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Introduction: Medical students often hesitate to enter the operating theatre because of poor visibility of the surgical field and anxiety about the theatre environment. In addition, ear, nose and throat (ENT) surgery is underrepresented in many medical curricula. Virtual systems like Proximie offer flexible viewing of surgeries with surgeon commentary, potentially addressing these issues. Methods: This descriptive survey study aimed to evaluate the use of Proximie as a surgical education tool for delivering ENT teaching to medical students. Live ENT procedures were recorded at the ENT Department of the John Radcliffe Hospital and shared with interested clinical medical students through Proximie accounts. Students were added to a private group chat to ask questions and provided feedback through structured forms, assessing procedural effectiveness and the platform's technology. Live-streaming and recording of procedures were facilitated by ENT surgeons providing commentary. Results: Conducted over four virtual theatre days, the study gathered 52 responses: 96% of students rated Proximie's educational value as 4 of 5 or higher; 57% preferred the virtual experience over physical attendance because of its convenience and the improved view of the surgical field. Students valued the live commentary and showed interest in using Proximie for a broader range of surgeries. Suggested improvements included fixing technical issues, better communication of theatre lists, and expanding surgical specialty coverage. Conclusions: Proximie has been highly rated by medical students for its effective and engaging approach in the instruction of surgical skills, underscoring its value as an educational tool. Future research is needed to formally assess knowledge acquisition and retention across multiple surgical subspecialties. This work is the first step towards evaluating the utility of virtual operating theatre platforms for medical student education. [ABSTRACT FROM AUTHOR]

Objectives: To develop the use of Thiel soft embalmed human cadavers (TeC) in open radical cystectomy (ORC) training for the first time, to investigate the effect of cadaveric training on surgical trainees' technical skills/performance and to determine how trainees perceive the use of cadaveric workshops. Methods: A 3‐day hands‐on workshop was organised. Ten trainees performed ORC on five TeC, supervised by five experts. Feedback from trainees and mentors was evaluated on a five‐point Likert scale. All procedures were completed in a fully equipped surgical environment and complied with the principles outlined in the Declaration of Helsinki. Results: The workshop participants evaluated the anatomical and manipulation characteristics of the TeC as similar to real‐life conditions. The colour and consistency of the urethra and ureter differed little from those in live patients. The trainees stated that the TeC were beneficial for learning the stages of ORC and urinary diversion (UD), while their self‐confidence increased. In terms of realism, all steps of radical cystectomy (RC) were rated 4 out of 5 or higher on the Likert scale by both trainees and faculty. Conclusions: The use of TeC for RC und UD was perceived as favourable by trainees and faculty. The TeC demonstrated a surprising ability to mimic real‐life anatomy and represent a new and effective surgical training tool. [ABSTRACT FROM AUTHOR]

Background Methods Results Conclusions There has been a proliferation of global surgery assessment tools designed for use in low‐ and middle‐income countries. This scoping review sought to categorize and organize the breadth of global surgery assessment tools in the literature.The search was conducted using PubMed from October 2022 to April 2023 according to PRISMA extension for scoping review guidelines. The search terms were ((“global surgery”[All Fields]) AND (“assessment”[All Fields]) OR (data collection)). Only tools published in English that detailed surgical assessment tools designed for low‐ and middle‐income countries were included.The search resulted in 963 papers and 46 texts described unique tools that were included for the final review. Of these, 30 (65%) tools were quantitative, 1 (2%) qualitative, and 15 (33%) employed mixed‐methods. 25 (54%) tools evaluated surgery in general, whereas 21 (46%) were focused on various surgical subspecialties. Qualitatively, major themes among the tools were noted. There was significant overlap of many tools.Nonspecialty surgery was represented more than any specialty surgery and many specialties had little or no representation in the literature. Ideally, local leadership should be involved in surgical assessment tools. Different methodologies, such as checklists and observational studies, aimed to target varying aspects of surgery and had distinct strengths and weaknesses. Further efforts should focus on expanding tools in neglected specialties. [ABSTRACT FROM AUTHOR]

Background: The current review aims to explore the evidence regarding the effectiveness of mandibular advancement orthodontic appliances with maxillary expansion device in treating pediatric Obstructive Sleep Apnea (OSA). Materials and methods: A systematic literature search was conducted across PubMed, Cochrane Central, Web of Science, Embase, Scopus databases, Chinese Biomedical Database, Chinese National Knowledge Infrastructure, and Wanfang. The research involved children and adolescents (under 16 years old) who received mandibular advancement and maxillary expansion functional orthopedic appliances for OSA treatment. We performed narrative reviews and subsequently amalgamated the findings from the studies. Results: Six articles were included for review. Although a small number of studies were included, the research suggested the potential advantages of mandibular advancement for children with OSA. Following treatment, there was a decrease in AHI/RDI, an improvement in sleep quality, and the increase in oxygen saturation. Conclusions: The limited quantity and quality of existing studies necessitate caution when drawing conclusions about the effectiveness of mandibular advancement and maxillary expansion for OSA. In the future, larger and well-designed randomized controlled trials (RCTs) are needed to provide more robust evidence. Patients should be carefully selected, and their orthodontic indications should be thoroughly evaluated before inclusion in such trials.We encourage researchers to design studies that monitor patients over several years to provide a comprehensive understanding of the long-term effectiveness. Trial registration: This study was registered in PROSPERO(CRD42023480407) on November 20, 2023. [ABSTRACT FROM AUTHOR]

This study develops an artificial intelligence model to quickly and easily determine correct mask-wearing in real time using thermal videos that ascertained temperature changes caused by air trapped inside the mask. Five types of masks approved by the Korean Ministry of Food and Drug Safety were worn in four different ways across 50 participants, generating 5000 videos. The results showed that 3DCNN outperformed ConvLSTM in both binary and multi-classification for mask wearing methods, with the highest AUROC of 0.986 for multi-classification. Each mask type scored AUROC values > 0.9, with KF-AD being the best classified. This improved use of thermal imaging and deep learning for mask fit-checking could be useful in high-risk environments. It can be applied to various mask types, which enables easy generalizability and advantages in public and occupational health and healthcare system. [ABSTRACT FROM AUTHOR]

Purpose: Recently, exoscope was introduced as a more ergonomic alternative to microscope, mainly in nerve and spinal surgery. Exoscope use in general surgery is still experimental and just few reports are present in literature. Here, we describe for the first time its application in transanal surgery, specifically during the transanal transection and single-stapled anastomosis in ileal-pouch anal anastomosis. Methods: After completing the proctectomy and pouch formation laparoscopically, two surgeons performed the transanal transection and single-stapled anastomosis using the vision provided by the ORBEYE™ exoscope system with a 3D 4K orbital camera and a 55-inches 3D screen. The transanal procedure was carried out with the surgeons looking at the 3D screen rather than at the operating field. Results: The system subjectively provided excellent operative view thanks to the magnification capacity and the high resolution. The ergonomics was improved compared to classical transanal surgery, allowing the operators and observers to have the same view in a comfortable position. In particular, the exoscope magnified vision allowed for clearer demonstration of techniques to trainees. Conclusions: This is the first report on the intraoperative application of the ORBEYE™ surgical exoscope in transanal surgery. The magnified vision allowed precise movements and the system appeared potentially a ground-breaking tool for surgical training. The ability to project high-quality images to observers make it ideal for teaching complex transanal procedures. Further studies are encouraged to validate this approach into standard colorectal practice. [ABSTRACT FROM AUTHOR]

