Search Results (115)

Introduction/Objective: Post-bariatric surgery patients require long-term, coordinated care to address complex nutritional, physiological, and behavioral challenges. Personalized smart nutrition, combining individualized dietary strategies with targeted monitoring, has emerged as a valuable direction for optimizing recovery and long-term outcomes. This article examines how traditional medical protocols can be enhanced by digital solutions in a multidisciplinary framework. Methods: The study analyzes current clinical practices, including personalized meal planning, physical rehabilitation, biochemical marker monitoring, and psychological counseling, as applied in post-bariatric care. These established approaches are then analyzed in relation to the NutriMonitCare system, a digital health system developed and tested in a laboratory environment. Used here as an illustrative example, the NutriMonitCare system demonstrates the potential of digital tools to support clinicians through real-time monitoring of dietary intake, activity levels, and physiological parameters. Results: Findings emphasize that medical protocols remain the cornerstone of post-surgical management, while digital tools may provide added value by enhancing data availability, supporting individualized decision making, and reinforcing patient adherence. Systems like the NutriMonitCare system could be integrated into interdisciplinary care models to refine nutrition-focused interventions and improve communication across care teams. However, their clinical utility remains theoretical at this stage and requires further validation. Conclusions: In conclusion, the integration of digital health tools with conventional post-operative care has the potential to advance personalized smart nutrition. Future research should focus on clinical evaluation, real-world testing, and ethical implementation of such technologies into established medical workflows to ensure both efficacy and patient safety. Full article

The management of adult spinal deformity (ASD) has evolved dramatically over the past century, transitioning from external bracing and in situ fusion to complex, technology-driven surgical interventions. This review traces the historical development of spinal deformity correction and highlights contemporary enabling technologies that are redefining the surgical landscape. Advances in stereoradiographic imaging now allow for precise, low-dose three-dimensional assessment of spinopelvic parameters and segmental bone density, facilitating individualized surgical planning. Robotic assistance and intraoperative navigation improve the accuracy and safety of instrumentation, while patient-specific rods and interbody implants enhance biomechanical conformity and alignment precision. Machine learning and predictive modeling tools have emerged as valuable adjuncts for risk stratification, surgical planning, and outcome forecasting. Minimally invasive deformity correction strategies, including anterior column realignment and circumferential minimally invasive surgery (cMIS), have demonstrated equivalent clinical and radiographic outcomes to traditional open surgery with reduced perioperative morbidity in select patients. Despite these advancements, complications such as proximal junctional kyphosis and failure remain prevalent. Adjunctive strategies—including ligamentous tethering, modified proximal fixation, and vertebral cement augmentation—offer promising preventive potential. Collectively, these innovations signal a paradigm shift toward precision spine surgery, characterized by data-informed decision-making, individualized construct design, and improved patient-centered outcomes in spinal deformity care. Full article

Atrial fibrillation remains the most frequent sustained arrhythmia, particularly in the elderly population, and is associated with increased risks of stroke, heart failure, and reduced quality of life. While catheter ablation is widely used for rhythm control, its efficacy is limited in persistent and long-standing atrial fibrillation. Over the past two decades, minimally invasive surgical strategies have emerged as effective alternatives, aiming to replicate the success of the Cox-Maze procedure while reducing surgical trauma. This overview critically summarizes the current minimally invasive techniques available for atrial fibrillation treatment, including mini-thoracotomy ablation, thoracoscopic ablation, and hybrid procedures such as the convergent approach. These methods offer the potential for durable sinus rhythm restoration by enabling direct visualization, transmural lesion creation, and left atrial appendage exclusion, with lower perioperative morbidity compared to traditional open surgery. The choice of energy source plays a key role in lesion efficacy and safety. Particular attention is given to the technical steps of each procedure, patient selection criteria, and the role of left atrial appendage closure in stroke prevention. Hybrid strategies, which combine epicardial surgical ablation with endocardial catheter-based procedures, have shown encouraging outcomes in patients with refractory or long-standing atrial fibrillation. Despite the steep learning curve, minimally invasive techniques provide significant benefits in terms of recovery time, reduced hospital stay, and fewer complications. As evidence continues to evolve, these approaches represent a key advancement in the surgical management of atrial fibrillation, deserving integration into contemporary treatment algorithms and multidisciplinary heart team planning. Full article

