Surgical Techniques Development

16 pages, 4062 KB

Open AccessReview

Arteriovenous Malformations and Fistulas of the Inferior Mesenteric Artery: A Comprehensive Literature Review and Clinical Experience

by Federica Ruggiero, Pasqualino Sirignano, Michele Rossi, Edoardo Ronconi and Francesco Stillo

Surg. Tech. Dev. 2026, 15(1), 3; https://doi.org/10.3390/std15010003 - 7 Jan 2026

Abstract

Background: inferior mesenteric arteriovenous malformations and fistulas (IMAVMs/IMAVFs) are rare but clinically significant vascular anomalies characterized by abnormal communications between arterial and venous systems, leading to major hemodynamic disturbances. These lesions may be silent or cause disabling and difficult-to-diagnose symptoms such as colonic [...] Read more.

Background: inferior mesenteric arteriovenous malformations and fistulas (IMAVMs/IMAVFs) are rare but clinically significant vascular anomalies characterized by abnormal communications between arterial and venous systems, leading to major hemodynamic disturbances. These lesions may be silent or cause disabling and difficult-to-diagnose symptoms such as colonic ischemia, portal hypertension, or even high-output cardiomyopathy. Methods: this narrative review aims to summarize current evidence on the pathophysiology, clinical features, diagnostic methods, and therapeutic management of these rare pathologies, supported by two our clinical cases. Conclusions: due to their rarity, multidisciplinary management and anatomical guided therapy are required for safe and lasting outcomes in patients with IMAVMs and IMAVFs. Full article

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9 pages, 610 KB

Open AccessArticle

Monitoring Vital Parameters Enhanced by Wireless Devices Related to Bariatric Surgery (MOVIES-Trial)

by Jai Scheerhoorn, Max Herman Funnekotter, Friso Schonck, R. Arthur Bouwman and Simon W. Nienhuijs

Surg. Tech. Dev. 2026, 15(1), 2; https://doi.org/10.3390/std15010002 - 3 Jan 2026

Abstract

Background: Obesity and its accompanying complications have an influence on diurnal rhythm, potentially causing cardiometabolic disease. This study explores how weight loss due to bariatric surgery affects circadian rhythm disruptions measurable through wearable heart rate monitors. Methods: A single-center observational study was performed, [...] Read more.

Background: Obesity and its accompanying complications have an influence on diurnal rhythm, potentially causing cardiometabolic disease. This study explores how weight loss due to bariatric surgery affects circadian rhythm disruptions measurable through wearable heart rate monitors. Methods: A single-center observational study was performed, in which patients who had undergone primary bariatric surgery 3 years ago with telemonitoring of vital parameters using a wireless accelerometer were eligible to participate. A Wilcoxon signed-rank test was conducted to evaluate the delta of, or amount of change in, circadian patterns between the baseline (before) and post-weight-loss peak, nadir, and peak–nadir heart rates. Results: In this cohort of 69 patients, 70% were female, with a median total weight loss of 31.4% towards a median BMI of 28.4 kg/m². Analysis revealed significant changes in peak–nadir excursions post-weight loss. Peak, nadir, and peak–nadir differences showed a significant reduction in values in the post-weight-loss group. No significant correlations between other clinical endpoints and change in peak–nadir excursion were found in the multivariable regression models. Conclusions: In conclusion, this study reveals significant changes in circadian heart rate patterns before and after weight loss due to metabolic surgery. The results could add to the health benefits of bariatric surgery, as it could lower the incidence of diseases associated with changes in diurnal rhythm due to obesity. However, a clear clinical explanation is lacking, as no correlation with total weight loss nor other variables was substantiated. Full article

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16 pages, 11571 KB

Open AccessCase Report

Role of Patient-Specific 3D-Printed Models for Complex Pediatric Craniocervical Junction Surgery: Case Description and Systematic Literature Review

by David S. K. Mak, Yu Tung Lo, Mark B. W. Tan, Dinesh S. Kumar and Sharon Y. Y. Low

Surg. Tech. Dev. 2026, 15(1), 1; https://doi.org/10.3390/std15010001 - 30 Dec 2025

Abstract

Background: Pediatric craniocervical junction (CCJ) anomalies consist of a unique subset of anatomically complex spine conditions. The aims of intervention are to achieve long-term stability, correct existing deformity, and prevent neurological compromise. However, surgery is challenging due to critical neurovascular and musculoskeletal structures [...] Read more.

