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Background Inguinal lymph node dissection (ILND) is an essential step in both treatment and staging of several malignancies including penile and vulvar cancers. Various open, video endoscopic, and robotic-assisted techniques have been utilized so far. In this review, we aim to describe available minimally invasive surgical approaches for ILND, and review their outcomes and complications. Methods The PubMed, Wiley Online Library, and Science Direct databases were reviewed in February 2020 to find relevant studies published in English within 2000–2020. Findings There are different minimally invasive platforms available to accomplish dissection of inguinal nodes without jeopardizing oncological results while minimizing postoperative complications. Video Endoscopic Inguinal Lymphadenectomy and Robotic Video Endoscopic Inguinal Lymphadenectomy are safe and achieve the same nodal yield, a surrogate metric for oncological adequacy. When compared to open technique, Video Endoscopic Inguinal Lymphadenectomy and Robotic Video Endoscopic Inguinal Lymphadenectomy may offer faster postoperative recovery and fewer postoperative complications including wound dehiscence, necrosis, and infection. The relatively high rate and severity of postoperative complications hinders utilization of recommended ILND for oncologic indications. Minimally invasive approaches, using laparoscopic or robotic-assisted platforms, show some promise in reducing the morbidity of this procedure while achieving adequate short and intermediate term oncological outcomes.

The shift from traditional apprenticeship models to competency-based curricula, compounded by working hour restrictions and rapid advances in surgical technology, has altered the delivery of early years surgical training. Simulation has been widely incorporated in other high-risk, high-reliability industries, but it has only just begun to be embedded in surgical programmes over the last two decades. In this article, we review key concepts in surgical simulation. Using Scotland's Core Surgical Training Programme as an example, we demonstrate the implementation of these concepts into a national integrated simulation strategy for early years surgical training. We highlight other global examples of simulation use in surgical curricula. The key messages for all stakeholders in surgical training are: (i) simulation is an adjunct to clinical training; (ii) simulation is a tool; however, it is not the tool that should be the main object of interest, but the learning for which it is used; and (iii) in the absence of a constructively aligned and purposeful programme that is valued by trainees, trainers and the training system, it is not enough to issue the kit, no matter how good the simulators are.

Nowadays, the problem of surgical treatment of incisional ventral hernia (IVH) still remains significant. According to the statistical data, the number of patients with postoperative ventral hernias has increased by more than 9 times over the past 25 years. Experts offer many solutions to this problem every year and the surgeon have to find the best method of postoperative rehabilitation in the flow of information. Academic research databases Google Scholar, CyberLeninka and others were used to search for the relevant literature. The following conclusions were drawn from this review. The etiology of IVH is multifactorial. There is no generally accepted evidence-based gradation of risk factors. There is no unified system for selecting the method of hernia repair of the anterior abdominal wall in patients with IVH. The choice of allotransplant material and the method of hernia repair are often individual. The value of the critical level of intraabdominal pressure have not been specified, however, all authors agree that its monitoring should become routine. The sublay technique remains the "gold standard" of plastic surgery by aponeurotic flap, inlay should be used when sublay is impossible to perform. Onlay should be used as a reserve method. In some situations, combinations of techniques are required. More and more laparoscopy is being introduced in the treatment of IVH as an assistance and in therapy. The introduction of new methods of hernia repair based on the uncontrolled separation of the anatomical structures of the abdominal wall imposes special requirements on surgical technology: plastic material, instrumental and technical support, wound closure and pharmacological support, especially in conditions of increased intra-abdominal pressure and tissue tension. We can use medication of pyrimidine’s row (xymedon) for a better implantation of the mesh implant and to increase the resistance of local tissues.

Rhegmatogenous retinal detachment (RRD) is one of the leading causes of vision loss world-wide. Despite advances in surgical techniques, rates of redetachment and vision loss remain high. Patients with RRD require a secondary surgery approximately 10 – 40% of the time. To achieve a high anatomical result, reduce the risk of reoperations and maintain high visual functions, it is necessary to develop and analyze microinvasive technologies to eliminate the main cause of RRD - the traction component. Purpose. To evaluate the results of microinvasive combined laser-surgical technology for RRD treatment. Material and мethods. The study included 43 eyes of 43 patients who underwent microinvasive laser-surgical technology for rhegmatogenous retinal detachment treatment, which included 3 consecutive steps: 1) YAG-laser excision of the horseshoe tear zone with vitreoretinal adhesion (VRA); 2) pneumatic retinopexy with 12% C3F8 (immediately after the first step); 3) barrier laser photocoagulation after complete retinal attachment (2-3 days after pneumatic retinopexy). The results were evaluated for anatomical efficacy (rates of retinal attachment and the occurrence of recurrent rhegmatogenous retinal detachment), functional efficacy (uncorrected (UCVA) and bestcorrected (BCVA) visual acuity, intraocular pressure (IOP)), and safety of technology (any intra- and postoperative complications). Results. In 40 patients (93%), the retina was attached with one surgical intervention. The success rate was significantly lower in patients with pseudophakia and a large retinal tear after YAG-laser excision of VRA zone. UNCA, BCVA and IOP after microinvasive combined laser-surgical technology was not significantly different from the initial values (p>0,05). Сlinically significant complications included gas migration into the subretinal space and epiretinal membrane formation. Conclusion. Microinvasive combined laser-surgical technology is characterized by high single surgery success rate (93%), preservation of initially high visual functions, a low rate of redetachment (7,5%) and clinically significant complications (7%). Key words: rhegmatogenous retinal detachment, optical coherence tomography, horseshoe tear, YAG-laser retinotomy, pneumatic retinopexy, vitreoretinal traction.

Surgical training does not end at the conclusion of residency training. Expansions in medical technology and surgical technique have created a steep learning curve for the young attending surgeon. The emergence of intraoperative telementoring has allowed experienced surgeons to guide learners through complex surgical cases remotely with the assistance of streaming video technology. Here, we describe the basics of telementoring, financial and legal considerations, and recommend hardware specifications for optimal use.

