Objectives: Reconstruction of complex midfacial defects remains challenging due to the need to restore three-dimensional anatomy, functional integrity, and facial symmetry. This study aimed to evaluate the clinical effectiveness, safety, and functional and aesthetic outcomes of patient-specific custom implants (PSCIs) in complex midfacial reconstruction. Additionally, we assessed whether virtual surgical planning (VSP) combined with PSCIs reduces operative time and improves postoperative symmetry and patient-reported outcomes. Materials and Methods: A retrospective comparative cohort study was conducted using prospectively recorded clinical data from patients treated with PSCI/VSP between January 2021 and June 2025 and a historical control cohort treated with standard pre-shaped implants. Eighty-seven consecutive patients undergoing reconstruction of acquired or post-oncologic midfacial defects using titanium or PEEK patient-specific implants were enrolled. Preoperative VSP was performed in all cases. The principal endpoint was postoperative facial symmetry assessed by three-dimensional photogrammetry. Secondary functional outcomes included ocular position and nasal airway patency. Secondary outcomes included operative time, complication rates, implant-related morbidity, and patient-reported outcome measures (FACE-Q) at 12 months. Outcomes were compared with a historical cohort reconstructed with standard pre-shaped implants. Results: Eighty-two patients completed at least 12 months of follow-up. PSCI reconstruction demonstrated significantly improved postoperative symmetry (mean deviation 1.8 ± 0.6 mm vs. 3.4 ± 1.1 mm in controls, p < 0.001) and higher patient satisfaction scores at 12 months (FACE-Q overall satisfaction score 82.8 ± 9.3 vs. 69.7 ± 11.2, p < 0.001). Mean operative time was reduced by approximately 24.7%, and intraoperative implant modification was required in only 6% of cases compared with 48% in the control group. The overall complication rate was 11%, with implant removal required in 2.4% of patients. Functional outcomes showed significant improvements in orbital positioning and nasal airway patency. Conclusions: Patient-specific custom implants combined with virtual surgical planning provide reliable and reproducible reconstruction of complex midfacial defects. This approach significantly improves facial symmetry, patient satisfaction, and operative efficiency while maintaining low complication rates. PSCIs should be considered a preferred reconstructive option in selected patients requiring complex maxillofacial reconstruction.
Background/Objectives: To evaluate the clinical effects of alveolar ridge preservation using a hyaluronic acid-based product combined with a resorbable collagen cone compared with spontaneous healing. Methods: In this prospective pilot comparative clinical study, extraction sockets were treated either with hyaluronic acid and a collagen cone (test group) or left to heal spontaneously (control group). Mesial and distal ridge height changes (ΔHm, ΔHd), ridge width reduction (ΔW), buccal mucosal thickness changes (ΔTmb), and occlusal mucosal thickness at 3 months (TmoT3) were assessed. Early wound healing was appreciated at 14 days follow-up, and postoperative complications after 7 and 14 days. Results: Complete 3-month follow-up data were available for 18 test and 14 control patients. Mesial bone loss was significantly lower in the test group than in controls [test ΔHm = 1.0 (1.0–1.0) vs. control ΔHm = 2.0 (1.0–2.0); p < 0.001]. Horizontal ridge width reduction was significantly lower in the test group [ΔW = 1.0 (1.0–1.0) vs. 2.0 (1.0–2.0); p = 0.021]. Buccal mucosal thickness was better maintained in the test group [ΔTmb = 0.0 (0.0–0.5) vs. 1.0 (0.5–1.0); p < 0.001], while TmoT3 was greater in the test group, in an exploratory analysis (p = 0.049). A statistically significant difference in early wound-healing scores favoring the test group was observed [4.0 (4.0–5.0) vs. 4.0 (3.0–4.0); p = 0.032]. No statistically detectable difference in postoperative complications was observed between groups. Conclusions: Alveolar ridge preservation was associated with reduced mesial vertical and horizontal dimensional changes and more favorable soft tissue outcomes compared with spontaneous healing. These preliminary findings should be considered hypothesis-generating.
