Search Results (188)

Objectives: The aim of this study was to compare the surgical and postoperative clinical outcomes of punch-only and linear incision techniques for implantation of the Ponto^® bone conduction implant. Methods: Surgical and follow-up data were collected from 101 patients: 46 treated with Minimally Invasive Ponto^® Surgery (MIPS) and 55 with the linear incision technique (LT). The analysis focused on: (1) the surgical procedure, including operative time and intraoperative complications; (2) the healing process; and (3) long-term implant-site outcomes, including implant loss. Results: Median operative time was significantly shorter for MIPS than for LT (30 min vs. 40 min, p < 0.001). No major intraoperative complications were observed in either group. Adverse skin reactions were more frequent in the LT group than in the MIPS group (18.2% vs. 8.7%), but the difference was not statistically significant (p = 0.249). A single implant loss occurred in the LT group 18 months after surgery and was unrelated to failed osseointegration or the surgical technique, being caused by recurrent cholesteatoma. Conclusions: MIPS was associated with a significantly shorter operative time than the LT. Both MIPS and LT appear to be safe techniques. No statistically significant differences were detected between the groups with respect to adverse skin reactions or implant survival during the follow-up period. Full article

Background/Objectives: The minimally invasive repair of pectus excavatum (MIRPE) and its modifications represent the gold standard for surgical repair of chest wall deformities. Severe complications during or after MIRPE are rare but likely underreported in the literature. Methods/Results: We report the case of a 14-year-old adolescent who underwent an uneventful repair of an asymmetric pectus excavatum. Six weeks postoperatively, the patient presented with shortness of breath and dizziness. Clinical examination and imaging revealed a spontaneous massive right-sided hemothorax. Following chest tube placement, an initial 600 mL of bloody pleural fluid was drained. CT angiography demonstrated no active bleeding but raised suspicion of an injury to the right-sided internal mammary artery. After a total drainage of 1600 mL, the patient remained hemodynamically stable, and the chest tube was removed within 24 h. During 32 months of follow-up, the further clinical course was uneventful, and imaging demonstrated no secondary displacement of the implants. Discussion/Conclusions: Accidental injury to the internal mammary or intercostal vessels during pectus surgery is a rare but potentially life-threatening complication. Only a few cases of delayed hemorrhage following MIRPE have been reported, and in many a clear source of bleeding could not be identified. Pectus surgeons should be aware of this rare complication and should report such cases to improve understanding of its incidence and management. Full article

Background and Objectives: Endoscopic beating-heart tricuspid valve (TV) surgery is increasingly adopted in cardiac surgery due to its association with improved postoperative recovery. Conventional approaches require jugular vein cannulation to establish adequate bicaval venous drainage, and caval snaring is considered mandatory during beating-heart TV procedures to prevent intraoperative air lock. We report our single-center experience with a novel percutaneously placed venous cannula (Smart Cannula) that enables minimally invasive TV surgery without jugular cannulation or caval snaring. Materials and Methods: Between February 2025 and May 2026, 31 consecutive patients underwent endoscopic beating-heart TV surgery using the Smart Cannula system for venous drainage. The device is a stent-like cannula with distributed wall perforations allowing sufficient venous return while preventing air lock. Preoperative atrial fibrillation was present in 21 patients (68%). Six patients (19%) underwent isolated TV procedures; the remainder had concomitant procedures. Mean age was 68.2 ± 10.8 years; 16 patients (52%) were female. Two different cannula lengths were used: 680 mm (n = 15) and 730 mm (n = 16). Six patients (19%) had history of prior cardiac surgery. Results: All procedures were completed without intraoperative air lock. Two patients (6%) required intraoperative conversion to sternotomy. Mean cardiopulmonary bypass time was 163 ± 52 min. Seven patients (23%) underwent beating-heart procedures with no aortic cross-clamping; in 24 patients (77%), aortic cross-clamping was required for concomitant procedures (mean cross-clamp time 79 ± 28 min), with tricuspid repair completed on the reperfused beating heart. Re-exploration for bleeding occurred in two patients (6%). Median ICU stay was 5 days and median hospital stay was 10 days. New permanent pacemaker implantation was required in three patients (10%). Thirty-day mortality was 0%. Postoperative echocardiography at discharge demonstrated TR Grade 0 in 61%, mild TR in 32%, and moderate TR in 3% of patients. Conclusions: In this first and largest published series on endoscopic beating-heart TV surgery without caval snaring or jugular vein cannulation, we have shown that the process is feasible and safe, eliminating the need for jugular vein cannulation and caval snaring while maintaining no occurrence of intraoperative air lock. The device enables a simplified venous drainage strategy without compromising operative safety or early clinical outcomes. Full article

