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Computer vision has emerged as a transformative technology with the potential to significantly enhance surgical practices' safety, efficiency, precision, and training. By leveraging advanced algorithms and artificial intelligence, computer vision applications offer real-time analysis of visual data during surgical procedures, enabling automated decision support, performance assessment, and intraoperative guidance. This article delves into the recent developments in computer vision technology within the realm of surgery, particularly focusing on its application in minimally invasive procedures. It also discusses the current state of computer vision in surgery while exploring its practical applications. The article highlights the challenges that must be overcome for widespread clinical adoption, emphasizing the crucial role of collective efforts in addressing these obstacles. With a balanced focus on both the technical advancements and the practical implications, this manuscript provides a comprehensive overview of the role of computer vision in modern surgery.

Objective To investigate the value of Hisense computer-assisted surgery (CAS) system in the surgical treatment of pediatric surgical diseases. Methods A retrospective analysis was performed for the clinical data of children who underwent surgical treatment in Department of Pediatric Surgery in our hospital from March 2016 to October 2022. Hisense CAS was used for three-dimensional reconstruction of lesions and surrounding tissue for all children before surgery, and the application and significance of Hisense CAS in the surgical treatment of pediatric surgical diseases were discussed by analyzing the 3D reconstructed images of thoracic, abdominal, and pelvic diseases, the simulated surgical resection volume of lesions, the feasibility of surgery in children, and follow-up results. Results After 3D reconstruction using Hisense CAS, the images clearly displayed the shape and branches of vessels around lesions, and the spatial anatomic relationship between the lesion and its surrounding vessels could be observed from any angle, thereby helping with the accurate localization and assessment of lesions. In this study, three-dimensional reconstruction was performed for 323 children before surgery, with 372 cases of reconstruction in total, and all 323 children underwent surgery according to the preoperative surgical plan. Among these 323 children, 287 were followed up after surgery and 36 were lost to follow-up, with a follow-up time of 9 (2, 16) months. Among the 287 children, 286 had no significant postoperative complications with good survival conditions, and 1 child with nephroblastoma had intestinal obstruction after surgery and achieved good survival conditions after the second surgery. Conclusion Hisense CAS can provide an accurate preoperative evaluation of tumors in parenchymal organs such as the liver and the kidney, assist in the design of optimal surgical plans, and help to achieve more accurate, safe, and effective surgery for infants and young children, which provides important guidance for precise implementation of surgical operation.

Abstract Objective The primary aim of the present study was to evaluate the long-term outcomes including survivorship of computer navigated distal femoral lateral opening wedge osteotomy (DFLOWO). The secondary aim was to identify the potential factors that may influence its survivorship. Methods A retrospective analysis of prospectively collected data for patients with lateral compartment arthritis who underwent navigated DFLOWO from December 2006 to November 2012 was performed. The International Knee Documentation Committee (IKDC) and Knee Injury and Osteoarthritis Outcome Score (KOOS) scores were analyzed for outcome measures. Conversion to arthroplasty during the follow-up was the end point. Results A total of 19 DFLOWOs were performed in 17 patients with a mean age of 46.6 ± 6.5 years formed the study cohort. The coronal alignment was corrected from a mean of 7.1° (2-11°) valgus to a mean of 2.1° (0.5°-3°) varus. The IKDC scores improved from mean of 39 preoperatively to 53 at the mean long-term follow-up of 9.1 years. The mean KOOS scores at the long-term follow-up were pain 71, symptoms 56, activities of daily living 82, sports and recreation 59, quality of life 43. Survivorship of the DFLOWO was 78.9% at a follow-up of 9.1 years. Presence of ≥ grade 2 according to the International Cartilage Repair Society (ICRS) cartilage degeneration in the medial compartment of the knee and >7° preoperative valgus deformity were strongly correlated with conversion to total knee arthroplasty (TKA) at the long-term follow-up (r= 0.66). ConclusionsComputer navigated DFLOWO has satisfactory clinical outcomes and 79% survivorship in long-term follow-up. Presence of more than ICRS ≥ grade 2 degenerative changes in the medial compartment of knee with > 7° preoperative valgus deformity negatively affects the survivorship of DFLOWO in the long-term follow-up.

