Search Results (88)

The adoption of neoadjuvant immune checkpoint inhibitor (ICI)-based chemoimmunotherapy has fundamentally transformed the operative landscape of resectable non-small cell lung cancer (NSCLC). Surgeons are now routinely confronted with ICI-altered tissue planes characterized by hilar fibrosis, vascular friability, and disrupted lymph node architecture. Simultaneously, robotic-assisted thoracic surgery (RATS) has consolidated its position as the dominant minimally invasive platform for pulmonary resection, accounting for the majority of lobectomies and segmentectomies performed at high-volume centers in 2023. Whether RATS confers specific technical advantages in this increasingly complex operative context remains incompletely characterized. We conducted a structured narrative review of published evidence, synthesizing data from randomized controlled trials, prospective cohorts, national registry analyses, and emerging technology reports addressing RATS in the setting of neoadjuvant ICI-based therapy for NSCLC. A systematic literature search was conducted across PubMed and EMBASE using predefined search terms. Available evidence, though largely retrospective and limited by small sample sizes, consistently demonstrates that RATS after neoadjuvant chemoimmunotherapy is technically feasible and oncologically sound, with R0 resection achievable in virtually all cases. The enhanced three-dimensional visualization, tremor filtration, and instrument degrees of freedom afforded by robotic platforms appear particularly advantageous in the setting of dense hilar adhesions and fragile pulmonary vasculature. Lymph node yield, a recognized robotic advantage, is preserved or enhanced despite post-ICI fibrosis. Pooled conversion rates to thoracotomy, derived from post hoc surgical analyses of ICI trial populations rather than trials designed to measure conversion, are higher than for upfront resection; available retrospective single-center data, including one direct RATS-versus-VATS comparison, suggest lower conversion rates with RATS in experienced hands, though this conclusion requires prospective validation. Emerging platform integrations, including combined robotic bronchoscopy and thoracoscopic surgery, single-port systems, and artificial intelligence-assisted anatomical navigation, are poised to further extend the reach of minimally invasive surgery in this challenging clinical scenario. In experienced centers, RATS appears to offer a technically favorable minimally invasive platform for pulmonary resection after neoadjuvant ICI-based therapy, with potential advantages over VATS in managing immunotherapy-altered anatomy; however, this conclusion is derived from retrospective series and should be interpreted cautiously pending prospective comparative data. Prospective multicenter trials with standardized surgical endpoints are urgently needed. Full article

Background: Endoscopic sinus surgery (ESS) is a core operative technique in otolaryngology and is associated with a steep learning curve due to complex sinonasal anatomy, limited depth perception with two-dimensional endoscopy, and the requirement for precise bimanual coordination. Given the potential for serious complications, including cerebrospinal fluid leak and visual loss, simulation provides an important opportunity for trainees to develop technical skills in a controlled environment without risk to patients. Recent advances in three-dimensional (3D) printing have enabled the development of high-fidelity models for ESS training. Methods: We describe an evidence-based, graded approach to ESS simulation using two commercially available 3D printed sinus surgery models tailored to the trainee’s stage of training. Early-stage simulation focuses on development of anatomical orientation, endoscopic hand–eye coordination, tissue handling, and basic procedures such as middle meatal antrostomy and anterior ethmoidectomy. Advanced simulation targets more complex procedures, including frontal and sphenoid sinus surgery, transsphenoidal approaches, and management of intraoperative complications. Results: Validation studies demonstrate high face and content validity for both models. Early-stage simulators support acquisition of fundamental technical skills, while advanced models allow simulation of complex anatomy, pathology, and operative complications. Conclusions: A structured, stage-appropriate simulation strategy using high-fidelity 3D printed models may enhance technical skill acquisition and support safe and effective training in endoscopic sinus surgery. Full article

