Background This study aims to report a case of a patient with multiple complex degenerative lumbar spine conditions and poor baseline status who achieved favorable clinical outcomes following precise decompression via transforaminal endoscopic lumbar discectomy (TELD). Case Description A 75-year-old woman with L5/S1 lumbar disc herniation combined with spinal canal stenosis, foraminal stenosis, and spondylolisthesis, as well as severe systemic comorbidities including diabetes mellitus and coronary atherosclerotic heart disease (American Society of Anesthesiologists physical status class IV), was treated with right-sided L5/S1 TELD. The responsible segment was identified preoperatively by selective nerve root block. Endoscopic foraminoplasty, neural decompression, and discectomy were performed under local anesthesia. Clinical outcomes were assessed using the Visual Analog Scale (VAS) and the Oswestry Disability Index (ODI). Conclusions The procedure was completed successfully without major perioperative complications, and postoperative imaging confirmed adequate neural decompression. During follow-up, the patient experienced significant pain relief and functional improvement, with marked reductions in VAS and ODI scores. Given the patient had a clearly identified symptomatic target lesion, we did not perform a traditional lumbar fusion to completely address the spondylolisthesis and spinal stenosis. Instead, we chose the less invasive TELD procedure to precisely decompress the affected nerve root, and local anesthesia was selected to minimize anesthesia-related risks. This approach relieved the patient’s pain, restored walking ability, and avoided anesthesia-related adverse reactions. The experience gained from this case provides valuable reference for our team in managing similarly complex patients in the future.
Purpose : Bladder neck invasion (BNI) by prostate cancer is associated with positive surgical margins, biochemical recurrence, and adverse oncologic outcomes after radical prostatectomy. We developed a hybrid transvesical robotic-assisted radical prostatectomy (htvRARP) technique based on direct intraluminal visualization to improve surgical control of tumor-infiltrated bladder neck tissue and evaluated its feasibility, safety, and early outcomes. Methods : Three consecutive patients with biopsy-proven cT4N1M0 prostate cancer and confirmed BNI underwent htvRARP between February 2024 and February 2025. The procedure comprised a transvesical phase for intravesical assessment and circumferential bladder neck dissection, followed by conventional robotic-assisted radical prostatectomy, tennis-racket-type bladder neck reconstruction, and urethrovesical anastomosis. Perioperative androgen deprivation therapy was initiated at diagnosis in all patients. Results All procedures were completed without intraoperative or postoperative complications. Operative times for Patients 1, 2, and 3 were 240, 180, and 200 minutes, respectively, and estimated blood losses were 150, 200, and 180 mL, respectively. Urethral catheters were removed on postoperative day 7, and all patients were discharged on postoperative day 7; the total hospital stay, including preoperative admission, was 9 days in all patients. Positive surgical margins were identified in all patients, whereas the bladder neck margin was negative in two patients. All patients recovered full urinary continence by 6 months. Two patients showed no biochemical recurrence during follow-up, whereas one developed biochemical recurrence at 12 months, confirmed by repeat PSA measurement, and subsequently underwent salvage radiotherapy. Conclusions In this preliminary three-patient case series, htvRARP appeared feasible and safe in selected patients with bladder neck-invading prostate cancer. Although the technique may facilitate surgical control at the vesicoprostatic junction and relieve bladder outlet obstruction caused by locally advanced disease, its oncological effectiveness cannot be determined from this limited experience. Larger prospective studies with longer follow-up are required to validate these preliminary findings.
