Surgical technology international最新文献

{"title":"Direct Anterior Total Hip Arthroplasty with VELYS™ Hip Navigation.","authors":"Sean E Slaven, Alexander V Strait, William G Hamilton","doi":"10.52198/24.STI.44.OS1787","DOIUrl":"10.52198/24.STI.44.OS1787","url":null,"abstract":"<p><p>We describe the technique of total hip arthroplasty via a direct anterior approach using the Depuy Synthes (Raynham, MA) VELYS™ Hip Navigation system This technique allows one to accurately set the acetabular component position as well as recreate leg length and offset to meet the goals of hip reconstruction in a precise and efficient manner.</p>","PeriodicalId":22194,"journal":{"name":"Surgical technology international","volume":null,"pages":null},"PeriodicalIF":0.8,"publicationDate":"2024-07-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141992390","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Risk Factors for Microscopic Disease Positivity at Ileocolic Resection Margins for Crohn's Disease.","authors":"Adam Truong, Jino Chough, Karen N Zaghiyan, Phillip R Fleshner","doi":"10.52198/24.STI.44.GS1764","DOIUrl":"10.52198/24.STI.44.GS1764","url":null,"abstract":"<p><strong>Introduction: </strong>Interest in microscopic margin positivity during surgical resection of medical-refractory Crohn's disease has been renewed with multiple recent studies showing an association between microscopic margin positivity with disease recurrence. Our aim was to determine risk factors for microscopic margin disease positivity following ileocolic resection (ICR).</p><p><strong>Materials and methods: </strong>A prospectively-maintained database of patients with Crohn's disease undergoing ICR at a tertiary-referral center was queried. Margin positivity was defined as the presence of cryptitis, erosion, transmural inflammation with lymphoid aggregates, or architectural distortion at either ileal (proximal) or colonic (distal) margins.</p><p><strong>Results: </strong>Amongst 584 patients, 97 patients had a positive microscopic margin (17%) of which 46% had a positive proximal margin, 17% had a positive distal margin, and 13% had both positive and distal margins. Using multivariable logistic regression analysis, index ICR was associated with less odds of positive margin (odds ratio [OR] 0.46, 95% confidence interval [CI] 0.24-0.89, p=0.02), and granuloma presence was associated with increased odds (OR 2.26, 95% CI 1.23-4.21, p=0.01).</p><p><strong>Conclusion: </strong>We found that repeat ileocolic resection and granuloma presence were predictors of microscopic margin disease.</p>","PeriodicalId":22194,"journal":{"name":"Surgical technology international","volume":null,"pages":null},"PeriodicalIF":0.8,"publicationDate":"2024-07-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140120678","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Vertical Mesh-Mediated Fascial Traction and Negative Pressure Wound Therapy: A Case Series of Nine Patients in General and Vascular Surgery.","authors":"Thomas Mones, Vasilena Chobanova, Thomas Halama, Thomas Nowroth, Martin Pronadl","doi":"10.52198/24.STI.44.HR1781","DOIUrl":"10.52198/24.STI.44.HR1781","url":null,"abstract":"<p><p>Open abdomen (OA) is a well-established procedure for life-threatening illnesses such as septic peritonitis, abdominal compartment syndrome (ACS), and damage control surgery (DCS). Furthermore, in cases of life-saving aortic repair after perforation of abdominal aortic aneurysm, an OA is sometimes indicated. Definitive fascial closure (DFC) is one of the main goals during treatment to prevent further complications such as fistula formation and the development of an incisional hernia. In 2019, a new technique was introduced for OA using a device called fasciotens®Abdomen to apply dynamic traction to the abdominal wall through vertical mesh-mediated fascial traction (VMMFT). We present a case series including nine patients and show an algorithm for OA combining VMMFT and negative pressure wound therapy (NPWT).</p><p><strong>Methods: </strong>Two patients in a vascular surgery unit and seven patients in an abdominal surgery unit with an OA were treated with VMMFT in combination with NPWT between September 2019 and June 2023.</p><p><strong>Results: </strong>A DFC was achieved in seven of nine cases. The mean duration of OA was 9.6 ± 3.8 days, and fascial dehiscence at the beginning of OA was 14.2 ± 4.0 cm on average. Time to DFC after VMMFT was established was 6.2 ± 3.5 days (mean). No method-related complications occurred.</p><p><strong>Conclusion: </strong>The standardized combination of VMMFT and NPWT gave positive results in achieving DFC in our heterogenic patient group. Following a strict treatment pathway as shown here seems to improve OA outcome. It represents a promising further development of mesh-mediated fascial traction for OA treatment.