Since the mid 20th century, transplantation has been a fast-developing field of contemporary medicine. The technical aspects of transplant operations were developed in the 1950s, with little significant change for more than 50 years. Those techniques allowed completion of various organ transplants and successful patient outcomes, but they also carried the inherent disadvantages of open surgery, such as post-operative pain, wound complications and infections, and prolonged length of hospital stay. The introduction and adoption of minimally invasive surgical techniques in the early 1990s to various surgical specialties including general, gynecologic and urologic surgery led to significant improvements in post-operative patient care and outcomes. Organ transplantation, with its precision demanding vascular anastomoses, initially had been considered infeasible to accomplish with conventional laparoscopic devices. The institution of robotic surgical technology in the late 1990s and its subsequent wide utilization in fields of surgery changed its accessibility and acceptance. The steady camera, three dimensional views and multidirectional wrist motions, surgical robotics opened new horizons for technically demanding surgeries such as transplantation to be completed in a minimally invasive fashion. Furthermore, the hope was this technique could find a niche to treat patients who otherwise are not deemed surgical candidates in many fields including transplantation. Here in, robotics in kidney transplantation and its ability to help provide equity through access to transplantation will be discussed. Supplemental Visual Abstract; http://links.lww.com/TP/C264.

BackgroundBalloon sinuplasty is a relatively new surgical technology proposed as a less invasive way of treating chronic rhinosinusitis and frontal sinus disease. It is crucial to monitor safety and efficacy to allow informed clinical decisions and appropriate counselling of patients. There are few papers with long-term follow up.MethodPatients were selected for surgery based on symptoms of frontal pain and pressure or headache, pre-operative Sino-Nasal Outcome Test-22 scores, and computed tomography findings. All were resistant to appropriate medical therapy. Balloon sinuplasty was performed followed by a Sino-Nasal Outcome Test-22 questionnaire at two months and then two years.ResultsAll patients underwent successful operations with no failure of technology or technique. There were no significant complications. The average Sino-Nasal Outcome Test-22 score reduced from 46 pre-operatively (standard error: +/− 5.7, n = 9) to 23 at 2 months (standard error: +/− 7.6, n = 7). At 2 years, the average Sino-Nasal Outcome Test score was 23 (standard error: +/− 4.3, n = 6). There was an even larger lasting benefit when pain or pressure symptoms were analysed in isolation.ConclusionThis study adds to the evidence of technique safety and feasibility. The procedure resulted in a significant long-term improvement in symptoms.

Objective. The purpose of this clinical research was to evaluate the result of microinvasive surgical technology: vestibular incision subperiosteal tunnel access (VISTA) and subepithelial connective tissue graft (SCTG) in multiple gingival recession. Methods. A total of 20 patients with 25 Miller I and 30 Miller III gingival recession teeth were treated with VISTA+SCTG. The data at baseline and 12 months were assessed: probing depth (PD), clinical attachment loss (CAL), gingival recession depth (RD), gingival recession width (RW), width of keratinized tissue (WKT), and gingival biotype (GB), and percentage of root coverage (RC) and complete root coverage (CRC) were calculated. Results. The average root coverage was 1.52 ± 0.70 mm in Miller I and 0.82 ± 0.79 mm in Miller III. The mean root coverage rate was 99.00 % ± 5.00 % in Miller I and 60.73 ± 37.90 % in Miller III. The width of clinical attachment loss of keratinized tissue was significantly improved. Conclusions. VISTA and SCTG are effective in the treatment of both Miller class I and III multiple gingival recessions. Gingival increment in Miller class I is better than that in III. It is the same for maxillary and mandibular teeth.

The combination of computing power, connectivity, and big data has been touted as the future of innovation in many fields, including medicine. There has been a groundswell of companies developing tools for improving patient care utilizing healthcare data, but procedural specialties, like surgery, have lagged behind in benefitting from data-based innovations, given the lack of data that is well structured. While many companies are attempting to innovate in the surgical field, some have encountered difficulties around collecting surgical data, given its complex nature. As there is no standardized way in which to interact with healthcare systems to purchase these data, the authors attempt to characterize the various ways in which surgical data are collected and shared. By surveying and conducting interviews with various surgical technology companies, at least 3 different methods to collect surgical data were identified. From this information, the authors conclude that an attempt to outline best practices should be undertaken that benefits all stakeholders.

Background The primary goal of brain tumor surgery is maximal safe resection while avoiding iatrogenic injury. As surgical technology increases, it is becoming more possible to resect these lesions using minimally invasive approaches. While keyhole surgeries are being advocated, the lower limit of these approaches is unclear. Bur hole–based approaches may represent a standardized minimally invasive approach. The exoscope may provide increased visualization over standard microscopic visualization, making this approach possible. This approach has yet to be described strictly for intra-axial brain tumors.Material and Methods All patients who underwent a bur hole–based surgery of an intra-axial tumor with exoscopic visualization by the senior author from January 2018 to December 2019 were prospectively identified and patient information and outcomes were collected.Results Fifteen consecutive patients underwent surgical resection of an intrinsic brain tumor using a bur hole–based approach with exoscopic visualization. The average ± standard deviation age was 57.9 ± 24.2 years. The pathology was a metastatic brain tumor in eight patients (53%), low-grade glioma in four patients (27%), and high-grade glioma in three patients (20%). The average percent resection was 100 ± 1%, where 14 (93%) underwent gross total resection. Following surgery, the median (interquartile range) Karnofsky performance scale (KPS) score was 90 (90–90), where 11 (73%) and four patients (27%) had improved and stable KPS, respectively. Zero patients had complications. The average length of stay following surgery was 1.4 ± 0.5 days, where nine patients (60%) were discharged on postoperative day 1.Conclusion This study shows that intra-axial tumors can be resected through a bur hole–based approach with exoscopic visualization with extensive resection, minimal morbidity, and early discharge rates.