Background: Pediatric craniocervical junction (CCJ) anomalies consist of a unique subset of anatomically complex spine conditions. The aims of intervention are to achieve long-term stability, correct existing deformity, and prevent neurological compromise. However, surgery is challenging due to critical neurovascular and musculoskeletal structures in the limited operative space of a young child. Recently, the use of three-dimensional (3D) printed models has been demonstrated to be valuable neurosurgical adjuncts. We therein report the application of a 3D-printed model for a pediatric case with a complex CCJ condition. A systematic review of the related literature is concurrently performed. Case description: A 10-year-old male presented with torticollis associated with neck pain and progressive thoracic kyphosis. Neuroimaging reported an unfused os odontoideum inferior to the basion and anterior half of the C2 vertebral body and anteriorly angulated with the C1 anterior arch. Of note, there was a large vertebral vein coursing over the left C2 lamina that was predominantly draining into the CCJ venous plexus. A radiologically derived 3D model of the patient’s CCJ was printed and used for pre-operative planning, multi-disciplinary team discussion, and detailed counseling with the patient and caregivers. The patient underwent an uneventful C1–C2 posterior screw fixation and has recovered well since. Separately, we observed there is a paucity of publications specific to this topic. Conclusions: As demonstrated, a custom-made 3D model was useful for clinicians work through technical difficulties and improve the perioperative discussion process in an otherwise difficult case. Full article

(This article belongs to the Special Issue Contemporary Surgical Strategies, Advanced Imaging, and Intelligent Technologies in Head and Neck Surgery)

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17 pages, 8945 KB

Open AccessArticle

Island Pedicle Flaps as a Suitable Method of Treatment in the Defects of the Non-Weight-Bearing Part of the Heel

by Radu Dan Necula, Bogdan-Radu Necula, Radu Vaidahazan, Claudiu Gabriel Coraiu, Adrian Burnariu and Florin Lucian Sabou

Surg. Tech. Dev. 2025, 14(4), 44; https://doi.org/10.3390/std14040044 - 16 Dec 2025

Abstract

Background: Covering the defects around the calcaneus is still a largely debatable subject. In the classical view, the defects at the level of the foot can be treated only by a free flap. In a modern approach, it has been observed that [...] Read more.

Background: Covering the defects around the calcaneus is still a largely debatable subject. In the classical view, the defects at the level of the foot can be treated only by a free flap. In a modern approach, it has been observed that for small or moderate foot defects, a local flap can be used. Methodology: In this case series, we have retrospectively selected the patients who were admitted to the orthopedic department for a calcaneal fracture and who presented soft-tissue complications during the treatment. The patients have been selected from the past five years if they have undergone reconstructive surgery with a local or regional flap. Results: By applying the inclusion and exclusion criteria, we found that out of 79 patients who have been admitted to the orthopedic department, only two patients met the criteria. Two flaps have been used to treat the defects that developed at the level of the calcaneus after traumatic injury of the foot. The reverse-flow sural flap, as a tunneled flap, had a good evolution, without vascular suffering of the flap. On the other hand, for defects at the medial level of the calcaneus, we have used the dorsalis pedis flap. The healing was fast, and the patient presented no complications at the level of the donor site. Conclusions: Both flaps presented a good evolution. We try to emphasize through this article that soft tissue defects around the non-weight-bearing area of the heel can also be treated through a non-microsurgical option. These two options can help the ortho-plastic team to manage difficult cases by avoiding a free flap or a split-thickness skin graft. Full article

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15 pages, 1626 KB

Open AccessArticle

Tractionless Arthroscopic Treatment of Suspected Hip Septic Arthritis in Adults: A Single-Center Retrospective Case Series with Minimum One-Year Follow-Up

by Nadav Graif, Ran Atzmon, Aimee Steen, Shai Factor, Samuel Belmont, Michal Dekel, Ehud Rath and Eyal Amar

Surg. Tech. Dev. 2025, 14(4), 43; https://doi.org/10.3390/std14040043 - 4 Dec 2025

Abstract

Background: Septic arthritis of the hip (SAH) requires emergent surgical intervention. While open arthrotomy has been the traditional approach, arthroscopic treatment is emerging as an effective alternative. Tractionless techniques in adult populations remain understudied. Methods: Twenty-one patients (22 hips) met inclusion criteria. Six [...] Read more.

