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Purpose: To examine the long-term performance of bonded all-ceramic restorations, specifically veneers, in patients with amelogenesis imperfecta (AI). There are few studies of long-term outcomes using a minimally invasive procedure in these patients. This aspect is essential when treating young patients. All-ceramic restorations, especially veneers, offer a more tissue-preserving treatment but rely on successful bonding. However, due to the defect enamel in AI patients, the bond strength is lower. Materials and Methods: A retrospective evaluation of 40 subjects with AI (26 women, 14 men) was provided with a total of 360 bonded restorations (282 veneers, 78 crowns). The restorations were evaluated according to complications, survival, and success rate. Results: The patients were observed up to 25.3 years (mean 15.4 ± 4.3 years). The mean age when receiving the restorations was 18.5 ± 4.2 years. In total, 59 (16.4%) restorations with prosthetic complications were made, 29 of which (8.1%) were remade (6 due to esthetic reasons, all in one patient) and 30 (8.3%) were recemented (60% caused by trauma). We found 11 teeth with caries and 3 with endodontic complications. The overall survival rate was 91.9%, and the overall success rate was 83.6%. Conclusions: Bonded all-ceramic restorations with no active retention in AI patients have excellent performance. The most common complications were debonding and fractures. The treatment should be based on individual indications and be preceded by a multidisciplinary approach. [ABSTRACT FROM AUTHOR]

This clinical case outlines a comprehensive digital workflow for a minimally invasive multidisciplinary treatment. The process utilizes one open-source software for digital wax-up and one low-cost software to address esthetic concerns related to teeth misalignment. The patient's function was stabilized with a digitally made occlusal splint. The application of the described digital workflow technique, incorporating open-source, lowcost, and closed software, played a pivotal role in attaining a straightforward and predictable outcome with minimally invasive treatment. Furthermore, the continual evolution of technology contributes to the growing precision of dental procedures. The presented digital workflow helped formulate a predictable treatment plan, replicate a diagnostic digital wax-up, and achieve precise teeth alignment. This approach satisfactorily addressed the patient's esthetic concerns, providing an outstanding approximation of the definitive result. [ABSTRACT FROM AUTHOR]

Objective: Periodontitis is characterized by bone resorption. Vertical bone loss results in an intraosseous defect. Multiple surgical approaches for treating intrabony defects have shown different grades of effectiveness. Recently, the entire papilla preservation technique has been proposed, improving clinical parameters, such as pocket depth and clinical attachment level. This series of cases aimed to describe the use of the entire papilla preservation surgical technique without using biomaterials to regenerate periodontal intrabony defects. The influence on the clinical periodontal parameters and radiographic parameters was measured through CBCT, the latter not described until now, and analyzed the possible postoperative complications. Method and materials: A total of six intrabony periodontal defects associated with at least one periodontal pocket with probing depths equal to or greater than 6 mm were treated with the entire papilla preservation technique. The clinical and radiographic parameters were evaluated at the beginning and 6 months after surgery. Results: The mean probing pocket depth reduction was 4.00 ± 0.63 mm, the mean clinical attachment level gain was 3.67 ± 1.03 mm, and the mean radiographic intrabony filling was 2.41 ± 2.03 mm. Early healing was uneventful; the mean visual analog scale at 7 days was 0. Conclusions: This minimally invasive technique results in an improvement in clinical and radiographic parameters, the latter showing a filling of the bone defect observed during the 6-month evaluation after surgical treatment. These results confirm the importance of clot and flap stability in regenerating intraosseous defects. [ABSTRACT FROM AUTHOR]

Objective: Currently, there is no established treatment protocol to treat interdental papillary loss. This research aimed to evaluate the outcomes of interdental papillary reconstruction using minimally invasive surgery, with injectable hyaluronic acid gel. Method and materials: Seventeen patients were included, each with five sites of class 1 papillary recession (40 sites in the maxilla and 45 sites in the mandible). Subperiosteal tunneling was performed through a horizontal incision made apical to the base of the papilla without penetrating it. The free gingival sulcus was sealed by 000 retraction cord. A total of 0.2 to 0.6 mL hyaluronic acid was injected gradually. The incision was sutured with poly-glycolic sutures. Treated sites underwent clinical and digital evaluation at three follow-up time points (1 month, 3 months, and 6 months). Results: The interdental papillary defect height in the maxillary sites significantly reduced by 60%, 66%, and 42% at 1,3, and 6 months, respectively. In mandibular sites, the reduction was 54%, 55%, and 40% at the same follow-up time points. Regarding interdental papillary defect surface area in the maxilla, the reduction was 65%, 71%, and 45% at 1, 3, and 6 months. In the mandible, a reduction of 60%, 64%, and 48% was noticed at the same time points. Regarding patients' pain level score, during the day of surgery, 16 patients reported pain; the average pain score out of 10 was 3.94, and 11 patients (64.7%) needed to take analgesics. The pain generally subsided in the following days. At the day of treatment, 12 out of the 17 patients (70.6%) reported mild difficulty in speaking and eating. No complication, hypersensitivity, or allergy was noted in any patient. Conclusion: Subperiosteal tunneling with hyaluronic acid injection demonstrates clinical improvements in papilla height and papillary recession surface area reduction after 3 months of follow-up, with reduction in improvement after 6 months. Clinical significance: Adjunctive use of hyaluronic acid injection with minimally invasive surgery in interdental papillary management may improve clinical and esthetic outcomes. [ABSTRACT FROM AUTHOR]

The purpose of the present study was to describe a novel protocol for a minimally invasive pocket elimination surgery (MI-PES) in the posterior maxilla and mandible, which consists of the combined use of (1) an access flap based on an internally beveled gingivectomy with minimal to no papilla mobilization at the buccal aspect, and (2) a resective procedure with an apically positioned flap on the lingual aspect. The interproximal bone defects were accessed with a single (lingual) flap, and the bone architecture was modified by the adoption of piezoelectric inserts for controlled bone recontouring associated with fiber retention. Mean probing depth (PD) was 5.5 ± 0.8 mm before surgery and 2.7 ± 0.6 mm at the 6-month reevaluation. All treated pockets showed a postsurgical PD < 4 mm. Gingival recession (REC) was 0.3 ± 0.5 mm at baseline and increased to 1.6 ± 0.8 mm at 6 months. When buccal and lingual pockets were analyzed separately, a trend toward a similar PD reduction, less REC increase, and greater clinical attachment level gain was recorded for buccal pockets. These preliminary observations seem to support the use of MI-PES as a valuable option for pocket elimination, at least when residual pockets are associated with a shallow interproximal osseous crater in the posterior maxilla or mandible. [ABSTRACT FROM AUTHOR]

Traditional GBR procedures have been associated with frequent complications and compromised peri-implant esthetics. Tunneling techniques have been proposed as a promising alternative in this regard. More recently, a subperiosteal minimally invasive aesthetic ridge augmentation technique (SMART) was reported to have been clinically successful in a prospective case series. This technique includes the use of a bone graft/recombinant human platelet-derived growth factor-BB combination delivered to the site by a tunneling method. However, published histologic information regarding the nature of the regenerated tissue has been limited. The current study evaluated the histologic and histomorphometric findings of four human specimens harvested at 2, 5, 9, and 14 months after ridge augmentation using the SMART method. Evaluations of the wound healing and bone regeneration sequence over time found that the ridge augmentation was the result of extensive new bone formation that progressed through the woven bone to lamellar bone stages, with remodeling of the xenogeneic graft material and replacement by patient bone. This is the first study utilizing sequential human specimens to histologically examine the chronology of wound healing following alveolar ridge augmentation. [ABSTRACT FROM AUTHOR]

Minimally invasive nonsurgical treatment (MINST) aims to remove an etiology with minimal damage to the healthy periodontium and provide the ideal healing environment. This case series introduces the novel protocol of laser-assisted MINST (LAMINST), combining minimally invasive surgery with a dental laser. A total of 25 patients (32 teeth) with advanced periodontal disease were enrolled and received periodontal treatment by following the LAMINST protocol. Probing depth (PD), recession, clinical attachment level (CAL), bleeding on probing (BOP), plaque presence, and site mobility were evaluated preoperatively and at 6 months. Based on the periodontal evaluations, all cases were diagnosed as stage III grade C periodontitis. Six months after LAMINST, the average PD reduction was 4.44 mm and CAL improved by 4.38 mm. Baseline mobility scores of 1 (6 teeth), 2 (9 teeth), and 3 (3 teeth) decreased to 1 (5 teeth) or 0 (13 teeth). The initial prognoses of 5 (hopeless; 15 teeth), 4 (questionable; 13 teeth), and 3 (poor; 4 teeth), improved to 4 (5 teeth), 3 (12 teeth), 2 (fair; 13 teeth), and 1 (good; 2 teeth). The number of BOP sites reduced from 179 to 12, and the number of plaque sites reduced from 173 to 9. All clinical parameters were improved after LAMINST. The application of LAMINST may overcome the traditional limitations of nonsurgical treatment, such as poor accessibility. [ABSTRACT FROM AUTHOR]

