Search

BACKGROUND: Robotic surgical procedures continue to increase both in the United States (US) and worldwide. Several novel robotic surgical platforms are under development or undergoing regulatory approval. This review explores robotic platforms that are expected to reach US consumers within the next 2-3 years. METHODS: The SAGES Robotic Platforms Working Group identified robotic surgery platforms in various stages of development and selected multi-visceral systems nearing or completing the US Food and Drug Administration (FDA) approval process. We outline key system components including architecture, unique features, development status, regulatory approval, and expected markets. RESULTS: We identified twenty robotic platforms that met our selection criteria. Ten companies were based in North America, and ten were based in Europe or Asia. Each system is described in detail and key features are summarized in table form for easy comparison. CONCLUSION: The emergence of novel robotic surgical platforms represents an important evolution in the growth of minimally invasive surgery. Increased competition has the potential to bring value to surgical patients by stimulating innovation and driving down cost. The impact of these platforms remains to be determined, but the continued growth of robotic surgery seems to be all but assured.

BACKGROUND: Ileal neuroendocrine tumors (i-NETs) are characterized by their multifocality and bulky mesenteric mass. Having shown that minimally invasive surgery (MIS) utilizing a hand-access port device has favorable short-term outcomes and achieves the goals of surgery for i-NETs, we sought to analyze long-term survival outcomes of MIS. METHODS: One hundred and sixty-eight patients who underwent resection of primary i-NETs at a single institution between January 2007 and February 2023 were retrospectively studied. Patients were categorized into the MIS or open surgery cohorts on an intention-to-treat basis. Open surgery was selected mainly based on the need for hepatectomy or bulky mesenteric mass resection. Overall survival was analyzed using log-rank tests with propensity score matching (PSM) and Cox proportional hazards regression. PSM was performed to reduce standardized mean differences of the variables to

BackgroundIncisional hernia (IH) is a known complication after colorectal surgery. Despite advances in minimally invasive surgery, colorectal surgery still requires extraction sites for specimen retrieval, increasing the likelihood of postoperative IH development. The objective of this study is to determine the effect of specimen extraction site on the rate of IH after minimally invasive right-sided colectomy for patients with available imaging.Study designThis is a retrospective multi-institutional cohort study at 2 large academic medical centers in the US. Adults who underwent right-sided minimally invasive colectomy from 2012 to 2020 with abdominal imaging available at least 1 year postoperatively were included in the analysis. The primary exposure was specimen extraction via a midline specimen extraction vs Pfannenstiel specimen extraction. The main outcome was the development of IH at least 1 year postoperatively as visualized on a CT scan.ResultsOf the 341 patients sampled, 194 (57%) had midline specimen extraction and 147 (43%) had a Pfannenstiel specimen extraction. Midline extraction patients were older (66 ± 15 vs 58 ± 16; p < 0.001) and had a higher rate of previous abdominal operation (99, 51% vs 55, 37%, p = 0.01). The rate of IH was higher in midline extraction at 25% (48) compared with Pfannenstiel extraction (0, 0%; p < 0.001). The average length of stay was higher in the midline extraction group at 5.1 ± 2.5 compared with 3.4 ± 3.1 days in the Pfannenstiel extraction group (p < 0.001). Midline extraction was associated with IH development (odds ratio 24.6; 95% CI 1.89 to 319.44; p = 0.004). Extracorporeal anastomosis was associated with a higher IH rate (odds ratio 25.8; 95% CI 2.10 to 325.71; p = 0.002).ConclusionsPatients who undergo Pfannenstiel specimen extraction have a lower risk of IH development compared with those who undergo midline specimen extraction.

Over the past two decades, minimally invasive approaches in rectal surgery have changed the landscape of surgical interventions, impacting both malignant and benign pathologies. The dynamic nature of rectal cancer treatment owes much to innovations in surgical techniques, reflected in the expanding literature on available treatment modalities. Local excision, facilitated by minimally invasive surgery, offers curative potential for patients with early T1 rectal cancers and favorable pathologic features. For more complex cases, laparoscopic and robotic surgery have demonstrated significant efficacy and provided precise, durable outcomes while reducing perioperative morbidity and enhancing postoperative recovery. Additionally, advancements in imaging, surgical instrumentation, and enhanced recovery protocols have further optimized patient care. The integration of multidisciplinary care has also emerged as a cornerstone of treatment, emphasizing collaboration among surgeons, oncologists, and radiologists to deliver personalized, evidence-based care. This narrative review aims to elucidate current minimally invasive surgical techniques and approaches for rectal pathologies, spanning benign and malignant conditions, while also exploring future directions in the field, including the potential role of artificial intelligence and next-generation robotic platforms. [ABSTRACT FROM AUTHOR]

Background: The fully endoscopic combined endonasal and supraorbital keyhole approach, which integrates the endoscopic endonasal approach (EEA) and the endoscopic supraorbital keyhole approach (eSKA), is effective for complex suprasellar tumors extending beyond the internal carotid artery (ICA). We detail its application for tuberculum sellae meningiomas with lateral extension. Method: Tumor resection is performed via the EEA, with support from the eSKA. This allows for careful management of the optic nerve under direct visualization and enables sufficient tumor resection. Conclusion: This combined approach facilitates extensive tumor resection, effective skull base reconstruction, and preservation of surrounding structures. [ABSTRACT FROM AUTHOR]

Copyright of Hungarian Medical Journal / Orvosi Hetilap is the property of Akademiai Kiado and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Purpose of Review: This review evaluates the current landscape of same-day discharge (SDD) following robotic-assisted laparoscopic prostatectomy (RARP), highlighting perioperative management strategies and proposing future research directions. Recent Findings: RARP has been shown to improve perioperative outcomes including reduced blood loss, postoperative pain, and hospital length of stay (LOS) when compared to open radical prostatectomy. Recently, the question of the feasibility of SDD for RARP has been proposed, aiming to reduce postoperative complications, hospital-acquired infections, and healthcare costs. The advent of single-port robotic systems aims to further minimize postoperative morbidity. Recent literature has reported SDD for RARP is safe and feasible in appropriately selected patients, with postoperative outcomes, including complication and readmission rates, similar to inpatient RARP. Summary: Our findings show SDD can be safely implemented without compromising patient outcomes, as evidenced by similar complication, readmission, and emergency department visit rates compared to inpatient cohorts. Future research should be aimed to refining patient selection criteria, enhancing opioid-free anesthesia pathways, and exploring new surgical technologies to improve SDD outcomes. [ABSTRACT FROM AUTHOR]

