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

Robotic surgery represents a milestone in surgical procedures, offering advantages such as less invasive methods, elimination of tremors, scaled motion, and 3D visualization. This in-depth analysis explores the complex biochemical effects of robotic methods. The use of pneumoperitoneum and steep Trendelenburg positioning can decrease pulmonary compliance and splanchnic perfusion while increasing hypercarbia. However, robotic surgery reduces surgical stress and inflammation by minimizing tissue trauma. This contributes to faster recovery but may limit immune function. Robotic procedures also limit ischemia–reperfusion injury and oxidative damage compared to open surgery. They also help preserve native antioxidant defenses and coagulation. In a clinical setting, robotic procedures reduce blood loss, pain, complications, and length of stay compared to traditional procedures. However, risks remain, including device failure, the need for conversion to open surgery and increased costs. On the oncology side, there is still debate about margins, recurrence, and long-term survival. The advent of advanced technologies, such as intraoperative biosensors, localized drug delivery systems, and the incorporation of artificial intelligence, may further improve the efficiency of robotic surgery. However, ethical dilemmas regarding patient consent, privacy, access, and regulation of this disruptive innovation need to be addressed. Overall, this review sheds light on the complex biochemical implications of robotic surgery and highlights areas that require additional mechanistic investigation. It presents a comprehensive approach to responsibly maximize the potential of robotic surgery to improve patient outcomes, integrating technical skill with careful consideration of physiological and ethical issues. [ABSTRACT FROM AUTHOR]

The Versius Surgical System is a next generation soft-tissue robot with instrument and endoscope arms split into individual modules. Despite its similarities with previous systems, the basic changes in the design raise concerns relating to the feasibility of the set-up for the different approaches in robotic head and neck surgery procedures. We used a complete unit with a surgeon's console and four modules on a training mannequin to depict the different configurations in the operating room. We tested transoral robotic surgery and the four basic configurations for the remote access to the neck: transoral/transvestibular, retroauricular, axillary and bilateral axillo-breast approaches. We obtained a high quality simulation for transoral robotic surgery, as well as for the usual remote access approaches, except for the axillary approach. We were able to obtain an optimal distribution of the modules around the surgical table and an adequate configuration of the joints allowing the instruments to reach their targets. The Versius Surgical System might be an alternative device for robotic procedures in head and neck surgery, although this needs to be proved in a clinical setting. [ABSTRACT FROM AUTHOR]

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

Introdução: O acesso endodôntico quando há obliteração do canal pulpar (OCP) parcial ou total é uma tarefa desafiadora. Uma nova técnica conhecida como acesso endodôntico guiado (AEG) tem sido relatada como uma solução alternativa nos casos com OCP. Métodos: O presente artigo relata dois casos clínicos usando AEG para localizar e tratar OCP. Imagens de tomografia computadorizada de feixe cônico e imagens do escaneamento intrabucal foram pareadas usando um software de planejamento virtual. Após o planejamento da posição da broca, foi elaborado um template virtual, posteriormente impresso em 3D, para confecção da respectiva guia, a qual foi, então, posicionada e os canais radiculares foram localizados com uma broca carbide. Os canais radiculares foram instrumentados com limas reciprocantes e irrigação com hipoclorito de sódio. Os dentes foram obturados com a técnica de guta-percha termoplastificada. Resultado: Os pacientes foram acompanhados por seis meses e demonstraram ausência de sinais e sintomas. Conclusão: Conclui-se que o tratamento endodôntico associado ao AEG foi uma opção terapêutica eficaz nos casos de OCP em incisivos centrais superiores, obtendo resultados seguros e confiáveis no tratamento endodôntico. [ABSTRACT FROM AUTHOR]

Objectives: To assess the surgical accuracy of 3D virtual surgical planned orthognathic surgery and the influence of posterior impaction and magnitude of the planned movements on a possible learning curve. Materials and methods: This prospective cohort study included subjects who underwent bimaxillary surgery between 2016 and 2020 at the Department of Oral and Maxillofacial Surgery of the Radboud University Medical Center, Nijmegen. 3D virtual surgical planning (VSP) was performed with CBCT data and digitalized dentition data. By using voxel-based matching with pre- and postoperative CBCT data the maxillary movements were quantified in six degrees of freedom. The primary outcome variable, surgical accuracy, was defined as the difference between the planned and achieved maxillary movement. Results: Based on 124 subjects, the surgical accuracy increased annually from 2016 to 2020 in terms of vertical translations (0.82 ± 0.28 mm; p = 0.038) and yaw rotations (0.68 ± 0.22°; p = 0.028). An increase in surgical accuracy was observed when combining all six degrees of freedom (p = 0.021) and specifically between 2016 and 2020 (p = 0.004). An unfavorable learning curve was seen with posterior impaction and with a greater magnitude of movements. Conclusion: The present study demonstrated a significant increase in surgical accuracy annually and therefore supports the presence of a learning curve. Clinical relevance: Cases with planned maxillary posterior impaction and/or a great magnitude of jaw movements should be transferred from the 3D VSP with extra care to obtain a satisfactory surgical accuracy. [ABSTRACT FROM AUTHOR]

