Surgeries

Low-grade myofibroblastic sarcoma is a malignant mesenchymal tumor with myofibroblastic differentiation, characterized by a high rate of local recurrence but low metastatic potential. It is commonly identified in the head and neck region, and particularly in the oral cavity. We report the diagnostic and treatment steps of a fast-growing lesion of the lower left jaw in a 22-year-old otherwise healthy woman. Based on histological and immunohistochemical features, the diagnosis of low-grade myofibroblastic sarcoma was determined. After a careful evaluation and given the absence of established protocols, our multidisciplinary tumor board recommended segmental mandibulectomy combined with a selective neck dissection. Histopathological examination of the resected specimen confirmed a low-grade mesenchymal neoplasm with focal intermediate-grade areas, resected within oncologically safe margins. In view of the histopathological findings, the case was further discussed by the multidisciplinary tumor board, which recommended adjuvant radiotherapy. No evidence of local recurrence or metastatic disease has been observed during the 10-month postoperative follow-up. Given the rarity of this tumor and the limited number of reported cases, this case report provides further insight into its diagnosis and management and contributes to the existing evidence available for the treatment of this pathology. Full article

Background/Objectives: Preoperative patient education (PPE) has been increasingly recognized as an important component of perioperative care in patients undergoing total knee arthroplasty (TKA). This study aimed to evaluate the association between preoperative education and knowledge acquisition, functional outcomes, health-related quality of life, and anxiety levels following TKA. Methods: A prospective controlled longitudinal study included 120 patients undergoing primary TKA. Participants were allocated to an intervention group receiving structured preoperative education (n = 80) and a control group receiving standard perioperative care (n = 40). Outcomes were assessed preoperatively and at one and six months postoperatively using validated instruments, including WOMAC, KOOS, Lysholm score, RAND SF-36, and the Beck Anxiety Inventory. Knowledge levels were evaluated using a structured knowledge test. Between-group comparisons and correlation analyses were performed. Results: Patients in the intervention group demonstrated significantly higher knowledge scores following education. The intervention group demonstrated more favorable postoperative functional outcomes across follow-up assessments, reflected by lower WOMAC scores and higher KOOS and Lysholm scores. Significant improvements in health-related quality of life were observed across most RAND SF-36 domains. Anxiety levels decreased over time in both groups, with consistently lower scores observed in the intervention group. Significant correlations were identified between baseline knowledge levels and selected functional and quality-of-life outcomes. Conclusions: Structured preoperative patient education was associated with improved knowledge acquisition and more favorable postoperative functional and health-related quality-of-life outcomes following TKA. Anxiety scores decreased over time in both groups; however, anxiety-related findings should be interpreted with caution because baseline BAI scores differed between groups. These findings support the integration of structured patient education into routine perioperative care pathways for individuals undergoing total knee arthroplasty. Full article

Introduction: Chronic sacroiliac joint (SIJ) pain is a frequent cause of low-back pain and remains challenging to diagnose and treat due to complex anatomy, overlapping clinical features, and limited long-term efficacy of conventional therapies. Case Presentation: We report the case of a 74-year-old woman with chronic right-sided sacroiliitis associated with spondyloarthritis, presenting with persistent gluteal pain refractory to nonsteroidal anti-inflammatory drugs, physiotherapy, and steroid injections. The patient underwent a dual imaging-guided intra-articular injection, consisting of pre-procedural ultrasound assessment and fluoroscopy-guided needle placement to confirm intra-articular access prior to injection. Autologous adipose tissue purified through mechanical filtration, without enzymatic manipulation, was administered. Pain intensity decreased from a visual analog scale (VAS) score of 8/10 at baseline to 2/10 at three months, with sustained improvement up to 12 months, functional recovery, and discontinuation of analgesic therapy, without procedure-related complications. Conclusions: This case suggests that dual imaging-guided intra-articular injection of mechanically filtered autologous adipose tissue may be feasible in selected patients with refractory SIJ pain. No causal inference can be drawn from a single case, and further studies are required to evaluate safety and clinical effectiveness. Full article