Background/Objectives: Reconstruction of orbital floor fractures remains surgically challenging due to limited intraoperative visibility and complex anatomy. Inaccurate implant placement often leads to persistent complications and the need for a revision surgery. This study evaluated the clinical accuracy and re-operation rates of a preoperative 3D-printed model-assisted technique compared to the conventional intraoperative free-hand mesh bending method. Methods: A comparative ambispective study was conducted on 74 patients with isolated orbital floor fractures. The control group (n = 34, retrospective) underwent reconstruction using intraoperatively formed titanium meshes. In the study group (n = 40, prospective), patient-specific 3D-printed models, created by mirroring the healthy contralateral orbit, were used for preoperative mesh adaptation. Primary outcomes included the rate of revision surgery due to implant malposition, changes in orbital volume, and postoperative diplopia. Results: The 3D model group demonstrated a significantly lower rate of revision surgery compared to the control group. In the retrospective group, 5 patients (15%) required reoperation due to implant malposition, whereas no patients (0%) in the prospective 3D group required secondary intervention (p = 0.017). While both techniques effectively restored orbital volume, the 3D group showed greater volumetric precision with less variance. The mean volume difference in the affected orbit was 3078 ± 2204 mm³ in the control group, compared to 2390 ± 1893 mm³ in the study 3D group. At the 6-month follow-up, persistent diplopia was observed in 12% of the control group compared to only 3% in the study group. Conclusions: The use of in-house 3D-printed models for preoperative mesh forming significantly enhances surgical precision and eliminates the need for revision surgery due to implant malposition. This workflow offers a cost-effective, predictable, and accessible alternative to expensive patient-specific implants (PSIs) or intraoperative navigation systems, improving patient safety and long-term clinical outcomes. Full article

Introduction: Perioperative factors can significantly accelerate the development of sarcopenia in patients with aortic dissection, weakening their metabolic and functional reserves. Progressive sarcopenia after surgery is associated with a worse prognosis, increased mortality, and a higher risk of complications, which makes its early diagnosis and prevention key elements of care for this group of patients. Methods: The study included 116 patients hospitalized from April 2022 to May 2025 due to aortic dissection. Prospective studies were conducted using standardized tools as well as clinical data. The effect of blood transfusion, grip strength as measured with a hand dynamometer, and survival of patients after aortic dissection 3 months postoperatively were evaluated. Results: In the group of patients with a high risk of stroke, completely dependent and suffering from insomnia, transfusions were used significantly more often. SGA scores, CHA2DS2-VA score, and Barthel scale scores were dependent on the level of pain at discharge. Grip strength was significantly higher among patients who survived 3 months. The differences reached statistical significance on the second postoperative day. Conclusion: The results indicate that malnutrition is a key factor in the clinical condition of patients, increasing the risk of sarcopenia, stroke, and the severity of insomnia. At the same time, a higher degree of malnutrition is associated with reduced functional independence, which in turn affects the patient’s overall condition. The study found that malnutrition is a key factor in worsening the clinical condition of patients with aortic dissection, increasing the risk of sarcopenia, stroke and exacerbation of insomnia. The relationship between lower self-reliance and higher insomnia levels underscores the complex interplay among nutritional status, physical functioning, and sleep quality. Full article

After vessel preparation, using different strategies such as balloon angioplasty, specialty balloons, atherectomy or intravascular lithotripsy, definitive treatment has emerged as a key feature in endovascular treatment strategies. Based on current guidelines, endovascular treatment is the most common treatment option in patients with claudication. In patients with chronic limb-threatening ischemia (CLTI), on the other hand, the best treatment modality, including bypass surgery and endovascular revascularization, needs to be selected by an interdisciplinary team, focusing on individual anatomic and patient-specific characteristics, on the availability of a vein graft and on cardiovascular and other comorbidities of the patients. With endovascular therapy, currently, a plethora of options are available for the treatment of femoropopliteal lesions, which are increasingly gaining in complexity. Therefore, a practical systematic case-based approach, entailing contemporary treatment options, like drug-coated balloon (DCB) angioplasty tools, self-expanding bare-metal stents (BMSs), drug-eluting stents (DESs), interwoven stents and covered stents, is crucial. Generally, most endovascular operators adhere to the ‘leave nothing behind’ concept, meaning that, after proper lesion preparation, lesions can be treated with DCBs, avoiding the implantation of permanent metallic implants. However, in the case of severe dissections or significant recoil, stent implantation becomes necessary to achieve adequate limb perfusion. The selection between long versus spot stenting and the different stent options depends on the current scientific evidence, guidelines and expert opinion statements. An interdisciplinary expert consensus was recently compiled on how these modalities should be used in specific lesions and patients in the femoropopliteal segment. Herein we present a practical case-based approach, which is based on this algorithm and aims at harmonization of endovascular treatment strategies in daily practice and ultimately at further improvements in limb and patient outcomes. Full article

