Surgical Techniques Development

21 pages, 838 KiB

Open AccessSystematic Review

Systematic Review of Hip Fractures and Regional Anesthesia: Efficacy of the Main Blocks and Comparison for a Multidisciplinary and Effective Approach for Patients in the Hospital Setting of Anesthesiology and Resuscitation

by Enrique González Marcos, Inés Almagro Vidal, Rodrigo Arranz Pérez, Julio Morillas Martinez, Amalia Díaz Viudes, Ana Rodríguez Martín, Alberto José Gago Sánchez, Carmen García De Leániz and Daniela Rodriguez Marín

Surg. Tech. Dev. 2025, 14(3), 27; https://doi.org/10.3390/std14030027 - 6 Aug 2025

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Abstract

Background: Hip fractures represent a major clinical challenge, particularly in elderly and frail patients, where postoperative pain control must balance effective analgesia with motor preservation to facilitate early mobilization. Various regional anesthesia techniques are used in this setting, including the pericapsular nerve group [...] Read more.

Background: Hip fractures represent a major clinical challenge, particularly in elderly and frail patients, where postoperative pain control must balance effective analgesia with motor preservation to facilitate early mobilization. Various regional anesthesia techniques are used in this setting, including the pericapsular nerve group (PENG) block, fascia iliaca compartment block (FICB), femoral nerve block (FNB), and quadratus lumborum block (QLB), yet optimal strategies remain debated. Objectives: To systematically review the efficacy, safety, and clinical applicability of major regional anesthesia techniques for pain management in hip fractures, including considerations of fracture type, surgical approach, and functional outcomes. Methods: A systematic literature search was conducted following PRISMA 2020 guidelines in PubMed, Scopus, Web of Science, and the virtual library of the Hospital Central de la Defensa “Gómez Ulla” up to March 2025. Inclusion criteria were RCTs, systematic reviews, and meta-analyses evaluating regional anesthesia for hip surgery in adults. Risk of bias in RCTs was assessed using RoB 2.0, and certainty of evidence was evaluated using the GRADE approach. Results: Twenty-nine studies were included, comprising RCTs, systematic reviews, and meta-analyses. PENG block demonstrated superior motor preservation and reduced opioid consumption compared to FICB and FNB, particularly in intracapsular fractures and anterior surgical approaches. FICB and combination strategies (PENG+LFCN or sciatic block) may provide broader analgesic coverage in extracapsular fractures or posterior approaches. The overall risk of bias across RCTs was predominantly low, and certainty of evidence ranged from moderate to high for key outcomes. No significant safety concerns were identified across techniques, although reporting of adverse events was inconsistent. Conclusions: PENG block appears to offer a favorable balance of analgesia and motor preservation in hip fracture surgery, particularly for intracapsular fractures. For extracapsular fractures or posterior approaches, combination strategies may enhance analgesic coverage. Selection of block technique should be tailored to fracture type, surgical approach, and patient-specific functional goals. Full article

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10 pages, 277 KiB

Open AccessSystematic Review

Autologous Fat Grafting for the Treatment of Non-Enteric Cutaneous Fistulas: A Systematic Literature Review

by Francesca Bonomi, Ettore Limido, Yves Harder, Ken Galetti and Marco De Monti

Surg. Tech. Dev. 2025, 14(3), 26; https://doi.org/10.3390/std14030026 - 4 Aug 2025

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Abstract

Background: Autologous fat grafting is increasingly used in daily clinical practice across various surgical fields, including the treatment of chronic wounds, scars, burns, and non-healing perianal fistulas. Recently, some studies have shown that non-enteric cutaneous fistulas can also benefit from adipose tissue injections, [...] Read more.

Background: Autologous fat grafting is increasingly used in daily clinical practice across various surgical fields, including the treatment of chronic wounds, scars, burns, and non-healing perianal fistulas. Recently, some studies have shown that non-enteric cutaneous fistulas can also benefit from adipose tissue injections, but the efficacy remains unclear. This study aims to systematically review the literature on fat grafting in the context of non-enteric cutaneous fistulas and to assess treatment outcomes. Methods: A comprehensive search of the PubMed/Medline database was conducted following Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines up to January 2024 without restrictions on the time period or the language of publication. Results: Seven studies meeting the inclusion criteria were analyzed, encompassing 13 patients with non-healing cutaneous fistulas treated with injections of autologous fat. The mean age of the patients was 58 ± 3 years, of which 85% had comorbidities. Fat grafting resulted in complete healing in 92% of the cases, with a mean fistula persistence of 158 days before treatment. Treatment protocols varied among patients, including preparation of the fistulous tract, fat processing techniques, and suturing of the fistulous orifice. Conclusions: The results highlight the potential of autologous fat grafting in promoting tissue regeneration and healing of non-enteric cutaneous fistulas. Standardized protocols are essential to confirm and optimize treatment efficacy and, eventually, improve patient outcomes. Further research with a larger sample size and standardization is needed to confirm fat graft efficacy. Full article

