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Background: Micro-arteriovenous malformations (AVMs) are a subgroup of AVMs with a nidus smaller than 1- cm. As such, intraoperative localization of micro-AVMs can be challenging. Once identified intraoperatively, however, treatment of the micro-AVM is often straightforward. Method: We discuss and illustrate the fundamental imaging and intraoperative steps to localize micro-AVMs with the aid of an illustrative clinical case. Conclusion: Micro-AVMs can be challenging to localize intraoperatively. With the aid of anatomical, clinical, and intraoperative findings, the micro-AVMs small draining vein can be localized and traced in a retrograde fashion to identify and remove the micro-AVM. [ABSTRACT FROM AUTHOR]

Background: In this study, we report the use of a complex surgical intervention termed modular one-stage emergent pancreaticoduodenectomy (MOEPD) for the treatment of acute Grade IV or V pancreaticoduodenal injuries in haemodynamically stable patients. We summarize the experiences of surgeons performing MOEPD in 12 patients from 3 centres. Methods: From 2015 to 2021, the clinical data of patients with blunt abdominal trauma who underwent MOEPD were extracted from three Chinese centres. The patients' perioperative variables were assessed. Results: All twelve MOEPD cases were analysed. All patients had Grade IV or V pancreatoduodenal injuries and received intensive antishock treatment for haemodynamic stabilization. The mean age of the patients was approximately 45.2 years (22–74 years). Ten patients (83.3%) were male. In contrast to the ten patients who underwent pancreaticoduodenectomy (PD), two patients underwent laparoscopic pancreaticoduodenectomy (LPD). Two patients presented with a combination of severe abdominal injuries. None the patients died in the perioperative period. Five patients (41.7%) experienced postoperative complications. A postoperative pancreatic fistula (POPF) was detected in 16.7% of patients, both of whom recovered within 3–4 weeks with conservative drainage. All patients were released from the institutions after an average of 31.8 days (21–53 days). There was no statistically significant difference in the incidence of complications between the 20 reviewed studies and this group (60.7% vs. 41.7%, P = 0.33), but the mortality rate was lower in this group (26.6% vs. 0%, P = 0.04). Conclusions: The experiences at these 3 centres suggest that MOEPD may be a lifesaving procedure for haemodynamically stable patients with acute Grade IV or V pancreatoduodenal injuries, despite the small sample size of this study. Clinical trial number: Not applicable. [ABSTRACT FROM AUTHOR]

Background/Objectives: This study aims to evaluate factors influencing revision cochlear implant surgeries, including patient demographics, surgical techniques, and radiological findings. The main aim was to identify factors influencing surgical success to inform clinical treatment and enhance patient outcomes. Methods: This cross-sectional study included adult patients over the age of 18 who underwent revision cochlear implant surgery due to implant-related complications. Data were collected from systematic chart reviews of electronic medical records, including demographics, surgical techniques, radiological output from standard high-resolution CT and MRI, and intraoperative data. The primary outcome was surgical success, defined by improved auditory function, stable device positioning, and absence of postoperative complications. Statistical analyses, including multivariate logistic regression, were conducted to identify independent predictors of surgical success. Results: A total of 188 patients were included, with a mean age of 45.67 years. Younger age, shorter duration of implant use, modified surgical techniques, and absence of co-morbidities are key factors contributing to surgical success. Modified surgical techniques were associated with better outcomes (39.29% vs. 68.75%, OR: 2.78, 95% CI: 1.25–6.14, p = 0.012). Radiological patterns significantly affected outcomes, with normal findings associated with higher success rates. In contrast, abnormalities such as electrode migration (OR: 2.14, 95% CI: 1.12–4.09, p = 0.021) and ossification (r = −0.51, β = −0.44, adjusted R2 = 0.25, p < 0.01) were correlated with poorer results. Smoking status, when comparing smokers to non-smokers, was associated with unfavorable outcomes (20.00% vs. 45.83%, OR: 2.01, 95% CI: 1.01–4.01, p = 0.048), and a history of previous surgeries (21.43% vs. 37.50%, OR: 1.95, 95% CI: 1.03–3.71, p = 0.033) was significantly associated with unfavorable outcomes. Conclusions: Statistically, significantly better outcomes are positively correlated with the duration of the first cochlear implant experience and negatively with prior otologic pathology and nonauditory environmental influences on surgical success. Younger age, modified surgical techniques, and normal radiological findings were related to better outcomes; complications such as electrode migration and ectopic ossification were strong predictive factors for surgical failure. These findings underscore the need for tailored surgical approaches and early intervention to enhance outcomes in revision cochlear implant surgeries. [ABSTRACT FROM AUTHOR]

Introduction: Despite the acknowledgment in the previous decades and all the extensive studies of necrotizing enterocolitis (NEC), the controversy regarding this problem is still on-going and unsolved. It is a common gastrointestinal life-threatening emergency that occurs primarily in 90% of the preterm infants. Surgery is usually indicated in approximately 27%–52% of infants with NEC. Case 1: Full-term, birth weight of 3.2 kg. At 14 days old, he developed pneumoperitonea, at exploratory laparotomy, all the necrotic segments were sealed and divided using 5 mm LigaSure device. All the edges of the resected bowel were sealed and return in the abdominal cavity. At the second look surgery, assurance of bowel viability was established. The sealed bowel segments were completely closed. Case 2: A 33-week-old gestational age, of 2000 g. was operated upon at the age of 14 days for developing pneumoperitoneum. At exploration, there was evidence of extensive NEC involving the entire small intestine reaching to the cecum with multiple necrotic and perforated areas was found. All the segments of necrosis were resected using 5-mm LigaSure device. The small areas of perforation were patched. At second-look surgery, all the sealed bowel segments and the areas of patch perforation were viable, with good sealing without any complications. Anastomosis of the multiple resected segments was done with "Shish-Kebab" technique. Discussion: Multifocal NEC is a challenging spectrum of the disease for pediatric surgeon, as there are various surgical options in their management. LigaSure is an electrothermal sealing system that combines dissecting and reconstructing abilities in a single instrument, without the need to reload with each use. Thus, it reduces the cost as well as shorten the operative time as mentioned in the previous studies. In addition, it has the advantage over clips as they do not leave any metallics in the body, furthermore, the risk to damage the surrounding structures is less due to minimal thermal spread so limited injury, and it considers easy to use. Conclusion: LigaSure device is an effective and safe method in sealing small bowel in sick neonates with multifocal NEC if applied with single application and with minimal manipulation of the bowel and most importantly minimizing the operative time. [ABSTRACT FROM AUTHOR]