Background Evidence for Enhanced Recovery After Surgery (ERAS) pathways in children undergoing intestinal stoma closure remains limited, and procedure-specific multicenter pediatric data are scarce. Methods We conducted a preliminary multicenter observational cohort study with historical controls, comparing children treated before ERAS with a prospective cohort treated after implementation of a standardized 22-element pediatric perioperative protocol. The protocol targeted fasting, bowel preparation, antimicrobial prophylaxis, opioid-sparing analgesia, near-zero fluid balance, minimization of nasogastric tubes, drains, and urinary catheters, and early feeding. The primary endpoint was postoperative day of discharge. Secondary outcomes included length of stay, feeding milestones, parenteral nutrition, nasogastric tube, drain, and urinary catheter use/removal, and 30-day safety outcomes. Adjusted analyses controlled for age, body weight, sex, stoma type, and center. Results The final cohort included 173 children: 114 historical pre-ERAS controls and 59 ERAS patients. Median postoperative day of discharge was 7.0 [IQR, 6.0-10.0] versus 6.0 [IQR, 4.0-8.0]. ERAS implementation was associated with earlier discharge in unadjusted analysis (mean difference, -2.7 days; 95% CI, -4.2 to -1.2; p < 0.001) and adjusted analysis (mean difference, -3.1 days; 95% CI, -4.9 to -1.4; p < 0.001). ERAS was also associated with earlier feeding milestones, reduced postoperative parenteral nutrition exposure, and earlier urinary catheter removal. Conclusions In this preliminary multicenter cohort study with historical controls, ERAS implementation was associated with faster postoperative recovery without an apparent increase in major short-term adverse outcomes. These findings should be interpreted cautiously and confirmed in larger prospective studies.
Objective Gastric Carcinoma (GC) is a prevalent malignancy worldwide. Cuproptosis is a newly discovered programmed cell death. We speculated that the expression of previously reported cuproptosis-related genes (CRGs) might serve as potential prognostic predictors and therapeutic hypotheses in GC. Methods Cuproptosis-related genes were systematically evaluated in the GC training group. Through unsupervised clustering and differential/prognostic analyses, we explored the association between the expression patterns of these genes and GC progression. Molecular docking was used as an exploratory computational approach to prioritize CDKN2A-related predicted binding compounds.. CCK8, invasion and migration assay were used to explore the anticancer effect of the drug and then verify it in nudes. Results Three genes, CDKN2A, GLS, and MTF1, were identified as prognostically relevant candidates in GC. TIMER analysis revealed weak associations between CRG expression and immune infiltration in GC. Saquinavir was prioritized by molecular docking as a candidate compound with predicted affinity for CDKN2A and showed inhibitory effects on the proliferation, invasion, and migration of GC cells in vitro. In the xenograft model, saquinavir-treated mice developed tumors with reduced volume and weight compared with controls. Conclusions Genes from a previously reported cuproptosis-related gene set showed prognostic relevance in GC. CDKN2A may serve as a potential survival-associated biomarker, and saquinavir showed preliminary anticancer activity in vitro and in vivo. However, direct mechanistic involvement of CDKN2A, GLS, and MTF1 in cuproptosis was not demonstrated and requires further validation.
Purpose Photography is used for triage, management and monitoring treatment in plastic surgery. However, in regards to soft tissue trauma, there are no current standards or guidelines, therefore the aims of this study were to: identify/establish key benchmark criteria for clinical photography in soft-tissue trauma, and investigate if recommendations improve the quality of images received. Methods Categories influencing photograph quality (certainty of imaged anatomy, clarity of background/foreground, image framing, orientation, correct angles, resolution, colour grading and lighting) were extracted from a Delphi questionnaire and used as the basis for recommendations. 60 sets of photographs before and after recommendations were assessed by blinded clinicians and scored 1(lowest)-to-5(highest) against the aforementioned categories, each clinician reviewed 20 sets of photographs, selected randomly. Average scores for each domain were compared using Student’s T-test and correlations with Spearman’s Rank correlation and regression modelling. Results ANOVA testing of the importance of each category of photography quality showed no significant difference (p>0.05) between seniority of clinicians. Significant increase in mean overall score of photograph quality was found following implementation of guidelines (3.58 to 4.17, mean increase= 0.583±0.144, p<0.001). Spearman’s rho assessing overall quality with individual quality categories was either significantly fairly (0.5>ρ≥0.2) or moderately (0.7>ρ≥0.5) positively correlative (p<0.05) across all domains both pre- and post-guidelines. Regression modelling identified overall photograph score correlated strongest when angles, resolution, and anatomy were combined, with R= 0.842 and R= 0.802 in pre- and post-recommendation cohorts respectively. Conclusions Recommendations lead to recordable improvement in photographs overall quality, future studies should assess impact of photograph quality on clinical decision making.