Flapless and fully guided implant placement has the potential to maximize efficacy outcomes and at the same time to minimize surgical invasiveness. The aim of the current systematic review was to answer the following PICO question: "In adult human subjects undergoing dental implant placement (P), is minimally invasive flapless computer‐aided fully guided (either dynamic or static computer‐aided implant placement (sCAIP)) (I) superior to flapped conventional (free‐handed implant placement (FHIP) or cast‐based/drill partially guided implant placement (dPGIP)) surgery (C), in terms of efficacy, patient morbidity, long‐term prognosis, and costs (O)?" Randomized clinical trials (RCTs) fulfilling specific inclusion criteria established to answer the PICO question were included. Two review authors independently searched for eligible studies, screened the titles and abstracts, performed full‐text analysis, extracted the data from the published reports, and performed the risk of bias assessment. In cases of disagreement, a third review author took the final decision during ad hoc consensus meetings. The study results were summarized using random effects meta‐analyses, which were based (wherever possible) on individual patient data (IPD). A total of 10 manuscripts reporting on five RCTs, involving a total of 124 participants and 449 implants, and comparing flapless sCAIP with flapped FHIP/cast‐based partially guided implant placement (cPGIP), were included. There was no RCT analyzing flapless dynamic computer‐aided implant placement (dCAIP) or flapped dPGIP. Intergroup meta‐analyses indicated less depth deviation (difference in means (MD) = −0.28 mm; 95% confidence interval (CI): −0.59 to 0.03; moderate certainty), angular deviation (MD = −3.88 degrees; 95% CI: −7.00 to −0.77; high certainty), coronal (MD = −0.6 mm; 95% CI: −1.21 to 0.01; low certainty) and apical (MD = −0.75 mm; 95% CI: −1.43 to −0.07; moderate certainty) three‐dimensional bodily deviations, postoperative pain (MD = −17.09 mm on the visual analogue scale (VAS); 95% CI: −33.38 to −0.80; low certainty), postoperative swelling (MD = −6.59 mm on the VAS; 95% CI: −19.03 to 5.85; very low certainty), intraoperative discomfort (MD = −9.36 mm on the VAS; 95% CI: −17.10 to −1.61) and surgery duration (MD = −24.28 minutes; 95% CI: −28.62 to −19.95) in flapless sCAIP than in flapped FHIP/cPGIP. Despite being more accurate than flapped FHIP/cPGIP, flapless sCAIP still resulted in deviations with respect to the planned position (intragroup meta‐analytic means: 0.76 mm in depth, 2.57 degrees in angular, 1.43 mm in coronal, and 1.68 in apical three‐dimensional bodily position). Moreover, flapless sCAIP presented a 12% group‐specific intraoperative complication rate, resulting in an inability to place the implant with this protocol in 7% of cases. Evidence regarding more clinically relevant outcomes of efficacy (implant survival and success, prosthetically and biologically correct positioning), long‐term prognosis, and costs, is currently scarce. When the objective is to guarantee minimal invasiveness at implant placement, clinicians could consider the use of flapless sCAIP. A proper case selection and consideration of a safety margin are, however, suggested. [ABSTRACT FROM AUTHOR]

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

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

The aim of this study was to assess whether the use of intraoral scans (IOS) is an eligible alternative to conventional plaster casts in terms of surgical accuracy of three-dimensionally planned bimaxillary osteotomies. This retrospective cohort study included patients who underwent bimaxillary surgery between 2016 and 2020 in the Department of Oral and Maxillofacial Surgery at Radboud University Medical Center, Nijmegen. Three-dimensional virtual planning was performed with the use of plaster casts in one group and IOS in the other group. Cone beam computed tomography scans were acquired preoperatively and at 1 week following surgery. By using voxel-based matching, the maxillary movements were quantified in six degrees of freedom. The primary outcome variable, surgical accuracy, was defined as the difference between the planned maxillary movements and those achieved. Of 152 patients, 113 were documented with plaster casts and 39 with IOS. The surgical accuracy was comparable in terms of maxillary vertical, sagittal, and transverse translations, as well as roll and yaw. Maxillary pitch (difference 0.55 ± 0.26°; P = 0.001) was in favour of the IOS group. This study demonstrated that IOS can be used as an alternative to conventional plaster casts in the three-dimensional planning of bimaxillary osteotomies. [ABSTRACT FROM AUTHOR]

Current planning of aortic and peripheral endovascular procedures is based largely on manual measurements performed from the 3-dimensional reconstruction of preoperative computed tomography scans. Assessment of device behavior inside patient anatomy is often difficult, and available tools, such as 3-dimensional-printed models, have several limitations. Digital twin (DT) technology has been used successfully in automotive and aerospace industries and applied recently to endovascular aortic aneurysm repair. Artificial intelligence allows the treatment of large amounts of data, and its use in medicine is increasing rapidly. The aim of this review was to present the current status of DTs combined with artificial intelligence for planning endovascular procedures. Patient-specific DTs of the aorta are generated from preoperative computed tomography and integrate aorta mechanical properties using finite element analysis. The same methodology is used to generate 3-dimensional models of aortic stent-grafts and simulate their deployment. Post processing of DT models is then performed to generate multiple parameters related to stent-graft oversizing and apposition. Machine learning algorithms allow parameters to be computed into a synthetic index to predict Type 1A endoleak risk. Other planning and sizing applications include custom-made fenestrated and branched stent-grafts for complex aneurysms. DT technology is also being investigated for planning peripheral endovascular procedures, such as carotid artery stenting. DT provides detailed information on endovascular device behavior. Analysis of DT-derived parameters with machine learning algorithms may improve accuracy in predicting complications, such as Type 1A endoleaks., Competing Interests: Declaration of competing interest The authors declare the following financial interests/personal relationships which may be considered as potential competing interests: JN Albertini is co-founder of PrediSurge SAS., (Copyright © 2024 Elsevier Inc. All rights reserved.)