</p>","PeriodicalId":22194,"journal":{"name":"Surgical technology international","volume":null,"pages":null},"PeriodicalIF":0.8,"publicationDate":"2024-07-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140861827","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"The Learning Curve From Converting From Fluoroscopic to Robotic-Assisted Direct Anterior Total Hip Arthroplasty.","authors":"Michael A Masini, Kara L Sawaya, Amy Harshberger, Daniel Hameed, Michael A Mont","doi":"10.52198/24.STI.44.OS1772","DOIUrl":"10.52198/24.STI.44.OS1772","url":null,"abstract":"<p><strong>Introduction: </strong>Robotic-assisted total hip arthroplasty (RA-THA) provides an alternative to fluoroscopic guidance, thus reducing radiation exposure for orthopaedic surgeons. This study was performed to assess the learning curve associated with the adoption of RA-THA using the direct anterior approach (DAA) with regard to surgical time, use of fluoroscopy, and implant placement. In addition, we compared complication rates and patient-reported outcome scores between both cohorts. A case report of an RA-THA is also presented.</p><p><strong>Materials and methods: </strong>This was a retrospective, non-randomized evaluation of the learning curve by assessing surgical time on a consecutive series of 89 DAA cases performed by a single surgeon. There were 53 cases that had manual THA with fluoroscopy and 36 cases with RA-THA. All cases had an acetabular component placement target of 40° inclination and 20° anteversion. An independent reviewer blinded to surgical technique used the Widmer method to measure acetabular inclination and version. Patient demographics were similar for both groups.</p><p><strong>Results: </strong>The mean surgical time for the manual fluoroscopic group was 88 ± 21 minutes and 101 ± 14 minutes for the RA-THA group. After 15 RA-THA cases, surgical time reached time neutral compared to the manual fluoroscopic group. The first 17 RA-THA cases utilized fluoroscopy to verify implant position until the surgeon became comfortable with the accuracy of the RA-THA system. After case 17, fluoroscopy was abandoned in all subsequent RA-THA cases. The mean radiation dose delivered to the surgical field was 5.61 ± 5.71 mGy. Manual THA with fluoroscopy resulted in a mean acetabular inclination of 41.3 ± 4.4° and a mean anteversion of 22.4 ± 3.0°. The RA-THA resulted in a mean acetabular inclination of 42.0 ± 4.2° and a mean anteversion of 22.3 ± 3.9°. There was no noted change in RA-THA placement accuracy after case 17, when fluoroscopy was eliminated from the surgical workflow. There were no statistical differences between the manual fluoroscopic and robotic-assisted groups with respect to complications and clinical PROM outcomes.</p><p><strong>Conclusion: </strong>The DAA THA can be performed with RA-THA and achieve comparable acetabular placement without fluoroscopy. Surgical time was higher for the RA-THA group during the learning curve, but then decreased and was consistent with the manual fluoroscopic group after 15 cases.</p>","PeriodicalId":22194,"journal":{"name":"Surgical technology international","volume":null,"pages":null},"PeriodicalIF":0.8,"publicationDate":"2024-07-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140866575","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"The Mitris RESILIA Valve: New Skin for a Proven Design.","authors":"Giulia Ciccarelli, Luca Weltert, Raffaele Scaffa, Andrea Salica, Alessandro Bellisario, Alessandro Ricci, Salvatore D'Aleo, Samuel Fusca, Lorenzo Guerrieri Wolf, Giulio Folino, Gino Gerosa, Ruggero De Paulis","doi":"10.52198/24.STI.44.CV1792","DOIUrl":"10.52198/24.STI.44.CV1792","url":null,"abstract":"<p><p>By incorporating the best features of the Carpentier-Edwards PERIMOUNT Magna Mitral Ease valve (Edwards Lifesciences Corporation, Irvine, California) and INSPIRIS RESILIA tissue (Edwards Lifesciences Corporation, Irvine, California), the mitris valve inherits the advantages of the remarkable hemodynamic performance of the former and the durability of the latter. In this paper, we will summarize the process that led to the creation of this new valve and report on the first implant's feasibility and first impression. The mitris valve has an overall implantability profile, overlapping the previous generation with no added challenges, but compared to the PERIMOUNT Magna Mitral Ease valve, the mitris valve boasts a more pliable saddle-shaped sewing cuff that is specifically tailored to fit the complex structure of the mitral valve with a lower stent height. This could be particularly beneficial in the context of double-valve replacement, as it may prevent any disturbance to the bioprosthesis located in the aortic position in small annulus. This could also prevent some rare but unpleasant complications such as left ventricle outflow obstruction or rupture of the atrioventricular sulcus. In addition, it could allow for better adherence to the saddle-shaped annulus of the mitral valve with the possibility of less stress (and therefore fibrosis) on the valve tissue, while further reducing the degeneration time. Furthermore, thanks to the possibility of being temporarily adjusted inwards, it is possible to ensure greater implantability compared to the previous generation of Magna Edwards mitral valves. Thanks to INSPIRIS technology, which prevents the generation of free aldehydes that promote oxidation and calcification of pericardial tissue, it is possible to assume that the durability will probably also improve. This reinforces the trustworthiness of the mitris valve.