Hydronephrosis, a clinically important condition associated with renal impairment and an increased healthcare burden, remains challenging to diagnose and manage despite advances in imaging and therapy. This bibliometric study analyzed 10,152 publications from 1901 to 2025 (as of August 2025) using the Web of Science Core Collection and VOSviewer to map the research landscape. The results demonstrate increasing research attention to hydronephrosis in WoSCC-indexed publications, with 6,742 contributing institutions, led by Harvard University, the University of Toronto, and the University of California, San Francisco. Pediatric centers formed strong international collaborations, with the University of Toronto achieving the highest total-link strength (135). The analysis identified 40,865 authors, of whom Armando J. Lorenzo was the most prolific (117 publications). Journal analysis revealed the Journal of Urology (871 papers) as the leading outlet, alongside emerging journals such as Cureus. Keyword analysis identified 264 high-frequency terms, with “Kidney” (451 occurrences) and “Ureter” (343 occurrences) being the most common. Recent emphasis has shifted toward case reports and kidney stone research. Collectively, these findings illustrate the transition from anatomical studies to advanced clinical applications, supported by robust pediatric-focused networks. Despite limitations, including database coverage and reliance on quantitative metrics, this study, to our knowledge, provides the first comprehensive analytical framework for hydronephrosis research, highlighting knowledge gaps and emerging frontiers. Future research should emphasize mechanistic investigations, clinical translation, and multinational collaboration to improve patient outcomes and inform evidence-based practice.
Background Minimally invasive hernia repair (MIS-HR) is widely performed in the United States, and perioperative outcomes may vary across payer groups. Insurance status influences access to care, healthcare utilization, and discharge pathways. Methods Using the 2018 - 2020 National Inpatient Sample, we identified adults undergoing laparoscopic or robotic hernia repair (inguinal, femoral, ventral, umbilical, parastomal). Insurance was categorized as private, Medicare, Medicaid, or other/uninsured. Survey-weighted multivariable regression assessed associations between payer type and in-hospital mortality, postoperative complications, non-home discharge, length of stay (LOS), and inflation-adjusted charges, adjusting for demographic, clinical, hospital factors, and surgical technique (robotic vs laparoscopic). Results Among 226,115 patients, significant differences in demographic and clinical characteristics were observed across insurance groups. In adjusted analyses, mortality did not differ by payer status. Medicaid (OR 1.27, 95% CI 1.15–1.39) and Other payers (OR 1.17, 95% CI 1.04–1.32) had higher odds of postoperative complications. All non-private groups had greater odds of non-home discharge (Medicaid OR 2.47; Medicare OR 1.52; Other OR 1.59). LOS was longer for Medicaid (β +0.70 days, p<0.001), Medicare (β +0.20 days, p=0.007), and Other payers (β +0.32 days, p=0.004). Robotic repair was associated with lower odds of complications (OR 0.51), non-home discharge (OR 0.35), and mortality (OR 0.38) (all p<0.001). Inflation-adjusted charges did not differ significantly across payer groups. Conclusion Insurance status was associated with postoperative morbidity, LOS, and discharge disposition after MIS-HR. Despite longer hospitalization among publicly insured groups, overall charges remained similar. These findings highlight the need for improved perioperative planning and post-acute care coordination for publicly insured patients.