Background: Postoperative pancreatic fistula (POPF) is one of the potentially serious complications after gastrectomy for gastric cancer (GC). Drain amylase level is a predictor of POPF in open and laparoscopic gastrectomy, but no study has focused on minimally invasive surgery (MIS), including robotic gastrectomy (RG). This study assesses the effect of drain amylase levels for POPF in MIS and develop a prediction model in the MIS era. Methods: This single-institutional retrospective study, conducted from January 2011 to December 2021, included 1,353 who underwent standard MIS for GC. We placed a drain in all patients undergoing MIS gastrectomy and measured the drain amylase level on the first postoperative day (D1Amy). The predictive accuracy of D1Amy for POPF was assessed. Additionally, the entire cohort was randomly categorized into the training (1,048 patients) and validation sets (305 patients) to establish the nomogram. Results: Of the 1353 patients, 530 underwent a robotic approach. POPF and intraabdominal infectious complications of Clavien–Dindo classification grade ≥ II were observed in 80 (5.9%) and 145 (10.7%) patients, respectively. Median D1Amy was 812 U/L. The receiver operating characteristic analysis of D1Amy for POPF revealed an area under the curve (AUC) of 0.888. Multivariate analysis revealed age, tumor location, splenectomy, and D1Amy as significant risk factors for POPF. The AUC of the nomogram was 0.8960, validated with AUC of 0.9259. Conclusions: We revealed the utility of D1Amy in predicting POPF in MIS gastrectomy. Furthermore, the nomogram, incorporating D1Amy and other clinical factors, was additionally used as a predictive model for POPF. [ABSTRACT FROM AUTHOR]

Introduction: Though open pancreatoduodenectomy (OPD) is the gold standard, robotic pancreatoduodenectomy (RPD) is on the rise due to its technical ease with robotic armamentarium and claim to decrease morbidity in the perioperative period. This study compares the perioperative and oncologic outcomes of RPD performed for periampullary neoplasms (PANs) with OPD. Method: This is a retrospective study conducted from January 2018 to December 2023 for all the patients who underwent either OPD or RPD for PANs. Demographic, peri-operative outcomes and oncological parameters [disease-free survival (DFS) and overall survival (OS)] were analysed and compared. The two groups were matched using 1:1 propensity score matching (PSM) to reduce the risk of confounding. Results: A hundred patients were analysed (30 in RPD and 70 in OPD), and both groups were similar in demographic characteristics. Post-operative morbidity in terms of clinically relevant pancreatic fistula, post-pancreatectomy haemorrhage, delayed gastric emptying and overall Clavien–Dindo ≥ Grade 3 complications were similar in both groups. Surgical site infection (SSI) was significantly higher in the OPD group compared to RPD (31.4% vs. 6.7, p = 0.008); however, the median postoperative hospital stay was similar in both groups. After PSM (26 patients in each group), the RPD group had significantly more operative time (480 min vs. 360 min, p = 0.007) less blood loss (250 ml vs. 400 ml, p = 0.004), and similar SSI [2(7.7%) vs. 6(23.1%), p = 0.178). The R0 resection rate, lymph nodal yield, lymph nodal positivity, DFS and OS were similar in both groups. Conclusion: The robotic approach for PD is technically safe and feasible with equivalent resection quality and oncological outcomes compared to the open approach. RPD has equivalent postoperative morbidity, DFS and OS. [ABSTRACT FROM AUTHOR]

Aim This survey analyzed techniques in laparoscopic inguinal hernia repair (LIHR) across pediatric age groups. Materials and Methods Data were collected through an online survey for pediatric surgeons, comprising of 38 questions, conducted by the European Pediatric Surgeons' Association (EUPSA) Trainees of European Pediatric Surgery (TEPS) LIHR Working Group. Results The survey was completed by 183 surgeons from 22 countries. Seventy-seven percent of respondents had performed LIHR at least once. Regarding preferences about the patient's gender, 7% respondents perform LIHR only in selected females, 9% routinely in females, 15% in both genders with age/weight restrictions, 24% routinely in both genders, 31% in selected cases, and 14% never perform LIHR. Percutaneous internal ring suturing (PIRS) was the preferred technique in all age groups, with totally extraperitoneal and transabdominal preperitoneal repairs preferred by 9% in adolescents. The majority (59%) repaired a contralateral patent processus vaginalis if present. Hydro-dissection (21%) and additional intra-abdominal instruments (42%) were preferred more often for male patients. The distal hernia sac was left intact by most respondents (92%). Responses regarding recurrence rates varied: 40% responded that LIHR had recurrence rates comparable to open surgery, whereas 10% reported increased recurrences and hence limited its use, and 10% consider that slightly increased recurrences are outweighed by lower complication rates associated with laparoscopic methods and thus continue LIHR. Conclusions PIRS is the preferred choice for pediatric LIHR. Surgical techniques vary and are influenced by patient gender and age. The survey gives insights into demographics, case selection, and approaches among pediatric surgeons with regard to LIHR. [ABSTRACT FROM AUTHOR]

Summary: Introduction: Implantable catheter chambers are widely used devices during the treatment of cancer whether for taking blood samples or for chemotherapy infusion. The placement of this type of chamber has significantly improved the care of cancer patients. However, it can expose the patients to numerous complications which may be related to the device itself or the implantation technique. Aim: The aim of this single-center study was to determine the epidemiological profile of patients who had undergone this procedure, identify the main indications for implantation, and most importantly to compare the techniques used for implantation. Methods: We conducted a retrospective descriptive study at the surgical intensive care unit of Ibn Rochd University Hospital in Casablanca from January 2009 to December 31, 2022, including 3197 patients who had an implantable catheter chamber placed. Data were collected prospectively. Results: The average age of the 3197 patients was 51 years; 63.60% of them had breast cancer. The most dominant age group was patients between 40 and 60 years. The main indication for the implantable chamber was chemotherapy for breast cancer at a rate of 63.60%, followed by gastrointestinal cancer at 15.09%. It is noted that 81.26% of the patients had a right-side approach and the most punctured vein was the right internal jugular vein (IJV) with a rate of 70.49%, followed by the left IJV at 28.37%. The percutaneous approach was the only method used. Percutaneous puncture of the right IJV was the preferred technique due to anatomical landmarks and accessibility of the vein. Ultrasound guidance during the puncture of the vein in question was used in 87% of patients. The average duration of the procedure was between 10 and 15 min. No per operative complications (arterial puncture, hematoma, pneumothorax) were observed. Prophylactic antibiotic therapy was administered to all patients. Conclusion: The placement of the chamber by ultrasound-guided percutaneous access to the IJV is a minimally invasive and safe technique that complies with the specifications of the 2008 Standards, Options and Recommendations (SOR) recommendations. Less invasive than surgical access and safer than "blind" puncture, it constitutes a reliable, simple procedure that minimizes subsequent risks to the greatest extent possible. [ABSTRACT FROM AUTHOR]