Gingival recession is an apical shift of the gingival margin with exposure of the root surface to the oral cavity, which creates an esthetic problem. The present study was attempted to compare vestibular incision subperiosteal tunnel access (VISTA) with and without advanced platelet-rich fibrin (A-PRF) in the treatment of Miller Class I gingival recessions. A total of 24 patients were assigned randomly to either the test group (VISTA with A-PRF) or the control group (VISTA alone). Clinical parameters like recession depth, recession width, clinical attachment loss, width of keratinized gingiva, gingival thickness, and probing depth were recorded at baseline and at 3 and 6 months postoperatively. Intergroup comparison of mean root coverage (RC) in mm, %RC, change in width of keratinized gingiva and clinical attachment gain revealed no statistically significant difference (P > .05). Change in gingival thickness showed statistically significant improvement in test group. Within the limitations of this study, both treatment options (VISTA with A-PRF and VISTA alone) have resulted in predictable and comparable RC, with increased gingival thickness in the test group. [ABSTRACT FROM AUTHOR]

The biggest challenge during periodontal regeneration in the anterior region is the prevention of soft tissue recession. Minimally invasive surgeries, particularly papilla preservation techniques and soft tissue augmentation, may significantly reduce such postoperative soft tissue recession. This article presents the vestibular incision subperiosteal tunnel access (VISTA) approach for periodontal regeneration in the anterior region. A subperiosteal tunnel prepared from a single vertical vestibular incision adjacent to the defect is used for debridement, application of enamel matrix derivative, defect grafting with corticocancellous tuberosity bone, and insertion of the connective tissue graft. Evaluation of six cases with up to 6 years of follow-up showed improvements in all clinical parameters. The probing pocket depth improved from 8.2 ± 0.75 mm initially to 2.7 ± 0.52 mm at follow-up, clinical attachment level improved from 8.5 ± 0.83 mm initially to 2.7 ± 0.52 mm at follow-up, and midfacial gingival recession of 1 mm at two sites was corrected. The papillae were stable at all sites, with an average distance of 4.8 mm from the incisal edge to the papilla tip. This technique seems to be a promising approach for achieving both esthetic and functional goals of periodontal regenerative surgery. However, experience in performing microsurgeries and harvesting tuberosity tissues may be a limitation. [ABSTRACT FROM AUTHOR]

Objectives: Addressing a single-tooth gap in the anterior region, resulting from aplasia or trauma, poses both esthetic and functional challenges. This case report presents the restoration ofa young adult with a cleft, exhibiting anterior hypoplasia and aplasia in the canine and incisor regions, using all-ceramic cantilever resin-bonded fixed dental prostheses. Method and materials: After verification of esthetic and functional considerations through a diagnostic wax-up and an intraoral mock-up, three anterior all-ceramic cantilever resin-bonded fixed dental prostheses made of veneered zirconium dioxide were planned in the region ofthe maxillary right lateral incisor and maxillary left canine. The impression was made with an intraoral scanner. The framework fit was evaluated. Glaze bring and full adhesive cementation under rubber dam followed. Results: The final restoration met the patients' expectations and restored facial esthetics and function. Conclusions: All-ceramic cantilever resin-bonded fixed dental prostheses offer a promising minimally invasive therapeutic option for cleft patients. [ABSTRACT FROM AUTHOR]

Xenogeneic-derived biomaterials are among the most routinely employed bone substitutes for immediate grafting of extraction sites as a modality of alveolar ridge preservation (ARP). The deproteinized bovine bone material is widely used and documented around the world. The present pilot clinical trial evaluated and compared the clinical and morphologic alterations of extraction sites after ARP using two commercially available yet differently processed bovine bone grafts. A total of 20 adjacent extraction sites in 10 patients were included. All sites received the exact same ARP therapy except for the type of bovine bone graft, which was randomly assigned between two adjacent extraction sockets in 10 patients (Group A received Bio-Oss particles and Group B received Cerabone particles). At all sites, healing was monitored at the time of surgery and at 1, 2, 3, and 4 months postoperative. All of the augmented extraction sites achieved successful implant therapy regardless of the bone graft material used for ARP. Six weeks after implant placement, second-stage/uncovering procedures were performed without complications. Intergroup comparisons of the crestal gingival healing process (CGHP), mean transversal crestal ridge resorption (MTRR), and mean implant primary stability (MIPS) were in favor of Group A sites (treatment with Bio-Oss particles). [ABSTRACT FROM AUTHOR]

Partial extraction therapy (PET) is a set of surgical techniques that preserve a portion of the patient's own root structure to maintain blood supply derived from the periodontal ligament complex in order to maintain the periodontium and peri-implant tissues during restorative and implant therapy. PET includes the socket shield technique (SST), proximal shield technique (PrST), pontic shield technique (PtST), and root submergence technique (RST). In a traditional hybrid technique, total extraction and full-arch dental implant therapy often require significant bone reduction and palatal/lingual implant placement. In addition, postextraction preservation of the ridge architecture is a major challenge. This case series demonstrates the use of a combination of PET techniques with digital implant planning and guided implant surgery to achieve highly esthetic outcomes in full-arch implant therapy. [ABSTRACT FROM AUTHOR]

Study Design. Retrospective review of prospectively collected data. Objectives. This study aimed to compare the clinical outcomes of obese patients undergoing minimally invasive transforaminal lumbar interbody fusion (MIS-TLIF) and open TLIF. Summary of Background Data. The perioperative benefits of minimally invasive surgery in obese patients have been described. However, there is limited literature on the patient-reported outcomes (PROs), satisfaction and return to work following MIS-TLIF and open TLIF in this subgroup of patients. Materials and Methods. Obese patients (BMI ≥ 30.0 kg/m²) who underwent a primary, one-level to two-level open and MIS-TLIF were stratified and matched using propensity scoring. Operative time, length of stay, and perioperative outcomes were recorded. Patient-reported outcomes (PROs) including Oswestry disability index, Short Form-36 physical component score, mental component score, visual analogue scale for back pain and leg pain were compared at each postoperative time point. Achievement of minimal clinically important difference (MCID), patient satisfaction and return to work were also assessed. Revision procedures were recorded at mean 10 ± 3.3 years follow-up. Results. In total, 236 obese patients were included: 118 open TLIF and 118 MIS-TLIF. Length of stay was longer in the open TLIF cohort and there was a trend toward a higher complication rate. However, there was no difference in operative time, transfusions, or readmissions. Patients who underwent open TLIF reported worse ODI (P = 0.043) and VAS leg pain at two years, although the latter did not reach statistical significance (P = 0.095). Achievement of MCID for each PRO, patient satisfaction, and return to work were also comparable. Conclusions. Obese patients who underwent MIS-TLIF had a shorter length of stay and improved functional disability at two years compared those who underwent open TLIF. However, a similar proportion achieved a clinical meaningful improvement. Patient satisfaction and return to work were also comparable at two years. Level of Evidence: Level III. [ABSTRACT FROM AUTHOR]