Background/Objectives: The association between gastroesophageal reflux disease (GERD) and chronic rhinosinusitis (CRS) has been debated, with conflicting evidence regarding its magnitude and clinical significance. This systematic review and meta-analysis aimed to evaluate the epidemiological association between GERD and CRS, assess the potential pathophysiological mechanisms, and determine the impact of diagnostic methodology on the observed relationship. Methods: A literature search was conducted across PubMed, Embase, the Cochrane Library, and Web of Science for observational studies published up to January 2026. Studies reporting the prevalence or odds of GERD in adult patients with CRS compared with controls were included. Methodological quality was assessed using ROBINS-E, JBI, and Hoy et al. Data were pooled using random-effects models with Hartung–Knapp–Sidik–Jonkman adjustment. Heterogeneity was explored using subgroup and meta-regression analyses. The certainty of the evidence was graded using the GRADE approach. Results: Twenty-two studies, involving 45,618 participants, met the inclusion criteria. Patients with CRS had significantly higher odds of having GERD than controls (OR 5.39; 95% CI: 2.06–14.11; p < 0.001). This association was corroborated by longitudinal data (aOR, 1.77; 95% CI: 1.44–2.17; p < 0.0001) and genetic evidence from Mendelian randomization. Subgroup analysis revealed that the magnitude of association was significantly stronger in studies utilizing objective diagnostic tools, such as pepsin assays (OR 15.20) and pH monitoring (OR 6.94), compared to subjective questionnaires (OR 1.43). This association was significant for CRS with nasal polyps (CRSwNP) and CRS without nasal polyps (CRSsNP). Meta-regression analysis indicated a stronger association in younger populations (p = 0.034). Moderate-certainty evidence supports a positive epidemiological association between GERD and CRS, although substantial between-study heterogeneity (I² = 69–89%) and wide 95% prediction intervals limit the precision and generalizability of the pooled estimates. Conclusions: An association between GERD and CRS is observed in studies using objective markers of extraesophageal reflux, whereas the association is attenuated and not statistically significant when reflux is assessed by subjective questionnaires. Objective reflux assessment may be considered in selected patients with medically and surgically refractory CRS, but routine reflux testing in unselected CRS patients is not yet supported by the available evidence. Full article

Background/Objectives: Minimally invasive surgery benefits patients but places physical and cognitive demands on surgeons. While robot-assisted laparoscopic surgery (RALS) reduces musculoskeletal strain, it may increase cognitive load. This study examined whether physical and psychological preparatory protocols (warm-ups) influence surgeon strain during RALS. Methods: Ten consultant surgeons from East Lancashire Hospitals NHS Trust (UK) participated in a preregistered, randomized study. Each performed RALS under three conditions: control, physical warm-up (10 min simulation tasks on the Da Vinci system), and psychological warm-up (10 min PETTLEP-based mental imagery). Electromyography (EMG) and electroencephalography (EEG) were recorded during key surgical phases. EMG data were normalized to maximal voluntary contractions. Results: The physical warm-up significantly increased EMG activity in the right deltoid and right trapezius (p < 0.05) compared to control, with no differences observed in other muscle groups. EEG alpha power data did not significantly differ between conditions. Conclusions: These findings suggest that brief physical warm-up can enhance muscle activation in key regions involved in RALS, potentially improving motor control and reducing fatigue. Incorporating such strategies may support surgeon performance and well-being. Full article

Background: The Plantaris tendon is a viable option for tendon grafting in various reconstructive procedures. This study aimed to develop a predictive model estimating plantaris tendon length (PTL) based on lower leg length (LL) to provide a preoperative baseline reference. Methods: An investigation was conducted on 238 lower limb sides from Thai cadavers to determine the prevalence and morphometry of the plantaris muscle. Measurements included PTL, tendon width (PTW), muscle belly length (PBL), total muscle length (PML), and LL. Results: The plantaris muscle was present in 88.24% of lower limb sides. A significant correlation was observed between PTL and LL (r = 0.581, p < 0.001). The predictive equation established was: PTL (mm) = 79.167 + [0.574 × LL (mm)], with a standard error of estimate of 20.06 mm. Testing on a separate sample showed no significant difference between predicted and actual PTL values (p = 0.206). Out of the 179 sides measured, 64.80% met the criteria for tendon graft suitability. Conclusions: These findings indicate that LL serves as a practical surface measurement providing an approximate preoperative estimate of PTL in a Thai population. Due to its moderate predictive power, it should be used as a supplementary assessment rather than a sole planning tool for surgical applications. Full article