Background: Septic arthritis of the hip (SAH) requires emergent surgical intervention. While open arthrotomy has been the traditional approach, arthroscopic treatment is emerging as an effective alternative. Tractionless techniques in adult populations remain understudied. Methods: Twenty-one patients (22 hips) met inclusion criteria. Six patients (7 hips) were excluded for age < 18 years, post-COVID osteomyelitis, prior hip surgery, or insufficient records, resulting in a final cohort of 15 patients. All fifteen patients underwent tractionless arthroscopic irrigation and debridement for suspected SAH (2014–2023). Inclusion required ≥2 clinical criteria (hip pain, limited range of motion, inability to bear weight, fever > 38 °C) AND ≥ 1 laboratory criterion (leukocytosis, elevated CRP, synovial WBC > 50,000, positive culture). Primary outcomes included Visual Analog Scale pain scores, inflammatory markers, and complications. Results: Median age was 33 years (range 20–76); 60% were female. VAS scores improved from 7 (6–10) to 1 (0–3) at discharge (p < 0.001). CRP levels decreased from 115 mg/L (35–206) to <5 mg/L (<5–9) postoperatively (p < 0.001). Positive cultures were obtained in 26.7% of cases, predominantly methicillin-sensitive Staphylococcus aureus. No perioperative complications occurred. Histopathological analysis revealed tenosynovial giant cell tumor (TGCT) in 33.3% of cases, representing an important differential diagnosis. Among non-TGCT cases, the culture-positive rate was 40%. No infection recurrence was observed during a minimum one-year follow-up. Conclusions: Tractionless arthroscopic irrigation and debridement appears effective for managing suspected SAH in adults, achieving significant improvements in pain scores and inflammatory markers without perioperative complications. This technique offers potential advantages by eliminating traction-related risks while maintaining effective joint debridement. Additionally, TGCT should be considered in the differential diagnosis of suspected SAH with culture-negative inflammatory arthropathy. Full article

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17 pages, 2268 KB

Open AccessArticle

Preservation Concept of Nerve Length During Limb Amputation to Enable Neural Prosthesis Integration: Experimental Validation on the Rat Sciatic Nerve Model

by Sorin Lazarescu, Mark-Edward Pogarasteanu, Walid Bahaa-Eddin, Bianca Mihaela Boga, Marius Razvan Ristea, Larisa Diana Ancuta, Cristin Coman, Dana Galieta Minca, Robert Daniel Dobrotă and Marius Moga

Surg. Tech. Dev. 2025, 14(4), 42; https://doi.org/10.3390/std14040042 - 4 Dec 2025

Abstract

Background/Objectives: This article brings forward a novel methodology for the intra-op approach of forearm amputation stumps to facilitate their subsequent wireless connection to a neural prosthesis. A neural prosthesis offers the amputee more motor functions compared to myoelectric prostheses, but the neural [...] Read more.

Background/Objectives: This article brings forward a novel methodology for the intra-op approach of forearm amputation stumps to facilitate their subsequent wireless connection to a neural prosthesis. A neural prosthesis offers the amputee more motor functions compared to myoelectric prostheses, but the neural prosthesis must be connected to the patient’s stump nerves. Methods: An experimental animal study was conducted on 15 Wistar rats. Under anesthesia, the sciatic nerve was carefully dissected and preserved using a folding technique to maintain maximum length without tension. Nerves were repositioned with consideration for future use with biocompatible conduits. Morphometric measurements (nerve length, external diameter, fascicle count) were performed, followed by statistical analysis of length–diameter correlations. Results: The techniques show that the length of the nerves in the amputation stump can be preserved and integrated into the muscle masses with appropriate methods and biomaterials, which ensures the transmission of motor impulses to control the movements of a prosthesis. Fibrosis and mechanical injury have a lower risk of occurring with the nerves protected in the muscle mass. Through statistical analysis we find that sciatic nerve length and diameter have a positive correlation (r = 0.71, p = 0.003), supporting anatomic plausibility for human extrapolation of results. Conclusions: The amputation technique preserves much of the nerve length and viability and is simple to perform. Neural electrode implantation can be facilitated by folding the nerve within a large muscle mass and using biomaterial conduits. Better rehabilitation of the patient may occur with the use of a prosthesis equipped with more functions and superior control. Full article

