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The article discusses the importance of promoting sustainability in traumatology and orthopaedic surgery due to the significant environmental impact of healthcare emissions. It highlights the need for reducing water and energy consumption in operating theatres, optimizing resource use, and implementing sustainable practices. The article also emphasizes the role of organizations like SICOT in promoting sustainable practices in orthopaedic surgery through initiatives such as waste management protocols and educational programs. Overall, the article underscores the importance of integrating sustainable practices in orthopaedics to reduce carbon emissions and costs while prioritizing patient care. [Extracted from the article]

Purpose: Sentinel lymph node biopsy (SLNB) has been recognized as "the gold standard" for axillary staging in early breast cancer patients with clinically negative lymph nodes, resulting in significant morbidity decrease and quality of life improvement. This study aims to validate the performance of a newly developed handheld portable gamma camera (PGC) produced by Imagensys (Italy), in detecting and locating sentinel lymph nodes (SLNs) during the preoperative and intraoperative phases in breast cancer patients compared to conventional lymphoscintigraphy. Methods: Adult female patients with histologically confirmed breast cancer, candidates for surgery and SLNB, were prospectively enrolled in this open-label, pre-marketing clinical trial. All patients underwent pre- operative assessment using both the PGC and conventional lymphoscintigraphy. The performance of the two devices was compared using the Poisson regression model for incidence rate ratios (IRRs). The intrinsic sensitivity of the devices was compared using the Wilcoxon Ranked Sign Test. The utility of PGC during intra-operative procedures was also evaluated. The manoeuvrability of the devices was evaluated using operator-satisfaction questioner. Results: Sixty-eight patients (median age 50 years, BMI 21.4) were enrolled, including two patients with bilateral breast cancer, who underwent SLNB on both axillae. The PGC demonstrated superior preoperative lymph node detection rate (IRR 8.01, 95% CI 6.11–10.50; p < 0.0001) and intrinsic device sensitivity (mean counts per second 409 ± 286 vs. 255 ± 1173 for conventional device, p = 0.0003) compared to the conventional gamma camera. Intra-operative assessment with PGC was performed in 62 patients and no additional lymph nodes were visualised. However, the conventional gamma camera demonstrated superior manoeuvrability (p < 0.0001). Conclusion: The PGC handheld gamma camera showed promising results for preoperative SLN assessment in patients with breast cancer. The limited manoeuvrability may be related to the operator's experience leading to higher inter-operator variability. Appropriate training and frequent use of nuclear medicine and surgical equipment could overcome this limitation. [ABSTRACT FROM AUTHOR]

Introduction: Video feedback, particularly with a head-mounted camera, has previously been described as a useful debriefing tool in well-funded health systems but has never been performed in a low-resource environment. The purpose of this randomized, intervention-controlled study is to evaluate the feasibility of using video feedback with a head-mounted camera during intestinal anastomosis simulation training in a low-resource setting. Methodology: This study recruited 14 first-year surgery residents in Senegal, who were randomized into control and camera groups. Both groups received reading materials and video lectures before performing a manual end-to-end intestinal anastomosis using a synthetic model. The control group received oral feedback, while the camera group's first attempt was recorded, reviewed, and discussed before the second attempt. The primary outcomes were OSATS scores and completion time. Results: There were no significant demographic differences between the groups. Both groups showed significant improvement in OSATS scores from the first to the second attempt (control group: p = 0.002; camera group: p = 0.0021). The camera group demonstrated a significant reduction in completion time on the second attempt (p = 0.0038), unlike the control group (p = 0.17). Both groups reported increased confidence in performing the task (control group: p = 0.003; camera group: p = 0.0029) and had positive perceptions of the workshop's effectiveness. Conclusion: This pilot study suggests that video feedback with a head-mounted camera is feasible and effective for debriefing during intestinal anastomosis simulation training in a low-resource setting, offering a low-cost, effective way to enhance technical skills. Further research with larger sample sizes is recommended to validate these findings and explore long-term impacts on surgical proficiency. [ABSTRACT FROM AUTHOR]

Background/Objectives: Emergency airway management is a critical skill for healthcare professionals, particularly in life-threatening situations like "cannot intubate, cannot oxygenate" (CICO) scenarios. Errors and delays in airway management can lead to adverse outcomes, including hypoxia and death. Cognitive aids, such as checklists and algorithms, have been proposed as tools to improve decision-making, procedural competency, and non-technical skills in these high-stakes environments. This systematic review aims to evaluate the effectiveness of cognitive aids in enhancing emergency airway management skills among health professionals and trainees. Methods: A systematic search of MEDLINE, Embase, CINAHL, Cochrane Library, Scopus, Web of Science, and ClinicalTrials.gov was conducted from February to March 2024. Studies examining the use of cognitive aids, such as the Vortex method, the ASA difficult airway algorithm, and visual airway aids, in emergency airway scenarios were included. Outcomes assessed included decision-making speed, procedural success rates, and non-technical skills. Data were extracted using standardized protocols, and the quality of included studies was appraised. Results: Five studies met inclusion criteria, encompassing randomized controlled trials, controlled studies, and mixed-methods research. Cognitive aids improved decision-making times (reduced by 44.6 s), increased procedural success rates, and enhanced non-technical skills such as teamwork and crisis management. Participants reported reduced anxiety and improved confidence levels (self-efficacy scores increased by 1.9 points). The Vortex method and visual cognitive aids demonstrated particular effectiveness in simulated scenarios. Conclusions: Cognitive aids significantly enhance emergency airway management skills, improving performance, reducing errors, and increasing provider confidence. Integrating cognitive aids into training programs has the potential to improve patient safety and outcomes. Further research is needed to validate these findings in clinical settings and optimize cognitive aid design and implementation. [ABSTRACT FROM AUTHOR]

Multispectral imaging (MSI) enables non-invasive tissue differentiation based on spectral characteristics and has shown great potential as a tool for surgical guidance. However, adapting MSI to open surgeries is challenging. Systems that rely on light sources present in the operating room experience limitations due to frequent lighting changes, which distort the spectral data and require countermeasures such as disruptive recalibrations. On the other hand, MSI systems that rely on dedicated lighting require external light sources, such as surgical lights, to be turned off during open surgery settings. This disrupts the surgical workflow and extends operation times. To this end, we present an approach that addresses these issues by combining active illumination with smart background suppression. By alternately capturing images with and without a modulated light source at a desired wavelength, we isolate the target signal, enabling artifact-free spectral scanning. We demonstrate the performance of our approach using a smart pixel camera, emphasizing its signal-to-noise ratio (SNR) advantage over a conventional high-speed camera. Our results show that accurate reflectance measurements can be achieved in clinical settings with high background illumination. Medical application is demonstrated through the estimation of blood oxygenation, and its suitability for open surgeries is discussed. [ABSTRACT FROM AUTHOR]

OBJECTIVE Assessment of feasibility and proof of concept study for microvascular reactivity in anesthetized cats. METHODS 12, adult, healthy, purpose-bred cats were included. Cats were anesthetized and instrumented with a perivascular ultrasound transit time flow probe around the main pulmonary artery, a femoral arterial catheter, a central venous catheter, and a laser Doppler flowmeter with a heating unit. After a 20-minute stabilization period, microvascular reactivity, hemodynamic variables, and arterial and central venous blood gases were measured during 3 phases: (1) baseline, (2) hemorrhage, and (3) isotonic crystalloid bolus. Hemorrhage was induced by atraumatic blood loss of 20 mL/kg over 20 minutes. An isotonic crystalloid bolus at 20 mL/kg was administered IV over 20 minutes. RESULTS 6 cats were excluded from the analysis due to equipment errors or surgical complications. Microvascular reactivity decreased significantly after hemorrhage and remained below baseline after isotonic crystalloid bolus. CONCLUSIONS Microvascular reactivity assessment is feasible in healthy anesthetized cats. Hemorrhage decreases microvascular reactivity, and the administration of an isotonic crystalloid bolus did not reverse these changes. However, the small sample size may limit the external validity of the results. CLINICAL RELEVANCE This study demonstrated the feasibility of microvascular reactivity assessment in anesthetized cats. However, proper validation is warranted before clinical application. [ABSTRACT FROM AUTHOR]

