Inflammatory myofibroblastic tumor (IMT) is a rare soft tissue tumor of mesenchymal origin that most commonly presents in children. IMTs hold non-specific symptoms and radiological features, rendering diagnosis challenging. Presentation: We report a case of a 26-year-old man who was diagnosed at a different center with IMT of the right lower lobe. He underwent lobectomy with a positive gross margin, after which he was referred to our institution for further management, where we performed redo surgery with removal of residual tumor from the bronchial stump. The case presented here shows that interdisciplinary surgical planning is vital to ensure proper detection and successful tumor resection, while highlighting a unique case of recurrence necessitating a redo surgery.Conclusion: IMT is a rare entity in adults presenting with diverse, non-specific symptoms. IMT’s usually follow a favorable prognosis, but behavior may be unpredictable. While uncommon in adults, strong clinical suspicion is warranted. Complete surgical resection is the treatment of choice and follow up is crucial given the potential for recurrence.

Breast cancer (BC) is a prevalent malignancy with various subtypes, each presenting unique diagnostic and therapeutic challenges. Triple-negative breast cancer (TNBC), which comprises 12-17% of breast cancers, is particularly aggressive due to its lack of estrogen receptor (ER), progesterone receptor (PR), and HER2 expression. This case report details the management of a 64-year-old woman with TNBC. Initially presenting with a left breast nodule, she underwent a biopsy that confirmed triple-negative infiltrating ductal carcinoma. Despite negative BRCA genetic testing, her significant family history of cancer and a newly detected right breast lesion led to a bilateral mastectomy. Post-surgery imaging revealed multiple hypodense nodules and a spiculated pulmonary nodule, prompting further investigation. An endoscopic lung biopsy identified a primary pulmonary carcinoma with histological features similar to the breast cancer, indicating the lung as the primary source. This case underscores the complexity of TNBC, the importance of comprehensive diagnostic evaluations, and the need for considering extramammary origins in metastatic cases. The findings emphasize the role of multidisciplinary teams in managing such rare and challenging cases and highlight the necessity for thorough and repeated evaluations in atypical BC presentations.

The purpose of this narrative review is to provide an overview of the latest literature on bariatric and metabolic surgery for diabetes mellitus type II and obesity (diabesity) and to discuss its implications for future research and clinical practice.

The purpose of this narrative review is to provide an overview of the latest literature on bariatric and metabolic surgery for diabetes mellitus type II and obesity (diabesity) and to discuss its implications for future research and clinical practice.

Objective To explore the endoscopic anatomical structures of lumbar surgery. Methods A total of 290 patients who underwent lumbar endoscopic surgery due to lumbar intervertebral disc (IVD) herniation from September 2020 to September 2022 were retrospectively reviewed in our hospital,179 patients had complete surgical video recordings, including 108 males and 71 females, aged from 19 to 65 years, with an average age of 41±16 years. The endoscopic structures through the intervertebral foramen and interlaminar space were independently identified by 3 doctors with more than 3 years of related surgery experience. When there were differences of opinions, the three doctors would discuss and come to a consensus. The probability, location, and neighboring structures of each specific structures were statistically analyzed. Results The anatomical structures observed through the lumbar foramen under endoscopy include muscles and ligaments attached to the superior articular process (SAP), main blood vessels inside the intervertebral foramen, blood vessels on the surface of IVD, and blood vessels on the surface of the dural sac and nerve root. The major anatomical structures observed through interlaminar space are multifidus, the conjugated ligament of ligament flavum and capsule ligament (capsule part of flavum ligaments), edges of the lamina, specific vessel bundle to facet with exit nerve root. Conclusion The anatomical structures under spinal endoscopy have certain characteristics, which are grossly different from those under open surgery. Familiarity with these anatomical structures has important clinical significance.

Background: Accidental caustic burns of the esophagus in children represent a significant global health challenge, often necessitating esophageal reconstruction. The aim of this study is to compare the efficacy and morbidity related to esophagus replacement with colonic and gastric tube transplants in a pediatric population followed for caustic stenosis. Method: This retrospective study was conducted at a tertiary pediatric surgery unit for children treated from January 1989 to December 2022. We compared colonic and gastric tube esophageal replacement. Short-term (within 30 days) and mid-term outcomes and complications were reviewed. Statistical evaluation was considered using a Chi-square test for categorical data analysis. Results: A total of 124 children with caustic esophageal burns were included. Among them, 23 (18.5%) had a gastric tube transplant for esophagus replacement and 101 (81.5%) a colonic transplant. During surgical intervention, we found a significantly higher risk of complications when using a colonic transplant (34%, p < 0.001). There was no significant statistical difference in postoperative short-term and mid-term complications between the two techniques. Twenty-six (26%) of the children required a reoperation, with a higher risk in the gastric tube transplant group (p < 0.001). Endoscopic dilatation after surgery was also performed on a higher number of children who had received a gastric tube transplant (p = 0.005). Overall, 97.6% recovered full normal oral feeding. Conclusions: We found that colonic and gastric tube replacement are both good options for pediatric esophageal replacement after a caustic injury and show effectiveness over time. Gastric tube transplants carried a slightly higher risk of reoperations and a higher number of dilatations post-surgery. However, our groups are not really comparable due to the much higher number of colonic transplants. Both surgical options have to be considered during surgery and the choice depends on the anatomy of the patient. Our future research will focus on assessing long-term quality of life and potential risk of neoplastic complications.

Objectives: Describe the epidemiology of burns in the pediatric population. Analyze and compare the results obtained from the treatment of burn wounds by using the bio-preserved human epidermis allograft (BHEA) and other types of dressings and determine the need for further need of a skin graft. Methods: A retrospective cross-sectional study of pediatric population with burn injuries was conducted, grouped into categories based on their age group, and the mechanisms of injury into 6 categories: scald, flame, contact, electrical, chemical and friction. Describing the extension and depth of the burn injury. The results of treatment of two groups; the patients who used (BHEA) and the group with “other dressings” were analyzed by inferential statistics to establish the relationship between the use of BHEA and the need for skin grafts compared to the other group. Results: A total of 65 patients were obtained. The average age was 4.5 years (±3.8). Preschoolers (1-5 years old) were the most frequent age group 64% (n=42). Male patients represented 61% (n=40) of cases. Scald was the most reported mechanism 64% (n=42). The average total body surface area burned (TBSAB) was 10.8% (± 9.2). Mixed partial thickness burn (superficial and deep) was the most common with a 55%. The head was the most affected anatomical site; 30%. The face was the most reported “special anatomical site” with a 40% (n=30). 32.2 % of the population (n=21) was treated with BHEA. The average time of epithelialization of the BHEA group was 8 days (±7.2), and their average hospital stay time was 7 days (±5.7). In the “other dressing” group, the average epithelialization time was 18 days (±13.6), and the average hospital stay time was 11 days (±12.6). Fifty percent (n=22) of the “other dressing” group required skin grafts. In the BHEA group only 19% (n=4) required skin grafts. An OR of 0.23 and CI of 95% (0.06 – 0.81) with a p value of (0.017) for the need of skin grafts after de use of BHEA was obtained. Conclusion: The epidemiological results reported are similar to those described in the literature. The use of (BHEA) proved to be a good option for the management of partial thickness burns and burns in transition, promoting timely epithelilization and avoiding deepening of the burns while reducing morbidity, hospital stay and care costs.

Accurate specimen marking is crucial during breast cancer surgery to avoid misorientation, which can cause inadequate re-excision and tumor recurrence. We studied marking methods at various breast cancer centers to create a tool that prevents specimen misorientation. An online questionnaire surveyed marking procedures at major breast cancer centers in Hungary, and a tool was developed using a troubleshooting method. Twelve out of twenty units responded (60\%). Nine use an institutionally standardized marking system. Only half of the surgical teams had clear specimen mammography images. Pathologists were unsure of specimen orientation in 5–10\% of cases in over 75\% of departments. Ambiguous marking methods caused orientation errors in half the cases, while unclear marking directions caused the rest. Most pathologists (85\%) and surgeons (75\%) believed that coronal plane specimen mammography would help solve the problem. A plastic specimen plate was developed to anchor breast tissue to a coronal breast scheme seen in mammographic images, providing clear localization information throughout the surgery process. There is a lack of standardization in breast specimen orientation and marking in Hungary. An optimized orientation toolkit is being developed to ensure consistent interpretation of specimen mammograms by surgeons and pathologists.

Background: Medication errors often stem from incomplete or incorrect transfer of drug information during reviews. To enhance medication review processes, a collaborative healthcare team, including a pharmacist in the surgical ward, is essential. This study aimed to identify the frequency and the kind of intentional and unintentional discrepancies related to the prescriptions within two surgical wards. Methods: A prospective observational study was conducted among adult patients admitted to two surgical settings. The patients were selected between May 30th and November 30th, 2021. The study followed a three-phase structure: patient selection, medication review to identify discrepancies and DRPs, and the detection of any such issues in the discharge letter. Results: The most frequent types of discrepancies collected were substitutions (60.9%) for the Endocrinological Surgery and omissions for General Surgery (53.4%). In Endocrinological Surgery, 45.9% of cases exhibited class C drug interactions. In General Surgery, class D drug interactions were predominantly observed (54.1%), with 93.3% attributed to drugs carrying an elevated risk of prolonging the QT interval. Conclusions: Frequently, the medication review process is superficially carried out, introducing errors that may adversely affect patient health. This study explores the potential positive impact of involving the clinical pharmacist in identifying and managing discrepancies and DRPs.

In this 10-year retrospective study we used the data from patients who were operated upon due to acute bowel obstruction, at the Surgical Department of General Hospital of Katerini in Greece, from 2012 to 2022. Patients were classified based on the date of operation, their sex, their age group (ranging from 26 to 92 years) and the etiology of the bowel obstruction. A sample of 197 patients was studied. Out of these, it was found that in 73 (37%) the cause of the obstruction was colorectal cancer. In 46 of those patients (63%) the tumor was resected, while in the remaining 27 (37%), some kind of diverting stoma was installed. In 17(43,5%) of the 39 total patients, who suffered from some kind of rectosigmoid cancer, Hartmann's operation was chosen. Our results showcase that, at district hospitals, the surgeon is sometimes obligated to a damage control approach regarding obstructive colon cancer and thus the majority of the patients will eventually end up with a stoma.

The Importance of Preoperative NLR, PLR, and MPV Values in Predicting the Risk of Complications in Colorectal Peritoneal Carcinomatosis Background Neutrophil-to-lymphocyte ratio (NLR), platelet-to-lymphocyte ratio (PLR), and mean platelet volume (MPV) measurements can be easily assessed in most hospital laboratories. Our aim is to emphasize the importance of preoperative inflammatory parameters such as NLR, PLR, and MPV in predicting postoperative complications in patients undergoing surgery for colorectal peritoneal carcinomatosis (CRC PC). Methods Patients operated for CRC PC were evaluated. Demographic data, NLR, PLR, and MPV values were calculated using the following formulas: NLR = (absolute neutrophil count)/(total lymphocyte count), PLR = (total lymphocyte count)/(total platelet count) × 100, MPV = mean platelet volume calculated by dividing platelet crit (PCT) by total platelet count. Results A total of 196 patients with CRC PC were included in the study. A statistically significant relationship was observed between NLR, PLR, MPV, and OS. Patients with an NLR value of 3.77 had a median OS of 22.1 months, whereas those with an NLR value below 3.77 had a median OS of 58.3 months (HR 2.7, 95% CI 1.1–5.3, p

We previously reported our initial experience of subxiphoid single-port robotic-assisted thoracic surgery (SRATS) thymectomy using the single-port robotic surgical system (SPS). However, the potential benefits of this technique remain unknown. Thus, this study examined the multi-institutional experience of SRATS thymectomy and compared perioperative outcomes of this technique with those of subxiphoid single-port video-assisted thoracic surgery (SVATS) thymectomy. Data of patients who underwent subxiphoid SRATS and SVATS thymectomy performed by three thoracic surgeons at three institutions between September 2018 and May 2024 were retrospectively collected. In total, 110 patients were included, with 85 and 25 undergoing SRATS and SVATS thymectomy, respectively. No significant differences were noted in the total operative time (154.46±74.06 vs. 146.76±67.07 min, P=0.674) and conversion rate to median sternotomy (0% vs. 4 %, P=0.227) between the two groups. The SRATS group was associated with a lower conversion rate to multi-port surgery (2% vs. 20%, P=0.006), shorter chest tube drainage duration (1.40±0.94 vs. 2.00±1.29 days, P=0.001), and shorter postoperative hospital stay (2.87±1.26 vs. 5.08±5.20 days, P=0.007). Subxiphoid SRATS thymectomy using the SPS is feasible and can be a good alternative to conventional minimally invasive thymectomy. Further large-scale randomized controlled studies are needed to confirm its benefits.

This case report describes the successful repair of a radial bone fracture and skin defect in a dog using an ulnar bone graft and an advancement flap. A one-year-old spayed female Poodle dog weighing 1.7 kg was brought in with non-weight-bearing lameness, an open wound, and a frac-ture in the right forelimb. The dog had fallen off the bicycle being ridden by its owner, causing its right forelimb to be caught in the wheel. The treatment included surgical debridement of the necrotic tissue, skin reconstruction with an advancement flap, and radial bone reconstruction with an ulnar bone graft, bone morphogenetic protein (BMP), humeral cancellous bone and a ti-tanium T-shaped plate. Postoperative management included antibiotics, pain medication, and activity restriction. The dog made a good recovery and was able to bear weight on the affected limb four months after surgery.

Introduction: Breast ptosis is characterized by the downward nipple-areola complex displacement below the inframammary fold. Breast ptosis is associated with ageing and its concomitant changes in estrogen levels in conjunction with other factors like macromastia, weight loss, pregnancy, and both alcohol and tobacco consumption products affecting breast tissue architecture impacting the well-being and quality of life in the affected women. This study aimed to evaluate the efficacy of a novel mastopexy technique in patients with breast ptosis. Methods: A longitudinal, non-experimental, analytical study was done in a cohort of 231 women diagnosed with breast ptosis treated with a novel low-level multifrequency laser-assisted mastopexy assessing sternal notch-to-nipple distance (SNND) and breast ptosis status according to the Regnault system at the first, second, and third postoperative month. Additionally, the incidence and nature of compli-cations within the first 30 days post-surgery were evaluated according to the Clavien-Dindo system. Results: The breast ptosis proportion significantly changed across the three-month fol-low-up period from 100% to only 10% (all ptosis grade I). 90% of the patients achieved the non-ptosis grade according to the Regnault system (p

Percutaneous aortic valve replacement (TAVI) has become the treatment of choice for elderly patients with severe aortic valve stenosis because of its less invasiveness compared to surgery. However, it introduces new complications, such as vascular lesions, access site problems, paravalvular leaks, and aortic dissection. Aortic dissection after TAVI is rare but serious, occurring in 0.2% to 0.3% of cases, with both intraprocedural and late cases reported. This case study concerns a 68-year-old woman who developed Stanford B aortic dissection, external iliac artery dissection, and right common femoral artery occlusion after TAVI. Treatment included stenting of the iliac and common femoral arteries, followed by a staged procedure: debranching, thoracic endovascular aortic repair (TEVAR) and endovascular aneurysm repair (EVAR), with satisfactory results. This case, underscores the importance of vigilance in the management of TAVI-related complications to optimize patient care and outcomes.

