Search Results (8,491)

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

Computer-assisted surgical simulation (CASS) in craniomaxillofacial (CMF) surgery is traditionally performed using a computer interface (CI) with a two-dimensional monitor, while the adoption of immersive virtual reality (VR) remains limited. This study examined how low-dose (LD) and high-dose (HD) cone beam computed tomography (CBCT) imaging modes influence image quality and usability across both CI and VR environments. Five CMF radiologists rated CBCT views and 3D-segmented models on a 0–4 Likert scale, and intra- and interobserver agreement was calculated. VR usability was further assessed using the NASA Task Load Index and follow-up interviews. LD imaging performed comparably to HD in both interfaces, with slightly higher scores for CBCT views in LD mode. For 3D models, HD scored marginally higher in CI, whereas LD performed slightly better in VR. Observer agreement ranged from fair to excellent, and VR demonstrated reliability like CI. NASA-TLX results indicated reductions in mental and temporal demand, along with decreased effort and frustration during VR use, suggesting diminishing cognitive and emotional strain over time. In this pilot study, the findings suggest that LD CBCT may be feasible for selected CMF CASS applications and that VR offers an immersive and user-friendly alternative without compromising diagnostic reliability, supporting its potential role in future surgical planning. Full article

Background: This study aims to assess how patient comorbidities and risk factors influence treatment outcomes of periprosthetic joint infection (PJI). The role of timing for DAIR intervention, administration of antibiotics, and the microbiological profile in relation to infection recurrence were investigated. Methods: This retrospective study included 58 patients, 26 after total hip arthroplasty (THA) and 32 after total knee arthroplasty (TKA), who underwent surgery for early PJI managed with the complete DAIR protocol at a single academic orthopedic center (Professor Adam Gruca Orthopedic and Trauma Teaching Hospital) between January 2014 and January 2021. A minimum follow-up period after DAIR was five years. Results: In the overall cohort, therapeutic success was achieved in 41 of 58 patients (71%). Treatment of early PJI after THA was successful in 21 of 26 patients (81%), while after TKA, 20 of 32 patients (63%) achieved a favorable outcome. An increase in the number of comorbidities associated with infection risk was correlated with a lower likelihood of successful treatment using the DAIR protocol. Our analysis also demonstrated that the timing from total joint arthroplasty (TJA) to surgical intervention, the administration of antimicrobial therapy, and positive culture results influenced the success rate. Conclusions: The effectiveness of the DAIR protocol in managing early PJI is influenced by multiple factors. This study suggests that crucial determinants include prompt and accurate diagnosis, identification of patient-specific risk factors, the causative pathogen and its antibiotic administration, as well as the timing of intervention. Full article

Background: Echo intensity (EI) has emerged as a promising and accessible tool for tracking changes in skeletal muscle quality; however, its utility during early-phase rehabilitation has not been studied. Using an observational cohort design, we examined changes in quadriceps muscle strength, size, and quality, along with self-reported knee function, 2, 6, and/or 10 weeks following anterior cruciate ligament reconstruction (ACLR). Methods: Thirteen participants (4 males, 9 females; mean age = 23 years) were assessed for bilateral isometric peak torque and cross-sectional area (CSA) and corrected EI of the vastus lateralis and rectus femoris. Self-reported knee function was measured using the International Knee Documentation Committee (IKDC) questionnaire. Results: Quadriceps peak torque was significantly lower in the surgical limb at 2 weeks following surgery but increased from weeks 2 to 10, while the nonsurgical limb remained stable. IKDC scores improved significantly over time. Vastus lateralis CSA decreased in the surgical limb between weeks 2 and 6, while rectus femoris CSA increased between weeks 6 and 10 in both limbs. Corrected EI values did not change over time. No significant correlations were observed among changes in muscle strength, size, quality, or self-reported knee function. Conclusions: We conclude that quadriceps strength, size, quality, and self-reported knee function change independently and do not follow a shared recovery trajectory. Full article

