Search Results (67)

Background: Minimally invasive surgery (MIS) is increasingly adopted in pediatric surgical practice, yet it demands specific technical skills that require structured training. Simulation-based education offers a safe and effective environment for skill acquisition, especially in complex procedures such as thoracoscopic repair of esophageal atresia with tracheoesophageal fistula (EA-TEF). Objective: This study aimed to evaluate the effectiveness of a 3D-printed simulator for training pediatric surgeons in thoracoscopic EA-TEF repair, assessing improvements in operative time and technical performance. Methods: A high-fidelity, 3D-printed simulator replicating neonatal thoracic anatomy was developed. Six pediatric surgeons at different training levels performed eight simulation sessions, including fistula ligation and esophageal anastomosis. Operative time and technical skill were assessed using the Stanford Microsurgery and Resident Training (SMaRT) Scale. Results: All participants showed significant improvements. The average operative time decreased from 115.6 ± 3.51 to 90 ± 6.55 min for junior trainees and from 100.5 ± 3.55 to 77.5 ± 4.94 min for senior trainees. The mean SMaRT score increased from 23.8 ± 3.18 to 38.3 ± 3.93. These results demonstrate a clear learning curve and enhanced technical performance after repeated sessions. Conclusions: Such 3D-printed simulation models represent an effective tool for pediatric MIS training. Even within a short time frame, repeated practice significantly improves surgical proficiency, supporting their integration into pediatric surgical curricula as an ethical, safe, and efficient educational strategy. Full article

Background: The aim of this study was to assess the relationship between sleep-related variables (sleep duration, sleep trouble, and sleep disorder), comprehensive sleep patterns, and the reported history of cataract surgery in the U.S. population aged 20 years and older. Methods: We utilized data from the National Health and Nutrition Examination Survey (NHANES) 2005–2008 database. First, we analyzed the association between covariates and the reported history of cataract surgery using univariable Poisson regression. Subsequently, we constructed three models to evaluate the association between sleep-related variables and the reported history of cataract surgery using multivariable Poisson regression. Subgroup analyses were conducted to determine whether the association between sleep and the reported history of cataract surgery exhibited heterogeneity. Finally, we performed a sensitivity analysis to assess the stability of the results. Results: A total of 8591 participants were included in this study, among whom 774 had a history of cataract surgery. After adjusting for all covariates, participants experiencing sleep trouble had a higher prevalence of reported history of cataract surgery than participants without sleep trouble [PR = 1.40; 95%CI = (1.22, 1.62)]. Regarding combined sleep, participants with poor sleep patterns had a 36% higher prevalence of reported history of cataract surgery than those with healthy sleep patterns [PR = 1.36; 95%CI = (1.13, 1.64)]. The results of the sensitivity analysis indicate that the relationship between sleep patterns and the reported history of cataract surgery is robust. Conclusions: Sleep trouble and poor sleep patterns are positively linked to the high prevalence of a reported history of cataract surgery. Further research is needed to explore the underlying mechanisms. Full article

Background: Diabetic foot ulcers (DFUs) remain a major complication of diabetes, characterized by impaired wound healing, high infection risk, and an increased likelihood of limb amputation. Platelet-rich plasma (PRP) has emerged as a promising adjunctive therapy due to its regenerative properties, promoting angiogenesis, modulating inflammation, and accelerating tissue repair. Methods: This literature review explores the current evidence regarding the use of PRP in the management of DFUs. It was conducted using the PubMed database to evaluate the efficacy of PRP in DFUs. The search was restricted to studies published in the last 10 years, including randomized controlled trials, meta-analyses, and systematic reviews. The inclusion criteria focused on studies assessing PRP as a standalone treatment or in combination with other wound care strategies, evaluating key clinical outcomes such as wound healing rates, infection control, tissue regeneration, and amputation prevention. Results: A total of 35 studies met the inclusion criteria, including 11 meta-analyses, 15 review articles, and 9 clinical trials. PRP demonstrated potential benefits in accelerating wound healing, reducing inflammation, and promoting granulation tissue formation. Additionally, PRP combined with negative-pressure wound therapy (NPWT) showed superior outcomes in reducing amputation rates. However, findings varied based on patient characteristics, PRP preparation techniques, and treatment protocols. Conclusions: PRP represents a valuable adjunct in DFU management, contributing to improved healing outcomes and reduced complications. However, the lack of standardized protocols and variability in clinical results highlight the need for further large-scale, multicenter studies to establish its definitive role in diabetic wound care. Full article

