Search Results (138)

Background and Objectives: Traditional open anterior cruciate ligament transection (ACLT) surgical models performed through arthrotomy may introduce capsular trauma and postoperative inflammatory responses that can interfere with the interpretation of post-traumatic osteoarthritis (OA). This study aimed to evaluate the feasibility of a minimally invasive, arthroscopic ACLT rabbit model performed entirely under arthroscopic visualization, without arthrotomy, using a 2.4-mm arthroscope and 2.5-mm shaver, and to provide preliminary structural, histological, synovial, and systemic biochemical characterization of the model for future therapeutic testing. Materials and Methods: Bilateral arthroscopic ACLT was performed in three skeletally mature New Zealand rabbits, followed by a supervised 12-week exercise protocol. Joint degeneration was evaluated macroscopically and histopathologically using the standardized Pritzker-Osteoarthritis Research Society International (OARSI) grading system. Collagen matrix remodeling was assessed via Picrosirius Red staining. Local intra-articular catabolism was quantified via Enzyme-Linked Immunosorbent Assay (ELISA) for matrix metallopeptidase 13 (MMP-13) and interleukin-1β (IL-1β) from synovial fluid. Systemic oxidative stress, including lipid peroxidation biomarkers, malondialdehyde (MDA), and nitric oxide (NO), was evaluated in serum. Results: The arthroscopic approach induced osteoarthritic changes, with severity varying across the cohort. Histopathology revealed vertical matrix fissures and disruption of the normal columnar chondrocyte organization, yielding a median comprehensive Pritzker-OARSI score of 6 (range 6–10), with horizontal degradation restricted to stage 2. Synovial fluid analysis demonstrated measurable concentrations of MMP-13 (188.77 ± 93.87 ng/mL) and IL-1β (174.93 ± 95.51 pg/mL). Furthermore, serum oxidative stress parameters at the 12-week endpoint included lipid peroxidation (MDA: 1.01 ± 0.03 nmol/mL) and NO levels (82.72 ± 0.32 µmol/L), presented descriptively in the absence of a comparator group. Conclusions: This study establishes the first multifaceted pathological baseline of a minimally invasive arthroscopic ACLT rabbit model before therapeutic intervention. The arthroscopic ACLT model produced structural cartilage degeneration alongside measurable intra-articular catabolic and systemic oxidative stress changes, establishing a baseline phenotype and a starting point for future therapeutic studies. Full article

Diagnosis in epilepsy depends on several distinct objectives—including interictal epileptiform discharge (IED) detection, source localisation of epileptiform activity, and seizure classification—each shaped by the underlying sensing technology. This review examines the opportunities that quantum magnetic sensing offers within this diagnostic framework, with particular emphasis on translational readiness and clinical potential. Seizure classification is included to situate the broader clinical context of epilepsy diagnostics, whereas the review of quantum sensing evidence is focused on IED detection and presurgical source localisation, the objectives for which such evidence currently exists. Magnetoencephalography (MEG) provides non-invasive source localisation that complements electroencephalography (EEG), and its clinical adoption is increasingly determined by advances in magnetic sensor technology. Optically pumped magnetometer (OPM)-based MEG represents the most clinically developed quantum sensing application, progressing from proof-of-concept in 2020 toward small-cohort clinical feasibility studies from 2022 onwards. By enabling on-scalp recordings at reduced sensor-to-brain distance, OPM-MEG improves signal amplitude and permits flexible sensor placement, with early evidence of benefit in paediatric populations and mesial temporal lobe epilepsy. However, current evidence derives from small, heterogeneous cohorts, and no prospective data yet link OPM-MEG to surgical outcomes. ⁴He-OPMs represent an early feasibility stage with IED detection comparable to superconducting quantum interference device (SQUID)-MEG in small case series; nitrogen-vacancy centres in diamond and silicon carbide divacancy magnetometry remain preclinical, constrained by a fundamental standoff-sensitivity trade-off. We conclude that OPM-MEG is best positioned as a complementary modality within established presurgical workflows, with prospective multicentre outcome studies representing the critical next step toward clinical translation. Full article