The convergence of artificial intelligence and robotic surgery is redefining the management of genitourinary cancers by enhancing diagnostic accuracy, surgical precision, and training efficiency. This narrative review explores recent advancements in artificial intelligence applications across the cancer care continuum, with a focus on prostate, kidney, and bladder malignancies. Artificial intelligence tools, particularly those based on machine learning and deep learning, have demonstrated strong performance in analyzing imaging data, segmenting tumors, predicting pathological features, and supporting clinical decision-making. Intraoperatively, artificial intelligence enables skill assessment, personalized feedback, and real-time navigation by processing data from surgical videos and robotic system sensors. Augmented reality and intraoperative modeling further enhance visualization and margin control during complex procedures. The review also discusses emerging technologies such as single-port robotic platforms, which offer advantages in confined anatomical spaces and support less invasive approaches. Additionally, the growing field of telesurgery is addressed, highlighting its feasibility for complex urologic operations across vast distances. While many of these innovations are still in early stages of clinical validation, their integration into practice has the potential to improve oncologic and functional outcomes, expand access to expert care, and foster the development of next-generation surgical strategies in urologic oncology. 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 and Objectives: Benign prostatic hyperplasia (BPH) is a progressive, androgen-dependent condition driven by dihydrotestosterone (DHT). 5α-reductase inhibitors (5-ARIs), including finasteride and dutasteride, target this pathway and provide disease-modifying effects. Materials and Methods: This narrative review summarizes evidence from randomized trials, meta-analyses, and observational studies evaluating the efficacy, timing, and safety of 5-ARIs in the management of LUTS due to BPH. Results: 5-ARI therapy reduces prostate volume by 18–28% and serum PSA by approximately 50% within 6–12 months. Landmark trials (MTOPS, CombAT) demonstrate significant reductions in acute urinary retention (AUR) and BPH-related surgery (>50% RR reduction). Combination therapy with α-blockers provides superior symptom control and greater prevention of clinical progression, particularly in men with prostate volume ≥ 30–40 mL or PSA ≥ 1.5 ng/mL. Early initiation of combination therapy improves long-term outcomes, while α-blocker withdrawal may be feasible in selected patients. Adverse events are mainly sexual, with emerging data suggesting a possible association with depression. Conclusions: 5-ARIs are central to BPH management, offering sustained clinical benefits and prevention of progression. Optimal outcomes depend on appropriate patient selection, early treatment in high-risk individuals, and individualized long-term strategies. Full article

Metabolic changes in saliva are known to be closely associated with the presence of non-oral cancers, particularly breast cancer. The diagnostic and prognostic potential of salivary biomarkers in breast cancer has been demonstrated, but their applicability for assessing therapy response has not yet been established. The aim of this study was to comprehensively analyze clinical, pathological, molecular, and salivary characteristics when assessing the response to neoadjuvant chemotherapy for breast cancer. The study included 361 breast cancer patients undergoing their first course of chemotherapy and 127 healthy volunteers without breast pathologies. Saliva samples were collected from all volunteers before treatment. Saliva analysis results for amino acids, lipids, and tumor markers were compared with tumor pathomorphism assessment after breast cancer surgery. The proportion of patients with a complete response to therapy was statistically significantly lower after menopause, and in those with HER2-negative breast cancer, moderate tumor differentiation, and high estrogen and progesterone receptor expression. For the first time, a body mass index (BMI) greater than 25 and low HER2 expression (HER2-low) were shown to have an unfavorable prognosis. The criterion for selecting informative salivary metabolites was a multidirectional change in minimal and complete pathological responses to therapy compared to healthy controls. Thus, prognostically favorable signs were a decrease in the concentration of urea below 7.5 mmol/L (OR = 1.921; 95% CI 1.061–4.270; p = 0.0342), a decrease in the area of the absorption band at 2957 cm⁻¹ below 24 (OR = 3.875; 95% CI 1.160–12.70; p = 0.0003), and an increase in the concentration of cancer antigen CA27.29 above 3 U/L (OR = 2.138; 95% CI 1.021–7.273; p = 0.0343) and CA-15-3 above 39 U/L (OR = 3.896; 95% CI 1.062–14.07; p = 0.0072). With a simultaneous increase in both CA27.29 and CA15-3, the probability of a complete response to therapy increased (OR = 4.288; 95% CI 1.056–17.09; p = 0.0013). Multivariate analysis showed that an independent prognostic indicator, along with the expression status of HER2, estrogen receptors, differentiation degree, BMI, and menopause status, was the concentration of CA15-3 in saliva (AUC = 0.789, 95% CI: 0.737–0.842, p = 0.0001). Identifying new markers will help physicians formulate treatment plans tailored to a patient’s individual risk factors, leading to increased survival and improved quality of life. Full article