Objective The aim of this study was to assess whether robotic assisted surgery is more efficient, in terms of estimated blood loss (EBL), operating time, post-operative pain scores, hospital stay and discharge disposition, than standard navigated MIS techniques when performing a transforaminal lumbar interbody fusion (TLIF). Methods Retrospective chart review was performed for 1,027 consecutive patients for a single spine surgeon. One-hundred patients who underwent either navigated MIS TLIF or robotic assisted MIS TLIF procedures were identified and included in the study. Primary outcome measures included EBL, operating time, post-operative pain scores, length of hospital stay and discharge disposition. Baseline demographic data, as well as outcome data, was recorded for each patient. Statistical analysis was performed to determine differences between the two groups. Results Patients who underwent robotic assisted MIS TLIF surgery had less intra-operative EBL (p=0.002), shorter operation time (p

Liver cancer is a leading cause of cancer deaths worldwide. Surgical resection of superficial hepatic lesions is increasingly guided by the disrupted bile excretion of the fluorescent dye indocyanine green (ICG). To extend this approach to deeper lesions, a dedicated bimodal tracer that facilitates both fluorescence guidance and radioguidance was developed. Methods: A tracer comprising a methylated cyanine-5 (Cy5) fluorescent dye and a mercaptoacetyltriserine chelate ( h HEPATO-Cy5) was synthesized and characterized. Cellular uptake and excretion were evaluated in hepatocyte cultures (2-dimensional culture and in vitro lesion model), using a fluorescent bile salt, MitoTracker dye, and methylated Cy5 as a control. After radiolabeling, the pharmacokinetics of 99m Tc- h HEPATO-Cy5 were assessed in mice over 24 h (percentage injected dose and percentage injected dose per gram of tissue, SPECT/CT imaging and fluorescence imaging). The ability to provide real-time fluorescence guidance during robot-assisted hepatobiliary surgery was evaluated in a porcine model using ICG as a reference. Results: The unique molecular signature of h HEPATO-Cy5 promotes hepatobiliary excretion. In vitro studies on hepatocytes showed that where methylated Cy5 remained internalized, h HEPATO-Cy5 showed fast clearance (10 min) similar to that of fluorescent bile salt. In vivo use of 99m Tc- h HEPATO-Cy5 in mice revealed liver accumulation and rapid biliary clearance. The effectiveness of bile clearance was best exemplified by the 2-orders-of-magnitude reduction in count rate for the gallbladder ( P = 0.008) over time. During hepatobiliary surgery in a porcine model, h HEPATO-Cy5 enabled fluorescence-based lesion identification comparable to that of ICG. Conclusion: The bimodal 99m Tc- h HEPATO-Cy5 provides an effective means to identify liver lesions. Uniquely, it helps overcome the shortcomings of fluorescence-only approaches by allowing for an extension to in-depth radioguidance., (© 2024 by the Society of Nuclear Medicine and Molecular Imaging.)

Abstract Background Immediate loading of implant-supported full-arch rehabilitations has become routine practice when treating edentulous patients. The combination of static computer-aided implant surgery (s-CAIS) and digital prosthetic workflow could eliminate several treatment steps and facilitate prostheses delivery. The aim of this study is to evaluate the 1-year results of digitally prefabricated polymethyl methacrylate (PMMA) provisional prostheses without a cast for full-arch computer-assisted immediate loading. Materials and methods A digital pre-operative treatment planning was realized for all patients: dental implants and screw-retained abutments were selected in the planning software and two surgical templates were fabricated for each patient. The first template was mucosa or teeth-supported to drill the holes for fixating pins, while the second template was placed after raising a full-thickness flap and was supported by pins as well as soft or hard tissue distal support. Furthermore, based on the surgical planning, interim prostheses were digitally designed and milled of PMMA resin blocks with subsequent pink resin veneering. Osteotomies and implant placement were performed through the surgical guides and all implants were immediately loaded with prefabricated full-arch interim prostheses directly connected to titanium copings with a flowable resin. Results A total of 55 dental implants were placed in ten patients. In all cases, interim prostheses allowed the insertion of titanium copings without the need of access hole enlargement or adaptation. All the prostheses had 1 year of functional loading to simulate the long provisional phase. No screw loosening occurred at the first removal of the prostheses after implant osseointegration. No fracture occurred during the whole period. After 1 year, the mean marginal bone loss level was 0.37 ± 0.06 mm, while the implant survival rate was 98.18% (n=54/55), with just one implant failing but not affecting final prosthesis delivery to the patient. Conclusions Within the limitations of the present study, the authors concluded that digitally prefabricated provisional prostheses for full-arch immediate loading with s-CAIS could be a valid alternative treatment modality. Milled PMMA restorations proved to be durable enough during the long provisional phase, without prosthetic complications.