Introduction: The main goals of rhinoseptoplasty are to correct any cosmetic and functional defects which may occur in a patient. As the most prominent facial feature, the nose has an increased risk of injury. A nasal fracture may eventually result in significant defects, posing challenges to the surgeon. Aim: The aim of the study is to compare the techniques used in post-traumatic and non-traumatic cases treated with rhinoplasty. Materials and methods: The study group consisted of 227 patients, mean age 37.5 ±11.4 years, median 36 years, age range from 18 to 79 years. Statistical analysis was performed using the Statistica 13.3 package StatSoft (Dell Statistica). Categorical variables are presented as frequencies and percentages. The Chi2 or Fisher’s exact test was used, when the values were less than 5, to check whether there was a correlation between nasal injuries and surgical technique. The level of statistical significance was assumed to be equal to α = 0.05. Results: Statistically significant differences were found in the use of five techniques. Septal filtration to the spine (44.1 vs. 10.7%), septal extension graft (5.9 vs. 1.3%), spreader graft (41.1 vs. 21.1%), and osteotomy (85.3 vs. 61.0%) were all performed more often in patients with nasal trauma. On the other hand, a lateral crural (LC) steal was performed significantly more often in patients without nasal trauma (36.5 vs. 22.1%). Conclusions: Nose injuries lead to cosmetic and functional complications and pose a challenge to the rhinoplasty surgeon. Optimal management of a post-traumatic nose injury requires a surgeon to have experience and precise surgical planning. [ABSTRACT FROM AUTHOR]

Abstract Background In this study, we report the use of a complex surgical intervention termed modular one-stage emergent pancreaticoduodenectomy (MOEPD) for the treatment of acute Grade IV or V pancreaticoduodenal injuries in haemodynamically stable patients. We summarize the experiences of surgeons performing MOEPD in 12 patients from 3 centres. Methods From 2015 to 2021, the clinical data of patients with blunt abdominal trauma who underwent MOEPD were extracted from three Chinese centres. The patients’ perioperative variables were assessed. Results All twelve MOEPD cases were analysed. All patients had Grade IV or V pancreatoduodenal injuries and received intensive antishock treatment for haemodynamic stabilization. The mean age of the patients was approximately 45.2 years (22–74 years). Ten patients (83.3%) were male. In contrast to the ten patients who underwent pancreaticoduodenectomy (PD), two patients underwent laparoscopic pancreaticoduodenectomy (LPD). Two patients presented with a combination of severe abdominal injuries. None the patients died in the perioperative period. Five patients (41.7%) experienced postoperative complications. A postoperative pancreatic fistula (POPF) was detected in 16.7% of patients, both of whom recovered within 3–4 weeks with conservative drainage. All patients were released from the institutions after an average of 31.8 days (21–53 days). There was no statistically significant difference in the incidence of complications between the 20 reviewed studies and this group (60.7% vs. 41.7%, P = 0.33), but the mortality rate was lower in this group (26.6% vs. 0%, P = 0.04). Conclusions The experiences at these 3 centres suggest that MOEPD may be a lifesaving procedure for haemodynamically stable patients with acute Grade IV or V pancreatoduodenal injuries, despite the small sample size of this study. Clinical trial number Not applicable.

Abstract Background To analyze the safety and efficacy of microsurgical subinguinal varicocelectomy(MSV) performed with and without preservation of all testicular arteries and lymphatic system. Methods All of the 98 patients with varicocele who underwent MSV were included in the analysis. Fifty-eight male patients surgically underwent MSV with preservation of all testicular arteries and lymphatic system(Group 1). The other 40 male patients surgically underwent MSV with preservation of a single testicular artery, while the remaining vascular bundle sparing the vas deferens with its vessels was then isolated"en bloc,” ligated and cut(Group 2). Operative time, semen parameters and complications were then compared. Results Mean operative time for Group 1 was significantly longer than that of Group 2(90.26 ± 21.69 min vs. 79.30 ± 19.58 min, P = 0.01). Visual analogue pain scale (VAS) decreased significantly in both groups. Group 1 experienced a decrease from a median of 5 (interquartile range, IQR: 4 ~ 6) to 1 (IQR: 0 ~ 2), P

Abstract Ossification of the posterior longitudinal ligament of the cervical spine (C-OPLL) is a degenerative disorder that leads to the narrowing of the spinal canal and compression of both the spinal cord and nerve roots. This condition is more prevalent in East Asian populations, with marked regional variations in incidence. Symptoms include neck pain, restricted movement, limb numbness, and motor impairment. In severe cases, surgery may be required. Surgical strategies for C-OPLL can be divided into anterior and posterior approaches, each offering distinct advantages and limitations. Anterior approaches, such as anterior cervical corpectomy and fusion (ACCF), anterior cervical discectomy and fusion (ACDF), anterior floating method and vertebral body sliding osteotomy (VBSO), provide the benefit of direct decompression but are technically demanding and carry a higher risk of complications. In contrast, posterior approaches, including laminectomy (with or without instrumented fusion) and laminoplasty (LAMP), offer indirect decompression but may increase the risk of cervical kyphosis. In recent years, innovative techniques like anterior cervical ossified posterior longitudinal ligament en bloc resection (ACOE), anterior controllable antedisplacement and fusion (ACAF), and minimally invasive endoscopic spine surgery have been developed to reduce complications and enhance surgical outcomes. Selecting the appropriate surgical technique requires a thorough assessment of factors such as the severity of the lesion, cervical alignment, and the surgeon’s experience. This narrative review examines the differences between these surgical options, discusses their respective advantages and disadvantages, and provides updated insights and recommendations.