Purpose: This study aimed to evaluate the clinical efficacy of applying real-time dynamic navigation (RDN) in the extraction of deep horizontal mandibular impacted third molars, hypothesizing that RDN reduces surgical time and minimizes the risk of injury to adjacent anatomical structures. Methods: A prospective study was conducted on 160 patients aged between 18 and 37 years with deep horizontal impaction of the mandibular third molar. The participants were randomly assigned to either the experimental group (receiving RDN-assisted extractions) or the control group (undergoing traditional extraction methods). Preoperative planning utilized cone beam computed tomography (CBCT) and Mimics software for the accurate localization and segmentation of impacted teeth. Parametric data were analysed via an independent t test for intergroup comparisons, and significance was set to p < 0.05. Results: In the experimental group, an average of 11 ± 1 min was required for preoperative planning via RDN, which was not required in the control group. The setup of the navigation system took an average of 4 ± 1 min in the experimental group and 0 min in the control group. The experimental group demonstrated a significantly shorter average surgical time (22 ± 3 min) than did the control group (36 ± 3 min). The differences in the preoperative design time, surgical time, and complication rates between the two groups were statistically significant (p = 0.005). Additionally, the RDN group reported no complications related to adjacent tooth damage or nerve injury. Conclusion: The precision, safety, real-time guidance of RDN supports its use in complicated dental extractions, which would introduce a new era of oral and maxillofacial surgery. [ABSTRACT FROM AUTHOR]

Background: Laparoscopic surgery is associated with a prolonged learning curve for emerging surgeons, and simulation-based training (SBT) has become increasingly prominent in this context due to stringent working time regulations and heightened concerns regarding patient safety. While SBT offers a safe and ethical learning environment, the accuracy of simulators in the context of evaluating surgical skills remains uncertain. This study aims to assess the precision of a laparoscopic simulator with regard to evaluating surgical performance and to identify the instructor's role in SBT. Materials and methods: This retrospective study focused on surgical residents in their 1st through 5th years at the Department of Surgery of Linkou Chang Gung Memorial Hospital. The residents participated in a specially designed SBT program using the LapSim laparoscopic simulator. Following the training session, each resident was required to perform a laparoscopic procedure and received individualized feedback from an instructor. Both simulator and instructor evaluated trainees' performance on the LapSim, focusing on identifying correlations between the simulator's metrics and traditional assessments. Results: Senior residents (n = 15), who employed more complex laparoscopic procedures, exhibited more significant improvements after receiving instructor feedback than did junior residents (n = 17). Notably, a stronger correlation between the simulator and instructor assessments was observed in the junior group (junior Global Operative Assessment of Laparoscopic Skills (GOALS) adjusted R2 = 0.285, p = 0.016), while no such correlations were observed among the senior group. Conclusion: A well-designed, step-by-step SBT can be a valuable tool in laparoscopic surgical training. LapSim simulator has demonstrated its potential in assessing surgical performances during the early stages of surgical training. However, instructors must provide intuitive feedback to ensure appropriate learning in later stages. [ABSTRACT FROM AUTHOR]

Purpose: Complete surgical resection is still the mainstay in the treatment of central nervous system low-grade tumors, eventually resulting curative. The complete surgical removal of these lesions, however, may be difficult in some cases because of their infiltrative nature. Intraoperative adjuncts may be a game changer. Sodium fluorescein (SF) is among the ideal candidates as intraoperative tools to favor the actual recognition of the tumor extension, since it accumulates in areas of altered blood–brain barrier, a typical characteristic of pediatric gliomas, and has a low rate of adverse events. This work proposes an update of previous works about the evaluation of the feasibility and usefulness of a systematic use of SF in a low-grade lesion group of pediatric patients. Methods: Pediatric patients operated on for a resection or a biopsy of a low-grade glial or glioneuronal lesion (WHO grade I and II) at our Institution between September 2021 and December 2023, with the intraoperative use of sodium fluorescein (SF), were enrolled in the study. We collected pre-operative and postoperative clinical and radiological data, intraoperative findings, and post-operative pathological diagnoses. Results: No adverse events were registered related to the intraoperative use of SF. SF appeared useful for the localization of boundaries of tumors, especially when characterized by a high degree of infiltration or by a deep-seated location, and for the checking of possible tumor remnants at the end of surgery. A good tumor-to-healthy tissue contrast was registered when tumor visualization was in a range between 1 to 2 h and 30 min after SF injection. Possible "false positives" due to intraoperative vascular wall injury and clearance of SF from both tumor and healthy tissue were observed in some cases and still remain open issues. Conclusions: SF is a feasible and safe intraoperative adjunct tool in the surgical removal of pediatric low-grade tumors. SF may show its usefulness especially in selected cases, such as deep-seated lesions and infiltrating tumors. Its safety profile, user-friendly management, and potential utility in both tumor resections and neuronavigated biopsies favor its wider use in the surgical treatment of pediatric low-grade tumors. [ABSTRACT FROM AUTHOR]

Purpose: To evaluate microbiological cultures of cataract surgical devices and products that were reused for multiple cases. Setting: Aravind Eye Hospital, Pondicherry, Tamil Nadu, India. Design: Prospective cohort study. Methods: Samples from multiple surgical instruments and products that were reused for consecutive cataract surgeries underwent bacterial and fungal cultures and were monitored alongside positive controls for 7 days. This included instruments that were processed using immediate use steam sterilization (IUSS) between cases (eg, surgical cannulas, syringes, phacoemulsification and coaxial/bimanual irrigation/aspiration [I/A] tips, phacoemulsification and I/A sleeves) (Group 1), instruments that were used without sterilization between cases (eg, phacoemulsification tubing/handpieces, coaxial I/A handpieces) (Group 2), and the residual (unused) fluid from balanced salt solution bags after being used for multiple patients (Group 3). Results: 3333 discrete samples were collected from all 3 product groups that were reused across multiple patients. In all collected samples, no bacterial or fungal growth was observed. Of the 3241 cataract surgeries that used reused and IUSS-sterilized instruments alongside instrument sets cultured on the same day and balanced salt solution bags shared across multiple patients, no eyes developed endophthalmitis over a 6-week follow-up period. Conclusions: Bacterial or fungal growth was not found in extensive microbiological cultures of IUSS-sterilized ophthalmic surgical instruments and cataract surgical products that were reused in multiple patients. This microbiological data complements clinical endophthalmitis data from 2 million consecutive cases at the Aravind Eye Hospital, suggesting that their instrument and surgical supply processing practices may allow for safe and sustainable ophthalmic care. [ABSTRACT FROM AUTHOR]

Background: Healthcare systems globally face the issue of resource constraints and need for prioritization of elective surgery. Inclusive, explicit prioritization tools are important in improving consistency and equity of access to surgery across health systems. The General Surgical Prioritization Tool developed by New Zealand's Ministry of Health scores patients for elective non‐cancer surgery based on surgeon's clinical judgement and patient derived Impact on Life (IoL) scores. This study aims to measure the changes in patient derived IoL scores after common general surgical procedures to enable direct comparison and inform future prioritization. Method: This longitudinal observational study enrolled 322 participants who had undergone elective general surgical procedures. Participants were contacted 3 to 9 months after their procedures and requested to complete the IoL questionnaire. The primary endpoint was the change in IoL scores after surgery among the different procedures. Results: Overall, 229/304 (75%) participants responded to the questionnaire and there were no significant baseline differences between responders and non‐responders. Patients in the gallbladder treatment group had the greatest improvement in IoL scores. Patients across all ethnic groups had similar changes in IoL scores. Multivariate analysis showed that gallbladder surgery (relative to hernia surgery) and pre‐surgery IoL scores significantly predicted improvement. Conclusion: The patient reported IoL score recorded at prioritization for surgery all reduced, albeit to varying amounts, after common general surgical procedures. This, combined with the fact that IoL scores predicted post‐operative improvement support their inclusion in prioritization tools in addition to surgeon derived components. [ABSTRACT FROM AUTHOR]