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10 pages, 3668 KB

Open AccessArticle

Clinical and Radiographic Outcomes of a Tibial Precut Technique for Severe Varus Deformity in Transfibular Total Ankle Arthroplasty: A Retrospective Case Series

by Koichiro Yano, Katsunori Ikari, Masataka Kakihana, Yuki Tochigi, Ken Okazaki and Lew C. Schon

Surg. Tech. Dev. 2025, 14(4), 41; https://doi.org/10.3390/std14040041 - 24 Nov 2025

Abstract

Background: Achieving orthogonal coronal-plane alignment in total ankle arthroplasty (TAA) remains challenging in cases with severe varus deformity. We developed a novel tibial precutting technique for use in transfibular TAA to resolve intra-articular bony conflict and enable accurate implant placement without excessive medial [...] Read more.

Background: Achieving orthogonal coronal-plane alignment in total ankle arthroplasty (TAA) remains challenging in cases with severe varus deformity. We developed a novel tibial precutting technique for use in transfibular TAA to resolve intra-articular bony conflict and enable accurate implant placement without excessive medial soft tissue release. Methods: This technique involves a controlled resection of the lateral distal tibia to eliminate impingement between the tibial plafond and talar dome. From November 2019 to June 2022, 15 patients with coronal varus deformities >15° underwent transfibular TAA using this method. Twelve patients with ≥2 years of follow-up were retrospectively evaluated. Coronal alignment was assessed using the tibiotalar angle (TTA) on weight-bearing radiographs. Clinical outcomes were measured using the Self-Administered Foot Evaluation Questionnaire (SAFE-Q) and ankle range of motion (ROM) before surgery and at final follow-up. Results: The median TTA significantly improved from 20.4° (IQR: 18.1–24.3) preoperatively to 1.8° (IQR: 0.9–3.6) at the latest follow-up (p < 0.01), indicating successful correction to neutral alignment. All SAFE-Q subscales showed statistically significant improvement (p < 0.05), and ankle ROM also increased significantly postoperatively (p < 0.05). No cases of talar subsidence, implant lucency, fibular non-union, or avascular necrosis were observed. Conclusions: These results indicate that the TIBIA #2 technique can broaden the indications for transfibular total ankle arthroplasty in severe varus deformity while delivering meaningful clinical benefit. Nevertheless, confirmation in larger, controlled, and multi-centre cohorts is required before widespread adoption. Full article

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10 pages, 1065 KB

Open AccessTechnical Note

Mandibular Ramus Vertical Augmentation in Hemifacial Microsomia: Technical Evolution from Osteogenic Distraction to Sagittal Osteotomy

by Francesco Laganà, Bruno Carlo Brevi, Alice Marzi Manfroni, Francesco Arcuri, Alessia Spinzia, Emanuela Ardito, Luigi Angelo Vaira, Marjon Sako, Edlira Baruti Papa and Bernardo Bianchi

Surg. Tech. Dev. 2025, 14(4), 40; https://doi.org/10.3390/std14040040 - 19 Nov 2025

Abstract

Introduction: Hemifacial hypoplasia is the second most common congenital craniofacial anomaly after cleft lip and palate. Mandibular ramus deficiency represents a key component of this condition, and vertical augmentation is traditionally managed with distraction osteogenesis. However, technical challenges related to device positioning and [...] Read more.

Introduction: Hemifacial hypoplasia is the second most common congenital craniofacial anomaly after cleft lip and palate. Mandibular ramus deficiency represents a key component of this condition, and vertical augmentation is traditionally managed with distraction osteogenesis. However, technical challenges related to device positioning and vector control continue to limit its reproducibility. This study aims to describe and compare three surgical techniques for mandibular ramus augmentation in hemifacial microsomia and to develop a surgical treatment algorithm based on individual anatomical characteristics and clinical complexity. Materials and Methods: From 2010 to 2022, eighteen patients with Pruzansky–Kaban grade I–IIb hypoplasia underwent staged orthodontic–surgical treatment at our institutions. The standard protocol included initial ramus vertical augmentation followed by bimaxillary osteotomy for asymmetry correction. The patients were equally divided into three groups of six patients each, based on the surgical technique employed. Three representative cases were selected to illustrate the evolution of our approach: (1) bidirectional distraction following a full-thickness osteotomy above the lingula; (2) unidirectional distraction applied to a sagittal ramus osteotomy according to Obwegeser; and (3) direct vertical augmentation with rigid fixation after sagittal osteotomy, supported by virtual surgical planning. Results: Vertical ramus augmentation of 15–25 mm was achieved in all cases. The first technique proved effective but technically demanding. The second approach improved vector control and device stability. The third, involving direct vertical augmentation with rigid fixation, simplified the procedure, reduced costs, and maintained bony contact for stable healing. Conclusions: Sagittal ramus osteotomy with direct stabilization represents a promising alternative to traditional distraction in selected patients, combining historical surgical principles with computer-assisted planning to achieve reproducible outcomes. Full article

