Search

The purpose of this article is to investigate a practical scheduling problem in which a group of elective surgical cases are scheduled over time, while considering their unpredictable durations and potential delays in the sterilisation of surgical instruments. The primary objectives were to schedule the maximum number of surgeries and decrease overtime for the surgical staff, as well as limit the number of instruments requiring emergency sterilisation. The study was conducted in collaboration with the University Hospital of Angers in France, which also contributed historical data for the experiments. We propose two robust mixed integer linear programming models, which are then solved iteratively through a rolling horizon approach, in which the objective functions are taken into account in lexicographic order. Experiments on randomly generated instances indicated which of the two approaches had better performance. Comparison of the results for a real-world scenario involving actual planning at the hospital indicated a greater than 69% decrease in overtime, and a minimum of 92% fewer stressful situations in the sterilising unit. [ABSTRACT FROM AUTHOR]

BACKGROUND: For patients with clinically node-positive (cN+) breast cancer undergoing neoadjuvant chemotherapy (NAC), retrieving previously clipped, biopsy-proven positive lymph nodes during sentinel lymph node biopsy [i.e., targeted axillary dissection (TAD)] may reduce false negative rates. However, the overall utilization and impact of clipping positive nodes remains uncertain. PATIENTS AND METHODS: We retrospectively analyzed cN+ ISPY-2 patients (2011-2022) undergoing axillary surgery after NAC. We evaluated trends in node clipping and associations with type of axillary surgery [sentinel lymph node (SLN) only, SLN and axillary lymph node dissection (ALND), or ALND only] and event-free survival (EFS) in patients that were cN+ on a NAC trial. RESULTS: Among 801 cN+ patients, 161 (20.1%) had pre-NAC clip placement in the positive node. The proportion of patients that were cN+ undergoing clip placement increased from 2.4 to 36.2% between 2011 and 2021. Multivariable logistic regression showed nodal clipping was independently associated with higher odds of SLN-only surgery [odds ratio (OR) 4.3, 95% confidence interval (CI) 2.8-6.8, p < 0.001]. This was also true among patients with residual pathologically node-positive (pN+) disease. Completion ALND rate did not differ based on clip retrieval success. No significant differences in EFS were observed in those with or without clip placement, both with or without successful clip retrieval [hazard ratio (HR) 0.85, 95% CI 0.4-1.7, p = 0.7; HR 1.8, 95% CI 0.5-6.0, p = 0.3, respectively]. CONCLUSION: Clip placement in the positive lymph node before NAC is increasingly common. The significant association between clip placement and omission of axillary dissection, even among patients with pN+ disease, suggests a paradigm shift toward TAD as a definitive surgical management strategy in patients with pN+ disease after NAC.

Background: The surgical time-out is a critical safety measure used in the operating room (OR). We examined the mediating relationship of the length of the time-out between team perceived usefulness of the time-out, and the rate at which the circulating nurse left the OR to retrieve instruments. Methods: 60 cardiac surgical teams were observed performing their work. The length of the time-out and the rate at which the circulating nurse left the OR was obtained by observation of the surgical team. We administered a survey with a 7-point Likert scale to assess the surgical staff's perceived usefulness of the time-out at the end of the surgery. An analysis was conducted to test if length of the time-out mediated the relationship between perceived usefulness of the time-out and rate at which the nurse leaves the OR to retrieve an instrument useful for the surgery. Results: The relationship of the length of the time-out with the rate at which the nurse leaves the OR was non-significant (β = 0.089, p =.496). However, the relationship between perceived usefulness of the time-out with the length of the time-out was significant (β = 0.346, p <.05) and the effect between perceived usefulness of the time-out and the rate at which the nurse left the OR was statistically significant (β= − 0.424, p = < 0.001). Conclusion: In this study we explore how surgical teams' attitudes towards the usefulness of the time-out affect its utilization, and how attitudes about time-outs are related to the important process measure of rate at which the circulating nurse leaves the OR. The full mediation model was not supported by the data; however, there appears to be a relationship between the perceived usefulness of the time-out and the rate at which the circulating nurse leaves the OR. [ABSTRACT FROM AUTHOR]

Background: Untreated cubitus varus results in cosmetic deformity as well as posterolateral rotatory instability at the elbow if longstanding. French osteotomy with its modifications is the most commonly done osteotomy and relies on a medial intact hinge and these osteotomies fail to address the lateral prominence. Intraoperative fixator assistance to adjust the translation and fine tune the osteotomy is a novel method to address the lateral prominence. This prospective study analyses the efficacy of the same. Materials and Methods: A total of 16 consecutive patients presenting with unilateral cubitus varus resulting from mal-united supracondylar fracture of humerus were included. The humero-ulnar angle correction required, size of lateral closing wedge and amount of translation required were calculated. After a lateral surgical approach, one Schanz pin of size 2.5mm–3.5mm depending on age, was passed just above the level of distal humerus physis, lateral to medial; a second pin was inserted in the shaft of humerus, again lateral to medial. Pre-calculated wedge of bone was removed, angular correction as well as translation done; fine tuning of the osteotomy was achieved using fixator assistance. Rotational and hyperextension deformities were corrected simultaneously. Fixation of the osteotomy was done by multiple K wires or plates, depending on the age of the patient. Observation and Results: The mean carrying angle corrected to 10.4 degrees valgus from a preoperative value of 19.8 degrees varus. The mean humero-ulnar angle corrected to 9.6 degrees valgus from a preoperative value of 19.6 degrees varus. The mean lateral prominence index reduced to − 3.8% from a preoperative value of − 5.5%. The mean cosmetic correction score was 9 (Max 10) from a preoperative value of 1.9. No patient had an 'S' shaped deformity in the operated elbow. No nerve palsies were observed in any of the operated patients. Conclusions: Fixator assistance during surgery allows angular, translation and rotational control of the fragments to fully correct the deformity. It also allows fine tuning of the osteotomy during surgery. [ABSTRACT FROM AUTHOR]

Objective: This study provides a comprehensive global overview of surgical instrument traceability systems and accentuates their growing importance in healthcare. Background: Surgical instruments pose risks to patient safety, economic costs, logistical challenges, and environmental impact. The increasing focus on instrument traceability reflects its potential to address these issues. Methods: We performed a systematic review using PRISMA guidelines, analyzing articles from 2000 to 2023 across five digital libraries (PubMed, Web of Science, IEEE, ACM, Google Scholar). Our review concentrated on traceability systems' lifecycle for reusable and sterile surgical instruments. Results: Out of 7189 articles retrieved, 22 were selected for evaluation, and only 6 were considered relevant after a thorough examination. These studies mainly deployed Radio Frequency Identification (RFID) technology. They enhance patient safety, reduce environmental impact, improve economic efficiency, and optimize logistics. Additionally, these systems encourage more responsible surgical practices. Conclusions: Our study underscores the limited applied research in this field and discusses system architectures and performance metrics. It proposes future research directions, including the development of public databases, integration of automation, and investment in artificial intelligence (AI) and computer vision to improve traceability and risk analysis. [ABSTRACT FROM AUTHOR]

Background & Objective: This study aimed to compare the outcomes of vaginal cuff separation using monopolar hook or harmonic scalpel in laparoscopic hysterectomy. Materials & Methods: A retrospective analysis was conducted on 210 women who underwent laparoscopic hysterectomy between 2022 and 2024. A total of 105 cases for each surgical method were randomly selected from patient records. Demographic and clinical data were extracted from medical records and analyzed using IBM SPSS version 26. P-value < 0.05 was deemed as statistically significant. Results: The mean age in the harmonic and monopolar groups was 24.76 (±5.41) and 25.75 (±4.64) years, respectively. There were no statistically significant differences between the groups in terms of age, BMI, hospitalization, history of previous abdominal surgery, preoperative hemoglobin levels, and hormone therapy (P>0.05). The mean postoperative hemoglobin level in the harmonic group (11.83 ± 1.26) was significantly higher than in the monopolar group (9.04 ± 1.13) (P<0.001). The average duration of vaginal cuff separation was significantly shorter in the monopolar group (22.24 ± 4.59) compared to the harmonic group (28.70 ± 5.93) (P<0.001). Postoperative complications, particularly vaginal lacerations, were less frequent in the harmonic group (45.7%) than in the monopolar group (60%) (P=0.015). The incidence of incidental findings, especially endometriosis, was lower in the harmonic group (12.4%) compared to the monopolar group (23.8%) (P=0.031). No cases of vaginal cuff dehiscence were observed in either group. Conclusion: This study demonstrated that vaginal cuff separation using harmonic scalpel in laparoscopic hysterectomy is associated with better outcomes compared to monopolar hook. [ABSTRACT FROM AUTHOR]