Background/Objectives: Patients aged ≥65 years undergoing colorectal cancer surgery are at increased risk of postoperative complications and mortality due to advanced age, comorbidity burden, frailty, and reduced physiological reserve. The aim of this study was to evaluate perioperative predictors associated with early in-hospital mortality in patients aged ≥65 years undergoing colorectal cancer surgery. Methods: This single-center retrospective cohort study included 438 patients aged ≥65 years who underwent colorectal cancer surgery at a tertiary referral center between January 2017 and December 2018. Demographic characteristics, comorbidities, American Society of Anesthesiologists (ASA) classification, surgical urgency, perioperative laboratory parameters, and transfusion requirements were analyzed. The primary endpoint was early in-hospital mortality. Survival analysis was performed using Kaplan–Meier curves and Cox proportional hazards regression analysis. Results: The overall in-hospital mortality rate was 9.4% (41/438). Emergency surgery was associated with significantly reduced in-hospital survival compared with elective procedures (log-rank p < 0.001). Non-survivors more frequently presented with emergency surgical indications, higher ASA scores, greater comorbidity burden, anemia, nutritional impairment, elevated inflammatory markers, renal dysfunction, and increased transfusion requirements. In univariate Cox regression analysis, emergency surgery, ASA score ≥ 3, elevated creatinine, leukocyte count, and C-reactive protein levels, lower hemoglobin, albumin and total protein levels, and red blood cell transfusion were significantly associated with mortality. In multivariate analysis, elevated creatinine (HR 1.004, p = 0.030), leukocyte count (HR 1.064, p = 0.004), C-reactive protein (HR 1.009, p < 0.001), and lower hemoglobin concentration (HR 0.938, p < 0.001) remained independent predictors of in-hospital mortality. Conclusions: Early in-hospital mortality after colorectal cancer surgery in patients aged ≥65 years is associated with systemic inflammation, anemia, and renal dysfunction. Routinely available clinical and laboratory parameters may assist in identifying high-risk patients and improving perioperative risk assessment and postoperative management.
Background: Acute appendicitis is the leading pediatric surgical emergency. Identifying drivers of disease severity and laparoscopic-to-open conversion remains critical for surgical planning. We evaluated the discriminative performance of clinical scores and inflammatory biomarkers for both peritonitis and surgical conversion, and explored combined clinical–laboratory models among children with acute appendicitis undergoing an initially attempted laparoscopic appendectomy. Methods: A retrospective study was conducted, including pediatric patients with acute appendicitis who underwent surgical treatment. Clinical scores (Alvarado score and Pediatric Appendicitis Score) and laboratory parameters (C-reactive protein, neutrophil count, and neutrophil-to-lymphocyte ratio) were analyzed. Receiver operating characteristic (ROC) curve analysis was used to assess discriminative ability, with calculation of the area under the curve (AUC). Combined models based on standardized variables were constructed and evaluated. Comparisons between AUCs were performed using DeLong’s test. Results: For prediction of peritonitis, clinical scores suggested good discriminative ability within the sample, with AUC values of 0.805 for the Alvarado score and 0.812 for the Pediatric Appendicitis Score, whereas C-reactive protein showed moderate performance (AUC = 0.735). Combined models achieved AUC values of 0.823 for both zPAS + zCRP and zAlvarado + zCRP, and 0.773 for zCRP + zNLR. For surgical conversion, higher within-sample AUC values were observed, reaching 0.879 for the Alvarado score and up to 0.932 for the combined models (zAlvarado + zCRP), followed by 0.926 for zPAS + zCRP and 0.874 for zCRP + zNLR. However, these results should be interpreted with caution due to the limited number of conversion events. Conclusions: Clinical scoring systems and inflammatory biomarkers suggested good ability to predict peritonitis in pediatric acute appendicitis, while their performance for predicting surgical conversion appeared higher but remains exploratory. Combined clinical–laboratory models showed promising within-sample discriminative ability; however, given the very small number of conversion events, these findings should be regarded as exploratory and hypothesis-generating only.
