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Background: Transcatheter implantation of the Edwards Sapien 3 valve (Edwards Lifesciences, Irvine CA) within the bioprosthetic mitral valve (MV) is an established method of treatment in adults. However, it has not been well studied in the pediatric age group. Methods: Transcatheter mitral valve-in-valve implantation was attempted in 4 symptomatic pediatric patients with a dysfunctional MV bioprosthesis implanted at an earlier stage due to severe MV stenosis or regurgitation. We reviewed our experience with MV implantation in this cohort. Results: The mean age and weight of the patients at the time of the procedure were 11.4 years (range: 10-14 years) and 36 kg (range: 31-44 kg), respectively. The transmitral mean gradient dropped from a mean of 19.75 mm Hg (range: 15-22 mm Hg) to a mean of 1 mm Hg (range: 0-3 mm Hg) after the procedure. The mean fluoroscopy time was 55.25 minutes (range: 40-72 minutes), and the mean hospital length of stay was 4 days (range: 3-7 days). The patients’ functional class improved from New York Heart Association class IV to class I during the follow-up period. Conclusions: Transcatheter mitral valve-in-valve implantation can be performed safely for dysfunctional bioprosthetic MVs in the pediatric age group with favorable early and midterm outcomes. This procedure offers a viable alternative in patients who have high surgical risk or are deemed unfit for conventional surgery. However, we still recommend a long-term study of this approach in a large cohort, multicentre study. Résumé: Introduction: L’implantation de la prothèse valvulaire Edwards Sapien 3 (Edwards Lifesciences, Irvine, CA) par cathéter dans la bioprothèse valvulaire mitrale (VM) est une méthode de traitement établie chez les adultes. Toutefois, cette méthode n’a pas fait l’objet d’études approfondies auprès d’enfants. Méthodes: Une tentative d’implantation valvulaire mitrale de type valve-in-valve par cathéter a été réalisée chez quatre enfants symptomatiques qui avaient une bioprothèse VM dysfonctionnelle implantée antérieurement en raison d’une sténose VM ou d’une régurgitation grave. Nous avons passé en revue notre expérience d’implantation VM auprès de cette cohorte. Résultats: L’âge et le poids moyens des patients au moment de l’intervention étaient respectivement de 11,4 ans (étendue : 10-14 ans) et de 36 kg (étendue : 31-44 kg). La moyenne du gradient moyen transmitral a baissé. Elle est passée de 19,75 mmHg (étendue : 15-22 mmHg) à 1 mmHg (étendue : 0-3 mmHg) après l’intervention. La durée moyenne de la fluoroscopie était de 55,25 minutes (étendue : 40-72 minutes), et la durée moyenne du séjour à l'hôpital était de quatre jours (fourchette : 3-7 jours). La classification fonctionnelle des patients selon la New York Heart Association a montré une baisse. Les patients sont passés de la classe IV à la classe I durant la période de suivi. Conclusions: L’implantation valvulaire mitrale de type valve-in-valve par cathéter peut être pratiquée de façon sûre chez les enfants porteurs d’une bioprothèse VM dysfonctionnelle dont les issues à court ou à moyen terme sont favorables. Cette intervention est une alternative viable pour ces patients dont le risque lié à l’intervention chirurgicale est élevé ou considérés inaptes à subir une intervention chirurgicale traditionnelle. Toutefois, nous recommandons encore une étude à long terme sur cette approche, voire une vaste étude multicentrique de cohorte.

Minimally invasive interventional embolization has tremendous advantages over conventional surgery in the treatment of vascular diseases and malignant tumors. Particularly, liquid embolic agents have garnered much attention owing to their properties of deep vascular penetration and full occlusion of vasculature independent of thrombus formation, which relies on the patient's coagulation system. Despite their drawbacks, traditional liquid embolic agents, such as lipiodol, N-butyl-2-cyanoacrylate, and Onyx, have benefited numerous patients. The original liquid embolic agents have been modified and optimized, and novel liquid embolic agents have also been developed using different strategies and mechanisms. This minireview provides a brief overview of liquid embolic agents, including approved and potential ones. Challenges, prospects, and rational design guidelines are also discussed. This review may spark interest in liquid embolic agents and open new avenues for the smart design of improved embolic agents in the development of personalized and precision medicine.

Yunpeng Cui, Xuedong Shi, Chuan Mi, Bing Wang, Yuanxing Pan, Yunfei Lin Department of Orthopaedics, Peking University First Hospital, Beijing, People’s Republic of ChinaCorrespondence: Xuedong ShiDepartment of Orthopedic, Peking University First Hospital, No. 7 Xishiku Street, Xicheng District, Beijing, 100032, People’s Republic of ChinaTel +86 10-83575660Email pku_ortho@163.comBackground: This study aimed to evaluate the perioperative safety and efficacy of minimally invasive tubular surgery for patients with spinal metastasis.Methods: A total of 161 consecutive patients with spinal metastasis between June 2017 and June 2020 were retrospectively reviewed. A total of 36 patients were included in this study, 14 patients underwent minimally invasive tubular surgery (M), and 22 patients underwent conventional surgery (C). T-test and chi-square tests were used to evaluate demographic and perioperative data differences between the two groups.Results: Baseline characteristics did not differ significantly between M and C groups except for the SINS (p=0.002) and preoperative Alb (p=0.026). There was no significant difference in operative time and complications between M and C groups (p< 0.05). The M group had less mean blood loss than the C group (1275 vs 718mL, p=0.045). Blood transfusion was comparable between the two groups (p< 0.05). The mean amount and drainage time were lower than the C group (141 vs 873mL, p< 0.001; 3.1 vs 7.0 days, P< 0.001). The mean postoperative hospitalization of the M group was 8.8 days, which was lower than the C group (11.3 days, p=0.045). Sub-analysis showed that for patients with hyper-vascular tumor, the M group had less mean amount and time of drainage compared with the C group (p< 0.05); for patients with hypo-vascular tumor, the mean blood loss and amount of blood transfusion were also reduced in M group (p< 0.05). The mean blood loss and drainage time of patients with hypo-vascular tumors were less than patients with hyper-vascular tumors in the M group (p< 0.05).Conclusion: In selected cases, minimally invasive tubular surgery is safe and effective for patients with spinal metastasis. Patients with hypo-vascular tumors were more suitable for this technique with less blood loss, fewer blood transfusions, minor drainage, and shorter postoperative hospitalization.Keywords: spinal metastasis, minimally invasive tubular surgery, minimally invasive spine surgery, conventional surgery, tubular retractor, hypo-vascular tumor

Conventional surgery for submandibular gland tumour is total excision of the gland affected by the tumour. Gland-preserving surgery is commonly used for benign tumours arising in the parotid gland but not in the submandibular gland. This study evaluated long-term oncological and functional outcomes after gland-preserving surgery in patients with pleomorphic adenoma of the submandibular gland via the submental approach. This longitudinal study included 105 consecutive patients with submandibular gland pleomorphic adenoma who underwent the gland-preserving surgery combined with the en-bloc resection of tumours via the submental approach. Salivary scintigraphy was performed 6 months after surgery, and ultrasonography was regularly followed. Intraoperative findings, postoperative complications, cosmetic and salivary functions, and tumour recurrence were assessed in these patients. Median tumour size and submental incision length were 2.0 and 3.3 cm, respectively. Median operation time and amount of blood loss were 25 min and 18.5 mL, respectively. None had marginal or lingual nerve paralysis and most patients were satisfied with incision scar and facial contour. The salivary function of the affected gland was equal to that of the unaffected gland. One patient (0.9%) had single nodular recurrence 54 months after surgery and others had no recurrence for follow-up of median 96 months. Pleomorphic adenoma of the submandibular gland can be safely removed by the gland-preserving surgery via the submental approach which has operation time, cosmetic and functional benefits with compromising oncological outcomes.