Background: The objective of an operating room (OR) ultra-clean ventilation system is to eliminate or reduce the quantity of dust particles and colony-forming units per cubic meter of air (CFU/m3). To achieve this, ultra-clean goal high air change rates per hour are required to reduce the particle load and number of CFU/m3. Aim: To determine the air quality in an ultra-clean OR during surgery, in terms of the number and type of microorganism and quantity of dust particles in order to establish a benchmark. Methods: Number of CFUs and the quantity of dust particles were measured. For measuring the CFUs, sterile extraction hoses were positioned at the incision, the furthest away positioned instrument table, and the periphery. At these locations, air was extracted to determine the quantity of dust particles. Findings: The number of CFU/m3 and particles was on average at wound level ≤1 CFU/m3 resp. 852.679 particles, at instrument table ≤1 CFU/m3 resp. 3.797 particles and in the periphery ≤8 CFU/m3, resp. 4.355 particles. Conclusion: The number of CFUs in the ultra-clean area is below the defined ultra-clean level of ≤10 CFU/m3 for ultra-clean surgery. The quantity of dust particles measured during surgery was higher than the defined ISO 5. [ABSTRACT FROM AUTHOR]

Background: The healthcare sector in the United States has increased its greenhouse gas emissions by 6% since 2010 and today has the highest per capita greenhouse gas emissions globally. Assessing the environmental impact and material use through the methods of life cycle assessment (LCA) and material flow analysis (MFA) of healthcare procedures, products, and processes can aid in developing impactful strategies for reductions, yet such assessments have not been performed in orthopaedic surgery. We conducted an LCA and an MFA on an ACL reconstruction (ACLR). The ACLR served as a test case on the assumption that lessons learned would likely prove relevant to other orthopaedic procedures. Questions/purposes: (1) What are the life cycle environmental impacts of ACLR? (2) What is the material flow and material circularity of ACLR? (3) What potential interventions would best address the life cycle environmental impacts and material circularity of ACLR? Methods: First, we conducted an LCA according to International Organization for Standardization standards for quantifying a product's environmental impact across its entire life cycle. One result of an LCA is global warming potential measured in carbon dioxide equivalent (CO2eq), or carbon footprint. Second, we conducted an MFA of ACLR. Material flow analyses are used to quantify the amount of material in a determined system by tracking the input, usage, and output of materials, allowing for the identification of where materials are consumed inefficiently or lost to the environment. To contextualize the MFA, we calculated the material circularity indicator (MCI) index. This is used to measure how materials are circulating in a system and to evaluate the extent to which materials are recovered, reused, and kept within the economic loop rather than disposed of as waste. These three methods are widely used in other fields, especially engineering, but are more limited in healthcare research. Data collection and observations of ACLRs were made during ACLRs at the University of Pittsburgh Medical Center Bethel Park Surgical Center in Pittsburgh, PA, USA, between 2022 and 2023. Three sessions of data collection and observations were needed due to complexity and scheduling, ranging from understanding the sterilization procedures to weighing individual items. Data encompassing electricity usage; surgical equipment type; the use of heating, ventilation, and air conditioning (HVAC) systems; the production and reuse of reusable instruments and gowns; and the production and disposal of single-use surgical products were collected. Following data collection, we conducted the LCA and the MFA and then calculated the MCI for a representation of a single ACLR. To identify strategies to reduce the environmental impact of ACLR, we modeled 11 possible sustainability interventions developed from prior work and compared those strategies against the impact of the baseline ACLR. Results: Our results show that the ACLR generated an estimated life cycle greenhouse gas emissions of 47 kg of CO2eq, which is analogous to driving a typical gasoline-fueled passenger vehicle for 120 miles. The total mass of all products for one ACLR was estimated at 12.73 kg, including 7.55 kg for disposable materials and 5.19 kg for reusable materials. Concerning material circularity, ACLR had a baseline MCI index of 0.3. Employing LCA for the carbon footprint and the MCI for 11 sustainability interventions indicated the potential to reduce greenhouse gas emissions by up to 42%, along with an increase in circularity (how materials are recovered, reused, and kept within the economic loop rather than disposed of as waste) of up to 0.8 per ACLR. Among the most impactful interventions are the reduction in the utilization of surgical pack products, reutilization of cotton towels and surgical gowns, maximization of energy efficiency, and increasing aluminum and paper recycling. Conclusion: ACLR has a substantial carbon footprint, which can meaningfully be reduced by creating a minimalist custom pack without material wastage, reusing cotton towels, and maximizing recycling. Combining LCA, MFA, and MCI can provide a thorough assessment of sustainability in orthopaedic surgery. Clinical Relevance: Orthopaedic surgeons and staff can immediately reduce the environmental impact of orthopaedic procedures such as ACLR by opening fewer materials—via making minimalist packs and only opening what is needed in the operating room—and by incorporating more reusable materials such as towels. Larger scale medical center changes, such as implementing recycling programs and installing energy-efficient systems, also can make a meaningful difference in reducing environmental impact. [ABSTRACT FROM AUTHOR]

Objectives: To evaluate the carbon footprint of the perioperative transurethral resection of bladder tumour (TURBT) pathway from decision to treat to postoperative discharge, and model potential greenhouse gas (GHG) emissions reduction strategies. Materials and Methods: This process‐based attributional cradle‐to‐grave life‐cycle assessment (LCA) of GHG emissions modelled the perioperative TURBT pathway at a hospital in Southwest England. We included travel, energy and water use, all reusable and consumable items, and laundry and equipment sterilisation. Resource use for 30 patients undergoing surgery was recorded to understand average GHG emissions and the inter‐case variability. Sensitivity analysis was performed for manufacturing location, pharmaceutical manufacturing carbon‐intensity, and theatre list utilisation. Results: The median (interquartile range) perioperative TURBT carbon footprint was 131.8 (119.8–153.6) kg of carbon dioxide equivalent. Major pathway categories contributing to GHG emissions were surgical equipment (22.2%), travel (18.6%), gas and electricity (13.3%), and anaesthesia/drugs and associated adjuncts (27.0%), primarily due to consumable items and processes. Readily modifiable GHG emissions hotspots included patient travel for preoperative assessment, glove use, catheter use, irrigation delivery and extraction, and mitomycin C disposal. GHG emissions were higher for those admitted as inpatients after surgery. Conclusions: This cradle‐to‐grave LCA found multiple modifiable GHG emissions hotspots. Key mitigation themes include minimising avoidable patient travel, rationalising equipment use, optimally filling operating theatre lists, and safely avoiding postoperative catheterisation and hospital admission where possible. A crucial next step is to design and deliver an implementation strategy for the environmentally sustainable changes demonstrated herein. [ABSTRACT FROM AUTHOR]