Background: Post-thyroidectomy vocal cord dysfunction (PT-VCD) is an important side effect of thyroid surgery. With the introduction of intraoperative neuromonitoring (IONM), hopes have been raised that either the rate or severity of PT-VCD could be reduced. However, data to support these concepts are scarce. To better understand the relationship between IONM outcomes and the severity of PT-VCD, a detailed time-course evaluation of recovery of PT-VCD was performed in a continuous clinical quality registry from a specialized high-volume endocrine surgery center. Methods: Data were prospectively recorded in a single-center clinical quality assurance registry (June 2015 to May 2016) and subsequently analyzed retrospectively, with a 12-month follow-up for all cases. All patients underwent vocal cord (VC) laryngoscopy (VCL) by independent ear–nose–throat (ENT) specialists before and after surgery. Cases with newly diagnosed PT-VCD were enrolled in a detailed follow-up program (recruitment from June 2015 to May 2016) that included structured telephone interviews every 4–6 weeks to assess the exact time course of PT-VCD recovery and VC status for a period of at least 12 months. Clinical data were analyzed for variables affecting the time course of recovery by univariate analysis. Results: From 6/2015 to 5/2016 there were 1097 consecutive thyroid procedures. During this period, 78 cases of PT-VCD (1591 nerves at risk (NARs); 4.9%) were entered into the detailed follow-up-program. Of these, three cases of PT-VCD persisted at 12 months (PT-VCD 0.18% NAR), with six cases lost to follow-up (maximum rate of potentially persistent PT-VCD of 0.54% NAR). In total, 15% of PT-VCD cases recovered within 4 weeks; the mean recovery time was 4.4 months, and 6 months after thyroidectomy, 18% still had impaired VCL tests. Individual cases were followed >12 months showing late full recovery of PT-VCD, thereby challenging the definition of permanent VCD. Logistic regression analysis revealed non-transitory loss of signal (ntLOS) (OR for recovery within 12 weeks: 0.39; 95%CI 0.15–0.98; p = 0.046) and more specifically, secondary ntLOS, to be a significant independent predictor of PT-VCP recovery beyond 12 weeks (OR for recovery within 12 weeks 0.303; 95%CI 0.115–0.797; p = 0.016). Conclusions: For the first time, these data provide a detailed description of the time course of PT-VCD recovery in a large cohort, along with correlations to operative data and IONM findings. Our study indicates that recovery from PT-VCD can be prolonged, and specifically, the occurrence of ntLOS—especially secondary ntLOS—during IONM was predictive of a longer recovery trajectory. This suggests that IONM may offer an additional advantage by functioning as a prognostic tool, helping to identify patients at higher risk for extended recovery periods. Such early identification could enable a more targeted approach, potentially allowing for the earlier initiation of supportive interventions, like speech therapy, in those most likely to benefit from proactive management. Full article

Background/Objectives: The patency and anatomical location of the maxillary sinus ostium are critical for preventing postoperative complications in dental implant planning and sinus lift surgeries in the posterior maxilla. Narrowing or obstruction of the ostium carries risks, including the development of acute/chronic sinusitis and bone graft failure after surgery. These risks must be carefully evaluated using preoperative radiographic images. It is time-consuming for physicians to manually perform this process, and details are overlooked due to a lack of clinical experience, which can increase surgical risks. Methods: This study aims to overcome these clinical challenges and improve the reliability of radiographic evaluation. In this study, a hybrid deep learning model is proposed for the automatic detection of the maxillary sinus ostium. The proposed model combines the local feature extraction power of CNN-based models with the global context modeling capabilities of transformer-based models, creating an effective model. Additionally, the gated fusion technique efficiently combines features from various designs, significantly enhancing classification performance. Results: The proposed model was compared with six different ViT and CNN architectures established in the literature. While the highest test accuracy among pre-trained models was 89.36%, the proposed hybrid model achieved 95.03%, demonstrating strong clinical diagnostic performance. Conclusions: Based on the performance metrics obtained, we believe the proposed model can be used to determine the patency of the maxillary sinus ostium. This will lighten the workload for specialists and minimize traditional errors. Full article