</p>","PeriodicalId":22194,"journal":{"name":"Surgical technology international","volume":null,"pages":null},"PeriodicalIF":0.8,"publicationDate":"2024-07-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142126714","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"The Evolution of Transvaginal Robot-Assisted Surgery in Gynecology.","authors":"Xiaoming Guan, Daniel Y Lovell, Robert Zurawin","doi":"10.52198/24.STI.44.GY1786","DOIUrl":"10.52198/24.STI.44.GY1786","url":null,"abstract":"<p><p>Laparoscopy has advanced over the last three decades with residency training programs focusing on trans-abdominal laparoscopic techniques whether conventional or robotic. Despite attempts over many years to adopt vaginal surgery as the preferred method of hysterectomy, traditional vaginal surgery has largely fallen out of favor. Vaginal natural orifice transluminal endoscopic surgery (vNOTES) has gained popularity with patients and promises to provide an attractive option, but the surgical skills of many gynecologists have limited its widespread adoption. We explore the use of robot-assisted vNOTES (RA-vNOTES), which offers improved ergonomics, visualization, and wristed instruments for more precise surgery. Robotic vNOTES, was originally performed in Taiwan by Dr. Chyi-Long Lee in 2014.1 Our center has used the robotic vaginal approach for hysterectomy, myomectomy, sacrocolpopexy, adnexal surgery, endometriosis excision, and more. We have also shown feasibility in performing surgery on patients with a completely obliterated posterior cul-de-sac, long been thought to be a contraindication for the transvaginal approach. Enhancements have been made to improve safety and efficiency, such as the use of indocyanine green to visualize the ureters. There are some limitations on instrument maneuverability and reach with the current da Vinci® Xi (Intuitive Surgical, Sunnyvale, California) platform. However, with over 300 cases logged in our center, these limitations may be overcome with the new da Vinci® SP (Intuitive Surgical, Sunnyvale, California). We are eager to share our experience and hope that more gynecologic surgeons will choose this innovative approach for the benefit of our patients.</p>","PeriodicalId":22194,"journal":{"name":"Surgical technology international","volume":null,"pages":null},"PeriodicalIF":0.8,"publicationDate":"2024-07-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141082519","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Diabetic Foot Ulcers: A Review of Debridement Techniques.","authors":"B. Sa, Narges Maskan Bermudez, Stephanie V Shimon, Robert S. Kirsner","doi":"10.52198/23.sti.43.wh1718","DOIUrl":"https://doi.org/10.52198/23.sti.43.wh1718","url":null,"abstract":"Diabetic foot ulcers (DFUs) are a prevalent complication of diabetes mellitus (DM) and lead to significant morbidity and mortality. Patients with DM have a lifetime risk of DFUs as high as 34%. The pathogenesis of DFUs is multifactorial, and the most common underlying causes are poor glycemic control, peripheral neuropathy, peripheral vascular disease, foot deformity, and poor foot care. Diabetic lower-extremity complications are also a significant burden in terms of healthcare costs. In the United States alone, the direct cost of diabetic foot care has been estimated to be $8,659 per patient, with total annual medical costs for managing diabetic foot disease ranging from $9 to $13 billion. Given the risk of amputation and poor wound healing, the fast, accurate diagnosis and treatment of DFUs are critical. Measures to prevent DFUs include glycemic control and annual foot inspections. For patients with DFUs, off-loading and local wound care are critical for wound healing. Debridement is the standard of care for DFU wounds, and several techniques exist. In this review, we discuss the current practices of diabetic wound care, different methods of debridement and their practical use in DFUs, and novel debridement approaches with the potential for improving wound-healing outcomes.","PeriodicalId":22194,"journal":{"name":"Surgical technology international","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2024-02-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140456485","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Adipose Tissue Stem Cells for Knee Arthritis and Cartilage Lesions: A Three-Year Follow Up.","authors":"Dimitrios Tsoukas, Christos Simos, Vasilliki Kalodimou","doi":"10.52198/23.STI.43.OS1742","DOIUrl":"10.52198/23.STI.43.OS1742","url":null,"abstract":"&lt;p&gt;&lt;strong&gt;Introduction: &lt;/strong&gt;The purpose of this research article is to evaluate the efficacy and the safety of injections of stromal vascular fraction (SVF), obtained with mini-lipoaspiration of fat tissue for knee osteoarthritis and cartilage lesions.