Background To evaluate the short-term outcomes of a novel surgical technique for hysterectomy: gasless transvaginal natural orifice transluminal endoscopic surgery (v-NOTES) utilizing the SHURUI surgical robotic system with flexible instruments. Methods A prospective pilot study was initiated to enroll patients with gynecological indications necessitating hysterectomy. All procedures were performed by the same surgeon using the SHURUI robotic system (SR-ENS-600) equipped with flexible instruments. Results All ten surgeries were successfully completed without conversions or complications. The median docking time was 12 (8.5-20.25 minutes), average console time was 32 (17-42.25 minutes), and total operative time averaged 105.8 ± 25.73 minutes. The median amount of estimated blood loss was 50 (50-175 ml), and the average uterus weight was 299.44 grams ± 188.62 grams. Conclusions The gasless v-NOTES using the SHURUI robotic system with flexible instruments for hysterectomy appears to be feasible and safe.
Background Parastomal hernia (PSH) is a common complication following colostomy and can significantly impair stoma function and quality of life. However, the risk factors for PSH after transperitoneal colostomy remain insufficiently defined in Chinese populations . This study aimed to identify independent risk factors and develop a preliminary predictive model for PSH. Methods A total of 114 patients who underwent permanent end colostomy via the transperitoneal route as part of abdominoperineal resection for rectal cancer were retrospectively enrolled from 2021 to 2024. Demographic characteristics, clinical parameters, and imaging data including subcutaneous fat area (SFA) and visceral fat area (VFA) were collected. Univariate and multivariate Firth's penalized logistic regression analyses were performed to identify independent risk factors for PSH. Four predictive models incorporating different combinations of significant variables were constructed and evaluated using receiver operating characteristic (ROC) curves, with area under the curve (AUC), sensitivity, specificity, and accuracy calculated. Bootstrap internal validation was performed to assess model stability and correct for overfitting. Results The overall incidence of PSH was 26.3% (30/114). Multivariate analysis using Firth's penalized logistic regression identified four independent risk factors: female sex (adjusted OR= 9.746, 95% CI: 2.891–32.855, P=0.001), BMI >22 kg/m² (adjusted OR=5.912, 95% CI: 1.613–21.669, P = 0.007), SFA >110 cm² (adjusted OR=7.125, 95% CI: 2.063–24.609, P=0.002), and stoma diameter >18 mm (adjusted OR=5.601, 95% CI: 1.424–22.033, P=0.014). The combined model incorporating all four factors demonstrated excellent predictive performance (AUC = 0.831, 95% CI: 0.754–0.908), with a sensitivity of 83.3%, specificity of 75.0%, and accuracy of 77.2%. Bootstrap internal validation confirmed model stability (optimism-corrected AUC = 0.812; optimism = 0.019). Conclusions Female sex, BMI >22 kg/m², SFA >110 cm², and stoma diameter >18 mm are independent risk factors for PSH. The predictive model combining these four factors exhibits good discriminatory ability and may serve as a useful tool for preoperative risk stratification. However, external validation in larger prospective cohorts is essential before clinical implementation.