Background: Despite advances in treatment, oral squamous cell carcinoma (OSCC) remains associated with high recurrence and mortality rates. Traditional TNM staging, while foundational, may not fully capture tumor aggressiveness. This study aimed to identify clinical and histopathological predictors of survival to enhance risk stratification and guide treatment planning in OSCC patients. Methods: A retrospective study of 100 patients with confirmed OSCC treated surgically with curative intent between January 2019 and January 2024 was analyzed. Clinicopathologic variables—including tumor volume, angioinvasion, perineural invasion, lymphatic invasion, and nodal status—were evaluated. Disease-specific survival (DSS) was assessed using Kaplan–Meier estimates, Cox regression, and logistic regression models. Results: The cohort had a mean age of 62.1 years, with a 46% OS rate and 43% DSS at study end. Perineural invasion (44%) and lymphatic invasion (42%) were the most common invasive features. Kaplan–Meier analysis revealed significantly reduced DSS in patients with angioinvasion, perineural invasion, and pN+ status. Multivariate logistic regression identified perineural invasion (OR = 3.93, p = 0.0023) and pN+ status (OR = 2.74, p = 0.0284) as independent predictors of cancer-specific mortality. Tumor volume was significantly associated with lymphatic invasion but not directly with DSS. Conclusions: Perineural invasion, angioinvasion, lymph node involvement, and tumor volume are important prognostic markers in OSCC, offering critical information beyond TNM staging. Incorporating these features into risk assessment models could improve prognostic accuracy and inform more individualized treatment strategies for high-risk OSCC patients. Full article

Background/Objectives: Severe jawbone atrophy, particularly in elderly or medically compromised patients, presents a significant challenge for conventional implant placement. In cases where bone augmentation is not feasible, alternative techniques—such as short, narrow, tilted, and zygomatic implants—may be indicated for the rehabilitation of the atrophic jaw. Subperiosteal implants have re-emerged as a further viable alternative, especially with recent advancements in digital planning and custom fabrication. This study aims to evaluate the clinical outcomes and complications associated with subperiosteal implants through a literature review and a supporting case series, and to propose clinical preliminary guidelines for their use. Methods: Fourteen studies—including case reports, case series, retrospective studies, and systematic reviews—were analyzed to assess the effectiveness and risk profile of subperiosteal implants. Additionally, we present a case series of nine patients with advanced vertical and horizontal alveolar bone atrophy treated using custom-made, digitally-designed subperiosteal implants. Surgical techniques, prosthetic workflows, and complications were recorded and assessed. Results: Subperiosteal implants were found to be particularly suitable for patients with narrow alveolar crests and severe atrophy where traditional implants are contraindicated. Literature and case series data indicated favorable outcomes, with early complications such as soft tissue inflammation and prosthetic misfit being manageable. A low complication rate was recorded in our series, with digital workflows contributing to improved implant fit and reduced technical errors. Conclusions: Subperiosteal implants could offer an effective solution for complex atrophic cases, provided that patient selection, surgical precision, and prosthetic design are meticulously managed. Based on our findings, clinical recommendations are proposed to guide their application in contemporary practice. Full article

Objective: This article presents a step-by-step digital technique for fabricating a 3D-printed surgical guide to assist in alveoloplasty for immediate denture placement. Methods: The workflow integrates intraoral scanning, virtual tooth extraction, digital soft tissue modeling, and additive manufacturing to produce a customized guide with an occlusal window and buccal slot, along with a verification stent. Results: This method ensures precise ridge recontouring and verification, enhancing surgical predictability and prosthetic fit. Conclusions: Unlike traditional surgical guides based on conventional casts or manual fabrication, this fully digital approach offers a practical and replicable protocol that bridges digital planning and clinical execution. By improving surgical precision, reducing operative time, and ensuring optimal denture fit, this technique represents a significant advancement in guided pre-prosthetic surgery. Full article