This Dataset reports the clinical information and measurements of 231 patients who underwent multifrequency low-level laser-assisted mastopexy. The Dataset was collected between February 2021 and November 2023. These data were used to assess the effect of this procedure on breast ptosis degree and the nipple to sternal notch distance to know the evolution of breast ptosis. This article presents demographic, personal and familial history, anthropometric measurements, pto-sis degree according to the Regnault system, Nipple-to-Sternal Notch distance (SNND), and complications according to the Clavien-Dindo System. The collected data were in English, and the responses were anonymised to ensure the Colombian legal framework. The data were stored in a .csv file.

Evans' Syndrome (ES) is a rare autoimmune disorder characterized by the simultaneous occurrence of immune thrombocytopenia (ITP) and autoimmune hemolytic anemia (AIHA). Thrombotic complications in ES patients are uncommon, particularly involving Buerger's Disease (BD). We report a case of a 49-year-old male with ES and a history of diabetes and heavy smoking, presenting with a necrotic wound on his right great toe. Diagnostic evaluations revealed severe stenosis and thrombosis in the lower limb arteries, diagnosed as BD. The patient underwent successful popliteal-tibioperoneal artery bypass surgery and subsequent disarticulation and revision of the distal phalanx, followed by the application of an acellular dermal matrix (ADM) to promote healing. Post-surgery, the patient showed significant improvement in blood flow and complete epithelialization without complications. This case highlights the importance of a multidisciplinary approach in managing complex wounds in ES patients, suggesting potential treatment pathways for future cases involving BD

Even despite rapid advances in colorectal surgery, morbidity and mortality rates in elective gastrointestinal surgery play a significant role. For decades, there have been tempestuous discussions on preventive measures to minimize the risk of anastomotic dehiscence. When mechanical bowel preparation before elective procedure, one of the key hypotheses, has been introduced into practice, it was assumed that it would decrease number of infectious complications and anastomotic dehiscence. The advancements in antibiotic treatment supported concomitant administration of oral antibiotics and mechanical bowel preparation. In the prospective study conducted at our clinic, we performed left-side colorectal procedures without the prior mechanical preparation. All patients enrolled in the study underwent the surgery and had been observed in the 3rd Surgical Clinic, Faculty of Medicine, Comenius University in Bratislava, Slovakia, from January 2019 to January 2020. As a control group we used similar group of patients with MBP. Our observed group included 87 patients with tumors in the left part of their large intestine (lineal flexure, descendent colon, sigmoid colon, and rectum). Dixon laparoscopic resection was performed in 26 patients. Sigmoid laparoscopic resection was performed in 27 patients. In 12 patients, the procedure was started laparoscopically but had to be converted due to adverse anatomical conditions. The conservative approaches mostly included Dixon resections (19 patients), sigmoid colon resection (5 patients) and left side hemicolectomy (6 patients), and Miles´ tumor resection with rectal amputation (4 patients). Our study highlighted the fact that MBP does not have the unequivocal benefit for patients with colorectal infection, which has an impact on development of anastomotic dehiscence.

Introduction: Vitamin B1 (thiamine) deficiency (TD) after metabolic and bariatric surgery (MBS) is often insidious and, if unrecognized, can lead to irreversible damage or death. As TD symptoms are vague and overlap with other disorders, we aim to identify predictors of recurrent TD and failure to collect B1 labs. Methods: We analyzed a large sample of data from patients with MBS (n=878) to identify potential predictors of TD risk. We modeled recurrent TD and failure to collect B1 labs using classical statistical and machine learning (ML) techniques. Results: We identified clusters of labs associated with increased risk of recurrent TD: micronutrient deficiencies, abnormal blood indices, malnutrition, and fluctuating electrolyte levels (aIRR range: 1.62-4.68). Additionally, demographic variables associated with lower socioeconomic status were predictive of recurrent TD. ML models predicting characteristics associated with failure to collect B1 labs achieved 75-81% accuracy, indicating that clinicians may fail to match symptoms with the underlying condition. Conclusion: Our analysis suggests that both clinical and social factors can increase the risk of life-threatening TD episodes in some MBS patients. Identifying these indicators can help with diagnosis and treatment.

Vascular rings are a rare congenital anomaly of the aortic arch in which a ring-shaped structure forms surrounding the trachea and/or esophagus, potentially causing compression. We describe the case of a 14-month-old female patient with failure to thrive secondary to dysphagia, and a vascular ring formed by a right aortic arch, an aberrant left subclavian artery, and a left liga-mentum arteriosum. Surgical repair involved ligamentum arteriosum division, Kommerell’s di-verticulum obliteration, and left subclavian artery re-implantation into the left carotid artery. Endoscopy and EndoFLIPTM evaluated intraoperative improvement in esophageal narrowing and impedance, respectively. Postoperative period was uneventful and follow-up visits demonstrated dysphagia resolution and a patent re-implanted left subclavian artery.

Background: Pediatric mallet finger injuries lack specific treatment guidelines, necessitating an exploration of effective techniques. Our aim was to evaluate the outcomes of the extension block technique in adolescent mallet finger management. Methods: A comprehensive retrospective analysis was conducted involving 36 adolescents who underwent surgery between 2014 and 2022. Ishiguro’s extension block pinning technique was the primary method employed. Treatment outcomes were evaluated using Crawford's criteria, and complications were also assessed. Results: Bone union was achieved in all cases with a mean union time of 42 days (range: 30-92 days). According to Crawford's criteria, 27 cases (75%) were classified as excellent, 5 cases (14%) as good, and 4 cases (11%) as fair. Minimal complications were observed, including three cases (8%) of superficial infections, one case (3%) of dermal necrosis, and another rare instance (3%) of osteomyelitis. No cases of poor outcomes or significant long-term complications were noted. The average follow-up period was 8.6 months (range: 2-42 months). Conclusions: Ishiguro’s extension block technique is a promising surgical option for adolescent mallet fingers. Its adoption could enhance pediatric orthopedic care, offering a valuable child-friendly treatment alternative.

A useful perioperative nutritional therapy for highly invasive esophageal cancer surgical cases needs to be developed. We clarified the usefulness of amino acid-enriched nutritional therapy using glutamine (Gln)/arginine (Arg)/calcium β-hydroxy-β-methylbutyrate (HMB) products on the short-term postoperative outcomes of minimally invasive esophagectomy for esophageal cancer. Altogether, 114 patients (Gln/Arg/HMB group) received perioperative nutritional therapy with Gln/Arg/HMB products, and we retrospectively investigated the change in nutritional parameters including skeletal muscle mass, occurrence of postoperative complications, and short-term postoperative outcomes in this group. The results were compared between the Gln/Arg/HMB and control groups (79 patients not receiving the Gln/Arg/HMB products). The incidence of all postoperative complications, sputum expectoration disorder, and pleural effusion of grade ≥III was significantly lower in the Gln/Arg/HMB group (62.0% vs. 38.6%, p = 0.001; 44.3% vs. 28.1%, p = 0.020; 27.8% vs. 13.2%, p = 0.011, respectively). The psoas muscle area and postoperative body weight was significantly higher at 1 month and 1 year after surgery in the Gln/Arg/HMB group than in the control group (93.5% vs. 99.9%, p &lt; 0.001; 92.0% vs. 95.4%, p = 0.006). Perioperative amino acid-enriched nutritional therapy may improve the short-term postoperative outcomes, nutritional status, and skeletal muscle mass of esophageal cancer surgical patients.

Background: C-reactive protein (CRP) is a predictive biomarker of colorectal surgery (CRS) complications but has not been evaluated by comparing patients undergoing CRS with intracorporeal anastomosis (IA) or extracorporeal anastomosis (EA). Therefore, we aimed to describe postoperative CRP values between two groups of patients who underwent laparoscopic right hemicolectomy for right-side colon cancer with IA or EA. Methods: We retrospectively reviewed the data of patients affected by right-side colon cancers who underwent laparoscopic right-hemicolectomy with ileo-colic IA or EA between January 2016 and December 2022. Results: A total of 340 patients underwent laparoscopic right hemicolectomy. EA was performed in 238 (70%) and IA in 102 (30%) cases. Patients with IA showed significantly higher values of CRP in the second, third and fourth postoperative days (15.2 mg/dL vs 9.5 mg/dL p=

Laparoscopic cholecystectomy (LC) is the gold standard of treatment for symptomatic gallstone disease. The aim of this study is to determine if postoperative opiate use is reduced with trans-versus abdominus plane (TAP) and rectus sheath (RS) regional anaesthetic blocks compared to port site local anaesthetic (LA) infiltration. A prospective, randomised cohort study was con-ducted of adult patients who underwent an emergency LC between 25 April 2022 and 25 May 2023. 40mls of 0.375% ropivacaine was infiltrated as either TAP and RS blocks or to port sites. Patient demographics, operative data and postoperative opioid use were collected from the med-ical record. 138 patients were enrolled in this study; 73 patients allocated to the LA to port sites cohort (52.9%) and 65 patients in the TAP and RS cohort (43.5%). The most common indication for surgery was acute cholecystitis. The average amount of opiate analgesia use was 115.2mg in the LA group compared to 61.2mg in the TAP and RS group (p

(1) Background: Mixed Reality is a technology that has gained attention due to its unique capabilities for accessing and visualizing information, becoming a valuable tool for medicine, particularly for the operating room and surgical learning; (2) Methods: A systematic review was conducted following the PRISMA guidelines to answer the research questions established using the PICO framework; (3) Results: Although implementation of Mixed Reality applications in the operations room presents some challenges, when used appropriately, it can yield remarkable results. It can make learning easier, flatten the learning curve for several procedures, and facilitate various aspects of the surgical processes; (4) Conclusion: Technical complexity, equipment costs, and steep learning curves present significant obstacles to the widespread adoption of Mixed Reality and computer-assisted evaluation. The possibility of integration of distinct medical imaging modalities and innovative functionalities holds promise for clinical applications. However, it is important to consider issues related to usability, bias, and statistical analyses need consideration. Mixed Reality offers significant benefits, but there are still open challenges such as ergonomic issues, limited field of view, and battery autonomy that must be addressed to ensure widespread acceptance.

Background: Pediatric forearm fractures represent a substantial proportion of childhood injuries, requiring effective and minimally invasive treatments. Our study investigated the mid-term outcomes of biodegradable poly-L-lactide-co-glycolide (PLGA) intramedullary implants in managing diaphyseal forearm fractures in children. Methods: A follow-up cohort study was conducted with 38 patients treated with PLGA implants. Control examinations were performed one year post-operation, assessing bone healing through radiographic evaluations and functional outcomes using injured and uninjured limb range of motion (ROM) comparisons. Scarring was evaluated employing the Vancouver Scar Scale (VSS), and satisfaction via a questionnaire. Results: Children were predominantly female (76.4%), with a mean age of 9.71 (SD: 2.69) years. Effective fracture stabilization and bone healing were found in all patients, with a minor reduction (mean difference of -1.5°, p = 0.282) in elbow flexion on the operated side (139.3°) compared to the intact (140.8°). Elbow extension presented negligible average changes (0.2°, p= 0.098). Forearm movements were slightly reduced on the operated side (mean pronation: 80.8° vs. 83.7°, p= 0.166; average supination: 83.5° vs. 85.7°, p= 0.141). Wrist palmar flexion and dorsiflexion showed no significant differences. VSS ratings indicated minimal scarring (mean guardian and doctor scores were 1.13 and 0.55, respectively, p= 0.020), and all patients reported satisfaction with the treatment outcomes. Conclusion: Biodegradable implants are effective for pediatric forearm fractures, providing stable bone healing while preserving functional ROM with minimal scarring and high patient satisfaction. PLGA proved to be a viable alternative to traditional metal implants, eliminating secondary removal surgeries.

Indocyanine Green (ICG) has significantly advanced minimally invasive surgery. It is widely recognized for its ability to visualize blood vessel patency in real-time across various surgical specialties. While its primary use in colorectal surgery is to evaluate anastomoses for leaks, nu-merous other applications have been documented in the literature. In this review, we aim to explore both established and emerging applications of ICG fluorescence in colorectal surgery, with the goal of improving patient outcomes. This includes preoperative tumor marking and the detection of metastatic disease. Some applications, such as lymphatic mapping, require further research to determine their impact on clinical practices. Conversely, oth-ers, like the intraoperative localizations of ureters, necessitate additional procedures and are not yet widely accepted by the surgical community. However, the development of alternative com-pounds could offer better solutions. Future research should focus on areas like quantitative ICG and protocol standardization in prospective multicenter studies.

Spontaneous splenic rupture (SSR) is a relatively rare, but potentially lethal complication of infectious mononucleosis (IM). While SSR is extremely rare in patients with proven IM, it is the most lethal complication of the infection (9% mortality rate) and can present completely asymptomatically or with abdominal pain and hemodynamic instability. As adolescents and young adults are the most affected population group, with this case report we intend to raise the vigilance of any doctor treating those patients in the emergency department. We present the case of a 16-year-old patient with an atraumatic splenic rupture and hemoperitoneum secondary to an Epstein-Barr virus (EBV) infection. The patient underwent an exploratory laparotomy, and a splenectomy was performed. This case demonstrates that even if the SSR in patients with IM is extremely rare, it should be always considered in a patient with relevant clinical presentation.

Background Main treatment modality for spinal meningiomas (SM) is gross total resection (GTR). However, optimal timing of surgery, especially in cases with absent or mild neurological symptoms remains unclear. The aim of this study is to assess the impact of early-stage resection on neurological outcome, quality of life (QoL) and quality of care. The primary objective was a favorable neurological outcome (McCormick scale 1); Methods: We retrospectively analyzed data from patients operated on SM between 2011 and 2021. Patients with mild neurological symptoms preoperatively (McCormick scale 1 and 2) were compared to those with more severe neurological symptoms (McCormick scale 3-5). Disabilities and QoL were assessed according to validated questionnaires (SF36, ODI, NDI). Results: Age, spinal cord edema, thoracic localization, and spinal canal occupancy ratio were associated with more severe neurological symptoms (all p<.05). Patients presented with mild symptoms were associated with favorable neurological outcome (OR: 14.778 (95%CI 3.918-55.746, p<.001), which is associated with shorter hospitalization, better QoL and less disabilities (p<.05). Quality of care was comparable in both cohorts; Conclusions: Early surgical intervention of SM, before the development of severe neurological deficits, should be considered as it is associated with a favorable neurological outcome and quality of life.

