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Introduction: Cervical laceration is an obstetric injury associated with severe postpartum hemorrhage and subsequent spontaneous preterm birth. While operative vaginal delivery is a known risk factor for cervical laceration, it is unclear whether forceps and vacuum deliveries incur the same risk. The aim of this systematic review was to compare the risk of cervical laceration between operative instruments (forceps vs vacuum). Material and Methods: Medline, Embase, Global Health, CENTRAL, Emcare, and Web of Science were searched from inception until August 2024 with terms related to operative vaginal delivery and cervical laceration. Studies comparing the risk of cervical laceration in individuals undergoing forceps or vacuum delivery were included. Two authors conducted screening, data extraction, and quality assessment of all studies. Random‐effects models were used to pool risk ratios across studies and certainty of evidence was assessed using Cochrane methods and the GRADE approach. PROSPERO Registration Number CRD42023421890. Results: Thirteen studies were eligible for inclusion, 3 randomized controlled trials (RCTs) and 10 observational studies. The overall rate of cervical laceration was 0.35% (990/284218 births) where 1.04% of forceps deliveries (456/43817) were complicated by cervical laceration compared to 0.22% of vacuum deliveries (534/240401). The risk of cervical laceration was 2–5 fold greater in forceps deliveries than in vacuum deliveries: pooled unadjusted risk ratio [RR] 4.83, 95% confidence interval [CI] 1.56–14.98 among RCTs and pooled unadjusted RR 1.89, 95% CI 1.59–2.24 among observational studies. The overall quality of evidence was low to moderate mainly due to the lack of attention to confounding in the included literature. The GRADE assessment indicated that the certainty of evidence was very low for observational studies and moderate for RCTs. Conclusions: Low certainty of evidence indicates that forceps deliveries may be associated with an increased risk of cervical laceration compared to vacuum deliveries. [ABSTRACT FROM AUTHOR]

Objective: This study describes the frequency of obstetric anal sphincter injuries (OASIS) in patients after instrumental delivery according to the type of forceps used. Methods: A retrospective comparative cohort study was conducted on patients who underwent instrumental delivery from January 2017 to April 2022. The primary outcome was the presence of OASIS following delivery. Patients were categorized into Cohort A if only rotation forceps were used, Cohort B for only traction forceps, and Cohort C if both types were used sequentially. Statistical analysis was performed with SPSS (IBM, New York, NY) with χ2, Fisher's exact, and analysis of variance testing. A P‐value <0.05 was considered significant. Results: OASIS occurred in 45 of 328 instrumental deliveries. OASIS after rotation forceps occurred in 12.9% (n = 8) of cases, after traction forceps in 13.2% (n = 34), and after sequential use of rotation and traction forceps in 37.5% (n = 3) of cases (p = 0.141). An odds ratio (OR) of 0.91 (95% confidence interval [CI] 0.40–2.08) for OASIS was obtained with the use of rotation forceps, 0.81 (95% CI 0.38–1.70) for traction forceps, and 3.97 (95% CI 0.91–17.2) for the sequential use of rotation and traction forceps. Conclusion: There were no significant differences in the presence of OASIS comparing traction and rotation forceps. A non‐significant trend of higher OASIS following the sequential use of traction and rotation forceps was observed. SYNOPSIS: This study investigates obstetric anal sphincter injuries after instrumental delivery, finding no significant difference between rotation and traction forceps in the Mexican population. [ABSTRACT FROM AUTHOR]

Background: Using primary airway epithelial cells (AEC) is essential to mimic more closely different types and stages of lung disease in humans while reducing or even replacing animal experiments. Access to lung tissue remains limited because these samples are generally obtained from patients who undergo lung transplantation for end-stage lung disease or thoracic surgery for (mostly) lung cancer. We investigated whether forceps or cryo biopsies are a viable alternative source of AEC compared to the conventional technique. Methods: AECs were obtained ex vivo from healthy donor lung tissue using the conventional method and two biopsy procedures (forceps, cryo). The influence of the isolation method on the quality and function of AEC was investigated at different time-points during expansion and differentiation in air-liquid interface cultures. In addition, fully-differentiated AECs were stimulated with house dust mite extract (HDM) to allow functional analyses in an allergic in vitro model. Vitality or differentiation capacity were determined using flow cytometry, scanning electron microscope, periodic acid-Schiff reaction, immunofluorescence staining, and proteomics. Results: As anticipated, no significant differences between each of the sampling methods were detected for any of the measured outcomes. The proteome composition was comparable for each isolation method, while donor-dependent effects were observed. Treatment with HDM led to minor differences in mucociliary differentiation. Conclusions: Our findings confirmed the adequacy of these alternative approaches for attaining primary AECs, which can now expand the research for a broader range of lung diseases and for studies at an earlier stage not requiring lung surgery. [ABSTRACT FROM AUTHOR]

Throat packing around the endotracheal tube is typically necessary for patients undergoing ENT, oral cavity, or head-neck surgeries under general anaesthesia. This involves a laryngoscopy and inserting a throat pack (TP) using Magill's forceps. The technique of laryngoscopy and the insertion of TP can result in a reflex sympathetic response, which is a cause for concern especially in high-risk patients. Aims and objectives: We are presenting a simple and effortless technique of throat packing around the endotracheal tube using Tilley's forceps and comparing it with the conventional method using Magill's forceps in terms of time duration, ease of insertion, and hemodynamic variations. Materials and methods: The study included 30 patients undergoing surgery under general anaesthesia requiring throat packing after endotracheal tube intubation. The patients were of either sex, aged between 20-55, weighed between 45-70 kg, and had an ASA physical status of I/II. After endotracheal tube intubation, throat packing was performed using either Magill's or Tilley's forceps, and data such as time taken for the procedure, ease of insertion, and hemodynamic variation were recorded. Results: Demographic data were similar in both groups. The time duration for the throat packing procedure (50.33± 12.72 vs 68± 14.68) was significantly shorter, and ease of insertion [13 (85%) vs 6(40%), p-0.02] was better in the group using Tilley's forceps compared to the conventional method with Magill's forceps. Both groups showed a pressor response to laryngoscopy, but the increase in heart rate (HR) and mean arterial pressure (MAP) was significantly higher with Magill's forceps. Conclusion: The use of Tilley's forceps for throat packing provides significant advantages, including less hemodynamic changes, ease of insertion, and shortened duration of laryngoscopy. This technique is recommended for throat pack insertion, even in ASA grade III/IV patients where hemodynamic variations are unacceptable. [ABSTRACT FROM AUTHOR]

Interhemispheric anatomical differences have long been thought to be related to language lateralization. Previous studies have explored whether asymmetries in the diffusion characteristics of white matter language tracts are consistent with language lateralization. These studies, typically with smaller cohorts, yielded mixed results. This study investigated whether connectomic analysis of quantitative anisotropy (QA) and shape features of white matter tracts across the whole brain are associated with language lateralization. We analyzed 1,040 healthy individuals (562 females) from the Human Connectome Project database. Hemispheric language dominance for each participant was quantified using a laterality quotient (LQ) derived from fMRI activation in regions of interest (ROIs) associated with a language comprehension task compared against amath task. A linear regression model was used to examine the relationship between structural asymmetry and functional lateralization. Connectometry revealed a significant negative correlation between LQs and QA of corpus callosum tracts, indicating that higher QA in these regions is associated with bilateral and right hemisphere language representation in frontal and temporal regions. Left language laterality in the temporal lobe was significantly associated with longer right inferior fronto-occipital fasciculus (IFOF) and forceps minor tracts. These results suggest that diffusion measures of microstructural architecture as well as geometrical features of reconstructed white matter tracts play a role in language lateralization. People with increased dependence on the right or both frontal hemispheres for language processing may have more developed commissural fibers, which may support more efficient interhemispheric communication. [ABSTRACT FROM AUTHOR]