Copyright of Operative Orthopädie und Traumatologie is the property of Springer Nature and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Copyright of Operative Orthopädie und Traumatologie is the property of Springer Nature and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Background: This study aims to evaluate the current rates and outcomes of minimally invasive versus open surgery for colonic diverticular disease in Germany, using a nationwide dataset. Methods: We analyzed data from 36 hospitals, encompassing approximately 1.25 million hospitalizations from 1 January 2019 to 31 December 2023. Patients aged 18 years and older with colonic diverticular disease (International Classification of Diseases, Tenth Revision (ICD-10): K57.2 and K57.3) who underwent surgical treatment were included. Surgeries were classified as open or minimally invasive (laparoscopic or robotic). Outcomes such as in-hospital mortality, complications, and length of stay were assessed using multivariable logistic and linear regression models. Results: Out of 1670 patients who underwent surgery for colonic diverticular disease, 63.2% had perforation and abscess. The rate of minimally invasive surgery increased from 34.6% in 2019 to 52.9% in 2023 for complicated cases and from 67.8% to 86.2% for uncomplicated cases. Open surgery was associated with higher in-hospital mortality (odds ratio (OR): 7.41; 95% CI: 2.86–19.21) and complications compared with minimally invasive surgery. The length of hospital stay was significantly longer for open surgery patients, with an increase of 4.6 days for those with perforation and abscess and 5.0 days for those without. Conclusions: Minimally invasive surgery for colonic diverticular disease is increasingly preferred in Germany, especially for uncomplicated cases. However, open surgery remains common for complicated cases, but is associated with higher mortality, more complications, and longer hospital stays. [ABSTRACT FROM AUTHOR]

Purpose: This study aimed to report the safety and feasibility of single-incision robotic totally extra-peritoneal repair (TEP) with the da Vinci Xi platform. Methods: We prospectively included patients with unilateral inguinal hernia who underwent elective single-incision robotic TEP between August 10, 2021 and December 12, 2022. The primary outcome was the determination of postoperative complications, and secondary outcomes were quality of life and recurrence rate. Results: Twenty patients were included in this study. The median age of patients was 60 (interquartile range [IQR], 44.8–62) years, and most were male (90%). Eighteen patients had an indirect hernia. The median total operative time was 70 (IQR, 60.5–82.0) min, the median docking time was 5 (IQR, 3.3–6.0) min, and the median console time was 42 (IQR, 30.3–49.8) min. No postoperative complications occurred within six months postoperatively. We observed an upward trend in quality of life, which was low preoperatively, with improvement noted one month postoperatively. During the six-month follow-up period, there were no cases of recurrence. Conclusion: For uncomplicated inguinal hernias, single-incision robotic TEP using the da Vinci Xi platform can be selectively and safely attempted. [ABSTRACT FROM AUTHOR]

Objective: Reoperations are part of neurosurgical practice. In these cases, an already formed craniotomy seems the most logical and appropriate. However, reoperations via large approaches can be quite traumatic for the patient. Then minimally invasive approaches, being less traumatic, can be a good alternative. Methods: We describe seven consecutive patients who underwent reoperations using minimally invasive approaches in the areas of conventional craniotomies. Surgical Theater® visualization platform was used for preoperative planning. The study evaluated the size of surgical approach, surgical efficacy, and the presence of complications. Results: The size of a minimally invasive craniotomy was significantly smaller than that of a conventional approach. The preoperative goals were achieved in all described cases. There were no complications in the early postoperative period. Although the anatomy of the operated brain region in reoperations is altered, keyhole approaches can be successfully used with the support of preoperative planning and intraoperative neuronavigation. Given that the goals of reoperations may differ from those of the primary surgery, and a large approach is more traumatic for the patient, minimally invasive craniotomy can be considered as a good alternative. The successful use of minimally invasive approaches in areas of conventional craniotomies reinforces the philosophy of keyhole neurosurgery. In cases where goals can be achieved using small approaches, it makes no sense to use large conventional ones. Conclusion: Minimally invasive approaches can be successfully used during reoperations in patients after conventional craniotomies. [ABSTRACT FROM AUTHOR]

We describe the updated Korean Society of Gynecologic Oncology (KSGO) practice guideline for the management of cervical cancer, version 5.1. The KSGO announced the fifth version of its clinical practice guidelines for the management of cervical cancer in March 2024. The selection of the key questions and the systematic reviews were based on data available up to December 2022. Between 2023 and 2024, substantial findings from large-scale clinical trials and new advancements in cervical cancer research remarkably emerged. Therefore, based on the existing version 5.0, we updated the guidelines with newly accumulated clinical data and added 4 new key questions reflecting the latest insights in the field of cervical cancer. For each question, recommendation was formulated with corresponding level of evidence and grade of recommendation, all established through expert consensus. [ABSTRACT FROM AUTHOR]

Studies have consistently shown an association of the Le Fort I osteotomy with undesirable adverse events in the nasolabial region, including lengthening and thinning of the upper lip, a reduction in upper vermilion exposure, and nasal base enlargement. Various minimally invasive techniques have been developed based on knowledge collected over recent decades on the aetiopathogenesis of these aesthetic impairments. The common scope of these techniques is to reduce the damage to the facial soft tissues and achieve a sound and spontaneous healing process, avoiding those procedures that are commonly used to counteract undesirable aesthetic changes. This paper provides a summary of the aetiopathogenesis of these adverse events, as well as an overview of current concepts in minimally invasive surgically assisted rapid maxillary expansion (miSARME). [ABSTRACT FROM AUTHOR]

OBJECTIVE: The aim of this study was to compare the outcomes and complications of selected patients treated with endovenous laser ablation (EVLA) or ambulatory phlebectomy for foot varicose veins. METHODS: From October 2016 to February 2022, selected patients undergoing EVLA (using 1470-nm with radial-slim or bare-tip fibers) or phlebectomy of foot varicose veins for cosmetic indications were analyzed, and the outcomes were compared. Patients were classified according to the Clinical, Etiologic, Anatomical, and Pathophysiological (CEAP) classification. Anatomic criteria provided the basis for the decision to perform EVLA or phlebectomy. Clinical and ultrasound assessments were performed on postoperative days 7, 30, and 90 for visualization of the sapheno-femoral and sapheno-popliteal junctions and the deep venous system. Disease severity was graded with the Venous Clinical Severity Score (VCSS), and quality of life was measured with the Aberdeen Varicose Vein Questionnaire (AVVQ) before and after treatment. Treatment outcomes were evaluated based on changes in VCSS and AVVQ scores. The groups were also compared for procedure-related complications. Data were statistically analyzed in SPSS v. 20.0 using the χ2, Student t test, Mann-Whitney test, Wilcoxon test, and analysis of variance. The results were presented as mean (standard deviation or median (interquartile range). RESULTS: The study included 270 feet of 171 patients. Mean patient age was 52.3 (standard deviation, 13.1) years, ranging from 21 to 84 years; 133 (77.8%) were women. Of 270 feet, 113 (41.9%) were treated with EVLA and 157 (58.1%) with phlebectomy. The median preoperative CEAP class was 2 (interquartile range, 2-3) in the phlebectomy and EVLA groups, with no statistically significant difference between the groups (P = .507). Dysesthesia was the most common complication in both groups. Only transient induration was significantly different between EVLA (7.1%) and phlebectomy (0.0%) (P = .001). The two approaches had an equal impact on quality of life and disease severity. CONCLUSIONS: Treatment complications were similar in phlebectomy and EVLA and to those previously described in the literature.