Objective The red blood cell distribution width to albumin ratio (RAR) has been confirmed as an independent prognostic risk factor in various diseases, including cardiovascular diseases, chronic heart failure, acute pancreatitis, sepsis complicated with acute respiratory distress syndrome (ARDS), and chronic obstructive pulmonary disease (COPD) complicated with atrial fibrillation. This study aimed to investigate the correlation between RAR and the prognosis of patients with traumatic brain injury (TBI) and to identify a simple and effective prognostic indicator for TBI. Methods A retrospective cohort study was conducted based on the Medical Information Mart for Intensive Care (MIMIC)-IV version 3.1 database. A total of 1376 participants were enrolled and divided into four groups (Q1-Q4) according to RAR quartiles. The primary outcome was 28-day mortality. Secondary outcomes included 90-day mortality, in-hospital mortality, length of hospital stay, and length of intensive care unit (ICU) stay. The Synthetic Minority Oversampling Technique (SMOTE) was used to address data imbalance. Multivariate regression analysis and machine learning were applied to explore the relationship between RAR and prognosis in TBI patients. SHAP (SHapley Additive exPlanations) interpretable analysis was used to interpret the machine learning results. Additionally, data from 88 TBI patients in our hospital were retrospectively used for external validation of the machine learning model. Results A total of 1376 participants were included in this study, with a mean age of 57.74±18.31 years and a mean RAR of 4.62±1.34 %/g·dL⁻¹. After adjusting for covariates, the hazard ratios (HR) [95% confidence intervals (CI)] for 28-day and 90-day mortality in the Q4 group (RAR > 5.280 %/g·dL⁻¹) were 1.992 (1.309, 3.031) and 2.237 (1.482, 3.377), respectively. Similar results were observed for ICU in-hospital mortality. Kaplan-Meier curve analysis showed that patients in the Q4 group had significantly higher 28-day mortality.To verify the stability of the model and the predictive validity of RAR for TBI prognosis, feature variables were screened using Lasso regression with 28-day mortality as the outcome. After SMOTE processing for data imbalance, multiple machine learning models were applied. The LightGBM model showed the best performance and good external validation results. SHAP interpretable analysis revealed that the Oxford Acute Severity of Illness Score (OASIS), first serum creatinine level, RAR, and first heart rate were the main predictive features. Elevated RAR was positively correlated with 28-day mortality risk in TBI patients, confirming its predictive value, while underlying comorbidities had minimal impact. Conclusion (1) RAR is independently associated with the clinical prognosis of TBI patients and can act as an auxiliary predictive indicator.(2) Elevated RAR levels are significantly positively correlated with 28-day, 90-day, and ICU mortality in TBI patients, while its predictive efficiency is only slightly better than that of RDW or albumin alone.(3) The LightGBM model presents favorable and acceptable predictive performance for 28-day mortality in TBI patients.
Purpose: This study compares the tensile strength of recently developed Schnelsen laparoscopic knot variants with that of the Melzer-Bueß knot to provide recommendations for clinical application. Methods: The Schnelsen knot in its original form (Schnelsen 1) and with one (Schnelsen 2) and two (Schnelsen 3) additional loops was compared with the Melzer-Bueß knot. All knots were tied in a laparoscopic training device (Lübecker Toolbox) using two types of non-absorbable suture materials (mono- and polyfilament). For each combination of knot and suture material, three surgeons each tied 10 knots (total = 240 knots). The loops were mounted on a tensile testing machine and loaded until failure, either by rupture or slippage. Knot strength was assessed by the clinical failure load, Ffail, defined as the maximum load without exceeding a slippage of 3 mm. The influence of factors such as knot type or suture material on Ffail was analyzed using a generalized linear mixed model (GLMM). Results: Most of the knots failed by slippage. Nevertheless, the results for monofilament material that show the established Melzer-Bueß and Schnelsen 1 have a Ffail of 3.74 N and 3.05 N, respectively. The new proposed Schnelsen 2, on the other hand, shows a higher Ffail with 5.15 N. According to the GLMM, the use of polyfilament material increases Ffail by 97 %. Conclusion: The results show that under these conditions, the new version of the Schnelsen knot with one additional loop (Schnelsen 2) shows higher Ffail compared to the Melzer-Bueß knot, while still offering the lower complexity of the Schnelsen 1 knot.