Objectives: To evaluate the clinical accuracy and patient-reported outcomes (PROMs) of robotic-assisted full-arch implant rehabilitation performed with an autonomous robotic implant system. Materials and Methods: Six consecutive edentulous patients requiring implant-supported full-arch rehabilitation were treated using the Yakebot task-autonomous robotic implant system following a fully digital workflow. A total of 36 Straumann Bone Level Tapered implants were placed using a flapless approach. Implant placement accuracy was assessed by comparing planned and postoperative CBCT datasets. Coronal, apical, depth, and angular deviations were automatically calculated using dedicated robotic planning software. Patient-reported outcomes were prospectively evaluated through a structured questionnaire assessing preoperative perceptions, postoperative morbidity, and overall treatment satisfaction. Results: All implants were successfully placed according to the robotic-assisted workflow without intraoperative complications or conversion to conventional surgery. Mean three-dimensional coronal and apical deviations were 0.45 ± 0.18 mm and 0.47 ± 0.19 mm, respectively, while mean total angular deviation was 1.30 ± 0.63°. Patients reported low preoperative anxiety (0.5 ± 0.8/10), limited postoperative pain (2.2 ± 3.5/10), swelling (1.3 ± 2.2/10), and interference with daily activities (1.3 ± 2.2/10). Overall surgical experience was highly rated (9.7 ± 0.8/10). Final satisfaction scores were exceptionally high, with all patients indicating they would undergo robotic-assisted surgery again and recommend the procedure to others. Conclusions: Robotic-assisted full-arch implant rehabilitation demonstrated a high level of clinical accuracy, with submillimetric coronal and apical deviations and low angular discrepancies. In addition, treatment was associated with low postoperative morbidity, excellent patient acceptance, and very high satisfaction. These findings support the potential of autonomous robotic implant surgery as a predictable and patient-centered approach for full-arch rehabilitation, although larger controlled studies are required to confirm these results. Full article

Background: Retroperitoneoscopic laparoscopic adrenalectomy (RLA) is widely adopted for benign adrenal lesions due to its direct access and minimal bowel interference. However, expanding indications to larger tumors and complex anatomies increase technical difficulty because of the confined retroperitoneal space and obscured hilar landmarks. Current predictive models mainly focus on transperitoneal approaches and lack specificity for RLA. This study aimed to develop and internally validate a preoperative nomogram for predicting RLA-specific surgical difficulty. Methods: All patients undergoing RLA from April 2024 to February 2025 at a single center were included. Operative time and postoperative hemoglobin (Hb) reduction were used as surrogate markers of difficulty. Patients were classified into high- and standard-risk groups. Univariate and multivariate analyses were performed to identify predictors of difficult RLA and develop a composite difficulty score. Results: Tumor position (between the upper renal pole and renal pedicle: OR 8.819, 95% CI 3.981–21.462, p < 0.001) and pheochromocytoma (PHEO) pathology (OR 34.881, 95% CI 3.841–4719.428, p < 0.001) were the strongest independent predictors of high surgical difficulty, whereas tumor size (≥40 mm: OR 3.926, p = 0.071) showed limited predictive value. The composite score demonstrated excellent discrimination, with an optimism-corrected area under the curve (AUC) of 0.828 (95% CI 0.796–0.835). The nomogram showed robust calibration, and a cutoff score ≥ 2 yielded a negative predictive value of 0.940. Conclusions: This study developed an RLA-specific nomogram incorporating tumor size, position, and pathology. The tumor–renal pedicle relationship was more predictive of surgical difficulty than tumor size alone, providing risk stratification to guide surgical planning, optimize patient selection, and enhance safety as RLA indications expand. External validation is required to confirm its generalizability. Full article

