 'surgical visualization' (26%). Medical or veterinary anaesthetists supervised anaesthesia in 70% of studies; non-anaesthetists provided NMB, unsupervised, in 23. Nine respondents prioritized experimental expediency over pig welfare. In laboratory pig studies, AAGA may be prevalent; reported details of its attempted prevention are woefully inadequate. [ABSTRACT FROM AUTHOR]

Surgical site infections are a complication of oral and maxillofacial procedures, with the potential for significant morbidity and mortality. Use of preoperative, perioperative, and postoperative antibiotic prophylaxis to reduce the incidence of surgical site infections must be balanced with considerations of a patients' risk of antibiotic-related adverse events. This review aimed to provide evidence-based recommendations for antibiotic prophylaxis. Searches were conducted using MEDLINE, the Cochrane Library, EMBASE, and PUBMED for maxillofacial procedures including: treatment of dental abscesses, extractions, implants, trauma, temporomandibular joints, orthognathics, malignant and benign tumour removal, and bone grafting, limited to articles published since 2000. A total of 98 out of 280 retrieved papers were included in the final analysis. Systematic reviews were assessed using AMSTAR criteria. Randomised controlled trials were assessed for bias using Cochrane Collaborative tools. The overall quality of evidence was assessed using GRADE. Prophylactic antibiotic use is recommended in surgical extractions of third molars, comminuted mandibular fractures, temporomandibular joint replacements, clean-contaminated tumour removal, and complex implants. Prophylactic antibiotic use is not routinely recommended in fractures of the upper or midface facial thirds. Further research is required to provide recommendations in orthognathic, cleft lip, palate, temporomandibular joint surgery, and maxillofacial surgical procedures in medically-compromised patients. [ABSTRACT FROM AUTHOR]

Background: The aim of this paper is to analyze the effectiveness of corticosteroid injections (CI), in combination with or without a local anaesthetic, for Civinini-Morton's Syndrome to determine which protocol could be the most appropriate among conservative treatments.Methods: All selected articles were screened using a thorough database search of PubMed, EMBASE and SCOPUS to assess their suitability to the research focus.Results: Selection produced 10 articles as full-text, for a total of 590 patients, with a mean follow-up of 14 ± 14.2 (range 3-48) months. Johnson satisfaction scale, resulting from 6 studies, scored 25.6% (range 5-38) and 39.4% (range 15-51.8), respectively completely satisfied and satisfied with minor reservations. Mean VAS, declared in 5 studies, decreased from 70.7 ± 16.5 (range 67-89) to 33.4 ± 7.6 (26-42.5) points (p < 0.01). Most common complication was skin depigmentation in 7 (2.6%) cases.Conclusions: CI appear to be a safe treatment allowing good results with a very low complications rate. A neuroma of 6.3 mm seems to be the cut-off size; below which CI could have best indications and be considered as an intermediate treatment between shoe modifications and more invasive procedures such as percutaneous alcoholization or surgery.Level Of Evidence: Level II, systematic review. [ABSTRACT FROM AUTHOR]

Although it has been clearly stated that vaginal dilation must be considered the first-line treatment for clinical conditions characterized by an absent or hypoplastic vagina, mainly Mayer-Rokitansky-Küster-Hauser (MRKH) syndrome, a great number of scientific papers on surgical vaginal reconstructions are reported every year. This wide variety of surgical techniques (more than 10) are recognized and performed worldwide, making it difficult to compare results and define an evidence-based approach. Standardized treatment should be considered even more important in the pediatric and adolescent population for the implications offered by the uterus transplantation scenario. [ABSTRACT FROM AUTHOR]

Background The aim of this paper is to assess the current state of quality and outcomes measures being reported for hepatic resections in the recent literature. Methods Medline and PubMed databases were searched for English language articles published between 1 January 2002 and 30 April 2013. Two examiners reviewed each article and relevant citations for appropriateness of inclusion, which excluded papers of liver donor hepatic resections, repeat hepatectomies or meta-analyses. Data were extracted and summarized by two examiners for analysis. Results Fifty-five studies were identified with suitable reporting to assess peri-operative mortality in hepatic resections. In only 35% (19/55) of the studies was the follow-up time explicitly stated, and in 47% (26/55) of studies peri-operative mortality was limited to in-hospital or 30 days. The time period in which complications were captured was not explicitly stated in 19 out of 28 studies. The remaining studies only captured complications within 30 days of the index operation (8/28). There was a paucity of quality literature addressing truly patient-centred outcomes. Conclusion Quality outcomes after a hepatic resection are inconsistently reported in the literature. Quality outcome studies for a hepatectomy should report mortality and morbidity at a minimum of 90 days after surgery. [ABSTRACT FROM AUTHOR]