Objectives: To explore the feasibility and surgical outcomes of robot-assisted vaginal natural orifice transluminal endoscopic surgery (RA-vNOTES) for women suffering from gynecologic disease. Methods: We performed an observational study reporting and analyzing the perioperative outcomes of 298 patients with gynecologic disease who underwent RA-vNOTES in a single institution from June 2019 to August 2024. Results: A total of 298 patients with a median age of 41 years and median body mass index of 29 kg/m² underwent RA-vNOTES. The primary indications for surgery were endometriosis (43.62%), chronic pelvic pain (11.07%), abnormal uterine bleeding (20.81%), and uterine leiomyomata (14.77%). A total of 286 of 298 (95.97%) patients had a hysterectomy. The median total operating time was 138 min, with a port placement time of 5 min, dock time of 3 min, and robot console time of 63 min. The median estimated blood loss was 50 milliliters. Endometriosis resection of all stages was performed in 192 of 298 (64.43%) patients. Three cases (1.01%) were converted to laparoscopic surgery. One case was converted to robot-assisted single incision plus one port laparoscopic surgery (SILS plus one) and two cases were converted to robot-assisted multi-port surgery. The total complication rate was 17.45% (52 cases), of which 2.1% (6 cases) were intraoperative complications and 15.44% (46 cases) were postoperative complications. Conclusions: Our findings indicate that RA-vNOTES is a feasible and less invasive option for various gynecologic procedures, including complex endometriosis excision and sacrocolpopexy. Full article

Purpose: Cataract, characterized by the clouding of the lens, is the leading cause of blindness and visual impairment worldwide. While cataract surgery is an effective treatment, it carries substantial costs, potential complications, and limited accessibility for those facing financial barriers. Hence, this study aimed to identify the sociodemographic, behavioral, medical, and occupational risk factors of cataract development among adults aged 40 and above. Methods: This cross-sectional study included 2866 participants from the National Health and Nutrition Examination Survey (NHANES) cycle from 2007 to 2008. We utilized a purposeful selection approach to identify the most suitable predictors for cataract surgery. We further used a multivariate logistic regression procedure that accounted for complex sampling design, to assess the main effect of each predictor, entered jointly into the model. Results: Age, blood pressure, and diabetes were identified as predictors of cataract surgery. Each additional year of age increased the odds of undergoing cataract surgery by 15% (OR: 1.15; 95% CI: 1.13–1.16). Participants with high blood pressure had a 38% higher likelihood of cataract surgery (OR: 1.38; 95% CI: 1.11–1.73), while those with diabetes faced a 63% higher likelihood (OR: 1.63; 95% CI: 1.27–2.09). Conclusions: Managing diabetes and blood pressure, especially among older adults, may be crucial in delaying cataract progression. Full article