Forceps-type mini-positron emission tomography (mini-PET) has been proposed as an intraoperative device for examining metastatic lymph nodes in the treatment of esophageal cancer. Although this forceps-type mini-PET detects cancer by radiation measurement, the scissor-like tip of the device affects the measurement accuracy. Therefore, to improve the detection sensitivity of the forceps-type mini-PET without depending on the operator, we fabricated a forceps tip mechanism using a parallel-link for parallel opening and closing motions, and verified the parallel motion and the force required for opening and closing. Consequently, we confirmed parallel motion from the opening and closing widths of the tip detectors. In addition, we confirmed that the forces required for opening and closing were significantly smaller than those required for the conventional mechanism. [ABSTRACT FROM AUTHOR]

Introduction: Magnetic intraocular foreign bodies can be removed with magnetized disposable forceps. Aim of this study is to compare the forceps magnetizability of different size, form and manufacturer. Methods: The forceps were magnetized using an established procedure. The inducible magnetic flux density was measured at the tip of the forceps. The mass that can be lifted with the magnetized forceps was then tested using steel balls in BSS solution. The weight of the metal parts of the forceps was measured. Results: The magnetic flux density that could be induced, the weight of the steel balls that could be lifted and the mass of stainless steel used in the forceps were as follows: Alcon end-grasping 23G: 7.12 mT, 87.43 mg, 1191 mg; Alcon end-grasping 25G: 6.43 mT, 87.43 mg, 1189 mg; Alcon serrated: 4.39 mT, 63.78 mg, 1284 mg; Alcon serrated 23G: 3.62 mT, 13.74 mg, 1200 mg; Alcon serrated 25G: 2.4 mT, 13.74 mg, 1195 mg; DORC end-grasping 23G: 5.52 mT, 32.54 mg, 153 mg; Synergetics end-grasping 23G: 4.35 mT, 16.37 mg, 193 mg; Vitreq BV end-grasping 23G: 2.65 mT, none, 88 mg. Discussion: The magnetizability of a disposable microforceps seems to depend on the mass of steel at the tip of the forceps. The structure of the iron lattice could have an even greater influence. Not every disposable forceps can be sufficiently magnetized for this technique. Key messages: What is known: • Steel intraocular foreign bodies can be lifted with magnetized forceps. What is new: • Not every forceps can be magnetized sufficiently. • Whether forceps can be magnetized well or poorly seems to have less to do with the stainless steel mass of the forceps. • The iron lattice structure of the used steel could be responsible for the magnetizability of the forceps. [ABSTRACT FROM AUTHOR]

Objective: To develop and validate a device that measures the pressure exerted by forceps on the fetal head for clinical use. Background: The lack of clinical tools to quantify forceps pressure on the fetal head may impact maternal and neonatal outcomes. Existing studies have not measured the direct contact pressure between forceps blades and the fetal head, highlighting the need for innovation. Methods: We integrated fluid pressure transducers into obstetric forceps using fluid-filled tubing encased in flexible silicone socks attached to the blades. Tubing materials—polyvinyl chloride (PVC) and polyurethane (PU)—and fluids (air and water) were tested with both biocompatible and non-biocompatible silicone socks. An onboard electronic board collected pressure data and transmitted them via Bluetooth for real-time analysis. The system was evaluated on a custom-built bench simulating forceps application. Results: Air-filled tubing exhibited significant drift and low accuracy due to air compressibility. Water-filled PU tubing reduced drift but was still suboptimal. Water-filled PVC tubing with both types of silicone socks provided the best results, showing minimal drift and a strong correlation between measured pressures and applied forces. Conclusions: The developed device represents a significant advancement, as no existing system measures the pressure exerted by forceps blades on the fetal head. By effectively measuring pressure across the entire contact surface in real time, it offers applications in both training and clinical practice. The device allows for objective feedback, potentially improving the safety and efficacy of forceps deliveries. Future work includes comprehensive mannequin tests and eventual in vivo studies to validate its effectiveness in realistic settings, aiming to enhance obstetric training and reduce maternal and neonatal complications. [ABSTRACT FROM AUTHOR]

Aim Methods Results Conclusion To determine the optimal first proximal screw position which permits proximal tibial fragment rotation adjustment while minimising osteotomy gap formation when a manual reduction technique is used for TPLO in dogs.TPLOs were performed on bone models using Synthes 3.5‐mm TPLO implants with a jig but without the use of an anti‐rotational pin. The osteotomy was held in manual reduction with pointed reduction forceps placed across the proximal tibial fragment while the first three screws were applied. The first two screws were placed in the non‐locking holes of the distal stem of the plate as per manufacturer's screw placement order guidelines. The third screw was placed in one of the three locking screw positions in the head of the plate, denoted as the ‘cranial’, ‘proximal’ and ‘caudal’ screw positions. After the first three screws were placed, the range of possible proximal tibial fragment rotation change (up to 6 mm in each direction) and the resultant cranial and caudal osteotomy gaps were measured.The proximal screw position minimises cranial osteotomy gap formation with negative rotation changes to the proximal tibial fragment. The caudal screw position minimises caudal osteotomy gap formation with positive rotation changes to the proximal tibial fragment. Rotation change had a greater effect on cranial osteotomy gaps compared to caudal osteotomy gaps. The cranial screw position had the most limited osteotomy rotation change.The proximal screw position should be placed first in the head of the plate to allow proximal tibial fragment rotation adjustment while minimising osteotomy gap formation when using a manual reduction technique when performing a TPLO. [ABSTRACT FROM AUTHOR]

Abstract 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

Objective: Obstetric forceps play an important role in safe childbirth, yet there is a lack of distinction between various forceps types in clinical practice. This study aimed to evaluate and compare perineal pressure and forces on the baby during nonrotational forceps‐assisted births using Simpson‐Braun forceps, Kielland forceps, and Thierry spatulas on a simulation model. Methods: This experimental study involved six obstetricians conducting 108 forceps‐assisted births on a simulation model. Instruments were assessed for their impact on perineal pressure, traction force, and operator‐assessed difficulty. Results: Thierry's spatulas exerted the lowest force on the baby, while Kielland forceps exhibited the lowest perineal pressure, though not statistically significant. An experienced obstetrician demonstrated less perineal pressure with Simpson forceps. Notably, no significant differences in difficulty were observed between instruments. Conclusion: This study highlights distinctions in forceps performance, with Thierry spatulas applying the least force on the fetal head, while an experienced obstetrician fared better with Simpson forceps in terms of perineal pressure. Kielland forceps remain a viable alternative for nonrotational forceps births, showing comparable outcomes. Synopsis: Thierry spatulas are gentlest on the fetal head, Simpson forceps are favored by experienced obstetricians for perineal pressure, and Kielland forceps offer an alternative with similar outcomes. [ABSTRACT FROM AUTHOR]

The gold standard for histological acute cellular rejection diagnosis is transbronchial forceps biopsy (FB), but in recent years, transbronchial cryobiopsy (CB) has been increasingly used. This study aims to compare the diagnostic rate and safety of FBs and CBs performed in two different periods. We retrospectively reviewed our case history for the two biopsy procedures: 251 FBs (223 for surveillance purposes and 28 for clinical indication) and 218 consecutive CBs (159 for surveillance purposes and 59 for clinical indication). All biopsies were scored according to the ISHLT criteria. Diagnostic yield was higher in the CB group for all the parameters considered: a grade of acute rejection (AR) was detected in 95.0% vs. 84.5% in the CB vs. FB groups (p < 0.001). The diagnostic rate of airway inflammation was 65.1% vs. 51.8% (p = 0.005), and 89.0% vs. 64.9% (p < 0.001) for chronic rejection. Pneumothorax requiring chest drainage occurred in 4% of the CB group and 3% of the FB group. Moderate and severe bleeding complicated CB and FB procedures in seven (3%) and three cases (1%), respectively. Transbronchial cryobiopsies improved the diagnostic yield in the monitoring of the lung allograft. The complication rate did not increase significantly in CBs vs. FBs. [ABSTRACT FROM AUTHOR]