Background: Surgical care significantly contributes to healthcare-associated greenhouse gas emissions (GHG). Surgeon attitudes about mitigation of the impact of surgical practice on environmental sustainability remains poorly understood. To better understand surgeon perspectives globally, the Society of American Gastrointestinal and Endoscopic Surgeons and the European Association for Endoscopic Surgery established a joint Sustainability in Surgical Practice (SSP) Task Force and distributed a survey on sustainability. Methods: Our survey asked about (1) surgeon attitudes toward sustainability, (2) ability to estimate the carbon footprint of surgical procedures and supplies, (3) concerns about the negative impacts of sustainable interventions, (4) willingness to change specific practices, and (5) preferred educational topics and modalities. Questions were primarily written in Likert-scale format. A clustering analysis was performed to determine whether survey respondents could be grouped into distinct subsets to inform future outreach and education efforts. Results: We received 1024 responses, predominantly from North America and Europe. The study revealed that while 63% of respondents were motivated to enhance the sustainability of their practice, less than 10% could accurately estimate the carbon footprint of surgical activities. Most were not concerned that sustainability efforts would negatively impact their practice and showed readiness to adopt proposed sustainable practices. Online webinars and modules were the preferred educational methods. A clustering analysis identified a group particularly concerned yet willing to adopt sustainable changes. Conclusion: Surgeons believe that operating room waste is a critical issue and are willing to change practice to improve it. However, there exists a gap in understanding the environmental impact of surgical procedures and supplies, and a sizable minority have some degree of concern about potential adverse consequences of implementing sustainable policies. This study uniquely provides an international, multidisciplinary snapshot of surgeons' attitudes, knowledge, concerns, willingness, and preferred educational modalities related to mitigating the environmental impact of surgical practice. [ABSTRACT FROM AUTHOR]

In the 2nd century AD, Galen argued that the failure to remove any single 'root' of a malignant tumor could result in a local relapse. After nearly 2 millennia, this problem appears to be even more challenging due to our increased understanding of the complexity of tumor formation and spread. Pathological analysis of tumor margins under a microscope remains the primary and only accepted method for confirming the complete tumor removal. However, this method is not an all-or-nothing test, and it can be compromised by various intrinsic and extrinsic limitations. Among the intrinsic limitations of pathological analysis we recall the pathologist handling, tissue shrinkage, the detection of minimal residual disease and the persistence of a precancerous field. Extrinsic limitations relate to surgical tools and their thermal damage, the different kinds of surgical resections and frozen sections collection. Surgeons, as well as oncologists and radiotherapists, should be well aware of and deeply understand these limitations to avoid misinterpretation of margin status, which can have serious consequences. Meanwhile, new technologies such as Narrow band imaging have shown promising results in assisting with the achievement of clear superficial resection margins. More recently, emerging techniques like Raman spectroscopy and near-infrared fluorescence have shown potential as real-time guides for surgical resection. The aim of this narrative review is to provide valuable insights into the complex process of margin analysis and underscore the importance of interdisciplinary collaboration between pathologists, surgeons, oncologists, and radiotherapists to optimize patient outcomes in oral cancer surgery. [ABSTRACT FROM AUTHOR]

Background: Until local healthcare infrastructure is strengthened, cardiac surgical care in low- and middle-income countries is often provided by non-governmental organizations by way of visiting healthcare teams. This is generally considered to be a cost-effective alternative to transporting patients to high income countries for surgical care, but the costs of cardiac surgery consumables under this model are poorly understood. Our objective was to identify the per-patient cost of cardiac surgery consumables used in single and double valve replacements performed by a non-governmental organization in Rwanda. Methods: Financial data from 2020 were collected from Team Heart, a non-governmental organization that supports cardiac surgical care in Rwanda. A comprehensive list of consumables was generated, including surgical, perfusion, anesthesia, and inpatient supplies and medications. Acknowledging the variability in perioperative needs, the quantities of consumables were calculated from an average of six patients who underwent single or double-valve replacement in 2020. Total costs were calculated by multiplying purchasing price by average quantity per patient. Costs absorbed by the local hospital were excluded from the calculations. Results: The total cost per patient was estimated at $9,450. Surgical supplies comprised the majority of costs ($6,140 per patient), with the most substantial cost being that of replacement valves ($3,500 per valve), followed by surgical supplies ($1,590 per patient). Conclusions: This preliminary analysis identifies a cost of just over $9,000 per patient for consumables used in cardiac valve surgery in Rwanda, which is lower than the estimated costs of transporting patients to centers in high income countries. This work highlights the relative cost effectiveness of cardiac surgical care in low- and middle- income countries under this model and will be instrumental in guiding the allocation of local and international resources in the future. [ABSTRACT FROM AUTHOR]

Background & Objective:: In clinical practice, obtaining informed surgical consent is rooted in respecting a person's dignity, and failure to obtain informed consent has been labeled as medical negligence. Teaching this process to undergraduates can improve doctor[ -patient relationships, thereby decreasing medico U -legal litigation. This study investigated whether a multimodal training module for teaching final-year medical students surgical informed consent was effective in improving this skill. It aimed to determine the students' perception of multimodal training in taking informed consent for surgical procedures. Material & Methods: This single-group quasi-experimental study was conducted in the authors' teaching hospital in Kerala, India, among 35 final-year medical students from January to July 2022. It evaluated their ability to obtain surgical informed consent and the improvement following an educational intervention based on a multimodal training module using a prevalidated Directly Observed Procedural Skills assessment. Results: Following the intervention, students showed an improvement in their ability to take surgical informed consent and in assessment scores, which was found to be statistically significant (p < 0.001). Male students showed a greater improvement in the Knowledge subcomponent of assessment score as compared to females, which was statistically significant (p < 0.001). All the students, in their feedback, felt the training was feasible, made learning interesting, helped identify weaker sections, and retained concepts in memory. They opined that it made them confident in taking consent and that they would prefer this type of learning in the future. Conclusion: Multimodal modular training enhanced the proficiency of final-year medical students in obtaining informed surgical consent from simulated patients. This enriched their professionalism and interaction with simulated patients. Utilizing faculty as simulated patients needs further exploration. We recommend that the undergraduate medical curriculum incorporate a prevalidated multimodal training module and assessment tool for surgical informed consent. [ABSTRACT FROM AUTHOR]

Purpose: While progress was made towards the Vision 2020: The Right to Sight goals, Ethiopia, Ghana, and Zambia fell short of the recommended cataract surgical rate (CSR) on a national level. Post-operative cataract surgical outcomes are also lower compared to other regions. This study aimed to describe perceived barriers to cataract surgical uptake, factors related to surgeon surgical productivity, and surgical offerings in each of these countries. Methods: An online survey was sent to ophthalmologists practicing in Ethiopia, Ghana, and Zambia. Responses were collected between June 25, 2021 and January 30, 2022. Results: Responses were received from 122 ophthalmologists from Ethiopia, Ghana, and Zambia. The estimated participation rate was 47% (122/257). Distance to cataract surgical centres, lack of surgical centres, and lack of surgical equipment were among the top 10 most agreed upon barriers by respondents within each country. Many respondents reported that current financial reimbursement does not incentivise maximum productivity in themselves (56%, 68/122) or their staff (61%, 74/122). Surgeons proposed several ways to improve productivity incentives. Private practice was perceived to have the best reimbursement incentives (77%, 94/122), whereas government hospitals were least agreed upon (4%, 5/122). Discrepancies in timely post-operative refraction and eyeglasses disbursement were reported. Conclusions: Overcoming the identified barriers, improving surgeon productivity, and addressing identified deficits in cataract care will likely reduce the backlog of cataract blindness while ensuring increasingly improved patient outcomes. [ABSTRACT FROM AUTHOR]