Objectives: To identify transfusion thresholds and risk factors for acute kidney injury (AKI) in gastrointestinal oncology surgery, enhancing early intervention and improving postoperative outcomes. Methods: From 2018 to 2022, 765 patients with gastric or colorectal cancer who underwent major gastrointestinal surgery were retrospectively enrolled. The primary outcome was AKI development within 7 days postoperatively. Clinicopathological characteristics and short-term outcomes were recorded and compared. Results: Of all enrolled patients, 39 (5.1%) developed AKI. Patients with AKI were predominantly older and had more preoperative comorbidities, lower levels of preoperative hemoglobin and serum albumin, but higher levels of blood urea nitrogen and serum creatinine (SCr). Patients developing AKI experienced higher rates of in-hospital complications (overall: 48.3% vs. 14.2%, p < 0.001), prolonged hospital stays (25.4 ± 22.5 days vs. 12.3 ± 7.9 days, p < 0.001), increased intensive care unit (ICU) admissions (53.8% vs. 22.5%, p < 0.001), and higher rates of 30-day re-admission (13.9% vs. 2.4%, p = 0.003). Significant AKI risk factors included age (per 10 years, OR: 1.567, 95% CI: 1.103–2.423, p = 0.043), preoperative SCr (per 10 μmol/L, OR: 1.173, 95% CI: 1.044–1.319, p = 0.007), intraoperative RBC transfusion (per 1000 mL, OR: 1.992, 95% CI: 1.311–3.027, p = 0.001 with a significant surge in AKI risk at transfusions exceeding 1500 mL), patient-controlled analgesia (protective, OR:0.338, 95% CI: 0.163–0.928, p = 0.033), and diuretic use (OR: 5.495, 95% CI: 1.720–17.557, p = 0.004). Conclusions: Early intervention is essential for patients with preoperative low perfusion or anemia, with particular emphasis on moderating interventions to avoid fluid overload while carefully avoiding nephrotoxic medications, thereby improving postoperative outcomes. Full article

Background/Objectives: Patients undergoing neoadjuvant therapy have ample time to engage in exercise prehabilitation. This study aimed to describe the current status, facilitators, and barriers of exercise prehabilitation among this population. Methods: This sequential explanatory mixed-methods evaluation was conducted at a general tertiary hospital in Beijing. It included a quantitative survey of patients who received neoadjuvant therapy before cancer surgery and qualitative semi-structured interviews with both patients and physicians. Thematic analysis was conducted using the Capability, Opportunity, and Motivation Behavior model. Results: A total of 269 patients participated in the survey, with a completion rate of 99.6%. Only 52.6% and 1.1% of patients met the standards for aerobic and muscle-strengthening activities, respectively. Fewer than 40% of patients reported learning about exercise prehabilitation from physicians. Patients’ knowledge was associated with meeting aerobic activity standards after adjusting for confounders (Level 1: odds ratio [OR] of 2.06, 95% confidence interval [CI] of 1.02–4.22; Level 2: OR of 2.56, 95% CI of 1.25–5.36). In total, 28 participants were interviewed. Facilitators of patient education on exercise prehabilitation included the surgeon’s ability to gain trust and patients’ prior commitment to exercise. Barriers included physicians’ lack of awareness of exercise benefits, insufficient knowledge or time for patient education, concerns about patients’ exercise ability, lack of referrals to rehabilitation clinics, challenges in follow-up, conflicts with cultural beliefs, and inadequate insurance coverage. Conclusions: This study revealed a lack of physician-led patient education on exercise prehabilitation. Efforts are needed to enhance physician education, implement collaborative clinics, and provide remote supervision. Full article

Background: Surgical resection remains an important treatment of choice for a large number of liver tumors in children. Sometimes, if a tumor infiltrates a large part of the liver, after resection, the future liver remnant (FLR) is not enough for normal liver function. The size of the FLR is one of the determining factors for resectability as postoperative liver failure (PLF) is the most severe complication after partial hepatectomy. A new strategy for treating marginally resectable liver tumors in adult patients which were initially considered as unresectable was formally reported in 2011. This operative technique is a hepatectomy consisting of two stages with initial portal vein ligation and in situ splitting of the liver parenchyma. In 2012, the acronym “ALPPS” (associating liver partition and portal vein ligation for staged hepatectomy) was proposed for this novel technique. However, there is a small number of ALPPS procedures performed in pediatric patients published in the literature. Objectives: The aim of this paper is to present the first case of a pediatric patient with a marginally resectable rhabdoid tumor of the liver which was initially considered unresectable and who was treated with two-stage hepatectomy. We report a case of a 4-month-old girl with a large rhabdoid tumor of the liver who underwent this procedure. Conclusions: ALPPS can be a valuable technique to achieve complete resection of pediatric liver tumors although indications for ALPPS in children still need further research mainly focused on validation of the minimally needed FLR in children undergoing extended liver resections. To our knowledge, this is the youngest patient on whom ALPPS was performed, and the only one with a rhabdoid tumor. Full article