Transabdominal preperitoneal patch plasty (TAPP) versus total extraperitoneal patch plasty (TEP) are surgical techniques commonly used to treat inguinal hernia. However, studies indicate that both procedures may lead to significant complications, particularly gastrointestinal complications, some of which can be life-threatening. We statistically analyzed the complications caused by adult inguinal hernia patients admitted from 2018 to 2022. We focused on gastrointestinal complications and conducted a case-by-case analysis on their causes and treatment processes. A total of 1034 patients were included in the final analysis, with 783 patients receiving TAPP treatment and 251 patients undergoing TEP. The overall complication rate for the TAPP group was slightly higher at 4.72% compared to 3.58% in the TEP group, but the difference was not statistically significant (p = 0.446). The incidence of both common and gastrointestinal complications is similar between the two groups, with no significant difference observed. Five patients (0.48%) suffered gastrointestinal complications, one with gastric perforation after TEP surgery, and four during TAPP surgery. All five cases of gastrointestinal complications were Grade III or higher according to the Clavien-Dindo classification, and all required reoperation. Gastrointestinal complications, though rare in LIHR, often require readmission and reoperation. Attempting non-operative management of such complications may lead to disastrous consequences. The majority of these complications are attributed to improper use of surgical instruments, necessitating vigilance on the part of the surgical team in preventing them. [ABSTRACT FROM AUTHOR]

Background/Objectives: Patient-specific instrumentation (PSI) in total knee arthroplasty (TKA) uses preoperative three-dimensional imaging to create cutting blocks tailored to patient anatomy. However, there is debate regarding the additional benefits of PSI in terms of improved alignment or functional outcomes compared to using conventional instruments. Although PSI design has undergone continuous development, the improvements have not been incorporated. Therefore, the aim of this study was to compare the surgical time and radiological outcomes between advanced-design PSI and conventional instruments. Methods: We conducted a retrospective review of 328 patients who underwent primary TKAs using PSI for osteoarthritis and compared them with 328 matched patients who underwent TKA performed with conventional instruments during the same period (March 2023 to August 2024). We compared the surgical time and component alignment between the advanced-design PSI group and the conventional instrument group. Results: The average surgical time was significantly shorter in the advanced-design PSI group (47.6 ± 12.4 min) compared to the conventional instrument group (59.2 ± 14.2 min, p < 0.05). The advanced PSI design group had a significantly lower occurrence of outliers in hip–knee–ankle alignment (7%) compared to the conventional instrument group (36.3%). This trend was also observed in femoral coronal alignment, tibial coronal alignment, and femoral sagittal alignment. Conclusions: The use of advanced-design PSI demonstrated significantly reduced surgical time and improved alignment compared to conventional instruments. This highlights that proper design is a key factor for PSI to achieve superior biomechanical effects. Our study shows that advanced-design PSI technology has the potential to replace conventional instruments in TKA, though further research is required to determine its clinical outcomes and economic benefits. [ABSTRACT FROM AUTHOR]

During gastric surgery, the stomach wall is compressed with clamps and sutures or staple lines. These short- and long-term deformations can severely compromise the integrity of the tissue and make it difficult for the stomach wall to respond and remodel to the new loading conditions. Consequently, serious intra- and postoperative complications such as the formation of leaks during bariatric surgeries, can be associated with these immense tissue deformations. Hence, the study aimed to investigate the effects of compressive loading of the stomach wall in the radial direction. This was done by macroscopic mechanical loading of the stomach wall in each region of the stomach and evaluating the microstructural changes inflicted in the tissue. For this purpose, several imaging techniques were used, i.e., a histological analysis, second-harmonic generation microscopy, and X-ray micro-computed tomography. The combination of these three methods allowed us to investigate the gradual compression of the different stomach layers as well as the local reorientation and deformation of the main microstructural components, e.g., collagen fibers and muscle bundles. Importantly, this study found that the collagen bundles in the stomach wall straighten and reorient toward the circumferential-longitudinal plane and partially fan out with increased radial compressive deformation. The 3D scans of the stomach wall indicated a deterioration of the blood vessels and buckling of the mucosal glands due to compression. Statement of significance Unfortunately, little is known about the load transfer in the stomach wall during gastric surgery and the associated deformations on the macro- and microscale. The present study investigates the structural changes of the stomach wall, its layers and the inherent biological building blocks using histology, multi-photon microscopy, and micro-computed tomography. For the first time, the layer-specific response to stepwise radial compression of the stomach wall was studied, the related collagen fiber parameters were estimated, and a 3D sample structure was visualized. This clinically-oriented study links the structural changes within the wall to the postoperative remodel- ing process and the irreversibly altered gastric motility, thereby underscoring its relevance to the field of biomedical engineering, e.g., the development and improvement of surgical instruments. [Display omitted] [ABSTRACT FROM AUTHOR]

Simple Summary: Robot-assisted radical prostatectomy (RARP) has been standardized for prostate cancer (PCa) over the last 20 years. Using the Sapienza residency program 3+2 trocar configuration with a second laparoscopic port replacing the fourth robotic arm, the bedside assistant is more involved during the surgical procedure and requires higher laparoscopic skills. In this study, we examine perioperative, functional, and oncological results of RARP using the Sapienza 3+2 trocar configuration in cases where the bedside assistant was either an attending surgeon or a urology resident. We identified that the level of expertise of the bedside assistant did not influence oncological and functional results. With this premise, the Sapienza 3+2 trocar configuration could be employed in residency programs to allow laparoscopic training of surgical residents without compromising the current request for robotic-assisted surgeries. Background/Objectives: Robot-assisted radical prostatectomy (RARP) for the treatment of prostate cancer (PCa) has been standardized over the last 20 years. At our institution, only n = 3 rob arms are used for RARP. In addition, n = 2, 12 mm lap trocars are placed for the bedside assistant symmetrically at the midclavicular lines, which allows for direct pelvic triangulation and greater involvement of the assisting surgeon. The aim of our study was to compare surgical and perioperative outcomes of RARP performed using our alternative trocar placement with no fourth robotic arm in the subgroups of experienced attending surgeons and post-graduate residents as bedside assistants. Residents' satisfaction was also explored. Methods: RARPs performed within the urology residency program between 2019 and 2024 were retrospectively analyzed. Only rob procedures performed using our 3+2 trocars configuration were included. Intra- and postoperative outcomes, as well as long-term functional outcomes including continence recovery and potency, were assessed, stratified by the level of expertise of the bedside assistant, i.e., an experienced attending or post-graduate Year I–III resident. Satisfaction of residents assigned to the two groups during their robotic rotation was evaluated considering three domains with a score from 1 to 10: insight into surgical procedure, confidence level, and gratification level. Results: Out of n = 281 RARP procedures, the bedside assistant was an attending in 104 cases and a resident in 177. Operative time was found to be slightly longer in cases where the second operator was a resident (attendings vs. residents: 134 ± 40 vs. 152 ± 24; p < 0.001). Postoperative hospitalization time was longer in patients in the resident group (attendings vs. residents: 3.9 ± 1.6 vs. 4.3 ± 1 days; p = 0.025). However, cases where the second operator was a resident had a lower rate of positive surgical margins, with rates of 19.7% in the resident and 43.3% in the attending surgeon cohorts (OR = 0.32; 95% CI 0.18–0.55). This difference remained significant in multivariate analysis. There was no significant difference in postoperative blood transfusion rates (attendings vs. residents: 1.9% vs. 1.2%; p = 0.6). Similarly, long-term functional outcomes in terms of erectile dysfunction and urinary incontinence rates mostly overlapped between groups. The mean score in all three domains evaluating residents' satisfaction was significantly higher when residents actively participated in the surgical procedure as bedside assistants (p = 0.02, p = 0.004, and p < 0.001, respectively, for insights into surgical procedure, confidence level, and gratification level). Conclusions: These findings provide insight into how an alternative port positioning during RARP could improve the involvement of the bedside assistant, particularly residents, without compromising perioperative outcomes or surgical safety. [ABSTRACT FROM AUTHOR]

Accurate identification of surgical instruments is crucial for efficient workflows and patient safety within the operating room, particularly in preventing complications such as retained surgical instruments. Artificial Intelligence (AI) models have shown the potential to automate this process. This study evaluates the accuracy of publicly available Large Language Models (LLMs)—ChatGPT-4, ChatGPT-4o, and Gemini—and a specialized commercial mobile application, Surgical-Instrument Directory (SID 2.0), in identifying surgical instruments from images. The study utilized a dataset of 92 high-resolution images of 25 surgical instruments (retractors, forceps, scissors, and trocars) photographed from multiple angles. Model performance was evaluated using accuracy, weighted precision, recall, and F1 score. ChatGPT-4o exhibited the highest accuracy (89.1%) in categorizing instruments (e.g., scissors, forceps). SID 2.0 (77.2%) and ChatGPT-4 (76.1%) achieved comparable accuracy, while Gemini (44.6%) demonstrated lower accuracy in this task. For precise subtype identification of instrument names (like "Mayo scissors" or "Kelly forceps"), all models had low accuracy, with SID 2.0 having an accuracy of 39.1%, followed by ChatGPT-4o (33.69%). Subgroup analysis revealed ChatGPT-4 and 4o recognized trocars in all instances. Similarly, Gemini identified surgical scissors in all instances. In conclusion, publicly available LLMs can reliably identify surgical instruments at the category level, with ChatGPT-4o demonstrating an overall edge. However, precise subtype identification remains a challenge for all models. These findings highlight the potential of AI-driven solutions to enhance surgical-instrument management and underscore the need for further refinements to improve accuracy and support patient safety. [ABSTRACT FROM AUTHOR]