Abstract Background The elaboration of a precise pre-surgical plan is essential during surgical treatment of dentofacial deformities. The aim of this study was to evaluate the accuracy of computer-aided simulation compared with the actual surgical outcome, following orthognathic surgery reported in clinical trials. Methods Our search was performed in PubMed, EMBASE, Cochrane Library and SciELO for articles published in the last decade. A total of 392 articles identified were assessed independently and in a blinded manner using eligibility criteria, out of which only twelve articles were selected for inclusion in our research. Data were presented using intra-class correlation coefficient, and linear and angular differences in three planes. Results The comparison of the accuracy analyses of the examined method has shown an average translation (

Standard volar plates often do not fit the surface of the malunited distal radius after osteotomy, necessitating an offset angle for accurate volar tilt correction. The correction can be achieved if the plate is held at the correct angle when the distal screws are locked. With the advantage of 3D surgical planning and patient-specific instruments, we developed a shim instrument to assist the surgeon in securing the plate at the intended angle when locking the distal screws, and evaluated radiological results. Five female patients aged 63-74 with dorsally angulated extra-articular malunions underwent surgery using 3D-printed guides and the shim instrument. The plate position, drilling guide alignment, screw placements, and distal radius correction on postoperative CTs were compared with the surgical plans. Errors were measured using an anatomical coordinate system, and standard 2D radiographic measures were extracted. Preoperative dorsal tilt ranged from 16° to 35°, and postoperative volar tilt from 1° to 11°. 3D analysis revealed mean absolute correction errors of 6.1° in volar tilt, 1.6° in radial inclination, and 0.6 mm in ulnar variance. The volar tilt error due to the shim instrument, indicated by the mean angle error of the distal screws to the plate, was 2.1° but varied across the five patients. Settling of the distal radius, due to tension during and after reduction, further contributed to a mean loss of 3.5° in volar tilt. The shim instrument helped with securing plates at the intended angle; however, further correction improvements should consider the tension between the fragments of osteoporotic bone.

Background: The objective of the present study was to evaluate the reliability of an augmented reality drilling approach and a freehand drilling technique for the autotransplantation of single-rooted teeth., Materials and Methods: Forty samples were assigned to the following surgical techniques for drilling guidance of the artificial sockets: A. augmented reality technique (AR) (n = 20) and B. conventional free-hand technique (FT) (n = 20). Then, two models with 10 teeth each were submitted to a preoperative cone-beam computed tomography (CBCT) scan and a digital impression by a 3D intraoral scan. Afterwards, the autotrasplanted teeth were planned in a 3D dental implant planning software and transferred to the augmented reality device. Then, a postoperative CBCT scan was performed. Data sets from postoperative CBCT scans were aligned to the planning in the 3D implant planning software to analize the coronal, apical and angular deviations. Student's t-test and Mann-Whitney non-parametric statistical analysis were used to analyze the results., Results: No statistically significant differences were shown at coronal (p = 0.123) and angular (p = 0.340) level; however, apical deviations between AR and FT study groups (p = 0.008) were statistically significant different., Conclusion: The augmented reality appliance provides higher accuracy in the positioning of single-root autotransplanted teeth compared to the conventional free-hand technique., (© 2024. The Author(s).)

Objective: Preclinical validation study to assess the feasibility and accuracy of electromagnetic image-guided systems (EM-IGS) in orbital surgery using high-fidelity physical orbital anatomy simulators., Methods: EM-IGS platform, clinical software, navigation instruments and reference system (StealthStation S8, Medtronic) were evaluated in a mock operating theatre at the Royal Victoria Eye and Ear Hospital, a tertiary academic hospital in Dublin, Ireland. Five high-resolution 3D-printed model skulls were created using CT scans of five anonymised patients with an orbital tumour that previously had a successful orbital biopsy or excision. The ability of ophthalmic surgeons to achieve satisfactory system registration in each model was assessed. Subsequently, navigational accuracy was recorded using defined anatomical landmarks as ground truth. Qualitative feedback on the system was also attained., Results: Three independent surgeons participated in the study, one junior trainee, one fellow and one consultant. Across models, more senior participants were able to achieve a smaller system-generated registration error in a fewer number of attempts. When assessing navigational accuracy, submillimetre accuracy was achieved for the majority of points (16 landmarks per model, per participant). Qualitative surgeon feedback suggested acceptability of the technology, although interference from mobile phones near the operative field was noted., Conclusion: This study suggests the feasibility and accuracy of EM-IGS in a preclinical validation study for orbital surgery using patient specific 3D-printed skulls. This preclinical study provides the foundation for clinical studies to explore the safety and effectiveness of this technology., Competing Interests: Competing interests: Professor CM has a competing interest whereby he is an associate editor to the submission journal BMJ Open Ophthalmology. The rest of the authors certify that they have no affiliations with or involvement in any organisation or entity with any financial interest (such as honoraria; educational grants; participation in speakers' bureaus; membership, employment, consultancies, stock ownership, or other equity interest; and expert testimony or patent-licensing arrangements) or non-financial interest (such as personal or professional relationships, affiliations, knowledge or beliefs) in the subject matter or materials discussed in this manuscript., (© Author(s) (or their employer(s)) 2024. Re-use permitted under CC BY-NC. No commercial re-use. See rights and permissions. Published by BMJ.)