Objective To compare the early effects on pelvic floor function of three modes of labor: natural delivery, cesarean section and forceps-assisted delivery. Methods Fifty-eight cases of women who underwent transperineal three-dimensional pelvic floor ultrasonography at 6 weeks postpartum at Obstetrics and Gynecology Hospital, Fudan University from Jan 2019 to Jan 2020 were collected and divided into three groups: the natural birth group (n=22), cesarean section group (n=9), and forceps group (n=27) . General data such as age, parity, birth order, neonatal weight, and pelvic floor ultrasonography findings were collected. Results The differences in age, gestational week at delivery, newborn weight and number of pregnancies among the three groups were not statistically significant. In pelvic floor ultrasonography, it was found that in the resting state, the cervix had a smaller vertical distance from the inferior border of the pubic symphysis and a smaller posterior vesicourethral angle in the forceps group compared with the cesarean section group. In the forceps group, the angle of urethral inclination was greater, and the area of the anorectal hiatus was smaller in the resting state compared with the natural birth group and cesarean section group. In the Valsalva state, the vertical distance of the bladder neck and the cervix from the lower edge of the pubic symphysis were smaller in the forceps group compared with the natural birth group and cesarean section group. In the transition from resting to Valsalva state, the angle of rotation of the urethra was greater in the natural birth group and the forceps group than in the cesarean section group. Cervical mobility and recto-pubic abdominal mobility were greater in the forceps group compared to the natural birth group and the cesarean section group. All these differences were statistically significant (P<0.05) . Conclusion In the early stage of labor, forceps-assisted delivery had a greater effect on the displacement of pelvic floor organs than natural labour and cesarean section. [ABSTRACT FROM AUTHOR]

Background Foreign bodies (FBs) in the ears and nose are common presentations among paediatric patients, necessitating prompt and appropriate management to avoid potential complications. Objective This article presents a standardised approach for FB retrieval based on local clinical data from a tertiary paediatric centre, addressing the challenges of identifying patients requiring specialist referral. Discussion The approach involves a detailed initial consultation and succinct examination to determine the most suitable retrieval method. Patient preparation and equipment availability are key to successful outcomes. A combination of microsuction and alligator forceps with adequate illumination is strongly recommended, along with various adjunct tools commonly available. Urgent referral to otorhinolaryngology is indicated for button batteries and previous failed attempts. This comprehensive approach seeks to achieve successful FB removal and optimise patient outcomes in both community and hospital settings. [ABSTRACT FROM AUTHOR]

Background and Objectives: Forceps delivery is a crucial obstetrical technique that has become increasingly underutilized in favor of cesarean delivery, despite the numerous complications related to cesarean sections. The major concerns with regard to assisted vaginal birth (AVB) are safety and long-term consequences. We aimed to investigate a neurological outcome of neonates and children at the age of 7 who were born via forceps delivery. This would greatly improve informed decision making for both mothers and obstetricians. Materials and Methods: A single-arm cohort study was conducted from January 2012 to December 2016 among 49 women and their children born via forceps delivery at the Clinic for Gynecology and Obstetrics, University Clinical Center of Serbia. The Sarnat and Sarnat classification was used to evaluate the neurological status of neonates, and logistic regression analysis was employed to explore the association with perinatal factors. Long-term neurological outcomes were assessed using the Griffiths Mental Development Scale and a questionnaire for parents based on the Motor and Social Development (MSD) scale, which was derived from the Bayley-III Scale. Results: The main indication for forceps delivery was maternal exhaustion (79.6%), followed by fetal distress (20.4%). A pathological neurological status was observed in 16.3% of newborns, with pathological ultrasound of the CNS in 3%. A statistically significant association was observed with the Apgar score, with an odds ratio of 0.575 (95% CI: 0.407–0.813, p = 0.002) and perinatal asphyxia, with an odds ratio of 9.882 (95% CI: 1.111–87.902, p = 0.04). However, these associations were unlikely to be related to the mode of delivery. Long-term adverse neurological outcomes were seen in three cases, which accounts for 6.4%. These included mild disorders such as delayed milestone, speech delay, and motor clumsiness. Conclusions: The present study highlights the safety of forceps delivery regarding children's neurological outcomes at 7 years of age. This is an important contribution to the modern management of labor, especially in light of increasing rates of cesarean deliveries worldwide. [ABSTRACT FROM AUTHOR]

Eponyms are widely used in the field of orthopedic surgery, including for surgical instruments. Although their use is at times controversial, an appreciation of the history behind eponymous terms allows one to both recognize the shortcomings of the past and simultaneously be inspired by ingenious inventors. The primary purpose of this review is to provide a historical perspective of clamps and forceps commonly used in orthopedic surgery, to better appreciate the evolution of their use over time, and to inspire innovation to constantly improve upon surgical instrumentation as the field of orthopedic surgery advances. [Orthopedics. 2024;47(6):e287–e291.] [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]

• This is the first study attempting to provide scientific evidence on the various maneuvers for the insertion of the blades in rotational forceps. • The best results were obtained with the direct maneuver. • Inserting the posterior blade first was the maneuver with the worst results. The Kielland's forceps is the most used forceps for assisting rotational operative births. There are various maneuvers described for blade insertion. Among these, the most used ones are the direct, first posterior, and wandering maneuver. The objective of this study was to compare these three maneuvers using a simulator. In this experimental study, 144 rotational forceps-assisted births were conducted using a simulation model, with 72 starting in a right occiput-transverse position and 72 in a left occiput-transverse position. Each of the three maneuvers (direct, first posterior, or wandering) for blade insertion was performed 48 times by a total of 6 operators, comprising 3 obstetricians with over 10 years of experience and 3 trainees. The assessment of forceps application included evaluating the placement of the blades in terms of asymmetry and the distance from the lock to the posterior fontanelle. Additionally, the study evaluated the number of reinsertions and relocations required, the perceived difficulty of the procedure, and the operator's level of experience. There were no statistically significant differences in terms of asymmetry with the three maneuvers. Regarding the distance from the lock to the posterior fontanelle, the best results were obtained with the direct maneuver. There were no differences in the number of reinsertions, relocations, and the perceived difficulty by the operators among the three maneuvers. Experienced obstetricians had better outcomes in terms of the need for reinsertions. The direct maneuver offer advantages in the insertion of blades for rotational forceps. [ABSTRACT FROM AUTHOR]

To evaluate the effectiveness of a "telestration" system in which the mentor annotates the view of the surgical field, for endoscopic transsphenoidal surgery (ETS). The use of telestration was evaluated for sellar floor-opening during ETS and for a task performed using ETS simulation training. During ETS, the mentor outlined the opening area of the sella turcica on the monitor and then the trainee surgeon opened the sella, either with the telestration displayed (telestration (+) group, n = 8) or without (telestration (−) group, n = 7). In the task using an ETS training model, 18 subjects were asked to touch the indicated targets with the forceps, once with the instructions given via telestration and once with verbal instructions only. During ETS, the telestration (+) group had a significantly higher concordance rate between the planned bone window and actual bone window than the telestration (−) group (92.97 ± 4.16% vs. 77.57 ± 10.51%, P = 0.014). In the ETS model, the time required to finish the task was significantly less with telestration than with verbal instructions alone (P = 0.002). None of the subjects had errors when telestration was used, while subjects made an average of 0.33 ± 0.59 errors and had to re-listen to the instructions 0.27 ± 0.46 times when only verbal instructions were given. The use of the telestration system during ETS facilitated the communication of the mentor's intentions to the trainee surgeon and contributed to safer, more accurate surgery. The system was also thought to be useful in reducing operative time. [ABSTRACT FROM AUTHOR]

