Surgical Innovation最新文献

{"title":"Revolutionizing Surgical Preparedness: Personalized Preoperative Planning with Digital Twins of an Organ.","authors":"Abdullah Sohail, Mariyah Zainab Irfan, Areeba Shaikh","doi":"10.1177/15533506251317719","DOIUrl":"https://doi.org/10.1177/15533506251317719","url":null,"abstract":"","PeriodicalId":22095,"journal":{"name":"Surgical Innovation","volume":" ","pages":"15533506251317719"},"PeriodicalIF":1.2,"publicationDate":"2025-01-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143067582","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Learning Curve for Robotic Inguinal Hernia Repair With da Vinci Single-Port Robotic System.","authors":"Francesco Celotto, Niccolò Ramacciotti, Giacomo Danieli, Federico Pinto, Gaya Spolverato, Luca Morelli, Francesco Maria Bianco","doi":"10.1177/15533506251314605","DOIUrl":"https://doi.org/10.1177/15533506251314605","url":null,"abstract":"<p><strong>Background: </strong>Transabdominal pre-peritoneal inguinal hernia repair using the da Vinci Single-Port robot (SP-TAPP) is currently performed in few centers. We aimed to define the learning curve for SP-TAPP by analyzing operative times.</p><p><strong>Methods: </strong>The operative times of 122 SP-TAPP performed between 2019 and 2024 were retrospectively analyzed. The following phases were analyzed: docking time (DT); pre-robot time (PRT, from skin incision to side cart placement); flap closure time (FCT); console time (CT), and overall time (OT). Cumulative sum analysis (CUSUM) was used to analyze learning curves. Surgical and 30-day outcome were analyzed.</p><p><strong>Results: </strong>The DT has remained constant over time (<i>P</i> > 0.9). PRT was divided into 3 phases with n1 = 5, n2 = 95 and n3 = 4, in which there was a progressive decrease in time (14.8 vs 11.9 vs 6.8 min; <i>P</i> = 0.08). In FCT and CT, 3 phases were identified in which times remained stable (<i>P</i> > 0.9 and <i>P</i> = 0.7). CUSUM analysis of OT identified 3 phases consisting of n1 = 13, n2 = 100 and n3 = 9 in which there was a progressive decrease in times (82 vs 72 vs 62 min; <i>P</i> = 0.3). Analysis of complications and early surgical outcomes did not differ except for estimated blood loss, although this was a clinically insignificant finding.</p><p><strong>Conclusions: </strong>The learning curve for SP-TAPP is rapid and it shows how the technical skills are transferable between the multiport platform and the da Vinci Single Port robotic system for an experienced surgeon. An improvement is evident in PRT and OT, also compared to multiport systems, showing a potential for the platform to increase surgical activity.</p>","PeriodicalId":22095,"journal":{"name":"Surgical Innovation","volume":" ","pages":"15533506251314605"},"PeriodicalIF":1.2,"publicationDate":"2025-01-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143047952","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Apple Vision Pro-guided Laparoscopic Radio Frequency Ablation for Liver Tumors: The Pioneer Experience.","authors":"Yu-Chieh Tsai, Chin-Cheng Hsiao, Charles Chung-Wei Lin, Ming-Chih Chern, Shih-Wei Huang","doi":"10.1177/15533506251316001","DOIUrl":"https://doi.org/10.1177/15533506251316001","url":null,"abstract":"<p><p><b>Background:</b> This study evaluates the feasibility of Apple Vision Pro goggles as an augmented reality (AR) surgical navigation tool for laparoscopic-assisted ultrasound-guided radiofrequency ablation (RFA) of liver tumors. Traditional RFA is effective but challenging due to the integration of multiple imaging modalities.<b>Purpose:</b> The primary aim of this research is to assess how Vision Pro goggles can enhance the surgical navigation process during RFA, improving tumor localization and the overall effectiveness of the procedure.<b>Research Design:</b> A feasibility study design was used to analyze the implementation of AR technologies in surgical navigation, focusing specifically on their application in laparoscopic surgeries.<b>Study Sample:</b> Participants included patients undergoing laparoscopic-assisted ultrasound-guided RFA, with pre-operative imaging workups involving CT and MRI scans followed by intraoperative laparoscopic sonography.