Background and Objectives: To evaluate the impact of Holmium Laser Enucleation of the Prostate (HoLEP) versus Transurethral Resection of the Prostate (TURP) on cognitive function and psychological well-being three months post-surgery. Materials and Methods: This prospective observational cohort study involved 150 patients undergoing surgical treatment for BPH; 132 patients (66 HoLEP, 66 TURP) completed baseline and 3-month follow-up evaluations. The Montreal Cognitive Assessment (MoCA) served as the primary measure of cognitive function, while the Mini-Mental State Examination (MMSE) functioned as a secondary measure. The Beck Anxiety Inventory and Beck Depression Inventory were utilized to assess individuals’ mental states. We employed repeated-measures General Linear Models, adjusted for age and educational attainment, to examine temporal variations. Results: Baseline demographic, clinical, cognitive, and psychological characteristics were comparable among the groups. The modified analysis revealed no significant interaction between time and surgical procedure for MoCA (p = 0.405), indicating that both groups exhibited comparable cognitive trajectories. No significant differences were seen between the groups in the adjusted MoCA scores (p = 0.162). A minor, statistically insignificant temporal effect was observed (p = 0.058; partial η² = 0.028). Educational attainment independently forecasted cognitive performance (p = 0.024). The MMSE demonstrated a slight temporal effect (p = 0.015) with no interaction of approaches. Anxiety and depressive symptoms persisted uniformly and comparably among the groups. Conclusions: Three months post-surgery, neither HoLEP nor TURP was associated with a notable deterioration in cognitive performance. The surgical modality did not independently influence cognitive trajectory after adjusting for demographic variables. Contemporary endoscopic BPH surgery appears to be neurocognitively safe during the medium-term postoperative period. Full article

Background: Reconstruction of maxillary defects in pediatric patients presents unique challenges related to craniofacial growth, functional rehabilitation, and long-term treatment planning. Although microvascular free-flap reconstruction is established in pediatric head and neck surgery, maxilla-specific data remain limited. This study aimed to describe donor-site selection patterns in pediatric maxillary microvascular reconstruction and to explore their relationship with patient age. Methods: This retrospective observational study included pediatric patients (aged 1–18 years) who underwent microvascular free-flap reconstruction of the maxilla between August 2011 and September 2025 at a single tertiary referral center. Clinical variables included age, defect characteristics, reconstruction timing, donor-site, and total flap loss. Donor-site selection patterns were analyzed in relation to patient age using nonparametric statistical methods. Results: Fifty-five patients were included. Overall flap survival was 81.82% (45/55). Donor-site selection demonstrated a significant association with patient age (p < 0.05). Younger children were more frequently reconstructed using soft-tissue flaps, whereas osseous flaps were more commonly used in older children and adolescents. No significant relationship was found between age and defect extent or reconstruction timing. Conclusions: In this single-center experience, pediatric maxillary reconstruction followed an age-adapted pattern, with soft-tissue flaps preferentially used in younger patients and osseous flaps more frequently selected in older children. These findings reflect differences in reconstructive priorities across developmental stages and support individualized planning in pediatric maxillary reconstruction. Age alone was not associated with total flap loss; however, this analysis was limited by the small number of flap loss events. Full article

