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Surgical Techniques Development
Volume 14
Issue 4
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Surg. Tech. Dev., Volume 14, Issue 4 (December 2025) – 6 articles

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11 pages, 3814 KB  
Case Report
Multidisciplinary Surgical Management of a Giant Incarcerated Ventral Hernia in a Nonagenarian: A Case Report
by Fahim Kanani, Majd Khalil, Khalid Aotman, Nir Messer, Anastasiia Iserlis and Narmin Zoabi
Surg. Tech. Dev. 2025, 14(4), 39; https://doi.org/10.3390/std14040039 - 11 Nov 2025
Abstract
The operative management of complex abdominal wall hernias in nonagenarians entails significant risk, with emergent repair associated with mortality rates approaching 40%. We report the case of a functionally independent 90-year-old male presenting with a 48 h history of abdominal pain, obstipation, and [...] Read more.
The operative management of complex abdominal wall hernias in nonagenarians entails significant risk, with emergent repair associated with mortality rates approaching 40%. We report the case of a functionally independent 90-year-old male presenting with a 48 h history of abdominal pain, obstipation, and emesis, consistent with an acute-on-chronic incarcerated ventral hernia. Despite advanced age and elevated perioperative risk, multidisciplinary evaluation supported surgical intervention. Laparotomy revealed a 22 × 18 cm hernia sac harboring an elongated sigmoid and approximately 150 cm of small intestine with signs of compromised perfusion secondary to an internal constriction band. Following adhesiolysis and decompression, bowel viability was restored, and a mesh repair was performed. The postoperative course was notable for transient respiratory failure necessitating reintubation and ICU management; however, full recovery was achieved by one-month follow-up. This case demonstrates that comprehensive assessment, rather than chronological age, should guide operative decision-making in nonagenarians and underscores the feasibility of complex abdominal wall reconstruction in this cohort when supported by multidisciplinary care and perioperative resources. Full article
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7 pages, 1097 KB  
Case Report
Percutaneous Ultrasonic Debridement for Heterotopic Ossification in Plantar Fasciopathy: A Case Report
by Alejandro Fernández-Gibello, Gabriel Camuñas-Nieves, Rubén Montes-Salas, Felice Galluccio and Alfonso Martínez-Nova
Surg. Tech. Dev. 2025, 14(4), 38; https://doi.org/10.3390/std14040038 - 2 Nov 2025
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Abstract
Background and objective: Heterotopic ossification (HO) of the plantar fascia is an exceptionally rare condition, with only a few cases mentioned in the literature. In comparison, calcification of the fascia occurs more frequently, especially in cases of chronic plantar fasciitis. Tenex™, a percutaneous [...] Read more.
Background and objective: Heterotopic ossification (HO) of the plantar fascia is an exceptionally rare condition, with only a few cases mentioned in the literature. In comparison, calcification of the fascia occurs more frequently, especially in cases of chronic plantar fasciitis. Tenex™, a percutaneous ultrasonic tenotomy system initially designed for tendinopathy treatment, may offer a minimally invasive alternative to conventional surgery in selected cases of HO. So, the aim of this case report was to assess the improvement in the pain and in the foot function after a percutaneous ultrasonic debridement. Case presentation: We present the case of an 82-year-old male with a history of hypertension and hyperuricemia, who reported a two-year history of mechanical-type plantar pain described as “walking on a stone.” Radiographs and MRI confirmed heterotopic ossification at the central component of the plantar fascia. Pain and function were assessed with the Foot Function Index (FFI). Under ultrasound and fluoroscopic guidance, percutaneous ultrasonic debridement with Tenex™ was performed following tibial and sural nerve block and conscious sedation. The procedure was completed in 6 min and 29 s of cutting time. After surgery, the patient wore a protective shoe for 3 weeks, followed a relative rest protocol, and received NSAIDs for 5 days. At 48–72 h, the patient reported noticeable pain relief, with significant functional improvement after 1 month. Conclusions: This case shows how Tenex™ effectively treats plantar fascia HO. It led to quick symptom relief and functional recovery. The ultrasonic percutaneous debridement with Tenex™ was a safe and effective option compared to open surgery for this patient. However, more research is needed to set standardized treatment protocols and assess long-term results. Full article
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12 pages, 673 KB  
Article
Prospective Real-Time Screw Placement Using O-Arm Navigation
by David W. Polly, Kenneth J. Holton, Paul Brian O. Soriano, Jason J. Haselhuhn, Kari Odland, Jonathan N. Sembrano, Christopher T. Martin and Kristen E. Jones
Surg. Tech. Dev. 2025, 14(4), 37; https://doi.org/10.3390/std14040037 - 23 Oct 2025
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Abstract
Background/Objectives: A variety of techniques for pedicle screw placement exist. Efficiency claims have varied, but limited data are available to support or refute these claims. Our goal was to study our screw placement efficiency, reporting real-time screw placement using O-arm 3D navigation. Methods: [...] Read more.