Objectives: This study aims to explore the use of murine models in peripheral nerve transection research, evaluating and synthesizing key methods for analyzing nerve regeneration to guide future research and clinical interventions. Methodology: A systematic review was conducted in February 2024, adhering to Cochrane and PRISMA 2020 guidelines, using Medline, Scielo, and Lilacs databases. The focus was on experimental studies of nerve regeneration in animal models post-transection. Only experimental clinical trials reporting nerve regeneration outcomes were included; studies lacking a comparator group or functional evaluation methods were excluded. Results: Out of 273 studies initially identified from MEDLINE, 19 were selected for detailed analysis. The average study included 32.5 subjects, with about 10.16 subjects per intervention subgroup. The predominant model was the sciatic nerve injury with a 10mm gap. The most common intervention involved unprocessed adipose-derived stem cells, utilized in 14 articles. Conclusions: The review underscores the significant potential of current methodologies in peripheral nerve regeneration, particularly highlighting the use of murine models and thorough evaluation techniques. These studies significantly contribute to our understanding of nerve regeneration processes and inform directions for future research.

Purpose: Proximal Femur Fractures (PFFs) in elder patients lead to decreased productivity. Skilled nursing facilities (SNFs) and inpatient rehabilitation facilities (IRFs) are non-home destinations for post-discharge disposition. This study aims to evaluate the loss of independence (LOI) following PFFs and examine the economic impact it entails. Method: Literature from various databases was collected and analyzed retrospectively. The inclusion criteria included patients age >18 years and articles published after 1990. All studies were screened and a PRISMA chart was used to demonstrate the search process. 24 studies were finally used for review. Results: LOI following PFFs significantly increases with age. Fractures in geriatrics avail a significant amount of post-care resources and had longer lengths of stay. Furthermore, six pre-operative risk factors were identified for non-home disposition including age >75, female, non-Caucasian race, Medicare status, prior depression, Charlson Comorbidity Index. Patients discharged directly to home have lower total cost compared to those discharged to rehabilitation units. Loss of independence increases with advancing age. Discussion: PFFs can lead to serious loss of independence among elderly patients with direct impact on economic, social, psychological aspects and the healthcare system.

Background: The two-stage technique combining the Endoscopic Retrograde CholangioPancreatography (ERCP) with common bile duct (CBD) clearance carried out before the laparoscopic cholecystectomy represents the most common approach for CBD stones. Over time, different techniques have been proposed to manage cholecysto- choledocholithiasis (CCL) advantageously in one stage. Among these, the laparoendoscopic rendez-vous (LERV) addresses the CCL issue with a laparoscopic cholecystectomy with insertion of a guide wire performed at initial stage of the procedure, followed by the clearance of the bile duct carried out by the endoscopists. The goal of this study was to evaluate the efficacy and safeness of LERV procedure recording results and complications, also making a comparison between our results and current literature. Methods: We reviewed our experience of all consecutive patients with cholecysto-choledocholithiasis managed with LERV between January 2018 and December 2023. LERV success rate, operative time, length of hospital stay, stone recurrence, incidence of endoscopic and surgical complications were analysed. Results: A total of 120 patients underwent LERV in our facilities. We reported a 97% LERV success rate, 1.6% conversion-to-open rate, a median intraoperative time of 122 (range 95-220) min. The median hospital stay was 4 (range 2-38) days. An overall morbidity of 15% was reported (18/120): 15 Clavien-Dindo type 1/2, 2 type 3a and one type 3b. In two cases a re-operation during the hospital stay was necessary. At a median follow-up of 14 months (3-59) five patients experienced stone recurrence requiring redo-ERCP in two cases. Conclusion: LERV offers the significant advantage of a single stage procedure and hospitalisation along with a lower risk of post-ERCP pancreatitis, failed CBD cannulation and complications. Our experience confirms safety and effectiveness of the technique for CCL management.

Background: Localization of acute appendicitis in a hernia sac is a rare phenomenon with a frequency of around 0.08 - 1 %. Even fewer cases of postoperative hernias with a vermiform appendix in the hernia sac have been described. We selected 23 cases in the English literature describing this phenomenon and analyzed diagnostic and treatment options. Case presentation: We present a 72-year-old woman who was complaining of a painful, rigid mass in the anterior abdomen wall for two days. After performing an ultrasound, incarcerated ventral hernia was diagnosed and emergency surgery was performed. During the surgery, gangrenous appendicitis was found in the hernia sac. It was decided to do an appendectomy and primal hernioplasty. Postoperative period was uneventful. Conclusion: Appendicitis within incisional hernia is an extremely rare phenomenon. Diagnosis may be challenging because of dominating incarcerated hernia symptoms. However, computed tomography might play a crucial role, by differentiating causes of acute abdomen. Appendectomy is the standard option for appendicitis treatment, however, there is no consensus on how abdominal wall integrity should be restored.

Introduction. “Vein definition” for locally advanced pancreatic ductal adenocarcinoma (LA PDAC) assumes portal-to-superior mesenteric vein (PV/SMV) unreconstructability due to tumor involvement or occlusion. Radical pancreatectomies with SMV resection without PV/SMV reconstruction are scarcely discussed in the literature. Retrospective analysis of 19 radical pancreatectomies for “low” LA PDAC with SMV and all its tributaries resection without PV/SMV reconstruction has shown zero mortality, overall morbidity – 56%, Dindo-Clavien – 3-10,5%, R0- rate – 82%, mean operative procedure time – 355±154 min, mean blood loss – 330±170 ml, delayed gastric emptying– 25%, clinically relevant postoperative pancreatic fistula – 8%. In three cases surgery was associated with superior mesenteric (n2) and common hepatic artery (n1) resection. Surgery was completed without vein reconstruction (n13) and with inferior mesenteric-to-splenic anastomosis (n6). There were no cases of liver, gastric, or intestinal ischemia. A specific complication of the SMV resection without reconstruction was 2-3 days-long intestinal edema (48%). Median overall survival – 25 months, median progression-free survival – 18 months. All the relapses, except two, were distant. The possibility of successful SMV resection without PV/SMV reconstruction can be predicted before surgery by CT-based reconstructions. The mandatory anatomical conditions for the procedure were: 1) preserved SMV-SV confluence; 2) occluded SMV for any reason (tumor or thrombus); 3) well-developed inferior mesenteric vein collaterals with dilated intestinal veins; 4) no right-sided vein collaterals, and 5) no varices in the upper abdomen. Conclusion: “Low” LA PDACs involving SMV with all its tributaries can be radically and safely resected in highly and specifically selected cases without PV/SMV reconstruction with an acceptable survival rate.

Background: Endovascular treatment of popliteal aneurysms (PA) has increased in the last few years, quickly becoming the main treatment in many vascular centers, based on the acceptable and promising outcomes reported in the literature. However, endograft infections are the most dangerous complication as a serious local compromise and usually require open surgical conversion and device explantation to preserve the affected extremity. Case report: We reported two patients admitted to the emergency room for pain and edema in the lower leg. Both patients have undergone exclusion of ruptured PA a few years before by endovascular graft. CTA showed a significant volume of fluid-corpuscular collection related to perianeurysmal abscess collection in both cases. Blood cultures and drained material cultures were positive for Staphylococcus Capitis in the first case and S. Aureus in the second. The antibiotics prophylaxis was performed for 10 days, then, patients underwent an open surgical conversion with a complete explantation of endovascular material and a femoro-popliteal bypass using an autologous vein in the first case and biological bovine pericardium prosthesis in the other case. Furthermore, we have questioned the literature and found eight more cases described in case report article referred to popliteal graft infections by different microorganisms, mostly presenting acute limb ischemia as the first symptom and suggesting endograft explantation with open conversion and autologous vein bypass as the commonest therapeutic choice. Conclusions: Open surgical conversion of popliteal endograft infection is the best strategy to manage peripheral infection of the popliteal stent.

Background: In the landscape of thoracic surgery, innovation continually drives progress, offering novel approaches to address complex pathologies while prioritizing patient well-being. Dual-portal robotic-assisted thoracic surgery DRATS represents the next frontier in this evolution. In this report we describe our experience with the DRATS approach for segmentectomy with the indocyanine green intersegmental plane identification. Methods: We presented the case of a patient who underwent a DRATS lingulectomy and lymphadenectomy stations 5, 6, 7, and 10 using the daVinci Surgical System. Results: The patient's postoperative course was uneventful with chest tube was removed in second post operative day. The final pathological analysis confirmed a low-grade malignant potential adenocarcinoma, with main diameter of 1.1 cm, at 3 cm from lung margins. 12 nodes were removed, from station 5,6,7,10,11, all of the free of metastases. Conclusions: Our initial observations suggest that Dual-Portal Robotic-Assisted Tho-racic Surgery (DRATS) demonstrates notable feasibility.

Treatment techniques for facial paralysis have evolved significantly over the past few decades, offering a variety of options to improve facial symmetry and muscle function. The purpose of this paper is to introduce a novel static treatment technique for the surface of the nasolabial fold (NLF) in patients with chronic facial nerve paralysis, aged between 40 and 80 years, who are not candidates for dynamic rehabilitation and present with NLF erasure. The surgical marking process was initiated by determining the projection of the nasolabial fold on the paralyzed side, through measurement of the NLF on the non-paralyzed side. Subsequently, a line was drawn around the nasal ala, and a second line was demarcated in the medial region of the sulcus. In the region close to the nasal ala, along this second line, a notch was planned. The procedure was conducted under local anesthesia. In this study, four procedures were performed without any complications. Comparatively, the outcomes demonstrated an improvement in facial symmetry, the creation of a new NLF, elevation of the ipsilateral lip commissure, and correction of nasal deviation. The proposed technique is straightforward, reproducible, and can be performed in an outpatient setting.

Background: This study aimed to investigate the impact of the COVID-19 pandemic on breast reconstruction trends in the United States, focusing on implant-based and autologous techniques, as well as the timing of reconstruction (immediate vs. delayed). Methods: A retrospective analysis of data from the American Society of Plastic Surgeons' National Plastic Surgery Statistics from 2015 to 2022 was conducted. Annual trends in breast reconstruction procedures were analyzed, comparing the pre-pandemic (2015-2019) and pandemic (2020-2022) periods. Results: The total number of breast reconstructions increased from 106,338 in 2015 to 151,641 in 2022. The proportion of implant-based reconstructions decreased from 81.41% pre-pandemic to 76.51% during the pandemic (p < 0.001), with a notable rise in direct-to-implant procedures from 10.37% to 19.12% (p < 0.001). Autologous reconstructions increased from 18.59% to 23.49% (p < 0.001). Among autologous techniques, DIEP flaps remained the most popular. Immediate reconstruction rates increased from 72.61% pre-pandemic to 75.57% during the pandemic, while delayed recon-struction rates decreased from 27.39% to 24.43% (p < 0.001). Conclusions: The COVID-19 pandemic has significantly influenced breast reconstruction trends in the United States, with a shift towards autologous techniques, particularly DIEP flaps, and an in-crease in immediate reconstructions. These changes may reflect adaptations in surgical practice and decision-making processes in response to the unique challenges posed by the pandemic. Further research is needed to assess the long-term outcomes and patient satisfaction associated with these trends.

Sublobar resection is a standard surgical procedure for small-sized non-small cell lung cancer (NSCLC). However, clinical role of adjuvant chemotherapy for small-sized NSCLC with pathological lymph node (LN) metastasis after sublobar resection is unknown. National Cancer Database was queried for NSCLC patients between 2004 and 2018. Eligibility included sublobar resection with pathological LN metastasis, R0 resection, Charlson comorbidity score = 0, clinical stage T1a-b, and tumor size ≤ 20 mm. Kaplan-Meier method with log-rank test and multivariable Cox proportional hazards analyses were used for assessing survival. Samples were evaluated before and after propensity score matching (PSM) with respect to age, sex, histologic type, and pathological LN status. Of 810 patients who met the eligibility criteria, 567 (70.0%) underwent adjuvant chemotherapy. After PSM, patients with adjuvant chemotherapy had a significantly longer survival than those without (median survival: 64.3 vs. 34.0 months, hazard ratio for death: 0.61, p < 0.0001). Multivariate analyses after PSM showed that younger age (p = 0.0206), female (p = 0.0005), and adjuvant chemotherapy (p < 0.0001) were independent prognostic factors for longer survival. Adjuvant chemotherapy has a prognostic impact in patients with small-sized NSCLC and pathological lymph node metastasis who undergo sublobar resection.

Background: Fingertip injuries with volar pulp tissue defects are challenging to manage due to the complex anatomy and critical role of the fingertip in sensory and motor functions. Traditional surgical approaches are associated with donor site morbidity, prolonged immobilization, and suboptimal functional outcomes. This study aimed to evaluate the efficacy of a conservative treatment protocol using artificial dermis and semi-occlusive dressing for these injuries. Methods: A single-center, prospective study was conducted on 31 patients with fingertip injuries involving volar pulp defects. The treatment protocol involved wound debridement, application of artificial dermis (Pelnac®), and semi-occlusive dressing (IV3000®). Outcomes were assessed using subjective questionnaires and objective measures, including fingerprint regeneration, sensory function, pain, and cosmetic appearance. The impact of injury characteristics on outcomes and treatment duration was evaluated. Complications were recorded, and patient satisfaction was assessed. Results: The mean treatment duration was 45.29 days (SD=17.53), with no significant differences based on injury characteristics. Complications were minimal, with only one case (3.22%) directly attributable to the treatment. Fingerprint regeneration was considerable (mean score=2.58, SD=0.67), with slightly better scores in bone-exposed injuries. Sensory disturbances were minimal, with no significant differences across injury types. Post-treatment pain was low (mean=0.45, SD=0.67), and cosmetic satisfaction was high (mean=4.09, SD=0.94). Overall patient satisfaction was high (mean=4.41, SD=0.67), regardless of injury severity. Discussion: This study demonstrates the efficacy of a conservative approach using artificial dermis and semi-occlusive dressing for fingertip injuries with volar pulp defects. The treatment protocol achieved favorable outcomes in tissue regeneration, sensory recovery, pain management, and cosmetic appearance while minimizing complications and morbidity associated with traditional surgical interventions. The high patient satisfaction across all injury types highlights the patient-centered nature of this approach. Conclusions: The conservative treatment protocol using artificial dermis and semi-occlusive dressing is a promising strategy for managing fingertip injuries with volar pulp defects. This approach harnesses the body's regenerative potential, minimizes surgical morbidity, and achieves excellent functional and aesthetic outcomes. Further research is needed to optimize treatment protocols and investigate long-term outcomes.

