ObjectiveTo systematically map the landscape of animal studies on absorbable meshes for hernia repair published from 2003 to 2025, with a focus on material types, animal models, follow-up durations, and outcome measures, and to access their implications for clinical translation.MethodsStudies published between 2003 and 2025 involving animal models of hernia repair were systematically identified and screened. Data on material classification, animal species, follow-up duration, and outcome domains were extracted and synthesized using an evidence mapping framework.ResultsA total of 165 studies covering 183 mesh types were included. Self-fabricated meshes were more commonly used than commercial products (62.3% vs 37.7%), with biologically derived materials predominating. Rats and rabbits were the primary experimental models, while follow-up durations were generally short, limiting long-term performance assessment. Although large-animal studies remained limited, their use-particularly miniature pigs and nonhuman primates-has increased in recent years due to greater physiological relevance. Histological outcomes and postoperative complications were most frequently reported, whereas long-term functional outcomes were rarely assessed. Substantial heterogeneity in scoring systems and evaluation methods was observed across studies.ConclusionPreclinical research on hernia repair materials is largely dominated by short-term, small-animal experiments using self-fabricated biologically derived meshes. Greater emphasis on large-animal models, extended follow-up, and standardized, multi-level outcome frameworks is needed to strengthen translational relevance.
BackgroundPeritoneal carcinomatosis (PC) of unknown primary origin remains a diagnostic challenge, often requiring surgical exploration and tissue sampling. Vaginal natural orifice transluminal endoscopic surgery (vNOTES) has emerged as a minimally invasive access route; however, evidence regarding its feasibility for diagnostic peritoneal assessment in this setting is limited. This study aimed to evaluate the technical feasibility of vNOTES for peritoneal exploration, biopsy acquisition, and intraoperative estimation of the Peritoneal Cancer Index (PCI).MethodsThis prospective single-center pilot study included 11 female patients with radiologically suspected PC and unknown primary malignancy. All patients underwent peritoneal exploration and biopsy via vNOTES. Intraoperative PCI was recorded and descriptively compared with preoperative radiological PCI. Perioperative outcomes and early postoperative complications were assessed.ResultsvNOTES access, peritoneal exploration, and biopsy acquisition were successfully completed in all patients without conversion. Adequate tissue samples were obtained in all cases. The mean surgical PCI was 28.9 ± 4.0, indicating advanced disease. Radiological and surgical PCI assessments showed apparent high concordance, likely influenced by the uniformly advanced disease burden. No intraoperative or major postoperative complications occurred, and all patients had an uncomplicated postoperative course.ConclusionsvNOTES appears to be a technically feasible minimally invasive approach for diagnostic peritoneal exploration and biopsy in selected patients with PC of unknown primary origin. These preliminary findings require validation in larger comparative studies to determine safety and clinical utility.
This systematic review evaluates current computer vision models and their applications in laparoscopic cholecystectomy. Using PRISMA guidelines, we analyzed studies reporting on primary computer vision model applications in laparoscopic cholecystectomy, from inception to March 2026. A total of 85 studies were included: workflow analysis (n = 26), anatomy recognition and segmentation (n = 14), safety assessment (n = 14), instrument detection (n = 12), tissue/image characterization (n = 7), event detection and scene understanding (n = 6), and surgical performance assessment (n = 6). The performance of the computer vision models in the studies was heterogeneous, with accuracy, F1-score, mean average precision, Dice coefficient, mean absolute error, and area under the receiver operating characteristic curve being commonly reported. Despite strong model performances in several studies, implementation in the clinical setting remains a challenge. We highlight the need for standardized model performance reporting, broader external and multi-institutional validation of models, and coordinated frameworks for safe and effective implementation of computer vision models in laparoscopic cholecystectomy.