Objectives: To investigate paediatric nurses’ postoperative pain management practices with the aim of identifying the factors associated with undermanaged paediatric postoperative pain. Design: Systematic search and review. Data sources: PsychInfo, CINAHL, PubMed, EMBASE and hand searching. Review methods: English peer-reviewed quantitative, qualitative, or mixed methods research articles published between 1990 and 2012 exploring registered nurses’ paediatric postoperative pain management practices were included. Articles with a primary focus on nurses’ pain management practices in the neonatal or paediatric intensive care units, recovery room, and/or focused on children with cognitive impairment were excluded. The search terms used were: postoperative pain; nurs*; paediatrics; pediatrics; children; pain assessment; non-pharm*; analges*. Titles and abstracts were used for initial screening. Two researchers conducted data extraction and assessment of rigour for each paper. Results: From the initial 248 citations, 27 studies were included. Most studies were descriptive and examined relationships between personal factors and nurses’ pain management practices. Observational data from four papers added insights beyond that provided in self-report studies. Two articles used experimental designs with vignettes. Data were categorised into four topics: pain assessment; pharmacological practices; nonpharmacological practices; and factors affecting practices. Despite improvements in analgesic administration over the past 20 years, practices remain suboptimal. Children’s behaviour appears to influence nurses’ pain assessment more than validated measures. A significant proportion of children did not have pain scores recorded in the first 24-h postoperatively. Children receive more analgesia when ordered around the clock compared to as required. However, around the clock analgesia prescription did not guarantee administration. Nurses reported using several non-pharmacological strategies routinely but some are not evidence based. Conclusions: The results of this review indicate nurses’ assessment and management of children’s pain is not consistent with published guidelines. Results of studies exploring nurse and child related factors are inconclusive. Research needs to examine the impact of organisational factors on nurses’ pain care practices. Intervention studies are needed to determine the most effective strategies to support and improve nurses’ pain care for children. [ABSTRACT FROM AUTHOR]

Degenerative spine disease is common in athletes and can progress to requiring surgical intervention. Traditional open surgical techniques necessitate prolonged recovery time and time away from play. Newly developed endoscopic surgical techniques may promote faster healing and recovery, and increased return to play. The goal of this paper is to summarize the current evidence in return to play after spine surgery and to present our series of 3 athletes who underwent endoscopic spine surgery. A complete search of all PubMed indexed articles pertaining to spine surgery in athletes was conducted. This was supplemented by a 3-patient case series of our own endoscopic spine experience in athletes. There are no current widely accepted guidelines for return to play after spinal surgery. The best evidence available cites a return to play of 81% at 5.2–8.7 months after traditional open and minimally invasive surgery, and endoscopic surgery produces an average 88% return to play rate at 3 months. Although return to play can vary widely, case-based evidence as well as biomechanical principles support endoscopic spine surgery as a viable surgical modality for the treatment of spinal pathologies in athletes. [ABSTRACT FROM AUTHOR]

Corneal cross-linking (CXL) is a common surgical procedure used to modify corneal biomechanics and stabilize keratoconus progression which is still under discussion. Its side effects, which are mostly related to anatomical unpredictability and stromal exposure, are the reason for the search for new CXL agents. In this work we have quantitatively evaluated the porcine corneal stroma architecture treated with collagen crosslinking agents such as riboflavin solutions and açai extract, using second harmonic generation microscopy. Aimed at evaluating the morphological changes in the corneal stroma after collagen crosslinking under a CXL chemical agent, a tubeness filter based Hessian matrix to obtain a 3D fiber characterization of the SHG images was applied. The results showed a curling effect and shortening of the collagen fibers treated with açai as compared to the control. They also showed a higher degree of clustering of the collagen fibers with larger empty spaces when compared to the other two groups. We believe that studies such as these presented in this paper are a good direct nondestructive and free labeling evaluation technique that allows the observation of morphologic features of corneas treated with new CXL agents. [ABSTRACT FROM AUTHOR]