Background: Combined bone and soft-tissue loss of the lower extremity requires complex reconstructive pathways. While acute post-traumatic infected defects and chronic osteomyelitis differ clinically, both present reconstructive challenges that demand radical debridement, infection-directed therapy, and radiology-guided soft-tissue coverage. Objective: To evaluate treatment options and functional recovery using a standardized orthoplastic workflow supported by radiological planning in patients with lower-extremity combined bone and soft-tissue loss of acute traumatic infectious etiology and chronic osteomyelitis. Methods: In this retrospective case series, 27 patients treated between May 2021 and December 2023 were included and divided into two groups: (A) acute post-traumatic bone and soft-tissue loss (n = 17) and (B) chronic osteomyelitis with fistula and soft-tissue loss (n = 10). Patients received multidisciplinary orthoplastic management with local and/or free flaps selected according to defect characteristics and radiology-guided vascular assessment (CT/MRI and angiographic CT; Doppler ultrasound for regional flap planning). Empirical broad-spectrum antibiotics were started after intraoperative biopsy sampling and later tailored to microbiological results. Healing was defined by bone union, infection/inflammation resolution, and flap healing. Functional outcomes were assessed using the Lower Limb Functional Index (LLFI). Due to baseline differences and a small sample size, within-group pre- vs. post-treatment changes in LLFI were analyzed separately. Results: Both groups demonstrated clinically relevant improvements in LLFI after treatment when assessed within each group. Flap selection and antibiotic strategy were implemented according to predefined multidisciplinary endpoints, achieving the study healing criteria in the included patients. Conclusions: A standardized orthoplastic reconstruction strategy supported by radiology-guided planning appears feasible in distinct clinical contexts of acute infected traumatic defects and chronic osteomyelitis, with improvement in lower-limb function assessed within groups.
Laser technology has recently gained renewed interest in hysteroscopic surgery due to advances in fiber-optic delivery systems, device miniaturization, and the growing adoption of office-based procedures. In this context, laser energy represents a potential alternative to conventional mechanical and electrosurgical techniques, particularly in settings where precision and tissue preservation are clinically relevant. This narrative review provides a comprehensive and clinically oriented overview of the role of laser technology in modern hysteroscopy. A literature search was conducted in PubMed, Scopus, and Web of Science up to December 2025, focusing on studies addressing technical aspects, clinical applications, safety, and outpatient feasibility of laser-assisted hysteroscopy. Different laser systems, including Nd:YAG, diode, CO2, Ho:YAG, and KTP lasers, are discussed in terms of physical properties and tissue interaction. Current clinical applications include the management of intrauterine adhesions, submucous myomas, endometrial polyps, septate uterus, and selected cases of endometrial ablation. Available evidence suggests that modern diode laser platforms are particularly suited for office-based procedures due to their combined cutting and coagulative effects and compatibility with small-caliber hysteroscopes. However, most of the current literature is based on small, heterogeneous studies, and robust comparative data with standard hysteroscopic techniques remain limited. As a result, laser hysteroscopy cannot yet be considered a standard approach across indications. To move beyond a purely technical appraisal, this review also frames laser hysteroscopy as a potential translational platform in which laser–tissue interaction, biomarker-informed patient selection, endometrial repair biology, fertility outcomes, and adhesion-formation mechanisms may be integrated into future functional precision medicine pathways. In conclusion, laser technology represents a promising and evolving tool in operative hysteroscopy, with potential advantages in selected clinical scenarios. Further prospective and comparative studies are required to better define its role and to support its broader integration into routine clinical practice.
Background: The Plantaris tendon is a viable option for tendon grafting in various reconstructive procedures. This study aimed to develop a predictive model estimating plantaris tendon length (PTL) based on lower leg length (LL) to provide a preoperative baseline reference. Methods: An investigation was conducted on 238 lower limb sides from Thai cadavers to determine the prevalence and morphometry of the plantaris muscle. Measurements included PTL, tendon width (PTW), muscle belly length (PBL), total muscle length (PML), and LL. Results: The plantaris muscle was present in 88.24% of lower limb sides. A significant correlation was observed between PTL and LL (r = 0.581, p < 0.001). The predictive equation established was: PTL (mm) = 79.167 + [0.574 × LL (mm)], with a standard error of estimate of 20.06 mm. Testing on a separate sample showed no significant difference between predicted and actual PTL values (p = 0.206). Out of the 179 sides measured, 64.80% met the criteria for tendon graft suitability. Conclusions: These findings indicate that LL serves as a practical surface measurement providing an approximate preoperative estimate of PTL in a Thai population. Due to its moderate predictive power, it should be used as a supplementary assessment rather than a sole planning tool for surgical applications.