Background and Objectives: Three-dimensional (3D) scanning is increasingly utilized in medical practice, from orthotics to surgical planning. However, traditional hand measurement techniques remain inconsistent and prone to human error and are often time-consuming. This research evaluates the practicality of a commercial 3D scanning method by comparing the accuracy of scans conducted by two user groups. Materials and Methods: This study evaluated the following two groups: an experimental group (n = 45) and a control group (n = 42). A total of 261 hand scans were captured using the Structure Sensor Pro 3D scanner for iPad (Structure, Boulder, CO, USA). The scans were then evaluated using Meshmixer software (version 3.5.474), analyzing key parameters, such as surface area, volume, number of vertices, and triangles, etc. Furthermore, a digital literacy test and a user experience survey were conducted to support a more comprehensive evaluation of participant performance within the study. Results: The experimental group outperformed the control group on all measured parameters, including surface area, volume, vertices, triangle, and gap count, with large effect sizes observed. User experience data revealed that participants in the experimental group rated the 3D scanner significantly higher across all dimensions, particularly in ease of use, excitement, supportiveness, and practicality. Conclusions: A short 15 min training session can promote scan reliability, demonstrating that even minimal instruction improves users’ proficiency in 3D scanning, fundamental for supporting clinical accuracy in diagnosis, surgical planning, and personalized device manufacturing Full article

Introduction: This manuscript addresses the limitations of traditional orthognathic surgery in achieving both functional and aesthetic correction in patients with Class II malocclusion and severe mandibular retrusion. Current techniques often struggle to simultaneously address mandibular deficiency and inadequate transverse dimension, leading to unsatisfactory outcomes. Methods: Seven male patients underwent bimaxillary osteotomy with mandibular advancement. A novel surgical plate, Implate, was used, which was designed to facilitate precise osteotomy and stabilization. Pre-surgical planning included CBCT scanning, 3D modeling, and surgical simulation. Postoperative assessments included clinical examinations, CT and OPT scans. Results: Implate successfully addressed the challenges of conventional techniques, minimizing the formation of bony steps and achieving a more harmonious facial profile. The minimally invasive procedure, with careful periosteal and muscle management, contributed to stable outcomes, and no complications were reported. At the 6-month follow-up, OPT analysis showed a mean mandibular width increase of 18.1 ± 6.2 mm and vertical ramus height gains of 6.0 ± 3.1 mm (left) and 5.8 ± 1.7 mm (right). Conclusions: According to our preliminary experience, the integration of Implate into surgical practice offers a significant improvement in treating complex Class II malocclusions. By simultaneously correcting mandibular retrusion and width while minimizing complications, Implate provides a superior solution compared to traditional methods. This innovative approach highlights the potential of combining advanced surgical techniques with personalized 3D-printed implants to achieve optimal functional and aesthetic outcomes. Further prospective studies with controls and longer follow-up are needed to validate the efficacy and reproducibility of Implate in wider clinical use. Full article

Accurate liver segmentation and volume estimation from CT images are critical for diagnosis, surgical planning, and treatment monitoring. This paper proposes a GPU-accelerated voxel-level cropping method that localizes the liver region in a single pass, significantly reducing unnecessary computation and memory transfers. We integrate this pre-processing step into two segmentation pipelines: a traditional Chan-Vese model and a deep learning U-Net trained on the LiTS dataset. After segmentation, a seeded region growing algorithm is used for 3D liver volume assessment. Our method reduces unnecessary image data by an average of 90%, speeds up segmentation by 1.39× for Chan-Vese, and improves dice scores from 0.938 to 0.960. When integrated into U-Net pipelines, the post-processed dice score rises drastically from 0.521 to 0.956. Additionally, the voxel-based cropping approach achieves a 2.29× acceleration compared to state-of-the-art slice-based methods in 3D volume assessment. Our results demonstrate high segmentation accuracy and precise volume estimates with errors below 2.5%. This proposal offers a scalable, interpretable, efficient liver segmentation and volume assessment solution. It eliminates unwanted artifacts and facilitates real-time deployment in clinical environments where transparency and resource constraints are critical. It is also tested in other anatomical structures such as skin, lungs, and vessels, enabling broader applicability in medical imaging. Full article

