Surgical technology international最新文献

{"title":"Outcomes of Femoral Popliteal Bypass in Octogenarians.","authors":"James Hu, Scott Safir, Ronald Bangiyev, Jonathan Weber, Peter Faries, Ageliki Vouyouka, Paul Lajos","doi":"10.52198/24.STI.44.CV1793","DOIUrl":"10.52198/24.STI.44.CV1793","url":null,"abstract":"<p><strong>Introduction: </strong>Femoral-popliteal bypass (FPB) surgery is a common lower extremity revascularization procedure. As the population continues to age, this procedure is being performed increasingly on older patients. This study investigated whether outcomes differ in this population.</p><p><strong>Materials and methods: </strong>Patients over and less than 80 years old who underwent FPB between 2009-2013 were queried using an existing hospital registry. Demographics, comorbidities, intraoperative complications, perioperative outcomes, and two-year patencies were compared.</p><p><strong>Results: </strong>Twenty-four patients in the octogenarian cohort (OC) and 72 patients in the non-octogenarian cohort (NOC) were identified. There was a lower prevalence of smoking (p=0.018) and higher prevalence of hypertension (p=0.021) among octogenarians. Other medical characteristics were similar (p<0.05). There were no differences in use of vein versus PTFE (p=0.002) as a conduit, or above (OC 20.0% vs. NOC 36.7%), versus below knee (OC 80.0% vs. NOC 63.3%) distal anastomosis (p>0.05) between the groups. There was a difference (p<0.01) in indication for procedure (OC/NOC): claudication (0%/44%), limb salvage (71%/31%), and rest pain (29%/25%). There were no differences in 30-day readmissions (17% vs. 21%; p=0.59) or incidence of postoperative (25% vs. 19%; p=0.56) or intraoperative complications (8.3% vs. 4.2%; p=0.52). Length of stay (LOS) was longer and statistically significant in octogenarians (12 days vs. 7 days; p=0.032) and remained significant after multivariate linear regression (p=0.015). Patencies in OC were lower and dropped faster after six months; however, there were no statistically significant differences in patencies at any time interval (p>0.05). The position of the distal anastomosis relative to the knee, conduit type, and indication were not independently predictive of patency outcomes (p>0.05).</p><p><strong>Conclusion: </strong>The safety and efficacy of FPB in octogenarians is similar to the general population despite LOS in octogenarians being 5.98 days longer. While the difference in indication suggests that vascular surgeons are more conservative in treating octogenarians, our analysis did not reveal significant differences between populations and suggests that lower extremity bypass can be performed safely with comparable results in this cohort. A larger cohort is needed to validate these results.</p>","PeriodicalId":22194,"journal":{"name":"Surgical technology international","volume":"44 ","pages":"223-229"},"PeriodicalIF":0.8,"publicationDate":"2024-07-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141432828","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":"Time to Operation and Mortality Risk in Elderly Patients with Intestinal Fistula: Not Too Early and Not Too Late.","authors":"Rahim Hirani, Abbas Smiley, Rifat Latifi","doi":"10.52198/24.STI.44.GS1779","DOIUrl":"10.52198/24.STI.44.GS1779","url":null,"abstract":"<p><strong>Introduction: </strong>This study aimed to ascertain the risk factors contributing to in-patient mortality in elderly patients 65 years and older who were admitted emergently, diagnosed with intestinal fistula, and underwent surgery.</p><p><strong>Materials and methods: </strong>Data were extracted from the National Inpatient Sample (NIS) spanning the years 2005-2014. Multivariable logistic regression and a generalized additive model (GAM) were employed to investigate predictors of mortality. Continuous variables are presented as mean values with standard deviations (SD).</p><p><strong>Results: </strong>The study encompassed 34,853 patients with a mean age of 77.7 years-56.5% were female and 79.4% were White. Patients were categorized into three groups based on the time elapsed between admission and surgery: less than two days (17,761), two to three days (8,407), and more than three days (4,233). Mortality rates were 2.7%, 6%, and 6.1% for patients who underwent surgery within two to three days, within two days, and after more than three days of admission, respectively. Notably, the group that operated more than three days from admission experienced nearly double the hospital length of stay (12 days, SD: 7.2) compared to the other two groups (6.3, SD: 6 and 6.1, SD: 4.8). Furthermore, the association between mortality and time to operation, as indicated by the GAM model, revealed a significant non-linear relationship after adjusting for age, gender, race, zip code, hospital location, and comorbidities (p<0.001).