Background: Mitral regurgitation due to Barlow’s disease remains surgically demanding. Despite widespread experience, consensus is lacking on whether the Alfieri repair can serve as a deliberate and durable rather than a rescue strategy in this complex pathology. Methods: We retrospectively analyzed patients undergoing mitral valve repair due to severe mitral regurgitation resulting from Barlow’s disease using either the Alfieri or Neochordae repair techniques. Patients received a uniform semi–rigid annuloplasty ring, while leaflet resection and concomitant coronary or aortic procedures were excluded. Results: Baseline demographics and echocardiography were broadly comparable. Perioperative mortality was 0% in both cohorts, with similarly low rates of major complications. Aortic cross–clamp time was significantly shorter with Alfieri repair (p < 0.001). No relevant postoperative transmitral gradient or systolic anterior motion occurred. At a mean follow–up of 4.2 years, more–than–moderate MR was observed in one patient per group (Alfieri 2.4% vs. Neochordae 1.2%). At 10 years, the cumulative incidence of more–than–moderate mitral regurgitation and redo mitral surgery was similarly low between techniques (p = 0.810 and p = 0.460). Most patients were NYHA class I–II at last follow–up, demonstrating improved functional status. Echocardiography showed left ventricular reverse remodeling without intergroup differences. Conclusions: These data indicate that the Alfieri approach provides durable competence and hemodynamic safety comparable to the Neochordae technique while reducing cross–clamp time, supporting its use as a deliberate strategy rather than a bailout in anatomically suitable valves. Full article

Background: Anesthetizing frail patients for hip surgery is challenging; spinal (SA) and general anesthesia (GA) often cause hemodynamic instability. Traditional nerve blocks provide analgesia but rarely complete surgical anesthesia without motor block. We evaluate the clinical feasibility of the SAFE (Subarachnoid-alternative Anaesthesia For Endoprosthesis) protocol—combining Anterior Pericapsular Nerve Group (A-PENG), POsterior pericapsular Nerve Group (PONG), and Local Infiltration Analgesia (LIA) under intravenous sedation—as a primary anesthetic preserving motor function and avoiding SA/GA. Methods: This single-center retrospective series analyzed patients undergoing elective or trauma-related hip surgery using the SAFE protocol between September 2022 and April 2026. The primary outcome was success rate (completion without SA/GA conversion). Secondary outcomes included procedural timings, recovery room (RR) transit, and motor preservation. Variables are reported as medians [IQR]. Results: We included 48 patients (median age 83.5 years [IQR: 68.7–87.2]; 66.7% female) undergoing hip hemiarthroplasty (n = 28) or total hip arthroplasty (n = 20). The success rate was 100%, without SA/GA conversion or advanced airway management. Median anesthetic preparation and surgical durations were 55 [IQR: 50–76.2] and 85 min [IQR: 74–110], respectively. RR transit times (recorded for 35 patients) were brief (40 min [IQR: 34.0–67.5]). Crucially, lower-limb motor capacity was preserved in 100% of cases. The technique also proved opioid-sparing, substantially reducing postoperative opioid consumption. Conclusions: The SAFE protocol is a clinically feasible primary anesthetic strategy for hip surgery. By preserving motor function and enabling rapid fast-tracking, it aligns with ERAS pathways, offering a promising alternative to conventional anesthesia for elective and frail trauma patients. Randomized controlled trials are warranted to validate these outcomes. Full article

Peripheral nerve blocks can effectively reduce the use of general anesthesia and opioids in situations where robust pain management is critical, such as severe extremity trauma and hip, femur, and knee surgeries. Despite these benefits, nerve blocks are underutilized due to the high skill required to accurately insert a needle and safely deliver local anesthetic. To overcome this challenge, ultrasound image guidance enabled by artificial intelligence (AI) offers a semi-automated solution for regional anesthesia delivery by non-specialists. As a first step towards realizing an integrated platform for AI-guided nerve blocks, the main objective of this study is to develop and characterize deep learning algorithms to interpret anatomical landmarks on ultrasound images in real time and identify aimpoints for needle placement. Our AI system was trained on over 55,000 images from 20 porcine models and demonstrated an average area under the precision–recall curve of 0.92 (SD = 0.03) for in vivo landmark detection in the femoral nerve region. In prospective live animal testing, aimpoint identification had a 98.3% success rate with an average time of 40.5 s (SD = 33.5). Future work will focus on integrated testing with handheld robotics towards a more accessible method for delivering regional anesthesia in settings from point of injury to medical transport to hospitals. Full article