Background and objectives: Outcomes of neonates diagnosed with esophageal atresia (EA), a rare congenital malformation, vary widely. Due to limited and fragmented data globally, major regional centers offer a crucial opportunity to better understand EA’s epidemiology and the management. This study aimed to address these gaps by determining total birth prevalence and early treatment outcomes of EA in southern Croatia. Methods: All EA cases (1991–2020) were retrospectively ascertained from medical documentation at the only tertiary referral center for EA in southern Croatia, with birth data collected from the entire background population. We collected data on neonates’ status and diagnosis, operative findings, early postoperative complications, and treatment outcome from this single center. Results: A total of 53 cases were identified, with an average total birth prevalence of 2.44 per 10,000 total births/year. No significant sex differences were found (p = 0.339), and most cases were complex Vogt 3B. The mortality rate dropped from 87 to 8% over a 30-year period (p < 0.001). The 1-year survival rate was 54% (95% CI 40–68%) for liveborns and 64% (50–79%) for liveborns who underwent surgery and intensive care. However, 16% of patients died before surgery due to hemodynamic instability, and among those operated on, high sepsis, pneumonia, and atelectasis rates were observed. Conclusions: EA prevalence in southern Croatia aligns with European data. Survival improved significantly after 2002, coinciding with a dedicated pediatric ICU and enhanced pediatric care training. Further advancements in early diagnosis and a multidisciplinary approach are needed to further reduce mortality. Strengthened postoperative infection control and optimized postoperative respiratory support are also crucial to minimizing complications. Full article

Although the advancements in craniomaxillofacial surgery have been significant, ischemic craniomaxillofacial diseases remain challenging to treat due to insufficient blood supply. Hyperbaric oxygen therapy (HBOT) has emerged as a promising adjunctive treatment, exhibiting the potential to promote angiogenesis, exert anti-inflammatory effects, enhance bone regeneration, and possess antibacterial properties. Numerous studies have demonstrated its efficacy in stimulating healing processes, particularly in cases such as medication-related osteonecrosis of the jaw, osteoradionecrosis, chronic jaw osteomyelitis, and refractory wounds. Hyperbaric oxygen therapy not only accelerates healing and shortens recovery times but also reduces postoperative complications, infection risks, and enhances patients’ overall quality of life. This review aims to synthesize the research progress on the application of hyperbaric oxygen therapy in ischemic craniomaxillofacial diseases, providing a valuable reference for clinicians. Full article

Background/Objectives: Our study describes hyperbaric oxygen therapy (HBOT) as an additional therapy in the conservative treatment of Crohn’s disease (CD) and its benefit in the early postoperative period to prevent surgical complications and improve gastrointestinal motility. Methods: This retrospective study evaluated HBOT in patients hospitalized at the Clinical Hospital Center Split for complications of CD between 2015 and 2020. Patients (N = 61) aged 19 to 67 with perianal fistulas, abscesses, fistulas, obstruction, stenosis, or bleeding were included, excluding those with ulcerative colitis or requiring intensive care. Patients were retrospectively divided into conservatively and surgically treated groups, and HBOT was administered over 15–25 days, with treatment lasting 60 min at 2.2 absolute atmospheres (ATA). We analyzed treatment outcomes between the HBOT-treated surgical and conservative groups and compared patients treated with HBOT to a cohort from the preceding five years who did not receive HBOT. Results: We treated 61 CD patients with HBOT, including 34 conservatively and 27 surgically treated patients. HBOT significantly reduced disease activity indices (311.7 ± 59.1 vs. 114 ± 29.8; 203.6 ± 24.1 vs. 83.8 ± 15, for conservatively treated patients, and 352.8 ± 45.7 vs. 109 ± 22.8; 270.4 ± 19.7 vs. 140.3 ± 10.6 for surgically treated patients) and accelerated bowel peristalsis recovery, with 94.1% of conservatively treated patients achieving remission. Comparison with a historical cohort showed faster recovery and improved outcomes in the HBOT group. Conclusions: HBOT is useful in postponing or avoiding surgical treatment, and in operated patients, it improves postoperative recovery and reduces the rate of postoperative complications. Full article

