Scleral fixation of intraocular lenses (SFIOL) was developed to address IOL implantation in aphakic eyes without capsular support. Leaving permanent sutures in the sclera poses long-term risks such as suture erosion or damage; thus, sutureless techniques have been developed. This article provides a comprehensive overview of multiple sutureless scleral fixation techniques for IOL implantation, discussing strengths, weaknesses, and clinical outcomes, as well as complications. This article covers the scleral tuck, fibrin glue-assisted method, Yamane flanged-haptic technique, the Carlevale self-anchoring lens, and the emerging 5F technique. Metrics such as visual acuity, refractive stability, operative time, and complications such as IOL tilt, subluxation, and macular pathologies are discussed. This review also guides on technique selection individualized to patient factors and surgeon expertise and best practices to optimize visual and surgical outcomes. Sutureless SFIOL is an effective and safe alternative to sutured SFIOL with favorable visual outcomes and operating time efficiency profiles when appropriately selected and executed.
Background/Objectives: Image guidance improves pedicle screw accuracy in pediatric spinal deformity yet may increase operative time and radiation. We evaluated the feasibility and safety of a single-scan hybrid strategy using freehand screws below the deformity apex and CT-navigated screws at apical and upper thoracic levels. Methods: We retrospectively reviewed 31 patients (24 adolescent idiopathic and 7 syndromic/neuromuscular scoliosis) undergoing posterior instrumentation with intraoperative neuromonitoring (age, 16 ± 5 years; follow-up, 19 ± 10 months). Freehand screws were placed below the apex, followed by one CT to verify them and register navigation; apical/upper thoracic screws were navigated, with alignment assessed by biplanar fluoroscopy. The primary outcome was safety; secondary outcomes were freehand screw accuracy (Gertzbein–Robbins classification), radiation dose, coronal correction, and SRS-22r scores. Results: No neurological or implant-related complications occurred. Of 278 freehand screws, 95.0% were grade A or B; four unacceptable screws (1.4%) were immediately revised with navigation. One of 282 navigated screws (0.4%) was revised after detection on a second intraoperative CT obtained for neuromonitoring changes. Effective dose was 3.80 ± 1.66 mSv per patient. Coronal correction was maintained, and the mean SRS-22r score was 4.2 ± 1.0. Conclusions: The workflow was feasible and safe, with a per-patient radiation dose corresponding to a single scan—about half that of two-scan fully navigated workflows—and high freehand accuracy on intraoperative CT. However, navigated screw accuracy may be overestimated because definitive assessment used fluoroscopy rather than postoperative CT, and the uncontrolled design does not allow conclusions on operative time, warranting prospective comparative studies.
Background: Choledocholithiasis complicates 10–15% of patients undergoing cholecystectomy. While endoscopic retrograde cholangiopancreatography (ERCP) followed by cholecystectomy is common, access to ERCP is inconsistent in rural and military hospitals, highlighting the role for single-stage laparoscopic common bile duct exploration (LCBDE). Methods: We describe a technical approach for fluoroscopy-guided, wire-based transcystic LCBDE using standardized endovascular tools, the “Biliary Endovascular Toolkit”. We performed a retrospective review of five patients undergoing cholecystectomy and transcystic LCBDE at our military hospital between May 2024 and October 2025. The operative technique employed percutaneous micropuncture sheath access, fluoroscopy-guided transcystic wire cannulation of the ampulla, and balloon dilation with sphincteroplasty for stone clearance. Results: Five patients (mean age 35.4 years) underwent single-stage cholecystectomy with transcystic LCBDE. Transcystic cannulation, duodenal wire access, and ductal clearance were successful in all cases (100%), without conversion or postoperative ERCP (0%). Mean operative time was 208 min (range 161–275). No patient experienced postoperative pancreatitis, pleural complications, or other 30-day adverse events. Conclusions: The Biliary Endovascular Toolkit offers a standardized, wire-guided workflow for transcystic LCBDE using off-the-shelf equipment. This technical note provides a practical framework for general surgeons managing choledocholithiasis, particularly in resource-limited settings.