The article discusses the need for a robust and scientific training program for cardiothoracic transplantation surgeons in the 21st century. It highlights the importance of training surgeons not only in surgical skills but also in transplantation at a molecular level. The article mentions the establishment of a national fellowship in the UK to deliver transplant-specific surgical training and the need for improvements in the quality of training. It also emphasizes the importance of early engagement and mentorship, an international approach, certification, formal training courses, research in education, mentorship programs, surgical research, funding, and reaching out to societies with lacking transplant infrastructure. Overall, the article emphasizes the need for investment in a structured and multifaceted training program to train competent and innovative transplant surgeons. [Extracted from the article]

Observational studies of human behaviour often require the annotation of objects in video recordings. Automatic object detection has been facilitated strongly by the development of YOLO ('you only look once') and particularly by YOLOv8 from Ultralytics, which is easy to use. The present study examines the conditions required for accurate object detection with YOLOv8. The results show almost perfect object detection even when the model was trained on a small dataset (100 to 350 images). The detector, however, does not extrapolate well to the same object in other backgrounds. By training the detector on images from a variety of backgrounds, excellent object detection can be restored. YOLOv8 could be a game changer for behavioural research that requires object annotation in video recordings. [ABSTRACT FROM AUTHOR]

Background and Objectives: This study aimed to evaluate the tibial tubercle–posterior intercondylar eminence (TT-IC) distance as a diagnostic tool and surgical guide for correcting extensor apparatus misalignment through tibial tubercle osteotomy. Materials and Methods: A retrospective analysis was conducted on patients with extensor apparatus misalignment. The TT-IC distance was measured using MRI. Patients underwent tibial tubercle osteotomy, guided by the TT-IC distance for correction. Post-operative outcomes, including alignment, pain scores, and functional recovery, were assessed. Results: A significant correlation was found between the TT-IC distance and the degree of extensor apparatus misalignment. Utilizing the TT-IC distance as a surgical guide led to improved alignment in majority of patients. Post-operative outcomes showed reduced pain and enhanced functional recovery. Conclusions: The study established the TT-IC measurement as a valuable tool for determining the need for tibial tuberosity osteotomy in patients with patellar instability, particularly those with trochlear dysplasia, by providing a more precise criterion than the traditional TT-TG distance. [ABSTRACT FROM AUTHOR]

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Optimizing the regeneration process of surgically created anastomoses (blood vessels, intestines, nerves) is an important topic in surgical research. One of the most interesting parameter groups is related to the biomechanical properties of the anastomoses. Depending on the regeneration process and its influencing factors, tensile strength and other biomechanical features may change during the healing process. Related to the optimal specimen size, the range and accuracy of measurements, and applicability, we have developed a custom-tailored microcontroller-based device. In this paper, we describe the hardware and software configuration of the latest version of the device, including experiences and comparative measurements of tensile strength and elasticity of artificial materials and biopreparate tissue samples. The machine we developed was made up of easily obtainable parts and can be easily reproduced on a low budget. The basic device can apply a force of up to 40 newtons, and can grasp a 0.05–1 cm wide, 0.05–1 cm thick tissue. The length of the test piece on the rail should be between 0.3 and 5 cm. Low production cost, ease of use, and detailed data recording make it a useful tool for experimental surgical research. [ABSTRACT FROM AUTHOR]

Background: Operating rooms contribute to over 40% of hospital expenses, with a portion attributed to waste from single-use, sterile surgical supplies (SUSSS). This research aimed to determine the amount of cost wastage due to not using SUSSS during laparotomy procedures. Methods: A descriptive-analytical investigation was conducted in two prominent teaching hospitals in Mashhad, Iran 2018. Seventy-seven laparotomy surgeries were scrutinized, documenting both used and unused disposable devices, with their respective costs being assessed. Data analysis was performed using SPSS version 16 software. Results: The study revealed that during surgery in the operating rooms, waste of SUSSS averaged 5.9%. Betadine solution and sterile Gauze types were the top two contributors to resource wastage. Sterile Gauze types incurred the highest cost loss. The study found a significant correlation between cost wastage and surgeon experience (r = 0.296, P < 0.001) as well as surgery duration (r = 0.439, P < 0.001). Conclusion: Inadequate management of available and commonly used disposable supplies leads to increased hospital expenses. Enhancing the surgical team's knowledge of sterile surgical supplies usage and making thoughtful selections can play a vital role in curbing health costs by minimizing waste of SUSSS in the operating rooms. [ABSTRACT FROM AUTHOR]

Proliferative vitreoretinopathy (PVR) significantly impacts the prognosis of rhegmatogenous retinal detachment (RRD), one of the most critical and increasing causes of vision loss in the Western world. Despite advancements in surgical instruments and techniques, the failure rate due to PVR remains substantial, necessitating additional surgeries and often leading to unsatisfactory visual outcomes. This comprehensive review explores the role of vitreoschisis‐induced vitreous cortex remnants (VCR) as a critical, previously under‐recognised factor contributing to PVR. Vitreoschisis, a phenomenon where the inner lamellae of the posterior vitreous cortex detach while the outermost layers remain attached to the retina, creates VCR that may contain hyalocytes and serve as scaffolds for fibrocellular proliferation. These remnants are difficult to visualise without triamcinolone acetonide (TA) staining, leading to their frequent lack of recognition in clinical practice. Moreover, removing VCR can be challenging and time‐consuming, often requiring meticulous surgical techniques to avoid retinal damage and ensure complete elimination. This review consolidates insights from basic research and clinical practice, emphasising the importance of complete vitreous removal and effective VCR detection and removal to mitigate PVR risks. It highlights the histopathological and clinical evidence supporting the hypothesis that VCR, containing hyalocytes, play a pivotal role in preretinal membrane formation. The review also discusses epidemiological data, surgical management strategies and potential future directions, including improved visualisation techniques and the development of new surgical tools and methods. This review aims to improve surgical outcomes and reduce the frequency and burden of RRD‐related complications by addressing VCR as a critical factor in PVR. [ABSTRACT FROM AUTHOR]

This article explores the use of technology in improving the assessment of surgical training. It acknowledges the challenges faced by surgeons in training, such as burnout and limited time for trainers. The article suggests that video recording of surgical procedures can be a valuable tool for assessment and training. However, there are obstacles to implementing video assessment, including technical, cultural, regulatory, and medicolegal issues. The article emphasizes the importance of systematic evaluation and involving stakeholders in the implementation process. It highlights the significance of evidence-based training interventions in the UK and encourages library patrons to participate in a national pilot study on video-based assessment to contribute to research in this field. [Extracted from the article]