Background: Older adults undergoing non-cardiac surgery are vulnerable to perioperative complications, but the prognostic value of routine echocardiographic markers in high-acuity cohorts remains incompletely defined. Methods: This secondary analysis of a prospective cohort included 503 consecutive adults with known cardiovascular disease undergoing non-cardiac surgery, characterized by a high proportion of urgent presentations. Patients were stratified by age (geriatric, ≥65 years; non-geriatric, <65 years). The primary endpoint was major in-hospital adverse events (MIAEs), defined as a composite of in-hospital death, surgical reintervention, and postoperative acute kidney injury (AKI). Postoperative creatinine was not routinely measured in stable patients discharged early; therefore, renal outcomes were interpreted strictly as available-case analyses (n = 364). Results: MIAEs occurred more frequently in geriatric than in younger patients (45.5% vs. 30.8%). Within the geriatric cohort, patients with reduced LVEF (<50%) had lower MAPSE values and higher crude rates of AKI, death, and MIAE than those with LVEF ≥ 50%. In multivariable analyses, reduced LVEF was associated with MIAE, although this small subgroup was susceptible to statistical overfitting. MAPSE reflected longitudinal systolic dysfunction but did not retain independent prognostic value after adjustment. Conclusions: In this pilot subgroup analysis of high-acuity patients, reduced preoperative LVEF (<50%) served as a clinical flag identifying a high-risk geriatric phenotype with increased cardiorenal vulnerability. Given the event-enriched available-case denominator, these findings should be considered hypothesis-generating observations intended to increase clinical awareness. Full article

Background/Objectives: This investigation was performed because corticosteroid injections are commonly used for symptomatic relief in patients with meniscal deficiency, yet their effect on graft survivorship and postoperative outcomes following meniscal allograft transplantation (MAT) remains poorly understood, with limited literature specifically addressing this topic. The aim of this study is to evaluate whether preoperative intra-articular corticosteroid injections (ICS) are associated with reoperation after MAT. Secondary aims included comparing reoperation-free survival, patient-reported outcome measures (PROMs), and patient acceptable symptom state (PASS) achievement. Methods: A retrospective review of 130 adults undergoing meniscal allograft transplantation (MAT) between 2011 and 2023 was performed. Patients with documented corticosteroid injection (CSI) status and ≥2 years of follow-up were included. Exclusion criteria included prior meniscal allograft transplantation, receipt of non-corticosteroid injections (e.g., hyaluronic acid or platelet-rich plasma), concomitant osteotomy procedures, multi-ligament knee reconstruction or inadequate follow-up. Propensity score matching (2:1 no steroid: steroid) based on age, sex, body mass index, fixation technique, operative compartment, and concomitant procedures yielded 54 matched patients (35 no steroid, 19 steroid). The primary outcome was ipsilateral knee reoperation, categorized as major reoperation (revision MAT, anterior cruciate ligament reconstruction, osteochondral allograft transplantation, conversion to total knee arthroplasty, meniscectomy and meniscus repair). Minor reoperations included irrigation and debridement, lysis of adhesions or manipulation under anesthesia, hardware removal, chondroplasty, and synovectomy. Reoperation-free survival was assessed using Kaplan–Meier analysis. PROMs and PASS were compared using adjusted regression models. Statistical significance was set at p < 0.05. Results: Baseline characteristics and follow-up were comparable between groups (7.6 ± 3.5 vs. 6.6 ± 3.2 years; p = 0.30). Overall reoperation occurred in 37.1% of patients in the no-steroid group and 31.6% in the steroid group (p = 0.771). Major reoperation rates were similar (17.1% vs. 15.8%; p = 1.000. There was no significant difference in minor reoperations between groups (20.0% vs. 10.5%; p = 0.468). Kaplan–Meier analysis demonstrated no difference in reoperation-free survival (p = 0.903), with comparable survival at the 1-, 2-, and 5-year time points. No individual subtypes differed significantly between groups. PROMs and PASS achievement were also similar, with no statistically significant differences observed. Conclusions: Preoperative corticosteroid injection was not associated with increased reoperation risk, inferior reoperation-free survival, or worse patient-reported outcomes following meniscal allograft transplantation. However, given the study’s limited power, lack of detailed injection characteristics, and the use of a heterogeneous complication outcome, these findings should be interpreted cautiously, as further investigation is warranted. Full article