Background and Objectives: Medulloblastoma is the most common malignant brain tumor in children. In recent decades, the therapeutic landscape has undergone significant changes, with stereotactic radiosurgery (SRS) emerging as a promising treatment for recurrent cases. Our study provides a comprehensive analysis of the long-term efficacy and safety of SRS in recurrent medulloblastomas across both pediatric and adult patients at a single institution. Methods: We retrospectively reviewed the clinical and radiological records of patients who underwent CyberKnife SRS for recurrent cranial medulloblastomas at our institution between 1998 and 2023. Follow-up data were available for 15 medulloblastomas in 10 patients. The cohort comprised 8 pediatric patients (ages 3-18) and 2 adult patients (ages 19-75). Median age at the time of SRS was 13 years, median tumor volume accounted for 1.9 cc, median biologically equivalent dose (BED) was 126 Gy, and single-fraction equivalent dose (SFED) was 18 Gy. The SRS was administered at 75% of the median isodose line. Results: Following a median follow-up of 39 months (range: 6-78), 53.3% of the medulloblastomas progressed, 13.3% regressed, and 33.3% remained stable. The 3-year local tumor control (LTC) rate for all medulloblastomas was 65%, with lower rates observed in the adult cohort (50%) and higher rates in pediatric patients (67%). The 3-year overall survival (OS) rate was 70%, with significantly higher rates in pediatric patients (75%) compared to adult patients (50%). The 3-year progression-free survival (PFS) rate was 58.3%, with higher rates in pediatric patients (60%) compared to adult patients (50%). Two pediatric patients developed radiation-induced edema, while two adult patients experienced radiation necrosis at the latest follow-up, with both adult patients passing away. Conclusion: Our study provides a complex perspective on the efficacy and safety of CyberKnife SRS in treating recurrent cranial medulloblastomas across pediatric and adult populations. The rarity of adverse radiation events (ARE) underscores the safety profile of SRS, reinforcing its role in enhancing treatment outcomes. The intricacies of symptomatic outcomes, intertwined with factors such as age, tumor location, and prior surgeries, emphasize the need for personalized treatment approaches. Our findings underscore the imperative for ongoing research and the development of more refined treatment strategies for recurrent medulloblastomas. Given the observed disparities in treatment outcomes, a more meticulous tailoring of treatment approaches becomes crucial.

3D-printed models with high anatomic fidelity are an increasingly viable tool in simulation-based medical education. One advantage of 3D models is they provide enhanced tactile and spatial understanding of complex anatomy to develop technical skills used in minimally invasive procedures. We propose that 3D anatomical models can improve the development of Interventional Radiology vascular access skills – first described in the 1950s as the Seldinger Technique – for pre-clerkship medical students. Early adoption of 3D-printed technology in pre-clinical medical education can lead to improved student engagement and satisfaction when learning procedural techniques. This study involved creating a 3D model of the upper extremity vasculature from an anonymized CT angiogram, using it as a medical education tool for 31 pre-clinical medical students practicing the Seldinger Technique on a prefabricated venipuncture arm, and assessing student satisfaction with this form of learning. Overall, attendees responded positively to the incorporation of the 3D model in medical education to improve their anatomic understanding and application to the Seldinger Technique. These results indicate that the use of 3D models in simulation-based medical education can provide benefits to acquiring technical skills and the potential to decrease training costs without harming a patient.

(1) Background: The lateral arm flap has been the very useful choice in the reconstruction of small- to medium-sized defects like hand, extremity, oral head and neck area reconstructions. Its versatile characteristics and surgical feasibility allow this flap to be widely applied, but the reconstructive potential in facial subunit after tumor ablative procedures has never been reported. In this study, we aimed to utilize the advantages of the flap to treat facial temple subunit defect reconstruction. (2) Methods: Between 2020 and 2023, 12 patients underwent temple reconstruction with lateral arm free flaps after malignant tumor wide excision. There were 7 women and 5 men, and the mean patient age was 60.6 years old. Among the patients with cancer, 6 had squamous cell carcinoma, 5 had basal cell carcinoma and 1 had myxofibrosarcoma. All the flaps were elevated under general anesthesia. Aloprostadil(PGE1, Eglandin®) were administered postoperatively. (3) Results: All the flap types were fasciocutaneous type with varied sizes from 3 × 4 to 5 × 7 cm (Average size of flap 22.7cm2) were utilized. The average pedicle length was 6.1cm. The versatility of the lateral arm flap enabled successful coverage of all cases with no specific complications. Good functional outcome and range of motion in the recipient arm were obtained after surgery. (4) Conclusion: The authors successfully verified the advantages of lateral arm flaps in the treatment of medium sized facial subunt temple defect reconstruction.

Background A mycotic aortic aneurysm is a rare type of aortic aneurysm that can cause serious and adverse outcomes. Most mycotic aneurysms originate from infectious sources, such as trauma, vegetation in the heart, and adjacent infectious sources. If a mycotic aneurysm is diagnosed, it should be treated simultaneously with the primary source of the infection. Case Report A 63-year-old male presented to the emergency room with a fever, the primary source of which had not been confirmed, and had not responded to antibiotic treatment for two weeks. Treatment was initiated for a mycotic aneurysm of the brachial artery that occurred suddenly while undergoing treatment for the fever. Further investigation revealed that a mycotic aneurysm of the brachial artery was the cause of the fever, followed by aneurysms in the abdomen and lower extremities, and even vegetation on the heart that was not initially present. The patient declined to undergo treatment for personal reasons. After five months, a contained rupture of the abdominal aortic aneurysm that was initially considered as normal aorta was diagnosed and was treated successfully. Conclusions A peripheral mycotic aneurysm may be associated with multiple aneurysms. Appropriate diagnosis and complete management are necessary to prevent fatal consequences.

Introduction: Lung cancer remains a global health concern, with non-small cell lung cancer (NSCLC) comprising the majority of cases. Early detection of lung cancer has led to an increased number of cases identified in the earlier stages of NSCLC. This required the revaluation of the NSCLC treatment approaches for early-stage NSCLC. Methods: We conducted a comprehensive search using multiple databases to identify relevant studies on treatment modalities for early-stage NSCLC. Inclusion criteria prioritized but were not limited to, clinical trials and meta-analyses on surgical approaches to early-stage NSCLC conducted from 2021 onwards. Discussion: Minimally invasive approaches, such as VATS and RATS, along with lung resection techniques, including sublobar resection have emerged as treatments for early-stage NSCLC. Ground-glass opacities (GGOs) hve shown prognostic significance, especially when analyzing the consolidation-tumor ratio (CTR). There have also been updates on managing GGOs, including the non-surgical approaches, the extent of lung resection indicated, and the level of lymphadenectomy required. Conclusion: The management of early-stage NSCLC requires further assessment of treatment strategies. This includes understanding the required extent of surgical resection, interpreting the significance of GGOs (specifically GGOs with a high CTR), and evaluating the efficacy of alternative therapies. Customized treatment involving surgical and non-surgical interventions is essential for advancing patient care.

Scaffold guided breast tissue regeneration (SGBTR) can both transform reconstructive and cosmetic breast surgery. Implant-based surgery is the most common method. However, there are inherent limitations as there is replacement of tissue rather than regeneration. Regenerating autologous soft tissue has the potential to provide a more like-for-like reconstruction with minimal morbidity. Our SGBTR approach regenerates soft tissue by implanting additively manufactured bioresorbable scaffolds filled with autologous fat graft. A pre-clinical large animal study was conducted implanting 100 ml breast scaffolds (n=55) made from medical-grade polycaprolactone in 11 minipigs for 12 months. Various treatment groups were investigated where immediate or delayed autologous fat graft, as well as platelet rich plasma were added to scaffolds. Computed Tomography and Magnetic Resonance Imaging was performed on explanted scaffolds to determine volume and distribution of regenerated tissue. Histological analysis was performed to confirm tissue type. At 12 months we were able to regenerate and sustain a mean soft tissue volume of 60.9 4.5 ml (95% CI) across all treatment groups. There was no evidence of capsule formation. There were no immediate or long-term post-operative complications. In conclusion, we were able to regenerate clinically relevant soft tissue volumes utilizing SGBTR in a pre-clinical large animal model.

Calcium sulphate (CS) is currently used as a bioabsorbable, completely synthetic and sterile material in the management of infected tissues and dead spaces (DS) mainly resulting from surgical procedures. Residual DS in the postoperative, may create an environment where hematomas fill up and bacteria can proliferate, leading to a high incidence of postoperative infections. Considering the available reviews in the literature, CS has been mainly studied in orthopedic surgery mostly giving brilliant results and low complication rates. Nowadays, orthopedists avail it in the form of pearls both as a bone void filler and as an “off-label” delivery agent for antibiotics in arthroplasty, chronic osteomyelitis and open fractures, paving the way of its application in many other contexts given its natural dis-position to biodegradation. In the last years, CS beads have been gaining ground in the general, vascular and endocrinological surgical specialties. Despite its clear potential and the increasing number of scientific evidences on the safety and effectiveness of CS application in the prophylaxis and treatment of infections, there are not many studies reporting on its application in fields other than orthopedics, with a substantial paucity in plastic and reconstructive surgery literature. This is some-how surprising, since reconstructive surgery often deals with complex wounds secondary to bone and soft tissue exposure, suture dehiscence, trauma, and surgical site infections. As far as we know this is the first updated systematic review assessing the state of the art, indications and new perspectives on the application of CS beads in plastic and reconstructive surgery.

Polyetheretherketone (PEEK) in the last few years emerged as an exceedingly promising material for craniofacial defect, due to its biocompatibility and mechanical properties. However, its utilization remains controversial due to its inertness and low osteoinductivity. This study aimed to investigate the postoperative outcomes of patients undergoing maxillo-facial and neurosurgical procedures with PEEK implants. The focus is on evaluating bone regrowth on the surface and edges of the implant, periosteal reactions, and implant positioning. A retrospective analysis of 12 maxillo-facial surgery patients and 10 neurosurgery patients who received PEEK implants was conducted. CT scans performed at least one-year post-operation, were examined for bone regrowth, periosteal reactions, and implant positioning. In maxillo-facial cases, the analysis included mandibular angle and fronto-orbital reconstruction, while neurosurgical cases involved cranioplasty. In maxillofacial surgery, 11 out of 12 patients showed radiological evidence of bone regrowth around PEEK implants, with favorable outcomes observed in craniofacial reconstruction. In neurosurgery, 9 out of 10 patients exhibited minimal or none bone regrowth, while one case demonstrated notable bone regeneration beneath the PEEK implant interface. The study highlights the importance of implant design and patient-specific factors in achieving successful outcomes, providing valuable insights for future implant-based procedures.

INTRODUCTION: Breast sensibility following reconstruction surgery, though often overlooked, holds significant importance due to its widespread occurrence and profound effects on patients’ well-being and safety. Our objective is to compare the sensory outcomes between DIEP flap microsurgery reconstruction and implant-based reconstruction. Additionally, we explored the potential influence of sociodemographic and clinical factors on sensory recovery, along with assessing temperature discrimination abilities and evaluating quality of life. MATERIAL AND METHODS: We conducted an ambispective descriptive-analytical study, involving women who underwent mastectomy with reconstruction using either DIEP flap and implants at our hospital between 1990 and 2021. Data were collected from medical records, patient histories, physical examination, and validated quality of life questionnaires (BREAST-Q). RESULTS: A total of 99 women with breast reconstruction were included, 47 with DIEP flap and 52 with implants. Sensory recovery in implant-based reconstruction was found to be superior to DIEP flap reconstruction (5.03 and 5.18 respectively, p-value &lt;0.005). A direct correlation was observed between sensory improvement and thermal discrimination (Spearman coefficient 0.9, p-value &lt;0.001). Factors such as radiotherapy, delayed reconstruction with DIEP flap, and height with implants were associated with poorer sensory recovery in the breast. Women experiencing better breast sensibility reported higher satisfaction with their surgeon, medical team, and psychosocial quality of life. CONCLUSION: Women reconstructed with implants or DIEP abdominal flap exhibit suboptimal overall sensory recovery of the reconstructed breast, with slightly better outcomes observed in women reconstructed with implants.

We report the case of a 44-year-old woman who suffered gastric perforation after receiving bag-valve-mask (BVM) ventilation in the setting of alcohol intoxication. She had a markedly distended abdomen and cold, dusky lower extremities upon arrival to the emergency department. Imaging revealed a large volume intraabdominal accumulation of air with compression of the aorta. Needle decompression relieved symptoms of lower extremity arterial insufficiency. However, the patient quickly decompensated and subsequent exploratory laparotomy confirmed gastric rupture. A subtotal gastrectomy was performed but the patient ultimately passed on post-operative day two due to multi-organ dysfunction. Although BVM ventilation is commonplace in both the hospital and field, there is a lack of awareness of the serious complications of abdominal air accumulation due to their rareness in the adult population. Checking for abdominal distention during resuscitation ought to be routine in all patients. Signs of arterial insufficiency accompanying abdominal distention, once confirmed by diagnostic imaging that shows extensive pneumoperitoneum, are indicators of having reached a life-threatening level of air accumulation, calling for immediate needle decompression and exploratory laparotomy.

Background: Fine-needle aspiration cytology (FNAC) is widely used to diagnose and monitor thyroid nodules. The Bethesda System for Reporting Thyroid Cytopathology (TBSRTC) is the standard for interpreting FNAC specimens. The risk of malignancy in Bethesda III nodules also known as Atypia of Undetermined Significance (AUS) varies significantly throughout several studies published worldwide. This retrospective study examines the risk of cancer in thyroid FNAC categorized as Bethesda III, as identified in the final histopathology of thyroidectomy specimens at a single endocrine surgery center. Methods: This retrospective cohort analysis included 1038 consecutive patients who underwent elective thyroid surgery with complete follow up data between January 2020 and March 2024. Preoperative data on clinical and pathological characteristics have been collected. The final histopathology report from the thyroidectomy specimen was compared to the results of the preoperative FNAC on nodules that were judged to be Bethesda category III. Statistical methods were performed using SPSS version 29. Results: A total of 670 ultrasound-guided FNACs (64.5%) performed during the study period were included in the final analysis. The study population was predominantly female, represented by 79.6% of patients with a mean age of 42.5 (SD 12.1), while 20.4% were male and significantly older with mean age 45.13 years (p = 0.02). The FNAC inadequacy rate was 5.1%, which was associated with a high risk of malignancy (6 out of 34, 17.6%). Out of the total sample size of 170 patients classified as group III, 57 were found to have malignancies in final surgical histopathology, representing 33.5% of the cases within this category. The secondary gender-related outcome analysis showed that female patients classified under the Bethesda II category had a significantly higher risk of malignancy, with a rate of 21.2%, compared to males who had a malignancy rate of 3.4% in the same Bethesda category (p = 0.001, chi square test). However, female had more better prognostic non-invasive tumors than male (p = 0.02, chi square test). Conclusion: The study's results indicate that Bethesda categories II and III are associated with a higher risk of malignancy in comparison to the reports of the first and third editions of the TBSRTC, particularly for female patients classified under category II.