<b>Data Collection and/or Analysis:</b> Data were collected through observations during surgical procedures using the Vision Pro goggles, which displayed various imaging inputs (MRI, 3D reconstruction, and laparoscopic sonography) in the surgeon's field of view. Image manipulation was assessed based on accuracy and effectiveness of tumor ablation.<b>Results:</b> The goggles enhanced tumor localization accuracy and facilitated real-time image manipulation, resulting in effective tumor ablation. Initial results show promising outcomes in the precision and efficiency of the RFA procedure.<b>Conclusions:</b> While the initial results are promising, larger studies are necessary to validate the technology's efficacy and safety. Future research should compare outcomes with traditional methods and explore its applicability to other surgeries, aiming to refine the system further. The Vision Pro goggles potentially represent a significant advancement in surgical technology by improving RFA precision and efficiency.</p>","PeriodicalId":22095,"journal":{"name":"Surgical Innovation","volume":" ","pages":"15533506251316001"},"PeriodicalIF":1.2,"publicationDate":"2025-01-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143034208","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Near-Infrared Fluorescence-Guided Segmentectomy: Added Benefit of Indocyanine Green Dye Diminishes With Surgeon Experience.","authors":"Yogita S Patel, Forough Farrokhyar, Marko Simunovic, Waël C Hanna","doi":"10.1177/15533506251315979","DOIUrl":"https://doi.org/10.1177/15533506251315979","url":null,"abstract":"<p><strong>Background: </strong>Near-infrared fluorescence (NIF)-mapping with indocyanine green dye (ICG) facilitates the identification of the intersegmental plane during minimally invasive segmentectomy. Our pilot study showed that ICG is associated with an increase in oncological margin distance from the tumour, greater than the surgeon's best judgment. We hypothesized that, with greater experience, the surgeon's judgement will improve, and the benefit of ICG will diminish.</p><p><strong>Methods: </strong>This is a phase 2 single-arm trial of patients undergoing robotic-assisted segmentectomy for NSCLC tumours less than 3 cm. After isolating the diseased segment(s), the predicted intersegmental plane (Dp) was identified by the thoracic surgeon. After intravenous ICG injection, the true intersegmental plane (Dt) was revealed using NIF. The primary outcome was the average distance between Dt and Dp (Dt-Dp). Comparisons were performed across 3 temporal tertiles: tertile 1 (t1) comprised of the first 30 participants, and the remaining participants were divided equally for tertiles 2 (t2) and 3 (t3). Kruskal-Wallis test was used to compare differences between tertiles (α = 0.05).</p><p><strong>Results: </strong>A total of 190 patients were enrolled from October 2016 to June 2021. The median age was 68 (interquartile range:62-72), and 57.37%(109/190) were women. ICG injection occurred in 60.53%(115/190) of the participants, and intersegmental plane visualization was achieved in 88.70%(102/115). Dt-Dp diminished significantly across tertiles: t1 = 20.65 ± 15.82 mm, t2 = 2.42 ± 15.49 mm, and t3 = 1.36 ± 9.87 mm (<i>P</i> = 0.0001). Locally estimated scatterplot smoothing revealed that this distance approaches zero as the surgeon performs more cases.</p><p><strong>Conclusion: </strong>In our single-surgeon experience with robotic-assisted segmentectomy for NSCLC, the added value of NIF-mapping with ICG diminishes with surgeon experience.</p>","PeriodicalId":22095,"journal":{"name":"Surgical Innovation","volume":" ","pages":"15533506251315979"},"PeriodicalIF":1.2,"publicationDate":"2025-01-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143024884","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Advancing Emergency Department Triage Prediction With Machine Learning to Optimize Triage for Abdominal Pain Surgery Patients.","authors":"Chen Chai, Shu-Zhen Peng, Rui Zhang, Cheng-Wei Li, Yan Zhao","doi":"10.1177/15533506241273449","DOIUrl":"10.1177/15533506241273449","url":null,"abstract":"<p><strong>Background: </strong>The development of emergency department (ED) triage systems remains challenging in accurately differentiating patients with acute abdominal pain (AAP) who are critical and urgent for surgery due to subjectivity and limitations. We use machine learning models to predict emergency surgical abdominal pain patients in triage, and then compare their performance with conventional Logistic regression models.