Background: Infrazygomatic crest (IZC) miniscrews provide reliable extra-alveolar skeletal anchorage for orthodontic tooth movement while minimizing dependence on patient compliance. Although guided insertion techniques have been proposed to improve placement accuracy, freehand insertion remains widely used because of its simplicity and clinical practicality. This retrospective study evaluated the clinical performance and survival of freehand-placed IZC miniscrews over a minimum follow-up period of 30 months. Materials and Methods: A retrospective observational study was conducted on 23 consecutive patients receiving a total of 30 IZC miniscrews between January 2022 and July 2024. All miniscrews were placed freehand by the same experienced orthodontist following individualized radiographic planning based on panoramic radiography and/or cone-beam computed tomography (CBCT), according to the patient’s anatomical requirements. Miniscrews were immediately loaded using light orthodontic forces (<100 g), with progressive force increases during subsequent appointments based on treatment objectives. Patients were reviewed at approximately 30–35-day intervals. Clinical records were analyzed to assess miniscrew survival, timing of failure, and procedure-related complications using descriptive statistical analysis. Results: Twenty-seven of the 30 miniscrews remained clinically stable throughout treatment, corresponding to an overall success rate of 90.0%. Three failures occurred during the early treatment phase, while no late failures were observed. Because of the limited number of failure events, potential contributing factors—including screw dimensions, mechanical interference, and deterioration of oral hygiene during treatment—were evaluated descriptively and should be interpreted with caution. No major surgical or radiographic complications were detected during follow-up. Conclusions: Within the limitations of this retrospective observational study, freehand placement of IZC miniscrews demonstrated favorable clinical performance when performed by an experienced operator following appropriate radiographic planning. However, the relatively small sample size, absence of a control group, and descriptive nature of the analysis preclude definitive conclusions regarding factors influencing miniscrew failure or the comparative effectiveness of freehand versus guided insertion. Larger prospective controlled studies are warranted to validate these preliminary findings. Clinical relevance Manual IZC miniscrew insertion represents a predictable, efficient, and cost-effective alternative to guided approaches in orthodontic practice. Full article

Background: Prosthetic joint infection (PJI) following total shoulder arthroplasty (TSA) is a rare but clinically relevant complication, largely attributable to the distinctive shoulder skin microbiome, predominantly composed of Cutibacterium acnes and coagulase-negative staphylococci (CoNS), which are considered low-virulence pathogens. Standard skin disinfection protocols do not completely prevent bacterial infiltration into the surgical field; therefore, the World Health Organization (WHO) recommends the use of intraoperative irrigation to reduce the risk of shoulder PJIs. Recently, the use of povidone–iodine (PVI) irrigation has been shown to significantly reduce both bacterial load and diversity after TSA; however, its activity against C. acnes remains suboptimal. Therefore, the aim of this study was to evaluate improved in vitro disinfection protocols by combining PVI and hydrogen peroxide for use as intraoperative irrigation in shoulder arthroplasty, which is characterized by a distinctive microbiome. Methods: In vitro broth dilution assays and time-kill experiments were performed to test PVI and H₂O₂, alone or in combination, against CoNS, Staphylococcus aureus, and Escherichia coli as representative aerobic bacteria, and against C. acnes as an anaerobic pathogen. Results: The results revealed that, when used alone, PVI exerted a more pronounced bactericidal effect against staphylococci, whereas H₂O₂ was more effective against C. acnes, even at a high bacterial inoculum, although at cytotoxic concentrations, particularly for PVI. Notably, when the disinfectants were used in combination, bacterial killing was achieved against all the tested pathogens, starting from short exposure times, mainly 3 min, and at low concentrations. Moreover, the antiseptics significantly reduced mature biofilm, although complete eradication was not achieved. Conclusions: A targeted irrigation protocol to prevent shoulder PJI can be achieved by combining PVI and H₂O₂ at non-toxic concentrations and for short exposure times that do not interfere with operating room costs or increase the risk of infection. Full article

Background/Objectives: Chronic post-surgical pain (CPSP) affects 25–60% of women after breast cancer surgery. Prospective data from the Middle East and North Africa (MENA) region remain scarce. This study estimated 3-month CPSP incidence in a Moroccan cohort, developed two internally validated prediction models, and quantified the mediated effects of regional anaesthesia and ketamine through prevention of severe acute postoperative pain. Methods: Prospective cohort of 862 women undergoing curative breast cancer surgery (Institut National d’Oncologie, Rabat; NCT04676438). CPSP was defined as a visual analogue scale (VAS) ≥ 3/10 AND Brief Pain Inventory (BPI) interference ≥ 3/10 at three months. Two logistic regression models were developed (Model A: 7 preoperative variables; Model B: 11 perioperative variables) and internally validated by 1000-bootstrap optimism correction. Counterfactual mediation analysis quantified effects mediated through severe acute pain. Results: CPSP incidence was 39.1% (95% confidence interval (CI) 35.9–42.4%), with 22.6% neuropathic-predominant. Model A showed limited discrimination (area under the curve (AUC) 0.58), with pain catastrophising as the dominant predictor. Model B demonstrated superior performance (AUC 0.694; Brier score 0.209) with net clinical benefit across the 15–55% range of clinically plausible decision thresholds. In counterfactual mediation analysis, an estimated 58.2% and 53.7% of the RA and ketamine effects, respectively, were mediated through severe acute pain, under the framework’s no-unmeasured-confounding assumption. Perioperative ketoprofen independently reduced chronification risk (adjusted odds ratio (aOR) 0.66). Conclusions: In this single-centre Moroccan cohort, 39% of women developed CPSP at three months. Two validated models enable risk stratification at distinct clinical decision points. Regional anaesthesia and ketamine were associated with lower CPSP risk, in a pattern consistent with mediation through prevention of severe acute pain under the model’s assumptions; ketoprofen was independently associated with lower chronification risk. These observational findings are hypothesis-generating and require confirmation before informing changes to analgesic protocols. Full article