Surface roughness has a great impact on the peristaltic motion of nanofluid flow and plays an important role in engineering, manufacturing, and material sciences. During tissue engineering, imaging techniques, implant surface finish, surgical instrument texture, and tissue engineering, and so forth. This study explores the effects of electrical double layers, surface roughness, velocity slip, and thermal slip to investigate the heat transfer rate of cobalt and alumina nanoparticles with water through uniform and nonuniform horizontal tubes. In the present study, the Jeffrey nanofluid flow model is chosen to investigate the heat transfer phenomenon of hybrid nanofluids based on alumina and cobalt nanoparticles suspension in water. The effects of electroosmosis, surface roughness, viscous dissipation, heat source/sink parameter, velocity, and thermal slips are also under consideration during the peristaltic motion of hybrid nanofluid in uniform and nonuniform tubes. The mathematical software MATHEMATICA 13.3 is utilized to find the exact solution and graphical results to investigate the complicated flow behavior. It is noticed that the velocity near the walls of the tube is lower for the surface roughness parameter and higher in the core part. The behavior of velocity for the remaining parameter is the opposite. The temperature of the current fluid flow increases for all parameters except the surface roughness parameter. The effects of velocity for hybrid nanofluid are prominent as compared with nanofluid in the core part. The temperature profile and heat transfer rate for hybrid nanofluids are lower as compared with nanofluids, which shows the cooling effects. This study is beneficial for hyperthermia, gene therapy, drug delivery, and tissue engineering. [ABSTRACT FROM AUTHOR]

Applying deep learning (DL) for annotating surgical instruments in robot-assisted minimally invasive surgeries (MIS) represents a significant advancement in surgical technology. This systematic review examines 48 studies that utilize advanced DL methods and architectures. These sophisticated DL models have shown notable improvements in the precision and efficiency of detecting and segmenting surgical tools. The enhanced capabilities of these models support various clinical applications, including real-time intraoperative guidance, comprehensive postoperative evaluations, and objective assessments of surgical skills. By accurately identifying and segmenting surgical instruments in video data, DL models provide detailed feedback to surgeons, thereby improving surgical outcomes and reducing complication risks. Furthermore, the application of DL in surgical education is transformative. The review underscores the significant impact of DL on improving the accuracy of skill assessments and the overall quality of surgical training programs. However, implementing DL in surgical tool detection and segmentation faces challenges, such as the need for large, accurately annotated datasets to train these models effectively. The manual annotation process is labor-intensive and time-consuming, posing a significant bottleneck. Future research should focus on automating the detection and segmentation process and enhancing the robustness of DL models against environmental variations. Expanding the application of DL models across various surgical specialties will be essential to fully realize this technology's potential. Integrating DL with other emerging technologies, such as augmented reality (AR), also offers promising opportunities to further enhance the precision and efficacy of surgical procedures. [ABSTRACT FROM AUTHOR]

Background: Contamination of sterilized surgical instruments is not a typically suspected source of increased infection rate, especially if no abnormalities in the sterilization process are detected. Purpose/Hypothesis: The purpose of this study was to report increased infection rates after knee ligament reconstructions due to undetectable sterilization process errors leading to residual moisture, not limited to a specific surgical tool. It was hypothesized that (1) residual moisture on surgical tools due to autoclave overloading would not be detected by autoclave self-diagnostics, chemical and biological tests, or organoleptic assessment and (2) this kind of contamination may elevate infection rates, especially in knee intra-articular reconstruction procedures. Study Design: Case series; Level of evidence, 4. Methods: A retrospective analysis of increased postoperative knee infection rate between January 2013 and January 2015 was performed. The inclusion criteria were all articular procedures. The exclusion criteria were joint arthroplasties, fractures, and open joint wounds. Criteria defining postoperative joint infections were as follows: (1) pain and effusion relapse and loss of achieved range of motion; (2) opaque/cloudy fluid on arthrocentesis; (3) fever >37.5°C lasting ≥3 days; and (4) ≥2-fold elevation in C-reactive protein levels, with symptoms onset within 21 days postoperatively. A negative culture result did not exclude a postoperative joint infection diagnosis and treatment. The data were summarized, and the infection rates of given subgroups were compared with a 2-tailed Fisher exact test. A risk ratio (RR) with 95% CIs was calculated. Results: Out of 533 orthopaedic procedures screened for inclusion, 4 joint arthroplasties, 7 fractures, and 2 open joint wounds were excluded. The remaining 520 articular procedures were included in the study—118 knee cruciate ligament reconstructions, 130 knee nonreconstruction arthroscopies, and 272 knee extra-articular/other joints arthroscopic and sports procedures. A total of 21.2% of knee intra-articular ligament reconstructions were complicated by postoperative joint infections, compared with 1.5% of knee nonreconstruction arthroscopies (RR, 13.8 [95% CI, 3.3-56.9]; P <.001) and 0.4% of knee extra-articular/other joints arthroscopic and sports procedures (RR, 57.6 [95% CI, 7.9-420.4]; P <.001). The source of the increased infection rate was identified as residual moisture on surgical tools due to autoclave overloading. This residual moisture was not detected by autoclave self-diagnostics, chemical and biological tests, or organoleptic assessment. After reducing the insert of surgical tools in the autoclave, the infection rate in the next 2 years after knee reconstructive procedures returned to <1% (P <.001). Conclusions: Our study demonstrated that residual moisture after the sterilization process may be an underestimated source of postoperative joint infections, undetectable in routine procedures and tests. Overcrowding of surgical equipment in the autoclave may be a root cause of this residual moisture identified. This kind of contamination may elevate the infection rate, especially in knee intra-articular reconstruction procedures. [ABSTRACT FROM AUTHOR]

The demographic shift has increased the demand for surgical interventions to address age-related degenerative diseases, such as spinal fusion. Accurate placement of pedicle screws, crucial for successful spinal fusion, varies widely with physician experience. Integrating tissue sensing into spine surgical instruments allows intraoperative examination of tissue properties, providing surgeons with additional information to prevent screw misplacement. This paper introduces a handheld fiber-optic tissue sensing device for real-time bone tissue differentiation during spine surgery using Diffuse Reflectance Spectroscopy (DRS). Our prototype employs laser diodes at two distinct wavelengths for tissue illumination, eliminating the need for a spectrometer and enabling direct light collection with a photodiode. The device includes a printed circuit board (PCB) with driver circuits that are adjustable for varying laser diode output power, and signal amplification to convert the photodiode current to a measurable voltage signal. Controlled by a microcontroller, the device computes a reflectance ratio from both laser diode signals to provide real-time audio feedback to surgeons across various healthcare settings. Despite challenges in coupling efficiencies from manual fiber-coupling of the diodes, our prototype is able to emit and collect light to distinguish bone tissues with DRS, demonstrating feasibility. It is compact, made of low-cost and readily available components, and offers fast, real-time feedback, thus serving as a successful proof-of-concept for enhancing surgical accuracy during spinal fusion procedures. [ABSTRACT FROM AUTHOR]

Venoarterial extracorporeal membrane oxygenation (VA-ECMO) has been utilized to treat massive pulmonary embolism (PE) accompanied by cardiac arrest or refractory cardiogenic shock. Our team opted for a femoral-femoral approach for vascular cannulation, using drainage and return cannulas in the common femoral vein and artery, respectively. However, femoral venous cannulation can be limited or challenging due to the presence of thrombus in the inferior vena cava (IVC), making the insertion of the drainage cannula via the femoral vein difficult. We present the case of a patient with massive PE who underwent aspiration thrombectomy and insertion of an IVC filter, followed by the initiation of VA-ECMO for cardiac arrest. We successfully inserted a femoral venous return ECMO cannula through the inferior vena cava filter during extracorporeal cardiopulmonary resuscitation. The patient stabilized with these interventions and ultimately achieved a favorable outcome with normal neurological status. [ABSTRACT FROM AUTHOR]