The Fundamentals of Endoscopic Surgery (FES) program became required for American Board of Surgery certification as part of the Flexible Endoscopy Curriculum (FEC) for residents graduating in 2018. This study expands prior psychometric investigation of the FES skills test. We analyzed de-identified first-attempt skills test scores and self-reported demographic characteristics of 2023 general surgery residents who were required to pass FES. The overall pass rate was 83%. “Loop Reduction” was the most difficult sub-task. Subtasks related to one another only modestly (Spearman’s ρ ranging from 0.11 to 0.42; coefficient α = .55). Both upper and lower endoscopic procedural experience had modest positive association with scores (ρ = 0.14 and 0.15) and passing. Examinees who tested on the GI Mentor Express simulator had lower total scores and a lower pass rate than those tested on the GI Mentor II (pass rates = 73% vs. 85%). Removing an Express-specific scoring rule that had been applied eliminated these differences. Gender, glove size, and height were closely related. Women scored lower than men (408- vs. 489-point averages) and had a lower first-attempt pass rate (71% vs. 92%). Glove size correlated positively with score (ρ = 0.31) and pass rate. Finally, height correlated positively with score (r = 0.27) and pass rate. Statistically controlling for glove size and height did not eliminate gender differences, with men still having 3.2 times greater odds of passing. FES skills test scores show both consistencies with the assessment’s validity argument and several remarkable findings. Subtasks reflect distinct skills, so passing standards should perhaps be set for each subtask. The Express simulator-specific scoring penalty should be removed. Differences seen by gender are concerning. We argue those differences do not reflect measurement bias, but rather highlight equity concerns in surgical technology, training, and practice.

PURPOSE OF THE REVIEW: The utilization of technology has increased over the last decade across all surgical specialties. Robotic-assisted surgery, among the most advanced surgical technology, applied to hip and knee arthroplasty has experienced rapid growth in utilization, surgical applications, and robotic platforms. The goal of this study is to provide a comprehensive review of the most commonly utilized robotic platforms for hip and knee arthroplasty and the most up to date literature on the benefits and limitations of robotic arthroplasty. RECENT FINDINGS: Studies consistently demonstrate that that robotic-assisted surgery during total hip arthroplasty (THA), total knee arthroplasty (TKA), and unicompartmental knee arthroplasty (UKA) improves component position and alignment. There is also growing evidence that robotic-assisted UKA improves clinical outcomes and implant survivorship and, therefore, may be cost-effective. However, there remains to be convincing evidence that robotic-assisted arthroplasty improves clinical outcome measures or reduces revision rates for THA and TKA. Potential disadvantages of robotic arthroplasty remain, including a learning curve, potential for additional radiation exposure preoperatively, and the financial costs. SUMMARY: Robotic hip and knee arthroplasty remains attactive as studies show that it consistently improves implant position and alignment over conventional techniques. There is growing evidence that robotic UKA may improve patient outcomes and reduce revision rates, but further study is needed. In addition, further and longer-term studies are needed to determine if improved component position and alignment in TKA and THA leads to improved clinical outcomes and reduced revision rates.

The practice of surgical intervention for the treatment of psychiatric disorders has a rich and fascinating history. Arguably dating back to more than 7 millennia ago, neurosurgery for psychiatric disease is shrouded in stigma, being widely portrayed in the media (almost invariably negatively). The first such procedure to be performed in modern history was conducted by the Swiss psychiatrist Gottlieb Burckhardt in 1882. The landscape of neurosurgery for psychiatric conditions has shifted constantly since, guided by new developments in neuroscience and surgical technology. In this article, we outline the salient events in the story of this field.

The application of computer-assisted virtual surgical technology in preoperative planning for distal femoral fractures has been rarely presented. This study aimed to evaluate the intra-operative realization of this technology and the clinical outcomes based on it for distal femoral fractures.Between February 2014 and May 2017, 32 patients with distal femoral fractures treated by open reduction and internal fixation were included and divided into 2 groups on the basis of preoperative planning methods: conventional (N = 17) and virtual surgical (N = 15). The time required for virtual segmentation, reduction, and fixation of the fracture fragments in virtual surgical group were analyzed. Operation time, intra-operative blood loss, times of fluoroscopy during operation and days of hospital stay in two groups were compared. Postoperative functional outcomes were assessed using the Knee Society Score (KSS), Short Form-36 (SF-36) scoring systems, and visual analogue scale (VAS) for pain.Mean total planning time for 33-A, 33-B, and 33-C fractures in virtual surgical group were 43.0 ± 1.7, 23.0 ± 1.3, and 51.4 ± 3.7 min, respectively. Compared with the conventional group, Patients in virtual surgical group had lower blood loss, fewer fluoroscopic images, less operative time, and shorter days of hospital stay (P 0.05). No significant difference could detected in the KSS, SF-36, or VAS scores between the two groups at the final follow-up (P 0.05).Computer-assisted virtual surgical technology could rapidly complete surgical treatment protocol, improve operative efficiency, and provide satisfying clinical and radiographic outcomes for distal femoral fractures.