Background: Astigmatism is a common refractive error that significantly affects visual outcomes after cataract surgery. This study examines the impact of two different nucleus management techniques, phacofracture and sandwich, on postoperative astigmatism, with a focus on incision size. METHODS: A retrospective analysis of 200 cataract surgery patients was conducted. Patients were divided based on the surgical technique used--phacofracture or sandwich. The primary outcome was the degree of postoperative astigmatism, measured one month after surgery. Incision sizes were classified as small(<5mm) or large(>5mm), and their relationship with postoperative astigmatism was analyzed using odds ratios and chi-square tests for statistical significance. Results: The phacofracture technique with small incisions resulted in lower postoperative astigmatism rates (10%) compared to the sandwich technique with large incisions (40%) (p=0.002). The odds of developing higher degrees of astigmatism (>0.50 diopters) were significantly greater in the sandwich group compared to the phacofracture group with small incisions (OR=3.00, 95% CI: 1.58-5.70, p=0.001). Conclusion: The phacofracture technique, particularly with smaller incisions, significantly reduces postoperative astigmatism compared to the sandwich technique. The results emphasize the importance of incision size in minimizing refractive errors following cataract surgery. [ABSTRACT FROM AUTHOR]

BACKGROUND Posterior capsular opacification (PCO) is a common complication of cataract surgery, leading to impaired visual acuity and reduced quality of life. Despite advancements in ocular surgical techniques, PCO remains a significant obstacle to achieving optimal visual outcomes. This study investigates the preoperative and intraoperative factors associated with PCO development in patients attending the ophthalmology outpatient department. METHODS A hospital based prospective cross-sectional study was conducted among cataract patients attending the ophthalmology outpatient department of a tertiary care hospital for a period of 15 months. Detailed histories, including the type of cataract surgery performed, intraocular lens (IOL) type and placement, and other preoperative and intraoperative parameters, were documented. Patients were monitored for six months post-surgery to evaluate the incidence of posterior capsular opacification (PCO) and identify associated risk factors. RESULTS In this study, 71 participants were included, examined, and followed up. Among them, 63.4% had posterior subcapsular cataracts (PSC), with 88.9% developing PCO. Conventional extracapsular cataract extraction was performed in 84.5% of cases, and 94.36% of participants received Poly Methyl Methacrylate (PMMA) IOLs, which had a 79.1% PCO incidence. PCO was observed in 78.3% of patients with IOLs placed in the capsular bag and 90.9% with sulcus placement. Participants with larger capsulorrhexis sizes exhibited slightly higher PCO rates 81.8%. Additionally, 14% of participants developed PCO within one month of cataract surgery, and 21% developed it within months CONCLUSION PCO development is influenced by both preoperative (age, steroid use, diabetes) and intraoperative (IOL type, placement, capsulorrhexis size) factors. Using acrylic IOLs, ensuring capsular bag placement, and optimizing surgical techniques can mitigate risk. Early PCO onset, noted in this study, highlights the need for close postoperative monitoring, particularly in high-risk patients. [ABSTRACT FROM AUTHOR]

Background: To analyze the safety and efficacy of microsurgical subinguinal varicocelectomy(MSV) performed with and without preservation of all testicular arteries and lymphatic system. Methods: All of the 98 patients with varicocele who underwent MSV were included in the analysis. Fifty-eight male patients surgically underwent MSV with preservation of all testicular arteries and lymphatic system(Group 1). The other 40 male patients surgically underwent MSV with preservation of a single testicular artery, while the remaining vascular bundle sparing the vas deferens with its vessels was then isolated"en bloc," ligated and cut(Group 2). Operative time, semen parameters and complications were then compared. Results: Mean operative time for Group 1 was significantly longer than that of Group 2(90.26 ± 21.69 min vs. 79.30 ± 19.58 min, P = 0.01). Visual analogue pain scale (VAS) decreased significantly in both groups. Group 1 experienced a decrease from a median of 5 (interquartile range, IQR: 4 ~ 6) to 1 (IQR: 0 ~ 2), P < 0.001; similarly, Group 2 saw a reduction from a median of 4 (IQR: 3 ~ 5.75) to 1 (IQR: 1 ~ 2), P < 0.001. Additionally, notable improvements were recorded in sperm count and motility in both groups at the 12-month follow-up compared to their pre-operative measurements. For Group 1, sperm count increased from a median of 35.5 × 106/mL(IQR: 29 ~ 60) to 60 × 106/mL(IQR: 50 ~ 74.25), and motility from 46.5% (IQR: 32 ~ 56%) to 69%(IQR: 54.5 ~ 79%), both with P < 0.001. Group 2 showed similar enhancements, with sperm count rising from a median of 31 × 106/mL (IQR: 20 ~ 56.25) to 57.5 × 106/mL(IQR: 51.25 ~ 73.75) and motility from 44% (IQR: 23 ~ 54.75%) to 75% (IQR: 51.25 ~ 80%), P < 0.001. The duration of postoperative hospital stay was comparable between the two groups, with both reporting a median stay of 3 days (IQR: 2–3 days, P = 0.83). No testicular atrophy and varicocele recurrence was observed in all patients. The incidence rates of hydrocele, wound infection, and orchitis and epididymitis showed no significant disparity between the two groups. Specifically, both groups each had a single incidence of hydrocele. Group 1 had one incidence of wound infection, while Group 2 had none. Orchitis and epididymitis occurred once in Group 1, but not in Group 2. Conclusion: Our study provides preliminary evidence supporting the implementation of the"en bloc" procedure in MSV as a potentially safe and effective option, especially for managing cases with severe adhesion. [ABSTRACT FROM AUTHOR]