Background: Forearm nonunions represent a challenging clinical condition that significantly impairs upper limb function. Various surgical techniques have been proposed, including vascularized bone grafts. Although these procedures are not considered first-line treatment, they play a crucial role in complex or recalcitrant cases, particularly after failure of conventional methods, where their superior biological potential can significantly enhance bone healing. Despite the widespread use of the medial femoral condyle corticoperiosteal flap, simultaneous bilateral harvest has not been previously described in the literature. Case Presentation: We report the case of a 50-year-old male presenting with persistent nonunions of both the radius and ulna following previous osteosynthesis and revision surgery with iliac crest bone graft. The patient was successfully treated using bilateral vascularized corticoperiosteal free flaps harvested from both medial femoral condyles. Conclusions: Double vascularized corticoperiosteal free flaps may represent an effective and reliable option for the treatment of complex forearm nonunions, especially in cases with multiple previous surgical failures. To the best of our knowledge, this case represents the first report of simultaneous bilateral medial femoral condyle corticoperiosteal flap harvest. Full article

Background/Objectives: Lymph node metastasis within the prostatic anterior fat pad (PAFP) is uncommon but may refine nodal staging when pelvic lymph node dissection and PSMA PET/CT are negative. Case Presentation: A 58-year-old man with PSA 59 ng/mL, negative digital rectal examination, and a PI-RADS 5 anterior lesion underwent transperineal MRI/US fusion biopsy, showing an acinar adenocarcinoma (Gleason score 5 + 5 = 10, ISUP grade group 5) confined to anterior cores. 18F-PSMA-1007 PET/CT showed intense intraprostatic uptake (SUVmax 55.2) without nodal or distant disease. Retropubic radical prostatectomy, bilateral extended pelvic lymph node dissection (ePLND), and separate PAFP submission were performed. Final pathology showed a 38 mm bilateral anterior tumor involving 35% of the prostate, focal anterior extraprostatic extension, negative margins, absent seminal vesicle and bladder neck invasion, perineural and lymphovascular invasion, and no cribriform or intraductal carcinoma. All 15 pelvic nodes were negative. One of two PAFP nodes contained a 3 mm PSA-positive metastasis without extranodal extension, resulting in pT3aN1 staging. Postoperative PSA persistence prompted radiotherapy plus androgen deprivation therapy; PSA was 0.01 ng/mL at 6 months. Conclusions: In very-high-risk anterior prostate cancer, separate PAFP evaluation may provide clinically relevant staging information when PSMA PET/CT and pelvic lymph nodes are negative. This case highlights the PAFP as a potential site of occult regional nodal disease. Full article

Background/objectives: Prostate cancer is the most common cancer in men over 60 years of age. The development of assisted robotic surgery has improved surgical performance across several variables in dynamic ways, introducing new reconstruction techniques. The present study aims to show differences between Retzius-sparing robotic-assisted prostatectomy vs. Retzius-sparing and posterolateral fascial reconstruction in patients diagnosed with localized prostate cancer. Methods: A retrospective study was performed in a 3-year time period by a single surgeon using the Da Vinci X platform. Two groups were assessed for the study, with and without posterolateral fascial reconstruction. Demographic data were analyzed with central tendency measures, and mean differences were calculated with the Mann–Whitney test and t-test, being significant if p < 0.05. Results: A total of 199 patients were included. The posterolateral reconstruction group had 81 patients, and outcomes saw similar performances to the non-reconstruction group. Urinary continence showed a positive trend of higher percentages in the first week after surgery but had similar results after one year, with no statistically significant differences. Oncologic results and sexual dysfunction showed no statistically significant differences between groups. Conclusions: Posterolateral reconstruction combined with Retzius-sparing radical prostatectomy demonstrated improved continence and was shown to be safe, without increasing overall complications such as bleeding. Full article