Study design. Retrospective review of prospectively collected data. Objective. To determine the impact of preoperative symptom duration on postoperative functional outcomes after cervical disc replacement (CDR) for radiculopathy. Summary of Background Data. CDR has emerged as a reliable and efficacious treatment option for degenerative cervical spine pathologies. The relationship between preoperative symptom duration and outcomes after CDR is not well established. Methods. patients with radiculopathy without myelopathy who underwent primary 1- or 2-level CDRs were included and divided into shorter (< 6 mo) and prolonged (≥ 6 mo) cohorts based on preoperative symptom duration. patient-reported outcome measures (pROMs) included neck disability index (NDi), visual analog scale (VAS) neck and arm. Changes in PROM scores and minimal clinically important difference (MCID) rates were calculated. Analyses were conducted on the early (within 3 mo) and late (6 mo-2 y) postoperative periods. Results. A total of 201 patients (43.6 ± 8.7 y, 33.3% female) were included. In both early and late postoperative periods, the shorter preoperative symptom duration cohort experienced significantly greater change from preoperative PROM scores compared with the prolonged symptom duration cohort for NDI, VAS-Neck, and VAS-Arm. The shorter symptom duration cohort achieved MCID in the early postoperative period at a significantly higher rate for NDI (78.9% vs. 54.9%, P = 0.001), VAS-Neck (87.0% vs. 56.0%, P < 0.001), and VAS-Arm (90.5% vs. 70.7%, P = 0.002). Prolonged preoperative symptom duration ( ≥ 6 mo) was identified as an independent risk factor for failure to achieve MCID at the latest timepoint for NDI (OR: 2.9, 95% CI: 1.2-6.9, P = 0.016), VAS-Neck (OR: 9.8, 95% CI: 3.7-26.0, P < 0.001), and VAS-Arm (OR: 7.5, 95% CI: 2.5-22.5, P< 0.001). Conclusions. Our study demonstrates improved patient-reported outcomes for those with shorter preoperative symptom duration undergoing CDR for radiculopathy, suggesting delayed surgical intervention may result in poorer outcomes and greater postoperative disability. Level of Evidence. Level III. [ABSTRACT FROM AUTHOR]

Low-temperature plasma ablation has been recently used for minimally invasive surgeries. However, more research is still needed on its generation process during tissue ablation and the underlying mechanism of tissue thermal damage. In this paper, high-speed camera footage, voltage–current signal collection, temperature analysis, and histological analysis were used to investigate the dynamic process of plasma tissue ablation and its thermal effect of dual-needle electrodes immersed in normal saline, which were driven by a high-frequency DC power supply with an output voltage ranging from 220 V to 320 V and a squire wave of 100 kHz. Microbubbles occurred around the ground electrode and merged to form a vapor layer that could completely cover the ground electrode. Plasma capable of ablating tissue would occur in the vapor layer between the ground electrode and tissue. The effect of electrical parameters on plasma generation and its thermal effect are analyzed by statistical results. The experimental results indicated that the voltage applied to the electrodes significantly influenced both the generation and stability of plasma, as well as the heat generation and tissue damage around the electrodes. Furthermore, under the same voltage, the existence of biological tissue promotes the formation of a vapor layer around the electrode, thereby facilitating the generation and stability of plasma. Notably, the temperature rise around the ground electrode is much higher than that around the powered electrode. These results have direct application to the design of plasma tissue ablation systems, which could achieve tissue ablation effects with minimal thermal damage. [ABSTRACT FROM AUTHOR]

Background: This study retrospectively compared short-term clinical outcomes and complications of minimally invasive surgery transforaminal lumbar interbody fusion(MIS-TLIF)and endoscopic lumbar interbody fusion(Endo-LIF))for two-segmental lumbar degenerative disease, aiming to guide spine surgeons in selecting surgical approaches. Methods: From January 2019 to December 2023, 30 patients were enrolled,15 in the MIS-TLIF group and 15 in the Endo-LIF group. All patients were followed up for more than 3 months after surgery and the following information was recorded: (1)surgery time, difference in hemoglobin between preoperative and postoperative, surgical costs, first time out of bed after operation, postoperative hospitalization time, postoperative complication; (2) ODI score (The Oswestry Disability Index), leg and back VAS score (Visual Analogue Scale), and lumbar vertebra JOA score (Japanese Orthopaedic Association Scores); (3) MacNab score at final follow-up to assess clinical outcome, CT to evaluate lumbar fusion. Results: There were significant differences between the two groups regarding operation time and cost, with the MIS-TLIF group performing significantly better. Intraoperative bleeding was considerably less in the Endo-LIF group compared to the MIS-TLIF group. However, there were no significant differences in the time of the first postoperative ambulation, postoperative hospitalization time, and postoperative complications. There was no significant difference in preoperative VAS, ODI, and JOA between the two surgical groups There were no significant differences in VAS(leg), ODI, and JOA scores between the two groups before and at 1 day,7 days, 1 month, 3 months and final follow-up. However, at 1 day postoperatively, the VAS(back)score in the Endo-LIF group was lower than that in the MIS-TLIF group, and the difference was statistically significant. At the final follow-up, all patients achieved grade III and above according to the Bridwell criteria, and there was no significant difference between the two surgical groups compared to each other. According to the MacNab score at the final follow-up, the excellent rate was 80.00% in the Endo-LIF group and 73.33% in the MIS-TLIF group, with no significant difference between the two groups. Conclusion: There was no significant difference in short-term efficacy and safety between Endo-LIF and MIS-TLIF for two-segment degenerative lumbar diseases. MIS-TLIF has a shorter operative time and lower costs, while Endo-LIF causes less tissue damage, blood loss, and early postoperative pain, aiding long-term recovery. Both MIS-TLIF and Endo-LIF are promising for treating two-segment lumbar degenerative disease. The choice of a surgical procedure depends on the patient's financial situation, their ability to tolerate surgery, and the surgeon's expertise. [ABSTRACT FROM AUTHOR]

Background: Large spacers offer numerous advantages such as higher fusion rates and lower subsidence rates. However, due to the anatomical constraints of the approach, the use of large spacers in biportal endoscopic transforaminal lumbar interbody fusion(BE-TLIF) necessitates an additional incision and special instruments for spacer implantation leading to less frequent use. Methods: This study has refined several techniques within BE-TLIF. We insert the cage and impact the cage transverse with a special design instrument in the same working portal. This allows for the use of large spacers during BE-TLIF procedures without the need for an auxiliary cage-inserting incision. Conclusion: The technique is a straightforward, safe, and minimally invasive method for inserting large cages in the treatment of lumbar instability. [ABSTRACT FROM AUTHOR]

This article explores the use of technology in improving the assessment of surgical training. It acknowledges the challenges faced by surgeons in training, such as burnout and limited time for trainers. The article suggests that video recording of surgical procedures can be a valuable tool for assessment and training. However, there are obstacles to implementing video assessment, including technical, cultural, regulatory, and medicolegal issues. The article emphasizes the importance of systematic evaluation and involving stakeholders in the implementation process. It highlights the significance of evidence-based training interventions in the UK and encourages library patrons to participate in a national pilot study on video-based assessment to contribute to research in this field. [Extracted from the article]

To evaluate the efficacy of neuronavigation-assisted stereotactic drilling drainage compared with that of craniotomy in the treatment of massive intracerebral haemorrhage (ICH) in elderly patients. This was a randomized, controlled, blind endpoint clinical study. Elderly patients with massive ICH treated at our neurosurgery department, without the formation of brain herniation preoperatively, all underwent neurosurgical intervention. Patients were randomly assigned to two groups: the minimally invasive surgery (MIS) group, which received neuronavigation-assisted stereotactic drilling drainage, and the craniotomy haematoma removal surgery (CHRS) group. Patient characteristics, surgical anaesthesia methods, surgery duration, intraoperative bleeding volume, duration of ICU stay duration of hospital stay, complications, and modified Rankin scale (mRS) scores at 90 days posttreatment were compared between the two groups. Statistical analysis was performed on the collected data. A total of 67 patients were randomly assigned, with 33 (49.25%) in the MIS group and 34 (50.75%) in the CHRS group. Compared with the CHRS group, the MIS group had advantages, including the use of local anaesthesia, shorter surgery duration, less intraoperative bleeding, shorter ICU stay, and fewer complications (P < 0.05). The MIS group had a significantly improved patient prognosis at 90 days (mRS 0–3). However, there were no significant differences in hospital stay or 90-day survival rate between the two groups (P > 0.05). For elderly patients with massive ICH without brain herniation, stereotactic drilling drainage is a simple surgical procedure that can be performed under local anaesthesia. Patients treated with this approach seem to have better outcomes than those treated with craniotomy. In clinical practice, neuronavigation-assisted stereotactic drilling drainage is recommended for surgical treatment in elderly patients with massive ICH without brain herniation. Clinical trial registration number: NCT04686877 [ABSTRACT FROM AUTHOR]

Bone cement based on magnesium phosphate has extremely favorable properties for its application as a bioactive bone substitute. However, further improvement is still expected due to difficult injectability and high brittleness. This paper reported the preparation of novel biocomposite cement, classified as dual-setting, obtained through ceramic hydration reaction and polymer cross-linking. Cement was composed of magnesium potassium phosphate and sodium alginate cross-linked with calcium carbonate and gluconolactone. The properties of the obtained composite material and the influence of sodium alginate modification on cement reaction were investigated. Our results indicated that proposed cements have several advantages compared to ceramic cement, like shortened curing time, diverse microstructure, increased wettability and biodegradability and improved paste cohesion and injectability. The magnesium phosphate cement with 1.50% sodium alginate obtained using a powder-to-liquid ratio of 2.5 g/mL and cross-linking ratio 90/120 of GDL/CC showed the most favorable properties, with no adverse effect on mechanical strength and osteoblasts cytocompatibility. Overall, our research suggested that this novel cement might have promising medical application prospects, especially in minimally invasive procedures. [ABSTRACT FROM AUTHOR]