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9 pages, 1620 KiB

Open AccessTechnical Note

Endoscopic Dacryocystorhinostomy with a Piezoelectric System: How We Do It

by Riccardo Nocini, Valerio Arietti, Luca Bianconi and Luca Sacchetto

Surg. Tech. Dev. 2025, 14(3), 25; https://doi.org/10.3390/std14030025 - 29 Jul 2025

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Abstract

Endoscopic dacryocystorhinostomy (DCR) is a widely recognized and highly effective procedure. This surgical procedure is performed globally, with minimal modifications across different regions. Background/Objectives: The fundamental goal of DCR is to marsupialize the lacrimal sac into the nasal cavity, which helps eliminate epiphora [...] Read more.

Endoscopic dacryocystorhinostomy (DCR) is a widely recognized and highly effective procedure. This surgical procedure is performed globally, with minimal modifications across different regions. Background/Objectives: The fundamental goal of DCR is to marsupialize the lacrimal sac into the nasal cavity, which helps eliminate epiphora (excessive tearing) and recurrent dacryocystitis (inflammation of the tear sac). With advancements in technology, new instruments are being developed to minimize risks and maximize efficacy, ultimately improving surgeon convenience, patient safety, and quality of life. One such innovation is piezosurgery, a method of bone cutting that utilizes ultrasound vibrations. Originally prevalent in oral and maxillofacial surgery, piezosurgery is now being applied in many clinical applications. Its primary advantages include the preservation of soft tissues, precise bone cutting, and the ability to work effectively in narrow spaces. Methods: This article outlines the standard technique used at our facility for performing endoscopic dacryocystorhinostomy (DCR) with a piezoelectric system. We describe the preoperative evaluation, intraoperative techniques, and postoperative care to present what we consider the standard procedure in our clinic. Results and Conclusions: Piezosurgery’s selective cutting prevents damage to surrounding soft tissues, making it theoretically advantageous in DCR by preserving tissue integrity. Additional case–control and multicenter studies are necessary to compare its outcomes with those of traditional osteotomy, particularly in relation to the potential increase in operative time. Full article

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11 pages, 1126 KiB

Open AccessArticle

Clinical Outcomes After Endoscopic Retrograde Cholangiopancreatography Using Balloon-Assisted Enteroscopy for Benign Anastomotic Stricture of Choledochojejunostomy: A Retrospective Study

by Koh Kitagawa, Shohei Asada, Jun-ichi Hanatani, Yuki Motokawa, Yui Osaki, Tomihiro Iwata, Kosuke Kaji, Akira Mitoro and Hitoshi Yoshiji

Surg. Tech. Dev. 2025, 14(3), 24; https://doi.org/10.3390/std14030024 - 23 Jul 2025

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Abstract

Background/Objectives: Benign choledochojejunal anastomotic stricture (CJS) is a major late adverse event (AE) after choledochojejunostomy. An endoscopic method using balloon-assisted enteroscopy endoscopic retrograde cholangiopancreatography (BAE-ERCP) was recently developed for CJS. Methods: We retrospectively reviewed 45 patients (98 cases) who underwent BAE-ERCP [...] Read more.

Background/Objectives: Benign choledochojejunal anastomotic stricture (CJS) is a major late adverse event (AE) after choledochojejunostomy. An endoscopic method using balloon-assisted enteroscopy endoscopic retrograde cholangiopancreatography (BAE-ERCP) was recently developed for CJS. Methods: We retrospectively reviewed 45 patients (98 cases) who underwent BAE-ERCP for benign CJS. The primary endpoint was the success rate of ERCP. The secondary endpoints were AEs and the recurrence rate of benign CJS. Results: ERCP was successful in 36 patients (80%). Balloon dilation of the anastomosis was performed in all 36 patients in whom ERCP was successful, and temporary plastic stent (PS) placement was performed in 20 of these patients (55.6%). Three cases of PS migration and one case of portal vein thrombosis occurred as mild AEs. However, one case of intestinal perforation required emergency surgery for repair. In univariate analysis, proficiency in ERCP procedures (p = 0.019) and surgery at our hospital (p = 0.010) emerged as major factors affecting the procedural success. In univariate analysis, only the early onset of CJS within 400 days after choledochojejunostomy was extracted as a significant factor for the early recurrence of CJS after ERCP (p = 0.036). Conclusions: To ensure successful BAE-ERCP for CJS, it is essential to have proficiency in the ERCP and collect as much detailed information about prior surgery as possible before the procedure. Additionally, the risk of CJS recurrence might be high in patients in whom CJS develops early after surgery. Full article