PurposeLiver transection techniques in robotic liver resection (RLR) have not yet been standardized. We introduced robotic ultrasonic shears (longitudinal clustered shears [LCS]); however, the lack of an articulating joint limits operative angles. To overcome this, we implemented strategic surgical maneuvers. This study aimed to evaluate the liver transection efficiency of the robotic ultrasonic shears in RLR.MethodsFifty-three patients who underwent RLR concurrently between 2023 and 2025 were retrospectively analyzed (LCS group, n = 23; conventional [CONV] group using Maryland bipolar forceps, n = 30). We compared liver transection speed, total ischemia time, and short-term outcomes.ResultsDespite a lower proportion of low-difficulty cases in the LCS group, it demonstrated significantly higher transection speed (median: 0.71 vs 0.38 cm2/min, P < .001) and shorter total ischemia time (63 vs 78 min, P = .011). Postoperative albumin levels on days 3 and 5 were significantly higher (P = .004), and the complication rate (Clavien-Dindo grade ≥ II) was significantly lower (8.7% vs 30.0%, P = .049) in the LCS group. Multivariate analysis identified the use of LCS (P = .003) as an independent predictor of higher transection speed. Exploratory subgroup analyses confirmed that the LCS group had significantly higher transection speed in non-anatomical resections (P < .001) and significantly shorter ischemia time in anatomical resections (P = .021), although the higher transection speed in anatomical resections did not reach statistical significance.ConclusionsRobotic ultrasonic shears with optimized maneuvers significantly improve transection speed and reduce ischemia time, enhancing the efficiency of RLR.
Background/needConventional bronchoscopy has a limited ability to localize and accurately target peripheral pulmonary lesions (PPLs) because these lesions are not endoscopically visible, and obtaining three-dimensional (3D) images of the position of sampling instruments relative to the target lesion in real time is also difficult. Three-dimensional optical coherence tomography (3D-OCT) which have the special resolution of 10-µm provides higher spatial resolution than intravascular ultrasound of 100-µm for intravascular imaging and is used to support the assessment and treatment of coronary artery stenosis. In the respiratory system, 3D-OCT guidance may enable real-time 3D analysis of the spatial relationship between the sampling instrument and the target lesion during transbronchial lung biopsy (TBB), which is difficult to achieve with two-dimensional radial endobronchial ultrasound (r-EBUS).Methodology and device descriptionWe evaluated whether 3D-OCT could visualize pseudo-lesions and enable real-time assessment of the spatial relationship between the sampling instrument and the pseudo-lesion during TBB.Preliminary resultsIn three excised pig lungs, a 3D-OCT probe and ultrathin biopsy forceps were simultaneously advanced through a guide sheath placed in the bronchus to a pseudo-lesion per an excised pig lung. The probe visualized the spatial relationship between the sampling instrument and the pseudo-lesion in real time. Furthermore, 3D-OCT-guided TBB was successfully performed in three consecutive biopsies per a pseudo-lesion.Current status3D-OCT-guided TBB was feasible in an ex vivo model for sampling target lesions. These results indicate that 3D-OCT-guided bronchoscopy may help to provide the special relationship of targeting and sampling of PPLs.
BackgroundLaparoscopic cholecystectomy (LC) has revolutionised gallstone management. However, the incidence of bile duct injury (BDI) remains unchanged. Achieving the critical view of safety (CVS) is the standard endpoint of LC dissection to prevent BDI. This study aimed to identify preoperative, intraoperative, and novel predictors of CVS quality using intraoperative doublet photography.MethodsThis prospective, single-centre observational study (March 2024-January 2025) evaluated CVS achievement in patients undergoing elective LC. Experienced surgeons assessed anterior and posterior view photographs. We analysed predictors of CVS quality, including novel parameters such as critical angle, critical distance, and critical area ratio.ResultsThe study included 64 patients undergoing elective LC. CVS was satisfactory in 82.8% (53) and unsatisfactory in 17.2% (11) of the participants. Significant predictors of CVS quality included preoperative biochemical factors like erythrocyte sedimentation rate (OR: 4.06, 95% CI: 0.96-17.09, P = .05) and alanine aminotransferase (OR: 5.48, 95% CI: 1.81-25.47, P = .02); radiological findings including stone impacted at gall bladder neck (OR: 9.52, 95% CI: 1.75-51.77, P = .009); intraoperative variables such as modified Nassar grade (OR: 7.42, 95% CI: 1.72-32.00, P = .007) and Hartmann's pouch stone (OR: 4.47, 95% CI: 1.00- 19.93, P = .04); and certain novel parameters including critical angle ratio anterior (AOR: 9.87, 95% CI: 1.1-83.12, P = .03).ConclusionsThis observational study introduces simple metrics for objective CVS assessment using novel parameters such as critical angle, distance, and area to improve grading accuracy. These parameters may support artificial intelligence tools for intraoperative CVS quality assessment, promoting safer cholecystectomy and contributing to a standardised grading system.