Extended reality has brought new opportunities for medical imaging visualization and analysis. It regroups various subfields, including virtual reality, augmented reality, and mixed reality. Various applications have been proposed for surgical practice, as well as education and training. The aim of this review was to summarize current applications of extended reality and augmented reality in vascular surgery, highlighting potential benefits, pitfalls, limitations, and perspectives on improvement., Competing Interests: Declaration of competing interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this article., (Copyright © 2024 Elsevier Inc. All rights reserved.)

Competing Interests: Die Autorinnen/Autoren geben an, dass kein Interessenkonflikt besteht.

Revision anterior cruciate ligament reconstruction (ACLR) is a challenging surgery occurring in 3 to 24% of primary reconstructions. A meticulous planning to study the precise size and location of both femoral and tibial bone tunnels is mandatory. The aim of the study was to evaluate the intra- and interoperator differences in the decision-making process between experienced surgeons after they were asked to make preoperative planning for ACL revision reconstruction with the use of both the computed tomography (CT) scan and a three-dimensional (3D)-printed model of the knee. Data collected from 23 consecutive patients undergoing revision of ACLR for graft failure at a single institute between September 2018 and February 2020 were prospectively reviewed. The double-blinded collected data were presented to three board-certificate attending surgeons. Surgeons were asked to decide whether to perform one-stage or two-stage revision ACLR based on the evaluation of the CT scan images and the 3D-printed custom-made models at two different rounds, T0 and T1, respectively, 7 days apart one from the other. Interoperator consensus following technical mistake was 52% at T0 and 56% at T1 using the CT scans, meanwhile concordance was 95% at T0 and 94% at T1 using the 3D models. Concordance between surgeons following new knee injury was 66% at T0 and 70% at T1 using CT scans, while concordance was 96% both at T0 and T1 using 3D models. Intraoperative variability using 3D models was extremely low: concordance at T0 and T1 was 98%. McNemar test showed a statistical significance in the use of 3D model for preoperative planning ( p  < 0.005). 3D-printed model reliability resulted to be higher compared with CT as intraoperator surgery technique selection was not modified throughout time from T0 to T1 ( p  < 0.005). The use of 3D-printed models had the most impact when evaluating femoral and tibial tunnels, resulting to be a useful instrument during preoperative planning of revision ACLR between attending surgeons with medium-high workflow., Competing Interests: None declared., (Thieme. All rights reserved.)

Objective: To evaluate the efficacy of stereotactic soft-channel and hard-channel aspiration in the treatment of primary brainstem hemorrhage., Methods: The clinical data of 146 patients with primary brainstem hemorrhage at the First Hospital of Hebei Medical University from August 2014 to August 2023 were analyzed. At admission, 146 patients were divided into soft-channel group or hard-channel group using a random number table method. Sixty-five patients were treated with stereotactic soft-channel aspiration, and 81 patients were treated with stereotactic hard-channel aspiration. The amount of residual hematoma was evaluated by head CT immediately after the operation, and the length of the indwelling drainage tube was recorded. Survival status at 30d after the operation and treatment outcome (mRS score and GOS score) at 90d after the operation were also recorded. The amount of residual hematoma immediately after the operation, the length of the indwelling drainage tube after the operation, the mortality rate and the treatment outcome were compared between the two groups., Results: There was significant difference in the mortality rate 30d after the operation (41.5% vs. 14.8%, χ 2 = 20.192, P = 0.035) between stereotactic soft-channel aspiration and stereotactic hard-channel aspiration for brainstem hemorrhage. The hard-channel group had a higher survival rate. There was significant difference in the treatment outcome at 90 days after treatment (18.5% vs. 32.1%, χ 2 = 4.783, P = 0.047). The hard-channel group showed better treatment outcomes 90 days after surgery., Conclusion: Stereotactic hard-channel aspiration for primary brainstem hemorrhage has greater clearance efficiency than soft-channel aspiration and can significantly reduce patient mortality and improve treatment outcomes. Stereotactic hard-channel aspiration is a safe and effective method for treating primary brainstem hemorrhage., Competing Interests: Declaration of competing interest The authors report no declarations of interest., (Copyright © 2024 Elsevier Inc. All rights reserved.)

Objective: Static 3-dimensional (3D) printing became attractive for operative planning in cases that involve difficult anatomy. An interactive (low cost, fast) 3D print allowing deliberate surgical practice can be used to improve interventional simulation and planning., Background: Endovascular treatment of complex aortic aneurysms is technically challenging, especially in case of narrow aortic lumen or significant aortic angulation (hostile anatomy). The risk of complications such as graft kinking and target vessel occlusion is difficult to assess based solely on traditional software measuring methods and remain highly dependent on surgeon skills and expertise., Methods: A patient with juxtarenal AAA with hostile anatomy had a 3-dimensional printed model constructed preoperatively according to computed tomography images. Endovascular graft implantation in the 3D printed aorta with a standard T-Branch Cook (Cook® Medical, Bloomington, IN, USA) was performed preoperatively in the simulation laboratory enabling optimized feasibility, surgical planning and intraoperative decision making., Results: The 3D printed aortic model proved to be radio-opaque and allowed simulation of branched endovascular aortic repair (BREVAR). The assessment of intervention feasibility, as well as optimal branch position and orientation was found to be useful for surgeon confidence and the actual intervention in the patient. There was a remarkable agreement between the 3D printed model and both CT and X-ray angiographic images. Although the technical success was achieved as planned, a previously deployed renal stent caused unexpected difficulty in advancing the renal stent, which was not observed in the 3D model simulation., Conclusion: The 3D printed aortic models can be useful for determining feasibility, optimizing planning and intraoperative decision making in hostile anatomy improving the outcome. Despite already offering satisfying accuracy at present, further advancements could enhance the 3D model capability to replicate minor anatomical deformities and variations in tissue density., Competing Interests: Declaration of Conflicting InterestsThe author(s) declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.