</p><p><strong>Conclusion: </strong>Elderly patients diagnosed with intestinal fistula should undergo operative treatment as soon as possible, once they are resuscitated. Delaying the operation more than three days after admission substantially increases the risk of mortality.</p>","PeriodicalId":22194,"journal":{"name":"Surgical technology international","volume":"44 ","pages":"125-130"},"PeriodicalIF":0.8,"publicationDate":"2024-07-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140899268","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 Growing Role of Artificial Intelligence and Technology in Hip and Knee Arthroplasty.","authors":"Joshua Rainey, Nipun Sodhi, Jeremy M Gililland, Michael A Mont","doi":"10.52198/24.STI.44.OS1809","DOIUrl":"10.52198/24.STI.44.OS1809","url":null,"abstract":"<p><p>Artificial intelligence and technology have continued to evolve over recent decades, and their utility in hip and knee arthroplasty is growing with interest and enthusiasm. A multitude of technologies are available to assist surgeons in the intraoperative execution of hip and knee arthroplasty, ranging from robotics and augmented reality to artificial intelligence-powered fluoroscopy. The purpose of this review is to provide a framework for arthroplasty surgeons to understand the concept of artificial intelligence and the advancements in technologies that impact the perioperative care of patients undergoing hip and knee arthroplasty.</p>","PeriodicalId":22194,"journal":{"name":"Surgical technology international","volume":"44 ","pages":"251-256"},"PeriodicalIF":0.8,"publicationDate":"2024-07-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141724564","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 Ross Operation Over 55 Years Later: Comparing Surgical Techniques and Outcomes.","authors":"Francesco Nappi","doi":"10.52198/24.STI.44.CV1763","DOIUrl":"10.52198/24.STI.44.CV1763","url":null,"abstract":"<p><p>The Ross procedure is often considered the best option for a small group of patients. Some critics argue that harvesting the pulmonary artery again can cause problems, such as exposing the native pulmonary autograft to systemic pressures and requiring further intervention. However, the pulmonary autograft is a living tissue that can adjust to growing conditions and undergo remodelling. The pathophysiology of living tissue, harvesting techniques, indications for use of pulmonary autograft in aortic valve disease, contraindications, and variations of pulmonary autograft as an aortic conduit are discussed in this seminar. Following recent updates from high-volume centres, the indications, contraindications, techniques, and variations of pulmonary autograft as an aortic conduit and, in the absence of substantial well-designed randomised controlled trials, areas where the Ross procedure needs to be reaffirmed as part of the surgical armamentarium are also discussed. Furthermore, increasing evidence suggests that the Ross procedure produces better long-term results than traditional aortic valve replacement in young and middle-aged adults. To enable cardiologists and surgeons to make appropriate decisions for their patients with aortic valve disease, the author provides a complete review of the most recent published studies on the Ross procedure.</p>","PeriodicalId":22194,"journal":{"name":"Surgical technology international","volume":"44 ","pages":"203-218"},"PeriodicalIF":0.8,"publicationDate":"2024-07-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141427690","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":"A Novel Strategy to Substantially Reduce the Incidence of Periprosthetic Joint Infection Following Total Hip Arthroplasty with Antimicrobial Agents.","authors":"Sean B Sequeira, Matthew F Myntti, Michael A Mont","doi":"10.52198/24.STI.44.OS1753","DOIUrl":"10.52198/24.STI.44.OS1753","url":null,"abstract":"<p><p>Periprosthetic joint infections (PJI) are devastating complications following total hip arthroplasty (THA) and are the most common reason for revision following primary arthroplasty. Although several devices, techniques, and procedures have been developed to combat this serious complication, there is little consensus as to how to prevent the development of PJI at the time of index arthroplasty. This article reviews the concept and implementation of a novel antimicrobial agent to substantially reduce the incidence of PJI. The regular implementation of this infection prophylaxis should be successful in drastically reducing the rate of PJI following primary THA.