Background Need Acute appendicitis is the most common pediatric surgical emergency. Conventional three-port laparoscopy is the mainstream surgical method currently. This study introduces a modified technique combining transumbilical two-port laparoscopy with miniature percutaneous needle-type forceps for pediatric appendectomy. Methodology and Device Description The modified procedure was performed through a transumbilical incision, employing laparoscopic needle-type forceps for pediatric appendectomy. The surgical technique utilized the following components: a 5-mm disposable laparoscopic trocar, needle-type grasping forceps, and 0- Mersilk Silk braided nonabsorbable suture. Preliminary Results A total of 30 pediatric patients were enrolled in this study, and all operations were completed by a single experienced surgeon. Relevant clinical indicators, intraoperative conditions and postoperative follow-up data were collected and analyzed. No intraoperative adverse events or postoperative complications were observed. Current Status Preliminary clinical results demonstrate that this modified transumbilical two-port laparoscopic technique is technically feasible and clinically safe for children with uncomplicated acute non-perforated appendicitis. It achieves excellent cosmetic outcomes, reduces surgical trauma, and possesses prominent clinical advantages compared with traditional laparoscopic approaches.
BackgroundCoronary artery bypass grafting (CABG) is associated with significant morbidity and mortality. Traditional risk scores, such as the Society of Thoracic Surgery (STS) and EuroSCORE II, have limitations in predicting outcomes, particularly in high-risk patients. Machine learning (ML) models may address these issues by detecting nuanced data patterns not captured by conventional methods. This systematic review and meta-analysis compared the efficacy of ML models with traditional risk scores in predicting outcomes after CABG.MethodsA comprehensive literature search of records up to August 14th 2025, was conducted using PubMed, Embase, Web of Science, and the Cochrane Library. Studies included used ML algorithms and traditional risk scores to predict all-cause mortality (in-hospital, 30-day, or longer term as reported by each study) following CABG. Data extraction and quality assessment were independently performed by two reviewers. Meta-analyses were conducted using a linear mixed-effects model, with C-statistics as the primary measure of discrimination.ResultsTwenty-six studies, comprising 565 063 participants, met the inclusion criteria. The pooled C-statistic for ML models was 0.82 (95% CI 0.79-0.85), significantly higher than the 0.73 (95% CI 0.71-0.76) for traditional risk scores (P < 0.0001). The top-performing ML model achieved a C-statistic of 0.98 (CI 0.95-1.00). Calibration was reported inconsistently across studies and was synthesised narratively rather than quantitatively. Where reported, ML calibration was generally adequate but a robust head-to-head comparison with traditional risk scores was not possible. Subgroup analyses revealed consistent superior performance of ML models across various algorithms and covariate sets.ConclusionsIn this meta-analysis of predominantly internally-validated models, ML approaches showed higher pooled discrimination than traditional risk scores for mortality after CABG. However, given the small number of pooled studies, very high between-study heterogeneity (I2 = 98%), the predominance of high risk-of-bias studies, and the scarcity of external validation, these findings should be interpreted as supporting the promise of ML rather than establishing proof of clinical superiority. Confirmatory prospective, externally validated studies are required before ML can be recommended for routine pre-operative risk stratification.
BackgroundPatient-specific three-dimensional (3D)-printed anatomical models are increasingly used for preoperative planning in spinal deformity surgery. Their potential to improve intraoperative efficiency is clinically attractive, but the available evidence remains limited. To assess whether preoperative planning assisted by patient-specific 3D-printed anatomical models improves surgical outcomes in patients undergoing surgery for non-traumatic spinal deformities and malformations, compared with conventional planning.MethodsA systematic review was conducted according to PRISMA 2020. Comparative studies evaluating patient-specific 3D-printed anatomical models for preoperative planning in pediatric or adult patients with non-traumatic spinal deformities were included. Studies primarily focused on intraoperative 3D-printed pedicle screw guides were excluded. Data on operative time, intraoperative blood loss, fluoroscopy time, and postoperative complications were extracted. Risk of bias was assessed using ROBINS-I.ResultsSix single-center comparative studies involving 344 patients were included. Operative time was reported in four studies; two showed significant reductions favoring 3D model-assisted planning, including 184.3 vs 212.3 min and 375 vs 456 min. Intraoperative blood loss was also reported in four studies; two found significantly lower blood loss in the intervention group, including 846.7 vs 1029.7 mL and 363 vs 442 mL. Postoperative complications were generally less frequent in intervention groups. Most studies were judged at serious risk of bias, and one at critical risk.ConclusionsPreoperative planning using patient-specific 3D-printed anatomical models may improve operative time and blood loss in non-traumatic spinal deformity surgery; however, the evidence remains methodologically weak, and long-term functional outcomes have not been evaluated.