Background/Objectives: In laparoscopic and robot-assisted surgery, bleeding may rapidly impair operative-field readability and procedural safety. In the broader Robin Heart teleoperation framework, interpretation of such events is relevant not only for scene understanding but also as a potential prerequisite for future safety-oriented supervisory functions under communication-degraded conditions. The aim of this study was to assess whether a deep learning model for blood segmentation could provide outputs suitable for preliminary image-level temporal characterization of visible blood-region behavior in laparoscopic video. Methods: A U-Net-based binary blood-segmentation model was implemented in-house in PyTorch and evaluated on three paired image–mask datasets: a simulated bleeding dataset prepared under controlled laboratory conditions, an internal operative laparoscopic dataset, and an external-domain subset derived from the public GynSurg dataset. Segmentation performance was assessed using 5-fold cross-validation and reported using the Dice coefficient and Intersection over Union (IoU). Training dynamics were analyzed using training and validation loss and Dice curves. Additional baseline comparisons were performed on the internal operative dataset using U-Net++ and DeepLabV3+. Temporal analysis was performed on selected video fragments, including a low-motion reference sequence without active bleeding progression, internal bleeding-related sequences, and external-domain sequences, using mask-derived descriptors and auxiliary optical-flow-based motion descriptors computed after camera-motion compensation within the detected blood-related ROI. Results: In 5-fold cross-validation, the U-Net-based model achieved Dice coefficient and IoU values of 0.915 ± 0.012 and 0.851 ± 0.019 on the simulated dataset, 0.856 ± 0.013 and 0.756 ± 0.025 on the internal operative dataset, and 0.707 ± 0.053 and 0.570 ± 0.056 on the external-domain GynSurg subset, respectively. On the internal operative dataset, the proposed model performed comparably to U-Net++ and slightly above DeepLabV3+ under the same cross-validation protocol. The temporal descriptor set differentiated low-motion reference behavior, more spatially coherent progression, rapid coherent expansion, and dynamic or motion-active progression profiles. Peak dA/dt reflected abrupt visible blood-area expansion, temporal IoU described mask stability over time, and optical-flow-based descriptors provided additional information on local motion activity within the detected blood-related ROI. Conclusions: The results support the feasibility of combining deep-learning-based blood segmentation with temporal and optical-flow-based descriptors for exploratory image-level characterization of visible blood-region behavior in laparoscopic video. Within the Robin Heart development pathway, such descriptors may, in the future, serve as candidate components of image-analysis support modules for safety-oriented teleoperative scenarios. At this stage, they should be interpreted as exploratory image-derived indicators rather than clinically validated markers of bleeding severity. Full article

Background: Periprosthetic joint infection is a severe complication after hip and knee arthroplasty, and using perioperative antibiotic prophylaxis (PABP) per guidelines and recommendations is one step in its prevention. The current study aimed to evaluate the attitude of Egyptian joint replacement surgeons toward PABP, their adherence to guidelines, and their insight into developing national guidelines. Methods: We conducted an online cross-sectional questionnaire study comprising three sections to collect information on various aspects of PABP and to gather insights into the development of national guidelines among members of the Egyptian Pelvis, Hip, and Knee Society (EPHAKS). The questionnaire targeted active practicing hip or knee replacement surgeons and was first sent by email to all members two weeks before the eighth EPHAKS annual conference. A reminder was announced during the conference, and subsequent email reminders were sent one week apart after the conference. The study was registered in clinicaltrials.gov (NCT06451224). Results: Out of 469 EPHAKS members, and among the 434 successfully delivered email invitations, 105 responded, giving a response rate of 24.2%. All were males, with a mean age of 42.98 ± 10.12 years; a total of 70.5% were consultants, and 13.3% performed more than 100 procedures annually. Most participants reported not following national or international guidelines, with response percentages of 80.9% and 62.9%, respectively. Consultants and surgeons performing more than 50 procedures annually showed significantly higher adherence to guidelines than others, with p-values of 0.046 and 0.004, respectively. Adherence to national or international guidelines for prescribing first- or second-generation cephalosporins was reported by 65.7% (preoperatively) and 59% (postoperatively). Only 9.5% reported prescribing antibiotics for the first 24 h postoperatively. Overall, 80% agreed that Egyptian patients are different and that PABP international guidelines do not suit them, and 98.1% agreed that developing national Egyptian PJI prevention guidelines is necessary owing to deficiencies and the broad applicability of the current national guidelines. Conclusions: Egyptian joint replacement surgeons rarely adhere to national or international guidelines for PABP, with higher adherence noticed among more experienced surgeons. The majority agreed that our patients are different and that international guidelines might not suit them, and nearly all participants expressed a strong desire to develop national guidelines. Full article