Objective Ascending aorta stent-grafting (AASG) is a new option that has shown initial promising results. In selected cases, when neither conventional surgery nor transfemoral retrograde approach are feasible, antegrade transapical (TA) access can be performed. The aim of this single-center retrospective study was to evaluate outcomes of patients undergoing AASG through a TA approach. Methods We analyzed all patients undergoing AASG through a TA approach at our institution. Three different devices were used, including Relay Stent-Graft System (Terumo Aortic, UK), Gore Conformable Thoracic Aortic Graft (W. L. Gore & Associates, Inc., USA), and Valiant Thoracic Stent Graft (Medtronic, Ireland). All patients underwent clinical and computed tomographic angiogram (CTA) evaluation before hospital discharge. Results From May 2010 to December 2019, 3 consecutive patients underwent AASG at our institution. Mean age was 69 years. Three different types of endografts were used in 1 patient each. All patients stayed in the intensive care unit for 24 hr and mean hospital stay was 12 days. We did not observe any major adverse event. One patient died of pneumonia 2 months after the procedure and the other 2 patients are alive and in good clinical conditions at a mean follow-up of 56 months. Predischarge CTA showed good anatomic results with no endoleaks in all cases. Conclusions This initial experience shows that AASG is feasible and provides encouraging clinical and anatomic results in selected high-risk patients.

An attempt has been made to briefly describe the origin of Homoeopathy, its advent in India, global acceptance, safety, limitations and evolution of Banerji Protocols. The major focus of the present review is on the role of homoeopathy in palliative and curative care of cancer. The findings from several laboratories and clinical studies suggest that homeopathy might have some beneficial effect in cancer care. In animal models, several homeopathic remedies showed an inhibitory effect on certain tumor development. Some clinical studies of homeopathic remedies combined with conventional care have shown that homeopathic remedies reduce the burden of side effects after conventional surgery, chemo and radiation therapies and thus improve quality of life and in some cases improve survival of cancer patients. However, further comprehensive clinical studies are warranted to confirm these beneficial effects. Considering the low cost, minimal risks, and the potential beneficial effects, the use of homoeopathy might be considered as an additional tool to integrate as complementary alternate medicine (CAM) with allopathic science for cancer care.

Made available in DSpace on 2022-04-29T08:32:48Z (GMT). No. of bitstreams: 0 Previous issue date: 2021-01-01 Purpose: The study aimed to evaluate the outcomes of flapless guided surgery related to surgery, patient, operator, assistant, and advisor, comparing it with conventional surgery performed by undergraduate students who had never placed implants in patients. Materials and Methods: A randomized controlled split-mouth clinical trial was carried out. Ten patients with bilateral mandibular posterior tooth loss received an implant on each side with conventional flap surgery or flapless guided surgery that was performed by undergraduate students. Surgery time, pain, patient satisfaction, quantity of consumed medications, time of procedure, ease of procedure, anxiety, and stress were assessed. Results: Conventional surgery showed statistically significantly inferior results compared with flapless guided surgery in terms of procedure time (56 minutes, 36 seconds ± 8 minutes, 38 seconds vs 30 minutes, 1 second ± 6 minutes, 2 seconds), consumption of analgesic medications (49 tablets vs 15 tablets), intraoperative (1.75 ± 1.56 vs 0.65 ± 0.64) and postoperative pain (4.62 ± 2.17 vs 1.17 ± 0.72), and operator anxiety (4.76 ± 1.66 vs 3.47 ± 1.50), respectively. Conclusion: Flapless guided implant surgeries performed by individuals with no previous clinical experience showed reduced surgery time and delivered better patient-reported outcomes both in the intraoperative and postoperative periods; reduced medication consumption; and showed better results in the operator and assistant perspectives Periodontics and Implantology FAESA Department of Diagnosis and Surgery FOAr/UNESP Department of Clinical Dentistry FAESA Department of Clinical Dentistry FAESA Department of Biologic and Materials Sciences and Prosthodontics University of Michigan School of Dentistry Department of Diagnosis and Surgery FOAr/UNESP Department of Clinical Dentistry FAESA

Background In pancreatic cancer surgery, accurate identification and resection of intrapancreatic residual tumors are quite difficult. We have developed a novel open-typed PET system (called 'OpenPET'), which enables high-resolution PET-guided surgery in real time, and demonstrated that OpenPET-guided surgery with intraperitoneally administered 64Cu-labeled anti-epidermal growth factor receptor antibody cetuximab is useful to detect and resect primary pancreatic cancer. Here, we investigated applicability of OpenPET-guided surgery for unexpected residual intrapancreatic tumors and examined its survival benefit over conventional surgery. Methods A mouse model with large (>1 cm) resectable pancreatic cancer of xPA-1-DC cells expressing red fluorescent protein was used. OpenPET-guided surgery was conducted 24 h after intraperitoneal administration of 64Cu-labeled cetuximab (7.4 MBq/mouse). For comparison, similar surgical procedures were conducted, and conventional tumor resection was attempted using only the naked eye (control). Survival rate after OpenPET-guided surgery was compared to that after control operations. Results Intraoperative OpenPET guidance enabled detection and resection of small residual tumors. Ten residual tumor specimens (3-10 mm in diameter) were intraoperatively isolated with OpenPET guidance (n = 7 mice). All isolated specimens showed tumor RFP signals. No resection of tumor tissue was performed in control group because the tumor could not be clearly detected with the naked eye alone. Mice after OpenPET-guided surgery showed significantly longer survival rates than those in control group. Conclusions OpenPET-guided surgery with 64Cu-labeled-cetuximab enabled intraoperative identification and resection of intrapancreatic small residual tumors. This technology could be useful to prevent tumor residuals during surgery and improve pancreatic cancer survival.

We present the long-term cosmetic results of the video-assisted thyroidectomy (MIVAT) in comparison to the conventional operation. Forty-eight patients (four males, 44 females; mean age 47.4 ± 12.5 years) constituted the video-assisted group (VA-Group). These were compared with 48 patients (10 males, 38 females; mean age 47.4 ± 12.5 years) operated by conventional surgery (C-Group). The patients were selected from all thyroid operations performed between January 2016 and June 2017. Patient Scar Assessment Scale (PSAS) and Observer Scar Assessment Scale (OSAS) were used for the evaluation performed by an independent surgeon. Both scales contained six items scored numerically on a ten-step scale ranging from 1 (normal skin) to 10 (worst result). Moreover, photos of all scars were taken and analyzed by six team surgeons using modified OSAS. The mean follow-up time was 31.7 ± 6.4 months for the MIVAT group and 32.9 ± 4.6 months for the conventional group (p = 0.39). The mean scar length in the VA-Group was 2.6 cm vs. 3.8 cm in the C-Group (p < 0.0001). The total score of PSAS was 9.93 (6–35) for MIVAT and 9.72 (6–29) for conventional thyroidectomy (p = 0.22). The total OSAS score by the independent surgeon showed a better cosmetic outcome for conventional surgery (13.19 vs. 12.33; p = 0.01). The total OSAS score by the six team surgeons did not differ between both groups in five of six ratings; one surgeon favored MIVAT (12.2 vs. 13.6; p = 0.04). This study does not find cosmetic advantages of minimally invasive video-assisted thyroidectomy compared to conventional thyroidectomy.

The current generation of heart surgeons is experiencing growing consternation with the introduction of the so-called disruptive transcatheter procedures, seemingly threatening the stability and even existence of contemporary cardiovascular surgery. We provide a commentary reporting the comparative outcomes of transcatheter therapies and conventional surgery throughout different scenarios and the evolving superiority of the surgical techniques. The upfront conclusion is that surgeons should strive to keep their surgical skills; the downfall of surgery is not anticipated and as revealed, will hold its ground for the foreseeable future.