Early data suggest that transanal total mesorectal excision (TaTME) is a safe alternative to the abdominal approach for rectal cancer. This study aims to understand the approach to the management of rectal cancer in Canada and to ascertain perspectives on introducing TaTME.Surgeons were invited to complete a survey that asked about their management practices relating to rectal cancer and their opinions regarding TaTME.Ninety-four surgeons completed the survey (38% response rate). The number of rectal cancer cases handled annually by surgeons varied widely (1–80 cases, median 15 cases). Twenty-seven percent of respondents performed TaTME at the time of the survey, and 43% of those who did not said they planned on learning the technique. Surgeons who performed TaTME felt that a higher annual volume of rectal cancer cases was required to maintain proficiency than did non-TaTME surgeons (median 20 cases [interquartile range (IQR) 15–25 cases] v. 15 cases [IQR 10–20 cases]). Surgeons who performed TaTME also felt that a higher annual volume of TaTME cases was required to maintain proficiency (median 12 cases [IQR 10–19 cases] v. 9 cases [IQR 5–10 cases]).These findings help define the current practice environment for rectal cancer surgeons in Canada and highlight the complex issues associated with learning TaTME.Selon des données préliminaires, l’exérèse totale du mésorectum par voie transanale (ou TaTME, pour transanal total mesorectal excision) est une solution de rechange sécuritaire à l’approche abdominale pour le cancer du rectum. Cette étude vise à faire le point sur le traitement du cancer rectal au Canada et à mesurer l’intérêt à l’endroit de la technique TaTME.Des chirurgiens ont été invités à répondre à un sondage sur leur façon de prendre en charge le cancer rectal et sur leur opinion au sujet de la TaTME.Quatre-vingt-quatorze chirurgiens ont répondu au sondage (taux deréponse 38 %). Le nombre de cancer rectaux traités annuellement par chirurgien variait grandement (de 1 à 80 cas, nombre médian 15 cas). Vingt-sept pour cent des participants appliquaient la TaTME au moment du sondage et 43 % de ceux qui ne l’appliquaient pas disait avoir l’intention de s’y initier. Les chirurgiens qui appliquaient la TaTME se disaient d’avis qu’il fallait un volume annuel plus élevé de cas de cancer rectal pour garder la main comparativement aux chirurgiens qui n’appliquaient pas cette technique (nombre médian de 20 cas [éventail interquartile (ÉIQ) 15–25 cas] c. 15 cas [ÉIQ 10–20 cas]). Les chirurgiens qui appliquaient la TaTME ont aussi estimé qu’il fallait un volume annuel plus élevé de cas de TaTME pour garder la main (nombre médian de 12 cas [ÉIQ 10–19 cas] c. 9 cases (ÉIQ 5–10 cas]).Ces observations permettent de mieux définir les pratiques actuelles des chirurgiens qui soignent le cancer rectal au Canada et mettent en lumière les enjeux complexes inhérents à l’apprentissage de la TaTME.

Background: The removal of small, metallic shrapnel fragments can be challenging, but may be indicated for pain, migration, infection, toxicity, etc. Methods: We report the novel use of minimally invasive spine surgery technology to remove a shrapnel fragment deep into the scapula. Results: Use of fluoroscopy and a 16 mm minimally invasive spine surgery tubular retractor allowed removal of the fragment in 30 minutes as an outpatient with good results. Conclusion: Minimally invasive spine surgical technology could be useful for removal of shrapnel fragments from the calf, thigh, buttocks and torso.

Over the past decade, the incidence of thyroid cancer has rapidly increased worldwide, and thyroid surgery has become one of the most common performed surgical procedure. Even though conventional open thyroidectomy remains the gold standard, this approach leaves a neck scar which could be worrying mainly for young women. The recent progress in surgical technology, as well as patient cosmetic requests, have led to the development of alternative access to the thyroid lodge. Thus, alternative techniques have been established in order to potentially provide a more appealing cosmetic result, both with a minimally-invasive cervical or remote-access approach. However, the introduction of these new techniques was initially approached with caution due to technical challenges, the introduction of new complications and, above all, skepticism about the oncologic effectiveness. Among several alternative approaches proposed, the minimally invasive video-assisted thyroidectomy and the robot-assisted transaxillary thyroidectomy became popular and obtained the favor of the scientific community. Moreover, the recent introduction of the trans-oral endoscopic thyroidectomy with vestibular approach, although the safety and the efficacy are still under discussion, deserves particular attention since it represents the only technique truly scarless and provides the best cometic result. The purpose of this article is to provide an overview of the current main alternative approaches for the treatment of thyroid cancer with particular focus on the oncological effectiveness of the procedures.

BACKGROUND: As the application of robotic surgical technology grows, so does the need to instruct surgical residents in robotic techniques. To better understand the challenges and benefits unique to robotic surgery education, this study explored the attitudes of teachers and learners. MATERIALS AND METHODS: A 43-item questionnaire was developed with 5 domains: challenges and benefits of robotic education, training methodologies, trainees’ readiness for learning, and education tips. This was delivered to surgeons and surgical fellows at a high-volume surgical department. RESULTS: 31 surgeons and 25 fellows from 7 specialties responded (response rate 70% and 43%). The teaching and learning of robotic surgery was perceived as superior to traditional minimally invasive surgery by both surgeons (in 7/9 factors studied) and fellows (7/9), but was seen as mostly disadvantageous compared to open surgery by both surgeons (in 6/9 factors studied) and fellows (8/9). Surgeons frequently stated the greatest challenge to teaching robotics was the need to relinquish total control to the trainee. CONCLUSIONS: Robotic surgery education is generally well-received and offers several advantages. However, teaching robotic surgery presents unique challenges, especially when compared to open surgery. Understanding the benefits of, and barriers to, robotic surgery education may help develop more effective training paradigms, that are responsive to educational needs while maintaining patient safety.

Surgical technology has advanced to a level where most gynaecological operations can be performed laparoscopically. Performing laparoscopic surgery requires a degree of surgical skill and structured training is required. A mixture of simulation training and supervised clinical training is required to acquire the skills to perform laparoscopic surgery competently. Attending good quality training courses will enhance the required skills and allow practice of these procedures before attempting these procedures on patients. A patient-centred approach should be adopted when counselling patients pre-operatively, particularly when choosing the route of a procedure. Structured training in technical and non-technical skills is essential.