Background: Severe maxillary atrophy remains a major challenge for implant-supported rehabilitation, often requiring complex grafting procedures or zygomatic implants associated with increased surgical morbidity. Advances in digital planning and additive manufacturing have enabled the development of patient-specific subperiosteal implants supported by cortical bone anchorage. Materials and Methods: This study presents a fully digital workflow combining customized subperiosteal implants (SP3D) with guided pterygoid fixation (PT3D) to achieve stable distal support and allow immediate loading in severely atrophic maxillae. Results: Nine patients presenting with advanced maxillary atrophy were treated using computer-assisted design, guided surgery, and immediate prosthetic rehabilitation. All implants were successfully placed according to the digital plan, achieving stable fixation through bilateral pterygoid engagement. No major intraoperative or postoperative complications were observed. Immediate loading was performed in all cases with stable prosthetic outcomes during the follow-up period (average follow-up period was 12.7 months). Conclusions: The combined SP3D–PT3D approach represents a minimally invasive alternative for full-arch rehabilitation in extreme maxillary atrophy, potentially reducing the need for bone grafting while improving surgical predictability and biomechanical stability. Full article

Tricuspid regurgitation (TR) is being increasingly recognized in the patient population. It is a common cardiac cause of chronic disability. This pathology is characterized by a heterogeneous and broad spectrum of clinical manifestations with signs and symptoms. The results from various and different analyses and studies suggest that TR-related deaths may have increased over the last 20 years. This trend may justify a greater focus on timely diagnosis and management of TR. For a long time, this problem has been underestimated or treated with only pharmacological therapy (diuretics). The use of the isolated surgical option remains infrequent, especially in patients at high surgical risk, for whom a significant number of patients with TR are still not treated, and a disability remains that is difficult to manage and rehabilitate. To date, there are emerging as an alternative to surgery in high-risk patients with severe TR multiple transcatheter devices that aim to reduce TR through different functional mechanisms. There are numerous minimally invasive treatments for TR, and many devices used for the treatment of this disabling pathology. In fact, there are various treatments with a transcatheter approach using ever-new devices. The use of heterotopic implantation of bioprosthetic valves in the superior and inferior vena cava represents an additional therapeutic armamentarium that, through caval reflux, can constitute an additional resource, too. Starting from a single clinical experience and describing a clinical case report, a narrative review has been undertaken by reviewing the various studies that have investigated this type of approach and their impact on the general, cardiac, and functional sides, to then discuss the cost–benefit ratio in light of knowledge on this specific topic. Full article

Background/Objectives: The Ross procedure is recognized for its excellent long-term outcomes in aortic valve surgery, providing superior hemodynamic performance, freedom from anticoagulation, and a low risk of valve thrombosis. The aim of this study was to evaluate the technical feasibility and early clinical outcomes of performing the Ross procedure through a minimally invasive V-shaped (arrow-shaped) partial sternotomy in adult patients. Methods: Eleven consecutive adult patients underwent a Ross procedure through a 7 cm upper midline skin incision and a V-shaped (arrow-shaped) ministernotomy sternotomy extending to the third intercostal space. Cardiopulmonary bypass was established through central cannulation. The pulmonary autograft was implanted in the aortic position using the miniroot technique, followed by implantation of a pulmonary homograft in the pulmonary position. Operative, perioperative, and early echocardiographic outcomes were prospectively evaluated. Results: All procedures were completed successfully without conversion to full sternotomy or major intraoperative complications. The cardiopulmonary bypass and aortic cross-clamp times were consistent across the series, averaging 144 and 86 min, respectively. Intraoperative transesophageal echocardiography confirmed satisfactory function of both the autograft and homograft in all patients. Postoperative recovery was uneventful, with mechanical ventilation times ranging from 4 to 8 h and intensive care unit stays of 24–48 h. No cases of stroke, renal failure, permanent pacemaker implantation, atrial fibrillation, wound infection, sternal instability, reoperation for bleeding, readmission, or mortality occurred. Patients were discharged between postoperative days 7 and 10. At 3-month follow-up, transthoracic echocardiography demonstrated preserved left ventricular function, absence of aortic regurgitation, and low transvalvular gradients in all patients. Conclusions: This initial single-center case series demonstrates the technical feasibility of performing the Ross procedure through a V-shaped (arrow-shaped) partial sternotomy in carefully selected adult patients. The approach provides satisfactory operative exposure for all components of the procedure while maintaining the advantages of minimally invasive surgery. Larger studies with longer follow-up are required to further evaluate clinical outcomes and long-term durability. Full article