Objective: This study aims to evaluate and identify the main preoperative risk factors affecting the timely discharge of day surgery patients, offering evidence to enhance preoperative assessments and minimize delayed discharge. Background: With the widespread adoption of day surgery in global healthcare systems, ensuring timely discharge of patients post-surgery has become a critical challenge. Numerous studies have explored various preoperative risk factors influencing delayed discharge. This meta-analysis integrates existing evidence to clarify the primary preoperative risk factors. Methods: A systematic search was conducted across the PubMed, CINAHL, Scopus, Web of Science, Embase, Cochrane Library, and CNKI databases, including all clinical studies on preoperative risk factors for day surgery published until 15 October 2024. A systematic review and random effects model were employed to aggregate data and estimate the main preoperative risk factors for day surgery. Results: A total of nine studies involving 41,458 patients were included. The analysis revealed statistically significant differences in the following preoperative risk factors: age (MD = 1.33, 95% CI: 0.73–1.93, p < 0.0001), body mass index (BMI) (MD = 0.69, 95% CI: 0.18–1.20, p = 0.008), the presence of chronic comorbidities (OR = 3.62, 95% CI: 2.93–4.46, p < 0.00001), the type of anesthesia (OR = 15.89, 95% CI: 7.07–35.69, p < 0.00001), a history of cardiac disease (OR = 2.46, 95% CI: 1.71–3.53, p < 0.00001), gender (OR = 3.18, 95% CI: 2.03–4.99, p < 0.00001), the expected duration of surgery (MD = 0.18, 95% CI: 0.15–0.20, p < 0.00001), complex procedures (OR = 1.78, 95% CI: 1.47–2.16, p < 0.00001), a lack of social family support (OR = 2.42, 95% CI: 1.60–3.67, p < 0.0001), and inadequate preoperative assessment (OR = 3.64, 95% CI: 2.06–6.41, p < 0.00001). There were no statistically significant differences between the delayed discharge group and the non-delayed discharge group in terms of the American Society of Anesthesiologists (ASA) classification (p = 1.00) and preoperative anxiety (p = 0.08). Conclusion: This study identifies the primary preoperative risk factors for delayed discharge in day surgery, including age, high BMI, the presence of chronic comorbidities, the type of anesthesia, a history of cardiac disease, gender, the duration of surgery, the complexity of the procedure, a lack of social family support, and inadequate preoperative assessment. These findings provide a reference for preoperative assessment, highlighting the need for clinical attention to these high-risk groups during preoperative screening and management to reduce the likelihood of delayed discharge and enhance surgical safety and success rates. Full article