</p>","PeriodicalId":22194,"journal":{"name":"Surgical technology international","volume":"44 ","pages":"257-261"},"PeriodicalIF":0.8,"publicationDate":"2024-07-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139900475","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 Batalha Clitoropexy: Shortening an Elongated Clitoris - A Minimally Invasive Technique.","authors":"John R Miklos, Robert D Moore, Cristina Sá Oliveira Maron, Ana Cristina Batalha","doi":"10.52198/24.STI.44.GY1766","DOIUrl":"10.52198/24.STI.44.GY1766","url":null,"abstract":"<p><strong>Background: </strong>Female cosmetic genital surgery is becoming increasingly sought after by women who are concerned with the appearance of their vulva. Labiaplasty for the labia minora is undoubtedly the most commonly performed female cosmetic genital surgery. However, an increasing number of patients seen in our clinics in both Brazil and the United States are presenting with clitoral hypertrophy, specifically clitoral elongation. The elongated clitoris will usually protrude beyond the labia minora and majora and from the patient's perspective will give a less feminine appearance as they will often describe the protruding clitoris as feeling like they have a small penis. The surgical technique described here, Batalha Clitoropexy, is a minimally invasive surgical technique for clitoral length-reduction that does not require amputation or debulking. This technique is presented in the form of the detailed sequential steps needed to achieve satisfactory results. Photos taken before and after the procedure in a representative case show that the clitoral length has been shortened from 5.0 cm to 1.5 cm without the need of an invasive amputation or debulking clitoroplasty. Many patients with clitoromegaly or an elongated protruding clitoris do not need to undergo an invasive clitoroplasty. Specifically, patients with clitoral elongation or clitoral ptosis can be surgically treated with a less-invasive clitoropexy surgical procedure which can restore normal anatomic position to treat a protruding clitoris.</p>","PeriodicalId":22194,"journal":{"name":"Surgical technology international","volume":"44 ","pages":"177-180"},"PeriodicalIF":0.8,"publicationDate":"2024-07-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139900478","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 New Era of Three-Dimensional Annuloplasty Devices for Mitral Valve Repair: Rationale and First Experiences.","authors":"Mario Torre, Luca Weltert, Raffaele Scaffa, Andrea Salica, Giulio Folino, Alessandro Ricci, Salvatore D'Aleo, Lorenzo Guerrieri Wolf, Francesco Irace, Ilaria Chirichilli, Samuel Fusca, Alessandro Bellisario, Alberto Bonadies, Marianna Primiterra, Ruggero De Paulis","doi":"10.52198/24.STI.44.CV1795","DOIUrl":"10.52198/24.STI.44.CV1795","url":null,"abstract":"<p><p>Annuloplasty should always accompany mitral valve repair in order to achieve proper annular remodeling and stabilization. Numerous types of annuloplasty rings-that differ from rigid to semi-rigid and flexible devices, from complete to partial, and from flat to saddle-shaped rings-are clinically available. A deeper understanding of mitral valve function, in conjunction with several recent studies, suggest it is advisable to prefer annuloplasty rings that mimic the physiological mitral annulus shape and three-dimensional (3D) dynamic changes in order to reduce haemodynamic stress on valve components and optimize leaflet coaptation, perhaps improving valve repair durability too. This paper aims to focus on 3D annuloplasty rings, with dynamic features: MEMO 3D™ and MEMO 4D™ (Sorin Medical, New York, New York), as well as Physio Flex (Edwards Lifesciences, Irvine, California).</p>","PeriodicalId":22194,"journal":{"name":"Surgical technology international","volume":"44 ","pages":"219-222"},"PeriodicalIF":0.8,"publicationDate":"2024-07-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141992394","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":"A Case Report of Neoadjuvant Gemcitabine Plus Cisplatin for Locally Advanced Unresectable Ampulla of Vater Carcinoma.","authors":"Ryosuke Tsunemitsu, Motoyasu Tabuchi, Shinya Sakamoto, Rika Yoshimatsu, Mototsune Kakizaki, Manabu Matsumoto, Jun Iwata, Yasuhiro Shimada, Takehiro Okabayashi","doi":"10.52198/24.STI.44.GS1768","DOIUrl":"10.52198/24.STI.44.GS1768","url":null,"abstract":"<p><strong>Introduction: </strong>Ampulla of Vater carcinoma (AVC) with para-aortic node (PAN) metastasis is considered unresectable and is equivalent to distant metastasis, contributing to poor outcomes.</p><p><strong>Case presentation: </strong>A 60-year-old man was referred to our hospital and was diagnosed with an unresectable ampulla of Vater carcinoma that had metastasized to the para-aortic nodes. The patient received a systemic chemotherapy regimen comprising a combination of gemcitabine and cisplatin. Following five cycles of treatment, imaging studies revealed a significant reduction in the primary tumor and para-aortic node metastasis, rendering detection difficult. Pancreatoduodenectomy with para-aortic node dissection was performed as a radical surgery. Upon pathological examination, no residual tumors were identified in the resected specimen, indicating that the systemic chemotherapy achieved a complete pathological response. The postoperative course of the patient was uneventful, and he was discharged on the 25th postoperative day. The patient was followed up as an outpatient and remained stable without any recurrence for two months after surgery.