Introduction: Tailoring surgical interventions to target age‐related transformations is paramount. Many candidates seeking blepharoplasty commonly exhibit eyebrow ptosis, underscoring the necessity for surgeons to possess a comprehensive understanding of techniques for brow and forehead rejuvenation. Methods: Various surgical techniques are available for eyebrow and forehead enhancement, contrasting the standardized approaches in upper and lower blepharoplasty. Thread lifting has gained popularity for forehead lifting, although a more precise term would be eyebrow lifting. The thread lifting methods using V and I techniques with floating‐type threads (Secret Line, Hyundai Meditech., Inc., Wonju‐si, Republic of Korea) are used. Results: The natural aging process often causes the forehead and eyebrows to sag under the influence of gravity, leading to the appearance of heavy eyelids. Elevating the eyebrows can mitigate droopiness, enhance vision clarity, and rejuvenate the facial aesthetic. While non‐surgical methods like Botulinum Toxin A can weaken muscles and potentially aid in brow elevation, their visible effects may be somewhat constrained. Discussion: Surgical methods encompass endoscopic forehead lift, eyebrow lift techniques, and scalp excision‐based forehead reduction surgery, each with specific advantages and drawbacks. Thread lifting bridges the gap between surgical and non‐surgical modalities. Forehead areas often lack subcutaneous fat, requiring precise anatomical understanding for effective thread lifting. Cannula usage with partial tunneling ensures efficacy even in patients with strong adhesions. Presented cases showcase successful eyebrow lifting using cog threads, illustrating immediate and gradual post‐procedure changes. Conclusion: Eyebrow thread lifting demands periodic procedures, offering subtler improvements than surgery. Anatomical knowledge is crucial, and the technique presents discomfort. Effects last about 6 months, requiring re‐treatment as effects regress. Thread lifting, a middle ground between surgical and non‐surgical methods, can rejuvenate brows with less downtime. [ABSTRACT FROM AUTHOR]

Objective: To compare fully guided flapless implant surgery using a light‐cured surgical guide (FG group) with partially guided open flap surgery (PG group) in the posterior maxilla when performing simultaneous sinus floor elevation in terms of the accuracy, time requirements, and patient/clinician‐reported outcomes (PROMs and CROMs). Materials and Methods: In this study, 56 tissue‐level implants were placed with crestal sinus floor elevation in 56 patients at single‐tooth sites, with 28 implants allocated to the PG group and 28 to the FG group. The deviations of the placed implants from the virtually planned positions were measured at the implant platform and apex and for the angular deviation. The presurgical preparation time and the duration of surgery were measured. PROMs and CROMs were made by administering questionnaires at multiple time points. Results: Horizontal deviations at the platform and apex and the angular deviation were significantly smaller in the FG group than the PG group (p <.05). Presurgical preparation and surgery times were significantly shorter in the FG group (p <.001). Patient satisfaction and willingness to receive repeat treatment were significantly better in the FG group than in the PG group (p <.005 and.025, respectively). Clinicians were more satisfied in the FG group than the PG group (p <.05). Conclusion: When placing an implant with sinus floor elevation, the flapless approach using a fully guided surgical system can be more accurate, faster, and increase the satisfaction of both the clinician and patient compared to the partially guided surgery. [ABSTRACT FROM AUTHOR]

Background: Recent studies in surgical techniques have significantly transformed therapeutic approaches, leading to substantial decreases in morbidity and mortality rates. Differential diagnosis plays a pivotal role in determining the most suitable surgical strategies for addressing aneurysms. Historically, clipping has been considered a longstanding tradition in the vascular field between 1937 and 1975, pioneered by Microneurosurgery pioneers Yasargil and Fox. Methods: This study followed the PRISMA (Preferred Reporting Items for Systematic Reviews), and the statistical analysis was performed using IBM SPSS Statistics for Windows, Version 26.0 (released 2020; IBM Corp., Armonk, New York, United States). And EXCEL: A comprehensive review of neurosurgical care for cerebral aneurysms in controlling subarachnoid haemorrhage through endovascular clipping and coiling was conducted by the followers' methods used on aneurysm patients. Databases like Science Direct and PubMed were utilized, and articles were searched from the earliest available dates up to January 2024. Tables 1-2-3 are shown. The search focused primarily on publications in English, adhering to PRISMA guidelines. The search process for scientific papers, including meta-analysis, centred on PubMed and Science Direct. Results: A total of 45,223.00 patients with aneurysms who underwent endovascular procedures or surgical methods involving clipping or colling are displayed in Table 1. Of these, 2769 patients had ruptured aneurysms associated with subarachnoid haemorrhage, while 985.00 patients did not rupture. In Table 2, 6090.14 patients with aneurysms are evaluated, and in Table 3, 36,251.00 patients with coils 31,502.00 and clips 28,803.00 were assessed. Conclusion: From the synthesis of various reviewed studies, effective management strategies involve early detection of bleeding using diagnostic tests like MRI or CT angiography, considering neurological functioning levels assessed through scales such as the Fisher scale or the Hunt and Hess scale for subarachnoid haemorrhage or potential stroke. [ABSTRACT FROM AUTHOR]