Peritoneal metastasis (PM) is the most frequent and lethal pattern of dissemination in gastrointestinal malignancies. Despite advances in systemic chemotherapy, outcomes remain poor because the unique biology of PM, characterized by poor vascularization and the peritoneal–plasma barrier (PPB), limits drug penetration and contributes to treatment resistance. To address these challenges, several locoregional treatment strategies have been developed, including cytoreductive surgery plus hyperthermic intraperitoneal chemotherapy (CRS + HIPEC) and pressurized intraperitoneal aerosol chemotherapy (PIPAC). However, their widespread adoption is constrained by invasiveness, strict patient selection, and inconsistent survival benefits. Normothermic intraperitoneal and systemic treatment (NIPS) has emerged as a practical and less invasive alternative, particularly in East Asia. Through an implanted intraperitoneal port, NIPS enables repeated drug administration, providing sustained regional exposure while imposing minimal procedural burden. Importantly, it can be readily integrated with systemic chemotherapy, making it suitable for long-term multimodal treatment. Among available agents, paclitaxel (PTX) is particularly well suited for intraperitoneal administration because of its prolonged retention within the peritoneal cavity and limited systemic absorption. These pharmacokinetic properties allow high local drug concentrations with relatively low systemic toxicity. Consequently, PTX-based NIPS represents a biologically rational and clinically feasible treatment strategy for PM. This review summarizes the pharmacological rationale, clinical evidence, and emerging innovations in drug formulation and delivery that may further enhance the efficacy of PTX-based intraperitoneal chemotherapy for this challenging disease. Full article

Patient-specific implants (PSIs) in orthognathic surgery offer optimal intraoperative accuracy. However, evidence regarding their postoperative skeletal stability, specifically comparing distinct fixation designs and segmentation patterns, remains limited. We present a retrospective cohort study that evaluated 64 adult patients undergoing customized maxillary orthognathic surgery between January 2020 and June 2025. The primary predictor variables were fixation design (conventional customized plates vs. minimally invasive plates) and maxillary segmentation (monoblock vs. multisegmental). The outcome variable was 3D skeletal stability, measured as linear displacement between preoperative planning and 6-month postoperative imaging. Non-parametric tests compared displacements and clinical instability rates (defined as ≥2.0 mm). Mann–Whitney tests compared landmark displacements, Fisher’s exact tests compared proportions with ≥2.0 mm displacement, and ORs with 95% CIs were computed (α = 0.05). Analysis of 64 patients revealed that median displacement across landmarks ranged from 0.7 to 4.28 mm and 28.1% exhibited displacement ≥ 2.0 mm, primarily in molar and canine regions. While overall instability rates did not differ significantly between single-segment and multisegmental osteotomies (p = 0.28), multisegmental cases showed significantly higher displacement at the left canine (p = 0.027). Plate design was not associated with skeletal instability (p = 0.88), suggesting that minimally invasive plates provide comparable stability to conventional designs. Customized maxillary plates provide reliable postoperative stability with median displacements within clinically acceptable limits (<2 mm). Minimally invasive PSI designs offer stability comparable to conventional extended designs. However, localized instability in multisegmental cases suggests a need for careful biomechanical management regardless of the fixation method used. Full article