Background The choice between sutures and staples for skin closure may influence wound healing, cosmetic outcomes, and clinical decision-making. However, evidence remains variable across surgical settings. Objective To compare wound healing outcomes, early cosmetic results, and surgeon preferences associated with sutures and staples in elective surgical skin closure. Methods This prospective observational cohort study was conducted at a tertiary care hospital in Pakistan from January to June 2024. A total of 250 patients undergoing elective surgery were included and allocated to closure method based on surgeon preference (staples: n = 125; sutures: n = 125). Wound healing was assessed using the Southampton Wound Grading System at postoperative Day 10, and cosmetic outcomes were evaluated at 3 weeks using the Stony Brook Scar Evaluation Scale (SBSES). Surgeon preferences were assessed using a structured questionnaire. Statistical analysis included chi-square tests, independent-samples t-tests, and Pearson correlation analysis. Effect sizes were reported using odds ratios (OR) and mean differences with 95% confidence intervals (CI). Results Normal wound healing (grades 0–I) was observed in 85.6% of patients in the staple group and 96.0% in the suture group (χ² = 10.27, p = 0.001). The odds of normal healing were higher in the suture group (OR = 3.95; 95% CI: 1.32–11.78). Mean SBSES scores were 4.03 ± 0.62 in the staple group and 4.20 ± 0.48 in the suture group, with a mean difference of 0.17 (95% CI: 0.04–0.30; p = 0.012). A negative correlation was observed between wound healing grade and cosmetic outcomes (r = –0.392, p < 0.001). Most surgeons (80%) selected sutures as their usual closure method, primarily citing perceived clinical considerations. Conclusion In this prospective observational cohort study, sutures were associated with a higher proportion of normal wound healing and slightly improved early cosmetic outcomes compared with staples. However, due to the non-randomized design, clustering of patients within surgeons, and potential confounding, these findings should be interpreted with caution. The short follow-up period further limits the assessment of long-term cosmetic outcomes and precludes causal inference. Further well-designed randomized studies with longer follow-up are warranted.
Objective Focal Cortical Dysplasia (FCD) is a common cause of intractable epilepsy, with complex pathological mechanisms. This study aimed to screen for FCD biomarkers associated with the FANCI gene and mitochondrial dysfunction. Methods The datasets GSE128300, GSE213488, and GSE268807 were obtained from the Gene Expression Omnibus (GEO). Differentially expressed genes (DEGs) between FCD and control groups were identified, and intersected with mitochondrial dysfunction-related genes (MDRGs) to derive candidate genes. Meanwhile, the expression differences and enrichment of FANCI between groups were analyzed. Correlation analysis with FANCI and validation of expression levels were performed to screen biomarkers. Functional investigations employed enrichment analysis, regulatory network construction, snRNA-seq analysis, cell communication analysis, and pseudo-time analysis. Results FANCI was highly expressed in the FCD group. Differential expression analysis identified 48 candidate genes and further screened eight core biomarkers (BOK, ABCD1, EFHD1, MAOB, HSD17B4, PDPR, SPTLC2, MALSU1) through correlation with FANCI and expression validation. Enrichment analysis linked these biomarkers primarily to lipid metabolism. Single-nucleus RNA sequencing revealed oligodendrocytes as potential key cells. Cell communication analysis showed markedly enhanced interactions between oligodendrocytes and other cells in FCD. Pseudo-time analysis demonstrated dynamic biomarker expression during oligodendrocyte differentiation: HSD17B4 and SPTLC2 were consistently upregulated, whereas EFHD1 increased initially then declined. Conclusions These findings suggest that the identified biomarkers are closely associated with mitochondrial dysfunction and lipid metabolism in FCD, as well as with oligodendrocyte differentiation, providing potential targets for the diagnosis and treatment of FCD.
Background Acute mesenteric ischemia (AMI) is a life-threatening condition requiring rapid diagnosis and revascularization. Device-assisted endovascular thrombectomy is an increasingly used minimally invasive treatment option in selected patients with acute superior mesenteric artery (SMA) occlusion. This study evaluated the short-term outcomes of device-assisted endovascular thrombectomy in AMI caused by SMA embolism or thrombosis. Methods A systematic review and single-arm proportion meta-analysis were performed in accordance with PRISMA 2020 and registered in PROSPERO (CRD420251090278). PubMed, Embase, Cochrane Library, Scopus, and ClinicalTrials.gov were searched from 4 May 2025 to 31 March 2026. Eligible studies included adults with acute arterial mesenteric ischemia due to SMA embolic or thrombotic occlusion treated with device-assisted endovascular thrombectomy. Risk of bias was assessed using ROBINS-I, and certainty of evidence was evaluated using GRADE. Random-effects REML models were used for pooled estimates. Results Five retrospective studies involving 56 patients were included. The pooled technical success rate was 89.8% (95% CI: 78.5–95.6%), the pooled bowel resection rate was 27.1% (95% CI: 16.6–40.1%), and the pooled early mortality rate was 16.9% (95% CI: 5.8–40.1%). The pooled rate of adjunctive PTA and/or stent implantation was 19.0% (95% CI: 4.2–56.4%), and adjunctive thrombolysis use was 29.9% (95% CI: 14.8–51.2%). Overall risk of bias was serious, and certainty of evidence was very low for all key outcomes. Conclusions Device-assisted endovascular thrombectomy appears feasible in selected patients with AMI caused by SMA embolism or thrombosis. However, evidence remains limited and requires confirmation in prospective multicenter studies.