Keywords: Tendon injuries; Mallet finger; Suture techniques

Background: Fine-needle aspiration cytology (FNAC) is widely used to diagnose and monitor thyroid nodules. The Bethesda System for Reporting Thyroid Cytopathology (TBSRTC) is the standard for interpreting FNAC specimens. The risk of malignancy in Bethesda III nodules also known as Atypia of Undetermined Significance (AUS) varies significantly throughout several studies published worldwide. This retrospective study examines the risk of cancer in thyroid FNAC categorized as Bethesda III, as identified in the final histopathology of thyroidectomy specimens at a single endocrine surgery center. Methods: This retrospective cohort analysis included 1038 consecutive patients who underwent elective thyroid surgery with complete follow up data between January 2020 and March 2024. Preoperative data on clinical and pathological characteristics have been collected. The final histopathology report from the thyroidectomy specimen was compared to the results of the preoperative FNAC on nodules that were judged to be Bethesda category III. Statistical methods were performed using SPSS version 29. Results: A total of 670 ultrasound-guided FNACs (64.5%) performed during the study period were included in the final analysis. The study population was predominantly female, represented by 79.6% of patients with a mean age of 42.5 (SD 12.1), while 20.4% were male and significantly older with mean age 45.13 years (p = 0.02). The FNAC inadequacy rate was 5.1%, which was associated with a high risk of malignancy (6 out of 34, 17.6%). Out of the total sample size of 170 patients classified as group III, 57 were found to have malignancies in final surgical histopathology, representing 33.5% of the cases within this category. The secondary gender-related outcome analysis showed that female patients classified under the Bethesda II category had a significantly higher risk of malignancy, with a rate of 21.2%, compared to males who had a malignancy rate of 3.4% in the same Bethesda category (p = 0.001, chi square test). However, female had more better prognostic non-invasive tumors than male (p = 0.02, chi square test). Conclusion: The study's results indicate that Bethesda categories II and III are associated with a higher risk of malignancy in comparison to the reports of the000 first and third editions of the TBSRTC, particularly for female patients classified under category II.

Background: Pancreatic neuroendocrine tumors (pNETs) represents a rare subset of pancreatic cancer. Functional tumors caused hormonal changes and clinical syndromes, while non-functional ones are often diagnosed late. Surgical management need a multidisciplinary planning, involving enucleation, distal pancreatectomy with or without spleen preserving, cen-tral pancreatectomy, pancreaticoduodectomy or total pancreatectomy. Minimally invasive ap-proach increased in the last decade compared to the open technique. The aim of this study is to analyze current diagnostic and surgical trends for pNETs, to identify better interventions and their outcomes. Methods: The study adhered to PRISMA guidelines, conducting a systematic review of literature from May 2008 to March 2022 across multiple databases. Several combinations of keywords was used ("NET", "pancreatic", "surgery", "laparoscopic", "minimally invasive", "robotic”, “enuclea-tion”,“parenchima sparing”) and relevant article references was manually checked. Manuscript quality was evaluated. Results: The study screened 3867 manuscripts, twelve studies were selected, primarily from Ita-ly, the United States, and China. A total of 7767 surgical treated patients was collected from 160 included centers. The mean age was 56,3 y.o. Enucleations (EN) and distal pancreatectomy (DP) was the most common performed surgery and represents 43.4% and 38.6% of the total interven-tions, respectively. Pancreatic fistula, post operative bleeding, re-operation and follow up was recorded and analyzed. Conclusions: Enucleation show better postoperative outcomes and lower mortality rates com-pared to pancreaticoduodenectomy (PD) or distal pancreatectomy (DP), despite similar risks of postoperative pancreatic fistula (POPF). DP was preferred over enucleation for pancreas body-tail, while laparoscopic enucleation is better for head pNETs.

Background: Eid al-Adha is celebrated every year in Muslim countries; however, it is a time when patients present to the emergency department with serious injuries. In our study, we examined current injuries at the time of Eid al-Adha in the largest patient population in one of the largest hospitals in Turkiye, including tendon injury map and maxillofacial injuries for the first time in the literature. Methods: Between 2019 and 2023, patients admitted to Ankara City Hospital during Eid al-Adha were examined. The demographic characteristics, injury patterns, and injury sites of the patients were evaluated by analyzing the patients admitted on the four days of Eid al-Adha. Statistical analysis were performed using IBM SPSS Statistics for Windows. Results: Six hundred and ten patients, including 101 female and 509 male patients, were included in this study. There was a statistically significant increase (p

(1) Background: Neurologic and musculoskeletal diseases represent a considerable portion of the underlying etiologies responsible for the widely prevalent symptoms of pain, weakens, numbness, and paresthesia. Because of the subjective and often nonspecific nature of these symptoms, different diagnostic modalities have been explored and utilized.; (2) Methods: Literature review; (3) Results: Nerve and muscle biopsy remains the gold standard for diagnosing many of the responsible neurological and musculoskeletal conditions. However, the need for invasive tissue sampling is diminishing as more investigations explore alternative diagnostic modalities. Because of this, it is important to explore the current role of neurosurgical intervention for nerve and muscle biopsies and its current relevance in the diagnostic landscape of neurological and musculoskeletal disorders. With consideration of the role of nerve and muscle biopsy, it is also important to explore innovations and emerging techniques for conducting these procedures. This review explores the indications and emerging techniques for neurological intervention for nerve and muscle biopsies; (4) Conclusions: The role of neurosurgical intervention for nerve and muscle biopsy remains relevant in diagnosing many neurological and musculoskeletal disorders. Biopsy is especially relevant as a supportive point of evidence for diagnosis in atypical cases. Additionally, emerging techniques have been explored to guide diagnostics and biopsy, conduct less invasive biopsies, and reduce risks of worsening neurologic function and other symptoms secondary to biopsy.

Despite their relatively low incidence globally, CNS tumors remain amongst the most lethal cancers, with only a few other malignancies surpassing them in 5-year mortality rates. Treatment decisions for brain tumors heavily rely on histopathological analysis, particularly intraoperatively, to guide surgical interventions and optimize patient outcomes. Frozen sectioning has emerged as a vital intraoperative technique, allowing for highly accurate, rapid analysis of tissue samples, although it poses challenges regarding interpretive errors and tissue distortion. Raman histology, based on Raman spectroscopy, has shown great promise in providing label-free, molecular information for accurate intraoperative diagnosis, aiding in tumor resection and identification of neurodegenerative disease. Techniques including Stimulated Raman Scattering (SRS), Coherent Anti-Stokes Raman Scattering (CARS), Surface-Enhanced Raman Scattering (SERS), and Tip-Enhanced Raman Scattering (TERS) have profoundly enhanced the speed and resolution of Raman imaging. Similarly, Confocal Laser Endomicroscopy (CLE) allows for real-time imaging and rapid intraoperative histologic evaluation of specimens. While CLE is primarily utilized in gastrointestinal procedures, its application in neurosurgery is promising, particularly in the context of gliomas and meningiomas. This review focuses on discussing the immense progress in intraoperative histology within neurosurgery and provides insight into the impact of these advancements on enhancing patient outcomes..

Abstract: Background: Irreversible electroporation (IRE) is a form of non-thermal ablation that delivers pulses of high voltage electrical current between electrodes. The role of IRE in the treatment of colorectal hepatic metastases is unestablished. This study is an international ques-tionnaire survey of the use of IRE for colorectal hepatic metastases. Methods: A questionnaire addressing views on the use of IRE for colorectal liver metastases was circulated to clinicians with an interest and/or expertise in this technique. Results: 64 clinicians from 17 different countries replied to the questionnaire. Thirty-six (56%) had experience of treating patients with colorectal liver metastases with IRE. The preferred mode of delivery of IRE was percutaneous treatment under CT guidance. Thirty-three (70% respondents) used IRE exclusively for lesions in proximity to inflow or outflow structures. Twenty (43% respondents) used IRE as their sole ablative treat-ment whilst 19 (40% respondents) used IRE in combination with thermal ablation. The maximum number of lesions that could be treated by IRE was two and preferred size of lesion was

Background. Cervical esophageal reconstruction is vital for improving the quality of life in cancer surgery patients. Microsurgery is crucial, providing vascularized tissue for defect repair, particularly in secondary cases with a higher risk of failure due to larger defects and damage from previous surgery and radiotherapy. The purpose of this study was to describe the clinical characteristics of a series of patients who underwent secondary repair of esophageal defects and provide practical information for the management and treatment of such cases based on the authors' experience and the literature review. Methods. We retrospectively reviewed the electronic medical records of the Plastic Surgery Clinic at the University of Trieste to identify cases of patients who underwent secondary esophageal microsurgical reconstructions following oncological surgery. Patient demographics, etiology of esophageal defects, previous surgical history, and preoperative assessments were collected from medical records. Surgical techniques employed for reconstruction, such as pedicled flaps or free tissue transfers, were documented along with intraoperative details. Postoperative outcomes, including complications, graft viability, and functional outcomes, were evaluated during follow-up. Results. We treated 13 cases of secondary esophageal reconstructions from 2011 to 2022. Most commonly, Antero-Lateral Thigh (ALT) flaps were used in 10 cases, while 2 cases employed Radial Forearm Flap (RFF), and 1 a chimeric parascapular flap. No flap failures occurred during a median 50-month follow-up. One ALT flap patient experienced post-op stricture but maintained swallowing ability. A single tracheoesophageal fistula occurred in a RFF patient with a history of radiotherapy and completion lymph node dissection. Conclusions. Cervical esophageal reconstruction significantly impacts patients' quality of life by restoring oral feeding and phonation. When local flaps fall short, microsurgical reconstruction with intestinal flaps is valuable, but burdened by limitations. For challenging secondary cases, ALT or RFF flaps emerge as safer options due to their robust pedicles, yielding low complication rates and positive functional outcomes.

Background/Objectives:The first attempts of posterior lumbar interbody fusion can be traced back to the 1940s, where their performance was marked by animosity due to high rates of failure. Nowadays, the use of interbody fusion involves a much more complicated consideration of factors such as global alignment, disc height, fusion rates, and operative risk, all combined at once.Our study aims to examine all these effects using Flarehawk 9 as a means of interbody fusion.Materials and methods: A total of 58 patients underwent open posterior lumbar surgery using Flarehawk 9 between September 2021 and February 2023 with a mean follow up of 1 year.The mean age was 59.8 years old ( range between 33 and 79 years old), 36 of them are males while 22 of them are females. The diagnostic groups included spinal canal stenosis (n=40), failed back surgery syndrome-revision surgery (n=5),spondylolisthesis with slip percentage 25% (n=4),recurrent herniated disc (n=7) and adjacent segment disease (n=2). Results: The majority of patients demonstrated remarkable improvement based on ODI scores.The rate of union varied based on the fused levels and whether the patients had previous surgery or not.The amount of lordosis postoperatively is increased by 2±0.4 degrees.Conclusions: Even though anterior approaches become more and more popular and advanced nowadays, posterior fusion with interbody cage still remains a safe and effective method to treat various spine surgical pathologies with optimal results.

BACKGROUND: Lower limb skeletal muscle ischemia-reperfusion (IR) injury associated with increased morbidity and mortality is common in several clinical situations such as aortic aneurysms repairment, peripheral arterial surgery, vascular injury repairment, and shock. Although it is generally accepted that oxidative stress mediators have a significant role in IR injury, its precise mechanism is still unknown. Anecdotally, it is sustained not only by structural and functional changes in the organ it affects but also by damage to distant organs. The purpose of this report is to illustrate the effect of proanthocyanidin on IR injury. METHODS: In our study, 18 male Wistar albino rats were used. The subjects were divided into three groups of six each. (Group Control-C, Group Ischemia-Reperfusion -IR, Group Ischemia-Reperfusion and Proanthocyanidin-IR-PRO). Intraperitoneal proanthocyanidin was given to the IR and proanthocyanidin groups 30 minutes before laparotomy and 1-hour ischemia led to these two groups. After one hour, reperfusion started. Muscle atrophy-hypertrophy, muscle degeneration-congestion, fragmentation-hyalinization, muscle oval-central nucleus ratio, leukocyte cell infiltration, catalase enzyme activity, and TBARS were all examined in lower-limb muscle samples after one hour of reperfusion. RESULTS: When skeletal muscle samples were evaluated histopathologically, it was discovered that muscle atrophy-hypertrophy, muscle degeneration-congestion, fragmentation-hyalinization, and leukocyte cell infiltration with oval-central nucleus standardization were significantly higher in the IR group than group control and group IR-proanthocyanidin. Besides, oval-central nucleus standardization was significantly higher in the IR and proanthocyanidin group than in the control group. TBARS levels were significantly higher in the IR group than in the control and IR-proanthocyanidin groups while, catalase enzyme activity was found to be significantly lower in the IR group than in the control and IR and proanthocyanidin groups. CONCLUSION: As a consequence of our research, we discovered that proanthocyanidins administered before IR have a protective impact on skeletal muscle in rats. Further research in this area is required.

Background: Locally advanced rectal cancers (10-20%) can present with infiltration into adjacent viscera. R0 resections remain the key factor for better survival. Traditionally these cases have been managed with open surgery. There are some limitations of laparoscopic surgery in these case, which can potentially be overcome by robotic surgery. Objectives: To determine the feasibility and outcome results of robotic multi-visceral resection of stage T4 rectal carcinoma. Methods: Consecutive patients having locally advanced carcinoma of rectum, who undergone robotic multi-visceral resection as the primary treatment between 2015 -2018 were included, through our database which was maintained prospectively. All perioperative and intraoperative parameters were analyzed. Patient demographics, co-morbidities, preoperative imaging, endoscopic findings, operative data, histopathology results, postoperative hospital course and procedure related postoperative adverse events were noted and analyzed. Results: Twenty-one patients with the diagnosis of nonmetastatic locally advanced rectal cancers were operated with Robotic Si/X platform. The median body mass index was 28.5 kg/m2 (range 21-42). The mean blood loss during operation was 20 ml (range 5-200), and the mean duration of surgery was 280 min (range 240-430). The median hospital stay after operation was 6 days (range 4-25 days). On postoperative histopathology, R0 resection rate was 90.5% (19/21). Conclusions: The robotic multi-visceral en-bloc resection of stage T4 rectal carcinoma is technically feasible and oncologically safe. Advanced technical skills, accurate radiological staging and careful patient selection can allow the extension of minimal access surgery to this challenging group of patients.