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14 pages, 1932 KiB

Open AccessArticle

The Treatment of Three-Part Fractures of Humeral Head: A Retrospective Study to Compare Nail vs. Plate

by Francesco Roberto Evola, Michele Vecchio, Marco Vacante and Giuseppe Evola

Surg. Tech. Dev. 2025, 14(3), 23; https://doi.org/10.3390/std14030023 - 12 Jul 2025

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Abstract

Background: There are no clear guidelines to support management decisions for patients with three-part fractures of the proximal humerus. The aim of the study is to identify the treatment used and to assess the functional and radiological outcomes at follow-up. Methods: A total [...] Read more.

Background: There are no clear guidelines to support management decisions for patients with three-part fractures of the proximal humerus. The aim of the study is to identify the treatment used and to assess the functional and radiological outcomes at follow-up. Methods: A total of 126 patients were retrospectively included in the study and were divided into two groups based on the type of surgery: plate and nail group. We collected data on the patient’s sex, age, fracture type, surgery duration, fracture healing, initial and final neck–shaft angles, shoulder joint score, and complications. Results: A total of 69 patients received locking-plate internal fixation, while 77 patients underwent fixation with intramedullary nail. The two groups were comparable, with no significant differences observed in age, sex, or the number of patients. The average operation time for the locking-plate group (88.7 ± 10.5 min) was significantly longer compared to the intramedullary nail group (70.2 ± 8.3 min). The Constant–Murley score was 91.2 ± 6.7 (range 79–98) in the plate group and 90.5 ± 7.7 (range 80–98) in the nail group, with no statistically significant difference. Complications were observed in 16 patients (23.2%) of the locking-plate group and in 7 patients (9.1%) of the intramedullary nail group, with significant difference. Conclusions: Our assessment revealed no significant differences in fracture healing times, loss of reduction, or Constant–Murley scores between two groups. However, our results suggest that intramedullary nails have an advantage over locking plates in terms of reduced operation time and complications. Full article

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12 pages, 1773 KiB

Open AccessReview

Advances in 3D-Printed Implants for Facial Plastic Surgery

by Joan Birbe Foraster

Surg. Tech. Dev. 2025, 14(3), 22; https://doi.org/10.3390/std14030022 - 1 Jul 2025

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Abstract

Facial reconstruction presents complex challenges due to the intricate nature of craniofacial anatomy and the necessity for individualized treatment. Conventional reconstructive methods—such as autologous bone grafts and prefabricated alloplastic implants—pose limitations, including donor site morbidity, implant rejection, and suboptimal aesthetic results. The emergence [...] Read more.

Facial reconstruction presents complex challenges due to the intricate nature of craniofacial anatomy and the necessity for individualized treatment. Conventional reconstructive methods—such as autologous bone grafts and prefabricated alloplastic implants—pose limitations, including donor site morbidity, implant rejection, and suboptimal aesthetic results. The emergence of 3D printing technology has introduced patient-specific implants (PSIs) that enhance anatomical fit, functional restoration, and biocompatibility. This review outlines the evolution of 3D-printed implants, key materials, computer-assisted design (CAD), and their applications across trauma, oncology, congenital conditions, and aesthetics. It also addresses current challenges and explores future directions, such as bioprinting, smart implants, and drug-eluting coatings. Full article

(This article belongs to the Special Issue New Insights into Plastic Aesthetic and Regenerative Surgery)

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19 pages, 286 KiB

Open AccessReview

Surgeon Training in the Era of Computer-Enhanced Simulation Robotics and Emerging Technologies: A Narrative Review

by Simon Keelan, Mina Guirgis, Benji Julien, Peter J. Hewett and Michael Talbot

Surg. Tech. Dev. 2025, 14(3), 21; https://doi.org/10.3390/std14030021 - 27 Jun 2025

Viewed by 531

Abstract

Background: Teaching methodology has recently undergone significant evolution from traditional apprenticeship models as we adapt to ever-increasing rates of technological advancement. Big data, artificial intelligence, and machine learning are on the precipice of revolutionising all aspects of surgical practice, with far-reaching implications. [...] Read more.

