Search Results (2,475)

Objective: This study aimed to evaluate the clinical and radiological efficacy of percutaneous laser disc decompression (PLDD) in patients with disc-related lumbar spinal stenosis. Methods: Data from 96 patients who underwent PLDD between January 2023 and January 2025 were reviewed retrospectively. Pain intensity (visual analogue scale [VAS]), functional capacity (pain-free walking distance), patient satisfaction (global patient evaluation), and radiological canal diameter were assessed before the procedure and at 1, 3, and 6 months postoperatively. Treatment response was determined based on a ≥2-point decrease in the VAS score, which is the minimal clinically important difference (MCID) criterion. Results: A marked improvement in VAS scores was observed from the early period following PLDD, with the mean VAS score decreasing from 8.02 to 5.02 ± 1.99 at 6 months (p < 0.001). The pain-free walking distance increased from 212.7 m to 345.8 m, resulting in a significant improvement in functional capacity (p < 0.001). A significant increase in the anteroposterior diameter of the spinal canal from 7.1 ± 1.7 mm to 7.9 ± 1.8 mm (p < 0.001) was observed, corresponding to a mean increase of 0.8 mm; however, the magnitude of this radiological change was modest and should be interpreted cautiously. A moderate correlation was found between radiological expansion and VAS change (r = 0.52). At 6 months, 72.9% of patients met the MCID criterion. Although ODI improved significantly over follow-up, the mean reduction remained below commonly accepted MCID thresholds, suggesting that the functional benefit may be modest. No major complications were observed; only short-term transient radicular irritation (2.1%) was seen. Conclusions: PLDD was associated with improvements in pain control, functional capacity, and modest radiological canal enlargement in this cohort of carefully selected patients with single-level, predominantly disc-driven lumbar spinal stenosis. However, because of the retrospective design and absence of a control group, no conclusions regarding comparative effectiveness can be drawn. PLDD should therefore be viewed as a selectively applicable minimally invasive option rather than a general treatment for all forms of lumbar spinal stenosis. The observed clinical benefit was limited to the 6-month follow-up available in this cohort, and its durability beyond this period remains uncertain. Prospective and comparative studies are required to better define its long-term role and its position relative to conservative treatment and surgery. Full article

Endoscopic spine surgery (ESS)—including full-endoscopic transforaminal and interlaminar techniques, and unilateral biportal endoscopy (UBE)—offers patients smaller incisions, preserved paraspinal muscle, and faster recovery. Because the working corridor is narrow, intraoperative fluoroscopy plays a larger role than in open or microscopic approaches, making radiation exposure worthy of attention for both patients and surgeons. This narrative review aims to be a practical resource for the endoscopic spine surgeon. We synthesize the available literature on typical radiation doses across the main ESS techniques, compare them with minimally invasive transforaminal lumbar interbody fusion (MIS-TLIF) and open alternatives, review the factors that drive exposure, and walk through the full menu of dose-optimization options—from simple measures such as collimation, pulsed fluoroscopy, and leaded eyewear, through navigation platforms, to robotic guidance. A consistent practical observation is that the simplest, least expensive interventions often deliver the largest dose reductions. Capital-intensive technologies add real value, particularly for endoscopic interbody fusion, and work best alongside rather than in place of these basics. With routine dosimetry and straightforward as-low-as-reasonably-achievable (ALARA) practices, surgeons can continue to build on the already favourable profile of ESS while keeping radiation exposure low. Conclusions are tempered by the largely retrospective and heterogeneous nature of the underlying evidence. Full article