Objective: To determine the trends of instrumental vaginal delivery (IVD) and cesarean section (CS) at the Lagos University Teaching Hospital (LUTH), Nigeria, over 16 years, from 2002 to 2017. Methods: A retrospective cross‐sectional study. The case records of all women who had IVD and CS during the study period were reviewed. The trends in the IVD and CS rates were evaluated using join point regression modeling. The average annual percent change (AAPC) and annual percent change (APC) with associated 95% confidence interval of segmental trends were calculated. Results: The overall IVD rate was 1.36%. Vacuum delivery rate was higher than forceps (0.79% vs 0.57%). The CS rate was 44.9 per 100 deliveries; the rate increased by about 3.7% per annum. CS rates were 7.1–89.9 times the IVD rates within the study period. The number of IVDs performed in the hospital declined by about 83.02%, from 53 cases in 2002 to nine cases in 2017. Forceps delivery declined at a faster rate than vacuum delivery between 2002 and 2017 (AAPC for forceps: −12.6% [−17.5 to −7.5], P < 0.001 vs AAPC for vacuum: −6.2% [−14.3 to 2.7], P = 0.200). The commonest indication for IVD was prolonged second stage of labor (47/162, 29.01%) and shortening of the second stage of labor for maternal conditions (47/162, 29.01%). Conclusion: IVD rates are low and declining at LUTH. There is need to train accoucheurs on the safe use of IVDs to potentially reduce the CS rate. Synopsis: The present study corroborates global reports of declining IVD rates and increasing CS rates. There is need to increase IVD use to potentially reduce CS rate. [ABSTRACT FROM AUTHOR]

The conventional methods of silicon stent insertion recommend usage of external loading devices, where the stent is folded into the loading device and pushed in to the tracheobronchial tree using an external pusher which is blind, and leads to placement of stent either distally or proximally needing repositioning or is done with fluoroscopy that involves radiation exposure. We demonstrate our experience in 16 cases of successful silicon stent placement using this technique, wherein an Ultrathin flexible bronchoscope or Hopkins Rigid telescope is pushed alongside the forceps that hold upper end of the folded silicon stent allowing stent placement under direct vision with control over the stent. The Proximal end of the stent can be pulled under vision before deployment for appropriate positioning while pulling the rigid barrel. The stent is always under the operator's control providing excellent control over placement, simplifies the procedure and is safe with no reported complications. [ABSTRACT FROM AUTHOR]

Importance: Lung biopsies are sometimes performed in mechanically ventilated patients with acute hypoxemic respiratory failure (AHRF) of unknown etiology to guide patient management. While surgical lung biopsies (SLB) offer high diagnostic rates, they may also cause significant complications. Transbronchial forceps lung biopsies (TBLB) are less invasive but often produce non-contributive specimens. Transbronchial lung cryobiopsies (TBLC) yield specimens of potentially better quality than TBLB, but due to their novel implementation in the intensive care unit (ICU), their accuracy and safety are still unclear. Objectives: Our main objective was to evaluate the risk of adverse events in patients with AHRF following the three biopsy techniques. Our secondary objectives were to assess the diagnostic yield and associated modifications of patient management of each technique. Design, Settings and Participants: We conducted a retrospective cohort study comparing TBLC, TBLB, and SLB in mechanically ventilated patients with AHRF. Main Outcomes and Measures: The primary outcome was the proportion of patients with at least one complication, and secondary outcomes included complication rates, diagnostic yields, treatment modifications, and mortality. Results: Of the 26 patients who underwent lung biopsies from 2018 to 2022, all TBLC and SLB patients and 60% of TBLB patients had at least one complication. TBLC patients had higher unadjusted numbers of total and severe complications, but also worse Sequential Organ Failure Assessment scores and P/F ratios. A total of 25 biopsies (25/26, 96%) provided histopathological diagnoses, 88% (22/25) of which contributed to patient management. ICU mortality was high for all modalities (63% for TBLC, 60% for TBLB and 50% for SLB). Conclusions and Relevance: All biopsy methods had high diagnostic yields and the great majority contributed to patient management; however, complication rates were elevated. Further research is needed to determine which patients may benefit from lung biopsies and to determine the best biopsy modality. [ABSTRACT FROM AUTHOR]

The stainless steel mesh was covered by MOF-199 and applied in the four-component synthesis of 2-aminospiro[indeno[1,2-b]quinoxalin-11,4-pyran]-3-carbonitriles as a novel and efficient heterogeneous catalyst. The preparation of MOF-199-covered stainless steel mesh (MOF-199@SSM) was confirmed by FT-IR, FE-SEM and DEX analyses. MOF-199@SSM catalyst can be easily separated from the reaction mixture by simple forceps and reused. The stability of the catalyst was examined using a hot filtration test and no leaching occurred during the reaction. The reactions conditions were mild and the reaction times were relatively short. No by-product was produced, so, high purity and high yields of products were obtained. [ABSTRACT FROM AUTHOR]

Background Disposable digital single-operator cholangioscopy (D-SOC) and direct peroral cholangioscopy (D-POC) using an ultraslim endoscope are established POC modalities for the diagnosis and treatment of various biliary diseases. We compared the usefulness of D-SOC and D-POC for the diagnosis of intraductal superficial lesions of the bile duct (ISL-Bs). Methods 38 consecutive patients with suspected biliary diseases who underwent both D-SOC and D-POC were enrolled. The primary outcome was ISL-B detection rate, and the secondary outcomes were technical success of POC and POC-guided forceps biopsy sampling (POC-FB), procedure time, visualization quality, and tissue adequacy. Results D-SOC had a higher technical success rate than D-POC but the difference was not statistically significant (100% vs. 92.1%, P = 0.25). D-POC had a marginally higher ISL-B detection rate (34.2% vs. 28.9%, P = 0.68) and significantly higher visualization quality (P = 0.03). The mean (SD) procedure time was significantly shorter with D-SOC (11.00 [1.33] vs. 19.03 [2.95] minutes, P<0.001). The technical success rate of POC-FB and tissue adequacy did not differ between the two techniques (D-SOC vs. D-POC: 81.8% vs. 84.6%, P = 0.69 and 77.8% vs. 90.9%, P = 0.57, respectively). Conclusions Both POC systems were safe and useful for the detection, characterization, and diagnosis of minute ISL-Bs. While D-SOC displayed a shorter procedure time and a tendency for higher technical success rate, D-POC provided superior visualization quality, allowing detailed observation of the surface structure and microvascular patterns. [ABSTRACT FROM AUTHOR]