This study examines the correlation between the weight-bearing (WB) long leg radiograph (LLR)-derived hip-knee-ankle angle (HKAA) and intraoperative supine computer-assisted surgery (CAS)-derived HKAA measurements at the beginning and end of total knee arthroplasty (TKA). The primary aim of the study was to determine if WB alignment could be mimicked or inferred based on intraoperative alignment findings. We conducted a prospective analysis from a cohort of 129 TKAs undergoing a CAS TKA at a single center by a single surgeon. The HKAA was recorded using the CAS navigation system immediately postregistration of navigation data and after implantation of the prosthesis. The intraoperative HKAA was recorded in both the supine "resting" position of the knee and also while the knee was manipulated in an effort to replicate the patient's WB alignment. These measurements were compared with the HKAA recorded on pre- and postoperative WB LLRs. There was a strong correlation between the preoperative WB LLR HKAA and the intraoperative preimplant CAS-derived stressed HKAA ( R  = 0.946). However, there was no correlation between the postoperative WB LLR HKAA and the postimplant insertion HKAA as measured intraoperatively via CAS for either a "resting" or "stressed" position of the operated knee ( R  = 0.165 and R  = 0.041, respectively). Thus, the interpretation of intraoperative alignment data is potentially problematic. Despite technological advances in the development and utilization of computer navigation and robotics in arthroplasty to help obtain the optimal alignment, it would seem apparent from our study that this alignment does not correlate to upright stance postoperatively. Surgeons should apply caution to the strength of assumptions they place on intraoperative coronal plane alignment findings., Competing Interests: None declared., (Thieme. All rights reserved.)

Purpose: Anticipating trends and pursuing innovative ideas are imperative for the advancement of science. The objective of this study was to conduct a bibliometric analysis of 3-dimensional virtual simulation in orthognathic surgery, explore its implications for clinical practice, and identify future publication trends through digital tools., Methods: This study employed a retrospective bibliometric analysis using data obtained from the Web of Science database. The search strategy focused on articles related to orthognathic surgery and virtual simulation techniques. RStudio and bibliometrix tools were used to data mining. The independent variables retrieved from digital analysis were the emerging themes related to virtual planning in orthognathic surgery. The trends that we identified were facial esthetics, digital workflow, personalized treatments, and complex cases. The primary outcome variable was the number of publications dedicated to virtual simulation in orthognathic surgery, along with secondary outcomes such as citation rates, language of publication, country of origin, institutional affiliations, and emerging research themes. Covariates included variables related to publication characteristics, author affiliations, and geographic distribution of publications. Publication analyses over time involved descriptive statistics, regression analysis, Pearson correlation tests, and graphical representation techniques. Statistical significance was set at a 95% confidence interval (P value < .05)., Results: A comprehensive analysis of 987 articles reveals the impact of included authors, with a mean h-index of 62 (SD = 18.4). The analysis further illuminates a discernible upward trend in publications on this subject, showcasing a linear pattern with a notable R 2 value of 0.88 (P = .021). English remains the predominant language of publication, accounting for 97.97% of articles, while contributions hailed from a diverse spectrum of 56 countries. Interestingly, a moderate correlation emerges between publication numbers and gross domestic product per capita (r = 0.30, P = .044) and total area (r = 0.30, P = .032), whereas a more substantial correlation is evident with total population (r = 0.61, P = .034). Notably, the most cited article amassed 254 citations. Furthermore, a Pearson correlation coefficient of 0.97 underscores the correlation between citation density and the year of publication., Conclusion: The bibliometric indicators provided insights for evaluating research productivity and the quality of research output. Emerging themes included facial esthetics, 3-dimensional printing, and the utilization of custom-made templates and implants. This study holds relevance for maxillofacial surgeons, academics, and researchers alike., (Copyright © 2024 American Association of Oral and Maxillofacial Surgeons. Published by Elsevier Inc. All rights reserved.)