Background: India ink has been a popular choice for a tattooing agent in preoperative endoscopic localization but often results in unfavorable effects. Subsequently, autologous blood tattooing has arisen as an alternative option. Due to the limited availability of comparative studies on the matter, we conducted a study to compare the perioperative outcomes associated with India ink tattooing versus autologous blood tattooing. Methods: A total of 96 patients who underwent minimally invasive surgical procedures for left-sided colonic neoplasm following preoperative endoscopic localization were included in the study. These patients were categorized into two groups: 36 patients who received India ink tattooing and 60 patients who underwent autologous blood tattooing. The perioperative outcomes including procedure-related outcomes and postoperative outcomes were compared between the two groups. Results: There was no significant difference in visibility and spillage of tattooing agent between India ink group and autologous blood group. However, India ink group showed a higher incidence of post-tattooing fever, higher level of postoperative C-reactive protein level, longer time to first flatus, resumption of surgical soft diet, and duration of hospital stay, and a higher occurrence of postoperative complications including ileus and surgical site infection compared with the autologous blood group. In the multivariate analysis, India ink tattooing was significantly associated with the occurrence of postoperative complications. In the subgroup analysis involving patients with intraperitoneal spillage, the autologous blood group demonstrated significantly favorable perioperative outcomes compared with India ink group. Conclusions: Autologous blood tattooing demonstrated comparable visibility and enhanced safety, establishing it as a potential alternative to India ink for preoperative endoscopic localization. [ABSTRACT FROM AUTHOR]

Intraoperative laparoscopic ultrasound (IOLUS), a dynamic imaging technique, has emerged as a valuable instrument for guiding surgery in various medical specialties. As IOLUS provides accuracy, improved visualization, and real-time guidance, the integration of IOLUS into many surgical procedures has occurred and IOLUS assists surgeons during advanced procedures. Today, laparoscopic myomectomy has become a prominent surgical procedure in gynecology. Despite its benefits, laparoscopic myomectomy presents certain challenges. The risk of residual fibroids is higher in laparoscopic myomectomy compared to abdominal surgery. The limited depth perception and restricted range of motion can also be obstacles for surgeons, especially when dealing with deeply embedded fibroids. IOLUS has the potential to overcome these limitations. In this study, our aim was to conduct a review of the literature concerning the use of IOLUS during laparoscopic myomectomy. [ABSTRACT FROM AUTHOR]

Background: Colorectal cancer (CRC) is a major health issue worldwide. As the population ages, more older patients including octogenarians will require CRC treatment. However, this vulnerable group has decreased functional reserves and increased surgical risks. Enhanced recovery after surgery (ERAS) pathways aim to reduce surgical stress and complications, but concerns remain about applying ERAS protocols to older patients. We assessed whether a modified ERAS (mERAS) protocol combined would improve outcomes in octogenarian CRC patients undergoing minimally invasive surgery. Methods: In this retrospective cohort study, we compared 360 non‐octogenarians aged 50–64 years and 114 octogenarians aged 80–89 years before and after mERAS protocol implementation. Outcomes including postoperative functionary recovery, length of stay, complications, emergency department visits, and readmissions were analyzed. Results: Despite comparable tumor characteristics, octogenarians had poorer nutrition, American Society of Anesthesiologists status, and more comorbidities. After mERAS, octogenarians had reduced complications, faster return of bowel function, and shorter postoperative length of stay, similar to non‐octogenarians. mERAS implementation improved recovery in both groups without increasing emergency department visits or readmissions. Conclusion: Although less remarkable than in non‐octogenarians, mERAS protocols mitigated higher complication rates and improved recovery in octogenarians after minimally invasive surgery for CRC, confirming protocol feasibility and safety in this vulnerable population. [ABSTRACT FROM AUTHOR]

Purpose: This study aimed to assess the clinical effectiveness and safety of percutaneous endoscopic interlaminar discectomy (PEID) in the management of high-grade migrated Lumbar disc herniation (LDH). Methods: A total of 328 patients who underwent PEID for high-grade migrated LDH between May 2020 and January 2023 in our hospital were selected. Patients were categorized into high-grade migrated group and low-grade migrated group according to preoperative MRI findings. The preoperative and postoperative evaluations of clinical outcomes, such as Visual Analogue Scale (VAS) for lower backs and legs, Oswestry Disability Index (ODI), and modified MacNab criteria for surgical success, were compared between groups. Results: No statistically significant differences were found in hospitalization time, surgery time, intraoperative hemorrhage, number of intraoperative fluoroscopies, or incision length between the two groups. The lower back and leg VAS scores and ODI exhibited a statistically significant decrease in both groups across all postoperative time intervals. However, the difference between the two groups was not statistically significant. Postoperative nerve root stimulation symptoms were reported in two and three cases in the high-grade migrated group and low-grade migrated group, respectively. One patient in the high-grade migrated group underwent reoperation due to re-herniation at the same segment. There was no significant difference in the rate of excellent-good cases between the two groups, with an overall rate of 94.7%. Conclusion: In treating high-grade migrated disc herniation, PEID offers advantages such as reduced trauma, small incision, quicker recovery and satisfactory clinical safety and efficacy. [ABSTRACT FROM AUTHOR]

Background: The technical challenges and safety concerns of single-incision laparoscopic gastrectomy for overweight and obese gastric cancer patients remain unclear. This study aimed to evaluate the safety and feasibility of single-incision laparoscopic distal gastrectomy (SIDG) compared to multiport laparoscopic distal gastrectomy (MLDG) in overweight and obese gastric cancer patients. Methods: This study retrospectively analyzed overweight and obese patients (body mass index ≥ 25 kg/m2) and pathologic stage T1 primary gastric adenocarcinoma treated with either SIDG or MLDG. The SIDG and MLDG groups were propensity score matched at a 1:2 ratio using age, sex, height, body weight, American Society of Anesthesiologists classification, year of surgery, pathologic N stage, and anastomosis method as covariates. Results: After 1:2 matching, the study included patients who underwent SIDG (n = 179) and MLDG (n = 358). No significant difference in the number of retrieved lymph nodes was found between the SIDG and MLDG groups (52.8 ± 19.3 vs. 53.9 ± 21.0, P = 0.56). Operation times were significantly shorter in the SIDG group (170.8 ± 60.0 min vs. 186.1 ± 52.6 min, P = 0.004). The postoperative hospital length of stay was comparable between the 2 groups (SIDG: 5.9 ± 3.4 days vs. MLDG: 6.3 ± 5.1 days, P = 0.23), as was postoperative complication rate (SIDG: 13.4% vs. MLDG: 12.8%, P = 0.89). Conclusions: SIDG was shown to be as safe and feasible as MLDG for overweight and obese gastric cancer patients, with comparable early postoperative complication rates without compromising operation time compared to MLDG. [ABSTRACT FROM AUTHOR]

Background: In 2019, the Gastrectomy Complications Consensus Group (GCCG) published a standardized set of complications aiming toward uniform reporting of post-gastrectomy complications. This study aimed to report outcomes after gastrectomy in the Netherlands according to GCCG definitions and compare them to previously reported national results and the European database reported by the GCCG. Methods: This nationwide, population-based cohort study included all patients undergoing gastrectomy for gastric cancer registered in the DUCA in 2020–2021. Postoperative morbidity and 30-day/in-hospital mortality were analyzed according to the GCCG definitions. For all patients, baseline characteristics and outcomes were compared with the GCCG cohort consisting of 27 European expert centers (GASTRODATA; 2017–2018). Results: In 2020–2021, 782 patients underwent gastrectomy in the Netherlands. Variation was seen in baseline characteristics between the Dutch and the GCCG cohort (N = 1349), most notably in minimally invasive surgery (80.6% vs 19.6%, p < 0.001). In the Netherlands, 223 (28.5%) patients developed a total of 407 complications, the most frequent being non-surgical infections (28.5%) and anastomotic leakage (13.4%). The overall complication and 30-day mortality rates were similar between the Dutch and GCCG cohort (28.5% vs 29.8%, p = 0.563; 3.7% vs 3.6%, p = 0.953). Higher surgical and endoscopic/radiologic reintervention rates were observed in the Netherlands compared to the GCCG cohort (10.7% vs 7.8%, p = 0.025; 10.9% vs 2.9%, p < 0.001). Conclusion: Reporting outcomes according to the standardized GCCG definitions allows for international benchmarking. Postoperative outcomes were comparable between Dutch and GCCG cohorts, but both exceed the international benchmark for expert gastrectomy care, highlighting targets for national and international quality improvement. [ABSTRACT FROM AUTHOR]