Background: Most malignant peripheral pulmonary lesions (PPLs) are situated in the peripheral region of the lung. Although the ultrathin bronchoscope (UTB) can access these areas, a robust navigation system is essential for precise localisation of these small peripheral PPLs. Since many UTB procedures rely on automated virtual bronchoscopic navigation (VBN), this study aims to determine the accuracy and diagnostic yield of the manual bronchial branch tracing (BBT) navigation in UTB-guided radial endobronchial ultrasound (rEBUS) procedures. Methods: Single-centre retrospective study of UTB-rEBUS patients with PPLs smaller than 3 cm over a two year period. Results: Our cohort consisted of 47 patients with a mean age of 61.6 (SD 9.53) years and a mean target size of 1.91 (SD 0.53) cm. Among these lesions, 46.8% were located in the 6th airway generation, and 78.7% exhibited a direct bronchus sign. Navigation success using BBT was 91.5% based on positive rEBUS identification. The index diagnostic yield was 82.9%, increasing to 91.5% at 12 months of follow-up. Malignant lesions accounted for 65.1% of cases, while 34.9% were non-malignant. The presence of a direct bronchus sign was the sole factor associated with higher navigation success and diagnostic yield. Cryobiopsy outperformed forceps biopsy in non-concentric rEBUS lesions (90.9% vs. 50.0%, p < 0.05), but not in concentric orientated lesions. One pneumothorax occurred in our cohort. Conclusions: BBT as an exclusive navigation method for small PPLs in UTB-rEBUS procedures has proved to be safe and feasible. Combination of UTB with cryobiopsy remains efficient for eccentric and adjacently oriented rEBUS lesions. [ABSTRACT FROM AUTHOR]

Background/Objectives: Postoperative intraocular lens (IOL) tilt is a risk associated with IOL scleral fixation. However, the cause of IOL tilt during IOL suturing remains unclear. Therefore, this study aimed to evaluate the surgical outcomes of a modified IOL suturing technique and investigate the factors contributing to postoperative IOL tilt and decentration. Methods: We included 25 eyes of 22 patients who underwent IOL suturing between April 2018 and February 2020. A modified IOL suturing technique that decreased the need for intraocular suture manipulation was used. Factors contributing to IOL tilt and decentration were investigated using an intraoperative optical coherence tomography (iOCT) system. Results: The mean postoperative best-corrected visual acuity improved from 0.15 ± 0.45 to −0.02 ± 0.19 (p = 0.02). The mean IOL tilt angle at the last visit after surgery was 1.84 ± 1.28 degrees. The present study reveals that the distance of the scleral puncture site from the corneal limbus had a stronger effect on IOL tilt; meanwhile, the suture position of the haptics had a greater effect on IOL decentration. Conclusions: The modified IOL suturing technique, which avoids intraocular suture handling, had favorable surgical outcomes with improved postoperative visual acuity and controlled IOL tilt and decentration. Accurate surgical techniques and careful measurement of distances during surgery are crucial for preventing postoperative IOL tilt and decentration. [ABSTRACT FROM AUTHOR]

Precision industries focus on achieving high accuracy and controllable motion in the structural design of components. Compliant mechanisms have emerged as a preferred choice among researchers, as they enable motion without relying on traditional joints. These compliant mechanisms, lacking hard junctions, facilitate the construction of microscale devices. This study introduces a novel two-phase de-sign methodology for compliant mechanism forceps, aiming to eliminate high-stress areas by employing a distributed compliant mechanism. The forceps design incorporates topological optimization with a new approach to create a distributed planar design. The introduction of a design domain with a pattern of holes restricts single point contact formation and promotes the formation of a distributed compliant mechanism. A parameterization technique is implemented to transition from conceptual design to a functional working design. The compliant forceps design is rigorously evaluated through finite element analysis (FEA) based on structural considerations. The research culminates in the development of a handle-equipped microgripper prototype. Experimental verification showcases the gripper's performance, revealing a variation of less than 3% compared to numerical results. An integrated force sensor measures gripping force, and the results are compared with the reaction force estimated through FEA. This comprehensive approach to compliant mechanism forceps design and evaluation contributes valuable insights to the field of precision industries. [ABSTRACT FROM AUTHOR]

Obstetric trauma refers to injuries that occur to the newborn during the birth process and can occur despite proper perinatal care. Limiting risk factors could reduce its incidence and avoid significant morbidity and mortality to the infant. The aim of our study was to determine the incidence of birth injury in our setting and to discover its associated risks factors. For this case–control study, all births that took place in our center during the year 2021 were systematically reviewed. A total of 231 full-term newborns, with 77 cases and 154 controls, were included. For each case, two controls of similar sex and gestational age, born during the same shift before and after the case were selected. Preterm infants, outborn patients, twins, and infants with major congenital anomalies were excluded. The incidence of birth injury was 22.8‰ of singleton births. The most frequent injuries were cephalohematoma, peripheral facial paralysis, and clavicle fracture. After the adjusted logistic regression analysis, the variables that were independently associated with obstetric trauma were (aOR; 95% CI) breech presentation: 10.6 (1.2, 92.6), p = 0.032; dystocia: 7.8 (3.8, 16.2), p < 0.001; forceps instrumentation: 3.1 (1.0, 9.1), p = 0.043; induced labor: 3.0 (1.6, 5.5), p < 0.001; and newborn birthweight (per each 100 g): 1.1 (1.0, 1.2), p = 0.004. In conclusion, the incidence of birth trauma in our setting was 22.8‰ of singletons. The most frequent injuries were cephalohematoma, peripheral facial paralysis, and clavicle fracture. There was an independent association between birth trauma and breech presentation, dystocia, forceps instrumentation, labor induction, and infant birthweight. [ABSTRACT FROM AUTHOR]

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Introducción: La adquisición de habilidades para la atención de partos instrumentalizados con fórceps se ha vuelto más desafiante debido a la disminución de la tasa de partos instrumentales a nivel mundial. Por lo tanto, se ha vuelto fundamental optimizar las estrategias y métodos de enseñanza de estos procedimientos en los residentes de Obstetricia y Ginecología. Objetivo: Exponer los métodos de enseñanza reportados en la literatura para la atención de partos con fórceps y su contribución al aprendizaje y adquisición de habilidades en residentes. Material y métodos: Revisión sistemática de la literatura mediante el protocolo PRISMA Extension for Scoping Reviews en la base de datos de WOS y SCOPUS. Se consideraron artículos originales publicados en español e inglés, sin delimitación temporal, referidos a los métodos o modelos de enseñanza de atención de partos instrumentalizados con fórceps. Se seleccionaron aquellos artículos de acuerdo con el objetivo de la investigación. Los autores revisaron y sintetizaron de forma independiente la información de los artículos incluidos. Resultados: Seis estudios fueron revisados y organizados en tres categorías: i) Tipos de método de enseñanza: destacaron las simulaciones de alta y baja fidelidad, así como métodos integrativos de simulaciones y clases teóricas. ii) Efectividad en la adquisición de habilidades y percepciones de los participantes: se evidenciaron progresos en habilidades técnicas, mayor confianza y satisfacción por parte de los residentes, además de mejores resultados clínicos. iii) Patrones y desarrollo de herramientas educativas: los simuladores avanzados permitieron replicar escenarios clínicos y optimizar las fuerzas aplicadas durante el procedimiento, además la retroalimentación inmediata permite perfeccionar la corrección de errores. Conclusiones: Esta revisión destaca la importancia de los métodos de enseñanza basados en simulación y currículos educativos estructurados para mejorar tanto las habilidades técnicas como la confianza de los residentes en la ejecución de partos instrumentales con fórceps.