INTRODUCTION: Literature regarding the impact of esophagectomy approach on hospitalizations costs and short-term outcomes is limited. Moreover, few have examined how institutional MIS experience affects costs. We thus examined utilization trends, costs, and short-term outcomes of open and minimally invasive (MIS) esophagectomy as well as assessing the relationship between institutional MIS volume and hospitalization costs. METHODS: All adults undergoing elective esophagectomy were identified from the 2016-2020 Nationwide Readmissions Database. Multiple regression models were used to assess approach with costs, in-hospital mortality, and major complications. Additionally, annual hospital MIS esophagectomy volume was modeled as a restricted cubic spline against costs. Institutions performing > 16 cases/year corresponding with the inflection point were categorized as high-volume hospitals (HVH). We subsequently examined the association of HVH status with costs, in-hospital mortality, and major complications in patients undergoing minimally invasive esophagectomy. RESULTS: Of an estimated 29,116 patients meeting inclusion, 10,876 (37.4%) underwent MIS esophagectomy. MIS approaches were associated with $10,600 in increased incremental costs (95% CI 8,800-12,500), but lower odds of in-hospital mortality (AOR 0.76; 95% CI 0.61-0.96) or major complications (AOR 0.68; 95% CI 0.60, 0.77). Moreover, HVH status was associated with decreased adjusted costs, as well as lower odds of postoperative complications for patients undergoing MIS operations. CONCLUSION: In this nationwide study, MIS esophagectomy was associated with increased hospitalization costs, but improved short-term outcomes. In MIS operations, cost differences were mitigated by volume, as HVH status was linked with decreased costs in the setting of decreased odds of complications. Centralization of care to HVH centers should be considered as MIS approaches are increasingly utilized.

Retrorectal tumors, although rare, pose diagnostic and treatment challenges due to their nonspecific symptoms and complex anatomical location. This single-center case series reports short-term outcomes of laparoscopic transabdominal resection as a surgical approach for large retrorectal tumors. Between 2017 and 2020, five patients underwent this procedure. The median patient age was 53.2 years (range, 34-60 years), and the median operating time was 130 minutes (range, 95-205 minutes). All tumors were located in the retrorectal space. The median tumor size was 5.8 × 4.3 cm (range, 3.5-7.5 cm). Biopsy results included epidermoid cysts, tailgut cyst, lipoma, and keratinous cyst. The median hospital stay was 7.8 days (range, 5-11 days), and the median follow-up duration was 78.0 days (range, 14-219 days). One patient developed a postoperative surgical site infection. Overall, laparoscopic transabdominal resection appears to be a minimally invasive and effective treatment option for retrorectal tumors.

Central pancreatectomy (CP) is a viable option for low malignant tumors located in the neck or proximal body of the pancreas. This procedure has the advantage of minimizing impairment to pancreatic function. However, it is technically challenging and carries a relatively high risk of postoperative pancreatic fistula. Recently, minimally invasive CP surgery has gained popularity, with evidence supporting its safety and efficacy. Nevertheless, conventional laparoscopic CP presents technical difficulties, while robot-assisted CP is associated with higher costs. ArtiSential (LivsMed Inc.) is a device that has been successfully utilized in various surgical procedures, offering the ergonomic advantages of robotic surgery within a laparoscopic setting. In this article, we share our successful experience of performing laparoscopic CP using ArtiSential in a patient with intraductal papillary mucinous neoplasm.

Low-velocity orbital penetrating injuries may result in an intracranial retained foreign body that requires surgical removal. We describe the endoscopic transorbital removal of a retained umbrella tip in the frontal lobe, which was secondary to trauma to the orbital roof. This technique facilitated the complete removal of the foreign body without causing additional damage to the surrounding tissue. The patient had a successful postoperative recovery. We also discuss the utility of the transorbital neuroendoscopic procedure in managing these traumatic injuries.

Abstract Purpose The aim of this study was to determine whether ultrasound guidance can reduce the duration, blood loss volume and invasiveness of surgery for internal fixator removal. Methods The clinical data from 35 adults patients who underwent ultrasound-guided surgical removal of internal fixators after complete healing of limb fractures between June 2019 and April 2023 were retrospectively analysed and compared with those from 34 controls who underwent the procedure without ultrasound guidance. Data concerning the patients’ demographic and clinical characteristics and surgical sites were collected. Differences in the patients’ demographic and clinical characteristics were compared between the two groups. Results Sixty-nine patients were enrolled in the study. Thirty-five patients underwent surgical removal of internal fixators with ultrasound guidance, and the average intraoperative blood loss volume was 15.17 ± 18.54 ml, average difference between the incision length and scar length was 4.24 ± 1.38 cm, average operation time was 60.66 ± 24.30 min, and average ultrasound assessment time was 10.00 ± 3.90 min. Thirty-four patients underwent surgical removal of internal fixators without ultrasound guidance, and the average blood loss volume was 46.76 ± 90.74 ml, average difference between the incision length and scar length was 2.68 ± 1.04 cm, and average operation time was 80.15 ± 58.84 min. The difference between the incision length and scar length was significant (P

Abstract Background Laparoscopic cholecystectomy with ultrasonic dissection presents a compelling alternative to conventional electrocautery. The evidence for elective cholecystectomy supports the adoption of ultrasonic dissection, citing advantages such as reduced operating time, diminished bleeding, shorter hospital stays and decreased postoperative pain and nausea. However, the efficacy of this procedure in emergency surgery and patients diagnosed with acute cholecystitis remains uncertain. The aim of this study was to compare outcomes of electrocautery and ultrasonic dissection in patients with acute cholecystitis. Methods A randomized, parallel, double-blinded, multicentre controlled trial was conducted across eight Swedish hospitals. Eligible participants were individuals aged ≥ 18 years with acute cholecystitis lasting ≤ 7 days. Laparoscopic cholecystectomy was performed in the emergency setting as soon as local circumstances permitted. Random allocation to electrocautery or ultrasonic dissection was performed in a 1:1 ratio. The primary endpoint was the total complication rate, analysed using an intention-to-treat approach. The primary outcome was analysed using logistic generalized estimated equations. Patients, postoperative caregivers, and follow-up personnel were blinded to group assignment. Results From September 2019 to March 2023, 300 patients were enrolled and randomly assigned to electrocautery dissection (n = 148) and ultrasonic dissection (n = 152). No significant difference in complication rate was observed between the groups (risk difference [RD] 1.6%, 95% confidence interval [CI], − 7.2% to 10.4%, P = 0.720). No significant disparities in operating time, conversion rate, hospital stay or readmission rates between the groups were noted. Haemostatic agents were more frequently used in electrocautery dissection (RD 10.6%, 95% CI, 1.3% to 19.8%, P = 0.025). Conclusions Ultrasonic dissection and electrocautery dissection demonstrate comparable risks for complications in emergency surgery for patients with acute cholecystitis. Ultrasonic dissection is a viable alternative to electrocautery dissection or can be used as a complementary method in laparoscopic cholecystectomy for acute cholecystitis. Trial registration The trial was registered prior to conducting the research on http://clinical.trials.gov , NCT03014817.