Background: Teaching methodology has recently undergone significant evolution from traditional apprenticeship models as we adapt to ever-increasing rates of technological advancement. Big data, artificial intelligence, and machine learning are on the precipice of revolutionising all aspects of surgical practice, with far-reaching implications. Robotic platforms will increase in autonomy as machine learning rapidly becomes more sophisticated, and therefore training requirements will no longer slow innovation. Materials and Methods: A search of published studies discussing surgeon training and computer-enhanced simulation robotics and emerging technologies using MEDLINE, PubMed, EMBASE, Scopus, CRANE, CINAHL, and Web of Science was performed in January 2024. Online resources associated with proprietary technologies related to the subject matter were also utilised. Results: Following a review of 3209 articles, 91 of which were published, relevant articles on aspects of robotics-based computer-enhanced simulation, technologies, and education were included. Publications ranged from RCTs, cohort studies, meta-analysis, and systematic reviews. The content of eight medical technology-based websites was analysed and included in this review to ensure the most up-to-date information was analysed. Discussion: Surgeons should aim to be at the forefront of this revolution for the ultimate benefit of patients. Surgical exposure will no longer be due to incidental experiences. Rather, surgeons and trainees will have access to a complete database of simulated minimally invasive procedures, and procedural simulation certification will likely become a requisite from graduation to live operating to maintain rigorous patient safety standards. This review provides a comprehensive outline of the current and future status of surgical training in the robotic and digital era. Full article

11 pages, 2077 KiB

Open AccessTechnical Note

Laparoscopic-Assisted Percutaneous Cryoablation of Abdominal Wall Desmoid Fibromatosis: Case Series and Local Experience

by Kadhim Taqi, Jaymie Walker, Cecily Stockley, Antoine Bouchard-Fortier, Stefan Przybojewski and Lloyd Mack

Surg. Tech. Dev. 2025, 14(3), 20; https://doi.org/10.3390/std14030020 - 24 Jun 2025

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Abstract

Background: Desmoid tumors (DTs) are rare, non-metastatic but locally aggressive connective tissue neoplasms. While standard treatments include surgery, radiation, and ablation, current guidelines advocate active surveillance unless tumors progress or symptoms worsen. Cryotherapy has shown promise in treating DTs; however, its application in [...] Read more.

Background: Desmoid tumors (DTs) are rare, non-metastatic but locally aggressive connective tissue neoplasms. While standard treatments include surgery, radiation, and ablation, current guidelines advocate active surveillance unless tumors progress or symptoms worsen. Cryotherapy has shown promise in treating DTs; however, its application in rectus abdominis DTs has been limited due to proximity to critical intra-abdominal structures. Methods: This case series describes a novel approach involving laparoscopic-assisted cryoablation in three patients with rectus abdominis DTs. Laparoscopic visualization was employed to improve tumor localization and procedural safety during percutaneous cryoablation. Results: The average tumor size was 7.4 cm, and a mean of 14 cryoprobes were used per case. All patients experienced complete symptom resolution. One patient developed a complication—injury to the inferior epigastric artery—requiring embolization. Follow-up imaging at three months showed significant tumor shrinkage and necrosis in two patients. The third patient had increased lesion volume due to post-procedural hematoma, although radiological markers of cryoablation efficacy were present. Conclusions: Laparoscopic-assisted cryoablation appears to be a feasible and effective technique for treating rectus abdominis DTs, providing symptom relief and favorable early tumor response. Further studies are warranted to evaluate long-term outcomes and validate this approach in broader clinical settings. Full article

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7 pages, 4665 KiB

Open AccessCase Report

Endless-Loop Craniotomy for Revision Surgery After the Burr-Hole Evacuation of Chronic Subdural Hematoma—A Technical Note

by Artem Rafaelian, Sae-Yeon Won, Thomas M. Freiman, Florian Gessler and Daniel Dubinski

Surg. Tech. Dev. 2025, 14(3), 19; https://doi.org/10.3390/std14030019 - 21 Jun 2025

Viewed by 255

Abstract

Background and Importance: Chronic subdural hematoma (cSDH) is a common and complex neurosurgical problem, particularly in elderly patients. Revision surgery for chronic subdural hematoma can be challenging, particularly in cases with inhomogeneous, firm consistency and extensive adhesions. Clinical Presentation: In this article, we [...] Read more.

Background and Importance: Chronic subdural hematoma (cSDH) is a common and complex neurosurgical problem, particularly in elderly patients. Revision surgery for chronic subdural hematoma can be challenging, particularly in cases with inhomogeneous, firm consistency and extensive adhesions. Clinical Presentation: In this article, we present our endless-loop craniotomy technique, which offers a novel approach to address these challenges by performing the wide, curved exposure of the subdural space utilizing the already-present burr hole. This technique allows for a wide, unobstructed view of the subdural space, enabling the access and evacuation of this chronic and often adhesive subdural hematoma. Conclusion: We believe that endless-loop craniotomy is a valuable addition to the neurosurgeon’s armamentarium for managing complex cases of revision surgery in chronic subdural hematomas. Full article

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Surg. Tech. Dev., Volume 14, Issue 3 (September 2025) – 9 articles

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