Background: Infections in hand surgery represent a clinically relevant complication, particularly in trauma-related procedures and in the presence of internal fixation devices. Data specifically addressing microbiological profiles and antimicrobial resistance patterns in hand surgery remain limited. Methods: A monocentric retrospective observational study was conducted, including 72 patients treated for hand surgery infections between January 2024 and June 2025. Microbiological isolates and antimicrobial susceptibility profiles were analyzed and stratified according to the clinical scenario, including trauma-related infections and infections associated with internal fixation devices. Monomicrobial and polymicrobial infections were evaluated separately. Results: Trauma-related infections accounted for 77.8% of cases, of which 64.3% were monomicrobial and 35.7% polymicrobial. Monomicrobial trauma-related infections were predominantly caused by Staphylococcus aureus, with methicillin resistance detected in 25.0% of cases. Polymicrobial trauma-related infections showed greater microbiological complexity but limited antimicrobial resistance. Infections associated with internal fixation devices represented 22.2% of cases and demonstrated a higher proportion of polymicrobial infections. Across all subgroups, no extended-spectrum beta-lactamase–producing Enterobacterales or carbapenem-resistant organisms were identified. Conclusions: This study fills an important evidence gap by characterizing pathogens and antimicrobial resistance in a dedicated hand surgery cohort, an area where published microbiological data remain limited compared with other orthopedic subspecialties. Hand surgery infections exhibit distinct microbiological and resistance profiles depending on the clinical scenario and microbial complexity. Despite frequent polymicrobial involvement, high-level antimicrobial resistance remains uncommon, supporting the value of local microbiological surveillance to guide empirical therapy. Full article

(1) Background: Hudson first described the procedure that includes en-block removal of an ovarian tumor fixed in the pelvis with the whole pelvic peritoneum and invaded surrounding structures. However, sometimes pelvic peritonectomy (PP) with or without shaving of the bowel serosa is not enough to achieve complete cytoreduction, and en-block rectosigmoid resection (RR) is necessary. This study aims to investigate the impact of bowel surgery on survival rates and morbidity of patients with advanced ovarian cancer. (2) Methods: We retrospectively analyzed patients with advanced ovarian cancer with cul-de-sac involvement that underwent debulking surgery at the 1st Department of Obstetrics—Gynecology of “Papageorgiou” General Hospital, from 2017–2022. The primary outcomes were the survival rates and morbidity between PP and RR. (3) Results: A total of 93 patients met the inclusion criteria. Patients were categorized into two groups: Group A (34 patients) with RR and Group B (59 patients) with PP. There was no statistically significant difference in the majority of patients’ characteristics and oncological outcomes. On the other hand, patients with RR had a significantly higher surgical complexity score (SCS), peritoneal cancer index (PCI), ICU admission, rate of postoperative complications, longer surgery duration and hospital stay. When comparing the duration of surgery, the RR group has significantly higher operation time during primary compared to interval debulking surgery. Concerning survival rates, there was no significant difference in progression-free (PFS) (p = 0.22) and overall survival (OS) (p = 0.85) between the two groups, while residual disease and postoperative complications were identified as independent prognostic factors for PFS and OS; (4) Conclusions: The modified Hudson procedure with RR is a safe and reproductible technique, but when complete gross resection can be achieved with PP, this technique is preferred in order to avoid increased patient’s morbidity. Full article