Introduction: Minimally invasive oncological resections have become increasingly widespread in the surgical management of cancers. However, the role of minimally invasive surgery (MIS) for gallbladder cancer (GBC) remains unclear. We aim to perform a systematic review and network meta-analysis of existing literature to evaluate the safety and feasibility of laparoscopic and robotic surgery in the management of GBC compared to open surgery (OS) by comparing outcomes. Methods: A literature search of the PubMed/MEDLINE (2000 to December 2021) and EMBASE (2000 to December 2021) databases was conducted. The primary outcome studied was overall survival, and secondary outcomes studied were postoperative morbidity, severe complications, incidence of bile leak, length of hospital stay, operation time, R0 resection rate, local recurrence and lymph node yield. Results: Thirty-two full-text articles met the eligibility criteria and were included in the final analysis with a total of 5883 patients undergoing either OS or MIS (laparoscopic or robotic) for GBC. 1- and 2-stage meta-analyses did not reveal any significant differences between OS, laparoscopic and robotic surgery in terms of overall survival, R0 resection, lymph node harvest, local recurrence and post-operative complications. Patients who underwent OS had significantly longer hospitalization stay and intra-operative blood loss compared to those who underwent laparoscopic or robotic surgery. Network meta-analysis did not reveal any significant differences between post-operative and survival outcomes of laparoscopic vs robotic surgery groups. Conclusion: This network meta-analysis suggests that both laparoscopic and robotic surgery are safe and effective approaches in the surgical management of GBC, with post-operative and survival outcomes comparable to OS. An MIS approach may also lead to shorter hospitalization stay, less intraoperative blood loss and post-operative complications compared to OS. There was no obvious benefit of either MIS approach (laparoscopic versus robotic) over the other. [ABSTRACT FROM AUTHOR]

Introduction: There is uncertainty regarding the method of mesh fixation and peritoneal closure during transabdominal preperitoneal (TAPP) repair for inguinal hernias, with no definitive guidelines to guide surgeon choice. Methods: MEDLINE, Cochrane, Central Register of Clinical Trials, and Web of Science were searched for RCTs published until November 2023. Risk ratios (RRs) and mean differences (MD) with 95% confidence intervals (CIs) were pooled with a random-effects model. Statistical significance was defined as p < 0.05. Heterogeneity was assessed using the Cochran Q test and I2 statistics, with p values inferior to 0.10 and I2 > 25% considered significant. Statistical analyses were conducted using Review Manager version 5.4 and RStudio version 4.1.2 (R Foundation for Statistical Computing). Results: Eight randomized controlled trials (RCTs) were included, comprising 624 patients, of whom 309 (49.5%) patients were submitted to TAPP with the use of tacks, and 315 (50.5%) received suture fixation. The use of tacker fixation was associated with a significant increase in postoperative pain at 24 h (MD 0.79 [VAS score]; 95% CI 0.38 to 1.19; p < 0.0002; I2 = 87%) and one week (MD 0.42 [VAS score]; 95% CI 0.05 to 0.79; p < 0.03, I2 = 84%). The use of tacks was associated with shorter operative time (MD—25.80 [min]; 95% − 34.31– − 17.28; P < 0.00001; I2 = 94%). No significant differences were found in overall complications, chronic pain, seromas, hematomas, and urinary retention rates. Conclusion: In patients who underwent TAPP hernia repair, tacks are associated with decreased operative time but increased postoperative pain at 24 h and one week. [ABSTRACT FROM AUTHOR]

Background: The adoption of Robotic Pancreaticoduodenectomy (RPD) is increasing globally. Meanwhile, reduced-port RPD (RPRPD) remains uncommon, requiring robot-specific techniques not possible with laparoscopy. We introduce a unique RPRPD technique optimizing surgical field exposure. Methods: Our RPRPD utilizes a single-site plus-two ports technique, facilitated by a single-port platform through a 5-cm incision. The configuration of robotic arms (arm1, arm2, arm3, and arm4) were strategically designed for optimal procedural efficiency, with the arms2 and arm3, alongside the assistant trocar, mounted on the single-port platform, while the arms1 and arm4 were positioned laterally across the abdomen. Drainage was established via channels created at the arm1 and arm4 insertion sites. A "gooseneck traction" was principally employed with the robotic instrument to prop up the specimen rather than grasp, improving the surgical field's visibility and access. Clinical outcomes of patients who underwent RPRPD performed between August 2020 and September 2023 by a single surgeon across two centers in Taiwan and Japan were reviewed. Results: Fifty patients underwent RPRPD using the single-site plus-two ports technique. The gooseneck traction technique enabled goodsurgical field deployment and allowed for unrestricted movement of robotic arms with no collisions with the assistant instruments. The median operative time was 351 min (250–488 min), including 271 min (219–422 min) of console time and three minutes (2–10 min) of docking time. The median estimated blood loss was 80 mL (1–872 mL). All RPRPD procedures were successfully performed without the need for conversion to open surgery. Postoperative major morbidity (i.e., Clavien-Dindo grade ≥ IIIa) was observed in 6 (12%) patients and median postoperative hospital stay was 13 days. Conclusions: The single-site plus-two ports RPRPD with the gooseneck traction proves to be a safe, feasible option, facilitating surgical field visibility and robotic arm maneuverability. [ABSTRACT FROM AUTHOR]

Background: The sleeve gastrectomy (SG) has become the most common bariatric procedure worldwide. However, insufficient weight loss or weight recidivism is frequent, which may require effective and safe revisional procedures. Objective: To determine the technical feasibility and safety of a minimally invasive, duodeno-ileal side-to-side anastomosis using a Sutureless Neodymium Anastomosis Procedure (SNAP) for patients with weight recidivism or inadequate weight loss following SG. Methods: This is a prospective, single-arm, open-label pilot study that enrolled patients with obesity to assist in weight reduction following an SG performed > 12 months prior. For the SNAP, self-assembling magnets were deployed into the ileum (laparoscopically) and duodenum (per-oral endoscopy). Magnets were coupled under laparoscopic and fluoroscopic guidance to create a compression anastomosis. The primary endpoints were technical feasibility, weight loss, and rate of serious adverse events (SAEs). Results: Successful duodeno-ileal diversions were created with SNAP in 27 participants (mean age: 50.6 ± 9.1, mean BMI: 38.1 ± 4.6 kg/m2) with no device-related serious adverse events. Upper endoscopy at 3 months confirmed patent, healthy anastomoses in all patients. At 9 months, patients (n = 24) experienced 11.9 ± 6.2%, 14.5 ± 10.8%, and 17.0 ± 13.9% TBWL at 3, 6, and 9 months, respectively. There were no device-related SAEs. Conclusion: The SNAP is technically feasible and relatively safe, with all patients presenting widely patent anastomosis at 3 months. Patients experienced a progressive, clinically meaningful weight loss. Further studies are needed to confirm our findings. [ABSTRACT FROM AUTHOR]

Introduction: Post-operative prescription opioid use is a known risk factor for persistent opioid use. Despite the increased utilization of robotic-assisted surgery (RAS) for inguinal hernia repair (IHR), little is known whether this minimally invasive approach results in less opioid consumption. In this study, we compare long-term opioid use between RAS versus laparoscopic (Lap) versus open surgery for IHR. Methods: A retrospective cohort study of opioid-naïve patients who underwent outpatient primary IHR was conducted using the Merative™ MarketScan® (Previously IBM MarketScan®) Databases between 2016 and 2020. Patients not continuously enrolled 180 days before/after surgery, who had malignancy, pre-existing chronic pain, opioid dependency, or invalid prescription fill information were excluded. Among patients exposed to opioids peri-operatively, we assessed long-term opioid use as any opioid prescription fill within 90 to 180 days post-surgery. Secondary outcomes were controlled substance schedule II/III opioid fill, and high-dose opioid fill defined as > 50 morphine milligram equivalent per day. An Inverse-probability of treatment weighted logistic regression was used to compare outcomes between groups with p-value of < 0.05 considered statistically significant. Results: A total of 41,271 patients were identified (2070 (5.0%) RAS, 16,704 (40.5%) Lap, and 22,497 (54.5%) open surgery). RAS was associated with less likelihood of prescription fills for any opioid (OR 0.78, 95% CI 0.60 to 0.98 versus Lap; OR 0.67, 95% CI 0.52 to 0.85 versus open), and schedule II/III opioid (OR 0.74, 95% CI 0.56 to 0.96 versus Lap; OR 0.68, 95% CI 0.51 to 0.88 versus open), but comparable high-dose opioid fill (OR 0.95, 95% CI 0.54 to 1.55 versus Lap; OR 0.96, 95% CI 0.56 to 1.52 versus open). Lap and open surgery had no significant difference. Conclusion: In this cohort of patients derived from a national commercial claims dataset, patients undergoing RAS had a decreased risk of long-term opioid use compared to laparoscopic and open surgery patients undergoing IHR. [ABSTRACT FROM AUTHOR]