Odontogenic abscesses are a frequent and challenging clinical issue in pet rabbits, often requiring a comprehensive diagnostic and therapeutic approach. This review collates current evidence on the etiology, diagnosis, and treatment of rabbit odontogenic abscesses, with a focus on imaging advances, microbial diversity, and local antimicrobial therapies. Predisposing factors include congenital conformation, inappropriate diet (insufficient abrasiveness, calcium or Vit D deficiencies, etc.), trauma, and neoplasia. Imaging techniques such as CT and cone-beam CT (CBCT) enable early detection and surgical planning, while traditional radiography remains useful in general practice. Treatment includes systemic antibiotics, surgical curettage, and the use of localized delivery systems such as antibiotic-impregnated polymethyl methacrylate (AIPMMA) beads. Adjunctive therapies like Manuka honey are also discussed. Two original heatmaps summarize bacterial prevalence and antimicrobial resistance from six peer-reviewed studies. These visualizations highlight the polymicrobial nature of these infections and the emergence of multidrug-resistant strains. Preventive strategies focus on optimal diet, regular dental checks, and owner education. The review also identifies key gaps in the literature, including the underreporting of anaerobes and lack of standardized treatment protocols. This article aims to support veterinary professionals in delivering evidence-based, individualized care to improve outcomes in rabbits with odontogenic abscesses. Full article

Background/Objectives: Limb malalignment disrupts physiological joint forces and predisposes individuals to the development of osteoarthritis. Surgical interventions such as distal femur or high tibial osteotomy aim to restore mechanical balance on weight-bearing joints, thereby reducing long-term morbidity. Accurate alignment is crucial since it cannot be adjusted after stabilization with plates and screws. Recent advances in personalized medicine offer the opportunity to tailor surgical corrections to each patient’s unique anatomy and biomechanical profile. This study evaluates the benefits of 3D planning and patient-specific cutting guides over traditional 2D planning with standard implants for alignment correction procedures. Methods: We assessed limb alignment parameters pre- and postoperatively in patients with varus and valgus lower limb malalignment undergoing acute realignment surgery. The cohort included 23 opening-wedge high tibial osteotomies and 28 opening-wedge distal femur osteotomies. We compared the accuracy of postoperative alignment parameters between patients undergoing traditional 2D preoperative X-ray planning and those using 3D reconstructions of CT data. Outcome measures included mechanical axis deviation and tibiofemoral angles. Results: 3D reconstructions of computerized tomography data and patient-specific cutting guides significantly reduced the variation in postoperative limb alignment parameters relative to preoperative goals. In contrast, traditional 2D planning with standard non-custom implants resulted in higher deviations from the targeted alignment. Conclusions: Utilizing 3D CT reconstructions and patient-specific cutting guides enhances the accuracy of postoperative limb realignment compared to traditional 2D X-ray planning with standard non-custom implants. Patient-specific instrumentation and personalized approaches represent a key step toward precision orthopedic surgery, tailoring correction strategies to individual patient anatomy and potentially improving long-term joint health. This improvement may reduce the morbidity associated with lower limb malalignment and delay the onset of osteoarthritis. Level of Evidence: Therapeutic Level III. Full article

Mitral valve disease, particularly in the context of extensive mitral annular calcification (MAC), poses significant challenges for traditional surgical management. Transcatheter mitral valve replacement (TMVR) has emerged as a promising alternative for high-risk and inoperable patients, driven by rapid advancements in valve technology, imaging techniques, and procedural strategies. Nevertheless, complications such as paravalvular leak (PVL), left ventricular outflow tract (LVOT) obstruction, and hemolysis remain obstacles to optimal outcomes, particularly in patients with complex annular anatomy. We present the case of an 89-year-old female with severe mitral stenosis and MAC who developed acute hemolytic anemia following experimental TMVR using the Edwards SAPIEN S3 valve. This case serves as a platform to explore recent advances in TMVR, including novel device platforms, enhanced imaging modalities for pre-procedural planning, innovative deployment strategies, and emerging adjunctive techniques aimed at reducing complications. Through this case, we underscore persistent challenges and emphasize the importance of meticulous patient selection and vigilant follow-up. Despite substantial progress, TMVR in the setting of MAC remains high-risk, demanding continued innovation in valve design, refined patient stratification, and improved peri-procedural management to enhance outcomes and mitigate risks such as hemolysis. Full article