Background/Objectives: Endoscopic submucosal dissection (ESD) is a state-of-the-art en bloc resection for early gastro-intestinal cancers and precursors developed and validated in Japan. Western expertise with this complex technique remains limited. Tutored training might be optimal for patients and ESD learning. We established ESD tutoring courses led by experienced Japanese experts to provide (i) optimal long-term curative outcomes and low complication rates for patients and (ii) hands-on training on difficult lesions for European endoscopists under direct expert supervision. Methods: Prospective data from 2011 to 2015 (follow-up to 12/2024) were analyzed. A total of 118 neoplasms (50% HGIEN and cancer) in 101 patients (median age 68 [37–91] years; 38% with significant comorbidities) were treated with expert or tutored ESD. Japanese experts performed 28 ESDs, while 22 trained beginners conducted 90 supervised procedures on difficult lesions during 5 live and 20 tutoring events (1–4 days each). Results: Analysis of the complete data showed curative and en bloc resection rates of 88% and 95%, respectively, with no recurrence after R0 resections during a median follow-up of 9.8 [1.5–14.9] years. Long-term survival remained recurrence-free after endoscopic resection of 3 recurrent adenomas (at R1/Rx) and curative surgery/2nd ESD for 5 non-curative ESDs. Adverse events occurred in 9.3% without emergency surgery or 30-day mortality. Comparing expert-only vs. tutored ESD procedures, beginners correctly applied curative ESD indications in 94% of 118 neoplasms. Experts resected larger lesions (22 cm²) at a rate of 9.3 cm²/h in 121 min. Tutored beginners achieved a 75% [25–100] self-completion rate on 33% smaller lesions in 112 min. Conclusions: ESD tutoring courses led by Japanese experts ensure excellent patient outcomes and standardized procedural training. This model may foster professional ESD performance across European referral centers. Full article

Traditional surgical techniques are based on the manual application of force using mallets and osteotomes, which often result in uncontrolled impact forces, procedural inconsistencies, and patient discomfort. Magnetic mallets (MMs), magnetodynamic devices, provide a controlled application of force using electromagnetism, aiming to achieve greater precision, reduced operating time, and improved surgical outcomes. The aim of the present systematic review was to evaluate the effectiveness of MMs compared to conventional surgical techniques in oral and implant surgery. The focused question was as follows: “Do magnetic mallets improve clinical outcomes in oral and implant surgery compared to traditional instruments?” Only clinical studies comparing the use of MMs with traditional techniques in oral surgery were included. The following databases were searched up to 27 November 2025: Pubmed, Scopus, Web of Science. For quality assessment, the Cochrane Risk of Bias 2 (RoB 2) tool was applied for randomized controlled trials (RCTs), while the Newcastle–Ottawa Scale (NOS) was used for non-randomized studies. Data were screened and synthesized by two reviewers. The systematic review was conducted based on Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) Statement. In total, 347 studies were initially found and 6 matched the inclusion criteria and were included in the review, for a total of 282 patients. Five RCTs were included, as well as one retrospective study. The studies investigated were as follows: implant site preparation (two studies with a total of 86 patients), sinus lift and contextual implant insertion (three studies, total: 102 patients), dental extraction (two studies, total: 70 patients), and split-crest (one study with 46 patients). The outcomes suggest that MMs may serve as a potential alternative to traditional techniques, exhibiting promising although preliminary outcomes. The studies included reported a lower incidence of benign paroxysmal positional vertigo with the use of MMs compared to hand osteotomes. Regarding quality assessment, RCTs raised some concerns, while the retrospective study had a moderate risk of bias. Despite the promising results, the paucity of high-quality controlled trials limits definitive conclusions on the superiority of MM over conventional techniques. Further well-designed comparative trials are needed to confirm the clinical benefits, optimize protocols across different indications, and evaluate MMs’ potential role in the management of critical bone conditions and complex surgery. Full article