Background: Lentigo maligna (LM) represents melanoma in situ and predominantly affects elderly individuals, typically arising on chronically sun-exposed skin of the head and neck. Although LM is characterized by slow horizontal growth and generally favourable prognosis, progression to invasive lentigo maligna melanoma may occur, making timely and effective treatment essential. Surgical excision remains the standard of care; however, advanced age, comorbidities, lesion size, and cosmetic or functional considerations may limit surgical feasibility. Case presentation: We report the case of a 93-year-old woman with no prior history of skin cancer who presented with a gradually enlarging pigmented lesion on the forehead. Clinical examination revealed an irregularly pigmented macule measuring 25 × 27 mm. Multiple mapping biopsies confirmed melanoma in situ of the lentigo maligna type, with adnexal extension and no evidence of dermal invasion. Given the patient’s advanced age and lesion location, a non-surgical approach was selected. Topical imiquimod 5% cream was applied five times per week for 12 weeks to the visible lesion and to a 20 mm margin around it. The patient was monitored closely throughout the treatment. Local inflammatory reactions were mild to moderate, consisting mainly of erythema, crusting, and superficial erosion, without systemic adverse effects. At treatment completion, marked clinical improvement with near-complete resolution of pigmentation was observed. Follow-up dermoscopic evaluation demonstrated only minimal residual granular pigmentation. Post-treatment mapping biopsies confirmed complete histological clearance of atypical melanocytic cells. Conclusions: This case illustrates that topical imiquimod may serve as a safe and effective alternative to surgery in carefully selected elderly patients with lentigo maligna. Close clinical follow-up and histological confirmation of clearance are essential to ensure treatment success and durable outcomes. Full article

Cutaneous melanoma is an aggressive skin cancer. While laser therapy is established for non-melanoma skin cancers, its role in melanoma remains controversial and largely unsupported by robust clinical evidence. The gold standard for melanoma management remains surgical excision, as it allows for definitive histopathological diagnosis, Breslow thickness measurement, and surgical margin assessment, which are essential for accurate staging. This narrative review analyzed preclinical and clinical studies evaluating various laser modalities, including Nd:YAG, CO₂, pulsed dye, photodynamic therapy (PDT) and photothermal therapy (PTT), for efficacy, recurrence rates, and limitations in cutaneous melanoma management. Nd:YAG laser (1064 nm) showed potential for local control in thin stage I melanomas, reporting a low local recurrence rate of 0–0.7% and favorable 5-year survival in small, non-randomized cohorts. CO₂ laser (10,600 nm) provides effective palliation and local control for in-transit or unresectable metastases, but local recurrence is highly variable, reaching up to 46.7%. Photodynamic therapy showed variable efficacy, although Chlorin e6 achieved complete local regression in a small series of metastases. A critical limitation of laser therapy is the irreversible destruction of tissue, which precludes these vital assessments. Therefore, laser treatment should be cautiously reserved for cases where standard surgery is not feasible, acknowledging that it may interfere with the evaluation of curative outcomes and accurate staging. Laser therapy is a valuable minimally invasive adjunct for local control in selected patients who are poor surgical candidates or require palliative care. Routine use is restricted by the lack of randomized controlled trials. Future studies should prioritize combination strategies with systemic or immunotherapeutic approaches to enhance overall outcomes. Full article

Background: Metabolic and bariatric surgery is an established therapeutic option for severe obesity and obesity-related medical problems. Although minimally invasive techniques and enhanced recovery pathways have reduced postoperative morbidity, infectious complications remain clinically relevant because they may lead to readmission, reoperation, prolonged antimicrobial therapy, and mortality. Methods: We conducted a narrative review of the literature on infectious complications after metabolic and bariatric surgery. Evidence was synthesized across five clinically relevant domains: host-related pathophysiology, microbial epidemiology, preoperative optimization, antimicrobial prophylaxis and pharmacokinetic considerations, and diagnosis and management of postoperative infectious complications. Results: Patients with obesity present specific infection-related vulnerabilities, including chronic low-grade inflammation, altered immune responses, impaired tissue oxygenation, obesity-related medical problems, and procedure-specific risks. Contemporary prevention relies on multidisciplinary preoperative optimization, appropriate skin antisepsis, weight-based antimicrobial prophylaxis, intraoperative redosing when indicated, and adherence to enhanced recovery principles. Anastomotic leaks and intra-abdominal abscesses represent the most severe organ/space infections and require early recognition, source control, antimicrobial therapy, nutritional support, and coordinated surgical, radiological, and endoscopic management. Conclusions: Infectious complications after metabolic and bariatric surgery result from the interaction between host physiology, microbial factors, pharmacological considerations, and surgical technique. A structured approach integrating prevention, early diagnosis, and multidisciplinary management may improve outcomes. Further bariatric-specific studies are needed to strengthen the evidence base for several preventive and therapeutic strategies. Full article