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

Background: The original Ozaki technique involves sizing the neovalve cusps during cross-clamp. It leads to prolonging the ischemic time compared to standard surgical AVR. Measurements taken on the collapsed Aortic Root (AR) may also be inaccurate. We use preoperative Computed Tomography (CT) to perform more accurate sizing in physiological conditions and shorten the ischemic time. This study analyzes the results of the CT-guided Aortic Valve Neocuspidization (AVNeo) compared with the Ozaki technique., Methods: The validity of the concept was evaluated ex vivo. Experimental valves underwent geometric, CT, and hydrodynamic controls. In the clinical phase of the study, we prospectively analyzed patients who received CT-guided AVNeo (N ​= ​7, Group 1). The control group enrolled patients who were operated on after the standard AVNeo technique (N ​= ​15, Group 2)., Results: In Group 1, Aortic Cross-Clamp (70.3 ​± ​17.0 vs. 91 ​± ​21.3 ​min, ρ ​= ​0.026) and Bypass times (92.9 ​± ​21.0 vs. 123 ​± ​24.8 ​min, ρ ​= ​0.011) were significantly shorter. At discharge, the peak (11.7 ​± ​2.75 vs. 15.4 ​± ​4.66 ​mm Hg, ρ ​= ​0.032) and mean Aortic Valve (AV) gradient (6.29 ​± ​1.25 vs. 7.87 ​± ​2.33 ​mm Hg, ρ ​= ​0.052) were lower in Group 1. Only one patient in Group 2 had Aortic Insufficiency (AI) greater than mild. The mean follow-up was 49.6 ​± ​6.9 months in both groups. There were no late deaths or any valve-related events detected in any patient. EchoCG revealed that peak (10.0 ​± ​2.65 vs. 12.6 ​± ​4.05 ​mm Hg, ρ ​= ​0.090) and mean AV gradient (5.14 ​± ​1.35 vs. 6.73 ​± ​2.25 ​mm Hg, ρ ​= ​0.054) also were lower in Group 1. AI indexes were stable in both Groups., Conclusions: CT-guided AVNeo is an example of personalized medicine in the surgical treatment of heart valve pathology. It allows the development of a biological AV that adapts to the patient's anatomy, shortens ischemic time, and results in better hemodynamics. A more significant number of clinical observations and longer follow-up are warranted to prove the viability of the concept., Competing Interests: Declaration of competing interest The authors have no conflicts of interest to declare., (Copyright © 2024 Society of Cardiovascular Computed Tomography. Published by Elsevier Inc. All rights reserved.)

We performed a systematic review to compare conventional (2-D) versus 3-D-guided corrective osteotomies regarding intraoperative results, patient-reported outcome measures, range of motion, incidence of complications and pain score. PubMed (MEDLINE), Embase and Cochrane CENTRAL were searched, and 53 articles were included, reporting 1257 patients undergoing forearm corrective osteotomies between 2010 and 2022. 3-D-guided surgery resulted in a greater improvement in median Disabilities of the Arm, Shoulder and Hand (DASH) score (28, SD 7 vs. 35, SD 5) and fewer complications (12% vs. 6%). Pain scores and range of motion were similar between 3-D-guided and conventional surgery. 3-D-guided corrective osteotomy surgery appears to improve patient-reported outcomes and reduce complications compared to conventional methods. However, due to the limited number of comparative studies and the heterogeneity of the studies, a large randomized controlled trial is needed to draw definitive conclusions. Level of evidence: III., Competing Interests: Declaration of conflicting interestsThe authors declare no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.

Abstract: 64 Cu-DOTATATE PET/CT of a 44-year-old man with an ileal neuroendocrine tumor demonstrated the primary tumor, local nodal metastases, and a pericaval nodal metastasis. Localization of the pericaval node during surgery may be difficult, thus 4.4 mCi of 111 In-pentetreotide was administered before surgery to assist with localization and resection. At surgery, the pericaval nodal metastasis was readily detected by gamma probe, which could then be resected and pathologically proven to be a metastasis. This demonstrates the use of somatostatin receptor-targeted imaging for intraoperative localization of an otherwise difficult to surgically localize metastasis. Without intraoperative somatostatin receptor-targeted radiosurgery, disease may have been incompletely resected., Competing Interests: Conflicts of interest and sources of funding: none declared., (Copyright © 2024 Wolters Kluwer Health, Inc. All rights reserved.)

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

The article discusses the challenges faced by surgeons due to the backlog of elective surgeries caused by the COVID-19 pandemic. It suggests that this situation presents an opportunity to reevaluate the role and expectations of surgery. The article highlights the need for evidence-driven surgery and mentions that some operations may not be more beneficial than non-surgical alternatives. It also discusses the impact of technological advancements on the cost of surgery and emphasizes the importance of balancing technological progress with limited resources. The article calls for system-wide changes, patient-centered approaches, and improved health literacy to ensure the best outcomes for patients. [Extracted from the article]

Objectives: To evaluate the performance of the nnU-Net open-source deep learning framework for automatic multi-task segmentation of craniomaxillofacial (CMF) structures in CT scans obtained for computer-assisted orthognathic surgery. Methods: Four hundred and fifty-three consecutive patients having undergone high-resolution CT scans before orthognathic surgery were randomly distributed among a training/validation cohort (n = 300) and a testing cohort (n = 153). The ground truth segmentations were generated by 2 operators following an industry-certified procedure for use in computer-assisted surgical planning and personalized implant manufacturing. Model performance was assessed by comparing model predictions with ground truth segmentations. Examination of 45 CT scans by an industry expert provided additional evaluation. The model's generalizability was tested on a publicly available dataset of 10 CT scans with ground truth segmentation of the mandible. Results: In the test cohort, mean volumetric Dice similarity coefficient (vDSC) and surface Dice similarity coefficient at 1 mm (sDSC) were 0.96 and 0.97 for the upper skull, 0.94 and 0.98 for the mandible, 0.95 and 0.99 for the upper teeth, 0.94 and 0.99 for the lower teeth, and 0.82 and 0.98 for the mandibular canal. Industry expert segmentation approval rates were 93% for the mandible, 89% for the mandibular canal, 82% for the upper skull, 69% for the upper teeth, and 58% for the lower teeth. Conclusion: While additional efforts are required for the segmentation of dental apices, our results demonstrated the model's reliability in terms of fully automatic segmentation of preoperative orthognathic CT scans. Key Points: • The nnU-Net deep learning framework can be trained out-of-the-box to provide robust fully automatic multi-task segmentation of CT scans performed for computer-assisted orthognathic surgery planning. • The clinical viability of the trained nnU-Net model is shown on a challenging test dataset of 153 CT scans randomly selected from clinical practice, showing metallic artifacts and diverse anatomical deformities. • Commonly used biomedical segmentation evaluation metrics (volumetric and surface Dice similarity coefficient) do not always match industry expert evaluation in the case of more demanding clinical applications. [ABSTRACT FROM AUTHOR]