Background: Older adults undergoing non-cardiac surgery are vulnerable to perioperative complications, but the prognostic value of routine echocardiographic markers in high-acuity cohorts remains incompletely defined. Methods: This secondary analysis of a prospective cohort included 503 consecutive adults with known cardiovascular disease undergoing non-cardiac surgery, characterized by a high proportion of urgent presentations. Patients were stratified by age (geriatric, ≥65 years; non-geriatric, <65 years). The primary endpoint was major in-hospital adverse events (MIAEs), defined as a composite of in-hospital death, surgical reintervention, and postoperative acute kidney injury (AKI). Postoperative creatinine was not routinely measured in stable patients discharged early; therefore, renal outcomes were interpreted strictly as available-case analyses (n = 364). Results: MIAEs occurred more frequently in geriatric than in younger patients (45.5% vs. 30.8%). Within the geriatric cohort, patients with reduced LVEF (<50%) had lower MAPSE values and higher crude rates of AKI, death, and MIAE than those with LVEF ≥ 50%. In multivariable analyses, reduced LVEF was associated with MIAE, although this small subgroup was susceptible to statistical overfitting. MAPSE reflected longitudinal systolic dysfunction but did not retain independent prognostic value after adjustment. Conclusions: In this pilot subgroup analysis of high-acuity patients, reduced preoperative LVEF (<50%) served as a clinical flag identifying a high-risk geriatric phenotype with increased cardiorenal vulnerability. Given the event-enriched available-case denominator, these findings should be considered hypothesis-generating observations intended to increase clinical awareness.
Background/Objectives: Minimally invasive surgery benefits patients but places physical and cognitive demands on surgeons. While robot-assisted laparoscopic surgery (RALS) reduces musculoskeletal strain, it may increase cognitive load. This study examined whether physical and psychological preparatory protocols (warm-ups) influence surgeon strain during RALS. Methods: Ten consultant surgeons from East Lancashire Hospitals NHS Trust (UK) participated in a preregistered, randomized study. Each performed RALS under three conditions: control, physical warm-up (10 min simulation tasks on the Da Vinci system), and psychological warm-up (10 min PETTLEP-based mental imagery). Electromyography (EMG) and electroencephalography (EEG) were recorded during key surgical phases. EMG data were normalized to maximal voluntary contractions. Results: The physical warm-up significantly increased EMG activity in the right deltoid and right trapezius (p < 0.05) compared to control, with no differences observed in other muscle groups. EEG alpha power data did not significantly differ between conditions. Conclusions: These findings suggest that brief physical warm-up can enhance muscle activation in key regions involved in RALS, potentially improving motor control and reducing fatigue. Incorporating such strategies may support surgeon performance and well-being.
Intravascular papillary endothelial hyperplasia (IPEH), also known as Masson’s tumor, is a rare benign vascular lesion first described in 1923. Its pathogenesis involves thrombus formation influenced by stasis, trauma, hormones, or radiation, followed by endothelial proliferation and papillary formation. IPEH occurs in various anatomical locations, including the hand and wrist, with a predilection for the skin and subcutaneous tissues. Clinical presentation varies according to the site, ranging from asymptomatic slow-growing masses to syndromes caused by the compression of surrounding structures. Diagnosis relies on histopathology, supported by immunohistochemistry. Complete surgical excision remains the treatment of choice, with excellent prognosis and low recurrence rates.