Variable stiffness endows continuum robots with both compliance and tunable rigidity, making them promising alternatives to traditional rigid manipulators in confined and unstructured environments. Over the past decade, great progress has been made in variable stiffness technologies involving structural design, actuation, modeling, and control. However, current research is fragmented and mostly focuses on individual aspects, lacking a systematic review and a unified framework integrating structure, modeling, and control. This paper presents a comprehensive review of variable stiffness in continuum robots, emphasizing the interrelationships among stiffness principles, modeling, and control strategies. We summarize classical and emerging variable stiffness methods, analyze their integration with control approaches, and evaluate the evolution of control strategies, especially multi-modal fusion of actuation, sensing, and control. Such fusion can improve control accuracy and robustness in human-centered environments and is regarded as a key driver for next-generation intelligent continuum robots. Finally, we outline future directions, highlight the “actuation–stiffness–control” paradigm, and discuss existing challenges and open research opportunities for high-performance intelligent control. Full article

Background: This study investigates textbook oncologic outcomes (TOO), a measurement operationally defined to produce a holistic measure of surgical success, with respect to patients diagnosed with pancreatic adenocarcinoma undergoing distal (left) pancreatectomy for pancreatic adenocarcinoma. This study aims to identify factors associated with achieving TOO, emphasizing the role of hospital type. Methods: The NCDB (2010–2022) was queried for patients with clinical stage I–III pancreatic adenocarcinoma. Inclusion criteria consisted of patients > 18 who underwent curative partial or total pancreatectomy. The primary outcome was the achievement of TOO—operationally defined as R0 resection, ≥12 lymph nodes examined, no prolonged hospital stay, absence of 30-day mortality, and no readmissions. Logistic regression analyses were conducted to identify predictors of TOO. Results: Analysis of 11,194 patients showed that 38.9% achieved TOO. Achievement of TOO was associated with a median increase in one year in overall survival. Factors associated with TOO achievements in the adjusted model include female sex, private insurance, a lower Charlson/Deyo score, minimally invasive surgery (MIS), and high-volume centers. Notably, MIS emerged as a significant factor associated with 26% higher TOO (OR 1.26, 95% CI: 1.14–1.40) while treatment at high-volume hospitals was associated with 28–112% increased TOO (OR 1.28, 95% CI: 1.08–1.54 for Q3 volume and OR 2.12, 95% CI: 1.76–2.55 for Q4 volume). Conclusions: Achieving TOO is significantly influenced by patient demographics, clinical characteristics, and notably, the case volume of the treatment facility. These findings underscore the importance of considering centers experienced in surgical planning and patient counseling to optimize outcomes in distal pancreatectomies. Full article

Background/Objectives: Accurate estimation of intraoperative blood loss in endoscopic spine surgery remains challenging because of continuous saline irrigation and blood infiltration into surrounding soft tissues and potential dead spaces. Hidden blood loss (HBL), resulting from extravasation into tissue compartments or hemolysis, may substantially increase total blood loss (TBL) and contribute to postoperative bleeding-related complications. This study aimed to compare HBL in full-endoscopic unilateral laminotomy with bilateral decompression (FE-ULBD) with that in biportal endoscopic ULBD (BE-ULBD) and open microscopic ULBD (OM-ULBD). Methods: A retrospective analysis was conducted of patients who underwent single-level FE-ULBD, BE-ULBD, or OM-ULBD for lumbar spinal stenosis (LSS) at a single institution. Data on perioperative characteristics, laboratory parameters, perioperative blood loss (TBL, HBL, and visible blood loss), and clinical outcomes were collected and compared. Univariate linear regression analyses were performed to identify factors associated with HBL in the FE-ULBD group. Results: A total of 93 patients were included, comprising 34 in the FE-ULBD group, 32 in the BE-ULBD group, and 27 in the OM-ULBD group. The FE-ULBD group demonstrated significantly lower TBL than both the BE-ULBD and OM-ULBD groups (493.20 ± 183.46 vs. 675.97 ± 192.02 vs. 822.94 ± 424.11 mL, p = 0.001 and p = 0.002, respectively). HBL in the FE-ULBD group was significantly lower than in the BE-ULBD group (390.48 [268.32–506.91] vs. 513.29 [437.96–633.36] mL, p = 0.012) and was numerically lower than in the OM-ULBD group without statistical significance (390.48 [268.32–506.91] vs. 516.38 [316.41–710.68] mL, p = 0.081). Male sex was the only variable significantly associated with increased HBL in the FE-ULBD group. Conclusions: FE-ULBD showed significantly lower TBL than BE-ULBD and OM-ULBD, and lower HBL than BE-ULBD. FE-ULBD may represent a feasible surgical option for single-level LSS, with the potential advantage of reduced perioperative blood loss while maintaining comparable clinical outcomes. Full article