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Objectives: To assess the accuracy of a real‐time dynamic navigation system applied in zygomatic implant (ZI) surgery and summarize device‐related negative events and their management. Material and methods: Patients who presented with severely maxillary atrophy or maxillary defects and received dynamic navigation‐supported ZI surgery were included. The deviations of entry, exit, and angle were measured after image data fusion. A linear mixed‐effects model was used. Statistical significance was defined as p <.05. Device‐related negative events and their management were also recorded and analyzed. Results: Two hundred and thirty‐one zygomatic implants (ZIs) with navigation‐guided placement were planned in 74 consecutive patients between Jan 2015 and Aug 2020. Among them, 71 patients with 221 ZIs received navigation‐guided surgery finally. The deviations in entry, exit, and angle were 1.57 ± 0.71 mm, 2.1 ± 0.94 mm and 2.68 ± 1.25 degrees, respectively. Significant differences were found in entry and exit deviation according to the number of ZIs in the zygomata (p =.03 and.00, respectively). Patients with atrophic maxillary or maxillary defects showed a significant difference in exit deviation (p =.01). A total of 28 device‐related negative events occurred, and one resulted in 2 ZI failures due to implant malposition. The overall survival rate of ZIs was 98.64%, and the mean follow‐up time was 24.11 months (Standard Deviation [SD]: 12.62). Conclusions: The navigation‐supported ZI implantation is an accurate and reliable surgical approach. However, relevant technical negative events in the navigation process are worthy of attention. [ABSTRACT FROM AUTHOR]

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

Purpose: Prostate-specific membrane antigen (PSMA)-targeted radioguided surgery (RGS) has gained increased interest in prostate cancer (PCa). This analysis aims to evaluate the feasibility, safety, and limitations of RGS with a novel drop-in gamma probe in primary PCa., Patients and Methods: The data of 13 patients with primary PCa undergoing RGS were analyzed retrospectively. After preoperative administration of 99m Tc-PSMA-I&S, a SPECT/CT was conducted and a robotic radical prostatectomy was performed the following day including intraoperative assessment of the lymph node stations using a novel robotic drop-in gamma probe. This was followed by an extended pelvic lymph node dissection (ePLND) with ex vivo control measurement using the drop-in and a conventional rigid gamma probe., Results: Eleven patients (median PSA value of 11 ng/mL) had high-risk and 2 patients had intermediate-risk PCa. Overall, a median of 22 ePLND lymph nodes were dissected. In 1 patient, preoperative SPECT/CT imaging showed suspicious lymph nodes, which could be confirmed intraoperatively with the robotic drop-in probe and subsequently in the final histopathological analysis. RGS failed to identify 2 patients with micrometastases (<3 mm) preoperatively and intraoperatively. No postoperative complications related to 99m Tc-PSMA-I&S RGS or ePLND occurred., Conclusions: RGS with the novel drop-in gamma probe and 99m Tc-PSMA-I&S allows for a reliable intraoperative screening for lymph node metastases in robot-assisted radical prostatectomy for primary PCa with an acceptable safety profile. However, limitations in the detection of micrometastases need to be overcome before omitting extended ePLND in patients at risk for lymphatic spread., Competing Interests: Conflicts of interest and sources of funding: No external funding or sponsorship was received for this study or publication of this article. N.N.H. has received honoraria for presentations from Intuitive Surgical, Janssen, and Pajunk, and compensation for travel from Bayer, Astellas, Pfizer, and Janssen. C.F. has obtained compensation for travel by Lightpoint. O.K. has received compensation for travel from Astellas., (Copyright © 2024 Wolters Kluwer Health, Inc. All rights reserved.)

Introduction: Ankylosing Spondylitis (AS) patients with acute spinal fractures represent a challenge for practicing spine surgeons due to difficult operative anatomy and susceptibility to complications., Research Question: Does intraoperative CT-navigation improve outcomes in patients with ankylosing spondylitis undergoing surgery?, Methods: A retrospective review was carried out at our centre from 05/2016-06/2021 to identify AS patients presenting with a traumatic spinal fracture, managed surgically with posterior spinal fusion (PSF). Cohorts were categorised and compared for outcomes based on those who underwent PSF with intraoperative CT-navigation versus those surgically managed with traditional intraoperative fluoroscopy., Results: 37 AS patients were identified. 29/37 (78.4%) underwent PSF. Intraoperative navigation was used in 14 (48.3%) cases. Mean age of the entire cohort was 67.6 years. No difference existed between the navigated and non-navigated groups for mean levels fused (5.35 vs 5.07; p ​= ​0.31), length of operation (217.9mins vs 175.3mins; p ​= ​0.07), overall length-of-stay (12 days vs 21.9 days; p ​= ​0.16), patients requiring HDU (3/14 vs 5/15; p ​= ​0.09) or ICU (5/14 vs 9/15; p ​= ​0.10), postoperative neurological improvement (1/14 vs 1/15; p ​= ​0.48) or deterioration (1/14 vs 0/15; p ​= ​0.15), intraoperative complications (2/14 vs 3/15; p ​= ​0.34), postoperative complications 4/14 vs 4/15; p ​= ​0.46), revision surgeries (3/14 vs 1/15; p ​= ​0.16) and 30-day mortality (0/14 vs 0/15)., Conclusion: This is the first study that compares surgical outcomes of navigated vs non-navigated PSFs for AS patients with an acute spinal fracture. Although limited by its retrospective design and sample size, this study highlights the non-inferiority of intraoperative navigation as a surgical aid in a challenging cohort., Competing Interests: Declaration of competing interest None of the authors has any potential conflict of interest., (Copyright © 2024 The Author(s). Published by Elsevier Ltd.. All rights reserved.)