BACKGROUND Glomus tumors are benign neurovascular neoplasms, most commonly located in the subungual region. These subcutaneous nodules are characterized by intense pain and temperature sensitivity. Although surgical excision is the curative treatment, permanent nail deformity and recurrence are not uncommon after conventional surgery. OBJECTIVE This study evaluated the long-term efficacy of a modified transungual approach with nail preservation for removing subungual glomus tumors. MATERIAL AND METHODS Thirty-nine patients with clinically diagnosed and histopathologically proven glomus tumors treated at a medical center over a 13-year period (2007-2019) were retrospectively evaluated. RESULTS The 39 patients included 28 women and 11 men (ratio, 2.5:1), with a mean age of 48.9 years. Thirty-four tumors were located in the fingers and 5 in the toes. All patients returned to normal activity soon after the surgery. At a mean follow-up of 28.8 months, all were pain free or experienced minimal pain and were satisfied with treatment outcomes. One patient (2.6%) experienced recurrence. No nail deformity was observed. CONCLUSION The transungual approach with nail plate preservation is a novel and effective method for removing subungual glomus tumors with reduced postoperative pain and rapid healing, while preserving or improving the configuration of the nail.

Objective: To determine the difference in outcomes of conventional surgery v/s. interventional methods for peripancreatic collections after acute pancreatitis at Pak Emirates Military Hospital and Combined Military Hospital Rawalpindi. Study Design: Prospective comparative study. Place and Duration of Study: Pak Emirates Military Hospital and Combined Military Hospital Rawalpindi, fromApr 2018 to Mar 2019. Methodology: A prospective study was conducted on 100 patients who underwent either surgical or intervenetional management of peri-pancreatic collections after an episode of acute pancreatitis. Detailed assessments of positive outcomes and all side effects were done immediately post-procedure, at 48 hours, at the time of discharge and two weeks after procedure on all the participants. Results: Out of 100 patients included in the final analysis 78 were male and 22 were female. Mean age of patients in our study who underwent either surgery or intervention for peri-pancreatic collection was 42.41 ± 3.521 years. Mean duration of hospital stay after the surgery was 6.93 ± 4.662 days. Using binary logistic regression we found no statistically significant difference between both approaches in terms of positive outcomes or therapeutic use but presence of infection and readmission in hospital had a strong relationship with conventional surgery (p-value

Aim and objective Report three different solutions in case of XEN-augmented Baerveldt fails. Background Drainage devices have been used for refractory pediatric glaucoma. To avoid early hypotony and corneal damage, Mermoud et al. introduced the augmentation of a XEN implant with a Baerveldt tube. In some cases, this technique fails to lead to a high intraocular pressure (IOP) and surgical revision. Case description Three cases of children with this combined implant needed surgical revision due to high IOP. Three different approaches were performed: XEN replacement in one case, stretching the Baerveldt's tube into the anterior chamber (AC) in the second case, and explant of the device followed by an implant of a new Baerveldt-250 in the same quadrant in the third case. Successful control of IOP (>18 mm Hg) was achieved in all patients under no topical treatment. Conclusion Despite the attractiveness of the XEN-augmented Baerveldt implant in refractory pediatric glaucoma as an alternative to conventional surgery, we have to learn how to deal with failures. Three different approaches are presented with good short-term results. The long-term efficacy is yet to be assessed. Clinical significance Describe three possible options when faced with a need for surgical revision in XEN-augmented Baerveldt implant. How to cite this article José P, Abegão Pinto L, Teixeira FJ. XEN-augmented Baerveldt Failure: Three Different Revision Approaches for Pediatric Patients. J Curr Glaucoma Pract 2021;15(2):96–98.

Rationale: Mucocoeles of paranasal sinuses are expansile and destructive lesions which can present with a variety of symptoms. If not treated early, they may lead to various complications. Patient Concerns: This report presents a case of a 26-year-old male patient with complaints of swelling of the left eye and double vision for 18 months. Diagnosis: Diagnosis of frontoethmoidal mucocoele with an unusual presentation of lateral displacement of the eyeball and proptosis was made based on patient history, clinical examination, and computed tomography. Treatment: The case was managed conservatively with marsupialization of the mucocoele using the transnasal endoscopic approach. Outcome: Complete resolution of the Mucocoele and its associated symptoms was observed, and frontal sinus ostium was found to be patent and completely epithelialized in 12-month follow-up. Take-away Lessons: The endoscopic approach toward the management of frontoethmoidal mucocoele is an effective alternative to conventional surgery with less patient morbidity and mortality.

Background. The incidence of skin cancer has been steadily increasing worldwide. Squamous cell skin carcinoma (SCSC ) is the second most common form of epithelial cancer. Treatment of SCSC remains a challenge, and the 10-year survival rate does not exceed 20 % in patients with regional lymph node metastases and 10 % in patients with distant metastases.The aim of the study was to evaluate the treatment outcomes in SCSC patients using modern cryogenic technologies.Material and Methods. Between 2013 and 2019, 64 patients with SCSC were treated at N.N. Petrov Research Center for Oncology (St. Petersburg, Russia). All patients were divided into two groups. Group I consisted of 32 patients who underwent cryosurgery. Group II comprised 32 patients who underwent conventional surgery.Results. No significant differences in the treatment outcomes between Group I and Group II patients were found. Cryosurgery has several advantages over other surgical modalities. The duration of surgery was shortened by an average of 54 %. Cryosurgery is less invasive than surgery; therefore, pain and bleeding are minimized. The procedure was well tolerated by all patients. According to the «VAS » scale, the intensity of the pain syndrome in the first day after surgery was 70 % lower in Group I than in Group II . In Group I patients, the length of hospital stay was shortened by 7–9 days (57 %), and postoperative complications were not observed. In Group II , local complications were noted in 3 (9.4 %) patients. Cryosurgery was proven effective in 40.6% of elderly patients with the Charlson Comorbidity Index of more than 7 points, to whom palliative therapy is usually recommended.Conclusion. Cryosurgery for patients with SCSC was safe and did not cause any negative impact on the immediate and long-term treatment outcomes. Cryosurgery is a method of choice in the treatment of patients with a comorbidity.

RESUMEN Anteriormente, cuando se diagnosticaba litiasis en la vía biliar, el procedimiento consistía en una co lecistectomía, coledocotomía, extracción de los cálculos y colocación de un drenaje de Kehr. En otros casos se podía hacer papiloesfinteroplastia o una derivación biliodigestiva. Actualmente tenemos mu chas herramientas diagnósticas y terapéuticas como la colangiorresonancia, la pancreatocolangio grafía retrógrada endoscópica, la cirugía laparoscópica de la vía biliar, la ecoendoscopia y la ecografía intraoperatoria. Los procesos de decisiones son más complejos y sin un sustento con evidencia con cluyente. Tenemos estudios que enfocan parceladamente el tema, por lo que, dependiendo de si el diagnóstico se hace antes o durante la colecistectomía laparoscópica, el cirujano empleará su sentido común individualizando cada caso. El manejo ideal de la litiasis de la vía biliar sigue siendo motivo de controversia. Decidir por un manejo endoscópico, laparoscópico o convencional requiere logística, entrenamiento y juicio clínico adecua dos. La cirugía convencional sigue siendo una opción vigente. ABSTRACT Previously, when a surgeon diagnosed bile duct lithiasis, he/she performed cholecystectomy, chole docotomy, stone removal and placement of a Kehr’s “T” tube. Some cases might require sphinctero plasty or bilio-digestive bypass. Nowadays, magnetic resonance cholangiopancreatography, endosco pic retrograde cholangiopancreatography, endoscopic ultrasound and intraoperative ultrasound have emerged as diagnostic and therapeutic tools. Decision-making processes are complex and there is no conclusive evidence supporting them. Many studies have focused on the matter with a non-compre hensive approach so that each surgeon will use his/her common sense for each individual case. The optimal management of the common bile duct is still controversial. Deciding on endoscopic, lapa roscopic or conventional management requires adequate training and clinical judgment. Conventional surgery is still in valid option.