</p><p><strong>Methods: </strong>Using 38 214 patients presenting with acute abdominal pain at Zhongnan Hospital of Wuhan University between March 1, 2014, and March 1, 2022, we identified all adult patients (aged ≥18 years). We utilized routinely available triage data in electronic medical records as predictors, including structured data (eg, triage vital signs, gender, and age) and unstructured data (chief complaints and physical examinations in free-text format). The primary outcome measure was whether emergency surgery was performed. The dataset was randomly sampled, with 80% assigned to the training set and 20% to the test set. We developed 5 machine learning models: Light Gradient Boosting Machine (Light GBM), eXtreme Gradient Boosting (XGBoost), Deep Neural Network (DNN), and Random Forest (RF). Logistic regression (LR) served as the reference model. Model performance was calculated for each model, including the area under the receiver-work characteristic curve (AUC) and net benefit (decision curve), as well as the confusion matrix.</p><p><strong>Results: </strong>Of all the 38 214 acute abdominal pain patients, 4208 underwent emergency abdominal surgery while 34 006 received non-surgical treatment. In the surgery outcome prediction, all 4 machine learning models outperformed the reference model (eg, AUC, 0.899 [95%CI 0.891-0.903] in the Light GBM vs. 0.885 [95%CI 0.876-0.891] in the reference model), Similarly, most machine learning models exhibited significant improvements in net reclassification compared to the reference model (eg, NRIs of 0.0812[95%CI, 0.055-0.1105] in the XGBoost), with the exception of the RF model. Decision curve analysis shows that across the entire range of thresholds, the net benefits of the XGBoost and the Light GBM models were higher than the reference model. In particular, the Light GBM model performed well in predicting the need for emergency abdominal surgery with higher sensitivity, specificity, and accuracy.</p><p><strong>Conclusions: </strong>Machine learning models have demonstrated superior performance in predicting emergency abdominal pain surgery compared to traditional models. Modern machine learning improves clinical triage decisions and ensures that critically needy patients receive priority for emergency resources and timely, effective treatment.</p>","PeriodicalId":22095,"journal":{"name":"Surgical Innovation","volume":" ","pages":"583-597"},"PeriodicalIF":1.2,"publicationDate":"2024-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141988970","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Three-Dimensional Holographic-Guided Robotic Lung Segmentectomy for Deep Pulmonary Nodules: Technique and Initial Results.","authors":"Patrick Bagan, Kaouther Aissa, Rime Essid, Wissam Azbabay, Rym Zaimi, Bassel Dakhil","doi":"10.1177/15533506241290069","DOIUrl":"10.1177/15533506241290069","url":null,"abstract":"<p><p><b>Background:</b> Diagnosis and treatment of <i>small and isolated lung</i> nodules remain challenging issues. <b>Purpose:</b> The aim of this article is to report the technique of real-time navigation using holographic reconstruction technology combined with a robot assisted thoracic surgery (RATS) platform for lung resection in patients with <i>small deep nodules</i>.<b>Research Design:</b> The pre-surgery 3D planning was based on the chest CT scan. The reconstruction was uploaded to a head-mounted display for real-time navigation during mini invasive robot assisted surgery performed with an open console platform. We evaluated this technique with the success rate of diagnosis, the operative time and the post-operative course.<b>Study Sample:</b> This technique was performed in 6 patients (4 female, mean age 65 years) to date.