Augmented reality improving intraoperative navigation in minimally invasive liver surgery: an interplay between 3D reconstruction and indocyanine green
AbstractTechnology have helped surgeons to increase MILS feasibility, so that currently liver surgery evolution is strongly based on technological advances and the same trend is expected even further soon. Aim of the present technical report is to provide insights regarding the possible interplay between 3D reconstructions based on augmented reality and intraoperative navigation by indocyanine green fluorescence. Augmented reality methods based on reconstructions created through artificial intelligence interact synergistically. The better the understanding of the anatomy and characteristics of the lesion, the more accurate...
Source: Updates in Surgery - May 2, 2024 Category: Surgery Source Type: research
Application and subgroup analysis of competing risks model based on different lymph node staging systems in differentiated thyroid cancer
This study evaluates the prognostic value of various lymph node staging systems in DTC using a competing risks model. We used SEER database records (1998 –2016) of 16,527 DTC patients, analyzing N stage, positive lymph node numbers (PLNNs), metastatic lymph node ratio (MLNR), log odds of positive lymph nodes (LODDS), and log odds of the negative lymph node (NLN)/T stage ratio (LONT). Univariate and multivariate analyses in a competing risks model w ere performed, along with subgroup analyses based on demographic and clinical characteristics. In this study of 16,527 patients with DTC, different lymph node staging systems ...
Source: Updates in Surgery - May 1, 2024 Category: Surgery Source Type: research
En-bloc excision of sacral squamous cell carcinoma with immediate reconstruction
AbstractSacral squamous cell carcinoma is an uncommon condition that may arise in scars following burns or in chronic wounds, such as an untreated pilonidal cyst. The aim of the present technical note is to describe a surgical technique aimed at minimizing local recurrence rates by en-bloc resection as well as providing immediate plastic reconstruction: 1. right-sided extended vertical rectus abdominis myo-cutaneous (VRAM) flap; 2. abdomino-perineal excision of the rectum with end colostomy; 3. en-bloc excision of the mass inclusive of gluteus maximus muscles and distal sacrectomy; 4. sacrectomy defect covered with VRAM fl...
Source: Updates in Surgery - May 1, 2024 Category: Surgery Source Type: research
A comparative retrospective analysis on robot-assisted laparoscopic surgery compared to conventional laparoscopy in case of myomectomy: experience in a third-level hospital of Southern Italy
This study aimed to compare robotic-assisted laparoscopic myomectomy (RALM) with laparoscopic myomectomy (LM) in terms of operative times, intraoperative estimated blood loss, pre- and post-hemoglobin levels drop, and length of hospital stay. Data from 50 clinical records (25 RALM in Group A and 25 LM in Group B) of patients with uterine fibroids were collected from December 2022 to December 2023 at Gynecological Unit of DAI Materno-Infantile Federico II in Naples, Italy. Patients aged 30 –49 years with symptomatic fibroids were included. Data on peri-operative outcomes, including operative time for myomectomy (OTM), ov...
Source: Updates in Surgery - April 30, 2024 Category: Surgery Source Type: research
Challenging repair of the left subclavian vein in a pediatric patient
AbstractThis is a case involving a 3-year-old child who presented with an iatrogenic left subclavian/innominate vein lesion, leading to severe bleeding and intravascular catheter rupture during its removal. We successfully performed a very challenging and minimally invasive repair of the vein, along with the removal of the catheter entrapped in the innominate vein. (Source: Updates in Surgery)
Source: Updates in Surgery - April 30, 2024 Category: Surgery Source Type: research
The Underestimated Impact of Hashimoto Thyroiditis on Thyroid Papillary Carcinoma
In this study, our aim is to investigate the effect of the presence of HT on clinicopathological data in patients with PTC. All 356 patients whose pathology was reported as PTC who were operated between 2015 and 2023 were included in the study. PTC patients were divided into 2 groups as those with and without HT. The effect of HT association on clinicopathological features was investigated. In 356 PTC patients, the rate of HT was 31.2%. PTC patients with HT had less multifocality (p < 0.05), more lymph node metastases (LNM) (p < 0.01) compared to PTC patients without HT. The presence of HT did not affect th...
Source: Updates in Surgery - April 30, 2024 Category: Surgery Source Type: research
Global disparities in surgeons ’ workloads, academic engagement and rest periods: the on-calL shIft fOr geNEral SurgeonS (LIONESS) study
AbstractThe workload of general surgeons is multifaceted, encompassing not only surgical procedures but also a myriad of other responsibilities. From April to May 2023, we conducted a CHERRIES-compliant internet-based survey analyzing clinical practice, academic engagement, and post-on-call rest. The questionnaire featured six sections with 35 questions. Statistical analysis used Chi-square tests, ANOVA, and logistic regression (SPSS® v. 28). The survey received a total of 1.046 responses (65.4%). Over 78.0% of responders came from Europe, 65.1% came from a general surgery unit; 92.8% of European and 87.5% of North Americ...
Source: Updates in Surgery - April 29, 2024 Category: Surgery Source Type: research
REDISCOVER guidelines for borderline-resectable and locally advanced pancreatic cancer: management algorithm, unanswered questions, and future perspectives
AbstractThe REDISCOVER guidelines present 34 recommendations for the selection and perioperative care of borderline-resectable (BR-PDAC) and locally advanced ductal adenocarcinoma of the pancreas (LA-PDAC). These guidelines represent a significant shift from previous approaches, prioritizing tumor biology over anatomical features as the primary indication for resection. Condensed herein, they provide a practical management algorithm for clinical practice. However, the guidelines also highlight the need to redefine LA-PDAC to align with modern treatment strategies and to solve some contradictions within the current definiti...