OBJECTIVES/HYPOTHESIS To estimate the impact of optical techniques on prevention of post-operative hypocalcemia and hypoparathyroidism after total thyroidectomy. STUDY DESIGN Systematic review and meta-analysis. METHODS A literature search was conducted in Pubmed, EMBASE, SCOPUS, and Cochrane databases. The main inclusion criteria for eligible articles for meta-analysis were patients with benign or malignant thyroid pathologies who underwent total thyroidectomy, utilization of optical techniques to support PGs preservation, the availability of calcium and/or PTH levels. The primary outcome was to evaluate the variation of calcium and PTH levels when adopting optical technologies compared to standard naked-eye surgery. RESULTS In total, 13 papers with 1484 procedures were included. Pooled proportion for short- and medium-term hypocalcemia rates were 8% (95% CI, 5%:11%) and 1% (95% CI, 0%:4%) for optical techniques, while for naked-eye surgery were 15% (95% CI, 9%:23%) and 5% (95% CI, 2%:9%), respectively. CONCLUSIONS Optical technologies reduced short and medium term hypocalcemia compared to conventional surgery. LEVEL OF EVIDENCE NA Laryngoscope, 131:1683-1692, 2021.

Purpose To compare joint line restoration after unicompartmental knee arthroplasty (UKA) between conventional and robotic-assisted surgery. Previous studies have shown that joint line distalization can lead to higher failure rates. The hypothesis was that robotic-assisted UKA is associated with less femoral component distalization and a precise tibial cut, which allows a more anatomical restitution of the knee joint line. Methods Retrospective cohort study of patients undergoing medial or lateral UKA between May 2018 and March 2020. Preoperative and postoperative radiologic assessment of the joint line was performed by two observers, using three different methods, one for tibial slope and one for tibial resection. Robotic assisted UKA and conventional UKA groups were compared. Results Sixty UKA were included, of which 48 (77.42%) were medial. Robotic-assisted UKA were 40 (64.52%) and 22(35.48%) were conventional The distalization of the femoral component was higher in the conventional group despite the method of measurement used In both Weber methods, the difference was statistically different: Conventional 2.3 (0.9 to 5.6) v/s Robotic 1.5 (− 1.1 to 4.1) (p =0.0025*). A higher proportion of patients achieved a femoral component position ≤ two millimeters from the joint line using robotic-assisted UKA compared to the conventional technique . No statistical difference between robotic-assisted and conventional UKA was found in tibial resection and slope. Conclusion Robotic-assisted UKA shows a better rate of joint line restoration due to less femoral component distalization than conventional UKA. No difference was found in the amount of tibial resection between groups in this study. Level of evidence III

Objective Muscle injury is inevitable during surgical exposure of the spine, and it is quantified by the release of creatine phosphokinase. The aim of the present study is to make a comparison between tubular microdiscectomy and conventional microdiscectomy by using the pre- and postoperative serum concentrations of creatine phosphokinase as an indicator of muscle injury. Materials and Methods A total of 28 patients who underwent surgery for lumbar disc herniation were allocated into 2 groups: 12 patients (group A) operated by transflaval microdiscectomy, and 16 patients (group B) operated by tubular microdiscectomy. The serum concentration of total creatine phosphokinase was measured before surgery (creatine phosphokinase 1) and 1 day after surgery (creatine phosphokinase 2). Results There were 12 women and 16 men; the mean age of the patients and the mean duration of the surgery were respectively 49.5 years and 56 minutes for group A, and 47.3 years and 60 minutes for group B. The p-values of creatine phosphokinase 1, creatine phosphokinase 2 and the creatine–phosphokinase ratio were respectively 0,34; 0,31; and 0,57 (p Conclusion The present study demonstrated that there was no significant difference between tubular microdiscectomy and conventional microdiscectomy according to the analysis of the levels of creatine phosphokinase.

Studies have shown lower treatment-related morbidity when using transoral robotic surgery (TORS) compared to conventional surgery. Patients investigated for oro- and hypopharyngeal cancer (T1, T2) were compared concerning quality of life (QoL) after tonsillectomy and TORS using validated QoL questionnaires: QLQ-C30 and QLQ-H&N35. The patients treated with TORS showed a higher pain score and thus also a higher need for painkillers, whereas they had lower values on self-assessment of anxiety/depression using the Hospital Anxiety and Depression Scale score. The pre- and postoperative information given did not meet the expectations of the patients treated with conventional surgery. The present data show advantages of the TORS technique from the patients’ perspective. Even if patients treated with TORS are in need of more painkilling treatment, they cope better with the long-term effects of treatment, as judged by self-assessment of anxiety and depression.

Relatively little is known about the true aggressive potential of pleomorphic dermal sarcoma (PDS) or optimal management strategies. To describe the outcomes of 16 cases of PDS treated at our hospital (14 with modified Mohs micrographic surgery [M-MMS] and two with conventional surgery) and establish an adequate plan for management. We reviewed 16 PDS cases treated at our hospital between October 2007 and June 2019 and compared our results with the available evidence. In total, 69% of cases had recurred after initial conventional surgery, M-MMS led to local disease control in 83% of cases, and 19% of patients developed metastasis. Combining all published PDS cases with ours, we calculated an overall metastasis rate of 12%, and an overall recurrence rate of 35% after conventional surgery and 17% after M-MMS. PDS is more aggressive than previously estimated, with an overall metastatic rate of 12%. Despite high recurrence rates with previous conventional surgery (69%), M-MMS achieved a good rate of local disease control (83%). Given the potential aggressivity of PDS and the importance of clear surgical margins, M-MMS appears to be more adequate than conventional excision. Staging studies and close monitoring are warranted in PDS patients, for which we propose a management algorithm.

INTRODUCTION Mohs micrographic surgery technique allows for complete margin analysis of skin tumors, which explains its lower recurrence rates over conventional surgery. Although it is known that routine processing of excision specimens represents less than 0.5% of the margins, a direct comparison with micrographic technique has not been performed so far. OBJECTIVE To compare the margins of nonmelanoma skin cancers excised conventionally, processed with serial transverse cross-sectioning ("bread-loafing"), and had negative margin readings, against the margins obtained through micrographic technique from the same tumors. MATERIALS AND METHODS Retrospective, descriptive, historical cohort study. Inclusion criteria as follows: patients who underwent conventional excision for nonmelanoma skin cancers between 2010 and 2013 in our dermatology department and had negative margin readings. Samples were dewaxed and processed with the 3-dimensional Mohs micrographic technique. RESULTS One hundred one basal cell carcinomas and 26 squamous cell carcinomas were analyzed. Thirteen positive fragments were obtained, which corresponded to 11 tumors and patients; therefore, 8.7% of patients were given a false negative result in their original study. Lateral margins were more commonly affected (81.8%). There was no clear association between false negative results and histopathologic type or subtype. CONCLUSIONS Our study is the first of its kind in terms of methodology. The "bread-loafing" technique can incorrectly report the state of the margins of surgical pieces excised by conventional surgery. Mohs' micrographic technique is superior when it comes to evaluating margins and should be regarded as the gold standard.

Highlights • Robotic TEMVR is the most advanced level of MICS. • We have performed TEMVR using no robotic system. • The used equipment included MICS instruments and a 3D Endoscopic system. • We improved mitral valve exposure techniques and surgical port placement. • We used sutures as a left atrial retractor to expose mitral valve., Introduction Totally endoscopic mitral valve repair (TEMVR) is the highest level of minimally invasive cardiac surgery (MICS). It brings many benefits to patients but the downside is that a robotic system is always required. The deployment of robotic surgery is very complicated and expensive. Therefore, we improvised, making it possible to perform TEMVR without the aid of a robotic system. Presentation of case A 66-year-old male patient presented with severe mitral valve regurgitation due to posterior leaflet prolapse. He was treated with TEMVR without robotic assistance. No chest incision was over 1.2 cm. The repair techniques included posterior leaflet resection and annuloplasty with ring implantation. Discussion A midline sternotomy is still the standard approach for mitral valve repair. In recent years, MICS has gradually replaced conventional surgery with the most advanced strategy being totally robotic mitral valve repair. However, complex surgical techniques and high cost make it less accessible for the majority of patients. Instead of using robot, we improved mitral valve exposure techniques, surgical port placement and therefore were able to perform TEMVR with MICS instruments. Conclusion TEMVR without robotic assistance is a safe, effective and cost-efficient procedure, which can be adopted in most cardiac centers.