Background/Objectives: A variety of techniques for pedicle screw placement exist. Efficiency claims have varied, but limited data are available to support or refute these claims. Our goal was to study our screw placement efficiency, reporting real-time screw placement using O-arm 3D navigation. Methods: We prospectively enrolled patients from July 2019 to February 2022 who were undergoing primary procedures involving thoracolumbar pedicle and pelvic screw placement with O-arm navigation. Screw time began at the first placement of the navigated probe/awl and ended once the navigated screwdriver was removed from the screw head. Confirmatory 3D scans were performed to assess all screw placements. Results: The real-time average to place pedicle screws was 2 min 9 s (SD ± 1 min 5 s); for pelvic screws, this was 3 min 36 s. Screw placement was slightly faster in pediatric patients (2 min 3 s) vs. adults (2 min 24 s), p < 0.001. Screw placement was faster in the thoracic spine (2 min 2 s) vs. the lumbosacral spine (2 min 22 s), p < 0.001. Screw placement was faster in adolescent idiopathic scoliosis (2 min 0 s) vs. all other diagnoses (2 min 24 s), p < 0.001. Screw placement performed by a single attending surgeon (2 min 24 s) was no different from dual-surgeon placement(2 min 13 s), p = 0.35. Conclusions: Our screw placement time is shorter than previously published estimates, and has a very high accuracy rate. While there are variations in how time is reported compared to the previous literature, our study serves as a benchmark for real-time screw placement for future studies. The use of navigation technology for pedicle and pelvic screw placement can be efficient. Full article
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10 pages, 1965 KB  
Article
A Modified Technique for Medial Pin Placement in Pediatric Supracondylar Humerus Fractures
by Zhi-Kang Yao, Li-Kai Kuo and Wei-Ning Chang
Surg. Tech. Dev. 2025, 14(4), 36; https://doi.org/10.3390/std14040036 - 21 Oct 2025
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Abstract
Background: Displaced pediatric supracondylar humerus fractures (PSHFs) commonly require surgical treatment. Medial pin placement can cause iatrogenic ulnar nerve injury. This study presents a modified, step-by-step cross-pinning technique for PSHFs designed to avoid iatrogenic ulnar nerve injury. Methods: We retrospectively included [...] Read more.
Background: Displaced pediatric supracondylar humerus fractures (PSHFs) commonly require surgical treatment. Medial pin placement can cause iatrogenic ulnar nerve injury. This study presents a modified, step-by-step cross-pinning technique for PSHFs designed to avoid iatrogenic ulnar nerve injury. Methods: We retrospectively included patients with PSHF (Gartland types III or IV) who underwent closed reduction and percutaneous cross-pinning at our hospital from June 2014 to December 2024. Demographic data, fracture type, and preoperative and postoperative neurological deficits were recorded. Results: A total of 40 patients (16 boys and 24 girls) with a mean age of 6.6 ± 2.2 years (range, 2–14) were included. Most injuries were type III (35/40; 87.5%), whereas five patients (12.5%) had type IV injuries. Our technique resulted in no new cases of postoperative ulnar neuropathy. Conclusions: This study describes a modified medial pin insertion technique for unstable PSHFs. Careful attention to medial pin placement can minimize iatrogenic ulnar nerve injury. Full article
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14 pages, 1587 KB  
Article
Anterior Column Reconstruction of the Thoracolumbar Spine with a Modular Carbon-PEEK Vertebral Body Replacement Device: Single-Center Retrospective Case Series of 28 Patients
by Samuel F. Schaible, Fabian C. Aregger, Christoph E. Albers, Lorin M. Benneker and Moritz C. Deml
Surg. Tech. Dev. 2025, 14(4), 35; https://doi.org/10.3390/std14040035 - 10 Oct 2025
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Abstract
Background: Carbon-fiber-reinforced polyetheretherketone (CFR-PEEK) vertebral-body replacements (VBRs) aim to mitigate subsidence, minimize imaging artifacts, and facilitate radiation planning while preserving fusion potential. We assessed the safety and efficacy of a novel modular, titanium-coated CFR-PEEK VBR (Kong®) for anterior column reconstruction (ACR) [...] Read more.