This study aimed to develop a predictive tool for surgical site infections (SSI) following hysterectomy and propose strategies for their prevention and control. We conducted a retrospective analysis at a tertiary maternity and child specialist hospital in Zhejiang Province, focusing on patients who underwent hysterectomy between January 2018 and December 2023 for gynecological malignancies or benign reproductive system diseases resistant to medical treatment. Risk factors associated with surgical site infections (SSI) following hysterectomy were identified using LASSO regression analysis on data from 2018 to 2022 as the training set. Independent risk factors were then used to develop a nomogram. The model was validated using data from 2023 as the validation set. Model performance was assessed using the area under the receiver operating characteristic curve (ROC), while calibration curves were employed to gauge model accuracy. Furthermore, clinical utility was evaluated through clinical decision curve analysis (DCA) and clinical impact curve analysis (CIC), providing insights into the practical application of the nomogram. Multivariate analysis identified six independent risk factors associated with SSI development after hysterectomy: BMI ≥ 24 kg/m2 (OR: 2.58; 95% CI 1.14–6.19; P < 0.05), hypoproteinaemia diagnosis (OR: 4.99; 95% CI 1.95–13.02; P < 0.05), postoperative antibiotic use for ≥ 3 days (OR: 49.53; 95% CI 9.73–91.01; P < 0.05), history of previous abdominal surgery (OR: 7.46; 95% CI 2.93–20.01; P < 0.05), hospital stay ≥ 10 days (OR: 9.67; 95% CI 2.06–76.46; P < 0.05), and malignant pathological type (OR: 4.62; 95% CI 1.78–12.76; P < 0.05). A nomogram model was constructed using these variables. ROC and calibration curves demonstrated good model calibration and discrimination in both training and validation sets. Analysis with DCA and CIC confirmed the clinical utility of the nomogram. Personalized nomogram mapping for SSI after hysterectomy enables early identification of high-risk patients, facilitating timely interventions to reduce SSI incidence post-surgery. [ABSTRACT FROM AUTHOR]

The field of ophthalmic surgery demands accurate identification of specialized surgical instruments. Manual recognition can be time-consuming and prone to errors. In recent years neural networks have emerged as promising techniques for automating the classification process. However, the deployment of these advanced algorithms requires the collection of large amounts of data and a painstaking process of tagging selected elements. This paper presents a novel investigation into the application of neural networks for the detection and classification of surgical instruments in ophthalmic surgery. The main focus of the research is the application of active learning techniques, in which the model is trained by selecting the most informative instances to expand the training set. Various active learning methods are compared, with a focus on their effectiveness in reducing the need for significant data annotation -- a major concern in the field of surgery. The use of convolutional neural networks (CNNs) and recurrent neural networks (RNNs) to achieve high performance in the task of surgical tool detection is outlined. The combination of artificial intelligence (AI), machine learning, and Active Learning approaches, specifically in the field of ophthalmic surgery, opens new perspectives for improved diagnosis and surgical planning, ultimately leading to an improvement in patient safety and treatment outcomes. [ABSTRACT FROM AUTHOR]

Silver nanoparticles can be produced by an array of procedures, such as chemical, physical, and biological processes. The process of biosynthesis is more economical and significantly more environmentally friendly. We describe an environmentally compatible method (biosynthesis) of producing silver nanoparticles (Ag: NPs) with the capping component Artocarpus heterophyllus in this research work. Powder-X-ray crystallography (P-XRD), Fourier Transform Infrared (FT-IR), UV–visible (UV–Vis), Photoluminescence (PL), Field emission scanning electron microscopy (FE-SEM), and an antimicrobial test were all used to examine the synthesized samples. The P-XRD analysis revealed that the produced NPs have an FCC form with a typical particle size of 23 nm. FT-IR spectra further demonstrate the availability of the functional groups in the synthesized nanoparticles. The absorbance and transmittance spectra of the UV–Vis study have shown substantial transparency and less absorbance of the Ag: NPs in the entire visible region. The bandgap of the Ag: NPs was found to be 3.25 eV using the Tauc relation. In the PL study, an emission peak at 472 nm was found, suggesting the fluorescence emission of Ag: NPs. The FE-SEM micrographs provide confirmation of the surface-wide aggregate of nanostructural homogeneities. The FE-SEM micrographs illustrate that Ag: NPs are homogeneous aggregates of very small spheres. Variations in particle size and surface area-to-volume ratios of synthesized NPs have been proven to be responsible for the antibacterial activities. According to the antibacterial study, Ag: NPs restrain the development of both normal and harmful bacteria and so have the potential to be utilized for coating surgical equipment for aseptic operators in the healthcare industry. [ABSTRACT FROM AUTHOR]

This article explores the significance of ergonomics and proper posture in thoracic surgery. It traces the historical roots of ergonomics and highlights its benefits, such as improved work quality and reduced fatigue. The article specifically addresses the challenges faced by thoracic surgeons and emphasizes the importance of considering ergonomic guidelines to prevent physical discomfort and work-related musculoskeletal disorders. It suggests interventions like ergonomic mats, adjustable operating tables, and supportive footwear. The text concludes by advocating for the integration of ergonomics into surgical practice and the implementation of practical measures to enhance ergonomics in the operating room. [Extracted from the article]

Background: Treatment methods for mandibular head fractures are controversial, although effective techniques for open reduction and rigid fixation (ORIF) have been known since the late 1990s. Notably, some forms of posttraumatic comminution of the mandibular head can be reduced or fixed. Methods: This study presents a personalized treatment to cure patients with nonreduced comminuted fractures of the mandibular head: total temporomandibular joint alloplastic replacement (18 patients). The reference group included patients who underwent ORIF (11 patients). Results: Personalized alloplastic joint replacements resulted in a more stable mandibular ramus after three months compared with ORIF. Conclusions: The authors recommend not performing osteosynthesis when the height of the mandibular ramus cannot be stably restored or when periosteal elevation from most of the mandibular head is necessary for ORIF. Personalized TMJ replacement should be considered in such patients. Personalized medicine allows patients to maintain a normal mandibular ramus height for a long period of time. [ABSTRACT FROM AUTHOR]

Introduction: Cytoreductive surgery (CRS) coupled with hyperthermic intraperitoneal chemotherapy (HIPEC) is a potentially curative approach to peritoneal disease (PD) and corresponds to the needs of patients with dire survival rates. However, the oncological community remains cautious toward this procedure because of its significant morbidity and mortality rates. This evolving evidence around CRS and HIPEC and its impact suggests a need for more standardized procedures in existing centers. Because of its complexity and potential for high morbidity and mortality, critical observation of our center's complication rates using complication management documentation tools were crucial to further develop our standard operating procedures (SOP) and maximize patient safety. Methods: Our prospectively maintained institutional database was queried to identify all patients who underwent CRS and HIPEC and had a filled-out quality management (QM) and complication management documentation tool at discharge at the surgical department of the Charité—Universitätsmedizin Berlin, Campus Virchow Klinikum, Berlin, Germany, between January 2018 and December 2023. Results: A total of 155 patients had a surgical and/or medical complication recorded. In total, 305 surgeries were surveyed. Some patients had more than one postoperative complication; hence, 344 events in 50 categories were recorded, of which 267 were graded 3a or higher in 92 patients. The most common medical complications were of pulmonary and renal origin. On the surgical side, surgical site infections (SSI) were most common. The incidence of anastomotic leakage (AL) was 5% (n = 8), with no events between 2021 and the present. Patients with longer surgery duration times were at higher risk for developing postoperative complications. Conclusions: Major abdominal surgeries like CRS and HIPEC are associated with significant patient morbidity despite achieving optimal oncological outcomes. Postoperative complications are managed through strict surveillance and transparency, particularly in our large reference centers, to minimize patient risk. Quality management programs in our department have successfully maintained high standards of care without compromising patient safety. [ABSTRACT FROM AUTHOR]

