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Purpose: Despite widespread adoption of NAVIO robotic-assisted total knee arthroplasty (NAVIO RATKA) in clinical practice, clinical outcome in terms of adverse events and complications remains unclear. The purpose of this study was to compare adverse events, length of stay, surgical time, hemoglobin drop, early readmission rate and revision rate between conventional TKA (CTKA) and NAVIO RATKA. Methods: This single-centre retrospective cohort analysis compared 230 NAVIO RATKA patients to 489 CTKA patients with a minimal follow-up of 12 months. Baseline demographic and comorbidity parameters were collected, as well as length of stay, revision rate and reason for revision, early readmission rate (< 6w) and reason for readmission, post-operative hemoglobin levels, adverse events, surgical time and operating room time. Data were compared using Mann–Whitney U test for continuous data without normal distribution and ordinal data, categorical variables were compared using the Chi-square or Fisher exact test. Results: There were no clinically relevant baseline demographic or comorbidity differences between groups. CTKA had shorter length of stay than NAVIO RATKA (5.0 days vs 5.4 days, p = 0.010) but trended towards a higher reoperation rate (4.1% vs 1.7%, p =.144, n.s). No differences were found in hemoglobin drop, readmission rate or overall incidence of adverse events, but CTKA showed more hematoma formation (1.6% vs 0%, p =.044) and higher incidence of periprosthetic joint infection (PJI) (1% vs 0%, p = n.s.), whilst NAVIO RATKA showed more periprosthetic fractures and persistent wound drainage (0.4% vs 2.2%, p =.038 and 0.6% vs 4.3%, p =.001, respectively). Surgical time remained significantly longer in NAVIO RATKA during all 230 cases (87 min vs 67.6 min) and showed a continuous downward trend. Conclusions: This study further validates the usage of NAVIO RATKA as a safe method to perform TKA, with comparable short term outcomes to CTKA in terms of early revisions and adverse events. Surgeons should be mindful of the differing adverse event profile in NAVIO RATKA and adjust their patient selection accordingly to ensure optimal outcomes. In addition, surgeons using NAVIO RATKA should expect a linear learning curve and a surgical time exceeding that of CTKA. Level of evidence: Level III (therapeutic retrospective cohort study). [ABSTRACT FROM AUTHOR]

Background: Metal bar removal after the Nuss repair procedure is prone to be cancelled in cases of operating time shortages due it being suitable to be postponed without harming patients. Consequently, planning operation times as exactly as possible could be one solution. Objective: Statistical modelling of operation times of metal bar removal after Nuss repair using the prespecified independent predictors of age, sex, intraoperative complications, and number of implanted metal bars. Material and methods: We included all patients whose operation notes included an operation time, which was modelled via linear regression and subject to internal validation via bootstrap. Exploratory analyses also consisted of the surgeon's experience, the number of stabilizers, the body mass index, and preceding re-do surgery for bar dislocation. Results: We included 265 patients (14% ♀) with a median age of 19 years (interquartile range 17–20 years), of whom 81% had 1 and 17% had 2 metal bars removed. The prespecified regression model was statistically significant (likelihood ratio 56; df = 5; P < 0.001) and had a bias corrected R2 of 0.148. Patient age influenced operation times by 2.1min per year of life (95% confidence interval 1.3–2.9min; P < 0.001) and 16min per explanted metal bar (95% confidence interval: 10–22min; P < 0.001). Conclusion: The patient-specific factors of age and the number of explanted metal bars influenced the operation times and can be included into scheduling operation times. [ABSTRACT FROM AUTHOR]

Purpose: We sought to verify the effect of intraoperative optical coherence tomography (iOCT) on vitrectomy for the treatment of proliferative diabetic retinopathy (PDR). Study design: Retrospective study. Methods: We reviewed 178 eyes with PDR treated with 25-gauge vitrectomy by a single surgeon between April 2013 and December 2017. In total, 98 eyes of 77 patients with PDR (mean age, 52.5 ± 11.7 years) treated with vitrectomy using iOCT (iOCT group) and 80 eyes of 60 patients with PDR (mean age, 53.1 ± 10.9 years) treated without iOCT (non-iOCT group) were included in the study. To determine the effects of combining vitrectomy with iOCT, a comparison was made of patients treated with this combination and patients treated with vitrectomy without iOCT. The effects of these treatments were assessed on the basis of intraoperative complications, reoperation ratios, postoperative complications, operation times, and postoperative visual acuity. Results: The operation time was significantly reduced for the iOCT group (72.9 ± 23.9 min) when compared with the non-iOCT group (91.3 ± 31.2 min) (P =.001). The incidences of intraoperative complications, reoperation, and postoperative complications did not differ significantly between the 2 groups (P =.542, 0.258, and 0.860 respectively). Six months after surgery, the postoperative visual acuity did not differ significantly between the 2 groups (P =.508). Multiple linear regression analysis revealed that the operation time was significantly correlated with iOCT (beta [standard partial regression coefficient] = − 0.28, P <.001), the fibrovascular proliferative membrane (beta = 0.17, P =.009), cataract surgery (beta = 0.22, P =.016), preoperative retinal photocoagulation (beta = − 0.14, P =.021), intraoperative complications (beta = 0.16, P =.023), and posterior vitreous detachment (beta = − 0.14, P =.04). Conclusion: Use of iOCT reduced the operation time without affecting the incidence rates of intraoperative and postoperative complications, reoperation ratios, or postoperative visual acuities in patients who underwent vitreous surgery for PDR. [ABSTRACT FROM AUTHOR]