Objectives: Guided implant systems can be used as a training approach for placing implants. This in vitro prospective randomized pilot study evaluated the learning progression and skill development in freehand placement of two implants supporting a three-unit fixed prosthesis on a simulation model among novice operators., Material and Methods: Four senior dental students with no prior implant placement experience participated in the study. As a baseline, each student placed two mandibular and two maxillary implants by freehand technique on a simulation model. Sixteen consecutive guided placements using a static guide, dynamic navigation, and template-based guide followed totaling 32 guided implant placements into maxillary and mandibular models. Freehand implant placements before and after the various guided navigation attempts were compared to assess their impact on freehand skill. Metrics compared included surgical time, horizontal, vertical, and angulation discrepancies between the planned and placed implant positions measured on superimposed CBCT scans and analyzed with repeated measures regression with Tukey's adjusted pairwise comparisons (α = .05)., Results: Before training with guided techniques, the average baseline freehand implant placement took 10.2 min and decreased to 8.2 after training but this difference was not statistically significant (p = .1670) There was marginal evidence of a significant difference in the 3D apex deviation with an average improvement of 0.89 mm (95% CI: -0.38, 2.16, p = .1120); and marginal evidence of a significant improvement in the overall angle with an average improvement of 3.74° (95% CI: -1.00, 8.48, p = .0869) between baseline and final freehand placement attempts., Conclusions: Within the limitations of this pilot study, guided implant placement experiences did not significantly benefit or hinder freehand placement skills. Dental students should be exposed to various placement techniques to prepare them for clinical practice and allow them to make informed decisions on the best technique based on their skills and a given clinical scenario., (© 2024 The Authors. Clinical and Experimental Dental Research published by John Wiley & Sons Ltd.)

Blood vessel and surgical instrument segmentation is a fundamental technique for robot-assisted surgical navigation. Despite the significant progress in natural image segmentation, surgical image-based vessel and instrument segmentation are rarely studied. In this work, we propose a novel self-supervised pretraining method (SurgNet) that can effectively learn representative vessel and instrument features from unlabeled surgical images. As a result, it allows for precise and efficient segmentation of vessels and instruments with only a small amount of labeled data. Specifically, we first construct a region adjacency graph (RAG) based on local semantic consistency in unlabeled surgical images and use it as a self-supervision signal for pseudo-mask segmentation. We then use the pseudo-mask to perform guided masked image modeling (GMIM) to learn representations that integrate structural information of intraoperative objectives more effectively. Our pretrained model, paired with various segmentation methods, can be applied to perform vessel and instrument segmentation accurately using limited labeled data for fine-tuning. We build an Intraoperative Vessel and Instrument Segmentation (IVIS) dataset, comprised of ~3 million unlabeled images and over 4,000 labeled images with manual vessel and instrument annotations to evaluate the effectiveness of our self-supervised pretraining method. We also evaluated the generalizability of our method to similar tasks using two public datasets. The results demonstrate that our approach outperforms the current state-of-the-art (SOTA) self-supervised representation learning methods in various surgical image segmentation tasks.