Background/Objectives: Tooth impaction and transposition are developmental dental anomalies that pose significant challenges in orthodontics, oral surgery, and restorative dentistry. These anomalies disrupt normal occlusal development and complicate diagnosis and treatment planning because of altered anatomy, a higher risk of adjacent tooth resorption, associated pathology such as cyst formation, and biomechanical challenges during orthodontic intervention. Methods: Three paediatric patients with complex eruption disturbances, including impacted incisors, impacted primary molars, and transposed maxillary canines, were managed using individualised conservative orthodontic approaches. The cases involved obstruction by supernumerary teeth, ectopic eruption with space loss, and tooth transposition complicated by root dilaceration and malocclusion. Comprehensive clinical and radiographic assessment, including CBCT when indicated, guided treatment planning. Management strategies included staged surgical interventions, space maintenance using 2 × 4 appliances, bite opening, and controlled orthodontic traction with modified biomechanics to minimise the risk of root resorption and interference with adjacent teeth. Results: Favourable functional and aaesthetic outcomes were achieved in all cases, although certain limitations such as incomplete root development, residual spacing, localised restorative complications, and difficulty in correcting root angulation of dilacerated adjacent teeth were observed. Conclusions: Careful diagnosis using advanced imaging, combined with conservative orthodontic and surgical approaches, can achieve satisfactory functional and esthetic outcomes while minimising complications. Further longitudinal studies are recommended to evaluate long-term stability and optimise treatment protocols. Full article

Background: Work-related musculoskeletal disorders (WRMSDs) are highly prevalent among orthopaedic surgeons, but procedure-related symptom patterns, symptom intensity, and perceived interference remain incompletely characterised. This exploratory cross-sectional study evaluated the prevalence, anatomical distribution, and occupational consequences of musculoskeletal symptoms among surgeons performing total knee arthroplasty (TKA) and explored a non-validated descriptive discomfort–interference composite score. Methods: A cross-sectional survey was administered to a diverse group of 72 orthopaedic surgeons in Spain who performed TKA as part of their broader orthopaedic practice. Data on demographics, anatomical discomfort, global discomfort intensity, and functional interference were collected. A raw discomfort–interference score (DIIraw, 0–600) and a normalised score (DII100, 0–100) were calculated strictly as exploratory descriptors. Subgroup comparisons were performed according to the surgical position adopted during TKA. Results: The prevalence of musculoskeletal symptoms was 81.9%, with the lumbar spine (47.2%) and neck (38.9%) being the most affected regions. Mean global VAS discomfort was low (1.94 ± 2.08; median 1.0 [0.0–3.0]), although 15.3% of participants reported VAS ≥ 5. Self-reported physician-diagnosed work-related musculoskeletal conditions were reported by 51.4%, with 5.6% reporting sick leave and 6.9% reporting surgical intervention. DII100 values were low and skewed (mean 1.41 ± 2.31; median 0.25 [0.0–1.75]). No statistically significant differences were observed across surgical positions. Conclusions: Musculoskeletal symptoms were common among surgeons performing TKA, mainly affecting the lumbar and cervical regions, but average symptom intensity was low. A smaller subset reported clinically relevant discomfort and occupational consequences. The discomfort–interference composite score and any distribution-based values should be interpreted only as exploratory descriptors and require external validation. This study found no evidence of differences in musculoskeletal burden between surgical positions. Full article