Background: To investigate the effect of the position of the femoral endobutton on knee function in the posterior cruciate ligament reconstruction (PCLR). Methods: A retrospective study was conducted to analyze 96 patients who underwent single-bundle reconstruction of posterior cruciate ligament (PCL) in our hospital from January 2020 to June 2023. The patients were divided into three groups according to the position of the endobutton on the lateral knee radiography. The first group is the position of endobutton in front of the lateral cortex of the femur, the second group is the position of endobutton in back of the lateral cortex of the femur, and the third group is the position of endobutton behind the femur. Knee Lysholm score, International Knee Documentation Committee (IKDC) Evaluation, Tegner Activity Scale, knee flexion angle and postoperative complication rate of the three groups were compared to evaluate whether there were statistical differences among the three groups. Results: There were 39 patients in group 1, 46 patients in group 2, and 11 patients in group 3. The mean Lysholm Knee Scores of the group 1 was 91.77, 92.17 in group 2, and 90.36 in group 3. The mean IKDC Evaluation of group 1 was 90.48, 92.41 in group 2, and 93.00 in group 3. Tegner Activity Level was 5.69 in group 1, 5.72 in group 2, and 5.45 in group 3. The mean flexion degree was found as 125° in patients in group1, 127° in group 2, and 122° in group 3. There was no statistically significant difference between Lysholm Knee Scores (p = 0.434), IKDC (p = 0.068), Tegner Activity Level (p = 0.797), and knee flexion angle (p = 0.135). There was also no significant difference in the incidence of complications among the three groups (p > 0.05). Conclusion: There were not statistically differences in clinical functional results when comparing patients' endobutton location on femur. This indicates that it does not need to adjust the orientation of the exit hole of the femur whether it is forward or backward during the PCLR. [ABSTRACT FROM AUTHOR]

The nanosecond pulsed fibre laser (NsPFL) treatment is extensively employed to distinguish hospital surgical instruments (micro-surgical forceps, surgical blades, orthopaedic drills, and high-precision laparoscopic tools), which are generally composed of stainless steel. Nevertheless, if the laser parameters are not properly optimised, this process may unintentionally provoke corrosion. Maintaining the structural integrity of these materials is essential for ensuring patient safety and minimising long-term costs. This work aims to optimise the laser scanning parameters for marking 316L stainless steel (316L SS), seeking to improve its corrosion resistance. The corrosion behaviour was assessed by using open circuit potential (OCP), potentiodynamic polarisation curves (PPc), and electrochemical impedance spectroscopy (EIS) techniques, conducted in 0.9% wt NaCl solution at a controlled temperature of 25 ± 1 °C. A comprehensive study employing optical profilometry has significantly enhanced our understanding of the corrosion micromechanisms of 316L SS, comparing specimens both with and without NsPFL treatment. Considering applications involving environments rich in chloride ions, the results indicated that the NsPFL-316L SS samples demonstrated markedly enhanced performance compared to the untreated base material after 48 h of immersion in 0.9% wt NaCl solution. This improvement is particularly noteworthy given the widespread utilisation of 316L SS in the manufacturing of surgical instruments, where corrosion resistance is of paramount importance. [ABSTRACT FROM AUTHOR]

Background: This study compared the results of stapled hemorrhoidopexy (SH) and harmonic scalpel hemorrhoidectomy (HSH) in the management of grade III and grade IV piles regarding the time of the procedure, postoperative pain, patient satisfaction, wound infection, bleeding, incontinence, and recurrence within 1 year. Patients and methods: This was a single-blind, prospective, randomized, controlled, single-center trial conducted from January to December 2022 that included 50 (68.75%) male and 20 (31.25%) female patients with third- and fourth-degree piles. Results: The patients were divided into two groups of 35 patients each. Group I underwent SH and group II underwent HSH. The mean age of group I was 42.94 years and of group II, 42.20 years. The mean time of the procedure was 24.42 min ± 2.367 for SH and 31.48 min ± 2.21 for HSH. Postoperative pain in group I was lower than in group II during the first 2 weeks, but there was persistent mild pain in most patients in group I at the 2‑week follow-up. In group II there was significant improvement in pain after 2 weeks, with higher patient satisfaction. Wound infection was detected in 3 (5%) patients in group I and no patients in group II (p = 0.077). Postoperative bleeding occurred in 4 (11.4%) patients in group I in the form of spotting after defecation only during the first postoperative month; no bleeding was detected in group II (p = 0.039). There were 3 (15%) cases of flatus incontinence but after taking a detailed history these were found to be cases of urgency to defecate rather than incontinence. There were 7 (20%) cases of recurrence at the 1‑year follow-up in group I and 1 (2.9%) case in group II (p = 0.024). Conclusion: Compared with SH, HSH was safer, easier, and associated with a lower incidence of recurrence after 1 year and with higher patient satisfaction. [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]

Background: Endoscopic instrument segmentation is essential for ensuring the safety of robotic‐assisted spinal endoscopic surgeries. However, due to the narrow operative region, intricate surrounding tissues, and limited visibility, achieving instrument segmentation within the endoscopic view remains challenging. Purpose: This work aims to devise a method to segment surgical instruments in endoscopic video. By designing an endoscopic image classification model, features of frames before and after the video are extracted to achieve continuous and precise segmentation of instruments in endoscopic videos. Methods: Deep learning techniques serve as the algorithmic core for constructing the convolutional neural network proposed in this study. The method comprises dual stages: image classification and instrument segmentation. MobileViT is employed for image classification, enabling the extraction of key features of different instruments and generating classification results. DeepLabv3+ is utilized for instrument segmentation. By training on distinct instruments separately, corresponding model parameters are obtained. Lastly, a flag caching mechanism along with a blur detection module is designed to effectively utilize the image features in consecutive frames. By incorporating specific parameters into the segmentation model, better segmentation of surgical instruments can be achieved in endoscopic videos. Results: The classification and segmentation models are evaluated on an endoscopic image dataset. In the dataset used for instrument segmentation, the training set consists of 7456 images, the validation set consists of 829 images, and the test set consists of 921 images. In the dataset used for image classification, the training set consists of 2400 images and the validation set consists of 600 images. The image classification model achieves an accuracy of 70% on the validation set. For the segmentation model, experiments are conducted on two common surgical instruments, and the mean Intersection over Union (mIoU) exceeds 98%. Furthermore, the proposed video segmentation method is tested using videos collected during surgeries, validating the effectiveness of the flag caching mechanism and blur detection module. Conclusions: Experimental results on the dataset demonstrate that the dual‐stage video processing method excels in performing instrument segmentation tasks under endoscopic conditions. This advancement is significant for enhancing the intelligence level of robotic‐assisted spinal endoscopic surgeries. [ABSTRACT FROM AUTHOR]

Background: If an increased posterior tibial slope (PTS) and concomitant unicompartmental osteoarthritis are present, a simultaneous sagittal (slope) and coronal correcting high tibial osteotomy has been recommended. However, no study has investigated the accuracy of such combined high tibial slope correction osteotomies. Purpose: (1) To report the accuracy of navigated high tibial slope correction osteotomies using patient-specific instruments (PSI) and (2) to analyze the influence of an open wedge osteotomy (OWO) versus a closed wedge osteotomy (CWO) and the hinge axis angle (HAA) on the accuracy of the PTS correction. Study Design: Cohort study; Level of evidence, 3. Methods: All PSI PTS-reducing osteotomies performed at 1 institution between 2019 and 2022 were reviewed. Three-dimensional (3D) accuracy was defined as the mean absolute 3D angular difference between the planned and achieved surgical correction (in degrees) in 3D models of computed tomography data. The influence of OWO versus CWO and the HAA on the reported accuracy was analyzed and a cutoff defined using receiver operating characteristic curve analysis. Results: Eighteen patients who underwent a slope-reducing CWO (n = 9) or OWO (n = 9) were included. The 3D accuracy for PTS was 2.3°± 1.1° (mean ± SD), with CWO being more accurate than OWO (1.4°± 0.9° vs 3.1°± 0.6°; P <.01). Accuracy strongly correlated with the HAA (r = 0.788; P <.01). An HAA >38.9° predicted a PTS error >2° (odds ratio, 1.12 [95% CI, 1.04-1.20; P =.004]; area under the curve, 0.95 [95% CI, 0.89-1.00; P <.001]) corresponding to a coronal/sagittal correction of 0.8:1. Conclusion: Slope-reducing osteotomy can accurately be achieved using PSI. CWO demonstrated an increased accuracy when compared with OWO, which strongly depended on the HAA. With an aim of combined PTS and coronal correction, CWO should be considered the primary choice for accurate slope reduction with a coronal/sagittal correction cutoff of 0.8:1 (HAA, 38.9°). [ABSTRACT FROM AUTHOR]