Medical therapy is the first treatment choice for most patients with glaucoma; however, in a relevant proportion of patients, intraocular pressure (IOP) reduction is achieved with multi-therapy and/or high therapeutic doses. Conventional surgery is the standard alternative to medical therapy when this is not effective or not tolerated. Recently, selective laser trabeculoplasty (SLT) has been advocated as first-line therapy, and "minimally invasive glaucoma surgery" (MIGS) has been developed as safer and less traumatic surgical intervention for patients with glaucoma. Schlemm's canal surgery has emerged as one of the approaches with the most favorable risk-benefit profile for glaucoma patients in need of cataract surgery. However, despite the promising results, use of MIGS in Italy has been extremely low. We aimed to investigate the reasons of the lower-than-expected use of Schlemm's canal-based MIGS devices in Italy, share our perspective on their potential place in therapy, and give practical suggestions to improve the management of glaucoma patients.

Limited data exist regarding knowledge and perceptions of surgeons and patients about robotic-assisted surgery (RAS) in the Middle East. This study aimed to explore perceptions of surgeons and patients about RAS. A questionnaire-based survey was distributed among surgeons of different specialties and patients. Between March and September 2019, 278 and 256 surveys were completed by surgeons and patients, respectively (95.2% and 94.8% response rate, respectively). The surgeons' self-reported experience with technology was related to the level of comfort with computers and computer literacy. Most surgeons have heard of RAS availability, and the majority agreed to its introduction into the healthcare system. However, only 75 (27%) of the surgeons thought that the surgeon has complete control over the robot, and 69 (25%) surgeons were not sure of the level of control the surgeon has over the robot reflecting poor knowledge about this technology. Less than a third of patient respondents have heard of RAS. However, half of them would consider it should they need to undergo surgery. When compared to open surgery, 23 (9%), 26 (10%), and 94 (37%) patient respondents thought that RAS caused less pain, had fewer complications, and was faster than conventional surgery, respectively. Knowledge and perceptions about RAS are limited among surgeons and patients in Kuwait. Efforts should focus on increasing awareness.

Purpose To evaluate real-world outcomes of astigmatism management with femtosecond laser arcuate incisions in patients with low corneal astigmatism ( Patients and methods The Wortz-Gupta™ Formula (available at www.lricalc.com) was used to calculate femtosecond laser arcuate parameters for 224 patients with Results The average preoperative cylinder was similar (0.61 D in the femtosecond group [n=124] and 0.57 D in the conventional group [n=100] (P>0.05)). More patients had ≤0.5 D of postoperative corneal astigmatism in the femtosecond group (n=110/124, 89%) than in the conventional group (n=71/100, 71%), respectively (P=0.001). The mean absolute postoperative refractive astigmatism was higher in the conventional surgery group than in the femtosecond group (0.43 ± 0.4 D vs 0.26 ± 0.28 D); these differences were statistically significant (P Conclusion Using the femtosecond laser for arcuate incisions in combination with a novel nomogram can provide excellent anatomic and refractive outcomes in patients with lower levels of preoperative astigmatism at the time of cataract surgery.

Introduction: Studies have suggested that stapled hemorrhoidopexy results in less postoperative pain and shorter recovery compared with conventional surgery, but a higher rate of recurrence. The present study aimed to assess the advantage and feasibility of stapled hemorrhoidopexy versus conventional hemorrhoidectomy in grade 3 and grade 4 hemorrhoids and to compare the short-term outcomes of stapled hemorrhoidopexy with conventional hemorrhoidectomy in a teaching hospital in Central India. Methods: After fulfilling the selection criteria, 100 patients were randomly allocated to the stapled (n = 50) or conventional group (n = 50). All patients were operated under spinal anesthesia. The 2 techniques were evaluated with respect to the operative time, pain scores, complications, hospital stay, return to work, and level of satisfaction. The follow-up period was 6 months. Results: The mean age of patients was 46.02 years in the stapled group and 48.64 years in the conventional group. Hemorrhoids were more common in men. The mean operative time was shorter in the stapled group (24.28 ± 4.25 minutes) versus 45.41 ± 6.36 minutes in the conventional group (P < 0.05). The blood loss and pain scores were significantly less in the stapled group. Conclusion: Stapled hemorrhoidopexy is a safe and effective day-care procedure for the treatment of grade 3 and grade 4 hemorrhoids. It ensures lesser postoperative pain, early discharge, less time off work, and complications similar to the conventional technique, and in the end a more satisfied patient with no perianal wound.

Background: Perforated appendicitis is one of the common surgical emergencies which need immediate surgical intervention.For many years, the classic open appendectomy still seems to be the routine treatment of perforated appendicitis. The improvement of technology and an increase in laparoscopic experience have been central to the development of laparoscopic surgery.The aim of this study is to compare outcome of laparoscopic versus open surgery for surgical management of perforated appendicitis in our locality. Patients and Methods: This is a prospective study that included 40 patients with perforated appendicitis admitted at general surgery department in Qena university hospital “between April 2018 to April 2019”, 20 patients underwent open appendectomy and 20 had laparoscopic surgery. All patients subjected to: full clinical evaluation, diagnostic modalities as: laboratory investigation, plain X-ray erect and abdominal sonography. Results:All cases were completed successfully.A20 patient underwent open conventional surgery their mean age 29.80±7.32 years. While those underwent laparoscopic surgery were 20 patients and their mean of age 28.80±7.37 years. There were statistically significant differences between studied groups regarding operative time,time to return to a normal diet, length of hospital stayand postoperative complications. Conclusion: Laparoscopicsurgery for perforated appendicitisis safe and carries many advantages of minimallyinvasivetechniques. So, it should beused selectively, reservingthe traditionalopen approach.

Transcatheter mitral valve replacement (TMVR) is an emerging therapy for patients with severe mitral valve disease considered unsuitable for conventional surgery. Pre-procedural planning is paramou...

PURPOSE: The main objective was to analyze the computer-assisted navigation (CAN)-specific complications that forced to switch to conventional procedure in primary total knee replacement (TKR). The secondary objective was to determine the influence of those complications on TKR short-term survival. METHODS: Retrospective study of 878 primary TKR in 753 patients. Two consecutive versions of the OrthoPilot navigation system (Braun Aesculap, Germany) were used during the study time. Specific complications of CAN were defined as those due to the instrumentation (hardware or software failures), which were classified in one of two categories according to whether they occurred during the registration or tracking process. RESULTS: There were 20 (2.3%) complications related to the navigation system use that forced to switch to conventional surgery: in 11 (1.2%) knees due to loosening of the tracking pins, and in the other nine (1.0%) there were information system failures. There was a trend for a higher conversion rate to conventional surgery with the use of the first version of the software. There were no fractures, infections, or nerve injuries at the pin site. We found no differences in the distribution of baseline variables among those with or without conversion to conventional surgery. There was no significant difference (p = 0.488) in the two year survival between patients with or without conversion. CONCLUSION: CAN for primary TKR is a safe method with few specific complications that forced to switch from the navigated to the conventional procedure. Conversion to conventional surgery did not affect the short-term survival of TKR.