The article reviews the current trends in the organ-preserving treatment of patients with muscular-invasive bladder cancer. An historical insight into the treatment tactics for this malignant disease included. The current trends in the use of surgical technology, radiation therapy, chemotherapy and immunotherapy, as well as molecular genetic diagnostic in patients with invasive bladder carcinomas are demonstrated. Due to the lack of randomized studies we are not able to use such organ-preserving techniques into practice, but it allows to performthis approach in carefully selected groups of patients.

The new development and finally the general acceptance of surgical techniques among the worldwide surgical community sometimes create fascinating stories. This is also true for the history of endoscopic lumbar spine surgery. In the last 100 years there was a "natural" evolution of surgical techniques with continuous improvement and "refinement" of lumbar decompression techniques towards less invasive operations with the final "endpoint" of microsurgery. However the application of percutaneous, image-guided, and endoscopic technologies has revolutionized minimally invasive surgery. This article describes the history of endoscopic lumbar spine surgery and its major milestones and protagonists which have helped to make endoscopic lumbar spine surgery "disruptive" minimally invasive surgical technology which has changed the world of lumbar decompression surgery. "The past is the mother of the future"Henri Cartier Bresson, French Photographer, 1908-2004.

After over a century of orthopaedic attention, injuries to the posterior cruciate ligament (PCL) continue to pose a significant management challenge. Isolated PCL tears constitute the minority of cases, with multiligament trauma (most commonly posterolateral corner injuries) predominating. Surgical reconstruction of the PCL remains technically demanding. Historical long-term outcomes have been associated with persisting knee instability and secondary degenerative arthrosis, irrespective of surgical intervention. The past two decades have witnessed a renewed focus on understanding the anatomy and biomechanics of the PCL, and its spectrum of injury. This, along with advancements in surgical technology and techniques, has heralded a renewed impetus for operative reconstruction. While there remains no clinically demonstrated difference in outcomes of double-bundle surgery over single-bundle reconstruction, many prefer a double bundle approach due to empirical data supporting its biomechanical superiority. Concomitant bony realignment in the coronal and sagittal plane should be considered where necessary. Graft reinforcement is an emerging concept that may aid in protecting the neoligament during the early healing phase. With modern approaches, there are increasing reports of more favourable short and mid-term post-operative outcomes. Despite this, most studies remain of a low level of evidence, with relatively small case series, and there is a paucity of well-designed controlled studies contrasting operative techniques.

Current endovascular surgical technology requires the development and introduction of new methods allowing the drawbacks of existing technologies to be overcome. These methods include combined approaches to recanalization of arteries and prevention of instent restenosis, which can be achieved by combining minimally invasive techniques. It is proposed that the reliability and efficacy of these methods, increasing comfort and radiation safety of the surgeon, can be ensured by introducing new robotic systems into endovascular surgery.

Background Effective dissemination of technology in global surgery is vital to realize universal health coverage by 2030. Challenges include a lack of human resource, infrastructure and finance. Understanding these challenges, and exploring opportunities and solutions to overcome them, are essential to improve global surgical care. Methods This review focuses on technologies and medical devices aimed at improving surgical care and training in low- and middle-income countries. The key considerations in the development of new technologies are described, along with strategies for evaluation and wider dissemination. Notable examples of where the dissemination of a new surgical technology has achieved impact are included. Results Employing the principles of frugal and responsible innovation, and aligning evaluation and development to high scientific standards help overcome some of the challenges in disseminating technology in global surgery. Exemplars of effective dissemination include low-cost laparoscopes, gasless laparoscopic techniques and innovative training programmes for laparoscopic surgery; low-cost and versatile external fixation devices for fractures; the LifeBox pulse oximeter project; and the use of immersive technologies in simulation, training and surgical care delivery. Conclusion Core strategies to facilitate technology dissemination in global surgery include leveraging international funding, interdisciplinary collaboration involving all key stakeholders, and frugal scientific design, development and evaluation.

Aim. The research was conducted to study the processes occurring in soft tissues in the surgical treatment of widespread purulent-inflammatory processes of the maxillofacial area and to confirm the effectiveness of the developed optimal surgical technology.Materials and methods. A surgical treatment of 20 patients with the widespread purulent-inflammatory processes of maxillofacial area was carried out according to the developed surgical technology. In all cases, the tissue was taken from the area of the pathological focus for the pathomorphological examination at all stages of treatment. Results. The morphological study of the drugs obtained during a primary surgery on the purulent-inflammatory focus showed a picture of the serous-purulent inflammation with a severe leukocyte infiltration. Necrobiosis and tissue necrosis prevailed in the center of the purulent-inflammatory focus. After 3 days, the wound began to grow young granulation tissue with a large number of capillary kidneys, a marked decrease in the level of leukocyte infiltration, the appearance of fibroblasts and lymph-histiocytic elements, the formation of fibrous connective tissue. Conclusion. The morphological assessment of the wound process showed a positive dynamics and the effectiveness of the proposed treatment of the patients with purulent-inflammatory processes of the maxillofacial area.

Purpose. Evaluation of structural changes in the macular area after surgical treatment of idiopathic macular holes (MH) with the use of autologous platelet-rich plasma (PRP) in terms up to 12 months. Material and methods. We examined 41 persons (45 eyes) with idiopathic MH; patients were under observation at least 12 (up to 24) months after surgery with application of PRP to MH region. Twelve eyes with a minimum diameter of MH of at least 440 µm were allocated to the subgroup «≥440 µm». For it the control group was formed of 19 patients (19 eyes) with MH of similar sizes, successfully operated earlier by standard technology. Optical coherence tomography (OCT) and other examinations were performed at 1, 3, 6 and 12 months after operation. Results. One month after the operation with the use of a PRP, OCT demonstrated in the region of the MH an area of increased optical density and a defect of the ellipsoid zone of photoreceptors. In the eyes with a minimum diameter of MH 440 µm or more, these changes by 12 months were mostly preserved, although the defect of the ellipsoid zone was significantly reduced. In the eyes with MH less than 360µm the normal structure of the retina was restored up to 3-12 months. In the eyes with MH of 360-439 µm both variants of changes were observed. In the subgroup «≥440 µm», despite a significantly larger size of the MH, the visual functions at the end of the observation period did not differ much from the control group. Conclusion. One month after surgical treatment of MH with the use of PRP, OCT demonstrated in the region of hole the area of increased optical density and the defect of the ellipsoid zone of photoreceptors, which by 12 months decreased in size, and at MH with a minimum diameter less than 360 µm were not determined. In comparison with the standard surgical technology, the use of PRP did not have a negative impact on the functional outcome of the operation.