Background/Objectives: Frontal sinus surgery remains one of the most challenging procedures in endoscopic sinus surgery due to the complex and variable anatomy of the frontal recess. While several radiological parameters have been proposed to guide surgical planning, there is no standardized anatomical classification that informs both approachability and techniques. This study aimed to develop a reproducible CT-based classification of the nasofrontal beak (NFB) and frontal ostium clearance (FOC), and to validate its surgical applicability through a two-phase design. Methods: A combined retrospective–prospective cohort study was conducted. In Phase 1, CT scans from 1383 patients (2595 sinuses) were analyzed to measure NFB and FOC lengths via a novel technique. The cutoff points were defined through histograms, kernel density estimation, and K-means clustering. In Phase 2, 100 patients (191 sinuses) who underwent frontal sinus surgery were prospectively assessed. Radiological classifications were compared with intraoperative findings, and instruments were selected on the basis of anatomical classes. Agreement between radiological and surgical classifications was analyzed, and surgical outcomes were recorded. Results: NFB and FOC were each classified into three groups: Class A (≤6 mm), Class B (6–12 mm), and Class C (≥12 mm) for NFB, and Class A (≥12 mm), Class B (6–12 mm), and Class C (≤6 mm) for FOC. There was excellent agreement between radiological and intraoperative NFB classes. Class-specific techniques included no modifications for Class A NFB, frontal sinus punches for Class B, and straight/curved drill for Class C. Only one intraoperative lamina papyracea injury and two cases of postoperative neo-ostium narrowing were reported. Significant sex-based anatomical differences and minor side-to-side asymmetries were also observed. Conclusions: This novel classification provides a reproducible, internally validated system for stratifying frontal sinus anatomy preoperatively, with good radiological–surgical concordance for the nasofrontal beak. By mapping the anatomical class onto instrument selection, it offers a practical planning adjunct. As a single-center derivation without an external cohort or comparator arm, it demonstrates anatomical–surgical concordance and feasibility rather than clinical superiority, and warrants multicenter external validation.
Context: Prosthetic rehabilitation of acquired maxillary defects with Maxillary Resection Prostheses (MRPs) remains biomechanically challenging, particularly in partially edentulous patients, where conventional clasp-retained designs often yield suboptimal retention, stability, and functional outcomes. Research Gap: The integration of telescopic crown systems with semi-precision attachments incorporating a rotational latching mechanism has not been previously described as a unified approach to optimise load distribution and prosthesis stability in maxillary defect rehabilitation. Objective: To describe and clinically evaluate a novel prosthetic design combining telescopic crowns and a semi-precision rotational latching attachment to enhance retention, stability, and functional performance of MRPs. Methodology: A 31-year-old patient with a unilateral maxillary defect following partial maxillectomy presented with an unstable interim prosthesis and impaired speech and mastication. A definitive MRP was designed using telescopic crowns on the remaining dentition to establish a controlled path of insertion and improved axial load transfer. A semi-precision attachment with a key–keyway rotational latching mechanism was incorporated into the secondary framework to engage specific undercuts while minimising lateral forces on abutment teeth. A provisional prosthesis was used for 3 months to evaluate base extension, phonetics, and functional parameters before fabrication of the definitive prosthesis. Results: Serial follow-up at 1, 3, and 6 months demonstrate consistent prosthesis stability, precise seating, and favourable retention. Marked improvements were observed in speech intelligibility, masticatory efficiency, and patient-reported comfort. Conclusions: This combined prosthetic strategy represents a novel and biomechanically optimised approach for the rehabilitation of partially edentulous maxillary defects, with promising clinical and functional outcomes.
Background: Several surgical techniques are available for the treatment of thumb trapeziometacarpal (TMC) osteoarthritis. Trapeziectomy with ligament reconstruction and tendon interposition (LRTI) is a widely accepted procedure, while suspensionplasty techniques have been introduced to improve first metacarpal stability after trapeziectomy. A simplified transosseous suture suspensionplasty (SUSP) has recently been introduced as an alternative to implant-based constructs, but comparative clinical data remain limited. This study aimed to compare the clinical and functional outcomes between LRTI and SUSP techniques in patients with TMC osteoarthritis. Methods: A retrospective comparative study was conducted on 54 consecutive patients treated surgically for TMC osteoarthritis between 2018 and 2022. Thirty-three patients underwent trapeziectomy with ligament reconstruction and tendon interposition (LRTI group), and 21 underwent trapeziectomy with transosseous suture suspensionplasty (SUSP group). At a minimum follow-up of 2 years, 44 patients were available for evaluation. Assessments were performed using DASH, 10 cm VAS, key pinch strength, Kapandji score, and radial/palmar abduction. Results: At 2 years, there were no significant between-group differences in DASH (median 4 vs. 16.5; p = 0.190), VAS (2.0 ± 2.1 vs. 2.9 ± 2.3; p = 0.235), key pinch (median 4 vs. 3 kg; p = 0.136), Kapandji score, or abduction. Both groups improved significantly over time in DASH and VAS (p < 0.001). Key pinch increased progressively in LRTI group (p < 0.001) but showed less consistent change in SUSP group. Conclusions: Both techniques provided comparable mid-term clinical and functional outcomes in patients with TMC osteoarthritis. No clear clinical advantage of suspensionplasty over tendon interposition was demonstrated. Transosseous suture suspensionplasty represents a valid alternative, while tendon interposition arthroplasty remains a reliable reference technique.