Background: The use of technology allows increased precision in component positioning in total knee arthroplasty (TKA). The objectives of this study were to compare (1) perioperative complications and (2) resource utilization between robotic-assisted (RA) and computer-navigated (CN) versus conventional (CI) TKA., Methods: A retrospective cohort study was performed using a national database to identify patients undergoing unilateral, primary elective TKA from January 2016 to December 2019. A total of 2,174,685 patients were identified and included RA (69,445), CN (112,225), or CI (1,993,015) TKA. Demographics, complications, lengths of stay, dispositions, and costs were compared between the cohorts. Binary logistic regression analysis was performed., Results: The RA TKA cohort had lower rates of intraoperative fracture (0.05 versus 0.08%, P < .05), respiratory complications (0.6 versus 1.1%, P < .05), renal failure (1.3 versus 1.7%, P < .05), delirium (0.1 versus 0.2%, P < .05), gastrointestinal complications (0.04 versus 0.09%, P < .05), postoperative anemia (8.9 versus 13.9%, P < .05), blood transfusion (0.4 versus 0.9%, P < .05), pulmonary embolism, and deep vein thrombosis (0.1 versus 0.2%, P < .05), and mortality (0.01 versus 0.02%, P < .05) compared to conventional TKA, though the cohort did have higher rates of myocardial infarction (0.09 versus 0.07%, P < .05). The CN cohort had lower rates of myocardial infarction (0.02 versus 0.07%, P < .05), respiratory complications (0.8 versus 1.1%, P < .05), renal failure (1.5 versus 1.7%, P < .05), blood transfusion (0.8 versus 0.9%, P < .05), pulmonary embolism (0.08 versus 0.2%, P < .05), and deep vein thrombosis (0.2 versus 0.2%, P < .05) over CI TKA. Total cost was increased in RA (16,190 versus $15,133, P < .05) and CN (17,448 versus $15,133, P < .05). However, the length of hospital stay was decreased in both RA (1.8 versus 2.2 days, P < .05) and CN (2.1 versus 2.2 days, P < .05)., Conclusions: Technology-assisted TKA was associated with lower perioperative complication rates and faster recovery., (Copyright © 2023 Elsevier Inc. All rights reserved.)

Objective: This systematic review and meta-analysis aimed to review the recent literature on the technical accuracy of surgical navigation for patient-specific reconstruction of orbital fractures using a patient-specific implant, and to compare surgical navigation with conventional techniques., Materials and Methods: A systematic literature search was conducted in PubMed (Medline), Embase, Web of Science, and Cochrane (Core Collection) databases on May 16, 2023. Literature comparing surgical navigation with a conventional method using postoperative three-dimensional computed tomography imaging was collected. Only articles that studied at least one of the following outcomes were included: technical accuracy (angular accuracy, linear accuracy, volumetric accuracy, and degree of enophthalmos), preoperative and perioperative times, need for revision, complications, and total cost of the intervention. MINORS criteria were used to evaluate the quality of the articles., Results: After screening 3733 articles, 696 patients from 27 studies were included. A meta-analysis was conducted to evaluate volumetric accuracy and revision rates. Meta-analysis proved a significant better volumetric accuracy (0.93 cm 3 ± 0.47 cm 3 ) when surgical navigation was used compared with conventional surgery (2.17 cm 3 ± 1.35 cm 3 ). No meta-analysis of linear accuracy, angular accuracy, or enophthalmos was possible due to methodological heterogeneity. Surgical navigation had a revision rate of 4.9%, which was significantly lower than that of the conventional surgery (17%). Costs were increased when surgical navigation was used., Conclusion: Studies with higher MINORS scores demonstrated enhanced volumetric precision compared with traditional approaches. Surgical navigation has proven effective in reducing revision rates compared to conventional approaches, despite increased costs., Competing Interests: Declaration of Competing Interests None. The authors declare that there are no conflicts of interest regarding this analysis., (Copyright © 2023 The Authors. Published by Elsevier Masson SAS.. All rights reserved.)

Purpose: The primary objective of this study was to evaluate how the utilization of virtual surgical planning (VSP) and the epidemiological profile of patients undergoing orthognathic surgery (OGS) have changed in the past decade., Methods: The records of patients who had undergone orthognathic surgery at a national dental hospital were reviewed. Trends in VSP, epidemiological data, presentation of dentofacial deformity, and management details were recorded., Results: A total of 1184 patients were included in this study. The majority of the patients seeking treatment in this dental hospital were young Chinese adults with dentofacial deformities requiring bimaxillary surgeries. Most patients presented with a skeletal Class III pattern (79.0%), and asymmetry was diagnosed in 80.8% of all cases., Conclusion: There was an initial slow pick-up rate for VSP, but this rapidly increased to a high adoption rate of 98.7-100% between 2019 and 2021. Together with an increasing body of evidence suggesting greater accuracy in VSP, utilization in this technology can be enhanced with greater familiarity with the technology and improvements in the VSP services., (© 2023. The Author(s), under exclusive licence to Springer-Verlag GmbH Germany, part of Springer Nature.)