Background: Anterior cruciate ligament reconstruction (ACLR) is a common orthopedic procedure with generally favorable outcomes, yet graft failure remains a significant challenge, particularly in young and active patients. While various anatomical and biomechanical risk factors for graft failure have been proposed, the influence of the sagittal tibial tubercle–trochlear groove (sTTTG) distance, representing anterior–posterior alignment of the tibial tubercle, has not been sufficiently explored. This study aimed to evaluate the association between sTTTG and ACL graft failure and assess contributing biomechanical variables, including tibiofemoral rotation (TFR), posterior tibial slope (PTS), and knee flexion angle. Methods: For this secondary analysis, a retrospective matched case–control study was conducted, involving 151 patients with ACL graft failure who underwent revision ACLR and 151 controls with intact grafts after a minimum 2-year follow-up period. sTTTG was measured on axial MRI as the anteroposterior distance from the trochlear groove to the tibial tubercle, perpendicular to the posterior femoral condylar axis. Secondary measurements included TT-TG, TFR, medial and lateral PTS, and knee flexion angle. Group differences as well as factors predictive of sTTTG were analyzed. Results: The ACLR failure group demonstrated a significantly lower sTTTG distance compared to controls (0.5 ± 4.6 mm vs. 2.4 ± 4.8 mm, p = 0.001). Logistic regression analysis revealed that a 1 mm increase in sTTTG was associated with an 8% reduction in revision risk (OR = 0.93 per 1 mm increase; 95% CI, 0.88–0.97; p = 0.003), although the predictive accuracy was low (AUC = 0.6). Multivariable analysis identified lateral PTS and knee flexion as significant independent predictors of sTTTG. Conclusions: A decreased sTTTG distance was significantly associated with ACL graft failure, underscoring the relevance of sagittal tibial tubercle positioning in ACL biomechanics. While not an independent clinical decision-making tool, sTTTG appears relevant to graft failure and may be considered in future risk assessment strategies. Full article

Background/Objectives: Robot-assisted surgery (RAS) has grown rapidly over the past few decades. To determine the effect of high stress levels on the performance of RAS, monitoring some parameters of surgeons is critical. This can be aided by the development of Artificial Intelligence (AI), which has exponentially grown in recent years. This study aims to predict the surgeon’s stress level based on ergonomic, kinematic and physiological parameters of the surgeon obtained in the immediately previous situation during RAS activities. Methods: Physiological data were recorded from surgeons during twenty-six surgical sessions involving twelve participants with different levels of experience and surgical specialties. After dataset generation, two preprocessing procedures (scaling and normalization) were applied to the recorded signals. The processed data were then partitioned into two subsets: 80% of the samples were used for model training and cross-validation, while the remaining 20% were reserved for testing. Six AI approaches were evaluated to build predictive models: multiple linear regression (MLR), a support vector machine (SVM), a multilayer perceptron (MLP), a convolutional neural network (CNN), random forest (RF), and a U-Net algorithm (UNET). These algorithms were trained using the training dataset and subsequently assessed on the independent test set. In addition, after each surgical session, surgeons completed a questionnaire reporting their perceived stress level, which was later compared with the stress estimates generated by the predictive models. Results: The results obtained showed that MLR and scaling pre-processing reached the highest R² coefficients and the lowest error for each studied parameter. The results of the surgeons’ surveys were highly correlated for microsurgery activities (R² = 0.7989) and for laparoscopy RAS (R² = 0.8381). Conclusions: The linear models proposed were correctly validated on cross-validation and the test dataset. This fact demonstrates the possibility of predicting factors that help us to improve the surgeon’s health during RAS. Full article

Background: Interstitial ectopic pregnancy (IEP) is a rare but potentially life-threatening form of ectopic pregnancy because rupture can result in catastrophic hemorrhage. Accurate diagnosis is particularly challenging when implantation occurs near a previously operated interstitial/cornual region, where postoperative scarring and anatomical distortion may mimic recurrent IEP. We report a case of two surgically managed interstitial/cornual pregnancies at the same anatomical site, followed by a third pregnancy that initially appeared to be recurrent IEP but ultimately progressed to term delivery. Case Presentation: A 35-year-old woman underwent IVF-ET after unsuccessful intrauterine insemination and a prior failed IVF-ET attempt. After a missed abortion from the second IVF-ET cycle requiring dilatation and curettage, she conceived again through a third IVF-ET cycle. Transvaginal ultrasound demonstrated a gestational sac in the right interstitial/cornual region with outward bulging, thinning of the overlying myometrium, and delayed embryonic growth. Because of the high risk of rupture, laparoscopic wedge-shaped excision of the bulging gestational sac with uterine repair was performed. Three months later, she conceived spontaneously, and the gestational sac again developed at the previous interstitial/cornual surgical site. The surrounding myometrium was extremely thin, and serum β-hCG increased despite methotrexate treatment. Laparoscopic cornuostomy with right salpingectomy was therefore performed. After another 3-month recovery period, she conceived spontaneously again. The third pregnancy was initially suspected to represent recurrent IEP because the gestational sac was located near the same right posterior interstitial/cornual region. However, unlike the previous pregnancies, the gestational sac maintained broad contact with the endometrial cavity, showed no narrowed connection, preserved myometrial thickness of at least 5 mm, and expanded inward toward the uterine cavity rather than outward. With intensive ultrasound surveillance and fully informed consent, expectant management was continued. A healthy male infant weighing 2930 g was delivered by planned cesarean section at 37 + 0 weeks of gestation. Conclusions: This case highlights the importance of serial sonographic assessment in pregnancies suspected to be recurrent IEP. In a surgically altered cornual region, eccentric intrauterine implantation may mimic recurrent interstitial ectopic pregnancy at initial presentation. Broad communication with the endometrial cavity, absence of a narrowed connection, maintained myometrial thickness, and inward progression may help distinguish such cases from true recurrent IEP. Expectant management should be considered only in exceptional cases with hemodynamic stability, intensive imaging surveillance, immediate surgical availability, and fully informed patient consent. Full article