This study aims to evaluate a temporomandibular joint (TMJ) arthroscopy simulator using construct and face analyses. Thirty participants attending a TMJ training course were divided into novice and expert surgeons (more than 100 procedures) and performed two arthroscopic tasks (cavity access/cavity exploration) during which the surgical tool movements were tracked. Five objective metrics were used to measure surgeon ability and construct validity was assessed by comparing novel and expert performance. Face validity was assessed by subjective questionnaires rating simulator realism and utility (1–5 scale) and tissue consistency (1–4 scale). Expert surgeons spent less total time (76.58 ± 47.40 vs. 27.60 ± 5.52; novices vs. experts) with higher average speed (7.40 ± 5.32 vs. 12.65 ± 5.37) and average acceleration (198.33 ± 2.42 vs. 325.93 ± 87.36). Movement smoothness revealed lower values in novice surgeons (3638.33 ± 1083.95 mm/s3; 2553.70 ± 768.01 mm/s3) than in expert surgeons (4655.63 ± 837.05 mm/s3; 4172.08 ± 1098.61 mm/s3). All these outcomes reached statistical significance (p ≤ 0.05) but in contrast total path of the instruments did not. Face validity scores averaged 4.75/5 for utility and over 4/5 for realism except for watertightness. Tissue consistency was regarded as lower than human tissue but without impact on the training experience. There were no statistically significant differences between the two groups. Both the construct and face validity analyses confirmed the TMJ simulator can be regarded as a valuable, safe, economic adjunctive tool to train TMJ arthroscopy. • High realism TMJ simulator with only exception of watertightness. • Expert and novice surgeons can be objectively distinguished by this TMJ simulator. • TMJ arthroscopy skills can be improved using this simulator. [ABSTRACT FROM AUTHOR]

Foreign objects lodged in the mandibular bone often result from trauma or dental procedures. Accurate localization of these foreign objects is crucial for guided surgical removal, especially when patients present with persistent pain. Conventional imaging modalities like periapical and panoramic radiographs may not provide sufficient detail for precise localization. Cone beam computed tomography (CBCT) has emerged as a valuable tool for guided surgical interventions owing to its superior imaging capabilities. We present two cases of foreign objects lodged in the mandible, where patients complained of prolonged pain, soreness, and numbness in the right mandible extending to the head and behind the ear. Both patients had undergone previous right mandibular tooth extractions and received treatment from a neurologist without resolution of symptoms. Both cases showed the control improvement in complaints, and no paresthesia or postoperative complications were found. CBCT-guided surgical removal was performed in both cases, revealing a metal specimen measuring 6 × 3 × 1 mm 3 in the first patient and a remaining root measuring 5 × 3 × 2 mm 3 in the second patient. Diagnosing foreign objects in the mandible poses challenges due to their varied size, composition, and proximity to vital structures. CBCT offers superior imaging resolution, enabling precise localization and assessment of anatomical relationships, such as the distance to the inferior alveolar nerve and surrounding boundaries. CBCT emerges as the preferred imaging modality for diagnosing and guiding the surgical removal of foreign objects in the mandible. Its advantages include accurate localization, low radiation exposure, and cost-effectiveness. Compared with CT scans, CBCT also offers faster scanning times, making it a valuable tool in clinical practice for managing such cases [ABSTRACT FROM AUTHOR]

Applying deep learning (DL) for annotating surgical instruments in robot-assisted minimally invasive surgeries (MIS) represents a significant advancement in surgical technology. This systematic review examines 48 studies that utilize advanced DL methods and architectures. These sophisticated DL models have shown notable improvements in the precision and efficiency of detecting and segmenting surgical tools. The enhanced capabilities of these models support various clinical applications, including real-time intraoperative guidance, comprehensive postoperative evaluations, and objective assessments of surgical skills. By accurately identifying and segmenting surgical instruments in video data, DL models provide detailed feedback to surgeons, thereby improving surgical outcomes and reducing complication risks. Furthermore, the application of DL in surgical education is transformative. The review underscores the significant impact of DL on improving the accuracy of skill assessments and the overall quality of surgical training programs. However, implementing DL in surgical tool detection and segmentation faces challenges, such as the need for large, accurately annotated datasets to train these models effectively. The manual annotation process is labor-intensive and time-consuming, posing a significant bottleneck. Future research should focus on automating the detection and segmentation process and enhancing the robustness of DL models against environmental variations. Expanding the application of DL models across various surgical specialties will be essential to fully realize this technology's potential. Integrating DL with other emerging technologies, such as augmented reality (AR), also offers promising opportunities to further enhance the precision and efficacy of surgical procedures. [ABSTRACT FROM AUTHOR]

We report a case of successfully lateralized adrenal cortisol hypersecretion by adrenal venous sampling (AVS) and improved by surgery. AVS is a commonly used tool to guide surgical management of primary hyperaldosteronism. It can determine lateralization, leading to unilateral adrenalectomies of the correct side, or nonlateralization, which precludes surgery. The use of AVS in determining lateralization in hypercortisolism is a growing field of discussion. Currently, there is no defined or unanimous protocol behind procedural details and interpretation of results. In this report, we describe the AVS protocol at our institution for hypercortisolism, interpretation of the results, and corresponding surgical outcomes for a case of mild autonomous cortisol secretion. [ABSTRACT FROM AUTHOR]

Rare earth elements (REEs) like lanthanum (La), cerium (Ce), thulium (Th), and yttrium (Y) are crucial in high-tech consumer products and medical applications, including anti-tumor agents, dialysis medicines, and surgical tools. The rare earth industry growth has spiked demand for high-purity REEs, making efficient separation essential. Since REEs typically exist in low natural concentrations, precise analysis methods are required. One promising approach is Ionic Imprinted Polymers (IIPs), derived from Molecularly Imprinted Polymers (MIPs), which can selectively recognize and separate specific ions. IIPs offer considerable advantages in extracting, detecting, and quantifying REEs. This review examines recent progress in ion imprinting technology for REE analysis and separation, focusing on studies published in the past 2007–2024 years. It begins with an overview of REE analysis and separation methods, including their physical and chemical properties, the role of nanomaterials, and IIP components. Following this, IIP applications for REE analysis and contamination management, along with related uses in actinide separation are discussed. [ABSTRACT FROM AUTHOR]

The significance of peristaltic activity in biological and biomedical engineering has recently received a lot of attention. Peristaltic pumping and heat transfer in magnetohydrodynamic biological fluids are fascinating topics with a wide range of physiological applications. These applications include dialysis, medication injection, cardiac surgery equipment, and cancer treatments. In this work, we investigate the characteristics of Casson fluid and peristalsis in a symmetric elastic tube. Buongiorno nanofluid model is taken with the features of thermophoresis and Brownian motion. The heat transfer mechanism is analyzed by acquiring the effects of heat dissipation, absorption/generation, and thermal radiation. A long wavelength is also anticipated when developing the flow model, which is predicated on a short Reynolds number. The non‐linear system of equations is numerically solved. Graphical outcomes are acquired to visualize the physical interpretation of several embedded parameters for heat transfer rate, concentration, velocity, and temperature. [ABSTRACT FROM AUTHOR]

Our aim was to determine the current trend of endourology in the management of upper urinary tract calculi in Africa reference centres. We conducted an online multiple-choice questionnaire survey involving 46 centres from 27 countries using a structured well-designed Google Form (®) questionnaire. The questionnaires were distributed to the head of service through their emails. The questions collected demographic data about the centre, the epidemiology of urolithiasis, diagnostic means and management of upper urolithiasis, especially access to endourology procedures and their practices. Descriptive analyses were performed. The participation rate was 77.9%. Urinary lithiasis was one of the three main pathologies encountered in 42/46 centres. 33 centres had easy access to CT scanners and 34 had operating theatres equipped with endo-urological surgery equipment. Of these 34 centres, 30 perform endourology for the management of upper urinary tract stones. Rigid ureteroscopy is the main technique used by the centres. It is the only endourology technique used for stone management by 12 centres (40%). 7/30 (23.3%) have the option of performing rigid ureteroscopy, flexible ureteroscopy and percutaneous nephrolithotomy. The frequency of procedures varies widely, with 43.3% rarely performing endourological surgery. Seventeen centres have their operating theatre equipped with a fluoroscope and 6/42 centres have extracorporeal lithotripsy. Open surgery is still used in 29/42 centres (69.1%). Laparoscopy is available in 50% of centres, but none reported performing laparoscopic lithotomy. In Africa, urinary lithiasis plays an important role in the activities of referral centres. Modern management techniques are used to varying degrees (not all centres have them) and with very variable frequency. Open surgery is still widely performed as a management. Rigid ureteroscopy is the main endourological technique. It is essential to develop the practice of modern urology in Africa, mainly endourology. [ABSTRACT FROM AUTHOR]