Background: Immediate loading of implant-supported full-arch rehabilitations has become routine practice when treating edentulous patients. The combination of static computer-aided implant surgery (s-CAIS) and digital prosthetic workflow could eliminate several treatment steps and facilitate prostheses delivery. The aim of this study is to evaluate the 1-year results of digitally prefabricated polymethyl methacrylate (PMMA) provisional prostheses without a cast for full-arch computer-assisted immediate loading. Materials and methods: A digital pre-operative treatment planning was realized for all patients: dental implants and screw-retained abutments were selected in the planning software and two surgical templates were fabricated for each patient. The first template was mucosa or teeth-supported to drill the holes for fixating pins, while the second template was placed after raising a full-thickness flap and was supported by pins as well as soft or hard tissue distal support. Furthermore, based on the surgical planning, interim prostheses were digitally designed and milled of PMMA resin blocks with subsequent pink resin veneering. Osteotomies and implant placement were performed through the surgical guides and all implants were immediately loaded with prefabricated full-arch interim prostheses directly connected to titanium copings with a flowable resin. Results: A total of 55 dental implants were placed in ten patients. In all cases, interim prostheses allowed the insertion of titanium copings without the need of access hole enlargement or adaptation. All the prostheses had 1 year of functional loading to simulate the long provisional phase. No screw loosening occurred at the first removal of the prostheses after implant osseointegration. No fracture occurred during the whole period. After 1 year, the mean marginal bone loss level was 0.37 ± 0.06 mm, while the implant survival rate was 98.18% (n=54/55), with just one implant failing but not affecting final prosthesis delivery to the patient. Conclusions: Within the limitations of the present study, the authors concluded that digitally prefabricated provisional prostheses for full-arch immediate loading with s-CAIS could be a valid alternative treatment modality. Milled PMMA restorations proved to be durable enough during the long provisional phase, without prosthetic complications. [ABSTRACT FROM AUTHOR]

Surgery has long been a cornerstone of cancer treatment in many types of cancer. Traditionally, intraoperative assessment of the resection margin is largely dependent on visual inspection and palpation of tumors, with the aid of frozen section analysis. Although preoperative imaging can provide gross anatomical information, in situ translation of these images to the operation field is challenging. With the advancement of molecular imaging technology and its clinical application, the gap between preoperative radiologic images and surgical findings has been reduced through image-guided surgery. However, the imaging probes for intraoperative visualization of tumors are not individual tumor-specific. As conventional oncology has moved toward precision oncology with genomic and biological information specific to each tumor, image-guided surgery should also shift toward tumor biology-based image-guided surgery, so-called precision surgery for cancer. In precision cancer surgery, tumors should be analyzed molecularly and genetically to select the optimal imaging probes for individual tumors before surgical resection, beyond the use of predetermined imaging probes for certain types of cancer. This will raise the likelihood of meeting the surgical goals of cancer treatment. In summary, precision cancer surgery can be defined as individual tumor biology-based image-guided surgery.

A technique for the design of a hybrid tooth and bone-supported implant drilling guide is described. The patient was scanned using cone beam computed tomography and an optical intraoral scanner. The dicom file was segmented according to the area of interest composed of bone and the remaining natural teeth. The Standard Tessellation Language (STL) file was trimmed to only the teeth providing support, followed by merging between the bone and teeth files in one STL. The implant drilling guide was designed with the Real Guide software program, and the file was 3-dimensionally printed in clear surgical guide resin. This technique offers an accurate, cost-effective digitally designed implant placement guide for patients with long-span distal extension edentulous areas and few remaining natural dentitions providing distal bone support. It can also be used in patients with hemi maxillectomy for zygomatic implant placement. This type of surgical guide provides more accuracy in implant surgeries that require flab elevation by gaining more support from the remaining natural dentition., (© 2024. The Author(s).)

Objective: The paper aimed to improve the accuracy limitations of traditional two-dimensional ultrasound and surgical procedures in the diagnosis and management of congenital heart disease (chd), and to improve the diagnostic and therapeutic level of chd., Method: This article first collected patient data through real-time imaging and body surface probes, and then diagnosed 150 patients using three-dimensional echocardiography. In order to verify the effectiveness of the combination therapy, 60 confirmed patients were divided into a control group and an experimental group. The control group received conventional two-dimensional ultrasound and surgical treatment, while the experimental group received three-dimensional ultrasound and image guided surgical treatment., Result: In the second diagnosis, the diagnostic accuracy of type 1, type 2, and type 3 in the control group was 84.21%, 84.02%, and 83.38%, respectively. The diagnostic accuracy rates of type 1, type 2, and type 3 in the experimental group were 92.73%, 92.82%, and 92.83%, respectively. In the control group, 2 males and 1 female experienced heart failure after surgery. However, in the experimental group, 0 males and 0 females experienced heart failure after surgery., Conclusion: The combination of three-dimensional echocardiography and image guided surgery can improve diagnostic accuracy and surgical treatment effectiveness, thereby reducing risks and complications, and improving surgical success rate., (© 2024. The Author(s).)