Background: Sleeve gastrectomy is the most common bariatric procedure and its long-term complications include inadequate weight loss, weight regain, and de novo GERD, often requiring revisional surgery. Revisions, notably re-sleeve and conversion to Roux-en-Y gastric bypass (RYGB), are frequently performed, but safety data is limited. Herein, we used the MBSAQIP database to compare 30 day outcomes of primary sleeve gastrectomy (SG) with re-sleeve (RS) and SG to RYGB conversion. Methods: Patients who underwent primary SG, RS, and SG to RYGB conversion within the MBSAQIP data registry from January 1, 2020 to December 31, 2022 were included in this study. Using Propensity Score Matching analysis, the cohorts were matched for 23 preoperative characteristics. We then compared 30 day postoperative outcomes and bariatric-specific complications between primary SG and RS (analysis 1) and between RS and SG to RYGB conversion (analysis 2). Results: A total of 302,961 were included. The matched cohorts in analysis 1 (n = 1630) and analysis 2 (n = 1633) had similar pre-operative characteristics. Propensity-matched outcomes in analysis 1 showed that patients in the RS group had significantly higher staple line leak (1.3% vs. 0.1%, p < 0.001) when compared to primary SG. Similarly, longer operative times (90.16 ± 51.90 min vs. 68.32 ± 37.54 min, p < 0.001) and higher rates of readmissions (5.5% vs. 2.1%, p < 0.001), reoperations (2.3% vs. 0.6%, p < 0.001), interventions (2.5% vs. 0.4%, p < 0.001) were found in those who underwent RS. In analysis 2, RS showed higher leak rates (1.3% vs. 0.5%, p = 0.015) when compared to conversion from SG to RYGB. Conclusion: The RS group has a higher risk of staple line leaks compared to primary SG and conversion from SG to RYGB. In our study, there was a 2.6-fold increase in staple line leak after re-sleeve compared to RYGB conversion and a 13-fold increase compared to primary SG. [ABSTRACT FROM AUTHOR]

Background: There is much heterogeneity in the instrumentation used for parenchymal transection in minimally invasive liver surgery. Instruments specifically designed for robotic parenchymal transection of the liver are lacking. We aim to gain insight into the safety and effectiveness of the SynchroSeal (Intuitive Surgical, Inc., Sunnyvale, CA), a novel bipolar electrosurgical device, in the context of liver surgery. Methods: The present study is a post-hoc analysis of prospectively collected data from patients undergoing robotic liver resection (RLR) using the SynchroSeal in two high-volume centres. The results of the SynchroSeal were compared with that of the previous generation bipolar-sealer; Vessel Sealer Extend (Intuitive Surgical, Inc., Sunnyvale, CA) using propensity score matching, after excluding the first 25 Vessel Sealer procedures per center. Results: During the study period (February 2020–March 2023), 155 RLRs meeting the eligibility criteria were performed with the SynchroSeal (after implementation in June 2021) and 145 RLRs with the Vessel Sealer. Excellent outcomes were achieved when performing parenchymal transection with the SynchroSeal; low conversion rate (n = 1, 0.6%), small amounts of intraoperative blood loss (median 40 mL [IQR 10–100]), short hospital stays (median 3 days [IQR 2–4]), and adequate overall morbidity (19.4%) as well as severe morbidity (11.0%). In a matched comparison (n = 94 vs n = 94), the SynchroSeal was associated with less intraoperative blood loss (48 mL [IQR 10–143] vs 95 mL [IQR 30–200], p = 0.032) compared to the Vessel Sealer. Other perioperative outcomes were similar between the devices. Conclusion: The SynchroSeal is a safe and effective device for robotic liver parenchymal transection. [ABSTRACT FROM AUTHOR]

Background: To compare the clinical and radiological outcomes of modified mini-open transforaminal lumbar interbody fusion (mMO-TLIF) via posterior midline incision for "targeted limited dissection" versus minimal invasive transforaminal lumbar interbody fusion (MIS-TLIF) via Wiltse approach in lumbar degenerative diseases. Methods: A total of 60 consecutive patients in our center from January 2019 to March 2020 were enrolled, including 30 patients who were treated with mMO-TLIF via posterior midline incision and 30 treated with MIS-TLIF through the Wiltse approach. Perioperative parameters were recorded. The questionnaires of Oswestry Disability Index (ODI) and Visual Analogue Score (VAS) were conducted before the operation and after the operation (3 days, 1 week, and 2 years). CT and MRI radiological outcomes were evaluated before the operation and at a 2-year follow-up. Results: There were no significant differences in the general data, gender, age, and BMI between the two groups. All patients were successfully operated without intraoperative complications. There were significant differences between the two groups in the operation time (p < 0.001) and intraoperative bleeding (p < 0.05). There was no difference in ODI and VAS scores between groups pre- and post-operatively, but they were both significantly improved compared to those before the operation (p < 0.01). At a 2-year follow-up, the paraspinal muscle atrophy and fat infiltration were increased comparing to pre-operation, but the difference was also not statistically significant (p > 0.05). In addition, both the two groups' fusion rates were more than 90% at a 2-year follow-up, however, no difference was detected between the two groups. Conclusion: mMO-TLIF via midline incision for "targeted limited dissection" could achieve similar clinical and radiological outcomes as MIS-TLIF for lumbar degenerative disease. [ABSTRACT FROM AUTHOR]

Surgery for cancer of the esophagus or gastro-esophageal junction can be performed with a variety of minimally invasive and open approaches. The left thoracoabdominal esophagectomy (LTE) is an open technique that gives an opportunity to operate in the chest and abdomen with excellent exposure of the gastro-esophageal junction through a single incision, and there is currently no equivalent minimally invasive technique available. The aim of this multi-institutional review was to study a large contemporary international study cohort of patients treated with LTE. An international multicenter cohort study was performed including all patients treated with LTE at six high-volume centers for gastro-esophageal cancer surgery between 2012 and 2022. Patient data were prospectively collected in each participating centers' institutional database. Information about patient, tumor, and treatment details were collected. The study cohort included a total of 793 patients treated with LTE during the study period. The most frequently observed complications were pneumonia in 185/727 (25.5%) patients and atrial fibrillation in 91/727 (12.5%). Anastomotic leak occurred in 35/727 (4.8%) patients; no patient suffered from conduit necrosis. Thirty-day mortality occurred in 15/785 (1.9%) patients and 90-day mortality in 39/785 (5.0%) patients. Factors with statistically significant association with survival were American Society for Anesthesiologists-score, tumor location, tumor stage, and tumor free resection margins. Neoadjuvant therapy was not associated with increased survival compared to surgery alone but neoadjuvant chemoradiotherapy compared to neoadjuvant chemotherapy showed statistically significant improved survival with hazard ratio 0.60 (95% confidence intervals:0.44–0.80, P  = 0.001) in a multivariable adjusted model. This study demonstrates that LTE can be applied in selected patients with results that are comparable to other large studies of open and minimally invasive surgery for esophageal or gastro-esophageal cancer at high-volume centers. [ABSTRACT FROM AUTHOR]