Background/Objective: Prehabilitation aims to improve physiological reserve before surgery to enhance postoperative outcomes. Multiple systematic reviews have evaluated preoperative interventions in adult cardiac surgery; however, variability in scope, methodological quality, and overlap of primary trials complicates interpretation. The aim of this study is to synthesise and critically appraise evidence from systematic reviews and meta-analyses evaluating prehabilitation interventions in adults undergoing cardiac surgery. No funding was received for this study. Methods: We conducted an umbrella systematic review following a prospectively registered protocol (PROSPERO: CRD420261292354) and PRISMA 2020 guidance. PubMed, Web of Science, and Scopus were searched from inception to 31 December 2025. Eligible reviews included adults (≥18 years) undergoing cardiac surgery, evaluated and compared preoperative inspiratory muscle training (IMT), respiratory muscle training, and exercise-based, educational, or multimodal prehabilitation with usual care or sham intervention. Reviews focused solely on postoperative interventions or non-cardiac surgery were excluded. Methodological quality was assessed using AMSTAR-2. Certainty of evidence was evaluated using GRADE. Overlap of primary studies was quantified using the Corrected Covered Area (CCA). A structured narrative synthesis with a direction-of-effect framework was applied. Results: Eighteen systematic reviews (published 2012–2025) were included, comprising 46 unique primary studies and more than 6674 participants (exact totals unavailable due to incomplete reporting in at least one review). Overall overlap was high (CCA 12.5%). Respiratory-focused prehabilitation, particularly IMT, demonstrated consistent reductions in postoperative pulmonary complications (PPCs) (risk ratios approximately 0.42–0.53), pneumonia (RR ~0.44–0.45), and atelectasis (RR ~0.49–0.59), favouring prehabilitation over usual care. Hospital length of stay was reduced by approximately 1.5–3 days across multiple reviews. Inspiratory muscle strength improved consistently (mean difference ~+12 to +17 cmH2O). Effects on ICU length of stay and mechanical ventilation duration were inconsistent or non-significant. Exercise-based programmes improved functional capacity (6 min walk distance increase ~50–75 m) and showed modest reductions in hospital stay, but heterogeneity was substantial. No intervention demonstrated a consistent reduction in postoperative mortality. Evidence was limited by clinical heterogeneity, performance bias in primary trials, inconsistent outcome definitions, and high overlap of key IMT trials across reviews. Mortality outcomes were underpowered. Conclusions: Preoperative IMT provides evidence for reducing pulmonary complications and shortening hospital stays in adult cardiac surgery. Exercise-based prehabilitation improves functional capacity but requires further high-quality, standardised trials. Integration of respiratory prehabilitation into cardiac surgical pathways appears supported by the current evidence.
Traumatic thumb loss causes severe functional impairment, as the thumb provides approximately 40% of total hand function. Toe-to-thumb transfer remains the gold standard for thumb reconstruction, yet donor site morbidity represents a significant functional and aesthetic limitation. A total thumb reconstruction using a “trimmed” right great toe transfer, combined with immediate donor site reconstruction using a free SCIP (superficial circumflex iliac perforator) flap and iliac crest bone graft. The flap was designed as a tubular skin island to create a neo-hallux with optimal contour and volume, minimizing visible scarring and avoiding microcirculatory compression. The patient, a 33-year-old man with post-traumatic thumb avulsion, underwent delayed reconstruction three months after injury. The postoperative course was uneventful, with no vascular or wound complications. At 12 months, he resumed full ambulation and manual activities, including motorcycle driving and work tasks. Baropodometric analysis demonstrated symmetric load distribution and gait dynamics. Thumb opposition was satisfactory (Kapandji score: seven); the patient rated the aesthetic results as excellent. This case demonstrates that SCIP flap reconstruction with iliac crest bone graft enables complete functional and aesthetic restoration of the great toe donor site after total toe transfer. Compared to previous techniques using cross-flaps, skin grafts, or peroneal flaps, this approach minimizes morbidity, optimizes cosmetic outcomes, and preserves gait. Although representing a single case, this constitutes the first documented instance of total hallux reconstruction following toe-to-thumb transfer, emphasizing the importance of the foot as a functional and aesthetic unit and the need for donor-site preservation in microsurgical reconstructive planning.