Background: Theoretically, a rapid urease test (RUT) using a swab of the gastric wall (Swab-RUT) for Helicobacter pylori (H. pylori) is safe. However, the validity and utility of Swab-RUT remain unclear. Therefore, we assessed the validity and utility of Swab-RUT compared to RUT using mucosal forceps of the gastric wall (Forceps-RUT) and 13C-urea breath test (UBT). Methods: This study was a multicenter prospective observational study. When the examinees were suspected of H. pylori infection during esophagogastroduodenoscopy, we performed Swab-RUT and Forceps-RUT continuously. When the examinees were not suspected of H. pylori infection, we performed Swab-RUT alone. We validated the status of H. pylori infection using UBT. Results: Ninety-four examinees were enrolled from four institutions between May 2016 and December 2020 (median age [range], 56.5 [26–88] years). In this study, the sensitivity, specificity, and accuracy of Swab-RUT to UBT were 0.933 (95% confidence interval: 0.779–0.992), 0.922 (0.827–0.974), and 0.926 (0.853–0.970), respectively. The Kappa coefficient of Swab-RUT to UBT was 0.833, and that of Swab-RUT to forceps-RUT was 0.936. No complications were observed in this study. Conclusions: Swab-RUT is a valid examination for the status of H. pylori infection compared to the conventional Forceps-RUT. [ABSTRACT FROM AUTHOR]

Labial salivary gland biopsy (LSGB) is one of the specific diagnostic criteria for primary Sjögren's syndrome (pSS). In traditional LSGB, there is no lower lip fixation device, the field of view is unclear due to intraoperative bleeding, and the incision is large, which is unfavourable for healing. The use of auxiliary devices to improve the shortcomings of traditional LSGB technique would be meaningful. Therefore, this case–control study aimed to assess the value of modified LSGB using chalazion forceps as compared with traditional LSGB. After obtaining written informed consent from all participating parents and patients, we randomly assigned 217 eligible participants to undergo LSGB using chalazion forceps (n = 125) or traditional LSGB (n = 92). The outcome variables were surgical time, incision length, intraoperative bleeding, pain score at 24 h after surgery, incision healing status at 7 days after surgery, gland collection, and pathological results. The final diagnostic results of the two surgical methods were compared, and the match rates between the pathological results and the final clinical diagnoses were compared between the two groups. The data were analysed using parametric and nonparametric tests. Compared with the traditional group, the modified group had a smaller incision, shorter operative time, less blood loss, lower 24 h pain score, and better Grade A incision healing at 7 days after surgery (p < 0.01). There was no statistically significant difference between the patients in the two surgical-method groups in terms of the positive biopsy results and the final diagnosis based on expert opinions (p > 0.05). By multivariable regression analysis, only a focus score (FS) of ≥ 1 (p < 0.01), dry eye disease (p < 0.05) and anti-nuclear antibodies (ANA) titre ≥ 1:320 (p < 0.05) were correlated with the diagnosis of pSS. The positive biopsy results of patients in the different surgical-method groups had a biopsy accuracy of > 80.0% for the diagnosis of pSS. The positive biopsy results in the different surgical-method groups were consistent with the expert opinions and the 2016 ACR-EULAR primary SS classification criteria. The modified LSGB using an auxiliary chalazion forceps offers a good safety with a small incision, shorter operative time, less bleeding, reduced pain and a low incidence of postoperative complications.The match rate of LSGB pathological results of the proposed surgical procedure with the final diagnosis of pSS is high. [ABSTRACT FROM AUTHOR]

• Manual rotation is the preferred method to rotate the fetal head in the UK. • There is no clear evidence to guide practices of rotational vaginal birth. • UK Obstetricians would support an RCT of manual versus instrumental rotation. • This RCT would ascertain which rotational method has the lowest chance of OASI. Malposition of the fetal head, defined as occiput transverse or posterior positions, occurs in approximately 5% of births. At full cervical dilatation, fetal malposition is associated with an increased risk of rotational vaginal birth. There are three different rotational methods: manual rotation, rotational ventouse or rotational (Kielland's) forceps. In the absence of robust evidence, it is not currently known which of the three methods is most efficacious, and safest for parents and babies. To gain greater insights into opinions and preferences of rotational birth to explore the acceptability and feasibility of performing a randomised trial comparing different rotational methods. A survey was sent via email to obstetricians from the British Maternal Fetal Medicine Society, as well as expert obstetricians and active academics in ongoing research in the UK. The questions focussed on perceived competence, preferred rotational method, location (theatre or labour room), willingness to recruit to an RCT, and its outcome measures. Closed questions were followed by the option of free text to allow further comments. The free text answers underwent thematic analysis. 252 consultant obstetricians responded. The majority stated they were competent in performing manual rotation (88.1%). Half felt proficient using Kielland's rotational forceps (54.4%). Most obstetricians felt skilled in rotational ventouse (76.2%). Manual rotation was the preferred first rotational method of choice in cases of both occiput transverse and posterior positions. The decision for which rotational method to attempt first was considered case-dependent by many. Two thirds of obstetricians would usually conduct rotational births in theatre (67.9%). Over half (52%) do not routinely use intrapartum ultrasound. Most (62.7%) would be willing to recruit to a randomised controlled trial comparing manual versus instrumental rotation. Over half (57.2%) would be willing to recruit to the same RCT if they were the most senior doctor competent in rotational vaginal birth supervising a junior. There is a wide range of practice in conducting rotational vaginal births in the UK. An RCT to investigate the impact of different rotational methods on outcome would be both feasible and desirable, especially in research-active hospitals. [ABSTRACT FROM AUTHOR]

Study Design: A prospective experimental study. Purpose: This biomechanical in vitro study aimed to examine the extent to which the use of a rod persuader (RP) leads to additional mechanical stress on the screw–rod system and determine its influence on the bony anchoring of primary pedicle screws. Overview of Literature: Degenerative spine diseases and deformities are the most common indications for the stabilization and fusion of spinal segments. The pedicle screw–rod system is considered the gold standard for dorsal stabilization, and an RP is also increasingly being considered to fit the spondylodesis material. Methods: Ten lumbar spines from body donors were examined. Bisegmental dorsal spinal lumbar interbody fusion of the L3–L5 segments was performed using a pedicle screw–rod system (ROCCIA Multi-LIF Cage; Silony Medical, Germany). In group 1, the titanium rod was inserted without tension, whereas in group 2, the rod was attached to the pedicle screws at the L4 and L5 levels, creating a 5-mm gap. To attach the rod, the RP was used to press the rod into the pedicle screw. The rod was left in place for 30 minutes and then removed. Results: The rod reduction technique significantly increased the mechanical load on the overall construct measured by strain gauges (p<0.05) and resulted in outright implant failure with pedicle screw pullout in 88.9%. Conclusions: In cases where the spondylodesis material is not fully attached within the pedicle screw, an RP can be used with extreme caution, particularly in osteoporotic bones, to avoid pedicle screw avulsion and screw anchor failure. [ABSTRACT FROM AUTHOR]

Introduction: The standard diagnosing Hirschsprung disease is obtained by pathologic evaluation. There are several techniques to acquire pathologic sample included Full Thickness Biopsy, Rectal Suction Biopsy, Punch Biopsy, and Endoscopic Biopsy. Currently, the endoscopic device is widely available and its utility is more frequent in pediatric population. This study conducted to compare the effectiveness in diagnosing Hirschsprung disease using the Colonoscopy Forceps Biopsy (CFB) and full thickness biopsy (FTB) method as a gold standard. Method: A preliminary study of the pathologic evaluation in 10 children clinically Hirschsprung disease who underwent two types of biopsy procedures: full-thickness biopsy and colonoscopy forceps biopsy. This study aimed to compare the diagnostic result of these two methods. Results: The biopsy results indicate that 10 FTB samples were aganglionic, while 9 samples taken using CFB were aganglionic. Conclusion: Colonoscopy with forceps biopsy may be used as an alternative for the diagnosis of Hirschsprung’s disease in children, further studies are needed to assess the diagnostic accuracy of colonoscopy with forceps biopsy. [ABSTRACT FROM AUTHOR]