Background: Robot‐assisted implant surgery has emerged as a novel digital technology, and the accuracy need further assessment. Purpose: This study aimed to compare the accuracy of single dental implant placement between a novel semi‐active robot‐assisted implant surgery (RAIS) method and the conventional free‐hand implant surgery (FHIS) method through a multicenter, randomized controlled clinical trial. Materials and Methods: Patients requiring single dental implant placement were recruited and randomized into RAIS and FHIS group. Deviations at the platform, apex, and angle between the planned and final implant positions were assessed in both groups. Additionally, the evaluation of instrument and surgical complications was examined. Results: A total of 140 patients (median age: 35.35 ± 12.55 years; 43 males, 97 females) with 140 implants from four different research centers were included, with 70 patients (70 implants) in the RAIS group and 70 patients (70 implants) in the FHIS group. In the RAIS and FHIS groups, the median platform deviations were 0.76 ± 0.36 mm and 1.48 ± 0.93 mm, respectively (p < 0.001); median apex deviations were 0.85 ± 0.48 mm and 2.14 ± 1.25 mm, respectively (p < 0.001); and median angular deviations were 2.05 ± 1.33° and 7.36 ± 4.67°, respectively (p < 0.001). Similar significant difference also presented between RAIS and FHIS group in platform vertical/horizontal deviation, apex vertical/horizontal deviation. Additionally, implants with self‐tapping characteristics exhibited significantly larger deviations compared with those without self‐tapping characteristics in the RAIS group. Both RAIS and FHIS methods demonstrated comparable morbidity and safety pre‐ and post‐operation. Conclusions: The results indicated that the RAIS method demonstrated superior accuracy in single dental implant placement compared with the FHIS method. Specifically, RAIS exhibited significantly smaller deviations in platform, apex, and angular positions, as well as platform and apex vertical/horizontal deviations. This clinical trial was not registered prior to participant recruitment and randomization. https://www.chictr.org.cn/showproj.html?proj=195045. [ABSTRACT FROM AUTHOR]

Hand gesture recognition and classification play a pivotal role in automating Human‐Computer Interaction (HCI) and have garnered substantial attention in research. In this study, the focus is placed on the application of gesture recognition in surgical settings to provide valuable feedback during medical training. A tool gesture classification system based on Deep Learning (DL) techniques is proposed, specifically employing a Long Short Term Memory (LSTM)‐based model with an attention mechanism. The research is structured in three key stages: data pre‐processing to eliminate outliers and smooth trajectories, addressing noise from surgical instrument data acquisition; data augmentation to overcome data scarcity by generating new trajectories through controlled spatial transformations; and the implementation and evaluation of the DL‐based classification strategy. The dataset used includes recordings from ten participants with varying surgical experience, covering three types of trajectories and involving both right and left arms. The proposed classifier, combined with the data augmentation strategy, is assessed for its effectiveness in classifying all acquired gestures. The performance of the proposed model is evaluated against other DL‐based methodologies commonly employed in surgical gesture classification. The results indicate that the proposed approach outperforms these benchmark methods, achieving higher classification accuracy and robustness in distinguishing diverse surgical gestures. [ABSTRACT FROM AUTHOR]

This study aims to explain our experience with dorsal preservation osteotomies, focusing on transverse, lateral, and dorsal aesthetic lines (DAL) osteotomies. We describe the utilization of a variety of surgical instruments, including osteotomes, saws, burrs, and piezo. This paper describes our concept of transcutaneous ultrasonic osteotomy, microedged-specific osteotomy, applying drills for lateral wall reshaping, and integrating piezo technology to establish new DAL. Furthermore, we present a radix–skull base computed tomography series analysis to evaluate the safety of transverse and radix osteotomies. [ABSTRACT FROM AUTHOR]

To improve patient safety and reduce burden on healthcare professionals and institutions, the individual management of surgical instruments is essential. There are two methods for individual item management: radio-frequency identification (RFID) and barcoding. However, there has been no examination of efficiency regarding reading times. Therefore, this study aimed to compare the reading times of RFID-tagged and barcode-engraved surgical instruments and evaluate the influence of operator proficiency. The participants included 8 individuals and 41 surgical instruments from a varicose vein set. RFID tags and barcodes were attached to the surgical instruments. Five trials were conducted for each, and the reading times were measured. The reading times for RFID-tagged surgical instruments in the skilled and unskilled groups were 64.0 ± 9.0s and 79.4 ± 17.0 s, respectively, whereas those for barcode-engraved surgical instruments were 190.4 ± 28.1 s and 212.3 ± 40.3 s, respectively. Barcodes took 3.0 and 2.7 times longer to read than RFID-tagged instruments for the skilled and unskilled groups, respectively. Additionally, skilled operators using barcodes required 2.4 times more time than unskilled operators using RFID. Even nonmedical individuals were able to achieve quick and accurate readings with RFID. The estimated labor hours per person were $24,146-$42,322 for RFID and $71,078-$110,898 for barcode scanning for a year (working 8 h/d for 250 d). RFID-tagged surgical instruments impose a lighter workload and financial burden than barcode-engraved surgical instruments. RFID technology may also improve patient safety due to less dependency on operator proficiency. [ABSTRACT FROM AUTHOR]

Lipoma is the most common soft tissue benign tumor in the body. It can occur in the head and neck area as well. Fibrolipoma is a variant of lipoma that contains fibrous tissue. Fibrolipomas of the head and neck are relatively rare, and their presentation depends largely on their size and location; some slowly growing tumors might go unnoticed until they reach significant size and become symptomatic. Here, we report a case of 64-year-old male who presented with large pedunculated oropharyngeal fibrolipoma that originated from the posterior oropharyngeal wall and extended downward into the postcricoid area and cervical esophagus. It was excised transorally using rigid endoscope, and ACE Harmonic scalpel was utilized to excise this 16.7 cm long mass. The postoperative pain was minimal, the surgical site showed complete healing, and oral diet was resumed easily in 5 days. [ABSTRACT FROM AUTHOR]

Designing a single domain generalization (DG) framework that generalizes from one source domain to arbitrary unseen domains is practical yet challenging in medical image segmentation, mainly due to the domain shift and limited source domain information. To tackle these issues, we reason that domain-adaptive classifier learning and domain-agnostic feature extraction are key components in single DG, and further propose an adaptive infinite prototypes (InfProto) scheme to facilitate the learning of the two components. InfProto harnesses high-order statistics and infinitely samples class-conditional instance-specific prototypes to form the classifier for discriminability enhancement. We then introduce probabilistic modeling and provide a theoretic upper bound to implicitly perform the infinite prototype sampling in the optimization of InfProto. Incorporating InfProto, we design a hierarchical domain-adaptive classifier to elasticize the model for varying domains. This classifier infinitely samples prototypes from the instance and mini-batch data distributions, forming the instance-level and mini-batch-level domain-adaptive classifiers, thereby generalizing to unseen domains. To extract domain-agnostic features, we assume each instance in the source domain is a micro source domain and then devise three complementary strategies, i.e., instance-level infinite prototype exchange, instance-batch infinite prototype interaction, and consistency regularization, to constrain outputs of the hierarchical domain-adaptive classifier. These three complementary strategies minimize distribution shifts among micro source domains, enabling the model to get rid of domain-specific characterizations and, in turn, concentrating on semantically discriminative features. Extensive comparison experiments demonstrate the superiority of our approach compared with state-of-the-art counterparts, and comprehensive ablation studies verify the effect of each proposed component. Notably, our method exhibits average improvements of 15.568% and 17.429% in dice on polyp and surgical instrument segmentation benchmarks. [ABSTRACT FROM AUTHOR]

Objective: Detailed quantifications of the environmental footprint of operations that include surgery, anaesthesia, and engineering are rare. We examined all such aspects to find the greenhouse gas emissions of an operation. Methods: We undertook a life cycle assessment of 10 patients undergoing total knee replacements, collecting data for all surgical equipment, energy requirements for cleaning, and operating room energy use. Data for anaesthesia were sourced from our prior study. We used life cycle assessment software to convert inputs of energy and material use into outputs in kg CO2e emissions, using Monte Carlo analyses with 95% confidence intervals. Results: The average carbon footprint was 131.7 kg CO2e, (95% confidence interval: 117.7–148.5 kg CO2e); surgery was foremost (104/131.7 kg CO2e, 80%), with lesser contributions from anaesthesia (15.0/131.7 kg CO2e, 11%), and engineering (11.9/131.7 kg CO2e, 9%). The main surgical sources of greenhouse gas emissions were: energy used to disinfect and steam sterilise reusable equipment (43.4/131.7 kg CO2e, 33%), single-use equipment (34.2/131.7 kg CO2e, 26%), with polypropylene alone 13.7/131.7 kg CO2e (11%), and the knee prosthesis 19.6 kg CO2e (15%). For energy use, the main contributors were: gas heating (6.7 kg CO2e) and heating, cooling, and fans (4 kg CO2e). Conclusions: The carbon footprint of a total knee replacement was equivalent to driving 914 km in a standard 2022 Australian car, with surgery contributing 80%. Such data provide guidance in reducing an operation's carbon footprint through prudent equipment use, more efficient steam sterilisation with renewable electricity, and reduced single-use waste. What is known about the topic? The environmental footprint of health care itself is important. Carbon footprinting of surgical operations are becoming more common, although detailed analyses are rare. What does this paper add? The carbon footprint of a total knee replacement was 132 kg CO2e, i.e. the equivalent of driving >900 km in a typical 2022 Australian car. Orthopaedic surgery itself contributed to 80% of the emissions, with anaesthesia and operating room energy use contributing 10% each to the total carbon footprint. What are the implications for practitioners? By replacing single-use with reusable equipment, and by using 100% renewable energy for decontamination, the greenhouse gas emissions for a total knee replacement can become negligible. [ABSTRACT FROM AUTHOR]