Study Design A fused deposition modeling three-dimensional (3D)-printed model of the L4–5 vertebra for lumbar discectomy was designed. The model included separately printed dura mater, spinal cord, ligamentum flavum, intervertebral disc (from thermoplastic polyurethane), and bony structures (from polylactic acid), and the material cost approximately US$ 1 per model. A simple plumbing endoscope was used for visualization. Dura mater injury was assessed by painting two layers on the dura mater, which peeled off with trauma. Purpose Endoscopic spine surgery is a subject of high interest in neurosurgery given its minimally invasive nature; however, it has a steep learning curve. This study evaluated the effectiveness of a cost-efficient 3D-printed model when teaching this technique to neurosurgery residents. Overview of Literature Only a few studies have investigated the efficacy of such a model. Methods Eight residents with >2 years of training participated. Residents performed the procedure bilaterally and twice at 1-week intervals. Results From the 32 surgeries, four were excluded because of facet removal (as it widened the surgical corridor), leaving 28 surgeries for analysis. Initial surgeries demonstrated a mean operation time of 21 minutes 18 seconds (standard deviation [SD], 2 minutes 32 seconds), which improved to a mean of 6 minutes 45 seconds (SD, 37 seconds) in the fourth surgery (F(3, 17)=19.18, p

This retrospective case series evaluated the effectiveness of minimally invasive spine surgery-transforaminal lumbar interbody fusion (MIS-TLIF) using the “trial-in-situ” technique for reducing high-grade spondylolisthesis. The surgical management of grade ≥III spondylolisthesis has been controversial, with various methods documented in the literature, including in-situ fusion, in-situ trans-sacral delta fixation, distraction techniques, and external reduction techniques. Recently, MIS techniques have gained popularity. This study analyzed 18 cases of high-grade spondylolisthesis treated with MIS-TLIF using the “trial-in-situ” technique. The clinical outcomes were assessed using the Visual Analog Scale (VAS) and the modified Oswestry Disability Index (mODI) scores. The spinopelvic parameters and sagittal balance were also analyzed. Preoperatively, the spinopelvic parameters were deranged, with a mean pelvic tilt of 28.31°, which improved to 13.91° postoperatively. Similarly, the sacral slope improved from 45.65° to 38.01°. VAS and mODI scores improved postoperatively, indicating the effectiveness of the “trial-in-situ” technique in reducing high-grade spondylolisthesis and achieving a better sagittal profile and spinopelvic parameters. The findings indicate that MIS-TLIF using the “trial-in-situ” technique is a viable and effective method for treating high-grade spondylolisthesis.

Abstract Background Lengthening of the extensor hallucis longus (EHL) is performed to address various forefoot pathologies. The retraction of this tendon is strongly associated with the Hallux Abductus Valgus (HAV) deformity. Minimally Invasive Surgery (MIS) lengthening of the EHL is carried out in combination with other surgical techniques for HAV bone realignment. It is performed without ischemia, using local anesthesia and sedation if required by the patient. One of the advantages of this technique is immediate ambulation with a postoperative shoe without the need for a cast. The objective of the research was to demonstrate the efficacy and safety of the minimally invasive technique for lengthening the tendon in patients with HAV. Materials and methods The procedures were performed on 11 fresh cryopreserved cadaveric feet. HAV surgery was performed through dorsomedial and dorsolateral portals for Reverdin-Isham, Akin and adductor tenotomy. In addition, EHL tendon elongation was performed using the Beaver 67 MIS scalpel through an incomplete zigzag tenotomy. The specimens used did not present any type of disease nor had they undergone previous surgeries that could affect the technique. First, the plantar flexion of the metatarsophalangeal joint was measured with a goniometer to establish the degrees of this joint before proceeding with the technique, the tenotomy was performed and remeasured and finally the osteotomy was performed. In addition, an anatomical dissection of cadaveric specimens was performed and various anatomical and surgical relationships were analyzed and measured. Results The data indicate that, after performing zigzag tenotomy, there is an average improvement of 13.91 degrees in plantar flexion. Conclusions The study confirms the effectiveness and safety of elongating the extensor hallucis longus tendon of the hallux using minimally invasive surgery. The zigzag technique for tendon elongation may be considered a viable minimally invasive treatment option for addressing tendon hyperextension in patients with HAV.

Objective Rapid and effective reduction is difficult for minimally invasive plate osteosynthesis (MIPO) surgery. This study aims to introduce a bidirectional rapid reductor (BRR) designed to assist in the reduction during MIPO surgery for proximal humeral fractures (PHFs). Methods This retrospective study was conducted between June 2021 and February 2022 in the Third Hospital of Hebei Medical University, involving patients diagnosed with PHFs. A detailed technical approach of BRR in MIPO surgery was described, and the patients' outcomes based on postoperative radiographic results including x‐ray postoperative follow‐up, and clinical outcome parameters including visual analogue scale (VAS) and constant‐Murley score at last follow‐up were reported. Results A total of 12 patients were included in this study, comprising three males and nine females, with an average age of 67.58 years. The mean operative time was 70.92 min (range 63–80 min). The mean blood loss was 102.27 mL (range 50–300 mL). The mean VAS and constant‐Murley scores at final follow‐up were 0.33 and 88, respectively. All patients had their fractures healed without secondary displacement at last follow‐up. One patient experienced shoulder stiffness post‐operation. There were no adverse events or complications following the use of this technique, such as acromion fracture, nerve or blood vessel injury. Conclusion The BRR can assist MIPO for good reduction of PHFs. However, the efficacy should be validated with a large‐sample randomized controlled trial and longer follow‐up.

ABSTRACT Purpose: We reported, as a referral center in prostate cancer, our perspectives and experience performing Telesurgery using robotic surgery and 5G network. Material and methods: We described and illustrated the Telesurgery applications and outcomes to treat a patient with prostate cancer located 1300 kilometers away from the surgeon (Beijing-Harbin) in China. We used the Edge Medical Robot (MP1000) in November 2023 in a 71-year-old patient with Gleason 6 (ISUP 1) in 8 cores from 13, PSA of 14 ng/dL, and clinical stage cT2a. MRI described a PIRADS 5 nodule on the left peripheral zone at the base, and 20gr prostate. We described details about the connection between centers, perioperative outcomes, and our perspectives as a referral center in prostate cancer. Results: We had no delays, or problems with network connection between the centers. The procedure was performed in 60 minutes, with no intra- or postoperative complications. Estimated blood loss was 100 mL. The patient was ambulating soon after anesthesia recovery. Final pathology described a Gleason 6 (ISUP 1) involving the left base and left seminal vesicle, negative surgical margins, and no lymph node involvement (pT3bN0). The patient was continent soon after catheter removal (7 days). Conclusion: As technological progress introduced novel robotic platforms and high-speed networks, the concept of Telesurgery became a tangible reality while 5G technology solved latency and transmission concerns. However, with these advancements, ethical considerations and regulatory frameworks should underline the importance of transparency and patient safety with responsible innovation in the field.