Ex vivo liver perfusion (EVLP) sustains human or large animal livers outside the body under near-physiological conditions, enabling functional monitoring for lactate clearance, bile production, and oxygen consumption and allowing targeted therapeutic interventions. Originally developed to optimize donor grafts for transplantation, EVLP has evolved into a powerful translational research platform bridging preclinical discovery and early clinical translation. This review discusses EVLP as a platform for gene therapy, immunotherapy, pharmacology, and personalized medicine, with particular emphasis on gene- and immune-based interventions as mechanistically mature exemplars. We consolidate advances in pharmacological testing and toxicity modeling, viral and non-viral gene delivery, genome engineering, and immunomodulation using perfused livers. We further describe emerging applications, including autologous EVLP pathways for organ-confined therapy, ex vivo liver surgery, and bioengineering strategies such as biliary organoid repair, RNA interference, and mitochondrial transfer. We highlight how these applications align with a paradigm shift in biomedical research, including the NIH’s recent initiative to prioritize human-based experimental models over animal-only studies. By leveraging transplant-declined or surgically resected organs that would otherwise be unused, ex vivo perfusion bridges the gap between pre-clinical testing and clinical practice, enabling real-time evaluation of interventions in functional human tissue. We discuss both the scientific opportunities afforded by EVLP and the technical, biosafety, and ethical challenges that must be addressed to enable responsible clinical translation. Full article

Background: Cancer pain affects approximately 44.5% of all patients with malignancy and up to 55–65% of those with advanced or metastatic disease; a substantial proportion remain inadequately controlled with conventional pharmacological approaches alone. Peripheral nerve stimulation (PNS), a minimally invasive neuromodulatory strategy, has emerged as a potential opioid-sparing analgesic option for the perioperative management of oncologic surgical patients. Objectives: This narrative review synthesizes current evidence on the application, mechanisms, clinical efficacy, safety, and integration of temporary and permanent PNS systems in cancer patients, with specific focus on cancer-specific pain syndromes, key clinical studies, opioid-sparing immunological implications, evidence quality, and directions for future research. Methods: As a narrative review, this work was structured in accordance with the Scale for the Assessment of Narrative Review Articles (SANRA) to ensure methodological transparency. A focused, non-systematic literature search of PubMed/MEDLINE, Embase, and the Cochrane Library was performed from database inception through March 2026, supplemented by hand-searching of reference lists and targeted retrieval of clinical practice guidelines. Sources were selected on the basis of relevance to PNS or closely analogous peripheral neurostimulation modalities in oncologic, perioperative, or chronic pain contexts. Evidence was synthesized narratively, with each cited study graded using the Oxford Centre for Evidence-Based Medicine (OCEBM) 2011 Levels of Evidence framework to enable transparent calibration of confidence. Results: Available preliminary and largely extrapolated evidence supports PNS as a promising but not yet established useful adjunct in oncologic perioperative care; because cancer-specific data rest substantially on a single pilot study (n = 12), one retrospective review (n = 15), and extrapolation from non-cancer populations, these conclusions should be regarded as hypothesis-generating. Randomized controlled trial data from non-cancer cohorts demonstrate opioid consumption reductions of approximately 80–90% in the PAINfRE trial, while the post-amputation trial demonstrated ≥50% pain-relief responder rates and reductions in pain interference, with clinically meaningful improvements in pain and function. Oncologic-specific pilot and retrospective evidence confirms feasibility and a 58–67% success rate across diverse cancer pain subtypes. Conclusions: The opioid-sparing properties of PNS carry additional biological plausibility for preserving perioperative antitumor immune function. High-quality prospective trials specifically designed for oncologic surgical populations remain needed to establish evidence-based recommendations. Full article