Full-endoscopic lumbar interbody fusion (FELIF) is a critical yet challenging procedure. However, extensive analyses of discectomy and cartilage endplate preparation techniques are limited. This can be attributed to the lack of universal protocols owing to diverse surgical practices and equipment preferences. Therefore, this narrative review presents a comprehensive overview of discectomy and cartilage endplate preparation techniques in FELIF. A literature search of the PubMed, Embase, and Google Scholar databases in December 2023 retrieved 490 studies, of which 53 met the predefined inclusion criteria, and 1373 patients were included in the analyses. Spinal endoscopic disc and cartilage endplate removal can be categorized into 2 main types: removal under direct endoscopic visualization and removal under radiographic guidance with the protection of a working sheath following the endoscope's removal. Removal under direct visualization ensures the safety and precision of the procedure. Radiographic guidance can enhance the efficiency of the removal process. Specially designed instruments can be utilized through the narrow working channels of spinal endoscopes for the scraping surgery. Moreover, many traditional spinal endoscopic instruments, through specific techniques and manipulations, can also aid in cartilage removal. The approaches and techniques vary significantly among physicians, but overall, these instruments and techniques aim to achieve a safe and efficient disc-scraping outcome. Thus, this review may offer a comprehensive guidance to surgeons in selecting the most efficient practices for FELIF. Uniform procedural protocols are needed to ensure broader adoption and standardized practice. [ABSTRACT FROM AUTHOR]

This article discusses the safety, structure, and function of two patients who underwent human embryonic stem cell-derived retinal pigment epithelium (hESC-RPE) patch transplantation for acute neovascular age-related macular degeneration (AMD) with submacular hemorrhage. The study followed the patients for five years and found no evidence of uncontrolled RPE proliferation, tumor formation, or major ocular immune reactions. The patients experienced improved best corrected visual acuity (BCVA) at two years, although the BCVA decreased for one patient at five years. The study also observed patch pigmentation and areas of continuous hyper-reflective lines consistent with the hESC-RPE on imaging. The authors note the need for further studies to address remaining questions in the field. [Extracted from the article]

Introduction: Numerous studies comment on quality of life outcomes comparing complete and partial fundoplication with or without a bougie. Society guidelines are moving toward recommending partial fundoplication over complete fundoplication due to improved side effect profile with similar outcomes. Retrospective studies and randomized trials have elucidated that use of a bougie during Nissen fundoplication does impact long-term dysphagia. To date there are no retrospective or prospective data that guide practice for partial fundoplications. Objective: The purpose of this project is to investigate the clinical implications of using a bougie for Toupet fundoplication with regard to short-term and long-term dysphagia and need for further therapeutic interventions. Methods: A retrospective review of a prospectively maintained gastroesophageal database was performed. Demographic, pre-operative quality of life outcomes data, perioperative, and post-operative quality of life outcomes data of 373 patients from 2011 to 2022 undergoing Toupet fundoplication without bougie or with a traditional Savary 56Fr or 58Fr bougie were reviewed. The two groups were compared using student's t-test to identify statically significant differences between the groups. Results: Between 2011 and 2022, 373 patients underwent Toupet fundoplication (276 with traditional bougie, 97 without). Median follow-up in the bougie group was 19 months, versus 9 months in the non bougie group. There was no difference between early (3 weeks) and late dysphagia scores (6 months). In the bougie group there were two mucosal perforations due to the bougie. There were no statistically significant differences in GERD-HRQL, gas bloat, and dysphagia scores between groups at one year. Conclusion: There is no difference observed in early or late dysphagia scores, GERD-HRQL, gas bloat or need for dilation in patients undergoing Toupet fundoplication with or without a traditional bougie. It is reasonable to discontinue the use of a traditional bougie during Toupet fundoplication, especially due to risk of esophageal perforation. [ABSTRACT FROM AUTHOR]

Background: There is much heterogeneity in the instrumentation used for parenchymal transection in minimally invasive liver surgery. Instruments specifically designed for robotic parenchymal transection of the liver are lacking. We aim to gain insight into the safety and effectiveness of the SynchroSeal (Intuitive Surgical, Inc., Sunnyvale, CA), a novel bipolar electrosurgical device, in the context of liver surgery. Methods: The present study is a post-hoc analysis of prospectively collected data from patients undergoing robotic liver resection (RLR) using the SynchroSeal in two high-volume centres. The results of the SynchroSeal were compared with that of the previous generation bipolar-sealer; Vessel Sealer Extend (Intuitive Surgical, Inc., Sunnyvale, CA) using propensity score matching, after excluding the first 25 Vessel Sealer procedures per center. Results: During the study period (February 2020–March 2023), 155 RLRs meeting the eligibility criteria were performed with the SynchroSeal (after implementation in June 2021) and 145 RLRs with the Vessel Sealer. Excellent outcomes were achieved when performing parenchymal transection with the SynchroSeal; low conversion rate (n = 1, 0.6%), small amounts of intraoperative blood loss (median 40 mL [IQR 10–100]), short hospital stays (median 3 days [IQR 2–4]), and adequate overall morbidity (19.4%) as well as severe morbidity (11.0%). In a matched comparison (n = 94 vs n = 94), the SynchroSeal was associated with less intraoperative blood loss (48 mL [IQR 10–143] vs 95 mL [IQR 30–200], p = 0.032) compared to the Vessel Sealer. Other perioperative outcomes were similar between the devices. Conclusion: The SynchroSeal is a safe and effective device for robotic liver parenchymal transection. [ABSTRACT FROM AUTHOR]

Lhermitte-Duclos Disease (LDD) is a rare condition characterized by a cerebellar mass composed of dysplastic ganglion cells. It is classified as a glioneuronal and neuronal tumor. The exact nature of LDD is still unclear, with debate over whether it is hamartomatous or neoplastic in nature. LDD is associated with Cowden syndrome (CS), a rare genetic disorder that increases the risk of certain cancers. The activation of the PTEN/AKT/mTOR pathway is believed to play a role in the pathogenesis of LDD. Diagnosis of LDD may prompt further screening for CS and associated malignancies. Surgical resection is the main treatment for LDD, and long-term follow-up is important for early detection of associated malignancies. [Extracted from the article]

Whether in the field of medical care, or in people's daily life and health protection, the importance of masks has been paid more and more attention. Acne, the most common complication after wearing masks, which is also called maskne, has been successfully introduced into the common language as a common topic of dermatologist consultations. This study aims to study the changes of microflora in maskne patients and healthy controls before and after wearing masks. In the summer of 2023, we collected a total of 50 samples from 15 maskne patients and 10 healthy controls before and after wearing surgical masks for a long time. 16 S ribosomal DNA sequencing and identification technology with V3-V4 variable region were adopted to explore the microbiome changes caused by mask wearing, analyze the changes in microbial diversity, and make interaction network. LDA effect size analysis was used to identify which bacteria showed significant changes in their relative abundance from phylum to genus. After wearing a mask, the microbiome of the maskne patients changed significantly more than that of the healthy controls, with both α diversity and β diversity lower than those of maskne patients before wearing masks and those of healthy controls after wearing masks. Co-occurrence network analysis showed that compared with other groups, the network of maskne patients after wearing masks for a long time had the lowest connectivity and complexity, but the highest clustering property, while the opposite was true for healthy controls. Many microbes that are potentially beneficial to the skin decreased significantly after wearing a mask. There was almost no difference in healthy controls before and after wearing a mask. [ABSTRACT FROM AUTHOR]