Introduction: The choice of the most adequate surgical technique for upper limb defects remains challenging. The aim of this article is to discuss the main microsurgical (pedicled or free) reconstructive options for the post-oncological reconstruction of different anatomical areas of the upper extremity. Materials and methods: We reviewed different reconstructive methods reported in the literature needing microsurgical expertise and compared them to our clinical experience, in order to provide further guidance in the choice of different flaps for upper limb soft tissue reconstruction. Six clinical cases, one for each anatomical district, are presented as examples of possible solutions. Results: We report the options available in the literature for post-oncologic upper limb reconstruction, dividing them by anatomical area and type of flap: local flaps, regional flaps, free flaps, and distant pedicled flaps. Our examples of the reconstruction of each anatomical area of the upper limb include one reverse ulnar pedicled perforator flap, one free Antero-Lateral Thigh (ALT) flow-through flap, one perforator-based lateral arm flap, two myocutaneous latissimus dorsi pedicled flaps, and one parascapular perforator-plus flap. Conclusions: In oncological cases, it is important to consider reconstructive options that provide stable tissue and allow for the early healing of the donor and recipient site if the patient needs to undergo adjuvant radiotherapy or chemotherapy. A wider range of flap options is essential when choosing the proper technique according to the patient’s needs, surgeon’s preference, and logistical possibilities. Perforator flaps combine the advantages of other flaps, but they require microsurgical expertise. Free flap reconstruction remains the gold standard to obtain a better overall and cosmetic outcome in complex and wide defects, where no suitable local pedicled flap option exists. The pedicled latissimus dorsi flap should still be included among the reconstructive options for its strong vascularization, size, and arc of transposition. Full article

Background: Combined pre-operative bowel preparation with oral antibiotics (OAB) and mechanical bowel preparation (MBP) is the current recommendation for elective colorectal surgery. Few have studied racial disparities in bowel preparation and subsequent post-operative complications. Methods: This retrospective cohort study used 2015–2021 ACS-NSQIP-targeted data for elective colectomy for colon cancer. Multivariate regression evaluated predictors of post-operative outcomes: post-operative ileus, anastomotic leak, surgical site infection (SSI), operative time, and hospital length of stay (LOS). Results: 72,886 patients were evaluated with 82.1% White, 11.1% Black, and 6.8% Asian or Asian Pacific Islander (AAPI); 4.2% were Hispanic and 51.4% male. Regression accounting for age, sex, ASA classification, comorbidities, and operative approach showed Black, AAPI, and Hispanic patients were more likely to have had no bowel preparation compared to White patients receiving MBP+OAB. Compared to White patients, Black and AAPI patients had higher odds of prolonged LOS and pro-longed operative time. Black patients had higher odds of post-operative ileus. Conclusions: Racial disparities exist in both bowel preparation administration and post-operative complications despite the method of bowel preparation. This warrants exploration into discriminatory bowel preparation practices and potential differences in the efficacy of bowel preparation in specific populations due to biological or social differences, which may affect outcomes. Our study is limited by its use of a large database that lacks socioeconomic variables and patient data beyond 30 days. Full article

Background: The postoperative period is the recovery time after surgery and is defined as an individual process whose purpose is to return the person to the state of normality and integrity that they had prior to surgery. Aim: Demonstrate the modification of the level of health of people in the early postoperative period through the development and validation of the Health Index Instrument, which is built from the Nursing Outcomes Classification (NOC) standardized language. Design: The design used a mixed method, which involved a first phase of instrument development and a second phase of instrument validation. Methods: The methods was based on focus group techniques with text analysis techniques, internal validation with a group of care language experts, external validation with a group of clinical nursing experts and a clinical validation with quantitative and qualitative analysis. A panel of experts in Language of Care evaluated the (NOC) labels and their correlation with the 11 Health Variables to construct the instrument. The instrument developed was subjected to external validation with a panel of clinical nurse experts in post-anesthesia care. The clinical validation included a cross-sectional descriptive study in a postoperative unit. The final sample of the cross-sectional descriptive study was 139 cases. Results: Of the 89 NOCs proposed in the preliminary construction phase of the instrument, 36 passed through the first round. Of those 36 NOCs, 25 passed through to the second round with a review performance and 11 directly as approved. The total number of approved NOCs were 4. The results of the research show that there are changes in the global score of the health level and in each health variable. It is observed that there was a significant increase in the scores of the health variables at admission and discharge (p < 0.001). Conclusions: The results of the data analysis show that six groups present a similar pattern of evolution of the health variables. A correlation was found between the time of stay in the unit with the scores obtained in the health variables, the physical functioning, comfort status and the presence of symptoms being particularly significant. Full article