Purpose: Hysterectomy may be a risk factor for pelvic organ prolapse (POP). We assessed the risk of recurrent POP (operations and visits) after hysterectomy among women with previous POP. We also studied patient and operation related risk factors for POP recurrence. Methods: This retrospective cohort study included 1697 women having previous POP diagnosis or POP at the time of hysterectomy (FINHYST 2006 cohort). Follow-up was until the end of 2016. The data was derived from the Finnish National Care register linked to the cohort. Hysterectomy approaches and other demographics were compared to the risk of a prolapse diagnosis and/or surgery. Cox regression model was used to identify hazard ratios. Results: Following hysterectomy, a total of 280 women (16.5%) had a POP reoperation and 359 (21.2%) had an outpatient visit due to POP. Vaginal vault prolapse repair was the most common POP reoperation (n = 181, 10.7%), followed by anterior wall repair (n = 120, 7.1%). Median time to POP reoperation was 3.7 years. Hysterectomy approach did not affect reoperations or visits. Previous cesarean section and anterior repair during hysterectomy were associated with decreased risk, whereas concomitant sacrospinous fixation and uterus prolapse as the main indication led to increased risk of anterior/vault prolapse reoperations. Concomitant posterior repair decreased posterior reoperations and visits, but uterus weight over 500 g caused a fivefold increased risk of posterior prolapse visit. Residential status was associated with elevated risk of any POP reoperations and visits. Conclusions: Approximately one out of five women suffering from POP ensue POP reoperation or visit after hysterectomy. These high rates are independent on hysterectomy approach, but probably indicate that hysterectomy may worsen previous pelvic floor dysfunction. [ABSTRACT FROM AUTHOR]

Ossification of the posterior longitudinal ligament of the cervical spine (C-OPLL) is a degenerative disorder that leads to the narrowing of the spinal canal and compression of both the spinal cord and nerve roots. This condition is more prevalent in East Asian populations, with marked regional variations in incidence. Symptoms include neck pain, restricted movement, limb numbness, and motor impairment. In severe cases, surgery may be required. Surgical strategies for C-OPLL can be divided into anterior and posterior approaches, each offering distinct advantages and limitations. Anterior approaches, such as anterior cervical corpectomy and fusion (ACCF), anterior cervical discectomy and fusion (ACDF), anterior floating method and vertebral body sliding osteotomy (VBSO), provide the benefit of direct decompression but are technically demanding and carry a higher risk of complications. In contrast, posterior approaches, including laminectomy (with or without instrumented fusion) and laminoplasty (LAMP), offer indirect decompression but may increase the risk of cervical kyphosis. In recent years, innovative techniques like anterior cervical ossified posterior longitudinal ligament en bloc resection (ACOE), anterior controllable antedisplacement and fusion (ACAF), and minimally invasive endoscopic spine surgery have been developed to reduce complications and enhance surgical outcomes. Selecting the appropriate surgical technique requires a thorough assessment of factors such as the severity of the lesion, cervical alignment, and the surgeon's experience. This narrative review examines the differences between these surgical options, discusses their respective advantages and disadvantages, and provides updated insights and recommendations. [ABSTRACT FROM AUTHOR]

Background: Pediatric pancreatic tumors, especially with duodenal invasion, are exceptionally rare and a strategy for their treatment has not been established. A pancreaticoduodenectomy is often the desired treatment, but may be over-invasive for solid pseudopapillary neoplasm (SPN). This study reports an innovative surgical approach for SPN with duodenal invasion using pancreatic enucleation and endoscopically guided partial duodenectomy. Case presentation: An 11-year-old girl complained of malaise and presented with severe anemia; imaging revealed a tumor of undetermined origin, involving the pancreatic head and descending duodenum. Intraoperative findings showed tumor adherence to the pancreatic head and endoscopy revealed invasion of the duodenum. The tumor was enucleated from the pancreatic head, and partial duodenectomy was performed under endoscopically guided direct visualization. Pathology confirmed SPN with duodenal invasion, and no residual tumor. Although a Grade B pancreatic fistula occurred postoperatively, it was managed conservatively. At the 15-month follow-up, no signs of tumor recurrence, duodenal stenosis, or pancreatic dysfunction were evident. Conclusions: Given the good prognosis of SPN, we believe that enucleation from the pancreatic head combined with an endoscopically guided partial duodenectomy could be a useful and less invasive alternative to pancreaticoduodenectomy for cases with duodenal invasion. [ABSTRACT FROM AUTHOR]

ABSTRACT Background Aims Patients/Methods Results Conclusions Thread lifting is a minimally invasive procedure that enhances facial aesthetics by repositioning sagging tissues with absorbable threads. It requires a comprehensive understanding of facial anatomy for safe and effective results.This study aims to highlight the critical anatomical considerations in thread lifting, including the navigation of facial vascular structures, the protection of facial nerves, manipulation of fat compartments, and engagement of retaining ligaments. These factors are essential for minimizing complications and achieving optimal outcomes.A review was conducted focusing on the anatomical elements critical to thread lifting. The study analyzed clinical outcomes related to vascular structures, nerve pathways, fat compartments, and ligaments in patients undergoing the procedure.The review revealed that careful navigation of facial blood vessels is crucial to avoid complications such as bleeding and bruising. Knowledge of facial nerve pathways is essential to prevent nerve damage, which could result in facial weakness or paralysis. Proper manipulation of facial fat compartments helps address aging‐related changes, and engaging retaining ligaments is vital for a sustainable lift without tissue distortion.Thread lifting demands not only technical skill but also a deep understanding of facial anatomy to ensure patient safety and desired aesthetic results. Expertise in these anatomical considerations is essential for minimizing complications and preserving the natural function of facial structures. [ABSTRACT FROM AUTHOR]