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Materials and methods: &lt;/strong&gt;Between January 2018 and February 2021, a total of 76 patients (45 females and 31 males, mean age 64 years; range 53-75 years, body mass index [BMI] no more than 30%, with symptomatic primary osteoarthritis of the knee, without previous arthroscopic intervention) underwent a local tumescent lipoaspiration procedure of 60-80cc of fat tissue from the abdomen. SVF was obtained after centrifugation according to the AdiPrep® Adipose Transfer System (Harvest-Terumo, Plymouth, Massachusetts) technique. The final product was checked with flow cytometry for absolute numbers, vitality, and the cluster of differentiation (CD) population. It was injected intraarticularly into the patients knees. Patients were divided in two groups: Group 1 had patients with knee osteoarthritis Kellgren-Lawrence grade early 4 and Group 2 with osteoarthritis K-L grade 2-3. The International Knee Documentation Committee (IKCD) and Knee injury and Osteoarthritis Outcome Score (KOOS) questionnaires were used to evaluate clinical effects and measure patient's subjective assessment of pain, joint mobility, and physical disability before the injections. They were repeated at six months, one year, two years, and three years post injections. Knee cartilage lesions patients were divided in two subgroups: Group A (11 patients with OA K-L grade 2-3 and Outerbridge cartilage lesions grade 2-3) and Group B (7 patients with OA K-L grade early 4 and cartilage lesions Outerbridge grade late 3 to early 4) were estimated with quantitive analysis of magnetic resonance imaging (MRI) at one, two, and three years post injections.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Results: &lt;/strong&gt;The average IKDC score in Group 1 was 45.9, 63.2, 62.4, 60, and 52. The KOOS score of the same group was 53, 79, 72, 69, and 62 at the end of the third year. At baseline, the average total IKDC score in Group 2 was 48.3, at 6 months 78.2, at one year 77, at two years 70.4, and at three years 61. The KOOS score of this group was 57, 84, 86, 79, and 69 at three years, respectively. For the patients with cartilage lesions, Group A presented lesser volume mean numbers of the lesion: 74% at the end of the first year post injection, 61% at the second, and 52% at the end of the third year with two out of seven patients in the group. The rest had no significant difference. Lesser volume mean number of the lesions in Group B was 85-88%, 70%, and 61% at the end of the third year in 5 out of 11 patients in the group. The rest had no significant difference.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Conclusion: &lt;/strong&gt;Adipose-derivedSVF, injected intraarticularly in arthritic knees, seems to provide good to excellent clinical results for three years and radiological results for ca","PeriodicalId":22194,"journal":{"name":"Surgical technology international","volume":null,"pages":null},"PeriodicalIF":0.8,"publicationDate":"2023-12-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"138446262","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Gaseous Micro-Embolic Activity and Goal-Directed Perfusion Management in a Closed System for Cardiopulmonary Bypass and Minimally Invasive Extracorporeal Circulation during Coronary Artery Bypass Grafting.","authors":"Ignazio Condello, Giuseppe Nasso, Kurt Staessens, Giuseppe Speziale","doi":"10.52198/23.STI.43.CV1721","DOIUrl":"10.52198/23.STI.43.CV1721","url":null,"abstract":"<p><strong>Background: </strong>Cardiopulmonary bypass (CPB) techniques are becoming minimally invasive in clinical practice. The literature describes various extracorporeal techniques which seek to eliminate air-blood contact and reduce both hemodilution and the contact surface such as in Minimally invasive Extracorporeal Circulation (MiECC) and closed systems for CPB. However, the delivery of micro-embolic activity in the circuit and metabolic activity in terms of oxygen delivery for Goal-Directed Perfusion (GDP) management, in relation to the patient's blood volume and central venous pressure, have never been related and correlated. In this report, we present a cohort study that investigated these aspects between the closed SVR2000 System and modular MiECC (both from Eurosets SRL, Medolla, Italy).