(This article belongs to the Special Issue Contemporary Surgical Strategies, Advanced Imaging, and Intelligent Technologies in Head and Neck Surgery)

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11 pages, 3814 KB

Open AccessCase 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

Open AccessCase 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

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

Open AccessArticle

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

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

Open AccessArticle

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

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

Open AccessArticle

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

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

Open AccessArticle

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

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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20 pages, 1057 KB

Open AccessEditor’s ChoiceReview

3D-Printed Models Are an Innovation Becoming Standard in Surgical Practice—Review

by Jakub Kopeć, Justyna Kukulska and Magdalena Lewandowska

Surg. Tech. Dev. 2025, 14(3), 33; https://doi.org/10.3390/std14030033 - 22 Sep 2025

Cited by 1

Abstract

Background: Three-dimensional (3D) printing technology has rapidly emerged as a transformative tool in medicine, enabling the conversion of two-dimensional scans into highly accurate 3D models. This technology, especially when combined with artificial intelligence (AI) and advanced materials, offers numerous applications in surgical planning, [...] Read more.

Background: Three-dimensional (3D) printing technology has rapidly emerged as a transformative tool in medicine, enabling the conversion of two-dimensional scans into highly accurate 3D models. This technology, especially when combined with artificial intelligence (AI) and advanced materials, offers numerous applications in surgical planning, simulation-based training, and patient-specific care. Methods: This review examines current literature and case studies on the use of 3D printing technology in various fields of medicine, especially in surgical specialties. Key applications include surgical planning, mock surgeries, biopsy guide creation, and customized implant fabrication across various surgical fields. Results: 3D printing is transforming surgery by enabling precise visualization of tumors and critical structures, significantly enhancing preoperative planning for conditions such as bone, soft tissue (e.g., neuroblastomas), renal, and maxillofacial tumors. In reconstruction surgeries, patient-specific 3D-printed implants ensure better anatomical compatibility, particularly in maxillofacial, neurosurgical, and vascular applications. Puncture guides improve procedural accuracy in interventions like percutaneous nephrolithotripsy. Detailed anatomical models aid in simulation-based training, increasing preparedness for complex procedures. Additionally, patient-specific implants and AI-integrated decision support systems are paving the way for more personalized and efficient surgical care. Conclusions: 3D printing technology, especially when combined with AI, is reshaping modern surgery by improving both accuracy, safety, and personalized healthcare. Its applications extend across multiple specialties, offering new possibilities in surgical planning, training, and patient-specific treatments. As AI and bioprinting continue to evolve, the potential for real-time applications, such as live-printed tissue implants and enhanced decision support, could drive the next phase of innovation in various fields. Full article

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9 pages, 4552 KB

Open AccessArticle

Integrated Diagnostic and Surgical Pathway for Tracheoesophageal Fistula in Neurorehabilitation: A Case-Based Narrative Review

by Luigi Di Lorenzo, Daniela Petracca, David Iapaolo, Annarita Passarella, Sabrina Pecorelli and Carmine D'Avanzo

Surg. Tech. Dev. 2025, 14(3), 32; https://doi.org/10.3390/std14030032 - 12 Sep 2025

Abstract

Acquired tracheoesophageal fistulas (TEF) are a rare but severe complication in post-coma neurorehabilitation patients, particularly those requiring long-term tracheostomy and enteral nutrition. Early recognition and proper surgical management are critical to prevent life-threatening outcomes and functional deterioration. However, variability in clinical presentation and [...] Read more.