Groove pancreatitis represents a chronic focal form of pancreatitis affecting the zone between the pancreatic head and the duodenal „C” loop, known as the groove area. This is a rare condition that affects the pancreatic periampullary part, including the duodenum and the common bile duct, associated usually with long-term alcohol and tobacco misuse and being more frequent in men than in women. The most common clinical symptoms of groove pancreatitis include weight loss, acute abdominal pain, nausea, and jaundice. This report is about a 66 year old woman with a history of heavy smoking, presenting with weight loss, nausea, and upper abdominal pain. Contrast enhanced computed tomography revealed the existence of a chronic pancreatitis as well as the dilatation of the main pancreatic duct, a cyst of the pancreatic head and enlargement of the biliary tract. Conservatory treatment was initiated but with no improvement of symptoms. Since there was no indication for endoscopic retrograde cholangiopancreatography, we decided to perform a pancreatoduodenectomy, as surgery appears to be the single effective treatment.

DIEP-based breast reconstruction necessitates wide undermining at the abdominal donor-site, creating large wound areas. Flap harvesting is usually conducted using electrosurgical dissection devices. This study sought to compare the clinical outcomes in patients after using the PEAK PlasmaBlade (PPB) versus monopolar electrocautery (MPE). This retrospective cohort study included 128 patients with DIEP-based breast reconstruction. Patient characteristics as well as information on the postoperative course were collected and a comparative evaluation was conducted. The MPE group exhibited significantly (p* = 0.0324) higher abdominal drainage volume (351.11 ± 185.96 ml) compared to the PPB group (279.38 ± 183.38 ml). Subgroup analysis demonstrated that PPB significantly reduced postoperative wound fluid in patients with BMI > 30 kg/m² (p* = 0.0284), without prior neoadjuvant chemotherapy (p** = 0.0041), and among non-smokers (p = 0.0046). Furthermore, postoperative pain was significantly (p**** < 0.0001) lower in the PPB cohort. This study confirms the non-inferiority of the PEAK PlasmaBlade to conventional electrocautery for abdominal flap harvesting. The PPB demonstrated advantages, notably reduced drainage volume and lower postoperative pain levels. Recognizing patient subsets that benefit more from the PPB highlights the importance of personalized device selection based on patient characteristics.

Background: Early postoperative airway management after laryngo-tracheal surgery is crucial. Acute respiratory failure due to glottis’ oedema may occur, requiring reintubation. This can prolong ventilatory assistance, jeopardizing the anastomosis. To date, only judicious steroid administration and fluid management are available to avoid more invasive procedures. High-Flow-Oxygen-Therapy(HFOT) is a noninvasive O2 support method providing humidification, warmed air, Positive-End-Expiratory-Pressure(AIRVO2). No data exist about HFOT use to prevent early complications after laryngo-tracheal surgery. Methods: Between Sept.2020-Sept.2022, 107 consecutive patients underwent laryngo-tracheal surgery received HFOT(Group A). Data and long-term results were compared with those of 80 patients operated between Sept.2018-Aug.2020(Group B), when HFOT was not available. All patients were operated in a single center. No pre- or post-operative settings changed, except for HFOT introduction. We analyzed and compared the risk for “delayed” reintubation (unexpected reintubation within the first 24-48 hours after extubating/laryngeal mask removal) in the two groups. Results: No patients reported HFOT-related adverse events. Control group(B) presented “delayed” reintubation in 37% (p= 0.027), Intensive Care Unit admission in 67%(p=0.005) and longer hospital stay(p=0.001) compared to HFOT group(A). Minor complications rate was 3% in both group and overall mortality was 0%. Re-stenosis was described in 4.6% of HFOT group, without a statistically significant difference (p=0.7006). Conclusions: Our study is the first to investigate HFOT use in patients undergoing laryngo-tracheal surgery, potentially representing a consistent innovation in the peri-operative management of these patients. With the limit of a retrospective series, we would suggest HFOT use for preventing post-operative reintubation rate, possibly reducing ICU admission and hospital stay.

Colorectal cancer is the third most diagnosed cancer in males and in females, representing 8% of estimated new cases and the third cause of cancer-related death in both sexes, accounting for 9% of cancer deaths in men and 8% in women. About 20% of patients diagnosed with CRC present metastatic disease. Although lung metachronous or synchronous metastatic spread without other involved sites has been reported in only a small proportion of patients, considering that this tumor is frequently diagnosed, the clinical approach to CRC pulmonary metastases represents a major issue for thoracic surgeons and CRC oncologists. Among patients diagnosed with pulmonary metastases from CRC, about 9 – 12% are eligible for local treatments with radical intent, including surgical resection, SBRT and ablation therapy. Due to the lack of randomized controlled trials among different local strategies, there is no definitive evidence about the optimal approach, although surgical resection is considered the most effective therapeutic option in this clinical scenario. Oncological achievement of primary radical resection, the biology of primary tumor and metastatic sites, disease free interval and or progression free survival are independent prognostic factors which make it possible to define a cohort of patients which might significantly benefit from pulmonary metastasectomy.

(1) Background: The aim of this study was to compare the survival benefit of radical ante-grade-modular pancreato-splenectomy (RAMPS) with conventional distal pancreato-splenectomy (cDPS) in left-sided pancreatic cancer. (2) Methods: A retrospective propensity score matching (PSM) analysis was conducted on 333 patients who underwent RAMPS or cDPS for left-sided pancreatic cancer at four tertiary cancer centers. The study assessed prognostic factors and com-pared survival and operative outcomes. (3) Results: After PSM, 99 patients were matched in each group. RAMPS resulted in a higher retrieved lymph node count than cDPS (15.0 vs. 10.0, p < 0.001). No significant differences were observed between the two groups in terms of R0 resection rate, blood loss, hospital stay, or morbidity. The 5-year overall survival rate was similar in both groups (cDPS vs. RAMPS, 44.4% vs. 45.2%, p = 0.853), and disease-free survival was also comparable. Multivariate analysis revealed that ASA score, preoperative CA19-9, histologic differentiation, R1 resection, adjuvant treatment, and lymphovascular invasion were significant prognostic factors for overall survival. Preoperative CA19-9, histologic differentiation, T-stage, adjuvant treatment, and lymphovascular invasion were independent significant prognostic factors for disease-free survival. (4) Conclusions: Although RAMPS resulted in a higher retrieved lymph node count, survival outcomes were not different between two groups. RAMPS was a surgical option to achieve R0 resection rather than a standard procedure. Adjuvant treatment was an independent prognostic factor for both overall and disease-free survival.

OBJECTIVES: To assess the predictive value of serum trypsin and Trypsinogen Activation Peptide (TAP) for the severity of AP by means of a single center cohort study as well as a systematic review of the current literature. METHODS: The literature search was conducted using Medline (PubMed), EMBASE and the Cochrane Central Register. A total of 142 patients with acute pancreatitis (AP) were included in the cohort study and parameters of the revised Atlanta criteria of 2012 and the APACHE II were assessed. RESULTS: The review showed promising results for the predictive value of serum trypsinogen-2, but conflicting results for serum TAP and trypsin. In the cohort study, patients were observed for 4 days after diagnosis of AP: 9 patients had severe AP, 35 patients had moderate AP and 81 patients had mild AP. The ratio of the geometric mean of severe vs mild AP for trypsin was 0.72 (95% CI: 0.51-1.00), p=0.053 and for TAP 0.74 (95% CI: 0.54-1.01), p=0.055 respectively. CONCLUSION: The cohort study showed an inverse correlation of serum levels of TAP and trypsin with severity of AP. Serum TAP and trypsin have an inferior predictive value of severity of AP compared to the clinical APACHE II score.

Ideas about Artificial Intelligence appeared about half a century ago, but only now is it becoming an essential element of everyday life. The data provided is getting bigger and bigger and, in this case, we need artificial intelligence that helps us with superhuman powers. The interaction with medicine is getting closer and closer, medicine being a field that continues to be perfected. Machine learning, deep learning, neural networks, computer vision are some of the mechanisms that are already applied in medicine, becoming a trend in healthcare worldwide. Artificial intelligence will be the thing that will change contemporary medicine. Developed countries such as Japan, France, Germany have already implemented artificial intelligence in their medical systems. The help is in medical diagnosis, patient monitoring, personalized therapy, and workflow optimization. Artificial intelligence will help surgeons to perfect their skills, to standardize techniques, to choose the best surgical technique. The goal is to predict complications, reduce diagnostic time, diagnose complex pathologies, guide the surgeon intraoperatively and reduce medical errors. We are at the beginning but the potential is enormous.

Thin people who undergo implant insertion into the chest wall face a high risk of implant exposure to the external environment. Five months after an 8-year-old boy underwent implantable cardioverter-defibrillator (ICD) implantation in a subcutaneous pocket in the left anterolateral chest wall to manage long QT syndrome, ICD replacement became necessary owing to exposure risk from distal and lateral thinning of the ICD pocket. Pocket rupture and exposure would increase the risk of infection; therefore, we performed ICD removal and primary pocket closure. Two weeks later, a new suprafascial pocket was created, acellular dermal matrix (ADM) was attached to the inner wall to prevent ICD protrusion, and a new ICD was inserted. One year postoperatively, the ADM was engrafted, and no complications were observed. A thin subcutaneous layer increases the risk of ICD implantation complications. Inner wall strengthening with ADM can help prevent pocket rupture.

Introduction Total pelvic exenteration (TPE) is a highly complex surgery associated with a high morbidity rate of 40% in reference units. It is performed for advanced or recurrences tumors in the pelvis with infiltration of multiple organs. Sometimes TPE is indicated in situations of palliation due to the side effects of radiotherapy or tumor progression. The aim of our study is to evaluate a single center experience in TPEs using a minimally invasive approach (LTPE) and compare the perioperative outcomes with the open technique (OTPE). Material and methods A prospective study of the TPE carried out in our unit between 2013-2023 was used. All anterior and posterior exenterations were discarded. Perioperative outcomes were evaluated. Results A total of 19 TPEs were analyzed, 9 LTPEs and 10 OTPEs. Most tumors originated from the colon and cervix. Hyperthermic intraperitoneal chemotherapy (HIPEC) was applied in one case of LTPE and intraoperative radiotherapy (IORT) in one case of OTPE. Cases with palliative intent were one in each group. Surgery time was 407 minutes for LTPE and 367 min for OPTE (p=0.38). Length of hospital stay was longer in the OPTE group at 21.6 days vs LTPE with 10.1 days, (p=0.23). The R0 rate excluding palliative cases was 88.9% for LTPE vs. 70% for OPTE (p=0.33). Major morbidity (grade III) was 45% in the LTPE group with no mortality and 40% (grade III/IV) in the OPTE group with one patient dying on admission. Survival was similar in both groups. Conclusion LTPE is a feasible and safe approach with similar perioperative outcomes and a trend toward shorter hospital stay.

The quest for surgical advancements regarding the enhancement of the submental and cervicofacial regions has witnessed a remarkable upsurge in recent years. Informed patients are actively seeking sophisticated plastic surgery techniques to achieve comprehensive rejuvenation in these specific areas. Common complaints expressed by these patients include sagging of the jawline, the emergence of deep perioral wrinkles, and the formation of "marionette lines" within the lower third of the face. Furthermore, the manifestation of age-related signs, including neck laxity, submental adipose accumulation, "witch's chin" deformity, and weakened platysma musculature, are common within this anatomical region. This literature review aims to summarize the recent technical improvements, historical evolution, indications, postoperative care, and challenges for facial rejuvenation of the lower third of the face and neck. Lastly, the application of minimally invasive procedures as part of a comprehensive approach to an aging face will also be discussed.

The case of a patient with autoimmune haemolytic anaemia and an anastomosing haemangioma, is presented. The main dilemma was whether the haemangioma was the cause or the consequence of the autoimmune haemolytic anaemia and how both processes should be management. The diagnostic methods used are analytical and imaging techniques, which have not been conclusive in the diagnosis of anastomosing haemangiomas. Preoperative corticosteroid treatment does not prevent the recurrence of autoimmune haemolytic anaemia in the postoperative period. Surgical indication is established by the progression of proliferative activity, tumor enlargement and compression of the vena cava over time. Surgical resection of the tumor is the procedure used. The indication for surgical treatment of the anastomosing haemangioma and the decrease in alpha- fetoprotein after tumor resection are the most relevant results, although it increases again after a few weeks. The development of an anastomotic haemangioma may be secondary to autoimmune haemolytic anaemia. Angiogenesis resulting from the formation of erythroblastic islands at the periphery of the tumor and clonal expansions may be a mechanism to compensate for the haemolysis caused by autoimmune haemolytic anaemia

Although a growing number of evidence emphasizes superior of VATS over conventional thoracotomy, still is little known about early postoperative diaphragm muscle function after lobectomy via these two approahces. To fill the gap in existing literature, we conducted comparative study between VATS and conventional thoracotomy in terms of postoperative diaphragm muscle function, assessing its contractility, strength, magnitude of effort and potential risk of dysfunction such as: atrophy and paralysis. A total of 59 patients (30 after VATS), who underwent anatomical pulmonary resection at our institution, were enrolled into this study. The control group was consisted of 28 health subjects without medical condition could contribute to diaphragm dysfunction. Diaphragm muscle was assessed before and after surgery using ultrasonography. We found that both surgical approaches were associated with postoperative impairment of diaphragm muscle function - compared to baseline data. Postoperative reduction of diaphragm contraction was demonstrated in all of 59 patients. In case of control group, the differences between measurements were no observed. We noted that lobectomy via thoracotomy was linked with greater percentage of patients with diaphragm paralysis or/and atrophy that VATS. Similar findings were observed in refer to diaphragm magnitude effort, as well as, diaphragm contraction strength, where minimal invasive surgery was associated with better diaphragm function parameters - in comparison to thoracotomy. Disturbance of diaphragm work was reported both at operated and non-operated side. Upper right and left lobectomy was connected with greater diaphragm function impairment than other segments. In conclusion, VATS technique seems to be less invasive than conventional thoracotomy providing a better postoperative function of a main respiratory muscle.