Purpose: To evaluate the safety and performance of a potential novel strategy to resolve the above scenario by simultaneously performing implant-related surgery and endodontic microsurgery (EMS). Materials and Methods: A total of 25 subjects requiring GBR during implant placement in anterior areas were allocated into two groups. In the experimental group (adjacent teeth with periapical lesions) with 10 subjects, implantation and GBR were performed for edentulous areas with simultaneous EMS for adjacent teeth. In the control group (adjacent teeth without periapical lesions) with 15 subjects, implantation and GBR were performed for edentulous areas. The clinical outcomes, radiographic bone remodeling, and patient-reported outcomes were assessed. Results: Within a 1-year follow-up, the implant survival rate was 100% in both groups, with no significant difference regarding complications. All teeth achieved complete healing following EMS. Repeated analysis of variance (ANOVA) measurements revealed a significant change over time in horizontal bone widths and postoperative patient-reported outcomes, but no intergroup statistically significant differences (P > .05) in horizontal bone widths and visual analog scale scores of pain, swelling, and bleeding were observed. Likewise, the bone volumetric decrease (7.4% ± 4.5% in the experimental group and 7.1% ± 5.2% in the control group) from T1 (suture removal) to T2 (6 months after implantation) revealed no intergroup differences. The horizontal bone width gain at the implant platform was slightly lower in the experimental group (P < .05). Interestingly, the color-coded figures of both groups showed a facial reduction of grafted material in edentulous areas. However, the apical regions following EMS exhibited stable bone remodeling in the experimental group. Conclusion: This novel approach to address the problem involving implant-related surgery close to the periapical lesion of adjacent teeth appeared safe and reliable (no.: ChiCTR2000041153). [ABSTRACT FROM AUTHOR]

Abstract Background This retrospective study aimed to analyze the evolution of primary indications and surgical techniques for corneal transplantation in Southern China from 2012 to 2021. Methods The medical charts of all patients who underwent keratoplasty between January 2012 and December 2021 at Zhongshan Ophthalmic Centre, Sun Yat-Sen University, Guangzhou, Southern China were reviewed. We collected and analyzed the primary indications for corneal transplantation and the surgical methods used in each keratoplasty. Results The total number of corneal transplantations was 7,286 during this decade, increasing from 210 cases in 2012 to 1054 cases in 2021. The primary indications for keratoplasty included acquired nontraumatic corneal diseases (56.2%), congenital corneal abnormalities (16.4%), acquired traumatic corneal diseases (14.0%), and regraft (13.4%). Infectious keratitis was the leading indication among all keratoplasties (18.5%), followed by regraft (13.4%). Over the decade, the proportion of infectious keratitis gradually decreased (P = 0.013), while the proportion of regraft increased (P = 0.019). The predominant surgical technique was penetrating keratoplasty (PKP), accounting for 56.7%. However, the number of deep anterior lamellar keratoplasty (DALK) and endothelial keratoplasty (EK) significantly increased from 2012 to 2021 (P = 0.007 and P = 0.002). Conclusions The annual number of corneal transplants significantly increased from 2012 to 2021. In the past decade, infectious keratitis and regraft have become the leading primary indications for corneal transplantation. Although the use of customized lamellar techniques has dramatically increased, PKP remains the predominant surgical technique for keratoplasty.

Background: Tibia shaft fractures are the most common lower limb long bone fractures, with approximately 80% occurring in the diaphysis region. Intramedullary interlocking nailing is a common procedure for treating these fractures, typically performed with the injured extremity positioned at a minimum of 90° of knee flexion to achieve optimal exposure of the correct entry point. However, the tension of the quadriceps tendon often leads to a typical apex anterior angulation of the proximal fragment. Suprapatellar nailing, performed with the knee in a semi-extended position, aims to reduce this anterior angulation. The objective of this study is to investigate the outcomes of suprapatellar access for intramedullary nailing in tibia fractures. Methods: This study employs a descriptive longitudinal design. Sixty cases of closed shaft tibia fractures were treated using the suprapatellar nailing technique. Results: Sixty patients with tibia fractures were included in the study. All patients underwent operative procedures involving intramedullary interlocking tibia nails using the suprapatellar approach. Out of the 60 patients treated with the suprapatellar approach, excellent outcomes were observed, with good range of movements and high scores on the lower extremity functional scale. Conclusions: The suprapatellar approach demonstrated excellent outcomes for proximal 1/3rd tibia fractures.

Background: This retrospective study aimed to analyze the evolution of primary indications and surgical techniques for corneal transplantation in Southern China from 2012 to 2021. Methods: The medical charts of all patients who underwent keratoplasty between January 2012 and December 2021 at Zhongshan Ophthalmic Centre, Sun Yat-Sen University, Guangzhou, Southern China were reviewed. We collected and analyzed the primary indications for corneal transplantation and the surgical methods used in each keratoplasty. Results: The total number of corneal transplantations was 7,286 during this decade, increasing from 210 cases in 2012 to 1054 cases in 2021. The primary indications for keratoplasty included acquired nontraumatic corneal diseases (56.2%), congenital corneal abnormalities (16.4%), acquired traumatic corneal diseases (14.0%), and regraft (13.4%). Infectious keratitis was the leading indication among all keratoplasties (18.5%), followed by regraft (13.4%). Over the decade, the proportion of infectious keratitis gradually decreased (P = 0.013), while the proportion of regraft increased (P = 0.019). The predominant surgical technique was penetrating keratoplasty (PKP), accounting for 56.7%. However, the number of deep anterior lamellar keratoplasty (DALK) and endothelial keratoplasty (EK) significantly increased from 2012 to 2021 (P = 0.007 and P = 0.002). Conclusions: The annual number of corneal transplants significantly increased from 2012 to 2021. In the past decade, infectious keratitis and regraft have become the leading primary indications for corneal transplantation. Although the use of customized lamellar techniques has dramatically increased, PKP remains the predominant surgical technique for keratoplasty. [ABSTRACT FROM AUTHOR]