Purpose: This study aims to evaluate the efficacy and satisfaction of using a multi-angle laser device (MLD) for C-arm fluoroscopy to assist novice learners during lumbar spine surgery., Methods: Forty novice learners were randomly assigned to Group A using an MLD-equipped C-arm or Group B using a traditional C-arm. Both groups performed X-ray fluoroscopy on a lumbar spine model in supine and rotated positions. Time, number of shots, and deviation from the target were compared. A questionnaire was used to assess the learning experience., Results: Group A required less time (13.66 vs. 25.63 min), and fewer shots (15.05 vs. 32.50), and had a smaller deviation (22.9% vs. 61.5%) than Group B (all p<0.05). The questionnaire revealed higher scores in Group A for comfort, efficiency, and knowledge mastery (all p<0.05)., Conclusion: The MLD significantly improves novice learning of C-arm fluoroscopy during lumbar spine surgery., Competing Interests: The authors have declared that no competing interests exist., (Copyright: © 2024 Zhuang et al. This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.)

X-ray/CT image registration plays a pivotal role in enhancing surgical navigation success rates. However, challenges stemming from sparse and noisy X-ray image features, coupled with the complexities of multi-parameter optimization, impose limitations on existing methods in terms of registration accuracy and efficiency. In response, this paper presents an innovative approach-a fast X-ray/CT image registration method based on perspective projection triangular features(F-PPTF). By leveraging the conformal nature of perspective projection, the proposed method constructs perspective projection triangular features with rotation, translation, and scale invariance using point feature descriptors. Diverging from multi-parameter iterative optimization techniques, this approach achieves the decoupling of the six transformation parameters. This decoupling simplifies computational intricacies, thereby facilitating swift registration. Experimental evaluations conducted on synthetic and real X-ray images reveal an average rotational absolute error of 0.41°, an average translational absolute error of 1.16 mm, and an average registration time of 14.89 s. In comparison to conventional registration methodologies, the method presented in this paper demonstrates pronounced superiority in terms of both registration accuracy and efficiency, thereby exhibiting heightened potential for broader applicability., Competing Interests: Declaration of Competing Interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (Copyright © 2024 Elsevier Ltd. All rights reserved.)

Background: Efficient utilization of residual bone volume and the prevention of inferior alveolar nerve injury are critical considerations in immediate implant placement (IIP) within the posterior mandibular region. Addressing these challenges, this study focuses on the clinical efficacy and implant accuracy of dynamic real-time navigation, an emerging technology designed to enhance precision in implantation procedures., Methods: This study included 84 patients with 130 implants undergoing immediate placement in the posterior mandibular region. Stratified into dynamic navigation, static guide plate, and freehand implant groups, clinical indicators, including initial stability, distance to the inferior alveolar nerve canal, depth of implant placement, and various deviations, were systematically recorded. Statistical analysis, employing 1- or 2-way ANOVA and Student's t-test, allowed for a comprehensive evaluation of the efficacy of each technique., Results: All 130 implants were successfully placed with an average torque of 22.53 ± 5.93 N.cm. In the navigation group, the distance to the inferior alveolar nerve and the depth of implant placement were significantly greater compared to the guide plate and freehand groups (P < 0.05). Implant deviation was significantly smaller in both the navigation and guide plate groups compared to the freehand group(P < 0.05). Additionally, the navigation group exhibited significantly reduced root and angle deviations compared to the guide plate group(P < 0.05), highlighting the superior precision of navigation-assisted immediate implant placement., Conclusions: It is more advantageous to use dynamic navigation rather than a static guide plate and free-hand implant insertion for immediate posterior mandibular implant implantation., (© 2024. The Author(s).)

Background and Objectives : Adolescent idiopathic scoliosis (AIS) is a prevalent three-dimensional spinal disorder, with a multifactorial pathogenesis, including genetics and environmental aspects. Treatment options include non-surgical and surgical treatment. Surgical interventions demonstrate positive outcomes in terms of deformity correction, pain relief, and improvements of the cardiac and pulmonary function. Surgical complications, including excessive blood loss and neurologic deficits, are reported in 2.27-12% of cases. Navigation-assisted techniques, such as the O-arm system, have been a recent focus with enhanced precision. This study aims to evaluate the results and complications of one-stage posterior instrumentation fusion in AIS patients assisted by O-arm navigation. Materials and Methods : This retrospective study assesses 55 patients with AIS (12-28 years) who underwent one-stage posterior instrumentation correction supported by O-arm navigation from June 2016 to August 2023. We examined radiological surgical outcomes (initial correction rate, loss of correction rate, last follow-up correction rate) and complications as major outcomes. The characteristics of the patients, intraoperative blood loss, operation time, number of fusion levels, and screw density were documented. Results : Of 73 patients, 55 met the inclusion criteria. The average age was 16.67 years, with a predominance of females (78.2%). The surgical outcomes demonstrated substantial initial correction (58.88%) and sustained positive radiological impact at the last follow-up (56.56%). Perioperative complications, including major and minor, occurred in 18.18% of the cases. Two patients experienced a major complication. Blood loss (509.46 mL) and operation time (402.13 min) were comparable to the literature ranges. Trend analysis indicated improvements in operation time and blood loss over the study period. Conclusions : O-arm navigation-assisted one-stage posterior instrumentation proves reliable for AIS corrective surgery, achieving significant and sustained positive radiological outcomes, lower correction loss, reduced intraoperative blood loss, and absence of implant-related complications. Despite the challenges, our study demonstrates the efficacy and maturation of this surgical approach.