Objective: The analysis of surgical videos using artificial intelligence holds great promise for the future of surgery by facilitating the development of surgical best practices, identifying key pitfalls, enhancing situational awareness, and disseminating that information via real‐time, intraoperative decision‐making. The objective of the present study was to examine the feasibility and accuracy of a novel computer vision algorithm for hysterectomy surgical step identification. Methods: This was a retrospective study conducted on surgical videos of laparoscopic hysterectomies performed in 277 patients in five medical centers. We used a surgical intelligence platform (Theator Inc.) that employs advanced computer vision and AI technology to automatically capture video data during surgery, deidentify, and upload procedures to a secure cloud infrastructure. Videos were manually annotated with sequential steps of surgery by a team of annotation specialists. Subsequently, a computer vision system was trained to perform automated step detection in hysterectomy. Analyzing automated video annotations in comparison to manual human annotations was used to determine accuracy. Results: The mean duration of the videos was 103 ± 43 min. Accuracy between AI‐based predictions and manual human annotations was 93.1% on average. Accuracy was highest for the dissection and mobilization step (96.9%) and lowest for the adhesiolysis step (70.3%). Conclusion: The results of the present study demonstrate that a novel AI‐based model achieves high accuracy for automated steps identification in hysterectomy. This lays the foundations for the next phase of AI, focused on real‐time clinical decision support and prediction of outcome measures, to optimize surgeon workflow and elevate patient care. Synopsis: AI‐based model achieves high‐accuracy surgical step detection in laparoscopic hysterectomies, paving the way for incorporation of surgical intelligence platforms in gynecology. [ABSTRACT FROM AUTHOR]

Cyst excision and Roux-en-Y hepaticojejunostomy (RYHJ) is the standard treatment for choledochal cysts (CCs). In the present study, the results of totally laparoscopic surgery for CCs (TLCCs) in a pediatric population were evaluated. The clinical data of 28 children with CCs between June 2020 and June 2023 were retrospectively reviewed. All patients underwent TLCCs involving cyst excision and RYHJ. The jejunojejunal anastomosis was completed laparoscopically using manual sutures. Age at operation, operative time, postoperative recovery and complications were evaluated. The 28 patients comprised 8 boys and 20 girls who underwent TLCCs at a mean age of 4.2 years (range, 1 month-12.3 years) with a mean weight of 15.9 kg (range, 4.6-43 kg). All patients received ultrasound and magnetic resonance cholangiopancreatography examinations, which revealed a mean cyst diameter and length of 1.74±0.76 cm and 3.85±1.25 cm, respectively. The mean operative time was 214±43.8 min. The mean time until starting an oral diet after surgery was 2.89±1.23 days. Apart from bile leakage and wound infection, no other complications occurred during a median follow-up period of 18 months (range, 4-42 months). TLCCs can be performed safely by skilled surgeons in pediatric patients. TLCCs may be more physiologically compatible and accelerate recovery of intestinal function with reduced trauma and better esthetic outcomes than conventional laparoscopic surgery for CCs. Therefore, TLCCs with manual sutures may be considered as an option for minimally invasive surgery in pediatric patients with CCs. [ABSTRACT FROM AUTHOR]

This article discusses the surgical management of primary hyperparathyroidism, specifically focusing on the use of minimally invasive parathyroidectomy (MIP) for solitary parathyroid adenoma. The study found that open MIP can be safely and reliably performed as a day-case procedure, with accurate pre-operative localization using ultrasound and 99m Tc-sestamibi scans optimizing the success of the surgery. The article emphasizes the importance of a multidisciplinary team involving various medical professionals to enable open MIP to become a routine day-case procedure. The study also highlights the low complication rates associated with MIP and the potential for same-day discharge. [Extracted from the article]

Introduction: Medical thoracoscopy is a minimally invasive and safe procedure mostly performed for unexplained exudative pleural effusions but may be considered for pneumothorax (PNX). Methods: This retrospective study included participants affected by PNX who underwent medical thoracoscopy with talc poudrage at a single academic hospital from 2008 to 2021. The primary endpoint was the observation of complete radiographical lung re-expansion and absence of air supply from the chest drain within 7 days of medical thoracoscopy. The secondary endpoint was achieving no recurrence of ipsilateral PNX at 24 months post-discharge. Results: A total of 95 patients affected by primary spontaneous PNX (PSP), secondary spontaneous PNX (SSP), iatrogenic, and traumatic PNX were enrolled. An additional procedure was required by 17.89% of patients, and only one patient with SSP required subsequent surgery. Recurrence of PNX occurred on the same side within 24 months after discharge in 9.47% of patients, with a median time to recurrence of 13.5 months. The PSP group was significantly more likely to achieve the primary endpoint. Pleural morphology was significantly associated with reaching the primary endpoint, while receiving a cumulative dose of talc greater than or equal to 4 g during hospitalization was associated with a lower risk of meeting it. Receiving a cumulative dose of talc greater than or equal to 4 g led in all cases to the achievement of the secondary endpoint. Patients with iatrogenic and traumatic PNX had an excellent prognosis in both the short- and long-term evaluation. Conclusion: Medical thoracoscopy is an effective procedure for treating PNX in the acute setting in selected cases while preventing long-term relapses. Large prospective clinical studies are needed to support and better define the role of medical thoracoscopy in current clinical practice. [ABSTRACT FROM AUTHOR]

Key points: The angled tip and small size of the crescent blade provide versatility for its use in a variety of endonasal procedures.The crescent blade enables cutting along 180° from the tip, ensuring a tangential cut through the mucosa, which is important for flap viability.The disposable nature of the blade ensures that it is always sharp, allowing for its use in mucosal and cartilaginous cuts. [ABSTRACT FROM AUTHOR]

BACKGROUND: Improving the quality of care is a priority for health systems to obtain better care and reduce costs. One of the tools for measuring quality is benchmarking (BM). We presented a 1- country prospective study of distal pancreatectomies (DPs) and determined BM. STUDY DESIGN: Prospective, multicenter, observational snapshot study of DP carried out at Spanish hepatopancreatobiliary centers for a year (February 1, 2022, to January 31, 2023). Hepatopancreatobiliary centers were defined as high volume if they performed more than 10 DPs per year. Inclusion criteria include any scheduled DP for any diagnosis and age older than 18 years. The low-risk group was defined following the criteria given by Durin and colleagues and major complications as Clavien-Dindo ≥III. RESULTS: A total of 313 patients from 42 centers and 46.6% from high-volume centers were included. Median DP by center was 7 (interquartile range 5 to 10), median age was 65 years (interquartile range 55 to 74), and 53.4% were female. The surgical approach was minimally invasive in 69.3%. Major complications were 21.1%. Postoperative pancreatic fistula grade B/C rate was 20.1%, and 90-day mortality was 1.6%. One hundred forty-three patients were in low-risk group (43.8%). Compared with previous BM data, an increasing MIS rate and fewer hospital stay were obtained. CONCLUSIONS: We present the first determination of DP-BM in a prospective series, obtaining similar results to the previous ones, but our BM values include a shorter hospital stay and a higher percentage of minimally invasive surgery probably related to Enhanced Recovery after Surgery protocols and prospective data collection. BM is a multiparameter valuable tool for reporting outcomes, comparing centers, and identifying the points to improve surgical care. [ABSTRACT FROM AUTHOR]

This research article explores the potential risk of pelvic hematoma following a prostatic urethral lift (PUL) procedure, which is used to treat benign prostate enlargement. The article identifies factors that can increase the risk of this complication, such as anatomical abnormalities and the use of certain medications. It emphasizes the importance of early diagnosis and monitoring, as well as individualized patient care. The article concludes by offering proactive management strategies to prevent complications and improve patient outcomes. The article was written by Vikas Kumar Panwar from the Department of Urology at the All India Institute of Medical Science and can be found on the website of the Investigative and Clinical Urology journal. [Extracted from the article]

The distal tibiofibular joint is described as a syndesmosis. The syndesmosis is important to the structural integrity of the ankle joint by maintaining the proximity of the tibia, fibula, and talus. Syndesmotic or high ankle sprains, involving the syndesmotic ligaments, pose a significant rehabilitative challenge due to their intricate anatomy, prolonged recovery periods following injury, and high susceptibility to persistent disability. Traditional management strategies have often been conservative, marked by lengthy periods of immobilization and a gradual return to activity. Severe syndesmotic injuries with diastasis have been treated surgically with screw fixation which may require a second intervention to remove the hardware and carries an inherent risk of breaking the screw during rehabilitation. Another fixation technique, the Tightrope™, has gained popularity in treating ankle syndesmosis injuries. The TightRope™ involves inserting Fiberwire® through the tibia and fibula, which allows for stabilization of the ankle mortise and normal range of motion. The accelerated rehabilitation protocol promotes early weight-bearing and has been shown to expedite the return to sport. This emerging strategy has shown promise in reducing recovery time as it is now possible to return to sport in less than 2 months after a tightrope repair and accelerated rehabilitation, compared with 3-6 months post screw fixation. This clinical commentary delves into this novel approach, highlighting the procedure, rehabilitation protocols, and the implications for physical therapy practice. [ABSTRACT FROM AUTHOR]