Background: Posterior spinal instrumentation and fusion (PSIF) for adolescent idiopathic scoliosis (AIS) can be lengthy and complication-ridden. The aim of this study was to evaluate the effect of surgical time on perioperative complications in this procedure when controlling for confounding variables with propensity score analysis., Methods: This was an IRB-approved review of electronic health records from 2010 to 2019 at a single tertiary care children's hospital. Patients undergoing PSIF were grouped into "short" (< 6 h) or "long" (≥ 6 h) surgical time groups. Outcome measures were estimated blood loss (EBL), cell saver transfusions, packed red blood cell (pRBC) transfusions, length of stay (LOS), intraoperative monitoring (IOM) alerts, hematocrit, ICU transfer, neurologic loss, surgical site infection, and 90-day readmissions. We controlled for age, sex, BMI, curve severity, number of segments fused, and surgeon factors., Results: After propensity score matching there were 113 patients in each group. The short surgical time group had lower EBL (median 715, IQR 550-900 vs median 875, IQR 650-1100 cc; p < 0.001), received less cell saver blood (median 120, IQR 60-168 vs median 160, IQR 97-225 cc; p = 0.001), received less intraoperative pRBCs (median 0, IQR 0-0 vs median 0, IQR 0-320, p = 0.002), had shorter average LOS (4.8 ± 1.7 vs 5.4 ± 2.5 days; p = 0.039), and fewer IOM alerts (4.3% vs 18%, p = 0.003)., Conclusions: Patients with shorter surgical times had less blood loss, received less transfused blood, had a shorter LOS, and fewer IOM alerts compared to patients with longer surgical times. Surgical times < 6 h may have safety and efficacy advantages over longer times., Level of Evidence: III., (© 2024. The Author(s), under exclusive licence to Scoliosis Research Society.)

Purpose: The goal of this study was to compare the risk of periprosthetic infection of a consecutive cohort of primary varus–valgus constrained (VVC) total knee arthroplasties (TKAs), with a matched 1:1 cohort of primary posterior-stabilized (PS) TKAs. Methods: 74 primary VVC TKAs performed in 66 patients were identified and matched 1:1 with a cohort of 74 primary PS TKAs performed in 73 patients. At last follow up, patients were clinically evaluated using the Knee Society Score (KSS). Kaplan–Meier survival curves were generated to analyze survivorship using as endpoints revision for any reason, revision for periprosthetic infection and revision for mechanical failure after excluding periprosthetic infection. A multivariate logistic regression analysis was constructed to determine whether revision surgery for periprosthetic infection was influenced by patients' gender, age, surgical time and reasons for TKA (primary vs secondary osteoarthritis). Results: Demographic data were not significantly different between the two groups as regard patients' age, gender, body mass index, Charlson Comorbidity Index, reasons for replacement, and length of follow-up. Surgical time was greater in the VVC group (95.7 ± 22.5 min vs 88.6 ± 17.1 min, respectively, p = 0.032). Postoperative KSS, range of motion and radiographic data did not differ significantly between the two groups. Overall revision rate and revision rate for mechanical failure after 5 years of follow-up was not statistically different between the two groups. Considering only the revision rate due to periprosthetic infection, the risk was higher in patients with primary VVC implants (p = 0.013). The surgical time was the only factor that significantly affected the risk of revision for periprosthetic infection (OR 1.0636, CI 95% 1.0209–1.1081, p = 0.0032), whereas patients' gender, age and reason for TKA had no influence. Conclusions: Patients and surgeons should be aware of the higher risk of periprosthetic knee infection using a VVC prosthesis. However, the present study supports the use of VVC implants in cases of difficult knee replacements, since comparable clinical outcomes and overall revision rate was found after at least 5 years of follow up. Level of evidence: Retrospective cohort study, Level III. [ABSTRACT FROM AUTHOR]