Background/Objectives: Open fasciectomy is the standard treatment for Dupuytren’s disease, but recent Australian outcome data are scarce. This study assessed outcomes and predictors of recurrence after open fasciectomy at a tertiary centre. Methods: We retrospectively reviewed all open fasciectomy procedures for Dupuytren’s disease at Peninsula Health, Victoria (January 2023–October 2024). Data included contracture correction, functional scores (URAM, Southampton), recurrence at 6 and 12 months, complications, and demographic predictors. Appropriate statistical tests were used (significance: p < 0.05). Results: Among 152 procedures (mean age 63.8; 70.2% male), contracture correction was significant for all joints. URAM and Southampton scores improved by 15.3 and 7.6 points (p < 0.001). Complications (22.4%) were mainly transient neuropraxia. Recurrence was 10.5% at six months and 13.8% at twelve months. Smoking and female sex increased recurrence risk. Conclusions: Open fasciectomy provides effective correction, functional gain, and low early recurrence rates. Smoking and female sex predict recurrence, supporting tailored counselling and reaffirming open fasciectomy as the standard for advanced Dupuytren’s disease. Full article

Background/Objectives: Anterior cruciate ligament (ACL) injuries are common in sports; they can be seen with an arthroscope in more than half of instances of acute traumatic hemarthrosis and are frequently associated with meniscal tears. By reducing soft tissue injury and enabling faster recovery while attaining comparable long-term outcomes, the switch from open surgery to arthroscopic ACL repair (ACLR) has transformed treatment. However, maintaining efficient intra-articular visualization is essential for both patient safety and surgical precision. Methods: Using the PRISMA guidelines, a comprehensive systematic search was conducted across major medical databases, including PubMed, Web of Science, and ScienceDirect. The search strategy incorporated key terms such as epinephrine, irrigation fluid, and ACL reconstruction to identify relevant studies. The study focused on English-language clinical studies within the last 10 years that clearly assessed the safety and efficacy of epinephrine-added irrigation in ACL repair. The study design, patient demographics, specific outcomes (visualization, operation time, hemodynamics), and statistical findings were all carefully retrieved. The results were combined to determine the intervention’s safety profile and clinical value. Results: The pooled analysis demonstrated that the intervention group significantly decreased operating time (SMD = −0.51, 95% CI: −0.90 to −0.12, p = 0.01; I² = 24%). However, postoperative knee function showed no statistically significant difference between groups (OR = 1.80, 95% CI: 0.61 to 5.30, p = 0.29; I² = 0%). Postoperative pain levels also did not differ significantly between groups (SMD = −0.27, 95% CI: −0.63 to 0.09, p = 0.14; I² = 0%). Heterogeneity was low across all analyses (I² = 0–24%). Conclusions: Low-dose epinephrine in irrigation fluid significantly reduces operative time during arthroscopic ACL reconstruction, suggesting improved surgical efficiency. However, it does not significantly improve postoperative knee function or reduce pain compared to control irrigation. The intervention appears to be a reasonable alternative to tourniquets without major systemic cardiovascular effects. Nevertheless, preclinical data indicate potential chondrotoxicity. Therefore, while epinephrine can be considered to improve operating efficiency and reduce tourniquet-related problems, surgeons should weigh its use cautiously, especially in younger patients or those with susceptible cartilage. Full article