The widespread use of video-assisted thoracoscopic surgery (VATS) has triggered the rapid expansion in the field of computed tomography (CT)-guided preoperative localization and near-infrared (NIR) fluorescence image-guided surgery. However, its broader application has been hindered by the absence of ideal imaging contrasts that are biocompatible, minimally invasive, highly resolvable, and perfectly localized within the diseased tissue. To achieve this goal, we synthesize a dextran-based fluorescent and iodinated hydrogel, which can be injected into the tissue and imaged with both CT and NIR fluorescence modalities. By finely tuning the physical parameters such as gelation time and composition of iodinated oil (X-ray contrast agent) and indocyanine green (ICG, NIR fluorescence dye), we optimize the hydrogel for prolonged localization at the injected site without losing the dual-imaging capability. We validate the effectiveness of the developed injectable dual-imaging platform by performing image-guided resection of pulmonary nodules on tumor-bearing rabbits, which are preoperatively localized with the hydrogel. The injectable dual-imaging marker, therefore, can emerge as a powerful tool for surgical guidance.

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

Introduction: This study aimed to evaluate the learning curve associated with the adoption of US guided PCNL and demonstrate that it can be carried out safely with results comparable to those obtained using standard PCNL., Methods: Prospective study with 65 patients who underwent PCNL between 2019 and 2020. all procedures were performed in supine position and an initial attempt to gain access to the kidney using US was made., Results: Mean procedure duration was 69.5 ± 27.8 min. Fluoroscopy was used with a mean dose of 276.68 ± 560.71 (cGycm 3 ) and mean fluoroscopy time 40.25 ± 77.69 (s). Throughout the study there was a steady decrease in the use of fluoroscopy and amount of radiation to gain access to the kidney to only 25% at the study end. 76.5% of the patients were stone free at follow-up. Complication rate was 9.2%., Conclusions: Fluoroless US guided PCNL is safe, feasible and reproducible procedure., Competing Interests: Declaration of conflicting interestsThe author(s) declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.

Introduction: Nowadays, the training of implant placement has shifted from once entirely instructor-student teaching to the increasing use of computer-assisted simulation. Based on computerized virtual planning, dynamic navigation has been used for implant placement with higher accuracy than the traditional freehand protocol. However, whether dynamic navigation benefits to the training of dental students in implant placement remains controversial. This study aimed to compare the surgical performance of dental students in implant placement using computer-assisted dynamic navigation and freehand approaches., Materials and Methods: A total of 20 dental students (6 males, 14 females, age: 25.6 ± 0.5 years) were enrolled in this study. With the traditional freehand approach (training 1) as the control protocol, computer-assisted dynamic navigation (training 2) was used in the training of dental students in implant placement. For each training, both the operating time (OT) of students and placement accuracy represented by the linear (at the implant platform, D pl , and apex, D ap ) and angular (D an ) deviations between the virtually planned and placed implants were recorded. Statistical comparisons were made between the two training protocols as well as male and female surgeons., Results: OT 2 was around twice of OT 1 (p < .0001), whereas D an1 was almost three times of D an2 (p < .0001). D ap1 and D pl1 were significantly higher than D ap2 (p = .014) and D pl2 (p = .033) respectively. Besides, male students showed statistically higher D pl1 (p = .033) and D an1 (p = .002) than females. No significant difference was found between male and female students in OT 1 , OT 2 , D pl2 , D ap1 , D ap2 and D an2 ., Conclusions: Within the limitations of this study, the use of computer-assisted dynamic navigation in the preclinical training could improve the surgical performance of the dental students in implant placement. The combination of dynamic navigation with the traditional preclinical surgical training may benefit to dental students and could be applied in dental education., (© 2023 John Wiley & Sons A/S. Published by John Wiley & Sons Ltd.)

Purpose: To realize a systematic review with prospective meta-analysis aiming to compare the accuracy of static fully guided implant placement depending on the drill key modality (conventional drill key surgery systems vs newer keyless systems) and evaluate the impact of deviation factors., Materials and Methods: An electronic systematic search was conducted to identify prospective clinical trials matching inclusion criteria. The variables of interest were coronal global, apical, vertical, and angular deviations. The types of edentulism and surgical guide support were investigated as deviation factors. Meta-regression (mixed-effect model) was performed. Heterogeneity was assessed using Cochrane's I. test and interpretation thresholds., Results: A total of 1,233 implants in 475 patients were analyzed (18 studies included). Coronal global deviation was significantly lower in the keyless group than in the key group (-0.36 mm; 95% CI -0.62, -0.09; P = .008). Angulation control of the keyless system was superior to that of the key system (-0.36 degrees; 95% CI -0.75, 0.02; P = .063). Nonsignificant differences were found between both groups in apical (P = .684) and vertical deviations (P = .958). Significant influence of the type of edentulism (single, partial, total) and surgical guide support (tooth, mucosa, bone) on the overall amount of coronal global, apical, and angular deviations was found (P < .001). The lowest deviations were found in partial edentulism and tooth-supported surgical guide groups. (P < .001)., Conclusions: Keyless static fully guided surgical systems allowed significantly better control of coronal and angular deviations than conventional systems. The types of edentulism and surgical guide support seemed to influence the positioning accuracy.

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