Purpose: To provide return‐to‐performance outcomes after surgical treatment for medial malleolus stress fractures in the elite athlete. Additionally, to describe an individualised surgical approach in the management of medial malleolus stress fractures. Methods: Five athletes (six ankles) underwent surgical treatment for a medial malleolus stress fracture. The surgical technique was based on the extent of the fracture line in steps with first arthroscopic debridement of bony spurs, microfracturing of the fracture line and screw fixation. Return‐to‐performance data included time to return to sport‐specific training, normal training, first competitive activity, performance and the return‐to‐performance rate. Results: Patients returned to sport‐specific training at a median of 10 weeks. They started normal training at 16 weeks postoperatively and returned to their first competitive activity after 19 weeks. All patients had bony spurs on the distal tibia which were arthroscopically debrided. One patient received arthroscopic debridement of bony spurs alone. Four patients received additional microfracturing of the fracture line and three patients received screw fixation. All patients achieved clinical and radiographic union on follow‐up computed tomography scan at 3 months postsurgery. At latest follow‐up, no refractures nor hardware complications, nor any other complications were observed. Conclusion: Arthroscopic debridement of bony spurs, debridement and microfracturing of the fracture line and screw fixation are all viable surgical tools in the management of medial malleolus stress fractures in elite athletes. The surgical approach containing these options should be tailored to the individual athlete based on the fracture line in the sagittal plane. While most athletes return to full competitive activity in 3–4 months, time to self‐reported return to full performance is often much longer. Level of Evidence: Level IV. [ABSTRACT FROM AUTHOR]

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

Background: There has been a proliferation of global surgery assessment tools designed for use in low‐ and middle‐income countries. This scoping review sought to categorize and organize the breadth of global surgery assessment tools in the literature. Methods: The search was conducted using PubMed from October 2022 to April 2023 according to PRISMA extension for scoping review guidelines. The search terms were (("global surgery"[All Fields]) AND ("assessment"[All Fields]) OR (data collection)). Only tools published in English that detailed surgical assessment tools designed for low‐ and middle‐income countries were included. Results: The search resulted in 963 papers and 46 texts described unique tools that were included for the final review. Of these, 30 (65%) tools were quantitative, 1 (2%) qualitative, and 15 (33%) employed mixed‐methods. 25 (54%) tools evaluated surgery in general, whereas 21 (46%) were focused on various surgical subspecialties. Qualitatively, major themes among the tools were noted. There was significant overlap of many tools. Conclusions: Nonspecialty surgery was represented more than any specialty surgery and many specialties had little or no representation in the literature. Ideally, local leadership should be involved in surgical assessment tools. Different methodologies, such as checklists and observational studies, aimed to target varying aspects of surgery and had distinct strengths and weaknesses. Further efforts should focus on expanding tools in neglected specialties. [ABSTRACT FROM AUTHOR]

Proliferative vitreoretinopathy (PVR) significantly impacts the prognosis of rhegmatogenous retinal detachment (RRD), one of the most critical and increasing causes of vision loss in the Western world. Despite advancements in surgical instruments and techniques, the failure rate due to PVR remains substantial, necessitating additional surgeries and often leading to unsatisfactory visual outcomes. This comprehensive review explores the role of vitreoschisis‐induced vitreous cortex remnants (VCR) as a critical, previously under‐recognised factor contributing to PVR. Vitreoschisis, a phenomenon where the inner lamellae of the posterior vitreous cortex detach while the outermost layers remain attached to the retina, creates VCR that may contain hyalocytes and serve as scaffolds for fibrocellular proliferation. These remnants are difficult to visualise without triamcinolone acetonide (TA) staining, leading to their frequent lack of recognition in clinical practice. Moreover, removing VCR can be challenging and time‐consuming, often requiring meticulous surgical techniques to avoid retinal damage and ensure complete elimination. This review consolidates insights from basic research and clinical practice, emphasising the importance of complete vitreous removal and effective VCR detection and removal to mitigate PVR risks. It highlights the histopathological and clinical evidence supporting the hypothesis that VCR, containing hyalocytes, play a pivotal role in preretinal membrane formation. The review also discusses epidemiological data, surgical management strategies and potential future directions, including improved visualisation techniques and the development of new surgical tools and methods. This review aims to improve surgical outcomes and reduce the frequency and burden of RRD‐related complications by addressing VCR as a critical factor in PVR. [ABSTRACT FROM AUTHOR]

Cranial vault remodelling for craniosynostosis aims to increase intracranial volume to facilitate brain growth, avoid the development of raised intracranial pressure and address cosmesis. The extent of vault expansion is predominantly limited by scalp closure and reconstruction technique. Virtual surgical planning tools have been developed to predict post-operative changes and guide expansion. We present a validation study of a novel 'Dura-based Automated Vault Expansion-Remodeling' (DAVE-R) model to guide pre-operative planning for fronto-orbital advancement and remodelling (FOAR). Methods: Patients with trigonocephaly who underwent FOAR with pre- and post-operative imaging from 2018 to 2020 were identified from a prospectively maintained database. Post-operative scans, normative atlas and whole brain parcellation were registered to the pre-operative images to quantify the change in intracranial volume and morphology (utilising measurement of fronto-orbital advancement and bifrontozygomatic distance) compared to that predicted by the DAVE-R model. Results: Ten patients were included. The DAVE-R model predicted bifrontozygomatic distances of 92.0 + / − 5.14 mm (mean + /SD), which closely matched the post-operative results of 92.7 + / − 6.02 mm (mean + / − SD); (t(d.f. 9) = -0.306, p = 0.77). The fronto-orbital advancement predicted by the DAVE-R method was 11.5 + / − 1.96 mm (mean + / − SD) which was significantly greater than 8.6 + / − 2.94 mm (mean ± SD); (t(d.f. 9) = 3.137, p = 0.01) achieved post-operatively. Conclusions: We demonstrate that the DAVE-R model provides an objective means of extracting realistic surgical goals in patients undergoing FOAR for trigonocephaly that closely correlates with post-operative outcomes. The normative dural model warrants further study and validation for other forms of craniosynostosis correction. [ABSTRACT FROM AUTHOR]

Objective: Detailed quantifications of the environmental footprint of operations that include surgery, anaesthesia, and engineering are rare. We examined all such aspects to find the greenhouse gas emissions of an operation. Methods: We undertook a life cycle assessment of 10 patients undergoing total knee replacements, collecting data for all surgical equipment, energy requirements for cleaning, and operating room energy use. Data for anaesthesia were sourced from our prior study. We used life cycle assessment software to convert inputs of energy and material use into outputs in kg CO2e emissions, using Monte Carlo analyses with 95% confidence intervals. Results: The average carbon footprint was 131.7 kg CO2e, (95% confidence interval: 117.7–148.5 kg CO2e); surgery was foremost (104/131.7 kg CO2e, 80%), with lesser contributions from anaesthesia (15.0/131.7 kg CO2e, 11%), and engineering (11.9/131.7 kg CO2e, 9%). The main surgical sources of greenhouse gas emissions were: energy used to disinfect and steam sterilise reusable equipment (43.4/131.7 kg CO2e, 33%), single-use equipment (34.2/131.7 kg CO2e, 26%), with polypropylene alone 13.7/131.7 kg CO2e (11%), and the knee prosthesis 19.6 kg CO2e (15%). For energy use, the main contributors were: gas heating (6.7 kg CO2e) and heating, cooling, and fans (4 kg CO2e). Conclusions: The carbon footprint of a total knee replacement was equivalent to driving 914 km in a standard 2022 Australian car, with surgery contributing 80%. Such data provide guidance in reducing an operation's carbon footprint through prudent equipment use, more efficient steam sterilisation with renewable electricity, and reduced single-use waste. What is known about the topic? The environmental footprint of health care itself is important. Carbon footprinting of surgical operations are becoming more common, although detailed analyses are rare. What does this paper add? The carbon footprint of a total knee replacement was 132 kg CO2e, i.e. the equivalent of driving >900 km in a typical 2022 Australian car. Orthopaedic surgery itself contributed to 80% of the emissions, with anaesthesia and operating room energy use contributing 10% each to the total carbon footprint. What are the implications for practitioners? By replacing single-use with reusable equipment, and by using 100% renewable energy for decontamination, the greenhouse gas emissions for a total knee replacement can become negligible. [ABSTRACT FROM AUTHOR]