Improving Operating Room Efficiency After each surgery in a hospital, every reusable instrument that has entered the operating room must be sterilized before it can be used again. Hospitals spend several million dollars a year on this sterilization process, instrument tray assembly, and instrument repurchase costs. However, 70%–80% of instruments that enter the operating room are not used at a large majority of hospitals resulting in wastage of millions of dollars. For a medium-sized hospital, approximately $4–$7 million are spent on the sterilization process. Across more than 5,000 hospitals in the United States, several billion dollars per year are wasted on unnecessary sterilization. Researchers at UNC Kenan-Flagler Business School, with partners from healthcare technology firm Operative Flow Technologies, have developed an algorithm that uses detailed data of instruments used to create optimized instrument tray configuration. The algorithm creates trays informed by historical usage of instruments to reduce unused instruments in trays significantly. This algorithm scales for hundreds of trays, thousands of instruments, and thousands of surgeries and can be applied to major healthcare systems. At one implementation, the number of unused instruments was reduced by 54%. Their solution has subsequently been implemented at multiple healthcare systems leading to several million dollars of cost savings for the hospitals. Surgical procedures account for over 60% of the operating cost of a hospital. About 15% of these costs are related to surgical instruments and supplies. Hospitals spend several million dollars annually on instrument sterilization, instrument tray assembly, and instrument repurchase costs. However, in a large majority of hospitals, less than 20%–30% of reusable instruments supplied to a surgery are used on average. Prior implementations of surgical tray rationalizations have typically been expert driven. This is a labor-intensive effort typically focused on a small set of trays. On the other hand, past mathematical programming model-based studies have typically tested models with simulated data because of the difficulty in obtaining actual instrument-level usage data. We obtained actual surgical instrument usage at a large multispecialty hospital in partnership with OpFlow, a healthcare software company. We formulate a data-driven mathematical optimization model for surgical tray configuration and assignment with the goal of reducing costs of unused instruments, such as sterilization, instrument purchase, and tray assembly costs. We develop a solution methodology that scales to thousands of surgeries, thousands of instruments, and hundreds of surgical trays. This methodology decomposes the problem into a tray rationalization and an add-on tray creation step. At each step, we solve a restricted version of the full problem. We perform extensive out-of-sample testing of our solution. Our model-based approach identifies improvements in tray configuration and assignment, which would lead to a 54% reduction in unused instruments per surgery compared with the current tray configuration used at this hospital. We also validated our model with an expert-recommended solution for a subset of trays. We find that our model-based solution leads to 20% lower overage and 21% lower underage than the expert-recommended solution. We estimate projected annual cost savings of 35% in instrument sterilization, tray assembly costs, and instrument repurchase costs from using the recommendations of our model. Our solution was implemented at the UNC Rex Hospital, and we report on the results of our implementation. This analysis has quantified the value of collecting point-of-usage data to be at least $1.39 million per year from using the model-recommended solution at the hospital. Supplemental Material: The electronic companion is available at https://doi.org/10.1287/opre.2022.2426. [ABSTRACT FROM AUTHOR]

Surgical robotic tools are being developed for a variety of surgical procedures that are executed within small workspaces. Novel designs of miniaturized cable-actuated surgical tools for cleft palate repair have previously been developed. However, the behavior and significance of friction within these tools are largely unknown. A study was conducted to investigate the friction in a pulleyless 3 mm diameter wristed instrument. The wrist utilizes cable guide channels that allow for miniaturization at the cost of increased friction. An experimental rig was developed to measure friction within the wrist link mechanism when the tool is positioned at various pitch angles. A strong relationship between the cable tension and the tool's pitch angle was found as a result of friction. The cable tension increased as the pitch angle approached extreme values (percent increases in the cable tension of 33% and 67.3% at a pitch of 90° and −90°, respectively). However, the resultant cable tension was below the failure strength of the cable, indicating that the design is feasible. The results of this study would be useful to those considering the design of miniature robotic surgical tools that are cable-driven. Significant tool reduction can be achieved by employing static guide channels for the cables, forgoing the use of additional moving components like pulleys while maintaining cable tension well within its break strength. Future work in the design and optimization of novel miniaturized wrist mechanisms should consider frictional effects and their impact on mechanism function. [ABSTRACT FROM AUTHOR]

Background: Coarctation of the aorta (CoA) is a congenital disease with an incidence of 4 out of 10,000 live births, therefore proper education of its treatment is essential. Understanding the disease and the wide array of treatment options is often difficult. Additive manufacturing technology can be used to produce 3D printed hands-on surgical training tools (HOSTT), which can be used for the education and practical training of CoA. This study aimed to investigate the effectiveness of a 3D printable HOSTT for the simulation of coarctation surgery, and it' possible role in practical education. Methods: Participants were medical students of Semmelweis University between the second and sixth academic year. A virtual 3D model of an aorta with CoA was generated from a computed tomography angiography scan. Each participant received a 3D-printed aorta phantom and performed either one of four surgical treatment modalities. The simulated surgeries included end-to-end anastomosis, end-to-side anastomosis, prosthetic patch, and subclavian flap aortoplasty. Participants provided feedback, evaluating their understanding of the disease and its treatment by the four surgical reconstruction modalities on a seven-point Likert scale before and after the sessions. Results: 21 medical students participated in this study. Participants' average rating of their understanding of CoA disease and it treatment options before practical training was 4.62 ± 1.07. After training, their average rating increased to 6.19 ± 1.08, showing statistically significant difference. Conclusions: Within this study's limitations, the applied HOSTT, manufactured using 3D printing, was effective for the practical training of CoA's surgical treatment methods for medical students. [ABSTRACT FROM AUTHOR]

In orthopedic surgery and maxillofacial there is a growing use of augmented reality (AR) as a technology to increase the visual perception of the surgeon in the operating room. The objective of this review is to analyze the state of the art in the use of AR for osteotomies, highlighting the advantages and the most-known open issues to be addressed in the future research. Scopus, Web of Science, Pubmed and IEEE Xplore databases have been explored with a keyword search, setting the time limits from January 2017 to January 2023, inclusive. Preferred Reporting Items for Systematic reviews and Meta-Analyses (PRISMA) guidelines has been used in this review, focusing on anatomical districts, real-virtual environment interaction, advantaged and limitations of existing AR-based applications. 49 articles met the inclusion criteria and have been selected in the final analysis. For the sake of clarity, works have been grouped according to the anatomical district, but also the real-virtual environment interaction methodology was reported, as well as information regarding accuracy assessment. A Quality Function Deployment (QFD) has been used to assess the AR-based solutions with regards to the more traditional freehand (FH) and Patient Specific Template (PST) approaches. Finally, some suggestions to foster the AR-based solution adoption in osteotomies treatment have been drawn, considering the highlighted advantages and limitations of this technology. The AR resulted to meet the surgeons' needs more than other traditional approaches. Among the emerged advantages, AR can lead to a better surgical field accessibility, more flexible solutions and lower the management effort. Nonetheless, future research should address some well-known issues, among which the calibration time, the robustness of the tracking, and the HMDs discomfort. [ABSTRACT FROM AUTHOR]