Purpose Total neoadjuvant therapy (TNT) is becoming the standard of care for locally advanced rectal cancer. However, surgery is deferred for months after completion, which may lead to fibrosis and increased surgical difficulty. The aim of this study was to assess whether TNT (TNT-RAPIDO) is associated with increased difficulty of total mesorectal excision (TME) compared with long-course chemoradiotherapy (LCRT) and upfront surgery. Methods Twelve laparoscopic videos of low anterior resection with TME for rectal cancer were prospectively collected from January 2020 to October 2021, with 4 videos in each arm. Seven colorectal surgeons assessed the videos independently, graded the difficulty of TME using a visual analog scale and attempted to identify which category the videos belonged to. Results The median age was 67 years, and 10 patients were male. The median interval to surgery from radiotherapy was 13 weeks in the LCRT group and 24 weeks in the TNT-RAPIDO group. There was no significant difference in the visual analog scale for difficulty in TME between the 3 groups (LCRT, 3.2; TNT-RAPIDO, 4.6; upfront, 4.1; P=0.12). A subgroup analysis showed similar difficulty between groups (LCRT 3.2 vs. TNT-RAPIDO 4.6, P=0.05; TNT-RAPIDO 4.6 vs. upfront 4.1, P=0.54). During video assessments, surgeons correctly identified the prior treatment modality in 42% of the cases. TNT-RAPIDO videos had the highest recognition rate (71%), significantly outperforming both LCRT (29%) and upfront surgery (25%, P=0.01). Conclusion TNT does not appear to increase the surgical difficulty of TME.

Purpose: The aim of this study was to determine whether ultrasound guidance can reduce the duration, blood loss volume and invasiveness of surgery for internal fixator removal. Methods: The clinical data from 35 adults patients who underwent ultrasound-guided surgical removal of internal fixators after complete healing of limb fractures between June 2019 and April 2023 were retrospectively analysed and compared with those from 34 controls who underwent the procedure without ultrasound guidance. Data concerning the patients' demographic and clinical characteristics and surgical sites were collected. Differences in the patients' demographic and clinical characteristics were compared between the two groups. Results: Sixty-nine patients were enrolled in the study. Thirty-five patients underwent surgical removal of internal fixators with ultrasound guidance, and the average intraoperative blood loss volume was 15.17 ± 18.54 ml, average difference between the incision length and scar length was 4.24 ± 1.38 cm, average operation time was 60.66 ± 24.30 min, and average ultrasound assessment time was 10.00 ± 3.90 min. Thirty-four patients underwent surgical removal of internal fixators without ultrasound guidance, and the average blood loss volume was 46.76 ± 90.74 ml, average difference between the incision length and scar length was 2.68 ± 1.04 cm, and average operation time was 80.15 ± 58.84 min. The difference between the incision length and scar length was significant (P < 0.01), as was the difference in the intraoperative blood loss volume (P < 0.05) between the two groups. Conclusion: Ultrasound is a convenient, noninvasive, radiation-free technique that allows dynamic scanning of multiple sections regardless of patient position. Ultrasound-assisted removal of internal fixators might reduce bleeding and therefore the invasiveness of the procedure. Physicians can use ultrasound for preoperative patient positioning, intraoperative monitoring, and postoperative confirmation of complete removal of internal fixators if necessary. [ABSTRACT FROM AUTHOR]

Objectives Patients and Methods Results Conclusions To investigate the differences in perioperative characteristics and postoperative outcomes between inpatient and ambulatory percutaneous nephrolithotomy (PCNL) with a subgroup analysis of same‐day discharge (SDD) patients, summarise published ambulatory pathways and compare cost and satisfaction data.This study was completed according to the Preferred Reporting Items for Systematic Reviews and Meta‐Analyses guidelines and registered a priori with the International Prospective Register of Systematic Reviews (PROSPERO: CRD42023438692). Ambulatory PCNL was defined as patients who were discharged after an overnight stay (≤23 h) and SDD was considered a subgroup discharged on postoperative Day 0.A total of 25 studies were included in the systematic review, of which 12 comparative studies were utilised for meta‐analysis. We had a pooled population of 2463 patients, of which 1956 (79%) ambulatory (747 [30%] SDD) and 507 (21%) inpatients. The ambulatory PCNL cohort had fewer overall complications (risk ratio [RR] 0.65, 95% confidence interval [CI] 0.47–0.90; P = 0.010); however, there were no differences in major complications (i.e., Clavien–Dindo Grade ≥III; RR 0.46; 95% CI 0.17–1.21; P = 0.12), emergency department visits (RR 1.09, 95% CI 0.69–1.74; P = 0.71), 30‐day readmission (RR 1.09, 95% CI 0.54–2.21; P = 0.81) or readmission at any point (RR 1.00, 95% CI 0.53–1.88; P = 0.99). The ambulatory PCNL cohort was more likely to be stone‐free defined by imaging (RR 1.35, 95% CI 1.09–1.66; P = 0.005); however, when stone‐free was inclusive of any definition there was no difference in stone‐free rates (RR 1.10, 95% CI 0.98–1.23; P = 0.10). Subgroup analysis of SDD did not result in any significant differences. Cost savings ranged from $932.37 to a mean (standard deviation) $5327 (442) United States Dollars per case. No studies reported patient satisfaction data.Ambulatory PCNL seems to be a safe and efficacious model for select patients. Selection bias likely influenced ambulatory outcomes; however, this supports overall safety of current ambulatory inclusion criteria. [ABSTRACT FROM AUTHOR]

Introduction: Non-surgical rhinoplasty has evolved with the introduction of volumizing threads, which offer a less invasive alternative to traditional methods by enhancing nasal contours while minimizing filler use. This technique is gaining popularity, particularly in Southeast Asia, due to its shorter recovery time, reduced risk profile, and ability to prevent the 'Avatar nose' effect. However, there is limited anatomical guidance available for its application, especially in the Asian population. Materials and Methods: This study analyzes the anatomical layers of the nose to guide the proper placement of volumizing threads. Three cases are presented, highlighting different approaches to nasal bridge enhancement, nasal tip augmentation, and combined use of threads and fillers. The placement of threads in the deep fat layer beneath the fibromuscular layer was emphasized to avoid vascular complications. Results: The cases demonstrated with mesh thread (Tess Inc., Korea) successful outcomes with well-defined nasal contours and patient satisfaction. The techniques used allowed for precise enhancements while minimizing risks associated with superficial thread placement and vascular injury. Conclusion: Volumizing threads provide an effective and safe method for non-surgical rhinoplasty, particularly when informed by a thorough understanding of nasal anatomy. The results support the growing use of this technique in esthetic practice, especially in regions like Southeast Asia. [ABSTRACT FROM AUTHOR]