Minimally invasive spine surgery (MISS) has progressively transformed the management of spinal disorders by reducing soft-tissue disruption, perioperative morbidity, and recovery time while maintaining clinical outcomes comparable to conventional open techniques. Beyond its technical evolution, MISS has increasingly assumed a central role in the treatment of bone-related spinal conditions, including vertebral fractures, degenerative instability, metastatic disease, and osteoporosis-associated pathology. This narrative review provides a comprehensive overview of the evolution of MISS with a specific focus on its interaction with vertebral bone biology, implant stability, and fusion processes. A structured literature search of the PubMed/MEDLINE database was conducted, including English-language studies published between 1980 and June 2025 addressing MISS techniques, enabling technologies, and bone-related clinical outcomes. Current evidence suggests that MISS may preserve paraspinal vascularization and soft tissue integrity, potentially supporting bone healing and fusion, although high-quality comparative data remain limited. The effectiveness of MISS in osteoporotic and metastatic vertebral disease is closely linked to bone quality, implant anchorage, and biomechanical considerations, particularly in the context of pedicle screw fixation and interbody support. Emerging technologies—including navigation, robotics, and artificial intelligence—may enhance accuracy in implant placement and reduce bone-related complications, but robust evidence of long-term benefit is still lacking. Despite its advantages, MISS presents important limitations, including a steep learning curve, increased costs, and uncertain superiority in terms of fusion rates and long-term biomechanical stability. Future research should prioritize high-quality comparative studies focusing on bone healing, implant integration, and patient-specific factors such as bone density. MISS should therefore be interpreted not only as a surgical paradigm shift but as an evolving strategy for optimizing outcomes in bone-related spinal disorders. Full article

Background and Clinical Significance: Infective endocarditis is a disease of the endocardial surface of the heart, most often affecting heart valves (native or prosthetic) or intracardiac device. Although relatively rare, it carries high embolic risk of complications and mortality. Complete device extraction is recommended; however, conventional surgery may be prohibitive in frail patients with multiple comorbidities. Case presentation: We present a case of a 74-year-old male with implantable cardioverter-defibrillator (ICD)-related infective endocarditis and large lead-associated vegetation measuring approximately 3 cm in size. Due to a high operative risk assessed by Euro SCORE II, a minimally invasive percutaneous approach using the Penumbra vacuum-assisted aspiration system was selected. The procedure enabled successful debulking of the vegetation, followed by complete device removal and targeted antibiotic therapy. The patient’s clinical condition improved, with normalization of inflammatory markers and no recurrence of infection, and a new ICD was safely reimplanted after recovery. Conclusions: This case highlights the potential role of percutaneous vacuum-assisted aspiration as an effective and less invasive therapeutic option in high-risk patients with CIED-related infective endocarditis, particularly when conventional surgical management is contraindicated or requires bridging therapy until the patient’s status is stabilized. Full article

Background/Objectives: Contemporary implant dentistry is increasingly oriented toward minimally invasive regenerative strategies designed to reduce surgical morbidity while preserving or improving clinical outcomes. Conventional bone augmentation procedures remain effective and biologically well established, but they may be associated with greater patient burden, increased risk of complications, and higher technical demands in selected clinical scenarios. This narrative review critically examines minimally invasive bone regeneration approaches in implant dentistry, with particular focus on the Bone Core Technique, the Sub-Periosteal Peri-implant Augmented Layer (SPAL) technique, and Immediate Dentoalveolar Restoration (IDR), emphasizing their biological rationale, clinical indications, surgical workflows, limitations, and reported outcomes. Methods: A structured, non-systematic literature search was conducted in PubMed/MEDLINE, Scopus, and Web of Science to identify publications relevant to minimally invasive bone regeneration in implant dentistry. Priority was given to clinical studies, prospective cohorts, case series, technical descriptions, and biologically oriented conceptual papers addressing vascular preservation, flap limitation, donor-site morbidity, and peri-implant hard- and soft-tissue integration. Results: Available evidence suggests that minimally invasive regenerative protocols may offer favorable clinical and patient-centered outcomes only in carefully selected indications and when performed by experienced operators. The strength of support is uneven across techniques: the Bone Core Technique currently has the strongest dedicated prospective follow-up for localized peri-implant defects, SPAL is supported by limited retrospective and emerging histologic evidence, and IDR remains largely based on case reports, technique-driven descriptions, and broader immediate implant literature. Conclusions: Minimally invasive bone regeneration reflects a shift toward biologically guided and patient-centered treatment concepts in implant dentistry, but it should not be interpreted as a universal substitute for conventional augmentation. Its successful application depends on careful case selection, sound knowledge of wound healing and defect morphology, and advanced surgical and prosthetic expertise. Further research should prioritize standardized outcome measures, longer follow-up, and comparative prospective studies. 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