Purpose: Poor scientific evidence exists on the issue of tourniquet application during total knee arthroplasty (TKA). It has been suggested that tourniquet application might improve interdigitation of the cement into the periprosthetic bones due to relatively dry surgical field. The hypothesis of the present study was that tourniquet use did not affect the periprosthetic bone cement penetration.Methods: The single-centre, randomized, controlled trial included 86 patients undergoing primary TKA (Clinical-Trials.gov NCT02475603). All patients meeting the inclusion criteria were randomly assigned to the tourniquet (n = 43) or non-tourniquet (n = 43) group after obtaining a written informed consent. The cumulative bone cement penetration was radiologically measured in AP (seven zones) and lateral views (three zones) as defined by Knee Society Scoring System. Further parameters such as perioperative blood loss, soft tissue swelling, pain level/analgesic consumption, operative time, length of hospital stay (LOS) and complication rate were statistically compared between the groups.Results: The cumulative bone cement penetration averaged 28.5 ± 1.7 mm in tourniquet versus 26.6 ± 1.6 mm in non-tourniquet groups (n.s.). The mean intraoperative blood loss was 250 ml higher in the non-tourniquet group (p = 0.0001). Patient-reported pre- to 6th-day post-operative reduction of the pain level was significantly higher in the non-tourniquet group (p = 0.003). The Morphine Equivalent Dose was higher in the Tourniquet group at discharge day (p = 0.02). Parameters such as total blood loss, soft tissue swelling, surgical time, LOS, and complication rates revealed similar results between the groups.Conclusions: Tourniquet application did not influence the bone cement penetration significantly. Even though the intraoperative blood loss was reduced, the total blood loss was not affected significantly by tourniquet use. There was a tendency of higher post-operative pain and opioid analgesic requirement in the tourniquet group.Level Of Evidence: I. [ABSTRACT FROM AUTHOR]

Background: Patients and surgeons are typically satisfied with the cosmetic results of total endoscopic thyroidectomy using the complete areola approach. However, the disadvantages of this approach include an excessive free flap and a longer operative time.Methods: A retrospective analysis was conducted in 72 patients (64 women and 8 men) with a benign thyroid nodule who underwent non-unvisual dissection to establish the operating space for endoscopic surgery.Results: The time needed to create the operating space in the chest was 6.43 ± 0.94 min. The time for the overall operating space was 15.35 ± 1.52 min. The overall surgical time was 96.54 ± 19.32 min. The flap area in the chest was 30.25 ± 3.42 cm2.Conclusions: Application of non-visual dissection shorten the time to create operating space and the overall surgical time, and markedly reduced the flap area. Our non-unvisual dissection technique for establishing the operating space is different from any previous techniques. [ABSTRACT FROM AUTHOR]

Purpose: It was hypothesized that surgical time of beginners would be much longer than that of experts. Our purpose was to investigate and clarify the important manoeuvres for beginners to minimize surgical time in primary total knee arthroplasty (TKA) as a multicentre study.Methods: A total of 300 knees in 248 patients (averaged 74.6 years) were enrolled. All TKAs were done using the same instruments and the same measured resection technique at 14 facilities by 25 orthopaedic surgeons. Surgeons were divided into three surgeon groups (four experts, nine medium-volume surgeons and 12 beginners). The surgical technique was divided into five phases. Detailed surgical time and ratio of the time in each phase to overall surgical time were recorded and compared among the groups in each phase. A total of 62, 119, and 119 TKAs were done by beginners, medium-volume surgeons, and experts, respectively.Results: Significant differences in surgical time among the groups were seen in each phase. Concerning the ratio of the time, experts and medium-volume surgeons seemed cautious in fixation of the permanent component compared to other phases. Interestingly, even in ratio, beginners and medium-volume surgeons took more time in exposure of soft tissue compared to experts. (0.14 in beginners, 0.13 in medium-volume surgeons, 0.11 in experts, P < 0.05).Conclusion: Beginners took more time in exposure and closure of soft tissue compared to experts. Improvement in basic technique is essential to minimize surgical time among beginners. First of all, surgical instructors should teach basic techniques in primary TKA for beginners.Level Of Evidence: Therapeutic studies, Level IV. [ABSTRACT FROM AUTHOR]