Background/Objectives: The goal of reconstructive hand surgery is to achieve both functional and aesthetic restoration. The primary aim of this study is to perform a detailed, practice-oriented evaluation of perforator-based and local flaps for soft-tissue reconstruction of the hand and digits, focusing specifically on their functional reliability, anatomical consistency, complication profile, and aesthetic integration in a real-world, high-complexity referral population. Methods: This retrospective single-center study included 37 patients with soft tissue defects of the hand that required flap coverage between September 2021 and September 2024. The study assessed patient demographics, defect characteristics, flap selection, surgical techniques, and outcomes including satisfactory soft tissue coverage, functional results and occurrence of complications. Various perforator flaps were analyzed, including the dorsal metacarpal artery flap, reverse radial forearm flap, reverse posterior interosseous artery flap, reverse homodigital and heterodigital island flaps, and the thenar flap. Results: Satisfactory soft tissue coverage was achieved in 35 out of 37 patients. One case involved partial distal flap necrosis, and another presented with Foucher flap failure. The remaining flaps demonstrated stable integration, preserved perfusion, and durable soft-tissue coverage with satisfactory contour and pliability. Functional outcomes were favorable, with restoration of joint mobility and absence of secondary deformities. Conclusions: This study supports the continued use of perforator and local flaps in upper extremity reconstruction, emphasizing the need for individualized planning to optimize the outcomes. Full article

Background: Random pattern flaps are widely used in reconstructive surgery when inadequate vascularity precludes skin graft survival or when regional pedicled flaps are unavailable due to local burn injury. Here, thin tissue from the upper arm was utilized to cover exposed cartilage over the proximal interphalangeal (PIP) joints of the contralateral hand. Methods/Technical Note: We report the uncommon application of multiple cross-arm (Colson) flaps to reconstruct dorsal skin defects over the PIP joints of the index, middle, and ring fingers following a high-voltage burn injury, in conjunction with a comprehensive literature review. Results: Three separate random-pattern flaps were harvested from the upper arm and transferred to the contralateral hand. All flaps demonstrated good perfusion, durable coverage, and a clean wound bed postoperatively, with preservation of joint mobility. Conclusions: To our knowledge, this represents one of the first reported reconstructions of multiple adjacent PIP joints using individual cross-arm flaps. This technique remains a dependable salvage option that should be considered in complex reconstructive scenarios when local or microsurgical options are not feasible. Full article

Background/Objectives: The da Vinci Single-Port (SP) system represents a recent evolution in robotic-assisted surgery, offering enhanced articulation and access through a single incision. The SP system was approved by the European Medicine Agency (EMA) in January 2024. Methods: This review synthesizes current clinical evidence on the feasibility, safety, and versatility of SP-assisted procedures across multiple surgical specialties to date based on a comprehensive literature search conducted through major databases (MEDLINE, EMBASE, and Cochrane) according to PRISMA and PICOS guidelines. Results: A total of 14 studies were included, highlighting that the SP platform has been successfully adopted in complex procedures such as cervical esophagectomy, radical prostatectomy, nephrectomy, gynecologic procedures, and wall surgery. Across indications, the SP approach is associated with reduced blood loss, shorter hospital stays, and low complication rates. On the other hand, limitations include restricted working space and the steep learning curve. Conclusions: Overall, the da Vinci SP platform expands the scope of minimally invasive surgery, but European centers lag behind international trends, particularly when compared to new, less-invasive techniques adopted in high-volume SP centers in the US. Urology remains the main field of application. Full article