Introduction: This study introduces and compares a new intraperitoneal laparoscopic para‐aortic lymphadenectomy method to reach the level of the renal vein, the "tent‐pitching" antegrade approach with the retrograde approach in gynecological malignancy surgeries in terms of success rate, complication incidence, and the number of lymph nodes removed. It focuses on the feasibility, safety, and effectiveness. Meanwhile, this article reports on the vascular anatomical variations discovered in the para‐aortic region to enhance surgical safety. Material and Methods: This was a retrospective cohort study including patients undergone laparoscopic para‐aortic lymphadenectomy at a single center from January 2020 to December 2023 for high‐risk endometrial and early‐stage ovarian cancer. Patient charts were reviewed for mode of operation, perioperative complications, operative details, and histopathology. The patients were divided into anterograde group and retrograde group according to the operation mode. The two groups were further compared based on the success rate of lymph node clearance at the renal vein level, perioperative complications, and the number of removed lymph nodes. Quantitative data were analyzed using the t‐test, non‐normally distributed data using the rank‐sum test, and categorical data using Fisher's exact test and the chi‐square test, with statistical significance defined as P < 0.05. Results: Among 173 patients, the antegrade group showed higher surgery success (97.5% vs 68.82%), more lymph nodes removed (median 14 vs 7), and less median blood loss. The operation time was shorter in the antegrade group. Postoperative complications like lymphocele and venous thrombosis were lower in the antegrade group. Vascular abnormalities were found in 28.9% of patients, with accessory lumbar vein routing anomaly and accessory renal arteries being most common. Conclusions: The antegrade approach is feasible, safe, and effective, improving surgical exposure, reducing difficulty without additional instruments or puncture sites, and minimizing organ damage risk. It is effective in achieving better access to the renal vein and removing more para‐aortic lymph nodes than the retrograde method. Recognizing and carefully managing the diverse vascular abnormalities in the para‐aortic area, including variations in renal arteries, veins, and the inferior vena cava, is essential to reduce intraoperative bleeding and the likelihood of converting to open surgery. [ABSTRACT FROM AUTHOR]

Introduction: Post-infarction ventricular septal defect formation remains a formidable mechanical complication of acute myocardial infarction associated with increased morbidity and mortality. Case presentation: We describe the case of a 72-year-old male who was admitted with post-myocardial infarction ventricular septal defect and cardiogenic shock. Discussion: Impella 5.5 with SmartAssist as temporary left ventricular assist device provided sufficient support throughout multiple bridging episodes including failed percutaneous repair and subsequent definitive surgical repair. Contemporary management of post-infarction ventricular septal defect is discussed. [ABSTRACT FROM AUTHOR]

Simple Summary: This research investigates the effectiveness and safety of totally implantable vascular access devices (TIVADs) used for delivering treatments such as chemotherapy. Over a five-year period, 70 patients received TIVADs through a standardized surgical method under local anesthesia. The study found very low complication rates, with only two notable incidents: one device needed adjustment due to a flipped catheter, and one infection occurred after over three years of use. The procedural success rate was 100%, with devices typically lasting around 22 months, and some even up to five years. These findings suggest that TIVADs are a reliable and safe option for long-term venous access, significantly benefiting routine clinical practices. Background: Daily clinical practice requires repeated and prolonged venous access for delivering chemotherapy, antibiotics, antivirals, parenteral nutrition, or blood transfusions. This study aimed to investigate the performance and the safety of totally implantable vascular access devices (TIVADs) over a 5-year follow-up period through a standardized well-trained surgical technique and patient management under local anesthesia. Methods: In a retrospective, observational, and monocentric study, 70 patients receiving POLYSITE® TIVADs for chemotherapy were included. The safety endpoints focused on the rate of perioperative, short-term, and long-term complications. The performance endpoints included vein identification for device insertion and procedural success rate. Results: The study demonstrated no perioperative or short-term complications related to the TIVADs. One (1.4%) complication related to device manipulation was identified as catheter flipping, which led to catheter adjustment 56 days post-placement. Moreover, one (1.4%) infection due to usage conditions was observed, leading to TIVAD removal 3 years and 4 months post-surgery. Catheter placement occurred in cephalic veins (71.4%), subclavian veins (20%), and internal jugular veins (8.6%). The procedural success rate was 100%. Overall, the implantable ports typically remained in place for an average of 22.4 months. Conclusions: This study confirmed the TIVADs' performance and safety, underscored by low complication rates compared to published data, thereby emphasizing its potential and compelling significance for enhancing routine clinical practice using a standardized well-trained surgical technique and patient management. [ABSTRACT FROM AUTHOR]