</p><p><strong>Conclusion: </strong>Neoadjuvant chemotherapy with gemcitabine and cisplatin was useful for downstaging the ampulla in patients with Vater carcinoma. This finding may help physicians manage patients with similar presentations.</p>","PeriodicalId":22194,"journal":{"name":"Surgical technology international","volume":"44 ","pages":"139-142"},"PeriodicalIF":0.8,"publicationDate":"2024-07-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141432869","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":"Custom Triflange Acetabular Implants for Complex Hip Revisions: A Case Series.","authors":"Daniel Hameed, Jeremy A Dubin, Ignacio Pasqualini, Viktor Krebs, Nicolas S Piuzzi, Michael A Mont","doi":"10.52198/24.STI.44.OS1784","DOIUrl":"10.52198/24.STI.44.OS1784","url":null,"abstract":"<p><p>Revision total hip arthroplasty (THA) presents a formidable challenge when addressing extensive acetabular defects, particularly in severe cases classified under Paprosky types 3A and 3B and American Academy of Orthopaedic Surgeons types 3 and 4. Traditional methods often fall short, prompting the potential use of custom triflange acetabular components or patient-specific acetabular implants (PSAIs). These implants are specifically designed to conform to an individual's anatomy, aiming to enhance defect reconstruction and pelvic stabilization. This case series describes the utilization of advanced 3-dimensional printing and rapid prototyping technologies to construct customized acetabular components, which can be instrumental in enabling precise preoperative planning and surgical execution for these difficult acetabular cases and potentially leading to improved surgical outcomes.</p>","PeriodicalId":22194,"journal":{"name":"Surgical technology international","volume":"44 ","pages":"333-342"},"PeriodicalIF":0.8,"publicationDate":"2024-07-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140871975","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":"On the Shoulders of Giants Through the Lens of the Laparoscope Dr. Harry Reich: Empathy, Optics and Courage.","authors":"Morris Wortman, Rebecca P Wortman, Julie A Madejski","doi":"10.52198/24.STI.44.GY1802","DOIUrl":"10.52198/24.STI.44.GY1802","url":null,"abstract":"<p><p>Harry Reich, MD, FACOG, FRCOG, FACS is known worldwide as a pioneer in the field of laparoscopic surgery. He performed the first laparoscopic hysterectomy, the first pelvic lymphadenectomy for cancer, and the first excision of cul-de-sac endometriosis that included rectal resection. This article explores his life and contributions. The author knew Dr. Reich from medical conferences over many years and visited Dr. Reich in Pennsylvania to observe him in the operating room. For this article, the author spoke with Dr. Reich on nearly a nightly basis over a 13-month period in 2022 and 2023. Dr. Reich's descriptions were cross-referenced with his publications and those of his peers. The author also interviewed physicians who worked closely with Dr. Reich and reviewed the trial transcript of the February 1980 Nesbitt Memorial Hospital special ad hoc investigatory committee. The result is a comprehensive review spanning from Dr. Reich's early life to his ultimate recognition as one of the most significant innovators of advanced laparoscopic surgery. The author concluded that Dr. Reich's accomplishments are rooted in his command of pelvic anatomy, his lifelong interest in surgery and his willingness to challenge existing surgical dogma. By attending medical school in Ireland, Dr. Reich benefitted from the deep study of anatomy offered there. He also had a unique background of being a Harvard-trained gynecologic surgeon practicing in Wilkes-Barre, a small Pennsylvania community that trusted him because both his parents practiced medicine there before him. Dr. Reich favored conservative surgery rather than hysterectomy for endometriosis and patiently excised deep disease, offering relief to countless women, at times without compensation. He exhibited astonishing bravery and perseverance in the face of scathing criticism. Dr. Harry Reich's empathy for his patients and willingness to challenge the status quo were pivotal in improving the lives of many thousands of women and revolutionizing gynecologic surgery.</p>","PeriodicalId":22194,"journal":{"name":"Surgical technology international","volume":"44 ","pages":"167-176"},"PeriodicalIF":0.8,"publicationDate":"2024-07-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141992392","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}