Objective To investigate the safety and superiority of robot‐assisted femoral head drilling decompression in the treatment of femoral head necrosis. Methods A total of 63 patients who underwent borehole decompression of the femoral head in our hospital from January 2016 to March 2019 were recruited. Patients were divided into two groups for comparison according to surgical methods. In the robot‐assisted surgery group, there were 30 cases with 41 femoral heads. The conventional group had 33 cases and 46 femoral heads. All patients signed the consent form before the operation. The follow‐up time was 6 months. The incision lengths, operation times, intraoperative blood loss, intraoperative fluoroscopies, guide needle punctures, postoperative Harris scores, and postoperative complications of the two groups were compared. Results The incision length of the robot surgery group was 5.16 ± 0.41 cm, while that of the traditional surgery group was 7.42 ± 0.50 cm. The operation time of the robot surgery group was 46.99 ± 4.94 min, while that of the traditional surgery group was 55.01 ± 6.19 min. The fluoroscopy frequency of the robot surgery group was 10.50 ± 1.78 times, while that of the traditional surgery group was 17.91 ± 2.20 times. The intraoperative blood loss in the robotic surgery group was 20.62 ± 2.52 mL, while that in the conventional surgery group was 52.72 ± 3.39 mL. In the robot operation group, each femoral head guide needle was punctured three times, and the puncture was successful one time. The number of guided needle punctures in the traditional group was 8.02 ± 1.73. The difference between the two groups was statistically significant (P 0.05). In the traditional group, there was one case of incision infection and one case of femoral head collapse during follow‐up. In the robot group, there were no complications, such as incision infection and deep vein thrombosis. No collapse of the femoral head was found in the robot group during follow‐up. Conclusion The positioning system of the orthopaedic robot is an ideal method for the treatment of femoral head necrosis. This method has the advantages of simple operation, accurate drilling, a short operation time, less surgical trauma, less radioactivity, and good recovery of hip joint function.

The purpose of this study was to determine the surgical outcome, dose-effect (DE), and degree of binocularity in patients undergoing surgery for consecutive exotropia following initial surgery of esotropia.Twenty-one patients were identified. We analyzed the mean angle of deviation pre- and postoperatively as measured with the alternate prism cover test, DE, and binocularity.All patients had had previous strabismus surgery. The surgery for consecutive exotropia had been performed at a mean age of 35.92 ± 18.26 years. In 19 of these patients, surgery of consecutive exotropia involved at least one previously operated extraocular muscle, and the mean interval to the previous surgery was 25.67 ± 16.14 years. The mean angle of deviation (DE) at distance and in the primary position was - 33.43 ± 12.75 prism diopters (PD) preoperatively, + 0.76 ± 7.91 PD 1 week after surgery, and - 7.24 ± 12.14 PD 3 months after surgery. The mean DE was 3.58 ± 1.53 mm/PD at 1 week and 2.70 ± 1.78 mm/PD at 3 months post-surgery. Postoperatively, 62% patients had a binocularity of at least Bagolini positive, 33% had either a positive TNO or Titmus Test, and 24% were Lang I positive (550″).Performing strabismus surgery with consecutive exotropia results in restoration of some binocularity in a large number of patients, even in adults, and should be considered as a possibility. The dose-effect is comparable to conventional surgery of exotropia.Das Ziel dieser Studie war es, die operativen Ergebnisse, den Dosiseffekt sowie den Grad an erreichter Binokularität bei Patienten nach Operation einer konsekutiven Exotropie zu untersuchen.21 Patienten wurden in die Studie eingeschlossen. Wir analysierten den prä- und postoperativen Schielwinkel, gemessen mit dem alternierenden Prismen-Cover-Test, den chirurgischen Dosiseffekt (DE) sowie die Stereofunktion.Alle Patienten waren aufgrund einer Esotropie im Kindesalter bereits operiert. Die Operation der konsekutiven Exotropie wurde im Mittel in einem Alter von 35,92 ± 18,26 Jahren durchgeführt. Bei 19 Patienten wurde an mindestens einem bereits voroperierten Muskel operiert. Das mittlere Intervall zur letzten Operation lag bei 25,67 ± 16,14 Prismendioptrien (PD). Der mittlere Schielwinkel lag bei − 33,43 ± 12,75 PD präoperativ, + 0,76 ± 7,91 PD 1 Woche postoperativ und − 7,24 ± 12,14 PD nach 3 Monaten. Der mittlere Dosiseffekt lag bei 3,58 ± 1,53 mm/PD 1 Woche postoperativ und bei 2,70 ± 1,78 mm/PD nach 3 Monaten. Postoperativ waren 62% zumindest Bagolini-positiv, 33% der Patienten waren entweder TNO- oder Titmus- und sogar 24% Lang-I-positiv (550″).Die Strabismuschirurgie der konsekutiven Exotropie erreicht in einer Vielzahl an Patienten ein gewisses Maß an Binokularität auch im Erwachsenenalter und sollte daher in Erwägung gezogen werden. Der Dosiseffekt ist vergleichbar mit der Chirurgie anderer Exotropieformen.

Background Since the 1900s, many methods have been developed to correct the epicanthal fold. Increased use of epicanthoplasty has yielded unsatisfactory results. Objectives To describe a method of epicanthal fold reconstruction using V-Y advancement and turnover flap for clinical application. This method is simpler than conventional surgery. It is easy to perform with excellent esthetic results. Methods The authors performed medial epicanthal fold reconstruction in 82 patients (16 males and 66 females) between April 2014 and September 2017. All patients enrolled in this retrospective study underwent surgical procedures at the authors' institution. Interepicanthal distance was the distance between medial epicanthal folds. It was measured with a surgical ruler. Results Before surgery, mean interepicanthal distance was 35.4 mm. Using our surgical technique, successful outcome was achieved in 79 (96.3%) patients with satisfactory results. The mean distance between the medial epicanthi post-surgery was 38.6 mm, increasing the total length by 3.2 mm without showing any major postsurgical complications. Discussion Epicanthal fold reconstruction using V-Y advancement and turnover flap is a simple and effective technique that can readily improve the frontal view. It improves periorbital contouring, makes eyes look natural without fully showing the caruncle, and yields excellent esthetic results. In particular, there were no major visible scars following eversion suture.

Background and Aim: Gliomas are the most common type of brain tumor in the world. Surgical resection is one of the most effective therapeutic methods in terms of patient prognosis. However, it is difficult for neurosurgeons and health-care providers to select which imaging technology to best support the procedure. These technologies included intraoperative magnetic resonance imaging (iMRI), intraoperative ultrasound (iUS), fluorescence guidance with 5-aminolevulinic acid (5-ALA), and intraoperative neuronavigation. Hence, in this study, we compared the gross total resection (GTR), postoperative complications within or outside of the central nervous system, and postoperative clinical improvement by multiple meta-analyses, which allows the integration of data through direct and indirect comparisons.Materials and Methods: The PubMed, Cochrane Library, Web of Science, Embase, China Knowledge Resource Integrated Database, and WanFang databases were searched for publications before April 2018. Randomized controlled trials, two-arm and three-arm prospective studies, and retrospective studies in patients who underwent surgical treatment for glioma were included. The most important outcome measures were the rates of GTR, postoperative complications, and clinical improvement. Results: In terms of GTR, iMRI (odds ratio [OR] = 5.70, 95% confidence interval [CI]: 3.40–9.60), iUS (OR = 2.70, 95% CI: 1.10–6.90), 5-ALA (OR = 2.40, 95% CI: 0.64–8.90), and neuronavigation (OR = 1.90, 95% CI: 1.20–3.10) were found to be more effective than conventional surgery. In addition, iUS (OR = 0.15, 95% CI: 0.04–0.52), iMRI (OR = 0.24, 95% CI: 0.14–0.43), and neuronavigation (OR = 0.34, 95% CI: 0.18–0.56) were more found to result in fewer complications than conventional surgery. Furthermore, patients' clinical improvement was better with iMRI (OR = 8.10, 95% CI: 3.00–25.00), iUS (OR = 4.90, 95% CI: 0.76–33.00), and neuronavigation (OR = 2.60, 95% CI: 1.00–7.20) than with conventional surgery. Conclusions: The developed ranking probability table indicated that iMRI was superior in terms of the GTR and clinical improvement, while iUS was the least likely to result in postoperative complications. Hence, it was concluded that iMRI or iUS is the most advantageous imaging modality.