Acquired tracheoesophageal fistulas (TEF) are a rare but severe complication in post-coma neurorehabilitation patients, particularly those requiring long-term tracheostomy and enteral nutrition. Early recognition and proper surgical management are critical to prevent life-threatening outcomes and functional deterioration. However, variability in clinical presentation and the lack of standardized multidisciplinary pathways often delay referral to thoracic surgeons. We present the case of a young patient with severe traumatic brain injury, prolonged tracheostomy, and percutaneous endoscopic gastrostomy (PEG), who developed a TEF due to tracheal ischemic injury. Clinical suspicion arose from indirect signs—such as recurrent aspiration and air in the PEG system—the diagnosis was confirmed by bronchoscopy and sagittal CT imaging. Surgical planning was carried out in close collaboration between rehabilitation physicians and thoracic surgeons, based on shared criteria involving ventilator weaning, nutritional status, and clinical stability. This case highlights the importance of a multidisciplinary, protocol-driven approach in managing TEF. Current literature supports timely but carefully selected surgical intervention, particularly in patients who are no longer ventilator-dependent, significantly reducing perioperative mortality (reported up to 60% in ventilated patients). Recent reviews advocate for standardized surgical techniques—such as single-stage repair with muscle flap interposition—and emphasize the value of early diagnosis using a combination of bronchoscopy, videofluoroscopy, and sagittal CT. We propose a structured clinical pathway integrating neurorehabilitation and thoracic surgery, aimed at optimizing timing and surgical outcomes in patients with acquired TEF. This model may serve as a foundation for future guidelines, improving both safety and efficiency in the multidisciplinary management of this complex complication. Full article

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12 pages, 945 KB

Open AccessEditor’s ChoiceArticle

“Pantaloon” Ureteroneocystostomy for Double Ureter Kidney Grafts: A Matched Single-Center Study of Perioperative and Long-Term Outcomes over 14 Years

by Aviad Gravetz, Vladimir Tennak, Vadym Mezhybovsky, Michael Gurevich, Sigal Eisner, Dana Bielopolski, Fahim Kanani and Eviatar Nesher

Surg. Tech. Dev. 2025, 14(3), 31; https://doi.org/10.3390/std14030031 - 5 Sep 2025

Abstract

Background/Objectives: Double ureter kidney grafts raise concerns about increased urologic complications. Limited data exist on optimal surgical management due to small sample sizes in previous reports. This study evaluated outcomes using pantaloon ureteroneocystostomy in the largest reported cohort worldwide. Research Questions: [...] Read more.

Background/Objectives: Double ureter kidney grafts raise concerns about increased urologic complications. Limited data exist on optimal surgical management due to small sample sizes in previous reports. This study evaluated outcomes using pantaloon ureteroneocystostomy in the largest reported cohort worldwide. Research Questions: Does pantaloon ureteroneocystostomy achieve comparable outcomes to single ureter transplants? Are long-term graft survival and function equivalent? Should this technique be adopted as standard practice? Methods: This retrospective matched cohort study involves 2210 kidney transplantations (2010–2024). Twenty-six double ureter grafts underwent pantaloon ureteroneocystostomy with dual stenting. Controls matched 1:1 for donor type, era, and recipient characteristics. The primary outcome was urologic complications. Statistical analysis included Kaplan–Meier survival curves and Mann–Whitney U tests. Results: Groups were well matched (median age: 51 vs. 52 years, 50% living donors each). Urologic complications occurred in 3.8% double ureter versus 7.7% control grafts (p = 1.000), markedly lower than 15.4% reported in recent literature. The single complication was early urinary leak, surgically repaired. No late strictures developed. The 5-year graft survival was 96.0% vs. 92.3% (p = 1.000). The final creatinine was comparable (1.25 vs. 1.28 mg/dL, p = 0.891). Conclusions: The pantaloon technique achieves superior outcomes in the largest reported double ureter cohort, with complication rates lower than previously published series. These findings support adopting this standardized approach globally to expand donor criteria while maintaining excellent outcomes. Full article

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10 pages, 2275 KB

Open AccessArticle

The Impact of the COVID-19 Pandemic on Proximal Humerus Fractures: Clinical Implications and Management Strategies

by Gianfilippo Caggiari, Alessandro Zanzi, Giuseppe Melis, Fabrizio Quattrini and Corrado Ciatti

Surg. Tech. Dev. 2025, 14(3), 30; https://doi.org/10.3390/std14030030 - 4 Sep 2025

Abstract

Background: Proximal humerus fractures (PHFs) constitute a significant orthopedic challenge, particularly among the elderly, due to osteoporosis and comorbidities. While surgical intervention is often considered for complex fractures, non-surgical treatment (NST) has gained attention, especially during the COVID-19 pandemic, when surgical resources [...] Read more.