<b>Results:</b> The precision of the head-mounted display based localization system was effective in all cases without the need of open conversion. The mean diameter of the nodules was 8 mm (6-9). The diagnosis was a lung cancer (n = 5) and tuberculoma (n = 1). The mean operative time was 125 min (100-145). The mean hospital stay was 2.5 days (1-3).<b>Conclusions:</b> In conclusion, the intraoperative navigation using the 3D holographic assistance was an helpful tool for mini invasive RATS lung segmentectomy without the need of preoperative localization.</p>","PeriodicalId":22095,"journal":{"name":"Surgical Innovation","volume":" ","pages":"618-621"},"PeriodicalIF":1.2,"publicationDate":"2024-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142372915","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Role of Qualitative and Quantitative Indocyanine Green Angiography to Assess Mastectomy Skin Flaps Perfusion: A Prospective Monocentric Experience.","authors":"Manuela Mastronardi, Stefano Fracon, Serena Scomersi, Margherita Fezzi, Zaira Pellin, Marina Bortul","doi":"10.1177/15533506241273383","DOIUrl":"10.1177/15533506241273383","url":null,"abstract":"<p><strong>Introduction: </strong>Mastectomy skin flap (MSF) necrosis remains a significant complication in breast reconstruction. This study aims to identify a correlation between the qualitative and quantitative analysis of the MSF perfusion grade and the skin necrosis rate 1 month after surgery using indocyanine green angiography (ICGA), focusing on lag time and perfusion metrics.</p><p><strong>Methods: </strong>Consecutive women scheduled for nipple/skin-sparing/skin-reducing mastectomy between May 2020 and October 2022 were prospectively enrolled. Patients were divided into Group 1 in the absence of superficial and full-thickness necrosis (SN; FTN) and Group 2 in the presence of both. Demographic data, lag time T1 (time between ICG injection and the initial perfusion of the least perfused MSF area), ICG-Q1, and ICG-Q% (absolute and relative perfusion values of the least vascularized area) were collected.</p><p><strong>Results: </strong>76 breasts were considered. FTN was reported in 8 breasts (10.5%) and SN in 4 (5.2%). The 2 groups statistically differ in T1 (Group2 > Group1), ICG-Q1, and ICG-Q% (Group1 > Group2) (<i>P</i> < 0.05). T1 longer than 170 seconds, body mass index, previous chemo/radiotherapy, arterial hypertension, breast weight, type of surgery, and ICG quantitative values can help in predicting MSF necrosis.</p><p><strong>Conclusions: </strong>MSF qualitative and quantitative perfusion evaluation can be helpful to prevent MSF necrosis. However, it should be considered together with the patient's characteristics, the type of surgery, and T1. In this way, it is possible to predict the risk of MSF necrosis and plan the best reconstructive strategy.</p>","PeriodicalId":22095,"journal":{"name":"Surgical Innovation","volume":" ","pages":"605-617"},"PeriodicalIF":1.2,"publicationDate":"2024-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141898297","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Who Says You can't go FAST at Night? Use of a Novel Ultrasound-Capable Night Vision Device for Prehospital Medical Personnel to Identify Noncompressible Truncal Hemorrhage.","authors":"James Williams, Daniel T Lammers, Andrew D Francis, Beau J Prey, Luke I Pumiglia, Matthew J Eckert, Yang Liu, Jason R Bingham, John M McClellan","doi":"10.1177/15533506241275288","DOIUrl":"10.1177/15533506241275288","url":null,"abstract":"<p><strong>Background: </strong>Early detection of abdominal hemorrhage via ultrasound has life-saving implications for military and civilian trauma. However, strict adherence to light discipline may prohibit the use of ultrasound devices in the deployed setting. Additionally, current night vision devices remain noncompatible with ultrasound technology. This study sought to assess an innovative night vision device with ultrasound capable picture-in-picture display via a intraabdominal hemorrhage model to identify noncompressible truncal hemorrhage in blackout conditions.