Background: Carbon-fiber-reinforced polyetheretherketone (CFR-PEEK) vertebral-body replacements (VBRs) aim to mitigate subsidence, minimize imaging artifacts, and facilitate radiation planning while preserving fusion potential. We assessed the safety and efficacy of a novel modular, titanium-coated CFR-PEEK VBR (Kong®) for anterior column reconstruction (ACR) in the thoracolumbar spine. Primary question: Does the implant safely and effectively achieve and maintain kyphosis correction after ACR for trauma and neoplasms? Methods: A single-center retrospective case series was performed on 28 patients who underwent thoracolumbar ACR with the Kong® VBR for fractures or tumors (2020–2021). The primary outcome was the bi-segmental kyphotic angle (BKA). Secondary outcomes were screw loosening, cage height loss, fusion rate, subsidence, and tilting. Clinical status was recorded with Odom criteria, Karnofsky Performance Status (KPS), and AOSpine PROST. Results: Twenty-eight patients (mean age, 61 yr; 33% female; mean follow-up, 17.7 mts) were studied. Mean postoperative BKA correction was 16.5° (p = 0.006) and remained 14.5° at final follow-up (p = 0.008); loss of correction was 2.0° (p = 0.568). Subsidence, cage height, and sagittal tilt were unchanged. Fusion (Bridwell grade I/II) was observed in 95% on CT. One deep surgical-site infection occurred. At final follow-up, 91% of patients were graded “excellent” or “good” by Odom. KPS improved by 20 points (p = 0.031), and mean AOSpine PROST was 56.9. Conclusions: Single-center early results indicate that the modular titanium-coated CFR-PEEK VBR is a safe, effective adjunct for thoracolumbar ACR in trauma and neoplasm, providing durable kyphosis correction, mechanical stability and high fusion rates and grants for improved follow-up imaging quality. Full article
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11 pages, 559 KB  
Article
From Triportal to Uniportal Video-Thoracoscopic Lobectomy: The Single Surgeon Learning Curve by CUSUM Chart and Perioperative Outcomes
by Giorgia Cerretani, Elisa Nardecchia, Elena Asteggiano, Alberto Colombo, Davide Di Natale, Luca Filipponi and Nicola Rotolo
Surg. Tech. Dev. 2025, 14(4), 34; https://doi.org/10.3390/std14040034 - 1 Oct 2025
Viewed by 417
Abstract
Background: Uniportal video-thoracoscopic lobectomy has improved postoperative outcomes in lung cancer patients. Thus, thoracic surgeons are increasingly required to learn this new approach. Methods: We evaluate the path of a single surgeon switching from triportal video-thoracoscopic lobectomy to the uniportal, using [...] Read more.
Background: Uniportal video-thoracoscopic lobectomy has improved postoperative outcomes in lung cancer patients. Thus, thoracic surgeons are increasingly required to learn this new approach. Methods: We evaluate the path of a single surgeon switching from triportal video-thoracoscopic lobectomy to the uniportal, using the cumulative sum (CUSUM) analysis, in a single center to assess the learning curve, enrolling 107 uniportal video-thoracoscopic lobectomies consecutively performed. CUSUM analysis detected how many uniportal video-thoracoscopies occur to obtain changes in mean operation time, among all procedures consecutively performed. CUSUM analysis identified the cut-off at the 67th procedure; this value was used to divide all patients into two groups: group A (first 67 patients, early phase) and group B (40 patients, experienced phase). Then, we analyze the perioperative outcomes between the two groups. Results: Gender characteristics of the two groups were statistically similar. Median operative time decreased significantly after the early phase [188 min (IQR: 151–236) vs. 170.5 (IQR: 134–202) (p-value = 0.02)], respectively. Similarly, during the second phase, the conversions rate decreased: [10 (15%) (group A) vs. 1 (2%) (group B) (p-value = 0.04)], as did the postoperative complications [28 cases (42%) vs. 9 cases (22%) (p-value = 0.04)] and the length of stay [6 days (IQR 5–9.5) vs. 5 days (IQR 4–8) (p-value = 0.04)], giving evidence of skills acquired in the second phase. Conclusions: CUSUM analysis identified 67 uniportal lobectomies, after which operative time, conversion rate, and perioperative complications significantly decreased; the moving average analysis further supports a progressive reduction in operative time. Despite prior multiportal video-thoracoscopic experience, switching to uniportal video-thoracoscopy requires a distinct learning process. Full article
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