Background/objectives: Prostate cancer is the most common cancer in men over 60 years of age. The development of assisted robotic surgery has improved surgical performance across several variables in dynamic ways, introducing new reconstruction techniques. The present study aims to show differences between Retzius-sparing robotic-assisted prostatectomy vs. Retzius-sparing and posterolateral fascial reconstruction in patients diagnosed with localized prostate cancer. Methods: A retrospective study was performed in a 3-year time period by a single surgeon using the Da Vinci X platform. Two groups were assessed for the study, with and without posterolateral fascial reconstruction. Demographic data were analyzed with central tendency measures, and mean differences were calculated with the Mann–Whitney test and t-test, being significant if p < 0.05. Results: A total of 199 patients were included. The posterolateral reconstruction group had 81 patients, and outcomes saw similar performances to the non-reconstruction group. Urinary continence showed a positive trend of higher percentages in the first week after surgery but had similar results after one year, with no statistically significant differences. Oncologic results and sexual dysfunction showed no statistically significant differences between groups. Conclusions: Posterolateral reconstruction combined with Retzius-sparing radical prostatectomy demonstrated improved continence and was shown to be safe, without increasing overall complications such as bleeding.
Background: Interstitial ectopic pregnancy (IEP) is a rare but potentially life-threatening form of ectopic pregnancy because rupture can result in catastrophic hemorrhage. Accurate diagnosis is particularly challenging when implantation occurs near a previously operated interstitial/cornual region, where postoperative scarring and anatomical distortion may mimic recurrent IEP. We report a case of two surgically managed interstitial/cornual pregnancies at the same anatomical site, followed by a third pregnancy that initially appeared to be recurrent IEP but ultimately progressed to term delivery. Case Presentation: A 35-year-old woman underwent IVF-ET after unsuccessful intrauterine insemination and a prior failed IVF-ET attempt. After a missed abortion from the second IVF-ET cycle requiring dilatation and curettage, she conceived again through a third IVF-ET cycle. Transvaginal ultrasound demonstrated a gestational sac in the right interstitial/cornual region with outward bulging, thinning of the overlying myometrium, and delayed embryonic growth. Because of the high risk of rupture, laparoscopic wedge-shaped excision of the bulging gestational sac with uterine repair was performed. Three months later, she conceived spontaneously, and the gestational sac again developed at the previous interstitial/cornual surgical site. The surrounding myometrium was extremely thin, and serum β-hCG increased despite methotrexate treatment. Laparoscopic cornuostomy with right salpingectomy was therefore performed. After another 3-month recovery period, she conceived spontaneously again. The third pregnancy was initially suspected to represent recurrent IEP because the gestational sac was located near the same right posterior interstitial/cornual region. However, unlike the previous pregnancies, the gestational sac maintained broad contact with the endometrial cavity, showed no narrowed connection, preserved myometrial thickness of at least 5 mm, and expanded inward toward the uterine cavity rather than outward. With intensive ultrasound surveillance and fully informed consent, expectant management was continued. A healthy male infant weighing 2930 g was delivered by planned cesarean section at 37 + 0 weeks of gestation. Conclusions: This case highlights the importance of serial sonographic assessment in pregnancies suspected to be recurrent IEP. In a surgically altered cornual region, eccentric intrauterine implantation may mimic recurrent interstitial ectopic pregnancy at initial presentation. Broad communication with the endometrial cavity, absence of a narrowed connection, maintained myometrial thickness, and inward progression may help distinguish such cases from true recurrent IEP. Expectant management should be considered only in exceptional cases with hemodynamic stability, intensive imaging surveillance, immediate surgical availability, and fully informed patient consent.