Cervical disc replacement (CDR) is a motion-preserving surgical procedure for treating patients with degenerative disorders. Numerous reports of first generation CDR "ball-and-socket" articulating devices have shown satisfactory clinical results. As a result, CDR devices have been safely implemented in the surgeon's armamentarium on a global scale. However, only minor design improvements have been made over the last few years, as first generation CDRs devices were based on traditional synovial joint arthroplasty designs. As a consequence, these articulating designs have limited resemblance to the complex kinematic behavior of a natural disc. This has driven the development of deformable viscoelastic CDR devices to better mimic the biomechanical behavior of a natural disc. As a result, several viscoelastic CDR devices have been developed in recent years that vary in terms of materials, design and clinical outcomes. Since these viscoelastic CDR devices are fairly new, their weaknesses and strengths, which are related to their design characteristics, have not been well described. Therefore, this literature review discusses design related advantages and disadvantages of deformable viscoelastic CDR devices. As such, this paper can provide insight for surgeons and engineers on specific design characteristics of several viscoelastic devices and could potentially help to develop and design future implants. Eleven viscoelastic CDR devices were identified. An extensive database search on the devices' tradenames in Medline and PubMed was performed next. The devices were categorized based on common design characteristics to give an overview of both category and device specific complications and advantages. Overall, literature shows that most of these viscoelastic CDR devices can provide motion in all six degrees-of-freedom and have a variable center of rotation. Nevertheless, the viscoelastic materials used do not have an extensive history in orthopedics, so the long-term material behavior in vivo is still unknown. Although the viscoelastic devices have common benefits and risks, each specific design and category also has its own design related advantages and drawbacks that are described in this review. Altogether, viscoelastic total disc replacements seem to be a promising option for the future of cervical arthroplasty, but long-term clinical outcome is needed to confirm the advantages of mimicking the viscoelasticity of a natural disc. [ABSTRACT FROM AUTHOR]

Uncontrolled bleeding has always been a sudden accident, which is the main cause of casualties in war trauma, emergency events and surgical operations. Rapid hemostatic materials can effectively reduce casualties and save lives. In this paper, marine collagen peptide grafted carboxymethyl chitosan (CMCS-MCP) was synthesized by 1-ethyl-(dimethylaminopropyl) carbodiimide (EDC)-mediated coupling reaction. To obtain CMCS-MCP conjugates with different degrees of substitution (DS), the reaction conditions were investigated by single-factor tests and optimized by response surface methodology. And the sponges of CMCS-MCP were prepared by freeze-thaw cycling and freeze-drying and characterized by Fourier transform infrared (FTIR) spectroscopy, scanning electron microscope (SEM), and X-ray diffraction (XRD). To evaluate the hemostatic properties of CMCS-MCP sponges, in vitro and in vivo hemostasis tests were carried out. The results showed that the optimum preparation conditions were the mass ratio of MCP to CMCS (M MCP /M CMCS) 6:1, reaction temperature 41 °C, and reaction time 16 h. And under which the DS of 58.86% was obtained. Structure analysis showed that MCP had been successfully grafted onto the CMCS molecular chain, and the CMCS-MCP sponges were of high porosity. In vitro and in vivo hemostasis tests showed that the CMCS-MCP sponges had significant procoagulant activities, especially the one with high DS of 58.86%. The hemostasis mechanism may be that the synergistic effects of MCP and CMCS accelerated coagulation through multiple approaches. The CMCS-MCP sponges give a new insight into biomedical hemostasis materials. • The synthesis conditions of marine collagen peptide grafted carboxymethyl chitosan (CMCS-MCP) were investigated. • The CMCS-MCP sponges exhibited high porosity and superior water absorption capacity. • The CMCS-MCP sponges showed excellent hemostasis activity in vitro and in vivo. [ABSTRACT FROM AUTHOR]

In this paper, an improved recurrent neural network (RNN) scheme is proposed to perform the trajectory control of redundant robot manipulators using remote center of motion (RCM) constraints. Firstly, learning by demonstration is implemented to model the surgical operation skills in the Cartesian space. After that, considering the kinematic constraints associated with the optimization control of redundant manipulators, we propose a novel RNN-based approach to facilitate accurate task tracking based on the general quadratic performance index, which includes managing the constraints on RCM joint angle, and joint velocity, simultaneously. The results of the conducted theoretical analysis confirm that the RCM constraint has been established successfully, and accordingly. The corresponding end-effector tracking errors asymptotically converge to zero. Finally, demonstration experiments are conducted in a laboratory setup environment using KUKA LWR4+ to validate the effectiveness of the proposed control strategy. [ABSTRACT FROM AUTHOR]