Purpose: Periprosthetic femoral fractures (PPFs) around the hip are challenging complications in orthopaedic surgery, particularly Vancouver type B2 (VTB2) fractures. The surgical management of these fractures is crucial and depends on various factors. Cementless short taper stem with plate osteosynthesis is an alternative surgical technique. This study aims to compare the outcomes of this surgical technique with revision arthroplasty (RA) with long stem in the treatment of VTB2 PPFs. Methods: This retrospective study was conducted in a single medical institute from February 2010 to May 2019. Patients who had received either total hip arthroplasty or bipolar hemiarthroplasty and subsequently developed a VTB2 PPF were included; patients who sustained intra-operative fractures or received a cemented stem previously were excluded from the analysis. The patients were divided into two groups: group I received RA with cementless long stem, while group II underwent RA with cementless short taper stem with plate osteosynthesis. Demographic data, radiographic and functional outcomes, and complications were analyzed between the two groups. Results: A total of 85 patients diagnosed with VTB2 PPFs were included in the study. There were no significant differences between the two groups in terms of demographic data, including age, gender, mean follow-up times, estimated blood loss, and operative times. The radiographic results showed that there was no significant difference in the incidence of subsidence and implant stability between the two groups. However, group II tended to have less subsidence and periprosthetic osteolysis. Patients in group II had significantly better functional scores (mean Harris hip score: post-operative: 60.2 in group I and 66.7 in group ii; last follow-up: 77.4 in group 1 and 83.2 in group II (both p < 0.05)). There were no significant differences in the overall complication rate, including infection, dislocation, re-fracture, and revision surgery, between the two groups. Conclusions: Both surgical techniques, cementless long stem and cementless short taper stem with plate osteosynthesis, are effective in the treatment of Vancouver B2 PPFs, with no significant differences in outcomes or complications. However, patients in cementless short taper stem with plate osteosynthesis had better functional scores at both post-operative and the last follow-up. [ABSTRACT FROM AUTHOR]

Objective: This scoping review aimed to (1) critically evaluate the outcomes measures used to assess the accuracy of implant placement with Computer Assisted Implant Surgery (CAIS) and (2) review the evidence supporting the efficient implementation of CAIS in training and education of clinicians. Methods: A scoping literature review was conducted aiming to identify (a) clinical trials assessing accuracy of implant placement with CAIS, and (b) clinical trials or simulation/cadaver studies where CAIS was utilised and assessed for the training/education of clinicians. Studies since 1995 were assessed for suitability and data related to the outcomes measures of accuracy and educational efficacy were extracted and synthesised. Results: Accuracy of CAIS has been mainly assessed through surrogate measures. Individual clinical trials have not shown any difference between static and dynamic CAIS, but recent meta‐analyses suggest an advantage of dynamic CAIS in reducing angular deviation. The combination of static and dynamic CAIS might offer higher accuracy than each of the two used alone. Dynamic CAIS is suitable for novice surgeons and might even have added value as an education tool for implant surgery, although mastering the technique requires longer training than static. Conclusion: Meta‐analyses of large samples, new and diverse outcomes measures, as well as benchmarking of levels of accuracy with specific clinical outcomes will help to better understand the potential and limitations of CAIS. Dynamic CAIS is suitable for novice operators, but educational interventions distributed over longer periods of time will be required for mastery of the process. [ABSTRACT FROM AUTHOR]

Introduction: The objective of the study was to provide a comprehensive description of perioperative morbidity associated with robot‐assisted surgery (RAS) in a gynecological oncology setting in order to improve the preoperative counseling of women and support shared decision‐making. Material and Methods: All women scheduled for intended RAS between January 2015 and December 2022 were prospectively included in an electronic morbidity database for the analyses of perioperative complications. Results: In total, 2225 women were included. Sixty‐four patients (2.9%) experienced an intraoperative complication. Intraoperative complications were associated with a higher rate of conversion to laparotomy (15.6% vs. 1.8%, p < 0.001), a higher rate of major postoperative morbidity (9.3% vs. 2.4%, p < 0.001), and a higher rate of reoperation (9.3% vs. 1.7%, p < 0.001), compared to cases without intraoperative complications. Thirty‐day postoperative morbidity was evaluated according to the Memorial Sloan‐Kettering Cancer Center Surgical Secondary Events Grading System. Grade 3–5 events were considered major. A total of 57 patients (2.6%) experienced a major event after surgery, postoperative rupture of the vaginal vault being the most common complication requiring surgical intervention. Conversion to laparotomy occurred in 49 cases (2.2%) and was associated with higher intraoperative blood loss (300 mL vs. 25 mL, p < 0.001), a higher rate of postoperative major events (20.4% vs. 2.2%, p < 0.001), and a higher rate of reoperation (11.8% vs. 1.6%, p < 0.001). Conclusions: Our study demonstrates low rates of major perioperative morbidity and conversion to laparotomy after RAS performed by trained high‐volume surgeons in a gynecological oncology setting. [ABSTRACT FROM AUTHOR]

Background: This study aimed to examine the relationship between anatomical surface landmarks in fresh frozen cadavers as related to in vivo endoscopic trigger finger release (ETFR) and present clinical outcomes after a single-portal antegrade ETFR technique. Methods: Endoscopic trigger finger release was performed on 40 cadaveric digits. Each digit was dissected and the following measurements were recorded: distance from palmar digital crease and A1 pulley, length of the A1 pulley, percentage of A1 pulley released, and injury to vulnerable anatomy. A retrospective chart review was performed on 48 patients (62 digits) treated with ETFR. Outcome measures included grip and pinch strength, range of motion, Disability of Arm, Shoulder, and Hand (DASH) questionnaires, and Visual Analog Scale (VAS) pain scores. Results: Release of the A1 pulley was achieved in 33 of the 40 cadaveric digits (83%) with an A2 pulley laceration rate of 25%. No flexor tendon or neurovascular injuries occurred. Gross grasp, lateral pinch, 3-jaw chuck, and precision pinch strength had 85%, 90%, 82%, and 90% recovery, respectively. At the final follow-up, average metacarpophalangeal joint, proximal interphalangeal joint, and distal interphalangeal joint range of motion were within the normal limits. Mean VAS scores decreased from 5.7 preoperatively to 1.0 postoperatively and mean DASH score at the final follow-up was 4.8. Conclusions: With the use of anatomical surface landmarks, ETFR may be performed in an efficient and reproducible manner. Patients treated with ETFR had low complication rates, good functional recovery, and improved pain at short-term follow-up. Further study of long-term outcomes and cost-effectiveness of ETFR is warranted. [ABSTRACT FROM AUTHOR]