Background Quality feedback is essential to surgical learning. Simulation training accelerates skill acquisition, and video-based assessment (VBA) offers proven educational benefits. However, evidence of their combined effect in real surgical cases is limited. We conducted a multi-center intervention integrating VBA and remote-asynchronous feedback for real laparoscopic cholecystectomies (LC) and the completion of an Advanced Laparoscopy Course (ALC). Users experience, and an analysis of objective performance outcomes was performed. Methods Seven general-surgery residency programs in Chile participated (2022-2025). Residents uploaded LC videos to the LAPPCLINIC platform and were randomized to receive either assessment-only or assessment + asynchronous expert feedback. Perceptions were evaluated through an online survey and focus group. Videos were assessed using OSATS and OPRS. ALC status was registered. The primary outcome was achievement of OSATS ≥20. Mixed-effects logistic regression adjusted for ALC status, feedback arm, cumulative case number, and surgical difficulty. Results Of 142 invited residents, 51 (35.9%) participated, uploading 455 videos (436 eligible). Twenty-eight residents completed the survey: 96% desired additional feedback beyond the OR. Platform feedback was rated higher than OR feedback (6.2 vs 5.25/7, P = .0065). ALC completion was independently associated with higher odds of OSATS ≥20 (OR 4.69; 95% CI 1.53-14.4; P = .0069). Feedback allocation was not significant (OR 0.40; 95% CI 0.15-1.08; P = .070). Conclusions Residents rated asynchronous feedback higher than conventional OR feedback. Completion of the ALC correlated with objectively higher surgical performance, supporting the integration of structured simulation and video-based coaching within residency curricula.
ObjectiveThis study is conducted to evaluate the clinical value of a modified ureteral stent placement technique in patients undergoing ureteroscopic surgery.MethodsA total of 138 patients with renal or ureteral calculi were randomized to receive either conventional or modified ureteral stent placement following ureteroscopic lithotripsy (69 per group). The primary outcome was the duration of postoperative hematuria, and the secondary outcomes included operative time, hospital stay, White blood cell count (WBC) and procalcitonin (PCT) levels, Ureteral Stent Symptom Questionnaire (USSQ), Generic Quality of Life Inventory-74 (GQOLI-74), stone clearance rate, postoperative complications, and 30-day readmission rates.ResultsCompared with the conventional group, the modified group had shorter hematuria duration, lower WBC and PCT levels at 2 weeks, lower USSQ scores for urinary symptoms, physical pain, and sexual life at 2 weeks, and higher GQOLI-74 scores for physical, psychological, and social function at 6 weeks (all P < .05). Operative time, hospital stay, stone clearance rate, and complication and readmission rates were similar between groups (all P > .05).ConclusionThe modified ureteral stent technique alleviates postoperative hematuria and stent-related symptoms, reduces early inflammatory responses, and improves quality of life without increasing adverse outcomes.
BackgroundArtificial intelligence (AI) and machine learning are transforming neurosurgical research and practice, yet the programming barrier has excluded most clinicians from building customized digital tools. Vibe coding - generating functional software through natural language instructions to large language models - has substantially lowered this barrier since its formalization in 2025. No study has examined its applications specifically within neurosurgery.MethodsA narrative review of the literature was conducted using PubMed, Google Scholar, and preprint repositories through April 2026, supplemented by the author's direct clinical experience developing vibe-coded tools in a tertiary neurosurgical unit.FindingsExisting literature on vibe coding in medicine is sparse and limited to non-surgical specialties; no prior publication addresses it in a neurosurgical context. Three practical domains of application are identified: (1) research data collection and multi-scale patient classification, illustrated by a personally developed integrated scoring tool for aneurysmal subarachnoid hemorrhage (Figure 1); (2) clinical workflow optimization including documentation and follow-up automation; and (3) educational tool development and literature engagement.ConclusionVibe coding represents an accessible paradigm enabling neurosurgical trainees to develop purpose-specific digital tools without programming expertise. The field lacks specialty-specific guidance on this approach. This review aims to address that gap and encourage adoption of vibe coding as a practical complement to institutional digital health infrastructure.