This video presents a case of L4–5 unstable spondylolisthesis treated with full-endoscopic transforaminal lumbar interbody fusion (Endo-TLIF), emphasizing the GUARD (Glider Used as a Rotary Device) technique for nerve root protection. This innovative approach involves controlled rotation of the cage glider before cage insertion to minimize the risk of nerve root injury, a significant complication in Endo-TLIF procedures. The GUARD technique, validated in previous cadaveric studies, provides enhanced safety during cage insertion by protecting the nerve root. A 48-year-old woman with a 3-year history of progressive low back pain and bilateral lower extremity radiculopathy (right-sided predominance) was diagnosed with L4–5 unstable spondylolisthesis and spinal stenosis. After failure of conservative management, she underwent uniportal full-endoscopic facet-resecting transforaminal lumbar interbody fusion using the GUARD technique. Postoperatively, the patient experienced significant symptomatic improvement and resolution of radiculopathy, without any intraoperative nerve root injury or postoperative neurological deficits. This case demonstrates the effectiveness of the GUARD technique in reducing neurological complications and improving patient outcomes. [ABSTRACT FROM AUTHOR]

Our research examines the learning curves of various minimally invasive lumbar surgeries to determine the benefits and challenges they pose to both surgeons and patients. The advent of microsurgical techniques since the 1960s, including advances in fluoroscopic navigation and intraoperative computed tomography, has significantly shifted spinal surgery from open to minimally invasive methods. This study critically evaluates surgical duration, intraoperative conversions to open surgery, and complications as primary parameters to gauge these learning curves. Through a comprehensive literature search up to March 2024, involving databases PubMed, Cochrane Library, and Web of Science, this paper identifies a steep learning curve associated with these surgeries. Despite their proven advantages in reducing recovery time and surgical trauma, these procedures require surgeons to master advanced technology and equipment, which can directly impact patient outcomes. The study underscores the need for well-defined learning curves to facilitate efficient training and enhance surgical proficiency, especially for novice surgeons. Moreover, it addresses the implications of technology on surgical accuracy and the subsequent effects on complication rates, providing insights into the complex dynamics of adopting new surgical innovations in spinal health care. [ABSTRACT FROM AUTHOR]

This article describes a novel minimally invasive technique for bilateral sagittal split osteotomy (BSSO) that aims to reduce surgical trauma while maintaining bone overlap and rigid internal fixation for proper consolidation of the bone segments. The technique involves a small vestibular mucoperiosteal incision made on the lateral aspect of the mandible between the first and second molars, enabling a standard ramus split, surgical segment movement, and miniplate fixation. A retrospective evaluation of 67 consecutive patients who underwent BSSO using this protocol showed favorable split of the mandible with no unfavorable splits or non-union. Patients were discharged from hospital within an average of 17 h with minimal postoperative complications. This technique provides good surgical visualization with a very small incision and allows standard BSSO surgery without difficulty. [ABSTRACT FROM AUTHOR]

Background: The aim of this study was to investigate differences in functional recovery eight years after total hip arthroplasty in patients who underwent hip joint surgery using two different approaches: the classic lateral approach and the anterolateral minimally invasive surgical approach. Methods: Eight years after the hip replacement, 68 subjects, 32 in the classic and 36 in the minimally invasive group, underwent follow-up measurements involving the Harris Hip Score (HHS), range of motion, strength of the abductor muscles, 50-m walk time, body mass index (BMI), physical activity questionnaire, and visual analogue scale (VAS) pain during general activities. Results: Higher HHS (p < 0.001), hip abduction (p < 0.001), and hip flexion (p = 0.018) range of motion values were obtained in the minimally invasive approach group. A correlation between physical activity (PA) and the hip abduction muscle strength in the classic group (r = 0.43; p = 0.011) and a correlation between PA and the HHS in the minimally invasive group (r = 0.34, p = 0.041) was found. BMI was correlated with the 50-m walk time in both groups (classical: r = 0.39; p = 0.027; minimally invasive r = 0.35; p = 0.030); meanwhile, in the minimally invasive group, BMI was negatively correlated with hip flexion (r = −0.37; p = 0.020). Conclusions: Eight years after total hip arthroplasty, performed using either an anterolateral minimally invasive or lateral approach, there was no difference in the patients' functional outcome in relation to BMI. The minimally invasive approach benefits patients by granting them better functional abilities. A clinical difference was found in the HHS, in favour of the minimally invasive group. [ABSTRACT FROM AUTHOR]

Copyright of Colo-Proctology is the property of Springer Nature and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Purpose Minimally invasive surgery (MIS) with integrated enhanced recovery pathways (ERPs) helps reduce length of stay and improve surgical outcomes. As these procedures have become more prevalent over time, pharmacists are in key positions to manage medications in the perioperative space to help optimize transitions of care and reduce safety events. Here we identify several clinical areas across phases of care for these procedures in which the knowledge and guidance of pharmacists, as members of the interprofessional team, are paramount. Summary Perioperative pharmacy expertise is often required for MIS procedures in the areas of acid suppression, antithrombotic management, blood glucose control, drug formulation, immunosuppressant optimization, pain mitigation, and postoperative nausea and vomiting prevention and treatment. For each MIS procedure, pharmacists should identify and consider diet and anatomical changes as well as patient- and surgery-specific risk factors. Pharmacists can then utilize their knowledge of the pharmacokinetics and pharmacodynamics of individual medications along with evidence-based medicine to recommend selection of appropriate agents. Conclusion Pharmacist contributions to perioperative medication management for MIS procedures can improve care as surgical patients navigate transitions through the perioperative setting. Pharmacists can further incorporate medication expertise through development and implementation of institutional MIS protocols within the context of ERPs. As such, any pharmacist should feel empowered to aid in the care of surgical patients. [ABSTRACT FROM AUTHOR]

Background: Laparoscopic cholecystectomy with ultrasonic dissection presents a compelling alternative to conventional electrocautery. The evidence for elective cholecystectomy supports the adoption of ultrasonic dissection, citing advantages such as reduced operating time, diminished bleeding, shorter hospital stays and decreased postoperative pain and nausea. However, the efficacy of this procedure in emergency surgery and patients diagnosed with acute cholecystitis remains uncertain. The aim of this study was to compare outcomes of electrocautery and ultrasonic dissection in patients with acute cholecystitis. Methods: A randomized, parallel, double-blinded, multicentre controlled trial was conducted across eight Swedish hospitals. Eligible participants were individuals aged ≥ 18 years with acute cholecystitis lasting ≤ 7 days. Laparoscopic cholecystectomy was performed in the emergency setting as soon as local circumstances permitted. Random allocation to electrocautery or ultrasonic dissection was performed in a 1:1 ratio. The primary endpoint was the total complication rate, analysed using an intention-to-treat approach. The primary outcome was analysed using logistic generalized estimated equations. Patients, postoperative caregivers, and follow-up personnel were blinded to group assignment. Results: From September 2019 to March 2023, 300 patients were enrolled and randomly assigned to electrocautery dissection (n = 148) and ultrasonic dissection (n = 152). No significant difference in complication rate was observed between the groups (risk difference [RD] 1.6%, 95% confidence interval [CI], − 7.2% to 10.4%, P = 0.720). No significant disparities in operating time, conversion rate, hospital stay or readmission rates between the groups were noted. Haemostatic agents were more frequently used in electrocautery dissection (RD 10.6%, 95% CI, 1.3% to 19.8%, P = 0.025). Conclusions: Ultrasonic dissection and electrocautery dissection demonstrate comparable risks for complications in emergency surgery for patients with acute cholecystitis. Ultrasonic dissection is a viable alternative to electrocautery dissection or can be used as a complementary method in laparoscopic cholecystectomy for acute cholecystitis. Trial registration: The trial was registered prior to conducting the research on http://clinical.trials.gov, NCT03014817. [ABSTRACT FROM AUTHOR]