Backgrounds: Laparoscopic surgery is widely used in abdominal emergency surgery (AES), and the possibility of extending this approach to the more recent robotic surgery (RS) arouses great interest. The slow diffusion of robotic technology mainly due to high costs and the longer RS operative time when compared to laparoscopy may represent disincentives, especially in AES. This study aims to report our experience in the use of RS in AES assessing its safety and feasibility, with particular focus on intra- and post-operative complications, conversion rate, and surgical learning curve. Our data were also compared to other experiences though an extensive literature review. Methods: We retrospectively analysed a single surgeon series of the last 10 years. From January 2014 to December 2023, 36 patients underwent urgent or emergency RS. The robotic devices used were Da Vinci Si (15 cases) and Xi (21 cases). Results: 36 (4.3%) out of 834 robotic procedures were included in our analysis: 20 (56.56%) females. The mean age was 63 years and 30% of patients were ≥ 70 years. 2 (5.55%) procedures were performed at night. No conversions to open were reported in this series. According to the Clavien-Dindo classification, 2 (5.5%) major complications were collected. Intraoperative and 30-day mortality were 0%. Conclusions: Our study demonstrates that RS may be a useful and reliable approach also to AES and intraoperative laparoscopic complications when performed in selected hemodynamically stable patients in very well-trained robotic centers. The technology may increase the minimally invasive use and conversion rate in emergent settings in a completely robotic or hybrid approach. [ABSTRACT FROM AUTHOR]

An autoclave is a device for sterilizing medical and surgical tools in hospitals and healthcare centers. The lack of electric power supply in some hospitals and rural health centers, in addition to pollution caused by fossil fuels, reinforces the need to search for other energy sources to operate the autoclave. Solar autoclaves can be utilized as an alternative choice in such circumstances. This work describes the effectiveness of the solar-powered autoclave, which is used for wet sterilization. The device is designed from a parabolic dish reflector covered with mirrors that reflect solar radiation toward the center of a focus for heating a vessel. It was found that the highest value of the average energy efficiency was 19 % and the average exergy efficiency was 2 % at 9:00 am and the lowest value of the average energy efficiency was 1.5% and the average exergy efficiency was 0.4 % at 12:00 noon. The effectiveness was tested against (pseudomonas aeruginosa) bacteria, where the highest values of steam temperatures for sterilization were recorded between 121 °C to 122 °C. It was also found that the sterilization efficiency was 100 % under steam pressure of 1.18 bar for every 30 minutes of the sterilization cycle for the periods 11:00 am to 11:30 am, 11:30 am to 12:00 noon, and 12:00 noon to 12:30 pm). [ABSTRACT FROM AUTHOR]

Objective: To investigate the feasibility of fluorescence molecular imaging (FMI), using cetuximab‐800CW, as an intraoperative tool to determine surgical margins in penile squamous cell carcinoma (PSCC). Patients and methods: A total of 11 patients with PSCC received 75 mg cetuximab followed by 15 mg cetuximab‐800CW 2 days before surgery. FMI of the whole excision specimen and tissue slices was performed. Fluorescence visualisation was correlated to histopathology. Based on tumour and healthy tissue regions of interest, mean fluorescence intensity was calculated for each individual patient. Results: Significant differences between tumour and healthy mean fluorescence intensity were found with tumour‐to‐background ratios of a median (IQR) of 1.51 (0.99) and a mean (SD) of 1.51 (0.32) in the excision specimen and tissue slices, respectively. One patient showed a high relative fluorescence intensity with a signal‐to‐background ratio of 1.79, corresponding to a tumour‐positive margin on fresh frozen sectioning. Conclusion: In this Phase I study we showed that cetuximab‐800CW seems suitable to discriminate PSCC from background tissue. The tracer was well tolerated, and no false positive spots were seen. [ABSTRACT FROM AUTHOR]

As hospitals strive to reduce their environmental footprint, there is an ongoing debate over the environmental implications of reusable versus disposable linens in operating rooms (ORs). This research aimed to compare the environmental impact of reusable versus single-use OR bed covers and lift sheets using life cycle assessment (LCA) methodology. LCA is an established tool with rigorous methodology that uses science-based processes to measure environmental impact. This study compared the impacts of three independent system scenarios at a single large academic hospital: reusable bed covers with 50 laundry cycles and subsequent landfill disposal (System 1), single-use bed covers with waste landfill disposal (System 2), and single-use bed covers with waste disposal using incineration (System 3). The total carbon footprint of System 1 for 50 uses was 19.83 ​kg carbon dioxide equivalents (CO 2 -eq). System 2 generated 64.99 ​kg CO 2 -eq. For System 3, the total carbon footprint was 108.98 ​kg CO 2 -eq. The raw material extraction for all the material to produce an equivalent 50 single-use OR bed cover kits was tenfold more carbon-intensive than the reusable bed cover. Laundering one reusable OR bed cover 50 times was more carbon intensive (12.12 ​kg CO2-eq) than landfill disposal of 50 single-use OR bed covers (2.52 ​kg CO2-eq). Our analysis demonstrates that one reusable fabric-based OR bed cover laundered 50 times, despite the carbon and water-intensive laundering process, exhibits a markedly lower carbon footprint than its single-use counterparts. The net difference is 45.16 ​kg CO2-eq, equivalent to driving 115 miles in an average gasoline-powered passenger vehicle. This stark contrast underscores the efficacy of adopting reusable solutions to mitigate environmental impact within healthcare facilities. • Life cycle assessments are a data-driven approach to facilitate healthcare sustainability • A reusable bed cover laundered 50x has a lower carbon footprint than single-use ones • Surgical equipment choices by surgeons can affect the environment [ABSTRACT FROM AUTHOR]

In response to appeals from the WHO and The Lancet, a collaborative statement from over 200 medical journals was published in September 2021, advising international governments to combat the "catastrophic harm to health" from climate change. Healthcare, specifically surgery, constitutes a major contributor to environmental harm that remains unaddressed. This article provides practical guidance that can be instituted at a departmental, hospital and national level to institute transformative, sustainable efforts into practice. We also aim to provoke healthcare leaders to discuss policy-making with respect to this issue and highlight the necessity for sustainability to become a core domain of quality improvement. The average orthopaedic service produces 60% more waste than any other surgical specialty. Fortunately, simple measures such as a comprehensive education programme can decrease waste disposal costs by 20-fold. Other simple and effective "green" measures include integrating carbon literacy into surgical training, prioritising regional anaesthesia and conducting recycling audits. Furthermore, industry must take accountability and be incentivised to limit the use of single-item packaging and single-use items. National policymakers should consider the benefits of reusable implants, reusable surgical drapes and refurbishing crutches as these are proven cost and climate-effective interventions. It is crucial to establish a local sustainability committee to maintain these interventions and to bridge the gap between clinicians, industry and policymakers. • The WHO has specified climate change as the greatest threat to global health in the 21st century. • Orthopaedic surgery produces 60% more waste than any other specialty. • Industry can boost sustainability by regulating single-use items and packaging. • National policy should allow for reusable surgical equipment, implants, drapes and crutches. • Simple initiatives like accurate waste segregation and departmental audit have a sizeable impact. [ABSTRACT FROM AUTHOR]

Background: Atlantoaxial instability is the most common cervical instability in patients with rheumatoid arthritis (RA). Its course may differ in different patients and may have different degrees of severity and symptoms. Methods: There are a number of studies on systemic factors associated with the development of this instability, but there are few publications in the scientific literature on the influence of biomechanical factors on the development of cervical instability. One of the areas that allows the study of biomechanical factors influencing spine pathologies is the analysis of sagittal balance using radiological parameters. The study of radiological parameters of sagittal balance has contributed to understanding the pathology of selected spine diseases and is currently an indispensable tool in planning surgical treatment. Results: The presented study, conducted on a group of RA patients with cervical instability, was performed to look for a relationship between C1–C2 instability and sagittal balance parameters. Conclusions: Among the examined selected parameters, a statistically relationship between C1–C2 instability and the Cobb angle C1–C7 and OD-HA parameters has been found. This confirms the need for further in-depth research on this areas. [ABSTRACT FROM AUTHOR]