Background: The Portsmouth physiological and operative severity score for the enumeration of mortality and morbidity (P-POSSUM) is an established tool for predicting surgical outcomes. However, its applicability and accuracy in predicting post-operative mortality in patients undergoing emergency craniotomy require further validation. Aims and Objectives: This study aims to validate the accuracy of the P-POSSUM score in predicting post-operative mortality in patients undergoing emergency craniotomy. Materials and Methods: A prospective observational study was conducted over 2 years (June 2022-May 2024) at Maharani Laxmi Bai Medical College, Jhansi. Patients undergoing emergency craniotomy were included in the study. Data were collected on pre-operative physiological parameters and intraoperative variables to calculate the P-POSSUM score. The primary outcome was post-operative mortality within 30 days. Statistical analysis involved receiver operating characteristic curve analysis and the Hosmer-Lemeshow test to assess the predictive accuracy and calibration of the P-POSSUM score. Results: A total of 200 patients were included in the study. The mean age was 53±17 years; 113 were male and 87 were female. The P-POSSUM score demonstrated good predictive accuracy for post-operative mortality with an area under the ROC curve of 0.85 (95% CI: 0.79-0.91). Calibration analysis using the Hosmer-Lemeshow test showed good calibration (P=0.23). Observed mortality was 56 (28%) compared to an expected 61, resulting in an observed-to-expected mortality ratio of 0.92. Conclusion: The P-POSSUM score is a reliable and accurate tool for predicting post-operative mortality in patients undergoing emergency craniotomy. Its integration into clinical practice can enhance risk stratification and inform clinical decision-making. Further studies with larger cohorts and diverse populations are warranted to generalize these findings. [ABSTRACT FROM AUTHOR]

To compare the predictive ability of the modified Frailty Index (mFI) and the revised Risk Analysis Index (RAI-Rev) for perioperative outcomes in patients undergoing major urologic oncologic surgery, aiming to identify the optimal frailty screening tool for surgical risk stratification. NSQIP was queried to identify patients undergoing radical prostatectomy, partial or radical nephrectomy, or radical cystectomy between 2013 and 2017. We investigated the association of mFI and RAI-Rev with the following 30-day perioperative outcomes using multivariable logistic regression: major complications, Clavien grade ≥4 complications, non-home discharge, 30-day readmission, and all-cause mortality. Receiver-operating characteristic curve analysis compared the predictive performances of the 2 frailty instruments, with differences between the C-statistics assessed using DeLong's test. Among 101,739 patients, 30-day major complication rates varied from 2.40% in prostatectomy to 26.86% in cystectomy, non-home discharge rates ranged from 1.92% to 13.54%, and mortality rates were between 0.16% and 1.43%. RAI-Rev showed higher discriminatory ability for mortality (C-statistic: 0.688-0.798) and non-home discharge (C-statistic: 0.638-0.734) compared to mFI (C-statistic: 0.594-0.677 and 0.593-0.639, respectively). Both frailty indices had similar discriminatory ability for major perioperative complications (C-statistic: 0.531-0.607). DeLong's test confirmed statistically significant differences in C-statistics between RAI-Rev and mFI for mortality (P <.001) and non-home discharge (P <.001) across all surgical cohorts. RAI-Rev may have greater utility as a frailty prognostic tool than mFI among patients undergoing major urologic surgery. Prospective studies and clinical trials exploring frailty should consider these results during trial design. [ABSTRACT FROM AUTHOR]

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Background: The use of patient-specific instruments (PSIs) for osteotomies is becoming more popular in orthopaedic surgery for correcting mechanical axis and posttraumatic deformities. However, the PSI reduction guides have great potential for intraoperative deformation, which adversely affects the accuracy of the procedure. Purpose: To conduct a finite element analysis (FEA) to analyze different design parameters to improve the intraoperative stability of the reduction guides. Study Design: Descriptive laboratory study. Methods: A reduction guide with a rectangular cross section and four 4-mm K-wire slots was simplified, and the following parameters were modified: width, height, profile design, K-wire thickness, and positions. Bending and torsional moments were applied to the guide construct and guide deformation and equivalent stress were determined using FEA. Results: Increasing the profile height by 25% resulted in a 44% reduction in guide deformation for bending (37% for torsion). A 25% increase in profile width led to an 18% deformation reduction for bending (22% for torsion). Transverse K-wire slots resulted in 51% less deformation in torsion compared with longitudinally oriented slots. Placing the central K-wire slots 25% closer to the osteotomy reduced guide deformation by 20% for bending and 11% for torsion. Conclusion: The most effective methods to increase reduction guide stability are to increase the guide height and reduce the central K-wire distance to the osteotomy. Clinical Relevance: When performing opening or closing wedge osteotomies, which mainly involve bending of the guide, a high-profile guide and longitudinally oriented K-wire slots should be used. When torque is expected as in rotational osteotomies, the K-wire holes in guides should be oriented transversely to reduce intraoperative deformation. [ABSTRACT FROM AUTHOR]

Background: Chondrosarcoma of the maxilla is extremely rare, requiring complete surgical resection with clear margins. Various surgical approaches have been used for wide surgical resection of chondrosarcomas in the head and neck region. 3D printed bone models are useful surgical and educational tools. Case: A 69-year-old man presented with a grade II chondrosarcoma of the maxilla. This tumor was resected by otolaryngologists and dental surgeons using an anterior segmental maxillary osteotomy and open rhinoplasty approach with the assistance of a 3D-printed bone model. Conclusion: Chondrosarcomas can be differentiated from chondromas by their higher mean apparent diffusion coefficient (ADC) on diffusion-weighted magnetic resonance imaging. The anterior segmental maxillary osteotomy and rhinoplasty approach, with ideal osteotomy and a good visual field, resulted in wide surgical safety margins, improving patient prognosis. [ABSTRACT FROM AUTHOR]

Background: The advent of ultrasonic scalpels has remarkably advanced minimally invasive surgery; however, the Chinese market's reliance on imports highlights the urgent need for a cost-effective, efficient, and domestically produced surgical scalpel. This study aimed to compare SanAgileTMSA01 with the Johnson & Johnson GEN11, and HAR36 surgical devices. Research design and methods: In total, 152 participants requiring urological or general laparoscopic surgery were randomly and equally divided between the two hospitals and randomized to the test and control groups. Clinical outcomes, adverse event rates, intraoperative bleeding, and surgery duration were compared between the two devices. Results: The clinical application rate of both devices was 100%. There were no significant differences between the two groups in intraoperative bleeding, surgery duration, and incidence of adverse events. In the test group, five device-related adverse events occurred (6.58%), compared to two (2.63%) in the control group (no significant difference). The device-related adverse events did not result in any sequelae. Conclusions: The clinical performance of the SanAgileTMSA01 was comparable to that of the Johnson & Johnson GEN11 and HAR36. The SanAgileTMSA01 device may serve as a viable alternative ultrasonic surgical tool, thereby providing clinicians with additional options. Trial registration: Registration number of Shanghai Medical Equipment Preparation 20,190,114 [ABSTRACT FROM AUTHOR]