Aims and objectives: To focus on comparison of forceps-assisted vs manual method of fetal head extraction during lower segment cesarean section (LSCS). Comparative study to identify the safety, effectiveness, and ease of obstetric forceps for delivery of head in cesarean section. Methods and materials: After getting ethics approval, the total 66 mothers from the ANC, attending antenatal OPD, and Emergency admitted for cesarean section in different indications fulfilling the selection and exclusion criteria. These were selected, randomized, and allowed into two groups such as group A (n = 33) = cases (forceps) and group B (n = 33) = controls (manual) in each group consisting of 33 patients. The data collection, data analysis, and the outcomes of individual groups analyzed as primary outcomes, secondary outcomes, newborn outcomes were tabulated and statistically significant calculated by GRAPH-PAD software. Results and analysis: In our study, the primary outcomes were statistically significant as weight, BMI, estimated intraoperative loss, drain volume in 48 hours, the weight of mops, PCV-drop, and the hemoglobin drop complicated with chest discomfort, required transfusion as blood, FFP, platelets, volume expanders needed intensive and/or critical care. The outcomes were significant in operation time with U-D time, difficulties head delivery and assisted fundal pressure, required conversion and ultimately failure to deliver. Intraoperative events were significant as extension/laceration-associated angle hematoma, stitch line hematoma, window at stitch site, cut through and apposition failure with major hazards landed in major operations. The indicators of the secondary outcomes in postoperative and follow-up period were revealed statistically significant as mobilization time, oral feeding time, pain and discomfort, analgesics requirement, developed febrile illness, and wound complications necessitated hospital stay with recovery-satisfaction and costs. The newborn outcomes were observed significant in form of I-D time, meconeum stain, weight, preterm, IUGR, cried at birth with Apgar score, needed essential newborn care (ENC), and NICU admission. Conclusion: Considering the outcomes, with proper selection of patient(s), application of forceps produced statistically significant better outcomes during cesarean operation than manual extraction. Recommended routine forceps application in cesarean delivery. [ABSTRACT FROM AUTHOR]

Background: The diagnosis of peripheral pulmonary lesions (PPL) is still challenging. We describe a novel method for sampling PPL without bronchial signs by creating invisible tunnel under electromagnetic navigation without the transbronchial access tool (TABT). Methods: During electromagnetic navigation, we adjust the angle of the edge extended working channel catheter based on the real-time position of the lesion in relation to the locating guide rather than preset route. A biopsy brush or biopsy forceps is used to punch a hole in the bronchial wall. A locating guide is then re-inserted to real-time navigate through the lung parenchyma to the lesion. Safety and feasibility of this method was analyzed. Results: A total of 32 patients who underwent electromagnetic navigation bronchoscopy were retrieved. The mean size of the lesion is 23.1 mm. The mean operative time of all patients was 12.4 min. Ten of the patients did not have a direct airway to the lesion, thus creating an invisible tunnel. For them, the length of the tunnel from the bronchial wall POE to the lesion was 11–30 mm, with a mean length of 16.9 mm and a mean operation time of 14.1 min. Adequate samples were obtained from 32 patients (100%), and the diagnostic yield was 87.5% (28/32). Diagnostic yield of with create the invisible tunnel TBAT was 90% (9/10), and one patient undergone pneumothorax after operation. Conclusions: This method is feasible and safe as a novel approach sampling pulmonary lesions without bronchial signs, and it further improves current tunnel technique. [ABSTRACT FROM AUTHOR]

Objective To compare the efficacy of triangular anchor reduction forceps and towel forceps in the treatment of long oblique or spiral distal tibial fractures. Methods The data of 58 patients admitted to the Department of Traumatic Orthopaedics in Second Affiliated Hospital of Anhui Medical University from June 2019 to March 2021 were analyzed prospectively. According to the reduction methods during operation, they were divided into point reduction forceps group (n = 26) and triangle anchor reduction forceps group (n = 32) . The operation time, intraoperative fluoroscopy times, intraoperative blood loss, postoperative fracture reduction quality, hospital stay, fracture healing time, American orthopedic foot and ankle society (AOFAS) score, curative effect and complications at the last follow-up were compared between the two groups. Results All patients participated in the follow-up for more than one year. There was no significant difference in age, sex, basic diseases and injury mechanism between the two groups. The operation time and fluoroscopy times of patients in triangle anchor reduction group were significantly lower than those in point reduction forceps group (P < 0.05), while the quality of fracture reduction was higher than that in point reduction forceps group (P < 0.05), and there was no significant difference in other perioperative indexes. The fracture healing time of patients in triangle anchor reduction group was shorter, and the ankle joint function was better than that in point reduction forceps group (P < 0.05) . There was no significant difference in the incidence of various complications between the two groups, but the overall incidence of complications in the triangle anchor reduction group was significantly lower (P < 0.05) . Conclusion Triangular anchor reduction forceps can improve the quality of fracture reduction, shorten the healing time of fracture, reduce the occurrence of complications, reduce the operation time and the number of fluoroscopy during operation, and there is no obvious increase in local infection. It is an effective and reliable reduction method. [ABSTRACT FROM AUTHOR]

Patients with malignant central airway obstruction often present with dyspnea and sometimes with frank respiratory failure. Airway stenting has become a routine modality in the management of these patients. A correctly placed airway stent will give good relief in dyspnea and respiratory failure and will even improve the patient's ECOG (Eastern Cooperative Oncology Group) performance score. The common complications associated with stents are migration, fracture, infection, and obstruction by tumors, granulation tissue, and secretions. These complications are more pronounced with metallic stents. Surveillance bronchoscopy should ideally be done in these patients at least 4–6 weeks post-stent insertion. Removal of granulation tissue has been attempted with modalities like lasers, Argon plasma coagulation, cryotherapy, and snare electrocautery. Here, we present a novel case of post-stent granulation tissue, which was removed and debulked with the help of electrocoagulation bronchoscopy biopsy forceps (hot biopsy forceps). Conclusion Hot biopsy forceps can be safely and easily used for the removal of granulation tissue in patients post-tracheobronchial stent insertion. [ABSTRACT FROM AUTHOR]

En bloc resection of bladder tumor (ERBT) involves removing bladder tumors and their base. Laser resection has been used to reduce complications including bleeding and obturator nerve reflex (ONR). We developed a novel approach (rotatable bi-channel en bloc resection of bladder tumor (RBC-ERBT)) and assessed its efficacy in a pilot in-vivo study to enhance laser ERBT's applicability in challenging bladder regions. In the laser RBC-ERBT procedure, lesions were excised by inserting a holmium laser through the rotating external working channel, while forceps were inserted through the internal working channel provided traction on the tissue. Fifteen laser RBC-ERBT procedures were performed in five different bladder areas of three live pigs. The technical success rate (TSR), procedure time, lesion size, occurrence of complications (bleeding, perforation, ONR), and detrusor muscle (DM) presence rate and DM thickness were evaluated. All 15 procedures were performed with a 100% TSR. The resections were successful in all bladder regions (posterior, left, right and anterior walls and dome). Median procedure time was 20 min. The resected specimen size was 10 mm × 7 mm to 17 mm × 13 mm. Mild bleeding occurred in two procedures (13.3%) but was effectively managed. No incidents of ONR or perforation were observed. Histological examination confirmed presence of DM in all specimens with a median DM thickness of 1.26 mm. Our pilot in-vivo study suggested the feasibility and effectiveness of laser RBC-ERBT for bladder tumors in various locations. This technique offers effective traction, improved visualization, and enhanced laser accessibility. Further studies are required to validate its effectiveness in humans. [ABSTRACT FROM AUTHOR]