Accurate implant positioning and restoration of native hip biomechanics are important technical objectives in total hip arthroplasty (THA). Evolution in surgical technology for THA has led to the development of individualised components and computer-assisted surgery, which aim to improve the accuracy and reproducibility of achieving these objectives compared to conventional manual THA. This chapter discusses the role of robotics, navigation, and patient-specific implants for delivering a patient-specific surgical plan, and explores how this technology may be adapted to execute individualised plans for optimal implant positioning based on dynamic changes in spinopelvic relations.

The introduction of laparoscopic cholecystectomy changed the approach to abdominal surgery revealing the patient-specific advantages of minimally invasive approaches to gastrointestinal diseases. Unfortunately, inherent limitations of laparoscopy impeded widespread utilization of laparoscopic surgery in advanced procedures such as laparoscopic colectomy. Even as prospective and randomized trials demonstrated outcomes advantages for the patient, few surgeons introduced laparoscopic colectomy into their practice. Robotic surgery has offered solutions to these inherent limitations of laparoscopic surgery. Yulan Wang and Computer Motion introduced the first FDA approved robotic surgery assistant, AESOP. This robot responded to foot controls and subsequently oral commands providing tremor free reliable video-laparoscopic camera control. As video-laparoscopic colorectal surgery evolved, Colorectal Surgeons were plagued with the intrinsic limitations of laparoscopic surgery, such as motion reversal and motion amplification of the surgical instruments caused by the fulcrum effect of the abdominal wall trocar. Using Department of Defense grants and venture capital funding, two surgical technology companies, Computer Motion and Intuitive Surgery developed robotic surgical systems to overcome these limitations, Zeus and da Vinci, respectively. Although these robotic surgical systems were intended to perform remote battle-field surgery with the surgeon stationed on an aircraft carrier or remote MASH Hospital, state licensing issues and malpractice concerns prompted both companies to focus on surgery with the patient, surgeon and robot in the same operating room. Zeus gained FDA approval first and Da Vinci followed shortly after. Eventually patent conundrums proved only solvable by Intuitive buying out Computer Motion leading to a consolidation of the technology from both companies into the subsequent generations of Da Vinci. More recently, as Intuitive׳s patents begin to expire, new robotic surgery companies are entering the market with surgical robots targeting specific niches in the future robotic surgery market. In particular, MedRobotics, for example, will soon introduce a surgical robot given FDA approval for transanal resections of neoplastic lesions. Similarly, Titan will enter the market with a surgical robot at a substantially lower price-point that the da Vinci. Clearly, surgical robotic options for colorectal patients will continue to expand in the near future. The long-term use of these technologies, of course, will require a long period of prospective and randomized clinical trials.

In this essay, I summarize a few ideas inspired by my involvement in the “Coronavation” working group, which spanned 2020’s COVID-19 crisis. Health-care practitioners, computer scientists, and engineers alike, we strive to meet the challenges associated with practice under threat of pandemic with the same ideals driving the rapid, positive developments in health care today: innovation, collaboration and technology convergence, and acquisition of valuable data that leads to better approaches and new ideas. The ideas sketched here, forged by the need for practical pandemic responses, are rooted in those ideals.

Innovations in lasers and surgical technology have led to a renewed interest in the miniaturization of percutaneous nephrolithotomy (PCNL). We review the different approaches and evidence on the efficacy of mini-PCNL. Mini-PCNL encompasses a range of techniques using tract sizes from 4.8 to 22 F to treat renal stones. The most common device uses irrigation to passively extract stones out of the sheath. Super-mini-PCNL incorporates active suction. Ultra- and micro-techniques reduce the tract to smaller diameters. Laser fragmentation is the main lithotripsy modality. Studies demonstrate an association with reduced complications, hospital stay, and increased tubeless rate. Drawbacks include longer operative times while stone-free rates for larger stones may be sub-optimal. Mini-PCNL has advantages of less trauma and the avoidance of nephrostomy tubes. Ambulatory surgery is feasible in select patients. Advances in laser lithotripsy and active suction have the potential to improve stone clearance and treat larger stones.

Partial nephrectomy is recommended for surgical management of small renal masses (SRM), or lesions ≤7 cm. The decision for surgical intervention involves a balanced patient assessment. Minimally invasive approach, which includes laparoscopic and robotic techniques, has shown to have improved blood loss, length of hospitalization, and post-operative pain while maintaining oncologic efficacy when compared to an open approach. Transperitoneal approach is preferred at most centers; however, retroperitoneoscopic minimally invasive surgery (MIS) partial nephrectomy expertise is essential for comprehensive kidney cancer care. With advances in surgical technology and deep penetration of robotics into surgical training and practice, robotic partial nephrectomy has become the modality of choice in modern clinical practice. This review discusses the indications and outcomes for various minimally invasive approaches of partial nephrectomy.

Acute aortic syndromes represent a spectrum of aortic pathology that most commonly manifest as an aortic dissection. The treatment of these potentially life-threatening conditions have benefited from a better understanding of their natural history along with advances in diagnostic and surgical technology. An overview of the historical evolution of these advances provides an insight into the pioneering work of numerous individuals that embraced the challenge of overcoming the barriers that stood between them and our current place in treating these complex patients.