Background Upper hemisternotomy (UHS) is an evolving minimally invasive approach for aortic dissection. This study aimed to evaluate the clinical outcomes of different UHS incision types, identify independent predictors of postoperative complications and 1-year mortality, and develop a robust predictive nomogram. Methods Following the STROBE guidelines, we retrospectively analyzed 94 patients undergoing aortic dissection repair via UHS (2013–2023), categorized into inverted T-shaped (n=80) and J-shaped (n=14) groups. To prevent overfitting and information loss, continuous variables were primarily analyzed using multivariable Logistic and Cox regression. Restricted cubic splines (RCS) were employed to validate the linearity of risk associations. Firth’s penalized likelihood method was utilized to ensure the stability of estimates for small-subgroup analysis. The predictive nomogram was internally validated using 1,000 bootstrap resamples and assessed via C-index, calibration plots, and decision curve analysis (DCA). Results Significant baseline imbalance was observed in diabetes prevalence (P<0.001), which was adjusted in multivariable models. J-shaped incision was identified as an independent risk factor for postoperative neurological dysfunction (OR: 9.09, 95% CI: 1.30–100.00, P=0.027). For recovery, preoperative renal failure (P=0.041) and smaller aortic sinus diameter (OR: 0.94 per mm increase, P=0.036) were associated with prolonged ICU stay. Multivariable Cox regression demonstrated that J-shaped incision (HR: 11.08, 95% CI: 3.17–38.73, P<0.001), increased ascending aortic diameter (HR: 1.06 per mm increase, P=0.037), and prolonged cross-clamping time (HR: 1.01 per minute increase, P=0.017) were independently associated with 1-year mortality. The nomogram exhibited high discriminative power (C-index: 0.881; 1-year AUC: 89.13%) and excellent calibration (mean absolute error: 0.006). DCA indicated a substantial clinical net benefit. Conclusion Preliminary findings suggest that J-shaped incision, larger ascending aortic diameter, and prolonged cross-clamping time are potentially associated with increased mortality following UHS for aortic dissection. Given the limited sample size of the J-shaped group and potential selection bias, these results should be interpreted as exploratory. The developed nomogram offers a promising tool for individualized risk stratification, though future multicenter prospective validation is essential.
Objective To assess the effectiveness and safety of totally thoracoscopic-laparoscopic Ivor Lewis esophagectomy. Methodology The retrospective analysis was conducted on clinical data from 194 patients who underwent esophagectomy at our institution between December 2020 and May 2023. Patients were divided into a minimally invasive group (n = 133, totally thoracoscopic-laparoscopic Ivor Lewis esophagectomy) and an open surgery group (n = 61). Surgical outcomes, postoperative complications, survival status, and disease progression were compared using Mann-Whitney U test, chi-square test, or log-rank test. Results Both groups achieved 100% R0 resection rate. The minimally invasive group had significant advantages: less intraoperative blood loss, more lymph nodes removed, and shorter postoperative hospital stay. However, it required longer operative time and incurred higher total hospitalization costs. Regarding complications, no significant differences were observed in anastomotic leakage, pulmonary infection, recurrent laryngeal nerve injury, thoracocentesis, or reoperation rates. The minimally invasive group had a higher pleural effusion incidence but milder postoperative pain, while the open group more frequently reported moderate pain. Two-year overall survival (OS) and progression-free survival (PFS) showed no statistical differences between the two groups. Conclusion Despite prolonged operative time, higher costs, and increased pleural effusion, the minimally invasive approach was associated with notable benefits and comparable survival outcomes. In this retrospective cohort, it appeared to be a safe and feasible surgical option, although residual confounding cannot be excluded.