Background: Evidence on Versius-assisted oesophagectomy remains limited. This retrospective single-centre case series describes the early implementation and outcomes of a fully minimally invasive Ivor–Lewis procedure comprising a laparoscopic abdominal phase and a Versius-assisted thoracic phase. Methods: A retrospective analysis was performed on prospectively collected data from 34 consecutive patients who underwent the RAMIE procedure using the Versius Surgical System at Klinikum Chemnitz between September 2024 and July 2025. The surgical technique consisted of a laparoscopic abdominal phase followed by a robotic thoracic phase with intrathoracic circular stapled anastomosis. The primary aim was to assess the safety and feasibility of using the Versius Surgical System in esophageal surgery. Results: The mean operative time was 329 min (range: 245–416), and the mean docking time was 11 min (range: 6–27). No conversions to laparoscopic or open procedures occurred (0%). R0 resection was achieved in 91.2% of patients. The median lymph node harvest was 28 (range: 15–44). The anastomotic leak rate was 8.8%, with no associated mortality. No deaths occurred within 90 days after surgery. Conclusions: In this initial single-centre series, the planned robotic Versius-assisted approach was completed in all patients. The observed perioperative and pathological outcomes provide preliminary descriptive evidence to support further prospective evaluation. They do not establish comparative safety, efficacy, or oncological equivalence.
Objectives: The incidence of distal gastric cancer has declined worldwide owing to successful Helicobacter pylori eradication and improvements in environmental and dietary factors. In contrast, adenocarcinoma of the esophagogastric junction (AEG) and proximal gastric cancer have become increasingly prevalent, creating a growing need for function-preserving surgical approaches. Proximal gastrectomy has emerged as an attractive alternative to total gastrectomy because of its potential advantages in nutritional preservation and postoperative quality of life. However, concerns regarding postoperative reflux esophagitis have historically limited its widespread adoption. This review aimed to summarize the evolution of reconstruction after proximal gastrectomy and evaluate the advantages, limitations, and clinical outcomes of contemporary reconstruction techniques. Methods: A narrative review of the current literature was performed, focusing on reconstruction strategies following proximal gastrectomy. Major contemporary techniques, including double-tract reconstruction (DTR), double-flap reconstruction (DFT; Kamikawa method), side-overlap fundoplication by Yamashita (SOFY), and Toupet-like fundoplication reconstruction, were reviewed. Comparative evidence regarding reflux control, nutritional outcomes, operative complexity, anastomotic complications, and postoperative quality of life was examined. Results: Substantial advances in reconstructive techniques have significantly improved functional outcomes after proximal gastrectomy. DTR provides reliable reflux prevention, reproducibility, and broad applicability in minimally invasive surgery. DFT achieves excellent anti-reflux efficacy while preserving physiological food passage through the remnant stomach. SOFY offers favorable functional outcomes with reduced technical complexity and is particularly suited to laparoscopic and robotic surgery. Toupet-like reconstruction represents a promising alternative with encouraging early clinical results. Comparative studies indicate that all contemporary anti-reflux reconstruction methods substantially reduce reflux esophagitis compared with conventional esophagogastrostomy. Although each technique demonstrates specific advantages and limitations, no single reconstruction method has consistently shown superiority across all clinically relevant outcomes, including reflux prevention, nutritional preservation, operative complexity, and quality of life. Conclusions: Modern reconstruction techniques have expanded the role of proximal gastrectomy as a function-preserving alternative to total gastrectomy for proximal gastric cancer and AEG. Current evidence suggests that DTR, DFT, SOFY, and Toupet-like reconstruction can all achieve satisfactory oncological and functional outcomes when appropriately applied. Rather than identifying a universally superior procedure, contemporary practice should emphasize individualized reconstruction based on patient characteristics, surgeon expertise, and institutional experience. Future advances in robotic surgery, perioperative care, and standardized outcome assessment are expected to further optimize long-term outcomes following proximal gastrectomy.