Flexible surgical robots are emerging as advanced tools for minimally invasive surgeries, offering greater versatility compared to traditional rigid robots. Unlike commercial endoscopes, the overtube should remain fixed to maintain stability, ensure a clear field of view, and allow surgical tools to perform tasks efficiently. While constant curvature bending of the overtube is sufficient for some lesions, certain lesions require the overtube to bend into specific shapes to achieve appropriate positioning. Various methods for creating different bending shapes have been proposed in previous research, typically involving connecting multiple segments. However, this approach complicates control and reduces both space and cost efficiency. This study proposed a conceptual method for adding a shaping tendon to control the bending shape and mathematically analyzed the effect of this shaping tendon, inserted along an arbitrary path in addition to the main driving tendons for constant curvature bending, on the bending shape of the hyper-redundant manipulator with rolling joints. The overall system was modeled and analyzed from an energy perspective, and the validity of the proposed mathematical modeling was verified through comparison with results obtained from physical experiments. In addition, it was identified that the design parameter determining the tendon path is a significant element in defining the bending shape of the overtube. [ABSTRACT FROM AUTHOR]

Background: Coarctation of the aorta (CoA) is a congenital disease with an incidence of 4 out of 10,000 live births, therefore proper education of its treatment is essential. Understanding the disease and the wide array of treatment options is often difficult. Additive manufacturing technology can be used to produce 3D printed hands-on surgical training tools (HOSTT), which can be used for the education and practical training of CoA. This study aimed to investigate the effectiveness of a 3D printable HOSTT for the simulation of coarctation surgery, and it' possible role in practical education. Methods: Participants were medical students of Semmelweis University between the second and sixth academic year. A virtual 3D model of an aorta with CoA was generated from a computed tomography angiography scan. Each participant received a 3D-printed aorta phantom and performed either one of four surgical treatment modalities. The simulated surgeries included end-to-end anastomosis, end-to-side anastomosis, prosthetic patch, and subclavian flap aortoplasty. Participants provided feedback, evaluating their understanding of the disease and its treatment by the four surgical reconstruction modalities on a seven-point Likert scale before and after the sessions. Results: 21 medical students participated in this study. Participants' average rating of their understanding of CoA disease and it treatment options before practical training was 4.62 ± 1.07. After training, their average rating increased to 6.19 ± 1.08, showing statistically significant difference. Conclusions: Within this study's limitations, the applied HOSTT, manufactured using 3D printing, was effective for the practical training of CoA's surgical treatment methods for medical students. [ABSTRACT FROM AUTHOR]

Background: Access to surgical equipment is critical to providing safe and equitable operative care. This is the first nationwide study to provide data on the availability of surgical equipment in Kenya. Methods: This cross-sectional study collected data from May to July 2018 on the availability of non-pharmaceutical equipment, patient care, intra-operative, and anesthesia supplies in level 4 hospitals. Information regarding infrastructure such as the number of functional operating rooms, sterilization capacity, and sources of water and electricity was also collected. Results: The availability of intra-operative and anesthesia equipment was 44.5% and 47%, respectively. Nearly 60% of facilities had general patient care supplies. Over 80% of the facilities had running water in maternity wards (83.1%). Sterilization equipment was present in about half of the facilities (range: 42.6–68.3%). Additionally, 79.1% had a generator as a backup source of electricity. Only 35% of facilities always had an X-ray on-site, and 52.6% of the facilities obtained blood from the national or a regional center. Conclusion: This study provides data on the availability of surgical equipment and infrastructure in level 4 hospitals in Kenya. Availability of radiology services and blood supply was lower than that in other sub-Saharan African countries, highlighting the need for improved surgical care resources in these community-based facilities.

PurposeMethodsResultsConclusionsTo demonstrate the role of Virtual Reality (VR) in orbital surgery as an educational tool for surgical trainees.A single-center prospective study was conducted from February 2021 to April 2023. Pre-operative magnetic resonance imaging and computed tomography scans were used to create patient-specific VR models of the orbit using ImmersiveTouch Software. Accuracy of the models was qualitatively assessed by an attending oculofacial surgeon. Surveys regarding understanding of the surgical plan were distributed to trainees before the VR simulation, after its use, and following surgery.VR models were made for 28 cases, and 52 surveys were completed by residents in ophthalmology, otolaryngology, plastic surgery, and by oculofacial fellows. The VR models for 93% of the cases were rated as accurate by the attending physician. Assigned trainee tasks included measurement of an orbital fracture (n = 1, 1.9%), measurement of orbital tumors (n = 12, 23.1%), and drilling of the orbital bone to simulate an orbital decompression (n = 10, 19.2%). The tumor measurements made by trainees using the VR system were not significantly different than those recorded by the radiologists (p > 0.05). Early trainees (i.e. residents and the first year oculofacial fellow) noted significant improvement in their understanding of the pathology relative to important anatomical landmarks within the orbit after utilizing the VR models prior to surgery (p < 0.001).Patient-specific VR models accurately simulate orbital pathology and may improve trainees’ understanding of orbital anatomy early in their careers. [ABSTRACT FROM AUTHOR]

ABSTRACT Background Methods Results Conclusion Currently, traditional UBE surgery, which is based on arthroscope, has been increasingly employed for complex lumbar degenerative diseases. However, this approach is associated with complications such as intraoperative dural sac tears, nerve root injuries, and postoperative epidural hematomas. In response to these challenges, we propose a novel technique utilizing uniaxial spinal endoscope to replace arthroscope—Unilateral Bi/Multi‐Portal Endoscopy (UME). This new method has successfully treated complex lumbar disc herniation and spinal stenosis, resulting in improved postoperative outcomes and a reduction in complications. Based on the previous findings, we utilized uniaxial spinal endoscopy as the primary operating method, with the assistance of multi‐portal endoscopic techniques (UME‐TLIF), to perform transforaminal lumbar interbody fusion. The feasibility and preliminary clinical results have been presented in this paper.A total of 18 patients (8 men and 10 women, aged 52.6 ± 15.29 years) diagnosed with lumbar degenerative diseases, such as giant lumbar disc herniation, severe lumbar spinal stenosis, or lumbar spondylolisthesis, were included in this study from January 2022 to March 2023. Various parameters including operation time, ambulatory time, intraoperative fluoroscopy times, hospitalization days, and complications were recorded during the perioperative period. Clinically relevant symptoms were evaluated and documented 1, 3, 6, and 12 months postoperatively. Visual analogue scale (VAS) scores for lower back pain and leg pain, as well as the Oswestry disability index (ODI), were measured. The extent of lumbar interbody fusion was assessed using lumbar X‐ray and CT scans at the 12‐months follow‐up. MRI was performed to assess the degree of nerve decompression in patients at the same time points. The paired t‐test or Wilcoxon signed‐rank test were used as statistical methods.The single‐segment UME‐TLIF procedure had an average operation time of 211 ± 53.3 min, and the average number of X‐rays taken during the operation was 11.78 ± 5.32. Patients were able to walk and perform functional exercises approximately 35.11 ± 8.41 h post‐surgery, and the average duration of hospital stay was 8.5 ± 2.27 days. The VAS and ODI values at each time point post‐surgery were significantly lower than the respective pre‐surgery values (p < 0.05). Two patients developed postoperative sensory disturbances which significantly improved with conservative treatment. Furthermore, a follow‐up CT scan conducted 12 months post‐surgery showed 100% fusion rate of the surgical segments in all patients.UME‐TLIF is an endoscopy‐assisted fusion procedure that minimizes muscle damage in patients and allows early rehabilitation. This technique broadens the surgical applications of uniaxial spinal endoscope as a surgical tool, particularly benefitingpatients diagnosed with severe lumbar disc herniation and lumbar instability. [ABSTRACT FROM AUTHOR]