Background Robotic right colectomy is increasingly adopted for the management of right-sided colon cancer, offering enhanced visualization and instrument dexterity. This video aims to present a standardized, stepwise approach to robotic right colectomy with intracorporeal anastomosis, designed for surgical education and reproducibility. The procedure is indicated for patients with right-sided colon cancer suitable for minimally invasive resection. Technique and key steps A medial-to-lateral approach is employed using the Da Vinci Xi® platform. Key steps include trocar placement, central vascular ligation of the ileocolic vessels, retroperitoneal dissection with preservation of critical structures, mobilization of the hepatic flexure, and division of the right branch of the middle colic vessels. The resection corresponds to a D2 lymphadenectomy.Bowel continuity is restored using an intracorporeal isoperistaltic side-to-side anastomosis using a robotic stapler and barbed suture closure. Perfusion is assessed using indocyanine green fluorescence imaging prior to anastomosis. The video highlights key anatomical landmarks, technical considerations, and potential pitfalls, including safe dissection planes and protection of the ureter and duodenum. Take-home points This standardized approach emphasizes safety, clarity, and reproducibility, aligning with LAP-VEGaS guidelines for surgical video reporting. It provides a practical framework according to the IDEAL framework stage 2a – technical development for surgeons adopting robotic right colectomy while maintaining adherence to oncologic principles.
Objectives Infrared thermography (IRT) is a non-contact, radiation-free imaging technique that measures skin temperature as an indirect marker of tissue perfusion, inflammation, and autonomic regulation. Advances in infrared camera technology and image-processing methods, including artificial intelligence–based analysis, have renewed interest in the potential clinical role of IRT in cardiovascular medicine. This systematic review aims to evaluate the diagnostic and clinical utility of infrared thermography in adult patients with cardiovascular diseases, focusing on its performance in assessing impaired tissue perfusion and ischemia. Methods A systematic literature search was conducted in PubMed/MEDLINE, Scopus, Cochrane CENTRAL, IEEE Xplore, and ACM Digital Library for studies published from January 1, 2016, to April 26, 2026, in accordance with PRISMA 2020 guidelines. Searches of Embase and Web of Science Core Collection were attempted, but could not be performed because these databases were not accessible through the authors’ institutional subscriptions. No language restriction was applied. Studies investigating the use of IRT in adult patients with cardiovascular conditions were included, while pediatric, animal, phantom-based, protocol-only, case-report, and other ineligible study types were excluded. Eighteen studies met the inclusion criteria and were qualitatively synthesized. Results The reviewed studies explored the utility of IRT across a range of cardiovascular conditions, most commonly peripheral arterial disease, carotid artery stenosis, coronary artery disease, and heart failure. Overall, infrared thermography demonstrated potential as an additional diagnostic or screening tool, particularly when combined with conventional diagnostics or artificial intelligence–based analysis. However, substantial heterogeneity was observed in study design, imaging protocols, outcome measures, and patient populations, limiting direct comparison across studies. Conclusion Infrared thermography may serve as a non-invasive and low-cost adjunct in the assessment of selected cardiovascular diseases. Nevertheless, current evidence is constrained by methodological variability, small sample sizes, and the lack of standardized acquisition and interpretation protocols. Further large-scale, well-designed prospective studies are required to define its diagnostic accuracy, clinical utility, and role within established cardiovascular diagnostic pathways.