Background/Objectives: This study evaluates the 1-year follow-up outcomes after minimally invasive nerve-sparing surgery for the complete excision of deep endometriosis (DE), with a specific focus on deep dyspareunia. Cases with undesirable outcomes were explored in detail to better understand the evolution of this cornerstone endometriosis-related symptom. This approach supports personalized medicine initiatives by seeking to stratify patients into likely surgical responders and non-responders. Methods: This is an interdisciplinary retrospective observational study assessing 195 consecutive cases. Inclusion criteria comprised women with an established diagnosis of DE who had been sexually active in the 6 months prior to surgery. Because pregnancy and postpartum can interfere with the longitudinal assessment of deep dyspareunia, women in these phases during follow-up were excluded. Additionally, individuals who had not been sexually active in the preceding 6 months for reasons unrelated to deep dyspareunia were excluded. Deep dyspareunia was measured using an 11-point (0–10) self-reported Numerical Rating Scale (NRS). Hierarchical clusters were established based on preoperative scores: NONE (NRS = 0), MILD (1 ≤ NRS ≤ 3), MODERATE (4 ≤ NRS ≤ 6), and SEVERE (NRS ≥ 7). Results: In the SEVERE cluster, 82.2% (95% CI: 72.4–92.0) of women improved by ≥3 points. In the NONE cluster, 70.1% (95% CI: 60.3–79.2) remained asymptomatic. Although improvements in deep dyspareunia were statistically significant across the total sample, individual trajectories were not uniform; the response was considered undesirable in 34 cases (17.4%; 95% CI: 12.1–22.8). The frequency of preoperatively asymptomatic women (NRS = 0) developing De Novo deep dyspareunia (NRS ≥ 3) at the 1-year follow-up was estimated at 14.9% (95% CI: 8.0–22.7). These results highlight the marked phenotypic and clinical heterogeneity in patient trajectories and the inherent unpredictability of adverse responses. Conclusions: Postoperative pain outcomes likely result from a complex interplay among surgical, myofascial, neurological, psychological, inflammatory, and hormonal factors. While surgery remains an effective and safe approach for treating pain, our findings underscore that even preoperatively asymptomatic patients should receive targeted counseling regarding the unexpected risk of developing postoperative deep dyspareunia. Full article

Manual counting of surgical tools, known as surgical counting, is a time-consuming and error-prone task that increases the risk of retained surgical instruments and extends operating room (OR) time. Presently, in hospitals around the world, surgical counting is often performed manually with paper or tablet checklists, often leading to delays, increased infection risk, and financial cost. RFID, barcode-based, and computer vision solutions exist but are expensive and have challenges with sterilization and signal interference. This paper presents ToolSafe, a low-cost, portable system that classifies surgical tools by their acoustic signatures when dropped into a detection box. A pilot dataset of 4004 audio samples from four tool types (n = 996, tissue forceps; n = 1005, iris scissors; n = 1006, scalpel handle; n = 997, testing needle) was collected using ToolSafe. A convolutional neural network (CNN) was evaluated using stratified five-fold cross-validation on the laboratory dataset, with a k-nearest neighbors (KNN) classifier implemented as a control model. In each fold, both models were trained on 80% of the data and tested on the remaining 20%, ensuring that all samples were used for both training and evaluation. The CNN achieved a mean (±standard deviation) classification accuracy of 99.55% (±0.19%) across the validation folds, outperforming the KNN model, which achieved a mean accuracy of 97.28% (±0.50%). The difference was statistically significant according to a paired t-test across folds (p = 0.0003), indicating CNN’s superior performance on the dataset. For a run of 100 additional samples using the Raspberry Pi-based system, spectrogram generation averaged 0.121 s (±0.025 s), CNN inference averaged 0.180 s (±0.033 s), and total end-to-end latency averaged 1.851 s (±0.253 s) per tool. This pilot study proposes a possible technological solution for surgical counting that reduces human error and enhances patient safety. ToolSafe may be subsequently improved by increasing the number of surgical tools used in the training dataset, testing under more robust OR-like environments, and comparing to other classification algorithms. Further refinement and incorporation of ToolSafe in operating room workflows have the potential to reduce patient risks from extended surgical times and retained surgical instruments. 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/Objectives: Laryngeal cancer has a high incidence and mortality rate, especially in advanced stages. Stoma recurrence after total laryngectomy is rare but lethal, and its risk factors remain controversial. We aimed to assess whether the presence of a tracheotomy performed prior to surgical treatment for advanced laryngeal cancer represents a risk factor for recurrence of the disease in the stoma and interferes with patient survival. Methods: A retrospective study was carried out in 138 patients who underwent total laryngectomy. Clinical-pathological variables were related to the presence of a preoperative tracheotomy. Results: Fifty-two patients without and 86 patients with preoperative tracheotomy were studied. There was a significant predominance of transglottic tumors (p = 0.02) and no patients with early-stage disease (T1 and T2, p = 0.002) in the tracheotomy group. There was no statistically significant difference in stoma recurrence (p = 0.53). On multivariate analysis, the risk of stoma recurrence was not significantly associated with the presence of a preoperative tracheotomy. Conclusions: The presence of a tracheotomy prior to total laryngectomy was not a risk factor for disease recurrence in the stoma or for reduced survival in the group. Full article