Adjustable Loop Fixation devices (ALD) were introduced to allow tensioning and re-tensioning while increasing flexibility of graft length in the bone tunnel. ALDs have shown comparable clinical and biomechanical results when used for anterior cruciate ligament reconstructions. We routinely use ALDs in multi-ligament knee reconstructions. In double bundle posterior cruciate ligament reconstruction, using an ALD, we can achieve differential tensioning of the anterolateral and posteromedial bundles utilizing two femoral and one tibial tunnel. When performing an anatomic posterolateral corner reconstruction using our modification of the anatomical LaPrade technique, an ALD permits differential tensioning of the fibular collateral ligament and popliteus tendon/popliteofibular ligaments with a single graft. In anatomic superficial medial collateral ligament reconstructions, ALD allows for tensioning from the femoral side, subsequent cycling, followed by re-tensioning to achieve a stable reconstruction. In conclusion, ALDs provide numerous benefits when performing multi-ligament knee reconstructions. ALDs allow for appropriate tensioning and re-tensioning which is helpful in removing creep from the graft to prevent postoperative laxity. Additionally, it permits differential tensioning which helps achieve accurate tensioning of individual bundles to help restore native knee kinematics. [ABSTRACT FROM AUTHOR]

Introduction: Medical students often hesitate to enter the operating theatre because of poor visibility of the surgical field and anxiety about the theatre environment. In addition, ear, nose and throat (ENT) surgery is underrepresented in many medical curricula. Virtual systems like Proximie offer flexible viewing of surgeries with surgeon commentary, potentially addressing these issues. Methods: This descriptive survey study aimed to evaluate the use of Proximie as a surgical education tool for delivering ENT teaching to medical students. Live ENT procedures were recorded at the ENT Department of the John Radcliffe Hospital and shared with interested clinical medical students through Proximie accounts. Students were added to a private group chat to ask questions and provided feedback through structured forms, assessing procedural effectiveness and the platform's technology. Live-streaming and recording of procedures were facilitated by ENT surgeons providing commentary. Results: Conducted over four virtual theatre days, the study gathered 52 responses: 96% of students rated Proximie's educational value as 4 of 5 or higher; 57% preferred the virtual experience over physical attendance because of its convenience and the improved view of the surgical field. Students valued the live commentary and showed interest in using Proximie for a broader range of surgeries. Suggested improvements included fixing technical issues, better communication of theatre lists, and expanding surgical specialty coverage. Conclusions: Proximie has been highly rated by medical students for its effective and engaging approach in the instruction of surgical skills, underscoring its value as an educational tool. Future research is needed to formally assess knowledge acquisition and retention across multiple surgical subspecialties. This work is the first step towards evaluating the utility of virtual operating theatre platforms for medical student education. [ABSTRACT FROM AUTHOR]

Innovation in image-guided procedures has been driven by advances in robotic Cone Beam Computed Tomography (CBCT) systems. A fundamental challenge for CBCT imaging is metal artifacts arising from surgical tools and implanted hardware. Here, we outline how two universal non-circular imaging orbits, optimized for metal artifact reduction, can be implemented in real-time on clinical robotic CBCT systems. Demonstrating potential clinical utility, the universal orbits were implemented during a pedicle screw cervical spine fixation and hip arthroplasty performed on a porcine and ovine cadaver respectively. In both procedures, the universal non-circular orbits noticeably reduced the metal artifacts surrounding the implanted orthopedic hardware, revealing anatomy and soft tissue obscured in current conventional CBCT imaging. This work represents a key step in clinically translating universal orbits, unlocking high quality in-room procedural verification to increase broader use of robotic CBCT systems and reduce the occurrence of secondary corrective surgeries. [ABSTRACT FROM AUTHOR]

The editorial discusses two cases of pediatric craniopharyngiomas, highlighting different treatment strategies. The first case involved subtotal resection with postoperative complications, while the second case underwent cyst fenestration with successful outcomes. The shift towards minimal surgical intervention combined with proton therapy is emphasized as a promising approach for treating pediatric craniopharyngiomas. The cases presented aim to stimulate discussions on tailoring treatment for these tumors, considering factors such as tumor characteristics and potential risks associated with different surgical approaches. [Extracted from the article]

Introduction: Medical waste is an environmental, financial, and administrative burden to the health care system. Attempts to decrease waste should begin by quantifying the amount of waste at an individual facility. This study attempts to quantify the amount of medical waste associated with operative cases at an urban Veterans Affairs Medical Center (VAMC). Methods: The study was a prospective of analysis of surplus equipment and supplies accumulated by a single surgical team over a 6-week period from a VAMC operating room. The equipment and supplies were counted and weighed. The cost of the most common items was calculated using standard procurement values. Results: Overall, there were 81 pieces of surplus equipment and 1122 pieces of surplus medical supplies. The most common piece of equipment was a towel clip, and the most common medical supply was a blue towel. The total weight of the equipment was 72.2 kg. The five most common items were blue towels, suture, gloves, gowns, and gauze pads. Based on standard pricing, the individual price for each of the five above items was $1.32, $1.84, $4.05, $5.74, and $0.13, respectively. Over the 6-week period, the total cost of the five most common items was $1,764.56. Finally, the total weight of the surplus items was 72.2 kg. Conclusions: Operative waste includes equipment and supplies that increase time, effort, and costs. Quantifying the waste allows each facility the opportunity to introduce potential strategies to reduce extraneous medical equipment and supplies. [ABSTRACT FROM AUTHOR]

Objectives: To develop the use of Thiel soft embalmed human cadavers (TeC) in open radical cystectomy (ORC) training for the first time, to investigate the effect of cadaveric training on surgical trainees' technical skills/performance and to determine how trainees perceive the use of cadaveric workshops. Methods: A 3‐day hands‐on workshop was organised. Ten trainees performed ORC on five TeC, supervised by five experts. Feedback from trainees and mentors was evaluated on a five‐point Likert scale. All procedures were completed in a fully equipped surgical environment and complied with the principles outlined in the Declaration of Helsinki. Results: The workshop participants evaluated the anatomical and manipulation characteristics of the TeC as similar to real‐life conditions. The colour and consistency of the urethra and ureter differed little from those in live patients. The trainees stated that the TeC were beneficial for learning the stages of ORC and urinary diversion (UD), while their self‐confidence increased. In terms of realism, all steps of radical cystectomy (RC) were rated 4 out of 5 or higher on the Likert scale by both trainees and faculty. Conclusions: The use of TeC for RC und UD was perceived as favourable by trainees and faculty. The TeC demonstrated a surprising ability to mimic real‐life anatomy and represent a new and effective surgical training tool. [ABSTRACT FROM AUTHOR]

Background/Objectives: Fracture-related infections (FRIs) are a significant complication in conflict zones, where limited resources and damaged infrastructure complicate orthopedic care. Methods: This study retrospectively reviews the management of FRIs during medical missions to Gaza from April to July 2024. Results: Among 135 patients treated for war-related fractures, 30% were identified with suspected FRIs, which were primarily following explosive injuries. Contributing factors to the high incidence of infection included malnutrition, poor sanitation, and the scarcity of sterile surgical supplies. The absence of standard infection control measures further complicated treatment. Conclusions: These findings highlight the critical need for a comprehensive approach that incorporates infection prevention, sustainable healthcare planning, and quality assurance tailored to the realities of conflict zones. The study underscores the importance of international support to ensure the availability of essential medical supplies and to develop effective, context-specific strategies for infection management. By applying these insights, healthcare providers can improve patient outcomes and reduce the burden of FRIs in resource-limited settings affected by conflict. [ABSTRACT FROM AUTHOR]