Background: Postoperative ileus (POI) remains a leading driver of delayed recovery and prolonged length of stay (LOS) after colorectal surgery. Although ERAS is well established, less is known about how pathway adherence and implementation fidelity relate to bowel recovery in pragmatic minimally invasive practice. Objectives: To evaluate whether a structured ERAS pathway, delivered in routine care, was associated with lower POI and improved early recovery compared with contemporaneous standard care after elective minimally invasive colorectal surgery. Methods: In a prospective, non-randomized pragmatic comparative study conducted from January 2022 to September 2024, 123 adults undergoing elective laparoscopic colorectal resection were managed with either an ERAS pathway (n = 62) or standard care (n = 61). POI was operationalized prospectively using predefined clinical criteria and daily team assessment. Primary outcome was POI. Secondary outcomes included time to flatus, LOS, 48 h opioid use (morphine milligram equivalents, MME), complications (Clavien–Dindo), 30-day readmission, and Quality of Recovery (QoR-15). Multivariable logistic regression and propensity score–adjusted sensitivity analyses were performed to address baseline imbalance. Results: POI occurred in 7/62 (11.3%) in ERAS vs. 22/61 (36.1%) in standard care (p = 0.002). ERAS patients had earlier flatus (38.6 ± 15.2 h vs. 60.0 ± 20.1 h, p < 0.001), shorter LOS (4.2 [3.4–5.0] vs. 5.4 [4.5–6.8] days, p < 0.001), lower 48 h opioids (35.4 [25.2–47.8] vs. 61.1 [41.5–88.6] MME, p < 0.001), and higher QoR-15 at POD2 (113.9 ± 14.9 vs. 104.8 ± 15.5, p = 0.001). In the primary multivariable model, ERAS was independently associated with lower POI odds (adjusted OR 0.2; 95% CI 0.1–0.7; p = 0.013); the association remained directionally similar in propensity-adjusted sensitivity analysis (adjusted OR 0.31; 95% CI 0.12–0.79; p = 0.015). Higher adherence was associated with lower POI and lower opioid exposure. Conclusions: In this prospective cohort, ERAS implementation was associated with lower POI incidence and faster early recovery; however, findings should be interpreted as observational and hypothesis-generating rather than causal. Full article

Background/Objectives: The optimal timing of asymptomatic congenital pulmonary airway malformations (CPAM) is controversial. Early resection may reduce inflammation and scarring secondary to respiratory infections, but contemporary practice patterns are unknown. This study assesses trends in operative timing and approach over the past decade. Methods: A retrospective review was performed of 1934 CPAM patients in NSQIP-P undergoing resection (2012–2021). Trends in surgical approach and age at resection were assessed using Mann–Kendall tests. Multivariable logistic and linear regression were used to model the influence of age at operation on operative length, postoperative complications, and postoperative length of stay. Results: Thoracoscopic approach increased from 47.2% in 2012 to 80.8% in 2021 (p < 0.001). Median age at operation was 7.7 months. There was a downtrend in the open approach in patients ≤3 months old (tau = −0.511, p < 0.05) without a corresponding increase in VATS approach (tau = −0.11, p = 0.72). Instead, there was a statistically significant uptrend in all other age cohorts >3 months old in the VATS approach. After adjusting for confounders there was no difference in complication rates between age cohorts. Conclusions: Adoption of thoracoscopic resection for CPAM has substantially increased. Despite the reported benefits of earlier resection, the timing of surgical resection remains variable with most surgeries still occurring after six months of age. Additionally, the decline in open surgeries in patients ≤3 months may reflect a preference towards the VATS approach in a slightly older infant population. Further research is necessary to determine optimal timing for CPAM resection. Full article