Purpose: Certain aspects of total knee arthroplasty (TKA) in severely and morbidly obese (SMO) patients (BMI ≥ 35 kg/m) remain controversial. This study aimed to assess the duration of TKA surgery and hospital stay in relation to patients' BMI. Methods: Three operative times during TKA surgery were recorded: tourniquet time, to determine surgical difficulty, total surgical time, to assess the difficulty of achieving anaesthesia, and time in the surgical area, to assess patient management in the surgical area. Length of hospital stay was also calculated. Data were collected prospectively from consecutive patients and were recorded in a database for retrospective analysis. Results: Data were obtained from 922 consecutive patients undergoing TKA. The non-obese group comprised 418 patients (45.3 %), obese group Class I 331 (36 %), and the SMO group (Class II-III) 173 (18.7 %). Mean tourniquet time was 53 min, mean total surgical time was 84 min, and mean time in the surgical area was 132 min. There were no differences according to BMI group. Median length hospital stay (LHS) was 6 days in all patients regardless of BMI. Factors that significantly prolonged LHS were ASA III-IV and pre-operative haemoglobin between 12 and 13 g/dl. Conclusion: Severely and morbidly obese (SMO) patients (BMI ≥ 35 kg/m) undergoing TKA surgery do not require longer operative time or hospital stay than non-obese or obese Class I patients. The fact that surgical time was not significantly different could be due to greater specialisation in the treatment of these patients, which may favour a lower incidence of post-operative complications. Level of evidence: Retrospective comparative study, Level IV. [ABSTRACT FROM AUTHOR]

Background: Nonmelanoma skin cancer (NMSC) is the most common skin cáncer worldwide. This study aimed to describe the differences in treatment, type of reconstruction, and outcome of nonmelanoma skin cancers (NMSCs) comparing residents to plastic surgeons within a university teaching hospital facility. Methods: A retrospective study selecting all patients treated for NMSC during 1 year (2011) in an in/outpatient facility were performed. All patients were identified by DRG codes, DC44.0–DC44.9. Three groups of surgeons were compared to each other: (1) plastic surgeons, (2) residents, and (3) plastic surgeon with attending resident who was either supervised or assisting. All groups were stratified according to tumor stage and location. Results: Plastic surgeons excised larger SCCs than residents ( p = 0.03), while the size of BCCs were the same in all three groups ( p = 0.6). No difference was found between the groups regarding complete excision rate ( p = 0.9). Residents used direct suturing more frequently when compared to plastic surgeons ( p < 0.001). For nasal reconstructions, flaps were applied more frequently when both grades of surgeons were operating together compared to residents ( p = 0.044). The overall surgical time for excision and reconstruction of a T1–2 tumor was 30 (5–265) min. There was no difference when comparing plastic surgeons and residents in terms of surgical time. However, the surgical time was prolonged by more than 20 min when the two grades of surgeons were operating together. The overall complication rate was 7.5 % with no difference found between the groups ( p > 0.05). Conclusions: Preoperative patient selection by a consultant increases the patient's positive outcome, making NMSC excision a safe procedure regardless of surgeon grade. Level of Evidence: Level III, prognostic-risk study [ABSTRACT FROM AUTHOR]

The importance and technical difficulties of septal surgery often are underestimated. Although septoplasty is among the most common procedures in nasal surgery, it is poorly taught and developed. Septoplasty was performed for 1,035 consecutive white patients (789 males and 246 females) with a mean age of 35.7 years (range, 6–62 years) using a new personal surgical technique. Septal surgery was associated with functional endoscopic sinus surgery (FESS) in 157 cases and rhinoplasty in 416 cases. Preoperative otorhinolaryngologic examination using flexible nasal endoscopy, anterior active rhinometry (AAR), and occasional computed tomography of the paranasal sinuses was performed. Postoperative AAR was carried out. Septoplasty operative time was measured. A significant reduction in nasal breathing resistances with respect to preoperative conditions was found in 1,017 patients (98%) after AAR ( p < 0.001). No septal perforation, nasal infection, or bleeding was noticed postoperatively. Three cases of turbinoseptal synechiae were observed. The mean septoplasty operative time was 13.83 ± 4.22 min (range, 8–31 min). A short learning curve (20 septoplasty procedures) for this new septoplasty technique was found. The proposed septoplasty technique is an effective and rapid procedure for the correction of septal deviations in both adults and children. Reproducible and easily learned, this technique can be associated with other surgical procedures such as FESS and rhinoplasty. [ABSTRACT FROM AUTHOR]

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Our objective was to evaluate reduction in surgical bleeding by a modification in the customary simple abdominal hysterectomy (TAH) technique, the clampless abdominal hysterectomy (CAH). Eligible women were those with indications for abdominal hysterectomy. CAH is based on a simple distal tie-cut technique of the round ligaments, infundibulopelvic ligaments, and uterine vein and arteries, in comparison with the TAH technique of clamp-clamp-cut-tie-tie. Differences between the groups were tested by two-tailed unpaired Student t-tests (or the Mann Whitney U-test). Women in the CAH group ( n=19) showed significantly less surgical bleeding (266.1±200.0 vs. 502.5±441.4 ml, p=0.04) and shorter surgical times (66.9±26.9 vs. 145.0±50.9 min, p=0.000002) than women in the TAH ( n=21) group. We conclude that CAH could be a useful alternative for removing the uterus, significantly reducing both surgical bleeding and surgical time. [ABSTRACT FROM AUTHOR]