This study aimed to assess retinal alterations following membrane peeling procedures using novel ILM Forceps with laser ablated surface with the help of intraoperative optical coherence tomography (iOCT). A post-hoc analysis was performed to evaluate iOCT findings in eyes that underwent membrane peeling procedures with the novel ILM Forceps. Pre-peel and post-peel iOCT videos and images were evaluated for each eye to assess for post-peel anatomic alterations. Surgical video/iOCT scan correlation was conducted to evaluate the etiology of anatomic alterations. Thirty-two eyes were included in the analysis. Three eyes (9%) had focal full thickness retinal elevations identified on iOCT following tissue-instrument interaction with the ILM Forceps. Two eyes (6%) had focal inner retinal elevations and one eye (3%) had a full-thickness retinal elevation that were not related to direct tissue-instrument interaction but rather indirect peeling forces. iOCT-identified architectural alterations related to direct-tissue instrument interaction were relatively infrequent (< 10%) with similar frequency to previously reported alterations with other surgical instruments. [ABSTRACT FROM AUTHOR]

Background: Dislocated IOL exchange conventionally involves manipulation within the anterior chamber which risks secondary injury to anterior chamber structures. We describe and evaluate a 4-haptic IOL rescue technique that avoids entering the anterior chamber and thus minimizes post operative inflammation, astigmatism and recovery time relative to conventional IOL explantation and replacement techniques. Methods: Retrospective, non-randomized, interventional study of all patients undergoing 4-haptic IOL rescue performed by two independent vitreoretinal surgeons at a single UK centre over two years. Surgical technique: A limited peritomy is performed with four 25-gauge scleral ports placed to enable use of two forceps, an infusion and a chandelier. A further four 27-gauge sclerotomies are symmetrically placed on the nasal and temporal sclera at 3 mm from the limbus with a 5 mm vertical separation on either side. A pars plana vitrectomy is performed followed by chandelier illuminated, bimanual cleaning of the dislocated IOL using 27-gauge serrated forceps. Gore-tex sutures are threaded through the IOL islets within the vitreous cavity and externalized through the sclerotomies for scleral re-fixation followed by conjunctival closure. Results: Seven patients underwent IOL recycling with Gore-Tex suture scleral re-fixation. All procedures were successful in repositioning the IOLs, with all patients satisfied with post-operative outcome. Mean (standard deviation) time to IOL dislocation was 13 (3) years. Median visual acuity significantly improved post-operatively from 0.85 logMAR (Interquartile Range [IQR]: 0.2–2.1) to 0.07 (0.02–0.60) logMAR (p = 0.02). No significant post-operative complications were noted apart from persistent cystoid macular oedema in one patient non-compliant with post-operative treatment. Conclusions: Transscleral refixation using Gore-Tex suture is an effective, safe and practical approach in the management of dislocated 4-piece IOLs. [ABSTRACT FROM AUTHOR]

• High success rates of centralized organoid generation in HIT-CF organoid study. • Low complication rates in taking rectal biopsies via both suction and forceps procedures. • Successful use of STAR protocol. • Proven feasibility of international biobanks through successful organoid generation. Patient-derived intestinal organoids (PDIOs) show great potential as in vitro drug testing platform for personalised medicine in Cystic Fibrosis and oncology. PDIOs can be generated by culturing adult stem cells obtained through rectal forceps biopsy or suction biopsy, but the safety of these procedures and the success rates of generating organoids after shipment to a centralized lab using these procedures has not been studied in this context. We here report the safety and success rates of both biopsy procedures and the subsequent generation of PDIOs in the international multicentre HIT-CF Organoid Study. 502 biopsy procedures were conducted, on 489 adult people with Cystic Fibrosis from 33 different hospitals across 12 countries. Depending on the preference of the hospital, either rectal forceps biopsies or suction biopsies were obtained and internationally shipped to a central laboratory for organoid generation. No adverse events were reported for 280 forceps biopsy procedures, while 222 rectal suction biopsy procedures resulted in 2 adverse events, namely continued bleeding and a probably nonrelated gastroenteritis. The success rate of organoid generation from all biopsies was 95%, and the main reason for failure was insufficient sample viability (3.2%). Our results indicate that both rectal suction biopsy and forceps biopsy procedures are safe procedures. The high success rates of PDIO generation from the obtained tissue samples demonstrate the feasibility of the organoid technology for personalised in vitro testing in an international setting. [ABSTRACT FROM AUTHOR]

Background: Conventional Forceps biopsy is associated with smaller specimen sizes and more crushed artifacts. Recently, cryobiopsy has been suggested to be associated with higher diagnostic yield due to its ability to obtain larger biopsies with less crush artifacts when compared to conventional biopsy techniques. This study aimed for assessment of the diagnostic yield of cryobiopsy compared to the forceps biopsy for endobronchial lesions. Methods: In this cross sectional study, 48 patients with endobronchial lesions underwent bronchoscopic forceps biopsy and cryobiopsy, at the Chest Department, Faculty of Medicine, Zagazig University, and the specimens were sent for histopathological analysis. Results: Two methods showed statistically significant differences as regards the diagnostic yield as all the cryoprobe biopsies (100%) were diagnostic while only (81.3%) of forceps biopsies were diagnostic (P value = 0.002). Conclusions: Cryobiopsy yielded larger tissue specimens, resulting in a higher diagnostic yield and a lower prevalence of non-diagnostic results compared to forceps biopsy. [ABSTRACT FROM AUTHOR]

Accurate and timely diagnosis of biliary strictures can be challenging. Because the diagnostic sensitivity and accuracy of standard endoscopic retrograde cholangiopancreatography‐based tissue sampling for malignancy are suboptimal, additional endoscopic evaluation by cholangioscopy and/or endoscopic ultrasound (EUS) is often necessary to differentiate between malignant and benign biliary strictures to guide clinical management. While direct visualization by cholangioscopy and/or high‐resolution imaging by EUS are often the first step in the evaluation of an indeterminate biliary stricture (IDBS), tissue diagnosis by cholangioscopy‐guided biopsy and/or EUS‐guided fine‐needle tissue acquisition is the preferred modality to establish a diagnosis of malignancy. Because each modality has its own strengths and limitations, selection of cholangioscopy and EUS is best guided by the biliary stricture location and local expertise. Artificial intelligence‐assisted diagnosis, biopsy forceps with improved design, contrast‐enhanced EUS, and dedicated fine‐needle biopsy devices are recent technological advances that may further improve the diagnostic performance of cholangioscopy and EUS in patients with IDBS. [ABSTRACT FROM AUTHOR]

Purpose: Stone extraction is an important treatment option when performing flexible ureteroscopic lithotripsy (f-URSL) for upper urinary stones. We used a f-URSL simulator model to investigate surgical factors affecting the efficacy of stone extraction with the one-surgeon basketing technique. Materials and Methods: This simulator-based study involved eight urologists and eight residents. These participants each performed two tasks, with Flexor (Cook Medical) and Navigator (Boston Scientific) ureteral access sheaths, with and without the M-arm (MC Medical) single-use basket holder, and with models representing both left and right kidneys. The two tasks were to touch each renal calix with the ureteroscope, and to extract stones. As outcomes, we recorded the number of times that the ureteroscope became stuck during insertion, the number of times a stone was dropped during removal, the number of times the basket forceps were opened and closed, and the time required to accomplish each task. Results: The ureteroscope became stuck significantly more often when Navigator was used compared with Flexor overall, and for both urologists and residents (all p<0.01). Stones were dropped significantly more often on the ipsilateral side (kidney on the same side as the operator's hand) than on the contralateral side overall (p=0.01), and the basket forceps were opened and closed significantly more often on the ipsilateral side than on the contralateral side both overall and by residents (all p<0.01). Conclusions: The efficiency of stone extraction during f-URSL with the one-surgeon basketing technique was affected by differences in ureteral access sheath and the kidney side. [ABSTRACT FROM AUTHOR]