Resection of deep medial frontal and parietal arteriovenous malformations (AVMs) is often challenging due to a tangential angle of attack and deep, narrow working corridor. Adequate visualization of the AVM and its feeding arteries without brain retraction is of particular importance when operating in or near eloquent cortical areas, where brain manipulation could inadvertently result in neurologic deficits. The aim of this paper is to provide a step-by-step description of surgical approach and report our experience with the contralateral transfalcine approach for resection of deep-seated parasagittal AVMs. Contralateral transfalcine resection of deep frontal, parietal, and cingulate gyrus AVMs was performed with the unaffected hemisphere positioned in a gravity-dependent manner in 5 cases. Surgical procedures were video documented, and an illustrative case is presented. All 5 patients had a modified Rankin Scale score of 0 or 1 at the last follow-up. Complete resection of the AVM was achieved in all 5 cases. No permanent major neurologic deficit was observed postoperatively. This approach allowed a superior visualization of arterial feeders, the parenchymal side of the AVM, and an early control of small parenchymal feeders while minimizing retraction of the brain. The contralateral transfalcine approach is a useful technique in the cerebrovascular surgeon's armamentarium for management of deep-seated medial frontal, parietal, and cingulate gyrus AVMs in or around eloquent brain areas, allowing to minimize normal brain retraction and avoid associated neurologic deficits. [ABSTRACT FROM AUTHOR]

Inferior vena cava (IVC) injuries occur in 0.5-5% of cases of penetrating abdominal injury. Uncommonly encountered in general surgical and trauma practice, they remain extremely lethal despite advances in resuscitation and critical care. Important factors determining treatment outcomes are the hemodynamic status of the patient at presentation, the level and extent of injury, and the presence of associated injuries. Operative approaches and techniques for definitive repair are to be tailored to the condition of the patient, type of injury, and available expertise. In a patient with severe hemodynamic compromise, damage control principles take priority to stop bleeding and save life. The most commonly employed strategies are venorrhaphy or ligation. Retro-hepatic and supra-hepatic caval injuries are particularly challenging in terms of exposure and repair, and are associated with high fatality. Endovascular approaches are being used in select cases with success. This paper reviews in detail the epidemiology, injury patterns, management protocols, and outcomes of IVC injuries due to penetrating abdominal trauma. [ABSTRACT FROM AUTHOR]

On 23rd March, the UK Government announced a nationwide lockdown in response to the COVID-19 pandemic, resulting in the unequivocal and absolute cessation of all elective dental treatment. With much conflicting evidence on best practice to deliver safe treatment comprising of emergency dento-alveolar surgery, this paper describes the protocols which were undertaken to successfully set up a novel Urgent Dental Care Centre (UDCC) service within a short timeframe. We present patient data from referral through to treatment for the entire ten-week period of operation. A UDCC was established at Queen Mary's Hospital, Sidcup within 10 days of this announcement. Through an iterative process with minor stakeholders and in collaboration with our Local Dental Committee, a comprehensive urgent dental service was established. Our UDCC received 1,311 referrals within a 10-week period, with 884 patients being accepted for treatment. The majority of treatment delivered in this emergency setting was surgical dento-alveolar procedures (84%). Sixteen per cent of patients attended for trauma, first stage restorative treatment for teeth and postoperative complications. Both aerosol and non-aerosol generating procedures were available to patients. Preventing acute hospital admissions relies on the ability to provide safe dento-alveolar surgery. Our results advocate that our unique UDCC is efficient and provides appropriate patient access and outcomes for those most in need of urgent dental treatment in the face of a pandemic. [ABSTRACT FROM AUTHOR]

Technical notes are known to be a popular method of publishing novel surgical techniques, up-to-date technological advances, and tricks of the trade in oral and maxillofacial surgery (OMFS). The British Journal of Oral and Maxillofacial Surgery (BJOMS) has a dedicated section for such papers, and this article explores the publication of technical notes over the last two years. In addition, comparison is made with previous reviews of technical notes in this journal a decade ago, to explore the progression of diversity and evolving topics of interest to the oral and maxillofacial surgery community. [ABSTRACT FROM AUTHOR]