NeedDuring deep brain stimulation (DBS) surgery, the base ring of the burr hole is the main structure that anchors the DBS lead. A discrepancy between the burr hole size and ring base renders the ring unstable which in turn compromises lead stability. Burr hole size mismatch is often seen in resource-poor countries where advanced perforators, that make exact size holes are not available.Technical SolutionWe describe a simple, cost-effective technique, the screw-lock method. When there is a mismatch, titanium self-tapping screws are inserted through the holding holes of the base ring into the skull with immediate and stable fixation.Proof of ConceptThis technique not only immediately secures the base ring to the skull but also prevents accidental displacement of the DBS lead.Next StepsThe titanium screws can be included in the burr hole ring set in commercially available products. A new type of expandable burr hole rings can be designed to fit any size of burr hole.ConclusionThis is an effective method to stabilize the burr hole base ring and the DBS lead.
BackgroundRetained surgical items (RSIs) represent a significant patient safety concern in minimally invasive surgery (MIS) due to the limitations of conventional detection methods. This study evaluated the technical feasibility of a novel triple-detector radiofrequency identification (RFID) system integrated into a laparoscopic port for automated, real-time tracking and directional differentiation of surgical gauze during procedures.MethodsWe developed a prototype system integrating three RFID detectors (134.2 kHz) longitudinally into a standard 12-mm laparoscopic port. In a controlled laboratory setting, 118 pieces of RFID-tagged gauze were systematically inserted and retrieved through the port, generating 236 events. The study evaluated detection accuracy across outer, middle, and inner channels, alongside directional discrimination capability and temporal tracking performance using a laparoscopic training model.ResultsDetection rates exceeded 99% across all three channels (99.58% for the outer channel and 99.15% for middle and inner channels). Directional differentiation accuracy, based on sequential detection patterns, was 94.92% for insertion and 95.76% for removal. Anomalous patterns (4-5%), such as channel omission or duplicate detection, were observed due to passage speed or angle, but they did not impact the final determination of gauze presence or absence.ConclusionsThis proof-of-concept study demonstrates that an RFID-integrated laparoscopic port can achieve high detection (>99%) and directional accuracy (∼95%). These findings support its technical feasibility as an automated safety mechanism for potentially reducing the risk of RSIs in laparoscopic surgery; however, further validation through animal studies and clinical trials is required to confirm these results.
BackgroundAccurate preoperative staging of peritoneal carcinomatosis (PC) is crucial for planning cytoreductive surgery (CRS) and hyperthermic intraperitoneal chemotherapy (HIPEC). However, conventional imaging often underestimates disease burden. This study evaluated whether three-dimensional (3D) reconstruction based on multimodality imaging improves estimation of the peritoneal cancer index (PCI) compared with CT.MethodsWe conducted a retrospective analysis of patients with PC undergoing CRS-HIPEC between February 2022 and February 2025. Preoperative imaging included contrast-enhanced CT and multimodality-based 3D reconstruction (CT, MRI, PET). Imaging-derived PCI (CT-PCI and 3D-PCI) was compared with surgical PCI (reference standard). The primary endpoint was the signed difference (PCI_ref - PCI_index). Agreement was assessed using Bland-Altman analysis. Region-level diagnostic performance (sensitivity, specificity, PPV, NPV) was evaluated.ResultsAmong 62 patients undergoing 3D reconstruction, 42 were included in the final analysis. The median signed difference between imaging and surgical PCI was lower for 3D than for CT (2.0 vs 3.0), although not statistically significant (P = 0.101). Bland-Altman analysis showed a slightly lower mean bias for 3D compared with CT (+5.3 vs +6.2), indicating a tendency toward underestimation by both modalities. Region-level analysis demonstrated high specificity (>90%) but limited sensitivity, particularly in anatomically challenging areas such as the mesenteric root and small-bowel serosa.ConclusionsMultimodality-based 3D reconstruction may improve PCI estimation compared with CT alone, although differences were not statistically significant. Both approaches showed limited sensitivity in critical regions. These findings are exploratory and highlight the need for prospective validation.