Study design: Technical note. Objectives: To present a new technique of treatment for a patient with thoracolumbar focal kyphosis due to osteoporotic verte-bral fracture (OVFs). Background : OVFs are common among the elderly population. Following a severe wedged fracture, patients often experience low back pain and disruptions in activities of daily living. Reconstruction surgeries, such as corpectomy, are among the treatment options for this condition. However, corpectomy requires longer surgical times and involves a significant amount of blood loss. Materials and Methods : An 80-year-old woman presented to our hospital with severe low back pain and gait disturbance. She had experienced an L2 OVF six years prior. Although she had no neurological deficit, she could not walk more than 200m due to pain. Preoperative spinal radiographs revealed severe sagittal malalignment, with the L2 vertebra collapsed and focal kyphosis of L1-3 measuring 34 degrees. Results: The patient underwent anterior and posterior surgery in the right decubitus position using a C-arm free technique. The surgical time was 133 minutes with an estimated blood loss of 100 ml. Hyperlordotic cages were inserted in the upper and lower disc space via a lateral approach, while percutaneous pedicle screws (PPS) were inserted from a posterior approach. These procedures were performed simultaneously under navigation guidance only. Post-operative images showed excellent spinal alignment, with local kyphosis reduced from 34 to 14 degrees, and no major or severe complications occurred. At one-year follow-up, the patient was able to walk smoothly, with her visual analogue scale for low back pain improving from 73mm to 13mm, and her Oswestry Disability Index improving from 53.3% to 13.3%. Conclusions/Level of Evidence : The simultaneous use of hyperlordotic cages and PPS is an effective and innovative navigation technique that yields promising outcomes for thoracolumbar focal kyphosis resulting from OVFs. This approach not only reduces surgical time but also minimizes intraoperative blood loss. Level V.

Abstract: Laryngoscopy for tracheal intubation has been developed for many decades. Among various conventional laryngoscopes, videolaryngoscopes (VL) have been applied in different patient populations, including difficult airways. The safety and effectiveness of VL have been repeatedly studied in both normal and difficult airways. The superiority of VL then has been observed and is advocated as the standard of care. In contrast to laryngoscopy, the development of video-assisted intubating stylet (VS, also named as styletubation) has been noticed two dec-ades ago. Since then, sporadic clinical experiences of use have appeared in literature. In this re-view article, we presented our vast use experiences of the styletubation (more than 55,000 pa-tients since 2016). We found this technique is swift (the time to intubate: from 3 s to 10 s), smooth (first-attempt success rate: 100%), safe (no airway complications), and easy (high subjective satis-faction and fast learning curve for the novice trainees) in both normal and difficult airway sce-narios. We therefore propose styletubation technique can be feasibly applied as universal rou-tine use for tracheal intubation.

Study design: Retrospective cohort study. Objectives: To investigate the outcomes of early ballon kyphoplasty (BKP) intervention compared with late intervention for osteoporotic vertebral fracture. Background: Osteoporotic vertebral fractures, can lead to kyphotic deformity, severe back pain, depression, and disturbances in activities of daily living (ADL). BKP has been widely utilized to treat symptomatic OVFs and has proven to be a very effective surgical option for this condition. BKP is relatively a safe and effective method due to less acrylic cement leakage and greater kyphosis correction. Materials and Methods: A retrospective comparative study was conducted at our hospital for patients who underwent BKP for osteoporotic vertebral fractures in the time frame between January 2020 and December 2022. Ninety-nine patients were included in this study, patients were classified into two groups: 36 patients underwent early BKP intervention (EI)

Background and Objectives: The purpose of the study was to analyze the relationships between several clinical and biological factors, but also the tumor topography and surgical strategies used in patients with colorectal cancer. Materials and Methods: We designed an analytical, observational, retrospective study that included patients admitted to our emergency surgical department and diagnosed with colorectal cancer. The study group inclusion criteria were: patients admitted during 2020-2022; patients diagnosed with colorectal cancer (including the ileocecal valve); patients who benefited from a surgical procedure, either in emergency or elective. Results: In our study group, consisting of 153 patients, we accounted for 56.9% male patients and 43.1% female patients. The most common clinical manifestations were pain (73.2% of the study group), followed by abdominal distension (69.3% of the study group) and absence of intestinal transit (38.6% of the study group). A number of 69 patients were operated in emergency (45.1%), while 84 patients (54.9%) benefited from elective surgery. The most frequent topography of the tumor was the sigmoid colon, with 19.60% of the patients, followed by the colorectal junction, with 15.68% of the patients and superior rectum and inferior rectum, with 11.11% of the patients in each subcategory. The most frequent type of procedure was right hemicolectomy (21.6% of the study group), followed by rectosigmoid resection (20.9% of the study group). The surgical procedure was finished by performing an anastomosis in 49% of the patients, an ostomy in 43.1% of the patients, while for 7.8% of the patients, a tumoral biopsy was performed. Conclusions: Colorectal cancer remains one of the most frequent cancers in the world, with a heavy burden that involves high mortality, alterations in the quality of life of the patients and their families, and also the financial costs of the medical systems.

Evidence regarding the role of oral antibiotics (oA) alone or combined with mechanical bowel preparation (MoABP) for elective colorectal surgery remains controversial. A prospective database of 8,359 colorectal resections gathered over a 32-month period in 78 Italian surgical units (the iCral 2 and 3 studies), reporting patient-, disease-, and procedure-related variables together with 60-day adverse events, was re-analyzed to identify a subgroup of 1,013 cases (12.1%) that received either oA or MoABP. This dataset was analyzed using a 1:1 propensity score-matching model including 20 covariates. Two well-balanced groups of 243 patients each were obtained: group A (oA), and group B (MoABP). The primary endpoints were anastomotic leakage (AL) and surgical site infections (SSIs) rates. Group A vs. group B showed a significantly higher AL risk [14 (5.8%) vs 6 (2.5%) events; OR 3.77; 95%CI 1.22-11.67; p = .021], while no significant difference was recorded between the two groups regarding SSIs. These results strongly support the use of MoABP for elective colorectal resections.

Thyroid surgery rates have tripled over the past 3 decades making it one of the most frequently performed procedures within general surgery. They are associated with the possibility of serious postoperative complications having a significant impact on the patient's quality of life. The recurrent laryngeal nerve (RLN) palsy and the external branch of the superior laryngeal nerve (EBSLN) palsy are, next to hypoparathyroidism and bleeding after operation, one of the most common complications. The introduction of neuromonitoring into thyroid surgery, enabling both confirmation of anatomical integrity and assessment of laryngeal nerve function, was a milestone that has begun a new era in thyroid surgery. The International Neural Monitoring Study Group made standardization of the technique of RLN and EBSLN monitoring during thyroid and parathyroid surgery which increased prevalence of neural monitoring during thyroidectomy. Current status of IONM and benefits of its use have been presented in this publication.

Study design: Technical note. Objectives: To present a novel technique of treatment for patient with basilar invagination. Background : Basilar invagination (BI) is considered a congenital condition and can compress the cervicomedullary junction, causing neurologic deficit. Severe neurological deficit due to BI should be treated surgically. However, there is controversy regarding whether an anterior or posterior approach should be used. Anterior approach is optimal for decompression of cervicomedullary junction, but this approach has high complication rates. Posterior reduction has a high risk of occipital screws backout and/or instrument failure. Materials and Methods : A 15-year-old boy with severe myelopathy was referred to our hospital. He had neck pain, muscle weakness of bilateral upper limbs, gait disturbance appeared 3 months before he visited our hospital, he drops a cup several times recently. In the examination, he had hyperreflexia of upper and lower limbs and muscle weakness of bilateral arms (MMT 4), hypoesthesis was observed bilaterally below elbow and both legs. He also had clumsiness of bilateral hands, mild urinary and bowel incontinence, and spastic gait. His 10 second grip and release test was 16 in both hands. His grip power was 20 kg in right and 17 kg in left. Radiograms showed severe BI and spinal cord was severely compressed with odontoid process.. Results : The patinet underwent posterior surgery with C-arm free technique. All screws including occipital screws were inserted adequate position under navigation guidance. Reduction was achieved with skull rotation and distraction. A follow-up at one year we have these results : Manual muscle testing results and sensory function tests showed almost full recovery, bilateral arms (MMT 5) ,walking smoothly. Cervical Japanese orthopedic association score of the patient has improved from 9/17 to 16/17. Post-operative images showed an excellent spinal cord decompression, and no major or severe complications has occured . Conclusions/Level of Evidence : Basilar invagination with Klippel-Feil syndrome is relatively rare condition. Posterior approach and occipito-cervical fixation for BI treatment with navigation technique is a safe method to treat severe myelopaty with reducible odontoid. This novel navigation technique provides an excellent results for a patient with BI. Level V.

Critically ill patients treated in the intensive care unit (ICU) can present many abdominal conditions that need a prompt diagnosis and timely treatment because of their general frailty. Clinical evaluation and diagnostic tools like ultrasound or CT scan are not reliable or feasible in these patients. Bedside laparoscopy (BSL) is a minimally invasive procedure that allows surgeons to assess the abdominal cavity directly in the ICU, thus avoiding unnecessary exploratory laparotomy or incidence related to intra-hospital transfer. We conducted a review of the literature to summarize the state-of-the-art of BSL. Medline, The Cochrane Central Register of Controlled Trials (CENTRAL), and Scopus databases were utilized to identify all relevant publications. Indications, contraindications, technical aspects, and outcomes are discussed. The procedure is safe, feasible, and effective. When other diagnostic tools fail to diagnose or exclude an intra-abdominal condition in ICU patients, BSL should be preferred over exploratory laparotomy.

Our objective was to investigate the effects of topically applied neuropeptide Y (NPY) on ischemic wounds. Initially, the animal model for ischemic wound healing was validated using 16 male Sprague-Dawley albino rats. In the intervention study, an additional 28 rats were divided into three groups: NPY (0.025%), the positive control insulin-like growth factor-I (IGF-I, 0.0025%), and the hydrogel carrier alone (control). The hydrogel was selected due to its capacity to prolong NPY release (p &lt; 0.001), as demonstrated in a Franz diffusion cell. In the animals, an 8-mm full-thickness wound was made in a pedunculated dorsal ischemic skin flap. Wounds were then treated and assessed for 14 days, and procured at the end of the experiment for in situ hybridization analysis (RNAscope®) targeting NPY receptor Y2R and for meticulous histologic examination. Wound healing rates, i.e. the percentage wound area changes, did not show an increase with NPY (p = 0.938) but did with rhIGF-I (p = 0.039) compared to the control. Y2R mRNA was not detected in the wounds or adjacent skin but was identified in the rat brain (positive control). Light microscopic examination revealed trends of increased angiogenesis and enhanced inflammatory cell infiltration with NPY compared to control. An interesting secondary discovery was the presence of melanophages in the wounds. Our findings suggest the potential of NPY to enhance neovascularization under ischemic wound healing conditions, but further optimization of the carrier and dosage is necessary. The mechanism is elusive but likely involves NPY receptor subtypes other than Y2R.

Acute peritonitis is a severe complication of abdominal surgery with a high mortality rate. Intes-tinal insufficiency syndrome (IIS) is a key factor in the progression of peritonitis, contributing significantly to morbidity and mortality. The most characteristic and rapid manifestation of IIS is the development of intestinal paresis. Intestinal paresis is a condition characterized by inhibi-tion of intestinal motility, with the inability to evacuate intestinal contents. Intestinal paresis is caused by a cascade of neuroreflex and humoral reactions that lead to severe microcirculatory and metabolic disturbances. In the absence of adequate treatment, IIS can progress to enteritis, a state of complete intestinal insufficiency, with the inability to absorb nutrients and water.

Injuries to humans caused by wild animals, particularly bears, are rarely mentioned in the literature. The frequency of such injuries is high in Siberia, which is a territory surrounded by dense forests and is a habitat of brown bears. Only for the last 4 months (September - December) 4 episodes of bear attacks on humans were registered in Khakassia, Russia. We present a clinical case of rehabilitating a patient after a bear attack for multiple fragmentary fracture of the facial skeleton with displacement of bone fragments, subcutaneous emphysema of soft tissues of the face, parietal and right occipital regions, and paranasal sinus hemorrhage on the left side. The nature of the injury was enhanced by the trauma to the upper extremity, with which the patient defended himself against the animal. In addition to the damage to the face, the bear tried to open the cranium, which was evidenced by 4 furrows from the canines, 2 on the frontal and 2 on the occipital bones of the skull. The complex treatment of the patient included both maxillofacial and reconstructive surgery, and at the stage of outpatient treatment the formation of normotrophic scars with the help of neodymium laser and injections of heterogeneous composition consisting of micro-particles of "cross-linked" collagen of animal origin, placed in a gel identical to the natural extracellular matrix.

This is a retrospective chart review of outcomes of maxillofacial microvascular free flap reconstructions in pediatric and adolescent patients. A single head and neck surgical team performed all the included 136 procedures. Demographic and surgical patient data were recorded. Type of transfer performed in each recipient site and major complications were analyzed. Relevant influencing factors, such as age, gender and etiology of defect were determined using the ANOVA test and χ² test of independence. Results indicate a 90% success rate. No significant relation was found between the incidence of total flap loss and patient age, etiology or graft source. The maxillary reconstructions showed a higher incidence of total flap loss compared to mandibular ones (11 vs. 3 cases). Despite the high success rate, the findings underline the necessity for further research to validate these observations and enhance surgical methods for pediatric and adolescent patients.

Late type II endoleak (T2EL) arising from internal iliac artery (IIA) network may occur after endovascular aortic repair (EVAR) of aortoiliac aneurysm and may require embolization if sac enlargement is demonstrated. When direct antegrade access to ipsilateral IIA is not achievable due to previous vessel coverage and/or embolization, access to the nidus can be challenging. We report a case of T2EL originating from IIA network causing iliac sac enlargement in a patient previously treated by EVAR for artoiliac aneurysm with IIA embolization and coverage, in which embolization of the nidus was performed through a percutaneous sheathless access to ip-silateral superior gluteal artery (SGA). A literature review dealing with all cases of percutaneous direct SGA access for retrograde embolization of T2EL arising from IIA after previous EVAR is also reported. The research was conducted on Pubmed database using keywords “superior glu-teal artery access,” “transgluteal embolization” and “retrograde embolization for type II endo-leak”. Related articles and references were screened for suitable articles.