Background: Central nervous system (CNS) tumors are the second most frequent type of neoplasm in childhood and adolescence, after leukemia. Despite the incorporation of molecular classification and improvement of protocols combining chemotherapy, surgery, and radiotherapy, CNS tumors are still the most lethal neoplasm in this age group. Mass spectrometry imaging (MSI) is a powerful tool to map the distribution of molecular species in tissue sections. Among MSI techniques, desorption electrospray ionization (DESI-MSI) has been demonstrated to enable reliable agreement with the pathological evaluation of different adult cancer types, along with an acceptable time scale for intraoperative use. Methods: In the present work, we aimed to investigate the chemical profile obtained by DESI-MSI as an intraoperative surgical management tool by profiling 162 pediatric brain biopsies and reporting the results according to the histopathology and molecular profile of the tumors. Results: The 2D chemical images obtained by DESI-MSI allowed us to distinguish tumor-transformed tissue from non-tumor tissue with an accuracy of 96.8% in the training set and 94.3% in the validation set after statistical modeling of our data using Lasso. In addition, high-grade and low-grade tumors also displayed a distinct chemical profile when analyzed by DESI-MSI. We also provided evidence that the chemical profile of brain tumors obtained by DESI-MSI correlates with methylation-based molecular classes and specific immunophenotypes found in brain biopsies. Conclusions: The results presented herein support the incorporation of DESI-MSI analysis as an intraoperative assistive tool in prospective clinical trials for pediatric brain tumors management in the near future. [ABSTRACT FROM AUTHOR]

Background: This study introduces a novel surgical instrument to reduce iatrogenic nerve injuries during procedures such as carpal tunnel and ulnar nerve decompression surgery. These injuries often result from direct damage to surrounding tissues by surgical instruments, whose designs have remained largely unchanged over the past decades. The novel device is a modified surgical forceps that has a deployable surgical scalpel that runs along a groove on the forceps. This design protects important anatomical structures while allowing fast dissection and cutting of fascial layers. Methods: The process used to develop a novel instrument included computer-aided design (CAD) modeling, 3D printing for prototyping, and the fabrication of an aluminum prototype. Biomechanical testing was performed with the novel device, iris scissors, bandage scissors, and a scalpel on an MTS Static Materials Test System. The peak force to slide-cut, number of cut attempts, and percentage cut on first attempt were compared between the prototype and traditional surgical tools. The materials cut in testing were Ace™ bandage, stockinette, and gauze. Statistical analyses were performed using Welch's t-tests and Fisher's exact tests. Results: Compared to conventional bandage and iris scissors, the novel surgical instrument required significantly less force to cut through an Ace™ bandage, stockinette, and gauze (p < 0.01). The number of cuts required to transect those same materials with the novel device was comparable to that of the scalpel and bandage scissors. Additionally, while there were no differences between the novel device and the other devices for an Ace™ bandage and stockinette, the novel device tended to cut a greater percentage of gauze in one pass than did the iris scissors. Conclusion: The novel surgical instrument designed in this study required less force compared to conventional scissors, demonstrated cutting efficiency similar to that of a scalpel blade, and had more safety features than either instrument. This study highlights the value of collaboration between biomedical engineering and orthopedic surgery departments on innovation in medical technology, through which new technologies with improved design and functionality demonstrate the potential to reduce iatrogenic injuries. [ABSTRACT FROM AUTHOR]

Background and Objective: Three-dimensional heads-up display (HUD) systems have emerged as an alternative to standard operating microscope (SOM) in the operating room. The goal of this study was to quantitatively measure vitreoretinal surgeon posture across visualization methods. Methods: Ergonomic data was collected from 64 cases at two tertiary eye care centers. Surgeons wore an Upright Go 2TM posture training device while operating either using the NGENUITY 3D heads-up display visualization system or the SOM. Results: Total percentage of time with upright posture as primary surgeon was significantly higher in surgeries performed using HUD (median 100%, interquartile range [IQR], 85.1% to 100.0%) as compared to surgeries performed using the SOM (median 60.0%, IQR 1.8% to 98.8%) (P = 0.001, Wilcoxon rank-sum test). Percent time with upright posture was significantly higher in surgeries performed using HUD for two of the three surgeons when assessed independently across systems. Results remained significant when accounting for length of surgery (P < 0.001, multiple linear regression). Conclusions: Ergonomic positioning was improved for surgeons operating using HUD. Given the high prevalence of back and neck pain among vitreoretinal surgeons, increased use of HUD systems may limit musculoskeletal pain and long-term disability from poor ergonomics. [Ophthalmic Surg Lasers Imaging Retina 2024;55:638–645.] [ABSTRACT FROM AUTHOR]

Background: Noise-induced hearing loss (NIHL) is a serious concern for orthopedic surgeons. The National Institute for Occupational Safety and Health (NIOSH) sets the safe exposure limit at 85 dB for 8 hours, yet operating rooms often surpass this limit. This study investigated if using an automated broaching system exposes orthopedic surgeons to dangerous decibel (dB) levels. Materials and Methods: A prospective study analyzed 138 intraoperative sound recordings from 92 total hip arthroplasty (THA) surgeries and 46 baseline measurements at an academic-affiliated private practice, using the NIOSH Sound Level Meter (SLM) application and a microphone. The surgeries were categorized into manual and automated broaching. Key metrics measured included maximal dB level (MDL), peak sound pressure (LCpeak), average continuous sound (LAeq), and average weighted sound in an 8-hour period (TWA), along with dose representations, to identify hazardous noise levels. Results: Of the 92 THA sound recordings, 50 used manual broaching and 42 employed automated broaching. Automated broaching exhibited higher noise levels, with an average MDL of 109.92 dBA, a LAeq of 86.09 dBA, a TWA of 76.48 dBA, and a projected noise dose of 137.74%. In contrast, manual broaching exhibited an average MDL of 105.87 dBA, a LAeq of 83.06 dBA, a TWA of 72.82 dBA, and a projected noise dose of 82.02%. Conclusion: This study highlights the auditory risks from automated broach and manual THA surgeries that orthopedic surgeons experience. Manufacturers should focus on reducing instrument noise when designing surgical tools and orthopedic surgeons and operating room staff should take measures to protect themselves from NIHL during surgery. [Orthopedics. 2024;47(6):349–354.] [ABSTRACT FROM AUTHOR]

Background: The results of surgical reconstructions of the anterior cruciate ligament (ACL) are improving with the association of extra-articular reinforcements, such as anterolateral ligament reconstruction and Lemaire tenodesis. However, ACL injury can occur through various mechanisms, and when there are valgus and external rotation of the tibia, anteromedial rotational instability (AMRI) may develop. Articular reinforcement in the anteromedial quadrant, in the topography of the anterior oblique ligament (AOL), can be an important tool for patients with ACL injury and external rotation instability. Indications: The physical examination under anesthesia in patients undergoing ACL reconstruction who are candidates for extra-articular reinforcements provides important information about rotational instability. Patients with instability in external rotation may benefit from anteromedial reinforcement in the AOL's topography. Technique Description: We propose an algorithm to be followed in patients with ACL injury and indication for extra-articular reinforcement. Patients with a positive pivot shift, indicating internal rotation instability of the knee, should undergo anterolateral reinforcements, as well as those patients with joint hyperlaxity. The algorithm suggests performing the anterior drawer in external rotation (ADER) test. When positive in isolation, anteromedial reinforcement is indicated. When the physical examination shows both positive ADER and pivot shift, both medial and lateral extra-articular reinforcement could be performed. Results: This new type of extra-articular reinforcement, in the AOL's topography, appears to be an important tool for improving surgical outcomes in ACL reconstructions. AMRI is a risk factor for central pivot reconstruction failure and should be investigated and treated, as proposed by the algorithm. Conclusions: Clinical examination of the ACL-injured knee, preferably under anesthesia, should include internal rotational and external rotational examination (pivot-shift and ADER tests). AMRI, when detected, should be treated, and the AOL reconstruction seems to be a good alternative. We propose a new algorithm based on rotational instability to make our extra-articular reinforcement in ACL patients. Patient Consent Disclosure Statement: The author(s) attests that consent has been obtained from any patient(s) appearing in this publication. If the individual may be identifiable, the author(s) has included a statement of release or other written form of approval from the patient(s) with this submission for publication. [ABSTRACT FROM AUTHOR]