Over the course of the last 20 years, minimally invasive liver surgery (MILS) has been gaining widespread acceptance. MILS is currently considered a good alternative to open surgery. Despite the numerous improved outcomes, MILS did not yet reach the apex of its popularity. The reasons for this delay in MILS routine adoption are partly to be found in several obstacles posed by laparoscopic liver resection (LLR). LLR is an effective approach (with all the minimally invasive advantages), but it has several hurdles/limitations. Robotic liver resection (RLR) provides multiple technological and operative advantages, and it has solved some of the LLR limitations. In this chapter, the present challenges in RLR will be described, and also we will give our additional remarks on possible future trends.

Introduction Laparoscopic lateral lymph node dissection (LLND) is an important treatment for patients with lateral lymph node metastasis. Aim To assess the technical feasibility and investigate the surgical outcomes after LLND using the fascia space priority approach for patients with advanced middle and low rectal cancer. Material and methods Consecutive patients undergoing laparoscopic LLND using the fascia space priority approach from June 2017 to June 2020 were identified from 12 medical centres in mainland China. Three anatomic fascia spaces were dissected to establish the boundaries of the LLND, and the obturator and internal iliac lymph nodes were excised in an en bloc manner. Retrospective clinical data including patient characteristics, surgical details, and pathology were analysed. Results A total of 112 patients were identified. All surgeries were completed laparoscopically with no conversions. The mean operation time was 343.6 ±103.8 min for the entire procedure. The median blood loss was 100 ml (range: 100-700 ml). The median lymph node yield was 6 (range: 1-41), and lymph nodes were positive in 39.3% (44/112) of the patients. Sixteen (14.3%) patients had Clavien-Dindo I-II complications, no Clavien-Dindo III-IV complications were identified. The incidence of complications between the bilateral dissection group and the unilateral dissection group was not statistically different (p = 0.19). The complication rate between the "nCRT" group and the "no nCRT" group was not significantly different (p = 0.62) either. There were no perioperative deaths. Conclusions Laparoscopic LLND using the fascia space priority approach is feasible and safe for patients with lateral lymph node metastasis.

Owing to increased awareness of the importance of mammogram and advances in surgical technology, survival rate of patients with primary breast cancer has dramatically increased. Despite all these advances in breast cancer treatment, there are no currently available treatments for this disease once it metastasizes to distant organs including bones, lungs, brain, and liver. This is mainly attributed to the complexity of metastatic process. Recent advances in technology enabled cancer biologists to dissect each step of the metastatic process, and this led to discovery of major players and molecules in this process. In this section, we will discuss recent discovery and advances in the field of breast cancer metastasis research.

Robotic technology has accelerated the modernization and integration into the healthcare field. Robotic machinery was first developed in the third century BC and for the amusement of wealthy ancient Grecians. Continued advancements through the Industrial Revolution and World War II laid the foundation for the first surgical robotic system. Throughout the last four decades, robotic surgical technology has transformed from initial neurosurgical biopsies to single-port and endoscopic functions. A number of FDA-approved platforms are currently in use including da Vinci surgical system, Senhance, Hugo, FlexⓇ robotic system, Invendoscopy E210 system, and the NeoGuide Colonoscope. Other emerging robotic platforms which are awaiting FDA clearance include MiroSurge, Sport™ Surgical System, Versius Robotic System, miniaturized in vivo robotic assistant (MIRA), and the STRAS i-Cube. Future directions include continued development for improved maneuverability, vision, and safety in a cost-effective manner. Current robotic technology paves the way for the modernization and advancement of cutting edge medicine.

Computed tomography (CT) image-guided procedures including biopsy, drug delivery, and ablation are gaining increasing application in medicine. Robotic technology holds the promise for allowing surgeons, and other proceduralists, access to such CT guided procedures by potentially shortening training, improving accuracy, decreasing needle passes, and reducing radiation exposure. We evaluated surgeon learning and proficiency for image-guided needle placement with an FDA-cleared robotic arm. Five out of six surgeons had no prior CT guided procedural experience, while one had prior experience with freehand CT guided needle placement. All surgeons underwent a 60-minute training with the MAXIO robot (Perfint Healthcare, Redmond, WA). The robot was used to place needles into three different pre-specified targets on a spine model. Performance time, procedural errors, and needle placement accuracy were recorded. All participants successfully placed needles into the targets using the robotic arm. The average time for needle placement was 3:44 ± 1:43 minutes. Time for needle placement decreased with subsequent attempts, with average third placement taking 2:29 ± 1:51 minutes less than the first attempt. The average vector distance from the target was 2.3 ± 1.2 mm. One error resulted in the need for reimaging by CT scan. No errant needle placement occurred. Surgeons (attending fellows and residents) without previous experience and minimal training could successfully place percutaneous needles under CT guidance quickly, accurately, and reproducibly using a robotic arm. This suggests that robotic technology may be used to facilitate surgeon adoption of CT image-guided needle-based procedures in the future.

Surgical training in the UK and Ireland has faced challenges following the implementation of the European Working Time Directive and postgraduate training reform. The health services are undergoing a digital transformation; digital technology is remodelling the delivery of surgical care and surgical training. This review aims to critically evaluate key issues in laparoscopic general surgical training and the digital technology such as virtual and augmented reality, telementoring and automated workflow analysis and surgical skills assessment. We include pre-clinical, proof of concept research and commercial systems that are being developed to provide solutions. Digital surgical technology is evolving through interdisciplinary collaboration to provide widespread access to high-quality laparoscopic general surgery training and assessment. In the future this could lead to integrated, context-aware systems that support surgical teams in providing safer surgical care.

Background: With the development of surgical technology, surgeons are paying more and more attention to minimally invasive procedures such as injury reduction, pain reduction, and beautiful incisio...