Background: Artificial Intelligence (AI) is revolutionizing healthcare by enhancing diagnostic precision and risk assessment. In dentistry, AI has been increasingly integrated into Cone Beam Computed Tomography (CBCT) to improve image interpretation and pre-surgical planning. The lingual foramen (LF), a vital anatomical structure that transmits neurovascular elements, requires accurate evaluation during implant procedures. Traditional CBCT studies describe LF variations but lack a standardized risk classification. This study introduces a novel AI-based model for stratifying the surgical risk associated with LF using machine learning. Objectives: This study aimed to (1) assess the prevalence and anatomical variations of the lingual foramen (LF) using CBCT, (2) develop an AI-driven risk classification model based on LF characteristics, and (3) compare the AI model’s performance with that of traditional statistical methods. Materials and Methods: A retrospective analysis of 166 CBCT scans was conducted. K-means clustering and decision tree algorithms classified foramina into Low, Moderate, and High-Risk groups based on count, size, and proximity to the alveolar crest. The model performance was evaluated using confusion matrix analysis, heatmap correlations, and the elbow method. Traditional analyses (chi-square and logistic regression) were also performed. Results: The AI model categorized foramina into low (60%), moderate (30%), and high (10%) risk groups. The decision tree achieved a classification accuracy of 92.6 %, with 89.4% agreement with expert manual classification, confirming the model’s reliability. Conclusions: This study presents a validated AI-driven model for the risk assessment of the lingual foramen. Integrating AI into CBCT workflows offers a structured, objective, and automated method for enhancing surgical safety and precision in dental implant planning. Full article

Background and Clinical Significance: Robotic surgery reduces the need for extensive surgical approaches and lowers perioperative complications. In particular, it offers enhanced dexterity, three-dimensional visualization, and improved precision in confined anatomical spaces. Pelvic masses pose significant challenges due to their close relationship with critical neurovascular structures, making traditional open or laparoscopic approaches more invasive and potentially riskier. Robot-assisted resection, combined with intraoperative neurophysiological monitoring, may therefore offer a safe and effective solution for the management of complex pelvic lesions. Case Presentation: An 18-year-old woman was incidentally diagnosed with an 11 cm asymptomatic pelvic mass located anterior to the sacrum. Initial differential diagnoses included neurofibroma, teratoma, and myelolipoma. Histopathological examination confirmed a ganglioneuroma. Following multidisciplinary discussion, the patient underwent a robot-assisted en bloc resection using the Da Vinci Xi multiport system. Preoperative planning was aided by 3D modeling and intraoperative navigation. Conclusions: Surgery lasted 322 min. Preoperative and postoperative eGFR values were 145.2 mL/min and 144.0 mL/min, respectively. The lesion measured 11 cm × 9 cm × 8 cm. The main intraoperative complication was a controlled breach of the iliac vein due to its close adherence to the mass. No major postoperative complications occurred (Clavien-Dindo Grade I). The drain was removed on postoperative day 3, and the bladder catheter on day 2. The patient was discharged on postoperative day 5 without further complications. Presacral ganglioneuromas are rare neoplasms in a surgically complex area. A multidisciplinary approach using robotic-assisted laparoscopy with nerve monitoring enables safe, minimally invasive resection. This strategy may help avoid open surgery and reduce the risk of neurological and vascular injury. Full article

Background/Objectives: Orthognathic surgery has evolved with digital advancements, improving precision and predictability. Traditional free-hand techniques rely on surgeon expertise, often leading to variable outcomes. Fully guided approaches integrate computer-assisted surgery, including virtual surgical planning (VSP), CAD/CAM, and dynamic navigation, enhancing accuracy and efficiency. This review compares these approaches, assessing their impact on surgical accuracy, efficiency, and patient outcomes. Methods: A scoping review was conducted across PubMed, MEDLINE, Scopus, Cochrane Library, and Embase databases, focusing on clinical trials and cohort studies. Key parameters analyzed include surgical precision, operative efficiency, complication rates, and functional/aesthetic results. Results: Fully guided techniques achieve sub-millimetric accuracy with mean length deviations ranging from 1.3 mm to 2.4 mm and mean angular deviations between 2.29° and 3.51°. Moreover, these approaches markedly reduce operative time, averaging between 34 min and 1.7 h, and postoperative complications. Digital tools streamline workflow, improving reproducibility and aesthetic outcomes. Free-hand methods remain cost-effective but require greater surgical expertise, often resulting in longer recovery periods and higher variability. Conclusions: Computer-assisted orthognathic surgery enhances precision and efficiency, outperforming free-hand techniques in accuracy and predictability. While free-hand methods remain viable for simpler cases, fully guided approaches optimize surgical execution. Future research should explore hybrid strategies combining digital precision with manual adaptability to further refine surgical techniques. Full article