The relationship between tissue effects, intensity (I), and voltage (V) of a high-frequency alternative current seems well known. However, the translation of the settings of the electrosurgical unit and their use during surgery seems not to be unanimously understood by all surgeons. This results in many variations of surgical technique and plenty of specific questions asked during live surgery. Above 200 V, the heat of the sparks results in the explosion of superficial cells and a cutting effect. With higher voltages, the associated coagulation is increasing. Voltage and amount of energy (Watt=I*V) are independent since a similar amount of energy can be obtained with a continuous current or an intermittent current half the time and a double voltage. Below 200 V, tissue is heated until the steam from boiling tissue stops the current. Therefore, slower heating with less energy or a larger contact area permits deeper coagulation. The maximal output (W) of the electrosurgical unit results in versatility of use besides being a safety measure. The current intensity increases with the area of contact. Therefore, when I*V exceeds the preset output, V has to drop. A limited maximal output thus permits using the same instrument for non-contact cutting with >200V and sparks and coagulation when the contact area is much larger. In conclusion, the tissue effects of electrosurgery vary with the device’s voltage setting (often indicated as force) and the maximal output. The sur-geon’s choice to cut or coagulate by changing the contact area adds versatility.

Background: Skin substitutes play a crucial role in wound care by actively modulating the wound healing process, promoting angiogenesis, and protecting the integrity of the native extracellular matrix. Consequently, surgeons have increasingly recognized these resources as excellent complements to improve reconstructive outcomes. This review focuses on the author's experience using these biomaterials in complex cases, highlighting the benefits they bring to patient care. Methods: A literature review was conducted to evaluate the regenerative properties of skin substitutes and their applicability in head and neck, upper and lower extremities, and trunk reconstruction. Results: The reviewed literature, along with the authors' experience, supports the adjunct use of skin substitutes in various reconstructive situations. Combining them with skin grafts improves resulting skin quality and may also enhance donor site healing. They have proven effective in addressing chronic venous ulcers, traumatic wounds with limited donor tissues for coverage, extensive burns, diabetic foot ulcers, and oncologic resections in the face and scalp. Furthermore, combining them with autologous tissue shows promising results in achieving stable closure. Conclusions: Incorporating skin substitutes in complex reconstructive scenarios offers multiple benefits. Their regenerative properties and ability to modulate the healing process contribute to enhanced outcomes and reduced overall costs.

Actually wide excision is recommended after the primary excision of any cutaneous melanomas. The definition of the margins of wide excision indicated by the guidelines has remained unchanged over the years, although the reported indications derived from fairly dated studies, in which melanomas tend to be thicker or in advanced stages at diagnosis. These indications may no longer be current; especially in those patients affected by in situ or thin melanoma, exposing patients to a possible overtreatment. A retrospective observational study was conducted in patients who had undergone surgery for melanoma in a single institution. In a univariate model a melanoma-positive wide excision resulted related with a worst progression free survival (PFS); but this association was not confirmed in the multivariable model. Moreover, logistic model were applied to estimate the probability to find a metastasis after wide local excision (WLE) in relation to demographic data of patients and histologic information of the melanoma. Results testified that the Breslow thickness was the only factor associated with the increase of the risk to found metastases in the WLE area. The ROC curve testified that the optimum cut-off value to differentiate patients with respect those without a tumor-positive wide excision, was a Breslow thickness of 2.31mm in women, and 2.4mm in men.

Introduction: Soft tissue sarcomas (STS) are low-incidence tumors whose clinical and histopathological factors are associated with adverse oncological outcomes. This study evaluated prognostic factors (PF) associated with tumor recurrence and overall survival (OS) in patients diagnosed with STS of the extremities, treated at the Instituto Nacional de Cancerología (INC), Bogotá, Colombia. Materials and methods: An analytical observational study of a historical cohort was carried out, including patients diagnosed with STS and managed surgically in the Functional Unit for Breast and Soft Tissue Tumors of the INC from January 2008 to December 2018. Results: A total of 227 patients were included; 74.5% had tumors greater than 5 cm. Most patients (29.1%) were in stage IIIB at diagnosis. Age was associated with higher mortality (HR=1.01; CI95%: 1–1.02; p=0.048); tumor persistence at admission to the INC (HR=2.34; CI95%: 1.25–4.35; p=0.007), and histologic grade III (HR=5.36; CI95%: 2.29–12.56; p=<0.001) showed statistical significance in the multivariate analysis for recurrence of any type, as were the PFs associated with a higher risk of local recurrence (HR=2.85; CI95%: 1.23–6.57; p=0.014 and HR=6.09; CI95%: 2.03–18.2; p=0.001), respectively. Tumor size (HR=1.03; CI95%: 1–1.06; p=0.015) and histologic grade III (HR=4.53; CI95%: 1.42–14.49; p=0.011) were associated with a higher risk of distant recurrence. Conclusion: This cohort showed that in addition to histologic grade and tumor size, tumor persistence at the time of admission has an impact on disease recurrence, so STS should be managed by a multidisciplinary team with experience in this pathology in high-volume reference centers.

A perirectal abscess, while typically considered benign, has the potential to invade extraperitoneal spaces, including the space of Retzius, resulting in complications with severe systemic illness. It is postulated that there is communication within adipose tissue between the pararectal spaces and the vesical extraperitoneal space anteriorly, secondary to the termination of the umbilical-vesical fascia at the reflection of the vesical peritoneum. While occurrences of perirectal abscess ex-tending to the extraperitoneal space are infrequent, a thorough understanding of the anatomical structure, physiology, and the subsequent therapeutic approach remains crucial. For assessment, a computed tomography scan with intravenous contrast is preferred for evaluation, given the probable insidious and nonspecific nature of the clinical presentation, physical exam signs, and even laboratory studies. Primary therapeutic modalities involve immediate resuscitation, intra-venous administration of broad-spectrum antibiotics, and percutaneous drainage. Surgical in-tervention may become necessary in cases where there is no prompt improvement in septic progression. Additionally, the underlying comorbidities and baseline illness could be indicative of unfavorable outcomes. If fever or sepsis is not efficiently controlled, a more comprehensive workup or intervention should be contemplated, considering the associated higher risks of complications and mortality rates. In this study, we presented the case of a 68-year-old male with diffuse pain located in the lower abdomen. Fortunately, an immediate computed tomography scan played a pivotal role in iden-tifying a perirectal abscess with upward extension to the space of Retzius, which was subse-quently treated appropriately. Above all, this rare case presentation underscores the anatomic complexity within pelvic compartments and emphasizes the importance of maintaining high-index suspicions and analyzing overall differential diagnosis.

Artificial Intelligence (AI) made its first appearance in 1956, and since then it has progressively introduced itself in healthcare system and patients’ information and care. AI functions can be grouped under the following headings: Machine Learning (ML), Deep Learning (DL), Artificial Neural Network (ANN), Convolutional Neural Network (CNN), Computer Vision (CV). Chronic limb-threatening ischemia (CLTI) represents the last stage of peripheral artery disease (PAD), and has increased over recent years, together with the rise in prevalence of diabetes and population ageing. Nowadays AI grants the possibility of developing new diagnostic and treatment solutions in the vascular field, given the possibility of accessing clinical, biological, and imaging data. By assessing the vascular anatomy in every patient, as well as the burden of atherosclerosis, and classifying the level and degree of disease, sizing and planning the best endovascular treatment, defining the perioperative complications risk, integrating experiences and resources between different specialties, identifying latent PAD, thus offering evidence-based solutions and guiding surgeons in the choice of the best surgical technique, AI challenges the role of the physician’s experience in PAD treatment.

This review summarizes available data on invasive procedures applied with questionable indications in Russia in the recent past: mastectomy with the removal of muscles, gastrectomy for peptic ulcers, spleno-renal anastomosis for diabetes mellitus, thoracic surgery for bronchial asthma, overuse of surgery in tuberculosis, excessive and compulsory treatments of alcohol-dependent patients, etc. Among factors contributing to the use of invasive procedures with unproven efficiency have been the partial isolation from international scientific community, insufficient consideration of the principles of professional autonomy, informed consent and scientific polemics, training of medical personnel. It is known that invasive procedures can exert a placebo effect, which might have contributed to reported efficiency of some methods discussed here. However, by definition, placebo must be free of risks.

Cosmetic surgery is the subfield of plastic surgery that enhances appearance mainly for aesthetic reasons. Currently, cosmetic surgery interventions are highly considered appealing and popular all around the world. Several factors have contributed in this rapidly evolving field such as scientific and economic development, breaking down barriers and cultural norms, globalization, social media and mental disorders. Nowadays, the morality of cosmetic surgery is facing many dilemmas due to its benefits and drawbacks. It is proven that the advantages of cosmetic surgery include improved body confidence, mental health, and function. Additionally, aesthetic corrections can upscale the quality of life and create career opportunities for special targeted groups. Also, cosmetic surgery has a major impact in gender affirmation procedures. Although, herein we also describe the disadvantages of this widely developing field such as minor and major medical complications, potential postoperative risks and addiction in plastic surgeries associated with damaging economic issues. Lack in self-confidence, altered mental health status and ethical crisis consist another negative aspects of aesthetic surgery’s impact.

Objective: The aim of this study was to evaluate the clinical outcome of patients suffering from chronic limb threatening ischemia (CLTI) and tissue loss treated with primary isolated femoral bifurcation endarterectomy (FBE) or with FBE combined with bypass surgery. Methods: This retrospective study was performed in a tertiary university based care center. Between January 2008 and December 2019 a prospectively collected database of patients suffering from CLTI and tissue loss and undergoing either primary FBE (group A) or FBE in combination with bypass surgery (group B) was analysed. Study endpoints were ulcer healing, primary and secondary patency rate, limb salvage and survival. Results: In total, FBE was performed in 73 and FBE with bypass in 60 patients. Between both groups there were no significant differences regarding demographic data or the Global Limb Anatomic Staging System (GLASS) grade III and IV of femoropopliteal lesions. After 3 years, ulcer healing could be achieved in 72% of FBE and in 75% of FBE with bypass patients. The primary patency rate was 95% and 91% for FBE and 83% and 80% for FBE with bypass after one and three years, respectively. The 3-year limb salvage rate was 78% for FBE and 84% for FBE with bypass. The secondary patency rate after one and three years was 99% and 97% for FBE and 93% and 88% for FBE with bypass. Conclusion: FBE and FBE with bypass are equally effective for ulcer healing in cases of combined CFA and superficial femoral artery lesions. There was no significant difference between both groups regarding primary and secondary patency

Keywords: Rhinoplasty - Augmentation rhinoplasty - Open rhinoplasty - Facial rejuvenation – Centrofacial lipofilling.

Breast cancer has become the most diagnosed cancer in women globally with 2.3 million new diagnosis each year. Accurate early staging is essential for improving survival rates with metastatic spread from loco regional to distant metastasis decreasing rates by 50%. Current guidelines do not advice the routine use of Positron Emission Tomography (PET)-Computed Tomography (CT) in staging of early breast cancer in the absence of symptoms. However, there is a growing body of evidence to suggest that PET-CT used in this early stage can benefit the patient by improving staging and as a result treatment and outcome as well as psychological burden without increasing costs to the health service. Ongoing research in PET radiomics and artificial intelligence is showing promising future prospects in its use in diagnosis, staging, prognosticatication and assessing response to treatment in breast cancer. Furthermore ongoing research to address current limitations of PET-CT by improving techniques and tracers is encouraging.

Surgical site infections (SSI) occur very frequently during post-operatory procedures and are often treated with oral antibiotics, which may cause some side-effects. This type of infections could be avoided by encapsulating antimicrobial/anti-inflammatory drugs within the surgical suture materials so that these can more efficiently act on the site of action during wound closure, avoiding post-operatory bacterial infection and spreading. This work was aimed at developing novel electrospun biobased anti-infective fiber-based yarns as novel suture materials for preventing surgical site infections. For this, yarns based on flying intertwined nanofibers were fabricated in-situ during the electrospinning process using a specially designed yarn collector. The electrospun yarn sutures were made of poly(3-hydroxybutyrate-co-3-hydroxyvalerate) with different contents of 3HV units and contained ciprofloxacin hydrochloride (CPX) as the antimicrobial active pharmaceutical ingredient (API). The yarns were then analyzed by scanning electron microscopy, Fourier transform infrared spectroscopy, wide-angle X-ray scattering, differential scanning calorimetry and in vitro drug release. The yarns were also analyzed in terms of antimicrobial and mechanical properties. The material characterization indicated that the varying polymer molecular architecture affected the attained polymer crystallinity, which was correlated with the different drug-eluting profiles. Moreover, the materials exhibited the inherent stiff behavior of PHBV, which was further enhanced by the API. Lastly, all the yarn sutures presented antimicrobial properties for a time release of 5 days against both gram positive and gram-negative pathogenic bacteria. The results presented highlight the potential of the herein developed antimicrobial electrospun fiber yarns as potential innovative suture materials to prevent surgical infections.

Background Robotic-assisted thoracic surgery (RATS) has become the standard procedure for treating lung malignancy, offering numerous advantages over traditional methods. However, the minimally invasive nature of RATS presents unique challenges, notably a limited field of view and reduced tactile feedback for the surgeon. These limitations can significantly impact the surgeon's ability to navigate complex anatomical structures during surgery. To address these challenges, we recognized the need for enhanced preoperative familiarization with each patient’s specific anatomy. In response, we developed an innovative virtual reality (VR) surgical navigation system, utilizing head-mounted displays (HMDs), designed to provide surgeons with a more comprehensive and interactive understanding of the patient's anatomy before the actual surgery. This VR system aims to extend the surgeon's capabilities in both preoperative sumilation and intraoperative navigation, potentially mitigating the inherent limitations of RATS. Methods Three-dimensional (3D) volumized data, meticulously extracted from preoperative computed tomography (CT) scans, were seamlessly integrated into the Perspectus VR Education software. These data were then displayed on an HMD, facilitating an interactive 3D reconstruction of pulmonary structures. This reconstruction allowed for each structure to be visualized individually, enabling detailed preoperative resection simulations tailored to each patient's unique anatomy. During RATS, these specific 3D reconstructed images were made accessible within the surgeon's console through the TilePro™ multi-display input, providing real-time, intraoperative guidance. Results During the preoperative simulations, the 3D anatomic structure of the pulmonary vessels, as well as the spatial relationship between the lesion and adjacent tissues, were successfully visualized. This enhanced visualization enabled surgeons to thoroughly evaluate a patient's anatomy, significantly improving the safety and accuracy of the subsequent procedure. The integration of VR software with the HMD provided surgeons with a true 3D interaction with real patient data. This setup not only offered a unique perspective through the surgical console but also allowed for easy manipulation of the data on a mobile laptop, thereby enhancing the overall surgical planning process. Conclusions VR simulation using HMDs offers a viewing experience akin to that of a robotic 3D viewer, potentially providing an innovative avenue for surgeons to develop specific robotic surgical skills without the need for practicing on live patients. This technology, when integrated with routine imaging modalities, can significantly enhance preoperative planning. Such integration not only contributes to the safety but also improves the accuracy of anatomical resections. Our findings suggest that VR simulation with HMDs is particularly effective in assisting surgeons to accurately identify lesion locations in RATS, thereby optimizing surgical outcomes.