Congenital protein C (PC) deficiency is a mostly autosomal dominant hereditary thrombophilia associated with early onset arterial and venous thrombotic diseases. In newborns, PC deficiency results in severe complications such as cerebral hemorrhage, cerebral infarction, and purpura fulminans, leading to death in some cases. We report two cases of deep vein thrombosis diagnosed during pregnancy that prompted genetic testing confirming definitive congenital PC deficiency. One patient with deep vein thrombosis at 30 weeks of gestation underwent anticoagulation therapy with the placement of an inferior vena cava filter. Genetic testing revealed a missense mutation in the PC gene. Another patient developed deep vein thrombosis at 9 weeks of gestation and received anticoagulant therapy, revealing a frameshift mutation in the gene. Genetic testing confirming congenital PC deficiency facilitates tailored postpartum management, including long‐term anticoagulation therapy, based on the mother's thrombosis risk. For newborns, early diagnosis allows timely preparation of treatments, such as freshly thawed frozen plasma or PC replacement therapy and ensures closer monitoring through imaging evaluations, enabling early intervention to decrease the severity of potential complications. Given its utility in managing maternal and neonatal outcomes, early genetic testing in suspected cases of maternal PC deficiency is crucial before delivery. [ABSTRACT FROM AUTHOR]

Protecting the adjacent soft tissues using a channel retractor prevents complications, such as excessive bleeding, during sagittal split ramus osteotomy. However, the saucer-shaped blade of the conventional channel retractor fits poorly into the posterior border of the mandibular ramus during medial osteotomy, which is typically performed parallel to the occlusal plane. Therefore, a novel channel retractor was developed with an adjusted blade bending angle, based on cephalometric data. The lateral cephalograms of 339 Japanese patients with jaw deformities were collected. Cephalometric landmarks were identified based on the definitions of the Downs–Northwestern analysis, and the acute angle between the occlusal and ramus planes was calculated. Based on the consistent mean and median occlusal ramus angles obtained, the blade was bent at 70° in the sagittal plane to fabricate the angled channel retractor. The engagement at the posterior border of the mandibular ramus during medial osteotomy enhances its stability. Furthermore, owing to the bending direction, the angled channel retractor used for medial osteotomy on one side can be used as a channel retractor for lateral osteotomy on the other side. The proposed angled channel retractor offers both stability and versatility for osteotomy manoeuvres. [ABSTRACT FROM AUTHOR]

Successful apical surgery relies on effective magnification and illumination. In the field of endodontics, the microscope has emerged as the predominant tool for meeting these requirements. The rigid endoscope is also a valuable instrument in apical surgery. This study introduces three cases demonstrating the application of endoscope technology in endodontic apical surgery. The first case employs a soft endoscope for treating an anterior tooth with apical periodontitis, the second integrates an endoscope with new attachments for a premolar, and the third combines an endoscope, attachments and navigation for the lower first molar surgery. It revealed that endoscopes offer certain advantages that are not achievable with microscope‐assisted surgery, these cases had a great outcome. In the future, a broader application of endoscopic technology in various procedures is anticipated. [ABSTRACT FROM AUTHOR]

Background: Preventing postoperative infection and promoting patient safety are essential responsibilities of the operating room nurse. In some hospitals, splash basins are used to rinse instruments during surgery, although previous studies emphasise the risk of bacterial contamination. A recent systematic review calls for further investigation into surgical teams' use of splash basins. Objectives: Our objective was to investigate bacterial contamination in splash basins and to identify the variables that may have an influence on this contamination. Methods: This prospective observational pilot study involved collecting, cultivating, and analysing water samples obtained from splash basins during operations performed in the thoracic and neurosurgical departments. The ventilation systems, length of surgery, number of instruments in the splash basin, number of persons present in the operating room, frequency of door openings during surgery, and type of bacteria were observed. Results: Bacterial growth was found in 44% of the final water samples: 41% from the thoracic surgical department, which had laminar airflow ventilation systems/unidirectional airflow ventilation, and 47% from the neurosurgical department, which had conventional ventilation systems/turbulent mixing ventilation. However, the binary logistic regression analysis revealed no significant correlation between bacterial growth and the ventilation systems, length of surgery, number of instruments in the splash basin, number of people in the operating room, or frequency of door openings. The most common types of bacteria found were coagulase-negative staphylococci and Micrococcus luteus. Conclusions: Splash basins become contaminated with bacteria during surgery. Therefore, using splash basins with sterile water is not recommended. Further research is needed to determine the best evidence-based practice for rinsing instruments perioperatively. [ABSTRACT FROM AUTHOR]

Background: Preventing postoperative infection and promoting patient safety are essential responsibilities of the operating room nurse. In some hospitals, splash basins are used to rinse instruments during surgery, although previous studies emphasise the risk of bacterial contamination. A recent systematic review calls for further investigation into surgical teams’ use of splash basins. Objectives: Our objective was to investigate bacterial contamination in splash basins and to identify the variables that may have an influence on this contamination. Methods: This prospective observational pilot study involved collecting, cultivating, and analysing water samples obtained from splash basins during operations performed in the thoracic and neurosurgical departments. The ventilation systems, length of surgery, number of instruments in the splash basin, number of persons present in the operating room, frequency of door openings during surgery, and type of bacteria were observed. Results: Bacterial growth was found in 44% of the final water samples: 41% from the thoracic surgical department, which had laminar airflow ventilation systems/unidirectional airflow ventilation, and 47% from the neurosurgical department, which had conventional ventilation systems/turbulent mixing ventilation. However, the binary logistic regression analysis revealed no significant correlation between bacterial growth and the ventilation systems, length of surgery, number of instruments in the splash basin, number of people in the operating room, or frequency of door openings. The most common types of bacteria found were coagulase-negative staphylococci and Micrococcus luteus. Conclusions: Splash basins become contaminated with bacteria during surgery. Therefore, using splash basins with sterile water is not recommended. Further research is needed to determine the best evidence-based practice for rinsing instruments perioperatively.

Vincent Qin,1,2 Ben LaHood,3 Ivo Guber,4 Sandro Di Simplicio Cherubini5 1Department of Ophthalmology, Delta Hospital (CHIREC), Brussels, Belgium; 2Department of Ophthalmology, Centre Medical du Val, Brussels, Belgium; 3Department of Ophthalmology, The Queen Elizabeth Hospital, Adelaïde, Australia; 4Department of Ophthalmology, University of Geneva, Geneva, Switzerland; 5The Newcastle Upon Tyne Hospitals NHS Foundation Trust, Newcastle, UKCorrespondence: Vincent Qin, Centre Medical du Val, 18 rue Edouard Gersis, 1150 Woluwe Saint Pierre, Brussels, Belgium, Email vincent.qin@live.bePurpose: To estimate the economic and environmental impact of single-use instruments (SUIs) to perform standard cataract surgery in six ophthalmology centers located in Europe and in the United States.Setting: Online survey and interview.Design: Comparative cost analysis based on an online survey with follow-up questionnaire and interview. The carbon footprint calculation was made by ClimatePartner.Methods: Annual costs of reusable instruments (RUIs) were calculated based on data provided by the centers. Annual costs of SUIs were estimated based on the average-selling price of a single-use cataract set of 5 instruments and the reported annual volume of cataract surgery. The calculation carbon footprint of a cataract instrument covered the whole life cycle from production to end-of-life.Results: Annual costs for SUIs were found inferior or similar to the annual costs for RUIs for 4 out of the 6 centers included in this study. The centers where SUIs were demonstrated to be the most cost-effective were also associated with the highest costs of sterilization per instrument. The carbon footprint of 5-years usage of a cataract instrument was found to be 5478.2 kg CO2 eq for SUIs without recycling, 4639.9 kg CO2 eq for SUIs with recycling and 20.6 kg CO2 eq for RUIs.Conclusion: The study demonstrated that SUIs can be an alternative solution to using RUIs in multispecialty hospitals associated with high sterilization costs.Keywords: cost analysis, cataract surgery, surgical instruments, reusable instruments, single-use instruments, environmental impact, carbon footprint

Limited or absent haptic feedback is reported as a factor hindering the continued adoption of surgical robots. This article presents a proof of concept for vibrotactile feedback integrated into a continuum robot to explore whether such feedback improves spatial perception in surgical settings. The robot is equipped with a capacitive sensor for noncontact endoscope localization, enabling spatial awareness of the robot’s tool center point (TCP) within the surgical environment. The data from the sensor is processed and transmitted to a bracelet worn by the user, which generates vibrotactile feedback. The bracelet contains four vibration motors providing tactile cues for navigation and positioning of the robot’s TCP. All subsystems are integrated into a unified system to deliver vibrotactile feedback to the user. When the user maneuvers the TCP of the robot near an object, they receive vibrotactile feedback via the bracelet. Thereby, the intensity of vibration increases as the TCP approaches the object, and the direction of the obstacle is mapped on the bracelet. Initial functional tests were performed and prove the functionality of the proposed system.