Objective: To compare the effects of electrical bipolar vessel sealing clamp and conventional suturing on postoperative pain, operative time, blood loss, and costs, in women undergoing vaginal hysterec- tomy. Patients and Methods: 20 women scheduled to undergo vaginal hysterectomy for prolapsed and non prolapsed uterus with benign indication of hysterectomy. Women were randomizedrandomly into two groups;Conventional vaginal surgery Groupand a Group using vessel sealing Erbe machine.Ten patient in each group. Operative time, intraoperative assessment of blood loss, postoperative pain, and estimated cost were evaluated and compared between both groups. Results: Pain was evaluated few hours post-operative.Patients in the vessel-sealing clamp group showed statisticallysignificant less pain (5.7 versus 4.5 on a scale of 0–10, P= 0.03), but this followed by comparable pain in both groups later. Operative time wasshorter in vessel sealing clamp group (39 versus 61 minutes = P

Interventional radiology (IR) is a rapidly evolving specialty. The minimally invasive nature of the procedures has led to a paradigm shift in treating many disease processes from conventional surgery to interventional techniques that have become the first choice and the preferred method for the treatment of peripheral vascular disease, many aortic pathologies, and venous diseases. Interventional oncology procedures have become widely available for the treatment of solid hepatic and renal tumors. This includes palliative techniques for many advanced malignancies, and fluid drainage that is exclusively performed by interventional radiologists in many hospitals all around the world. Women's health-related procedures such as uterine fibroid embolization, fallopian tube recanalization, and embolization for pelvic congestion syndrome have become attractive choices for many patients. Family physicians (FPs) are the main source of patient referral to hospitals. However, there is a notable knowledge deficiency of IR among FPs in Saudi Arabia. This may be due to poor communication between FP and IR or the lack of FP's awareness of IR procedures. This is a nonsystematic review to introduce some IR procedures to FPs pertinent to their practice to optimize patient referral and management with the use of IR services. We focused on the most commonly performed IR procedures paying special attention to their clinical indications, benefits, and alternatives.

Background Intertrochanteric femoral fractures are prevalent among the elderly, and usually demands surgical treatments. Proximal femoral nail antirotation Asian version (PFNA-II) is widely used for intertrochanteric fracture treatment. The computer-assisted preoperative planning (CAPP) system has the potential to reduce the difficulty of PFNA-II in the treatment of intertrochanteric fractures. The aim of the study was to investigate and compare the learning curves of PFNA-II treatment with CAPP and conventional preoperational planning methods for intertrochanteric femoral fractures. Methods A total of 125 patients with intertrochanteric fracture who were treated with PFNA-II between March 2012 and June 2015 were retrospectively analyzed. Patients who underwent surgery with CAPP procedure by a junior surgeon were regarded as group A (n = 53); patients who underwent the conventional surgery by another junior surgeon were regarded as group B (n = 72). Each group was divided into three subgroups (case 1–20, case 21–40, case 41–53 or case 41–72). Results The average operation time of group A was 45.00(42.00, 50.00) minutes, and in group B was 55.00 (50.00, 60.00) minutes (P P P Conclusion Compared with conventional preoperative planning methods, CAPP system significantly reduced operation time, radiation frequency and blood loss, thus reshaped the learning curve of PFNA-II treatment with lower learning difficulty. Trial registration researchregistry4770. Registered 25 March 2019.

Purpose: The aim of this study is to present our experience in UMHATEM "Pirogov" in the laparoscopic treatment of perforated peptic ulcer in the last two years. Material and Methods: A total of 37 patients with the diagnosis of perforated peptic ulcer were hospitalized for a period of two years from 1. 1. 2015 to 1. 1. 2017 in the Department of General, Visceral and Emergency Surgery at UMHATEM "Pirogov". Of these, women were 11 (29.73%) and men 26 (70.27%). The age in this retrospective analysis varied from 18 to 71 years (average 47 years.). Results: In 34 cases perforation was localized in the stomach (91.89%) and in three in the duodenum (8.11%). In 6 patients (16.22%), the ulcer was of a chronic nature (broad, raised edges), and in the remaining 31, it was acute (83.78%). Laparoscopic treatment was performed in 33 (89.19%) patients. The surgical methods were primary suture or omentoplastica. Three patients had post-operative infections of the abdominal wounds (morbidity-8.11%). One patient died (2.7%). Conclusions: Laparoscopic treatment of perforated peptic ulcer is a safe method with low morbidity and mortality rates, reduced postoperative pain (hence a decrease in the amount of analgesics) as well as a short hospital stay and early recovery to normal activities.

Tendon repair is a complex process due to the low tenocyte density, metabolism, and vascularization. Tears of rotator cuff (RCT) and Achilles tendons ruptures have a major impact on healthcare costs and quality of life of patients. Scaffolds are used to improve the healing rate after surgery and long-term results. A systematic search was carried out to identify the different types of scaffolds used during RCT and Achilles tendon repair surgery in the last 10 years. A higher number of clinical studies were reported on RCT ruptures. Biological scaffolds were used more than synthetic ones, for both rotator cuff and Achilles tendons. Moreover, platelet-rich plasma (PRP)-based scaffolds were the most widely used in RCT. A different type of synthetic scaffold was used in each of the five studies found. Biological scaffolds either provide variable results, in particular PRP-based ones, or poor results, such as bovine equine pericardium. All the synthetic scaffolds demonstrated a significant increase in clinical and functional scores in biomechanics, and a significant decrease in pain and re-tear rate in comparison to conventional surgery. Despite the limited number of studies, further investigation in the clinical use of synthetic scaffolds should be carried out.

Aim Our objective was to compare guided virtual surgery to conventional surgery in terms of angular deviation of single dental implants placed in the posterior mandible. Materials and methods Patients with bilateral homologous single teeth missing in the posterior mandible were eligible for this split-mouth randomized clinical trial. Cone beam computed tomography (CBCT) was performed for virtual planning of implant position and manufacturing of the stereolithographic guides. One week after the surgery, a second CBCT scan was superimposed to the initial planning. Primary endpoint was the angular deviation between virtual and clinical implant position. Secondary endpoints were linear deviations and patient-reported outcomes collected with a questionnaire. Results Data from 12 patients were available for analysis. Angular deviation was significantly lower using stereolithographic guides as compared to conventional guides (2.2 ± 1.1° vs. 3.5 ± 1.6°, p = .042). Linear deviations were similar for both techniques in the coronal (2.34 ± 1.01 vs. 1.93 ± 0.95 mm) and apical (2.53 ± 1.11 vs. 2.19 ± 1.00 mm) dimensions (p ˃ .05). The selection of the surgical technique had no significant impact on the patient-reported outcomes. Conclusion Our data suggest that the angular discrepancy between the virtual and the clinical implant position is slightly lower when using stereolithographic guides as compared to conventional guides.

Severe tricuspid regurgitation constitutes a growing disease burden. Conventional surgery for tricuspid valve disease has an increased risk while several interventional procedures are currently under clinical investigation, yet do not offer comprehensive solutions. We investigated a novel surgical approach for off-pump beating-heart tricuspid annuloplasty in circulating blood through a single port in the right atrium. Early feasibility results in preclinical porcine in vivo studies encourage further development of this approach, combining the proven concept of surgical annuloplasty with the benefits of minimally invasive off-pump procedures in a hybrid setting.

Background Surgical resection of brain mass lesion mandates safety and the best outcome for the patient. Objectives The aim of this study was the evaluation of intraoperative ultrasound (IOUS) in gross total resection of brain mass lesions and patients’ safety in comparison to conventional surgery. Materials and methods In total, 632 patients were operated for brain mass lesion resection at Neurosurgery Department, Zagazig University Hospitals, during the period from January 2011 to October 2018 and divided randomly into two groups, IOUS group and conventional group, for the detection value of IOUS in resection, safety, and outcome after 3 months follow-up. Results The IOUS group showed statistically significant gross total resection regardless to pathology, location, size, age, and sex in favor of IOUS use, and also, there were significantly less complications and better outcome after 3 months follow-up with the IOUS group. Significantly better outcome was found with gross total resection in total surgeries. Conclusions The use of IOUS during brain mass lesion surgery is safe and can assist the surgeon in gross total resection with better outcome.