Background and Objectives: Minimally invasive cervical spine surgery (MIS-CSS) relies heavily on intraoperative fluoroscopic imaging, raising concerns about radiation exposure to patients and surgical staff. Unlike lumbar MIS, cervical-specific radiation exposure has not been systematically reviewed, despite distinct anatomical considerations, including proximity to the thyroid gland and lens of the eye. This review aims to quantify intraoperative radiation exposure during MIS cervical spine procedures and evaluate available dose-reduction strategies. Materials and Methods: A systematic literature search was conducted across PubMed/MEDLINE, Scopus, and Google Scholar in April 2026 following PRISMA 2020 guidelines. Studies reporting original quantitative radiation data during minimally invasive cervical spine procedures in adult patients (≥10 patients) were included. Quality was assessed using the MINORS tool and the JBI checklist. Results: Seven studies encompassing 380 patients were included. Procedures comprised ACDF (four studies), minimally invasive posterior cervical laminoforaminotomy (two studies), and CT-navigated cervical instrumentation (one study). Patient effective doses during ACDF ranged from 0.015 to 1.3 mSv, with thyroid doses of 0.194–0.290 mGy. Standalone ACDF reduced patient dose by 36–58% compared to plated ACDF (p < 0.001). Navigation-assisted posterior cervical foraminotomy achieved a median fluoroscopy time of 10 s with negligible staff exposure. Surgeon per-procedure exposure during cervical discectomy (chest 0.122 µSv, lens 3.1 µSv, hands 7.1 µSv) was approximately half that of lumbar discectomy. Conclusions: Radiation doses during individual MIS cervical procedures appear to be within occupational safety limits, though the current evidence is insufficient to establish definitive dose thresholds. Standalone implant designs and intraoperative navigation represent effective, complementary dose-reduction strategies. Standardized prospective research is needed to establish cervical-specific radiation safety benchmarks. Full article

Background: Knee osteoarthritis (OA) is one of the leading causes of disability in older adults. As definitive treatment often involves knee replacement surgery, effective non-invasive approaches capable of alleviating symptoms and preserving mobility are needed to delay surgical intervention or bridge waiting periods for surgery. Methods: Thirty-two patients with knee OA were included in this pilot comparative study. Patients underwent either a standardized physical therapy program (10 sessions) or the same program supplemented with vacuum-compression therapy (VCT), according to treatment received during routine clinical care. Outcome measures included the Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC), Visual Analog Scale (VAS), and the Physical and Mental Component Summary scores of the SF-12 questionnaire (PCS, MCS). Assessments were performed at baseline and at 1-month follow-up, with WOMAC additionally evaluated immediately after treatment. Responder analysis based on minimal clinically important difference (MCID) thresholds was also performed. Results: Both groups demonstrated significant improvement across most outcomes. Between-group analysis showed greater improvements in the intervention group, with statistically significant differences observed for functional outcomes (WOMAC and PCS). Conclusions: In this pilot comparative study, the addition of VCT to standard physical therapy was associated with greater functional improvement in patients with knee OA. Full article