</p><p><strong>Materials and methods: </strong>Data were collected retrospectively and used to compare 60 consecutive patients who underwent isolated coronary artery bypass grafting (CABG) surgery by two surgeons using an SVR2000 oxygenator in 30 procedures, with a matched cohort of patients from the same period who underwent isolated CABG surgery by two other surgeons using a modular MiECC in 30 procedures. The primary endpoints collected were data on micro-embolic activity, including the number of gaseous micro-emboli in the circuit during the procedure, the mean maintenance value of oxygen delivery (DO2) and data relating to venous return volume and central venous pressure (CVP).</p><p><strong>Results: </strong>During the CPB procedures, the following values were recorded for the closed SVR2000 and MiECC groups, respectively: the average number of gaseous micro-emboli (GME) in the venous line, 833 ± 23 vs 1221 ± 45 (p = 0.028); GME in the outlet of the pump, 375 ± 45 vs 429 ± 76 (p = 0.89; GME in the arterial line, 189 ± 36 vs 205 ± 27 (p = 0.92), and the volume of GME in the arterial line (mL), 0.32± 12 vs 0.49± 17 (p = 0.93). The mean Indexed Oxygen Delivery (DO2i) during cross-clamp (ml/min/m2) was 319 ±12 vs 278 ±9 (p = 0.0019), respectively. The maximum mean volume of venous return in the soft-shell venous reservoir (ml) was 1801 ±128 vs 824 ±192 (p = 0.038). The mean central venous pressure (CVP) during cross-clamp (mmHg) was 0 ± 2 vs 6 ± 2 (p = 0.019).</p><p><strong>Conclusions: </strong>In this study, the results in the closed SVR2000 group were not statistically inferior to those in the modular MiECC group in terms of gaseous micro-embolic activity during CPB. Our analysis showed an important reduction of GME delivery in both systems. The closed SVR2000 group showed better management for GDP in terms of DO2i, associated with the flexibility of dynamic volume management and the absence of cavitation and regulation of the rate per minute and pump flow, which were reported in the MiECC group. The SVR2000 and modular MiECC systems were both safe and effective in perioperative practice without iatrogenic problems.</p>","PeriodicalId":22194,"journal":{"name":"Surgical technology international","volume":null,"pages":null},"PeriodicalIF":0.8,"publicationDate":"2023-12-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"41238638","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"The Novel Use of Bipolar Radiofrequency Microneedling in the Treatment of Lichen Sclerosus.","authors":"Tracy A Blusewicz, Katherine P Coley, Robert D Moore, John R Miklos","doi":"10.52198/23.STI.43.GY1743","DOIUrl":"10.52198/23.STI.43.GY1743","url":null,"abstract":"<p><strong>Introduction: </strong>Lichen sclerosus (LS) is a chronic, distressing, inflammatory process that has a huge impact on quality of life in women. Uncontrolled vulvar LS can lead to chronic symptoms of itching and pain and can lead to anatomic changes, scarring, and elevated risk of cancer. First-line therapy with corticosteroids is often not successful in controlling symptoms, especially over the long term. This is the first study to review the effects of bipolar radiofrequency (RF) with microneedling to treat the vaginal and vulvar symptoms of LS.</p><p><strong>Materials and methods: </strong>This retrospective study was initiated due to the recognition of improvement in vulvar skin condition and resolution of lichen sclerosus symptoms in patients who had already failed traditional treatment and underwent radio frequency with microneedling procedures of the vulva, perineum, and perianal regions. Patients were treated with three treatments of bipolar RF and bipolar RF with microneedling four to eight weeks apart. Patient questionnaires were used to assess improvement in the symptoms of LS including itching, tearing of tissue, changes in the appearance and color of tissue, and dryness of skin and mucosa.</p><p><strong>Results: </strong>The data from the questionnaires showed a significant reduction or complete resolution in these symptoms, with 86% of the patients reporting either significant or complete resolution. In the case of itching, which is typically one of the most severe symptoms of LS, 91% of patients reported significant or complete resolution. 87% of patients reported symptom resolution lasting at least six months, with 39% of the patients having results lasting 12 months or more before recurrence. Recurrences can be retreated on an as-needed basis or with annual maintenance therapy consisting typically of just one treatment.</p><p><strong>Conclusion: </strong>Radiofrequency with microneedling treatments for persistent LS showed significant improvement in LS symptoms. As LS is a chronic recurring condition, the treatment protocol resulted in high patient satisfaction for these women who had not experienced these results in terms of amount of symptom resolution or duration of symptom resolution with prior treatments using topical steroid cream or other modalities.</p>","PeriodicalId":22194,"journal":{"name":"Surgical technology international","volume":null,"pages":null},"PeriodicalIF":0.8,"publicationDate":"2023-12-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"138462727","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}