</p><p><strong>Methods: </strong>8 post mortem fetal porcine specimens were used and divided into 2 groups: intrabdominal hemorrhage (n = 4) vs no hemorrhage (n = 4). Intrabdominal hemorrhage was modeled via direct injection of 200 mL of normal saline into the peritoneal cavity. Under blackout conditions, 5 participants performed a focused assessment with sonography for trauma (FAST) exam on each model using the prototype ultrasound-capable night vision device.</p><p><strong>Results: </strong>Of the 40 FAST exams performed, 95% (N = 38) resulted in the correct identification of intraabdominal hemorrhage. Of the incorrectly identified exams, both were false positives resulting in a 100% sensitivity, 90% specificity, 91% positive predictive value, and a 100% negative predictive value. All participants noted the novel device was easy to use and provided superior visualization for performing FAST exams under blackout conditions.</p><p><strong>Conclusion: </strong>The ultrasound-enabled night vision prototype demonstrated promising results in identifying noncompressible truncal hemorrhage while maintaining strict light discipline in blackout conditions. Further research efforts should be directed at assessing the ability of providers to perform procedures in blackout conditions using the ultrasound-enabled prototype night vision device.</p>","PeriodicalId":22095,"journal":{"name":"Surgical Innovation","volume":" ","pages":"577-582"},"PeriodicalIF":1.2,"publicationDate":"2024-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141996539","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Letter re: Knotless Closure of the Cardiac Arterial Canulation Site Using Barbed Suture.","authors":"Filip W N Haenen","doi":"10.1177/15533506241285233","DOIUrl":"10.1177/15533506241285233","url":null,"abstract":"","PeriodicalId":22095,"journal":{"name":"Surgical Innovation","volume":" ","pages":"672-677"},"PeriodicalIF":1.2,"publicationDate":"2024-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142354231","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Oxygen Saturation Endoscopic Imaging as a Novel Alternative to Assess Tissue Perfusion During Esophagectomy.","authors":"Mohammad Alomari, Ishaq Wadiwala, Steven Bowers, Enrique F Elli, Mathew Thomas","doi":"10.1177/15533506241290071","DOIUrl":"10.1177/15533506241290071","url":null,"abstract":"<p><strong>Background: </strong>Assessment of gastric conduit perfusion during esophagectomy is crucial to determine its viability and identify the optimal site for anastomosis. Indocyanine green (ICG) fluorescence imaging is commonly used for this purpose, but it is contraindicated in patients with hypersensitivity to ICG, iodine, or shellfish. Oxygen saturation endoscopic imaging (OXEI) is a newer, non-pharmacologic technique for assessing perfusion. We report our experience with OXEI in 3 esophagectomy patients who had contraindications to ICG.</p><p><strong>Methods: </strong>All 3 patients underwent robot-assisted esophagectomies. None of the conduits had ischemic areas identified by white light. Using a 5 mm laparoscopic specialized camera (ELUXEO Vision, FUJIFILM Healthcare Americas Corp., USA), OXEI was deployed for intracorporeal assessment of gastric conduit perfusion after pull-up into the chest. Postoperative outcomes including anastomotic leaks and complications were recorded.</p><p><strong>Results: </strong>In two patients, OXEI revealed ischemic zones, which were resected to ensure optimal conduit viability. In the remaining patient, OXEI indicated robust vascularity throughout the conduit. All three patients experienced uneventful postoperative courses and were discharged within 10 days. There were no instances of anastomotic leaks or other major complications.</p><p><strong>Conclusion: </strong>In our experience, OXEI is a viable method for intraoperative assessment of gastric conduit perfusion in patients with contraindications to ICG. Prospective studies are needed to validate its efficacy in preventing anastomotic complications and to compare it with other methods of perfusion assessment including gross visual and ICG dye in a larger patient population.</p>","PeriodicalId":22095,"journal":{"name":"Surgical Innovation","volume":" ","pages":"622-626"},"PeriodicalIF":1.2,"publicationDate":"2024-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142366602","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}