Background: Urethral injury occurs in 1-6 % of male cases during minimally invasive surgery of lower rectal cancer. A Foley catheter emitting near-infrared (NIR) fluorescence of sufficient intensity has been expected to locate the urethra during image-guided surgery. Although it has been difficult to impart NIR fluorescent properties to biocompatible thermosetting polymers, we have recently succeeded in developing a NIR fluorescent compound for silicone rubber and a NIR fluorescent Foley catheter (HICARL). Here, we evaluated its NIR fluorescence properties and visibility performance using porcine anorectal isolation specimens., Methods: The HICARL catheter was made of a mixture of solid silicone rubber and a NIR fluorescent compound that emits fluorescence with a wavelength of 820-880 nm, while a conventional transparent Foley catheter was made of solid silicone rubber only. As a standard for comparison of the intensity of NIR fluorescence, a transparent Foley catheter the lumen of which was filled with a mixture of indocyanine green (ICG) and human plasma was used. As a comparison to assess the visibility performance of the HICARL catheter, a transparent Foley catheter into which a commercially available NIR fluorescent polyurethane ureteral catheter (NIRC) was placed was used., Results: A NIR fluorescence quantitative imaging analysis revealed that the Foley-NIRC catheter and the HICARL catheter emitted 3.42 ± 0.42 and 6.43 ± 0.07 times more fluorescence than the Foley-ICG catheter, respectively. The location of the HICARL catheter placed in the anorectum with a wall thickness of 3.8 ± 0.1 mm was clearly delineated in its entirety by NIR fluorescence, while that of the Foley-NIRC catheter was faintly or only partially visible., Conclusions: The HICARL catheter emitting NIR fluorescence of sufficient intensity is a promising and easy-to-use tool for urethral visualization during image-guided surgery of lower rectal cancer., Competing Interests: Declaration of competing interest Takayuki Sato and Ichiro Kitani have no conflict of interest to disclose., (Copyright © 2024 The Author(s). Published by Elsevier B.V. All rights reserved.)

Background: The aim of this study was to compare the efficacy and safety of patient-specific instrumentation (PSI) and conventional instrumentation (CI) for unicompartmental knee arthroplasty. Our hypothesis was that the PSI would be superior to CI in improving implant positioning and clinical function., Methods: We searched electronic databases (PubMed, Web of Science, Embase, and Cochrane) to identify relevant studies published before July 1, 2023 that met our inclusion criteria. The identified reports at least included one of the following outcome variables: coronal component alignment, sagittal component alignment, number of outliers, hip-knee-ankle angle, postoperative complications, operative time and knee joint functional evaluation. For dichotomous variables, we calculated the risk ratio and its 95% confidence interval (CI). For continuous variables, we calculated the mean difference (MD) and its 95% CI. Heterogeneity of the included studies was assessed using the standard chi-square test. Meta-analyses were performed using RevMan 5.4. software. The meta-analysis was registered with PROSPERO (No. CRD42023454160)., Results: A total of 9 articles were included in the analysis, consisting of 4 randomized controlled trials and 5 cohort studies. The study population comprised 494 patients, with 262 in the PSI group and 232 in the CI group. Our findings demonstrate that the PSI group exhibits superior tibial component coronal alignment compared to the CI group (MD = -0.66, 95% CI: -1.21 to -0.12, P = .02). Conversely, the CI group demonstrates better femoral component coronal alignment than the PSI group (MD = 0.89, 95% CI: 0.17-1.60, P = .01). No significant between 2 groups differences were observed in tibial component sagittal alignment, femoral component sagittal alignment, tibial coronal axis outliers, tibial sagittal axis outliers, femoral coronal axis outliers, femoral sagittal axis outliers, postoperative complications, operative time, hip-knee-ankle angle, and postoperative knee joint function score., Conclusions: Our study findings suggest that the PSI confer an advantage in achieving superior tibial component coronal alignment, whereas the CI associated with better femoral component coronal alignment. However, no significant differences were observed between the groups in terms of other parameters. Future studies with larger sample sizes are needed to validate these findings., Competing Interests: The authors have no funding and conflicts of interest to disclose., (Copyright © 2024 the Author(s). Published by Wolters Kluwer Health, Inc.)