Background: Proximal humerus fractures (PHFs) constitute a significant orthopedic challenge, particularly among the elderly, due to osteoporosis and comorbidities. While surgical intervention is often considered for complex fractures, non-surgical treatment (NST) has gained attention, especially during the COVID-19 pandemic, when surgical resources were limited. This study evaluates the functional outcomes of patients over 65 years old who underwent NST for PHFs during the pandemic. Methods: A retrospective analysis was conducted on patients presenting with 3- or 4-part PHFs at the Hospital Marino di Alghero (Italy) between 9 March 2020 and 18 May 2020. Inclusion criteria included age over 65, conservative management, and a minimum 30-month follow-up. Seven patients were evaluated through radiographic imaging and clinical assessments, including the Constant Shoulder Score (CSS), Oxford Shoulder Score (OSS), and Disabilities of the Arm, Shoulder, and Hand Score (DASH). Functional recovery was analyzed over a 48-month period. Results: The average CSS was 69.4 (SD: 22.3), OSS was 34 (SD: 14.6), and DASH was 27.9 (SD: 30.3), indicating moderate functional recovery. One patient required surgical fixation due to excessive displacement. Tuberosity union was observed in 85.7% of cases, and complications were minimal. NST allowed patients to recover shoulder function while avoiding surgical risks, particularly during the pandemic. Conclusions: NST proved to be a viable treatment for elderly patients with PHFs, yielding satisfactory functional outcomes with minimal complications. The pandemic highlighted the importance of conservative approaches in orthopedic management, emphasizing the need for individualized treatment decisions based on patient comorbidities and fracture characteristics. Full article

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10 pages, 730 KB

Open AccessArticle

Retrospective Validation Study of a Treatment Strategy for Benign Bone Lesions in the Proximal Femur

by Naohiro Shinohara, Satoshi Nagano, Hiromi Sasaki and Noboru Taniguchi

Surg. Tech. Dev. 2025, 14(3), 29; https://doi.org/10.3390/std14030029 - 22 Aug 2025

Abstract

Background: Benign bone tumors and tumor-like lesions in the proximal femur increase the risk of pathological fractures, often requiring surgical intervention. However, no consensus exists on the optimal treatment strategy. We developed a structured approach to guide the selection of implant types (compression [...] Read more.

Background: Benign bone tumors and tumor-like lesions in the proximal femur increase the risk of pathological fractures, often requiring surgical intervention. However, no consensus exists on the optimal treatment strategy. We developed a structured approach to guide the selection of implant types (compression hip screw [CHS] or intramedullary nail [IMN]) with or without bone grafting. This study aims to validate our treatment strategy through a retrospective analysis and a review of previous surgical outcomes. Methods: We sought to validate this strategy through a retrospective analysis of 16 patients (6 males and 10 females, mean age at surgery 37.4 years [range, 16–64 years]) with primary benign bone tumors or tumor-like conditions of the proximal femur, including the femoral head and neck. Curettage and synthetic or autologous bone graft was performed according to our treatment flowchart, utilizing either CHS or IMN for internal fixation. We compared the blood loss, operative time, time to full weight bearing, and perioperative complications between the CHS and IMN groups. Results: Blood loss did not significantly differ between the CHS and IMN groups (p = 0.11), but the operative time was significantly longer in the CHS group (p < 0.01). Two CHS cases experienced local recurrence, while no postoperative fractures were observed in either group. The median time to full weight bearing was 5 weeks, consistent with previous reports. No perioperative complications were noted. Conclusions: Our strategy achieved favorable clinical outcomes. IMN was selectively used in patients with non-aggressive benign tumors not involving the femoral head and neck, yielding good results with reduced surgical invasiveness, while in those patients with aggressive disease involving the head and neck, CHS was more appropriate. This approach may serve as a practical guide for surgical decision-making in benign proximal femoral bone tumors. Full article

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