Disc displacement without reduction (DDwoR) can cause pain and limitations in mouth opening, with a significant impact on function. The optimal management strategy for DDwoR is unclear. Treatments include conservative management such as mandibular manipulation, occlusal splints, and patient education/self-management, as well as arthrocentesis, which is a minimally invasive procedure. The aim of this systematic review and meta-analysis was to ascertain whether there is a role for arthrocentesis in the management of DDwoR. Studies analysing the outcomes pain and maximum mouth opening (MMO) in patients with DDwoR treated by arthrocentesis or occlusal coverage devices were eligible for inclusion. Following a database search, six studies with a total of 343 participants were found to be eligible for analysis (three prospective observational studies, one retrospective observational study, one non-randomized single-blind clinical trial, and one unblinded randomized clinical trial). When compared to occlusal coverage splints, arthrocentesis demonstrated a slight improvement in pain, although this was statistically non-significant (standardized mean difference (SMD) −0.50, 95% confidence interval (CI) −1.04 to 0.05, P = 0.07; I 2 = 81%), and a significant improvement in MMO (SMD 0.79 mm, 95% CI 0.24–1.35 mm, P = 0.005; I 2 = 79%). However, due to the significant heterogeneity between studies and the high risk of bias, along with the paucity of double-blind randomized controlled clinical trials, definitive conclusions cannot be drawn for this clinical question. [ABSTRACT FROM AUTHOR]

Background: Radiofrequency ablation (RFA) for thyroid nodules has recently been introduced into the United States healthcare system landscape. Little is known about the process of incorporating this procedure into existing clinical practice. Methods: A retrospective chart review of a single institution was conducted to examine referral patterns and decision‐making after the introduction of RFA into an endocrine surgery‐focused practice. Patient demographics and thyroid‐specific data were recorded. Two reviewers abstracted and coded reasons for the noncompletion of RFA. Two‐sample t tests were used to compare groups; linear regression was used to assess trends and practice patterns. Results: Chart review identified 451 patients referred for consideration of RFA from January 2020 to December 2022. Only 255 (56.5%) went on to receive the treatment. There was no significant difference in nodule volume between treated and nontreated groups (18.5 vs. 14.9 cm3, p = 0.07). Concern for malignancy on genetic testing, size (too large/too small), recommendation for Ethanol ablation, and multinodular disease without target nodules were the most common reasons for physician deferral. Of patients who declined to proceed, 46% opted to undergo surgical excision. Linear regression showed that referral numbers significantly increased with time; however, the proportion of patients receiving treatment decreased yearly, primarily because of higher rates of physician deferral. Conclusions: This study reflects the complex decision‐making in offering minimally invasive thyroid nodule ablation. Despite a greater number of referrals over time, physician criteria became increasingly selective. Optimal candidacy in RFA is an evolving determination requiring patient and physician input to guide ideal practice patterns. [ABSTRACT FROM AUTHOR]

Purpose: Endoscopic sleeve gastroplasty (ESG) is a minimally invasive day procedure that the MERIT randomized controlled trial (RCT) has demonstrated to be an effective and safe method of weight loss versus lifestyle modification alone. We sought to evaluate the cost-effectiveness of ESG from the perspective of a US commercial payer in a cohort of adults with class II and class I obesity with diabetes based on this RCT. Materials: We used a Markov modelling approach with BMI group health states and an absorbing death state. Baseline characteristics, utilities, BMI group transition probabilities, and adverse events (AEs) were informed by patient-level data from the MERIT RCT. Mortality was estimated by applying BMI-specific hazard ratios to US general population mortality rates. We used BMI-based health state utilities to reflect the impact of obesity comorbidities and applied disutilities due to ESG AEs. Costs included intervention costs, AE costs, and BMI-based annual direct healthcare costs to account for costs associated with obesity comorbidities. A willingness-to-pay threshold of $100,000 per quality-adjusted life year (QALY) was assumed. Results: In our base-case analysis over a 5-year time horizon, ESG was cost-effective versus lifestyle modification alone with an incremental cost-effectiveness ratio of $23,432/QALY. ESG remained cost-effective in all sensitivity analyses we conducted and was dominant in analyses with longer time horizons. Conclusion: ESG is a cost-effective treatment option for people living with obesity and should be considered in commercial health plans as an additional treatment option for clinically eligible patients. [ABSTRACT FROM AUTHOR]

Key Points Positive pressure transmitted from continuous positive airway pressure (CPAP) to the sinuses and skull base in the early post‐operative period has not been studied in live subjects and controversy exists in when to restart this post‐operatively. This study found that approximately 32.76% and 13.52% of the delivered CPAP pressures reached the post‐surgical sphenoid sinus and the mid‐nasal cavity, respectively, suggesting that surgical factors such as tissue edema, nasal packing, blood, and nasal secretions may provide a protective effect. Positive pressure transmitted from continuous positive airway pressure (CPAP) to the sinuses and skull base in the early post‐operative period has not been studied in live subjects and controversy exists in when to restart this post‐operatively.This study found that approximately 32.76% and 13.52% of the delivered CPAP pressures reached the post‐surgical sphenoid sinus and the mid‐nasal cavity, respectively, suggesting that surgical factors such as tissue edema, nasal packing, blood, and nasal secretions may provide a protective effect. [ABSTRACT FROM AUTHOR]

Purpose: Previous studies have shown a higher recurrence rate and longer operative times for thoracoscopic repair (TR) of congenital diaphragmatic hernia (CDH) compared to open repair (OR). An updated meta-analysis was conducted to re-evaluate the surgical outcomes of TR. Methods: A comprehensive literature search comparing TR and OR in neonates was performed in accordance with the PRISMA statement (PROSPERO: CRD42020166588). Results: Fourteen studies were selected for quantitative analysis, including a total of 709 patients (TR: 308 cases, OR: 401 cases). The recurrence rate was higher [Odds ratio: 4.03, 95% CI (2.21, 7.36), p < 0.001] and operative times (minutes) were longer [Mean Difference (MD): 43.96, 95% CI (24.70, 63.22), p < 0.001] for TR compared to OR. A significant reduction in the occurrence of postoperative bowel obstruction was observed in TR (5.0%) compared to OR (14.8%) [Odds ratio: 0.42, 95% CI (0.20, 0.89), p = 0.02]. Conclusions: TR remains associated with higher recurrence rates and longer operative times. However, the reduced risk of postoperative bowel obstruction suggests potential long-term benefits. This study emphasizes the importance of meticulous patient selection for TR to mitigate detrimental effects on patients with severe disease. [ABSTRACT FROM AUTHOR]

Background: The free deep inferior epigastric artery perforator (DIEP) flap is the gold standard in autologous breast reconstruction. Asian patients often present with a smaller body mass index with relatively insufficient tissue. To restore appropriate symmetry, a larger flap inset ratio must be transferred. Supercharging of the second vein or inclusion of bilateral pedicle is commonly required. Current paradigm shifts in mastectomy has also resulted in more minimally invasive surgeries (MIS) espousing smaller lateral incisions, leading to a significant change in available recipient vessels. This study aimed to demonstrate our experience in changing strategies of DIEP flaps following the evolution of mastectomy techniques. Methods: Between October 2008 and March 2022, retrospective data was gathered for 278 patients who underwent breast reconstruction surgery utilizing DIEP flaps by a single plastic surgeon. These patients were divided into two distinct groups based on their operation dates, with November 2018 marking a pivotal moment when the first MIS, including endoscopic-assisted and robot-assisted mastectomy, was introduced. Results: A total of 278 patients were included. Bipedicle vessel utilization for flap supercharge saw a significant increase (15.9% vs. 7%, p < 0.001), while the use of the superior inferior epigastric vein (SIEV) decreased (5.1% vs. 17.1%, p = 0.01). Preceding MIS, SIEV was the primary choice for flap supercharge (96.0%, p < 0.001), whereas post-introduction, the contralateral DIEP pedicle gained prominence (75.9%, p < 0.001). There was also an increased utilization of thoracodorsal artery and lateral thoracic artery following MIS. Conclusion: These findings underscore the profound impact of MIS on the strategic choices made in DIEP flap-based breast reconstruction. Trial registration: This study is retrospectively registered on ClinicalTrials.gov (NCT06321549). [ABSTRACT FROM AUTHOR]