The combination of multiple imaging methods has made an indelible contribution to the diagnosis, surgical navigation, treatment, and prognostic evaluation of various diseases. Due to the unique advantages of luminogens with aggregation-induced emission (AIE), their progress has been significant in the field of organic fluorescent contrast agents. Herein, this manuscript summarizes the recent advancements in AIE molecules as contrast agents for optical image-based dual/multi-modal imaging. We particularly focus on the exceptional properties of each material and the corresponding application in the diagnosis and treatment of diseases.

Background: Over the last few decades, shoulder surgery has undergone rapid advancements, with ongoing exploration and the development of innovative technological approaches. In the coming years, technologies such as robot-assisted surgeries, virtual reality, artificial intelligence, patient-specific instrumentation, and different innovative perioperative and preoperative planning tools will continue to fuel a revolution in the medical field, thereby pushing it toward new frontiers and unprecedented advancements. In relation to this, shoulder surgery will experience significant breakthroughs. Main body: Recent advancements and technological innovations in the field were comprehensively analyzed. We aimed to provide a detailed overview of the current landscape, emphasizing the roles of technologies. Computer-assisted surgery utilizing robotic- or image-guided technologies is widely adopted in various orthopedic specialties. The most advanced components of computer-assisted surgery are navigation and robotic systems, with functions and applications that are continuously expanding. Surgical navigation requires a visual system that presents real-time positional data on surgical instruments or implants in relation to the target bone, displayed on a computer monitor. There are three primary categories of surgical planning that utilize navigation systems. The initial category involves volumetric images, such as ultrasound echogram, computed tomography, and magnetic resonance images. The second type is based on intraoperative fluoroscopic images, and the third type incorporates kinetic information about joints or morphometric data about the target bones acquired intraoperatively. Conclusion: The rapid integration of artificial intelligence and deep learning into the medical domain has a significant and transformative influence. Numerous studies utilizing deep learning-based diagnostics in orthopedics have remarkable achievements and performance., Competing Interests: Declaration of conflicting interestsThe author(s) declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.

Dynamic infrared thermography (DIRT) has been used for the preoperative mapping of cutaneous perforators. This technique has shown a positive correlation with intraoperative findings. Our aim was to evaluate the accuracy of perforator mapping with DIRT and augmented reality using a portable projector. For this purpose, three volunteers had both of their anterolateral thighs assessed for the presence and location of cutaneous perforators using DIRT. The obtained image of these “hotspots” was projected back onto the thigh and the presence of Doppler signals within a 10-cm diameter from the midpoint between the lateral patella and the anterior superior iliac spine was assessed using a handheld Doppler device. Hotspots were identified in all six anterolateral thighs and were successfully projected onto the skin. The median number of perforators identified within the area of interest was 5 (range, 3–8) and the median time needed to identify them was 3.5 minutes (range, 3.3–4.0 minutes). Every hotspot was correlated to a Doppler sound signal. In conclusion, augmented reality can be a reliable method for transferring the location of perforators identified by DIRT onto the thigh, facilitating its assessment and yielding a reliable map of potential perforators for flap raising.

ABSTRACT Objective: To prove the accuracy of a customized guide developed according to our method. Methods: This customized guide was developed from a three-dimensional model of proximal femur reconstructed using computed tomography data. Based on the new technique, the position of the guide pin insertion was selected and adjusted using the reference of the anatomical femoral neck axis. The customized guide consists of a hemispheric covering designed to fit the posterior part of the femoral neck. The performance of the customized guide was tested in eight patients scheduled for total hip arthroplasty. The stability of the customized guide was assessed by orthopedic surgeons. An intraoperative image intensifier was used to assess the accuracy. Results: The customized guide was stabilized with full contact and was fixed in place in all patients. The mean angular deviations in relation to the what was planned in anteroposterior and lateral hip radiographs were 0.5º ± 1.8º in valgus and 1.0º ± 2.4º in retroversion, respectively. Conclusion: From this pilot test, the authors suggest that the proposed technique could be applied as a customized guide to the positioning device for hip resurfacing arthroplasty with acceptable accuracy and user-friendly interface. Level of Evidence IV, Cases Series.