Critical size bone defects (CSBD) remain a major challenge in orthopedic surgery. Autologous bone grafting is considered the gold standard but is limited by restricted availability and significant donor-site morbidity. Synthetic bone substitutes offer an alternative; however, these materials are avital and lack osteoinductive properties. This study evaluated whether intraoperative bioactivation of bone substitutes using a surgical suction handle can safely enhance their regenerative potential. Fifty patients with CSBD, non-unions, or high-risk defects were enrolled, and calcium phosphate-based ceramics were intraoperatively coated with autologous tissue via a surgical suction handle and implanted into the defects. Clinical outcomes—including pain, range of motion, and wound healing—were scored using a standardized system, with all patients achieving results in the “excellent” range (10–13 points). Radiographic follow-up showed progressive cortical and extracortical bone formation in all patients. Surgeons reported high ease-of-use for the device, and no device-related complications occurred. Although biomaterial resorption was incomplete in some cases (36% with <75% resorption at six months), no patient required revision surgery. Our data indicate that intraoperative bioactivation of bone substitutes using a surgical suction handle is safe, feasible, and promotes local bone regeneration, providing a minimally invasive and practical approach to enhance the performance of synthetic grafts in challenging defects. Full article

Background/Objectives: Glaucoma is a leading cause of irreversible blindness, and lowering intraocular pressure (IOP) is the only proven strategy to slow disease progression. The Preserflo^® Microshunt (PMS) is a minimally invasive subconjunctival drainage device used to treat uncontrolled glaucoma. Given that cataracts and glaucoma often coexist, this study aimed to compare the 12-month efficacy and safety of PMS implanted as a standalone procedure versus combined with phacoemulsification (PCE). Methods: This single-center retrospective case–control study included 104 eyes (26 PMS + PCE; 78 standalone PMS) from patients treated between 2019 and 2023. Controls were matched 3:1 to cases on sex, age, glaucoma severity, baseline IOP, and number of prior glaucoma surgeries. Success at 12 months was defined as absolute (IOP ≤ 21 mmHg without medications) or qualified (IOP ≤ 21 mmHg with the same or fewer medications). Secondary outcomes included changes in IOP, medication burden, and safety profiles. Results: At 12 months, absolute success was achieved in 23.1% of the PMS + PCE group versus 43.6% in the standalone PMS group (p = 0.13). However, the Kaplan–Meier survival probability of absolute success was significantly higher for standalone PMS (75.2% vs. 40.2%, p = 0.0028). Qualified success rates were comparable (53.9% vs. 70.5%, p = 0.30). Both groups showed similar reductions in mean IOP and medication counts. Although safety profiles were comparable, the mean time to first bleb revision (p = 0.031) and first needling (p = 0.015) was significantly shorter in the combined group. Conclusions: Both standalone and combined PMS procedures are effective and safe in achieving sustained IOP reduction. Although standalone implantation appears to be associated with higher medication-free success rates, combined surgery remains a reasonable option for patients with coexisting cataract, despite a tendency toward earlier bleb fibrosis likely related to the inflammatory response induced by PCE. Full article

In this study, a fully digital workflow enabling the alignment of pre- and postoperative mandibular intraoral scans in complete-arch implant rehabilitation using intraosseous fiducial reference markers is presented. A prosthetically driven digital workflow was implemented for mandibular complete-arch rehabilitation in which two cylindrical intraosseous pins were placed in a median or paramedian mandibular region and used as fiducial reference markers to align pre- and postoperative intraoral scans. Pin osteotomies were prepared using a calibrated drilling protocol and preserved throughout surgery to allow for the exact repositioning of the pins. Implant positions were recorded using photogrammetry, while postoperative intraoral scans were acquired after suturing with the pins reinserted. Scan alignment was performed using a best-fit algorithm based exclusively on the fiducial pin geometry. Standardized convergent scanbodies without undercuts were used for intraoral scanning. The proposed workflow allowed for the alignment of pre- and postoperative mandibular scans without additional radiographic acquisitions and was compatible with both guided and free-hand implant placement, regardless of the degree of mandibular atrophy. Within the limitations of a proof-of-concept report, the use of intraosseous fiducial reference markers represents a minimally invasive and clinically applicable solution to a critical limitation of fully digital mandibular rehabilitation workflows, without the quantitative validation of accuracy, trueness, or reproducibility. Full article