The treatment of rectal cancer is complex and responsible for sequelae due to the various therapeutic modalities, especially the surgical resection. The advent of minimally invasive surgery provided a faster postoperative recovery and a lower complication rate when compared to conventional surgery. The implementation of laparoscopic approach in rectal cancer was responsible for these better results, but the limitations of this method added to the development of robotics, raised the question of which minimally invasive method would be more advantageous in the approach of rectal cancer. The present review will address the most recent data regarding the comparison between the laparoscopic and robotic approach in rectal cancer. Resumo: O tratamento do câncer de reto é complexo e responsável por sequelas causadas pelas diversas modalidades terapêuticas, principalmente a ressecção cirúrgica. O advento da cirurgia minimamente invasiva está associado a uma recuperação pós-operatória mais rápida e uma menor taxa de intercorrências do que as observadas na cirurgia convencional. A implementação da abordagem laparoscópica no câncer de reto foi responsável por esses melhores resultados, mas as limitações do método, bem como o desenvolvimento da cirurgia robótica, levantaram a questão de qual método minimamente invasivo seria mais vantajoso na abordagem desse tipo de câncer. A presente revisão apresenta os dados mais recentes na comparação entre a abordagem laparoscópica e robótica no câncer retal. Keywords: Rectal cancer, Minimally invasive surgery, Robotic surgery, Laparoscopic surgery, Palavras-chave: Câncer retal, Cirurgia minimamente invasiva, Cirurgia robótica, Cirurgia laparoscópica

Background Dermatofibrosarcoma protuberans (DFSP) is an invasive skin tumor traditionally associated with very high recurrence rates when treated with conventional surgery (CS). Objective To calculate the minimum margin that would have been required to achieve complete tumor clearance with hypothetical CS. To analyze DFSP characteristics and Mohs micrographic surgery (MMS) effectiveness in treatment of this tumor. Materials and methods Minimum margin was calculated by measuring the largest distance from the visible edge of the tumor to the edge of the surgical defect. Tumor variables (age, sex, size, time since onset, and location) were correlated with surgical variables (number of stages and minimum margin). Results We studied 222 cases of DFSP treated with MMS. A mean of 1.47 MMS stages and a mean minimum margin of 1.23 cm were required to achieve tumor clearance. Tumors on the head and neck required significantly more stages and a significantly wider margin. Tumor size was positively correlated with time to diagnosis, age, and number of MMS stages. Conclusion Tumors located on the head and neck have greater subclinical extension. Tumor size was also a predictor of surgical difficulty, but time to diagnosis was not.

Pathologies related to the cardiovascular system are the leading causes of death worldwide. One of the main treatments is conventional surgery with autologous transplants. Although donor grafts are often unavailable, tissue-engineered vascular grafts (TEVGs) show promise for clinical treatments. A systematic review of the recent scientific literature was performed using PubMed (Medline) and Web of Science databases to provide an overview of the state-of-the-art in TEVG development. The use of TEVG in human patients remains quite restricted owing to the presence of vascular stenosis, existence of thrombi, and poor graft patency. A total of 92 original articles involving human patients and animal models were analyzed. A meta-analysis of the influence of the vascular graft diameter on the occurrence of thrombosis and graft patency was performed for the different models analyzed. Although there is no ideal animal model for TEVG research, the murine model is the most extensively used. Hybrid grafting, electrospinning, and cell seeding are currently the most promising technologies. The results showed that there is a tendency for thrombosis and non-patency in small-diameter grafts. TEVGs are under constant development, and research is oriented towards the search for safe devices.

It has been reported that superior rectus transposition combined with medial rectus recession can provide as good results as transposition of both vertical rectus muscles, with no adverse effects on torsion or postoperative vertical misalignment. Further augmentation of transposition surgery can be achieved through the use of posterior fixation sutures, myopexy and botulinum toxin into the medial rectus. We report a patient with complete bilateral traumatic sixth cranial nerve palsies who underwent sequential superior rectus transposition surgery combined with medial rectus recession. The surgery was augmented with a myopexy (posterior suture joining superior and lateral recti with no scleral fixation) in the first eye and with a posterior fixation suture (with scleral fixation) in the second eye. After the second procedure, despite a significant improvement in horizontal alignment, the patient developed 15 degrees of incyclotorsion which was attributed to the scleral fixation suture. The patient underwent removal of the scleral suture and 3 months postoperatively had a significant reduction in incyclotorsion to 8 degrees; however this continued to be a barrier to fusion. Vertical rectus transposition of superior and inferior recti augmented with posterior scleral fixation sutures is one type of conventional surgery for complete lateral rectus palsy. In more recent times, it has become common to transpose the superior rectus alone along with recession of the contracted medial rectus. This procedure can also be augmented with a posterior fixation suture which may or may not be attached to the sclera. Whilst this surgery has gained popularity it is not without risk as demonstrated by our case in which transposition of the superior rectus was associated with postoperative incyclotorsion. In this case a possible explanation may be the use of a the posterior scleral fixation suture as it did not occur when no scleral fixation was used. Furthermore, removal of the posterior scleral fixation suture did reduce the torsion significantly although it did not eliminate it.

Background Blood loss in posterior surgery patients with thoracolumbar metastasis posed a significant challenge to surgeons. This study aimed to explore the risk factors of blood loss in posterior surgery for patients with thoracolumbar metastasis. Methods One hundred forty-two patients were retrospectively reviewed. Their baseline characteristics were recorded. The Gross equation was used to calculate blood loss on a surgical day. Multivariate linear regression was used to analyze the risk factors. Results Mean blood loss of 142 patients were 2055 ± 94 ml. Hypervascular primary tumor (kidney, thyroid and liver) (P = 0.017), wide or marginal excision (en-bloc: P = 0.001), metastasis at the lumbar spine (P = 0.033), and the presence of extraosseous tumor mass (P = 0.012) were independent risk factors of blood loss in the posterior surgery. Sub-analysis showed that wide or marginal excision (en-bloc: P < 0.001) and metastasis at lumbar spine (P = 0.007) were associated with blood loss for patients with non-hyper vascular primary tumors. Wide or marginal excision (piece-meal: P = 0.014) and the presence of an extraosseous tumor mass (P = 0.034) were associated with blood loss for patients with hypervascular primary tumors. Conclusion Hypervascular primary tumor (kidney, thyroid, and liver) was an independent risk factor of blood loss in the posterior surgery. The presence of extraosseous tumor mass and wide or marginal excision (piece-meal) were independent risk factors for patients with hypervascular primary tumors. Metastasis at the lumbar spine and wide or marginal excision (en-bloc) were independent risk factors for patients with non-hyper vascular primary tumors.

Background: Minimally invasive surgery (MIS) is replacing conventional surgery as the “gold standard” in different surgical areas. Although cervical MIS is already accepted in the adult population,...

Objective: High-energy lasers are used as an alternative to surgical treatment of potentially malignant disorders in the oral cavity. The present article aims to make a prospective randomised comparative clinical assessment of the effect of laser surgery and conventional surgery in the treatment of oral leukoplakia (OL). Materials and methods: In the study were included 89 patients with histologically confirmed oral leukoplakia lesions. Laser excision of the lesions using Er YAG laser was performed in 36 of the patients, while standard surgical excision was used in 53 of the cases. Following clinical assessment comparing the two treatment methods was conducted based on: pain, wound healing, infection and recurrence of the lesions. Results: A statistically significant difference between two groups according pain in the postoperative period was found. Patients treated with laser ablation experienced far less pain than those treated with surgical excision. The healing time was significantly faster in the group treated with Er YAG laser, and regarding the occurrence of postoperative infections, the results of the two methods did not differ significantly. Recurrence was observed earlier in the group treated with laser ablation, but the levels align over a longer period of time. Conclusion: Er YAG laser ablation is a contemporary method for the treatment of oral leukoplakia without dysplasia, providing similar success, compared to conventional surgical excision, with less postoperative discomfort for the patients. Keywords Er YAG laser; Leukoplakia; Potentially malignant disorders.