Source: Updates in Surgery - April 29, 2024 Category: Surgery Source Type: research
Conversion rate to open surgery during transanal total mesorectal excision (TaTME) for rectal cancer: a single-center experience
AbstractMinimally invasive techniques for rectal cancer have demonstrated considerable advantages in terms of faster recovery and less post-operative complications. However, due to the complex anatomy and a limited surgical field, conversion to open surgery is still sometimes required, with a negative impact on the short-and long-term outcomes. The purpose of this study was to analyse the conversion rate to open abdominal surgery during laparoscopic transanal total mesorectal excision (TaTME) procedures performed at a high-volume Italian referral center. All consecutive TaTME performed for mid-to-low rectal cancer between ...
Source: Updates in Surgery - April 28, 2024 Category: Surgery Source Type: research
Intraperitoneal prophylactic drain after pancreaticoduodenectomy: an Italian survey
AbstractIntraperitoneal prophylactic drain (IPD) use in pancreaticoduodenectomy (PD) is still controversial. A survey was designed to investigate surgeons ’ use of IPD in PD patients through 23 questions and one clinical vignette. For the clinical scenario, respondents were asked to report their regret of omission and commission regarding the use of IPD elicited on a scale between 0 (no regret) and 100 (maximum regret). The threshold model and a mul tilevel mixed regression were applied. One hundred three (97.2%) respondents confirmed using at least two IPDs. The median regret due to the omission of IPD was 84 (67–100,...
Source: Updates in Surgery - April 25, 2024 Category: Surgery Source Type: research
Toward a new paradigm of care: a surgical leaders ’ Delphi consensus on the organizational factors of the new pancreas units (E-AHPBA PUECOF study)
AbstractPancreas units represent new organizational models of care that are now at the center of the European debate. The PUECOF study, endorsed by the European –African Hepato-Pancreato-Biliary Association (E-AHPBA), aims to reach an expert consensus by enquiring surgical leaders about the Pancreas Units’ most relevant organizational factors, with 30 surgical leaders from 14 countries participating in the Delphi survey. Results underline that surgeons believe in the need to organize multidisciplinary meetings, nurture team leadership, and create metrics. Clinical professionals and patients are considered the most rele...
Source: Updates in Surgery - April 25, 2024 Category: Surgery Source Type: research
Laparoscopic totally extraperitoneal hernia repair in patients with a history of previous abdominopelvic surgery
AbstractA retrospective cohort study of patients undergoing laparoscopic inguinal hernia repair compared short- and long-term outcomes between individuals with or without history of previous abdominopelvic surgery, aiming to determine the feasibility of totally extraperitoneal (TEP) repair within this population. All patients who underwent elective TEP inguinal hernia repair by one consultant surgeon across three London hospitals from January 2017 to May 2023 were retrospectively analysed to assess perioperative outcomes. Two hundred sixty-two patients were identified, of whom two hundred forty-three (93%) underwent laparo...
Source: Updates in Surgery - April 23, 2024 Category: Surgery Source Type: research
Adjuvant chemotherapy is associated with better oncological outcomes after ALPPS for colorectal liver metastases
This study aims to evaluate the short and long-term outcomes of ALPPS in patients with CRM. Single-cohort, prospective, observational study. Patients with unresectable CLM due to insufficient liver remnant who underwent ALPPS between June 2011 and June 2021 were included. Of 32 patients treated, 21 were male (66%) and the median age was 56 years (range = 29–81). Both stages were completed in 30 patients (93.7%), with an R0 rate of 75% (24/32). Major morbidity was 37.5% and the mortality nil. Median overall survival (OS) and recurrence-free survival (RFS) were 28.1 and 8.8 months, respectively. The 1–3, and 5-yea...
Source: Updates in Surgery - April 22, 2024 Category: Surgery Source Type: research
Indocyanine green (ICG)-guided robotic resection for liver adenoma: combined technologies for precision surgery
AbstractHCA resection is crucial to prevent bleeding and malignant transformation. The aim of this study was to enhance the precision of tumor resection in hepatocellular adenoma (HCA) through the combination of intraoperative ultrasound (IOUS) and indocyanine green (ICG) fluorescence imaging. ICG was intravenously injected 24 h before surgery, enabling positive staining of HCA nodules. IOUS guided the parenchymal transection performed using the RoboLap approach. IOUS combined with ICG effectively demarcated lesions, allowing precision surgery while sparing healthy liver tissue. Intraoperative frozen examination further ...
Source: Updates in Surgery - April 19, 2024 Category: Surgery Source Type: research
Diagnostic performance of serum CA-125 for overall and complicated acute appendicitis: a systematic review and meta-analysis
This study aimed to analyze the diagnostic performance of serum CA-125 in acute appendicitis (AA). This review was registered in PROSPERO (CRD42023450988). We included prospective and retrospective original clinical studies evaluating the diagnostic performance of serum CA-125 in AA. A search was conducted in PubMed, Web of Science, Scopus, and OVID. Search terms and keywords were: (appendicitis OR appendectomy) AND (CA-125 OR CA125). Two independent reviewers selected the articles and extracted relevant data. Methodological quality was assessed using the QUADAS-2 index. A synthesis of the results, standardization of the m...
Source: Updates in Surgery - April 18, 2024 Category: Surgery Source Type: research