Background/Objectives: Lymph node metastasis within the prostatic anterior fat pad (PAFP) is uncommon but may refine nodal staging when pelvic lymph node dissection and PSMA PET/CT are negative. Case Presentation: A 58-year-old man with PSA 59 ng/mL, negative digital rectal examination, and a PI-RADS 5 anterior lesion underwent transperineal MRI/US fusion biopsy, showing an acinar adenocarcinoma (Gleason score 5 + 5 = 10, ISUP grade group 5) confined to anterior cores. 18F-PSMA-1007 PET/CT showed intense intraprostatic uptake (SUVmax 55.2) without nodal or distant disease. Retropubic radical prostatectomy, bilateral extended pelvic lymph node dissection (ePLND), and separate PAFP submission were performed. Final pathology showed a 38 mm bilateral anterior tumor involving 35% of the prostate, focal anterior extraprostatic extension, negative margins, absent seminal vesicle and bladder neck invasion, perineural and lymphovascular invasion, and no cribriform or intraductal carcinoma. All 15 pelvic nodes were negative. One of two PAFP nodes contained a 3 mm PSA-positive metastasis without extranodal extension, resulting in pT3aN1 staging. Postoperative PSA persistence prompted radiotherapy plus androgen deprivation therapy; PSA was 0.01 ng/mL at 6 months. Conclusions: In very-high-risk anterior prostate cancer, separate PAFP evaluation may provide clinically relevant staging information when PSMA PET/CT and pelvic lymph nodes are negative. This case highlights the PAFP as a potential site of occult regional nodal disease.
Background/Objectives: Trapeziometacarpal osteoarthritis (TMC OA) is a common disabling condition. This study compared clinical and radiographic outcomes of trapeziectomy with suspension arthroplasty and dual mobility TMC joint replacement in a prospective comparative cohort study design. Methods: A prospective comparative study was conducted on 122 patients contributing 129 hands with Eaton–Littler stage II–III TMC osteoarthritis. Patients were treated with trapeziectomy with suspension arthroplasty (58 patients, 60 hands) or TMC joint replacement with a dual mobility prosthesis (64 patients, 69 hands), based on surgical indication and shared decision-making. Clinical and radiographic evaluations were performed up to 24 months postoperatively. Results: Both techniques significantly improved pain, function, range of motion, and strength (p < 0.05). Joint replacement provided faster pain relief and functional recovery, with superior strength at all follow-up points. At 12 months, pain and functional outcomes were comparable between groups. No implant loosening or failures were observed. Conclusions: Both surgical techniques are effective for TMC osteoarthritis. Dual mobility TMC joint replacement allows faster recovery and greater strength, while achieving comparable mid-term clinical outcomes to suspension arthroplasty.
Background/Objectives: Minimally invasive aortic valve replacement via right anterior thoracotomy (Mini-AVR) has been proven safe and effective. However, the restricted surgical field through this approach makes this surgery challenging and therefore limits its application. A simple modification of an exposure technique involving third-rib detachment from the sternum in a wedge shape allows for expansion of the surgical field to the left, facilitating surgical exposure and performance, which may shorten the learning curve for surgeons, and make this surgery applicable to patients with less favorable anatomy. Methods: This is a retrospective study. From 2019 to 2024, 176 patients aged 62.9 ± 17.5 years old underwent Mini-AVR via right anterior thoracotomy with third-rib detachment at our hospital in Vietnam. Results: A mechanical prosthesis was used in 98 patients (55.7%) and bioprosthesis in 78 patients (44.3%). Leftward and deep aorta position were seen in 57 (32.4%) and 18 (10.2%) patients, respectively. The aortic cross-clamp and bypass time were 78.69 ± 24.1 and 128.1 ± 26.3 min, respectively. Root enlargement was performed in 2 patients (1.1%). Conclusions: Wedge-shape detachment of the third rib from the sternum in Mini-AVR allows for expansion of the surgical field to the left, facilitating surgical exposure and performance, especially in patients with less favorable anatomy.