Aims: This study aimed to assess the carbon footprint associated with total hip arthroplasty (THA) in a UK hospital setting, considering various components within the operating theatre. The primary objective was to identify actionable areas for reducing carbon emissions and promoting sustainable orthopaedic practices. Methods: Using a life-cycle assessment approach, we conducted a prospective study on ten cemented and ten hybrid THA cases, evaluating carbon emissions from anaesthetic room to recovery. Scope 1 and scope 2 emissions were considered, focusing on direct emissions and energy consumption. Data included detailed assessments of consumables, waste generation, and energy use during surgeries. Results: The carbon footprint of an uncemented THA was estimated at 100.02 kg CO2e, with a marginal increase to 104.89 kg CO2e for hybrid THA. Key contributors were consumables in the operating theatre (21%), waste generation (22%), and scope 2 emissions (38%). The study identified opportunities for reducing emissions, including instrument rationalization, transitioning to LED lighting, and improving waste-recycling practices. Conclusion: This study sheds light on the substantial carbon footprint associated with THA. Actionable strategies for reducing emissions were identified, emphasizing the need for sustainable practices in orthopaedic surgery. The findings prompt a critical discussion on the environmental impact of single-use versus reusable items in the operating theatre, challenging traditional norms to make more environmentally responsible choices. Cite this article: Bone Jt Open 2024;5(9):742–748.

AbstractA physical model of soft tissue that provides realistic and real-time haptic and visual feedback is crucial for neurosurgical procedures. This paper investigates the interaction between surgical instruments and soft brain tissue, proposing a soft tissue deformation simulation method based on the principle of energy minimization and constrained energy function. The model includes a permanent deformation energy function induced by friction and a volume preservation energy function to more accurately depict tissue response during procedures such as resection of convex meningiomas and evacuation of intracerebral hematomas. Experimental results show that the proposed method meets the requirements of neurosurgical simulation. [ABSTRACT FROM AUTHOR]

Simple Summary: This paper explores a modern surgical technique called posterior retroperitoneal laparoscopic adrenalectomy (PRLA), which is used to remove the adrenal glands. Unlike traditional open surgery, PRLA uses small incisions in the patient's back, allowing surgeons to access the adrenal glands directly without disturbing other organs in the abdomen. Here, we explain the complex anatomy involved, describe how surgeons perform this procedure step by step, and discuss its benefits and challenges. PRLA can lead to less pain after surgery, shorter hospital stays, and quicker recovery for patients. However, it requires surgeons to have a deep understanding of the body's structure from a different angle than they are used to. This technique is becoming increasingly popular, but it is not suitable for every patient. Our goal is to help surgeons better understand PRLA, potentially improving outcomes for patients who need adrenal gland surgery. Posterior retroperitoneal laparoscopic adrenalectomy (PRLA) has emerged as a revolutionary, minimally invasive technique for adrenal gland surgery, offering significant advantages over traditional open approaches. This narrative review aims to provide a comprehensive update on PRLA, focusing on its anatomical foundations, surgical technique, and clinical implications. We conducted an extensive review of the current literature and surgical practices to elucidate the key aspects of PRLA. The procedure leverages a unique "backdoor" approach, accessing the adrenal glands through the retroperitoneum, which necessitates a thorough understanding of the posterior abdominal wall and retroperitoneal anatomy. Proper patient selection, meticulous surgical planning, and adherence to key technical principles are paramount for successful outcomes. In this paper, the surgical technique is described step by step, emphasizing critical aspects such as patient positioning, trocar placement, and adrenal dissection. PRLA demonstrates reduced postoperative pain, shorter hospital stays, and faster recovery times compared to open surgery, while maintaining comparable oncological outcomes for appropriately selected cases. However, the technique presents unique challenges, including a confined working space and the need for surgeons to adapt to a posterior anatomical perspective. We conclude that PRLA, in the right clinical setting, offers a safe and effective alternative to traditional adrenalectomy approaches. Future research should focus on expanding indications and refining techniques to further improve patient outcomes. [ABSTRACT FROM AUTHOR]

Objective • This study aims to assess the impact of details management on the handling of instruments in the operating room, comprehensively evaluating its impact on device intactness, economic efficiency, overall care quality, and physician satisfaction. Methods • We analyzed 1050 procedural packs used in our hospital from March to December 2019. The control group included 525 procedural packs with conventional management (March-August 2019), while the experimental group had 525 instrument packs with details management. Outcome measures included operating room device use, surgical care quality, and device tracking outcome. Results • Details management showed significantly higher device intactness (97.73%), a marked decrease in device preparation errors (0.00%), and more efficient device checking time (1.13±0.41) compared to conventional management (84.09%, 11.36%, 2.85±1.03) (P < .05). The experimental group had higher scores in intraoperative nursing ability, nursing operating specification, nursing staff professionalism, and device care quality (9.08±0.31, 9.23±0.32, 9.17±0.55, 97.81±0.96) compared to the control group (8.11±0.67, 7.98±0.98, 8.35±0.69, 75.25±1.87) (P < .05). Details management was associated with higher economic efficiency and lower incidences of device loss and mix-up compared to conventional management (P < .05). Conclusions • Implementing details management in instrument handling positively affects device intactness, economic efficiency, overall care quality, and physician satisfaction. It enhances device intactness, reduces device checking time, improves economic efficiency and overall care quality, and increases physician satisfaction. The findings provide insights into the benefits of a detailed instrument management approach in a hospital setting. [ABSTRACT FROM AUTHOR]

Objective • This study aims to investigate the implementation of visual management in the central sterile supply department, focusing on enhancing work efficiency, improving work quality, reducing errors and accidents, and elevating the satisfaction levels of clinical departments. Methods • Visual flow diagrams were carefully developed and classified by a dedicated team from July to August 2021, led by an established visual management team. Subsequently, department staff underwent organized training sessions to understand the concepts, requirements, and contents of these visual management flow diagrams through a related examination. The application of visual flow diagrams extended to instruments and equipment, infection control, and instrument package management. To assess the impact, a control group comprising 400 pieces of instruments used in the operating room and clinical practice in June 2021 and an observation group with 400 pieces for surgical instruments and clinical use in October 2021 were selected using a convenience sampling method. The study analyzed and compared the qualified rate of instrument cleaning, the qualified rate of instrument packaging, and clinical satisfaction between the two groups. Results • The device qualified rates for instrument cleaning in the observation and control groups were 99% and 95%, respectively; for instrument packaging, they were 96% and 92%. Clinical satisfaction rates were 99% and 90%, respectively. These findings indicate an improved qualified rate for instrument cleaning, instrument packaging, and clinical satisfaction in the observation group compared to the control group before the implementation of visual management, with statistically significant differences (P = .000). Conclusions • The application of visual flow diagrams has a significant positive impact on the work quality in the central sterile supply department and enhances clinical work satisfaction. This approach is deemed suitable for broader promotion. [ABSTRACT FROM AUTHOR]

Summary: Background: Delirium is a common and potentially serious complication after major surgery. A previous history of depression is a known risk factor for experiencing delirium in patients admitted to the hospital, but the generalised risk has not been estimated in surgical patients. Methods: We conducted a systematic review and meta‐analysis of studies reporting the incidence or relative risk (or relative odds) of delirium in the immediate postoperative period for adults with pre‐operative depression. We included studies that defined depression as either a formal pre‐existing diagnosis or having clinically important depressive symptoms measured using a patient‐reported instrument before surgery. Multilevel random effects meta‐analyses were used to estimate the pooled incidences and pooled relative risks. We also conducted subgroup analyses by various study‐level characteristics to identify important moderators of pooled estimates. Results: Forty‐two studies (n = 4,664,051) from five continents were included. The pooled incidence of postoperative delirium for patients with pre‐operative depression was 29% (95%CI 17–43%, I2 = 99.0%), compared with 15% (95%CI 6–28%, I2 = 99.8%) in patients without pre‐operative depression and 21% (95% CI 11–33%, I2 = 99.8%) in the cohorts overall. For patients with pre‐operative depression, the risk of delirium was 1.91 times greater (95%CI 1.68–2.17, I2 = 42.0%) compared with patients without pre‐operative depression. Conclusions: Patients with a previous diagnosis of depression or clinically important depressive symptoms before surgery have substantially greater risk of experiencing delirium after surgery. Clinicians and patients should be informed of these increased risks. Robust screening and other risk mitigation strategies for postoperative delirium are warranted, especially for patients with pre‐operative depression. [ABSTRACT FROM AUTHOR]