PurposeThis study aimed to compare the outcomes of laparoscopic Ladd's procedure (LL) and open Ladd's procedure (OL) for the treatment of intestinal malrotation in infants and children, focusing on operative parameters, postoperative recovery, and complications through a systematic review and meta-analysis.MethodsA comprehensive literature search of PubMed, Embase, Web of Science, and the Cochrane Library was conducted up to June 2025 following PRISMA guidelines. Studies comparing LL and OL in pediatric patients (<18 years) were included. Data were analyzed using Review Manager 5.4. Mean differences (MD) and odds ratios (OR) with 95% confidence intervals (CI) were calculated using fixed- or random-effects models depending on heterogeneity.ResultsEighteen studies including 3479 patients (LL: 928; OL: 2551) met the inclusion criteria. There was no significant difference in operative time between LL and OL (MD = 9.14, 95% CI: -4.01-22.28; P = 0.17). However, LL showed shorter time to full intake (MD = -2.64 days; P < 0.001) and shorter hospital stay (MD = -3.19 days; P < 0.001). LL was associated with lower rates of adhesive bowel obstruction (OR = 0.44; P < 0.001) and overall complications (OR = 0.39; P < 0.001), but higher rates of postoperative volvulus (OR = 3.26; P = 0.002) and reoperation (OR = 1.67; P = 0.03).ConclusionsLaparoscopic Ladd's procedure offers advantages in postoperative recovery and reduced complication rates compared with the open approach, though it may carry a higher risk of volvulus and reoperation.
BackgroundDisposal of unused surgical items exacerbates the environmental footprint and costs of hospitals. Surgeon preference cards (SPCs), which specify equipment needed for surgeries, impact inventory control and wasted supplies. This study assessed the effect of SPC age on surgical waste and costs, and examined staff attitudes towards SPC systems.MethodsA random selection of elective surgeries was observed in four operating theatres (March - October 2023) at a regional public hospital in New South Wales, Australia. Wasted items per procedure and the age of SPCs were recorded. Waste cost calculations were based on hospital records. An online survey measured perioperative nursing staff and surgeon attitudes. Data analysis involved simple linear regression, descriptive and summary statistics.ResultsData from 35 of 1456 (2.4%) elective surgical procedures showed that 285 single use items were unused (median 2 per procedure, IQR 7). Each year the SPC aged, 1.6 additional items were wasted (95% CI 1.3-1.9, P < 0.01). The total waste from unused single-use items amounted to 22.4 kg (18.7 kg general waste, 1.9 kg sharps waste, and 1.9 kg recycled) and purchase price totalled $3543.07 AUD. Survey respondents (n = 36) expressed mixed opinions about the current SPC system, with concerns about waste, cost, and environmental consequences. They favoured an electronic system for its potential to enhance efficiency and patient safety but noted barriers such as resource constraints and costs.ConclusionUpdating SPCs is an effective strategy to minimise surgical waste and costs. Hospitals using paper based SPCs should consider transitioning to electronic systems for better sustainability.
BackgroundDiaphragmatic plication is a standard treatment for symptomatic unilateral diaphragmatic paralysis, but the best minimally invasive technique and reinforcement material remain debated. We evaluated a two-port VATS plication technique using porous Nitinol pledgets.MethodsThis retrospective single-center study included 30 consecutive adults with symptomatic unilateral diaphragmatic paralysis who underwent two-port VATS plication between 2018 and 2024. All procedures were performed using porous NiTi pledgets (7 × 5 × 3 mm) and non-absorbable sutures. Perioperative outcomes included operative time, blood loss, extubation, ICU use, chest tube duration, pain scores, complications, and length of stay. Functional outcomes comprised spirometry (FVC, FEV1), MRC dyspnea scores, and radiographic hemidiaphragm elevation at 1, 6, and 12 months.ResultsMean age was 61.3 ± 10.3 years; 66.7% of patients were female. Mean operative time was 123.1 ± 29.0 min and blood loss 20.3 ± 20.8 mL. Immediate extubation occurred in 86.7%; 40% required brief ICU monitoring. Chest tube duration and hospital stay were 2.2 ± 1.3 and 5.5 ± 2.9 days. Complications occurred in 13.3%, all grade I-II. At 12 months, FVC increased from 60.2 ± 12.2% to 82.1 ± 10.6%, FEV1 from 60.2 ± 14.5% to 81.1 ± 11.8%, MRC score improved from 3.8 ± 0.4 to 0.5 ± 0.6, diaphragm elevation decreased by ∼34%, and 90% of patients reported symptomatic improvement.ConclusionsTwo-port VATS diaphragmatic plication reinforced with porous NiTi pledgets demonstrates feasibility, safety, and reproducibility with sustained functional and symptomatic improvement and low morbidity. The absence of a control group precludes claims of material superiority; observed benefits primarily reflect the mechanical restoration achieved by plication itself, with porous NiTi serving as a biocompatible alternative to standard PTFE pledgets.