Over the last three decades there has been significant advancements in knee and hip replacement technology. The implants and the surgical technology we now have to aid in their implantation are advancing and improving functional outcomes and survivorship. Despite these advancements there are still issues with patient satisfaction, functional limitations and early revisions due to instability and aseptic loosening. This article reviews the state of current technology in hip and knee replacement implant design and surgical technique, and reviews some the current implant designs and surgical technology that may be able to solve some of the most common issues in knee and hip replacement surgery. This article is protected by copyright. All rights reserved.

There have been significant advancements in surgical technology over the last several decades. This has led to the establishment of minimally invasive surgery and robotic surgery specifically. These novel surgical approaches have improved patient outcomes and satisfaction. A strong interest by both surgeons and engineers has led to the development of miniature robots that can be inserted into surgical environments via a single access site. Swarmed miniature robots can be controlled in a cooperative fashion by the operator to accomplish tasks in an efficient and minimally invasive fashion. In the future, swarm and cooperative robotics are expected to provide solutions to difficult access surgical environments.

SUMMARY Advances in minimally invasive techniques, including robotic surgical technology, have led to improved outcomes in esophagectomy. In this article, we detail our approach to the robotic Ivor Lewis esophagectomy.

Urologists have always been leaders in advancing surgical technology and were the first to utilize modern robotic surgery for robotic-assisted laparoscopic radical proctectomy. Surgeon ergonomics, instrument precision, operative time, and postoperative recovery were all objectively improved. In urology, robotic surgery is now used for all intra-abdominal, retroperitoneal, and pelvic procedures and has been expanded to renal transplants and pediatric use. Modern robotic surgery has become an essential part of treating complex urologic disease in the developed world. Urologists continue to lead the way with the latest robotic surgical systems, including the newly approved single port systems.

Since its introduction in 2000, robotic surgical technology has redefined minimally invasive surgery, and in more recent years has increasingly influenced how pediatric urologists approach complex upper tract reconstructive procedures. The robotic platform provides greater dexterity for intracorporeal suturing, along with superb access to and visualization of the kidney and ureter, thus offering advantages over traditional laparoscopy in complex cases such as ureterocalicostomy or renal ectopia. In comparison to open surgery, robotic surgery has been associated with reduced morbidity, decreased postoperative pain, lower analgesic requirements, quicker postoperative recovery, and shorter length of hospital stay.

In patients with anticipated challenges to compliance with refractive amblyopia management after pediatric cataract surgery, primary intraocular lens (IOL) implantation after lensectomy has become the preferred alternative to aphakia ever since the Infant Aphakia Treatment Study (IATS) demonstrated that was an acceptable decision (The Infant Aphakia Treatment Study Group, JAMA Ophthalmol 132:676–682, 2014). However, there can be a variable degree of myopic shift after pseudophakia that can result in significant anisometropia while the child is still within amblyogenic age. As the focus in pediatric cataract surgery has shifted more toward optimizing refractive outcomes given advances in surgical technology, IOL exchange has become a widely accepted option for managing severe anisometropia and associated intolerable aniseikonia in pseudophakic children. Utilizing an illustrative case, the preoperative, intraoperative, and postoperative considerations for IOL exchange in pediatric cases are discussed in detail within this chapter. A step-by-step guide to extracting the primary IOL and implanting a new IOL (planned sulcus placement with optic capture) is explained.

It’s 2018 and suction-assisted lipoplasty (SAL) has been around in America for almost 35 years. Without chronicling each advance in this technology, one can say that this has become a mature, yet integral surgical technology for thinning of subcutaneous adipose tissue (SAT). Lipoplasty has evolved into a sophisticated technique for 3D body contouring, harvesting of fat for grafting, and as a complimentary procedure with excisional body contouring (lipoabdominoplasty).

Welcome to our Basic Skills for the OR Series! Complete series includes: Scalpels Surgical Sutures Surgical Staplers Opening Sterile Surgical Packs Opening Sterile Surgical Instrument Containers Laparoscopic Instruments

This study aimed to determine the difference between computer-assisted virtual surgical technology and 3-dimensional (3D) printing technology in preoperative planning for proximal humeral fractures.Between February 2009 and October 2015, 131 patients with 3 and 4-part proximal humeral fractures were divided into 3 groups on the basis of the preoperative planning method: conventional (n = 53), virtual surgical (n = 46), and 3D printing (n = 32). Fracture characteristics and intraoperative realization of preoperative planning (reduction shape and implant choices) were evaluated. Postoperative functional outcomes were assessed using the American Shoulder and Elbow Surgeons, Constant-Murley, and Short Form-36 (SF-36) scoring systems and shoulder range of motion; postoperative radiographic outcomes were assessed with respect to the loss of the neck-shaft angle (NSA) and loss of humeral head height (HHH).Excellent sensitivity, specificity, and accuracy for fracture characteristics were seen in all 3 groups. The correlations for NSA (p = 0.033) and HHH (p = 0.035) were higher in the virtual surgical group than in the 3D printing group. The lengths of the medial support screws in the actual choices were shorter than those in the preoperative plan for the 3D printing group, but a similar pattern was not seen in the virtual surgical group. Compared with the conventional method, the virtual surgical and 3D printing methods of preoperative planning resulted in shorter operative time, less blood loss, and fewer fluoroscopic images. The functional outcomes in both the 3D printing and virtual surgical groups were better than those in the conventional group. The virtual surgical method was faster than the 3D printing method, as suggested by a shorter time to surgery (2.5 compared with 4.6 days; p0.001), a shorter time for preoperative planning (30.4 compared with 262.4 minutes; p0.001), and a decreased duration of hospital stay (10.9 compared with 14.6 days; p0.001).The clinical outcomes in both the virtual surgical and 3D printing groups were better than those in the conventional group. However, computer-assisted virtual surgical technology is more convenient and efficient, considering the shorter time for preoperative planning. In addition, it has improved correlation with preoperative planning.Therapeutic Level III. See Instructions for Authors for a complete description of levels of evidence.