Transorbital Neuro Endoscopic Surgery (TONES) stands at the forefront of neurosurgical innovation, providing a transformative approach for accessing intricate intracranial vascular lesions within the orbit. The versatility of TONES extends beyond orbital confines, reaching into challenging territories such as the anterior cranial fossa, making it a promising option for lesions extending into the orbital region. This review explores the historical evolution, technical intricacies, and clinical applications of TONES, emphasizing its role in managing vascular lesions. The genesis of TONES aimed to overcome limitations inherent to traditional surgical approaches, offering equivalent visibility while minimizing invasiveness and complications associated with open skull base surgery. Introduced in 2007 by Moe, TONES has evolved into a minimally invasive access corridor, expanding the horizons of neurosurgery through refined instrumentation and advanced surgical techniques. In the context of intracranial vascular lesions, particularly arteriovenous malformations and cerebral cavernomas, TONES exhibits advantages over conventional methods. Its minimally invasive nature, reduced morbidity, and superior cosmetic outcomes position it as a viable alternative. However, meticulous planning, coordination, and adherence to sterile protocols are imperative. Preoperative imaging, intraoperative navigation, and customized bone defects tailored to lesion specifics contribute to procedural success. Complications associated with TONES procedures demand systematic categorization for proactive risk mitigation. From eyelid necrosis to trigeminal hypoesthesia, anticipating and addressing potential pitfalls require a multifaceted approach. Meticulous dissection techniques, intraoperative monitoring, and postoperative assessments are crucial components of risk reduction. In conclusion, TONES represents a paradigm shift in neurosurgical approaches to intracranial vascular lesions, showcasing its adaptability and precision. [ABSTRACT FROM AUTHOR]

Introduction: Restorative proctocolectomy (RPC) and total colectomy with ileorectal anastomosis (TC-IRA) are traditional surgical options for individuals with familial adenomatous polyposis (FAP). Re-appraisal and modification to these techniques, such as near-total colectomy with ileo-distal sigmoid anastomosis (NT-IDSA) and RPC with robotic intracorporeal single-stapled anastomosis (RPC-RiSSA), have been implemented in recent years. This study aimed to evaluate the early postoperative outcomes associated with novel techniques employed in a single centre for restorative surgery in patients with FAP. Methods: A retrospective analysis was conducted using data from patients with FAP who underwent prophylactic restorative surgery between January 2008 and December 2022 at St Mark's Hospital. Results: Two hundred fifty-three individuals underwent restorative surgery over the 15-year period; 102/253 (40.3%) underwent TC-IRA, 84 (33.2%) had NT-IDSA, and 67 (26.5%) underwent RPC. Laparoscopic approach was the most common (88.2%) operative access. Seventeen patients (6.7%) underwent robotic operations. For robotic-assisted procedures, no conversions were reported. No anastomotic leaks or 30-day reoperations were reported in the NT-IDSA group compared to 8% (0/84 vs 8/102, p = 0.009) and 11% (0/84 vs 11/102, p = 0.002), respectively, in the TC-IRA group. Regarding RPC, following the introduction of robotic RPC-RiSSA in 2019, no anastomotic leakage was observed compared with 9% (0/11 vs 5/56, p = 0.3) in those undergoing conventional RPC. Conclusion: Our institution has transitioned from TC-IRA to NT-IDSA since 2014 and conventional RPC to RPC-RiSSA in 2019. To date, since refinement of the techniques there have been no anastomotic failures amongst these cohorts. The reported results may offer future horizons for patients undergoing similar procedures for alternative colorectal diseases. [ABSTRACT FROM AUTHOR]

Introduction: A supraorbital keyhole craniotomy (SOKC) is a novel alternative to frontal craniotomies for accessing the anterior fossa for resecting tumors and clipping aneurysms; however, its implementation is limited in patients at a high risk of complications. We present two cases involving the use of augmented reality (AR) and virtual reality (VR) for patient selection and preoperative planning for a supraorbital tumor resection of anterior fossa meningiomas. Methods: This is a prospective, single-center case series at a research institute. We identified patients with an anterior or middle fossa meningioma regardless of age, gender, and tumor characteristics who could undergo an SOKC and MRI. The preoperative planning was performed with the BrainLab Magic Leap AR/VR platform. The meningiomas were resected through the SOKC under neuronavigation. Results: We identified two cases: a 37-year-old male with a meningioma in the sellar region and an 84-year-old male with a right anterior fossa meningioma, both confirmed by MRI. Both patients had a complete tumor resection by a minimally invasive SOKC after preoperative planning with the AR/VR platform. Postoperatively, hyponatremia complicated the first case, while the second case developed an intracranial hemorrhage. They both recovered after the appropriate interventions. Conclusions: The use of an SOKC for anterior skull base meningiomas should be individualized after considering the lesion characteristics, vascular control needs, and the surgeon's expertise. VR/AR-assisted preoperative evaluation and planning will optimize the patient selection and surgical outcomes. We can utilize VR/AR technologies to identify patients that will benefit from an SOKC and expand the implementation of the approach beyond its current limitations. [ABSTRACT FROM AUTHOR]

Purpose: Emerging evidence supports the use of minimally invasive partial nephrectomy (MIPN) in ambulatory settings. We conducted a systematic review and meta-analysis to evaluate differences in perioperative characteristics, complication/readmission rates and satisfaction/cost data between ambulatory and standard-length discharge (SLD) MIPN. Methods: This study was prospectively registered in PROSPERO (CRD42023429854). A systematic literature search of PubMed, Embase, and Web of Science databases was conducted, including studies comparing ambulatory MIPN vs SLD MIPN for patients with renal masses. Studies were assessed for quality using the Methodological Index for Non-Randomized Studies score. Meta-analysis was performed for comparative studies, and non-comparative studies were included narratively. Results: Eleven studies were included with a pooled population of 20,548 patients, of which 1,419 (7%) had a length of stay less than 1 day and were considered the ambulatory group. There were no significant differences in the total complication rates (RR: 0.50, 95% CI: 0.24, 1.04; p = 0.06) or 30-day readmission rates (RR: 0.87, 95% CI: 0.56, 1.35; p = 0.53) between the ambulatory and SLD groups. There were fewer >3 Clavien–Dindo complications in the ambulatory group (RR: 0.34, 95% CI: 0.19, 0.59; p = 0.0002). Few studies reported average health care cost and patient satisfaction. Conclusions: In appropriately selected patients, ambulatory MIPN is safe and feasible. Future studies are needed to quantify cost and patient satisfaction differences and further identify appropriate patient selection criteria for ambulatory MIPN. [ABSTRACT FROM AUTHOR]