Surgical decompression is the recommended treatment for patients with nonfunctioning pituitary macroadenomas (NFPMAs) with associated visual impairment. Other relative indications for surgery include endocrinopathies, craniopathies, and headaches. Nevertheless, patients without these classical indications who would otherwise be considered asymptomatic with regard to the NFPMA and treated conservatively with clinical radiological surveillance may experience higher rates of other morbidities related to the NFPMA. We aimed to evaluate the prevalence of newly diagnosed comorbidities in conservatively treated patients with NFPMAs. We reviewed the medical records of 55 patients with NFPMAs from 2012 to 2022 who lacked classical indications for surgery at diagnosis. During the follow-up period, we searched for any of the following potentially associated newly reported symptoms and signs: headache, dizziness, syncope, gastrointestinal symptoms, hyponatremia, falls, weakness and general deterioration, cerebrovascular accident–related symptoms, and endocrine-related symptoms including type 2 diabetes mellitus. Patients were compared with a matched control group. Cohort patients were further analyzed to detect specific endocrine axis deficiencies, and tumor volumes were measured using magnetic resonance imaging at diagnosis. The final cohort included 55 patients. NFPMAs were associated with the development of newly diagnosed headaches, hypertension, and hypopituitarism. Other symptoms associated with NFPMAs included dizziness, syncope/presyncope, gastrointestinal-related symptoms, hyponatremia, general weakness and falls, and infection-related symptoms. Average associated emergency department visits in this group were higher compared with the control group. These results may suggest the advantages of early surgical intervention for NFPMAs to mitigate comorbidities and improve health-related quality of life. [ABSTRACT FROM AUTHOR]

Background: This study introduces a new access method for one-anastomosis gastric bypass (OAGB) by placing ports at the bikini line. Objective: To describe our initial experience and assess the feasibility, safety, and effectiveness of this novel access. Setting: University Hospital. Methods: This prospective case–control study included 72 patients: 42 were allocated to the bikini line one-anastomosis gastric bypass (BLOGB) group, and 30 were assigned to the control group. Exclusion criteria included a history of major abdominal surgery, hiatal hernia, extensive lower abdominal adhesions, or a body mass index (BMI) exceeding 55 kg/m2. Results: The mean preoperative BMI of the study sample was 40.01 ± 2.84. Weight loss was satisfactory, with the highest percent excess weight loss (%EWL) observed at 12 months: 90.88 ± 7.90 and 91 ± 7.11 (p = 0.474) in both groups, respectively. Both groups showed no significant differences in operative complications, hospital stay, weight loss, or resolution of obesity-associated diseases. However, the BLOGB patients had a longer mean operative time of 110.71 ± 17.72 min compared to 98 ± 18.27 min in the control group (p = 0.002). Moreover, they experienced less postoperative pain and reported greater satisfaction with the appearance of their scars. Conclusion: BLOGB was found to be potentially feasible, safe, and effective, offering improved aesthetic outcomes and reduced postoperative pain. This approach may be suitable for a select group of patients concerned with scar appearance. However, large-scale studies are necessary to ensure that safety is not compromised in pursuit of aesthetic benefits. [ABSTRACT FROM AUTHOR]

Background: The European Society of Gastroenterology and Endoscopy recommends a primarily flexible endoscopic approach for the treatment of Zenker's diverticulum. Due to the rarity of the disorder, evidence for its effectiveness and safety comes mainly from small, retrospective, single-center studies. Methods: In this retrospective, observational, multicenter cohort study, data from six German tertiary referral centers were analyzed. The primary outcome parameters were technical and clinical success; among the secondary outcomes, the rates of adverse events (AE) and re-admission with symptomatic recurrence and mortality were the most relevant. Results: Between 2003 and 2024, 384 treatments were performed in 327 patients (61.8% male, mean age 74.70 (± 10.60)). Incision methods/techniques were 250 needle knives, 44 ESD knives, 64 stag beetle knives, 24 staplers, one APC-probe, and one Z-POEM. The Zenker's diverticulum overtube was used in 65.1%, prophylactic clipping in 30.2%, and antibiotic therapy in 25.3% of treatments. The rates of technical and clinical success were 99.2% and 97.4%, and the rates of AE and re-admission with symptomatic recurrence were 11.2% and 16.7%, respectively. Mortality was 0.3%. Comparative subgroup analyses of 312 diverticula without prior treatment versus 72 symptomatic recurrences and incision methods/techniques showed no significant differences in outcome parameters. The use of additional devices and prophylactic measures (clipping, antibiotic therapy) were not independent predictors of technical/clinical success or AE in uni-/multivariable regression analysis. Conclusions: Flexible endoscopic Zenker's diverticulotomy is a safe and effective minimally invasive treatment. Recurrences can be treated by flexible endoscopy with comparable results. None of the cutting methods, ancillary devices, or prophylactic measures showed superiority in effectiveness or safety. [ABSTRACT FROM AUTHOR]

Background: Percutaneous endoscopic gastrostomy is commonly used for enteral nutritional access, but gastrocutaneous fistulae (GCF) may persist after tube removal, posing clinical challenges. The use of endoscopic closure devices, including over-the-scope clips (OTSC), has shown promise in managing non-healing fistulae, although data in the pediatric population are limited. Methods: A retrospective multicenter study analyzed pediatric patients who underwent GCF closure following gastrostomy tube removal. Data from seven centers across multiple countries were collected, including patient demographics, procedural details, complications, and outcomes. Closure techniques were compared between OTSC and surgical closure. Results: Of 67 pediatric patients included, 21 underwent OTSC closure and 46 had surgical closure. Surgical closure demonstrated a higher success rate (100%) compared to OTSC closure (61.9%, P < 0.001). While procedural duration was shorter for OTSC closure (25 vs. 40 min, P = 0.002), complications, and scar quality were comparable between techniques. A subsequent sub-analysis did not reveal differences based on center experience. Conclusion: OTSC closure is feasible and safe in pediatric patients, but surgical closure remains superior in achieving sustained GCF closure, although OTSC offers benefits, such as shorter procedural duration, potentially reducing the duration of general anesthesia exposure. Non-operative approaches, including OTSC, may be a valuable alternative to surgical closure. [ABSTRACT FROM AUTHOR]

• Sex difference in LTP was observed in control but not for VPA-exposed offspring. • LTP was reduced in VPA-exposed male offspring only. • Continuous exercise rescues hippocampal LTP in VPA-exposed male offspring. • Exercise had no effect on intact LTP in VPA-exposed female rats. • Sex-specific responses to exercise shed light on tailored interventions for ASD. Long‐term potentiation (LTP) impairment has been reported in many studies of autistic models. The aim of the present study was to investigate the effects of interval training (IT) and continuous training (CT) exercises on LTP in the hippocampal dentate gyrus (DG) neurons of valproic acid (VPA) rat model of autism. To induce an autism-like model, pregnant rats were injected 500 mg/kg NaVPA (intraperitoneal) on the embryonic day 12.5. IT and CT aerobic exercises started on postnatal day 56 in the offspring. Four weeks after IT and/or CT exercises, the offspring were urethane-anesthetized and placed into a stereotaxic apparatus for surgery, electrode implantation, and field potential recording. In the DG region, excitatory post synaptic potentials (EPSP) slope and population spike (PS) amplitude were measured. Sex differences in LTP were evident for control rats but not for VPA-exposed offspring. LTP was significantly smaller in VPA-exposed male offspring compared with control male rats. In contrast to males, there was no difference between VPA-exposed female offspring and control female rats. Interestingly, we observed a sex difference in the response to exercise between VPA-exposed male and female offspring. CT exercise training (but not IT) increased LTP in VPA-exposed male offspring. Both IT and CT exercise trainings had no effect on intact LTP in VPA-exposed female offspring. Our work suggests that there may be differences in the benefits of exercise interventions based on sex, and CT exercise training could be more beneficial for LTP improvements. [ABSTRACT FROM AUTHOR]

Introduction: Despite promising results regarding using long-acting cardioplegia in the adult population, little data exists specifically for operations requiring prolonged aortic cross-clamp needing additional doses. In this pilot study, we evaluated the outcomes of patients undergoing surgery with prolonged cross-clamp time based on four different redosing compositions. Methods: During the period from January 2019 until June 2022, 288 patients undergoing cardiac surgery with an expected cross-clamp time over 60 min were prospectively randomized regarding the type of the cardioplegia used: Group 1 (N = 150)- single-dose del Nido antegrade cardioplegia and Group 2 (N = 138)- single-dose Histidine-Tryptophane-Ketoglutarate (HTK) antegrade cardioplegia. In patients with ischemic time over 60 min, needing a redosing were further analyzed separately in four subgroups: (A) Cold whole blood (CWB) (4:1) (N = 95); (A1: DN-CWB; A2: HTK-CWB) and (B) St Thomas Solution (N = 92) (B1: DN-St Thomas; B2: HTK-St Thomas. Control groups were C1 (DN redosed by DN) and C2 (HTK by HTK). Results: Troponin levels in A1 and B1 groups were significantly lower than in DN-control. Respiratory support time and incidence of atrial fibrillation were significantly lower in Group A1 versus DN-control. Conclusions: Long-acting cardioplegic techniques are becoming widely utilized in the adult population, with minimal data on redosing methods/compositions for prolonged cases. Due to the small patient population, further investigation is needed to delineate optimal redosing methods, but this report brings to attention the initial success of multiple strategies. [ABSTRACT FROM AUTHOR]