Background: The T-hook is a recently introduced device for ab interno trabeculotomy, first reported in 2022. This study compared the one-year surgical outcomes of Kahook Dual Blade (K group)- and T-hook (T group)-assisted trabeculotomy combined with phacoemulsification in patients with primary open-angle glaucoma (POAG). Methods: This retrospective study included patients with POAG who underwent 180° ab interno trabeculotomy combined with phacoemulsification at our institution between June 2018 and September 2024 and were followed for at least 12 months. Changes in intraocular pressure (IOP), mean IOP reduction rate, number of antiglaucoma medications, postoperative complications (hyphema and transient IOP spikes), and cumulative surgical success rates were evaluated. Results: A total of 45 patients (61 eyes) were included, comprising 29 patients (42 eyes) in the K group and 16 patients (19 eyes) in the T group. A transient increase in IOP at one week postoperatively observed in the K group (p < 0.0001); however, both groups demonstrated significant IOP reduction from baseline after 1 month (p < 0.05). The mean IOP reduction rate at 12 months did not differ significantly between groups (p = 0.0720, ANCOVA). The number of antiglaucoma medications significantly decreased at all postoperative time points in both groups compared with baseline (p < 0.05). Kaplan–Meier survival analysis revealed no significant difference in cumulative surgical success rates between groups (p = 0.6217). The incidence of hyphema was comparable between groups (p = 1.00), whereas transient IOP spikes occurred significantly more frequently in the K group (p = 0.0057). Conclusions: While both procedures demonstrated comparable intraocular pressure-lowering efficacy, T-hook-assisted trabeculotomy was associated with fewer transient postoperative IOP spikes during the early postoperative period in this cohort. Full article

Introduction: Postoperative pulmonary complications, particularly pneumonia, remain frequent after esophagectomy and contribute significantly to morbidity. One-lung ventilation (OLV) is a potential modifiable risk factor, but its impact in minimally invasive (MIE) and robot-assisted Ivor Lewis esophagectomy (RAMIE) within European populations is not well defined. Methods: 619 patients undergoing MIE or RAMIE were analyzed. OLV duration was extracted from operative records. Postoperative pneumonia incidence, overall survival, and perioperative outcomes were assessed. ASA classification and other risk factors were considered. Results: The overall incidence of postoperative pneumonia was 18.6%, with no significant difference between MIE (20.4%) and RAMIE (18.2%). Prolonged OLV duration increased pneumonia risk by 4% per 10 min. Female sex and higher ASA classification were also significant risk factors. Likely reflecting early diagnosis and advanced perioperative management, pneumonia did not affect overall survival, which remained comparable between MIE and RAMIE. Conclusions: Prolonged OLV during MIE and RAMIE increases the risk of postoperative pneumonia without significantly affecting overall survival, reflecting effective complication management. OLV duration may serve as a practical intraoperative indicator to guide risk stratification and optimize postoperative care in minimally invasive and robot-assisted Ivor Lewis esophagectomy. Full article

Introduction: Plantar fasciitis is a common cause of heel pain in adults, with a significant impact on quality of life and athletic performance. While conservative treatments are effective in most cases, a subset of patients remains symptomatic and may require surgical intervention. Minimally invasive techniques, such as bipolar radiofrequency (RF) coblation using the TOPAZ system, have emerged as promising alternatives to traditional open or endoscopic procedures. Methods: This retrospective study evaluated the clinical outcomes of 49 consecutive patients (20 males and 29 females; mean age 54.3 ± 11.4 years; mean BMI 25.3 ± 3.2, range 21.5–34.7) with chronic plantar fasciitis unresponsive to at least six months of conservative treatment. The affected side was left in 24 patients and right in 25, and 35 patients were regularly engaged in sports prior to symptom onset. All patients underwent percutaneous bipolar RF coblation using the TOPAZ device between July 2019 and November 2024. Patient-reported outcome measures—including the Visual Analog Scale (VAS), AOFAS Ankle–Hindfoot Score, SF-36, and Tegner Activity Scale—were collected at the final follow-up (mean 41.7 ± 18.3 months, range 6–71). Results: Statistically significant improvements were observed in pain and function: mean VAS decreased from 8.5 to 3.1 (p < 0.001), and American Orthopaedic Foot and Ankle Society (AOFAS) pain and function scores improved from 2.5 and 12.75 to 28.75 and 38.75, respectively (p < 0.001). The mean Tegner score increased from 1.3 to 4.1 (p < 0.001), with 100% of previously active patients returning to sport. No major complications or reoperations were reported. Conclusions: Percutaneous bipolar RF coblation appears to be a safe and effective treatment for recalcitrant plantar fasciitis, offering significant pain relief, functional improvement, and a high return-to-sport rate with minimal morbidity. This technique may represent a valuable intermediate option between conservative care and open surgery. Full article