Background and Objectives: Complex hand injuries often lead to long-term functional impairment and require structured rehabilitation following surgery. While early rehabilitation may improve outcomes by preventing stiffness and adhesions, it can also increase pain and psychological distress. In contrast, delayed rehabilitation may offer short-term comfort but risks slower recovery. The study aimed to compare the outcomes of early versus delayed rehabilitation through a four-phase therapeutic protocol, with standardized assessments at baseline, 4 weeks, and 12 weeks. Materials and Methods: This study included 90 patients with complex hand trauma who underwent emergency surgical intervention followed by a structured rehabilitation program. Key parameters included active range of motion (TAM), grip strength, pain (VAS), edema, hand function (QuickDASH), and anxiety levels (GAD-7). Statistical analysis was used to evaluate differences in physical and psychological recovery over time between the two rehabilitation approaches. Results: This study demonstrated that both early and delayed postoperative rehabilitation significantly improved physical and psychological outcomes in patients with complex hand trauma. However, early rehabilitation was associated with faster resolution of edema, quicker gains in functional mobility, and earlier improvement in grip strength, despite causing higher initial levels of pain and anxiety. Conversely, delayed rehabilitation resulted in lower early pain and anxiety but showed slower functional recovery. Subgroup analysis revealed that patients with flexor tendon injuries benefited most from early rehabilitation in terms of mobility, strength, and anxiety reduction, while those with multifocal or complex injuries achieved greater long-term pain relief. Conclusions: As rehabilitation continues to evolve, the adoption of personalized, multimodal, and technologically integrated strategies holds promise for improving both the speed and quality of recovery while addressing the psychological and functional dimensions of patient care. Overall, the study supports early, structured, and individualized rehabilitation protocols, emphasizing a multidisciplinary approach that integrates both physical and psychological recovery strategies. Full article

Background: Glenohumeral instability is one of the most frequent and clinically impactful complications following proximal humerus resection and reconstruction with a megaprosthesis, especially in patients treated for bone tumors or complex fractures. Its incidence, risk factors, and influence on functional recovery remain variably reported in the literature. Methods: A systematic review was conducted according to PRISMA guidelines, searching PubMed, Scopus, and Google Scholar up to April 2025. Studies reporting on postoperative instability, dislocation, functional outcomes (MSTS, DASH), and related complications were included. Two independent reviewers performed data extraction and quality assessment. A pooled analysis was performed using random-effects models. Results: A total of 17 studies including 387 patients were analyzed. The pooled incidence of glenohumeral instability was 32%, with a revision surgery rate of 10% due to instability. The most common reconstruction technique was modular megaprosthesis (47%), followed by allograft–prosthesis composites (APCs) and reverse total shoulder arthroplasty (RSA). Functional outcomes were reported in 12 studies using the Musculoskeletal Tumor Society (MSTS) score, with a weighted mean of 22.3 ± 3.8 (74.3% ± 12.7%). Disabilities of the Arm, Shoulder, and Hand (DASH) scores, reported in 3 studies, showed worse outcomes in unstable shoulders (mean 61.4 ± 5.2 vs. 26.6 ± 4.1). Soft tissue reconstruction, particularly involving the rotator cuff and deltoid, significantly influenced postoperative stability and function. Conclusions: Glenohumeral instability after proximal humerus megaprosthesis is a common and disabling complication that adversely affects functional outcomes and revision rates. Optimizing soft tissue management and prosthetic design is essential to improve joint stability and long-term results. Full article

New-onset postoperative atrial fibrillation (POAF) is common after cardiac and major noncardiac surgery and significantly associated with short- and long-term adverse events. Multiple management strategies have been described but the lack of evidence from large randomized controlled trials and the lack of consensus regarding best practices has led to major variations in practice patterns. Considering on the one hand its serious adverse effects and complex drug interactions, and on the other hand discrepancies among recent international guidelines, the indications of amiodarone to both prevent and treat POAF should be reserved to patients at high risk of POAF only, or patients with hemodynamic instability and/or severely reduced left ventricular ejection fraction. Perioperative optimization of oral and intravenous cardio-selective beta-blockers to prevent POAF, and control heart rate when POAF occurs with a rapid ventricular response is the recommended first-line strategy, simultaneously with the treatment of associated factors. Given their efficient and safe profile, ultra-short-acting intravenous beta-blockers like esmolol or landiolol could be preferentially used in acute care patients. Besides waiting for the results of ongoing RCTs in cardiac and noncardiac surgery, the use of oral anticoagulation in patients with POAF should take into account the individualized thromboembolic/hemorrhagic risk ratio. Full article