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Relationship Between Lymphaticovenular Anastomosis Outcomes and the Number and Types of Anastomoses.The Journal of Surgical Research Jan 2022Lymphaticovenular anastomosis (LVA) is the first-line treatment for lymphedema in many hospitals. However, many aspects of its effects remain unclear. This study aimed... (Review)
Review
BACKGROUND
Lymphaticovenular anastomosis (LVA) is the first-line treatment for lymphedema in many hospitals. However, many aspects of its effects remain unclear. This study aimed to analyze problems with regard to the relationship between lymphaticovenular anastomosis and outcomes of surgery for lymphedema in the upper and lower extremities.
METHODS
Eighteen articles were selected for review. The following information was extracted from these articles as factors associated with LVA for lymphedema in the upper and lower extremities: number of cases, average patient age, mean number of bypasses, lymphedema stage, duration and type of lymphedema, anastomotic technique, follow-up period, type of scale, and treatment outcomes.
RESULTS
Upper extremity lymphedema: The average age of patients was 54.2 (range: 41.3-60.1) years. The mean number of anastomoses was 3.91 (range: 1.0-7.2). Six of nine articles provided data for volume change, and the mean volume change was 29% (-5%-50%). Lower extremity lymphedema: The average age of patients was 50.3 (range: 34-64 years). The mean number of anastomoses was 4.6 (range: 2.1-9.3). Comparison was difficult as different methods were used for postoperative evaluation (lower extremity lymphedema index in three patients, limb circumference in one, volume change in two, and restaging in three).
CONCLUSIONS
We obtained useful information with regard to the effects of LVA in this review. An increased number of anastomoses between the lymphatic ducts and veins did not seem to improve the effectiveness of LVA. With regard to the stage of lymphedema, LVA may be useful for both early and advanced stages.
Topics: Adult; Anastomosis, Surgical; Humans; Lower Extremity; Lymphatic Vessels; Lymphedema; Microsurgery; Middle Aged; Treatment Outcome
PubMed: 34547586
DOI: 10.1016/j.jss.2021.08.012 -
Journal of Reconstructive Microsurgery Nov 2019Laboratory training courses have traditionally offered an attractive method to learn microsurgery in a low-risk environment. However, courses are often limited by...
BACKGROUND
Laboratory training courses have traditionally offered an attractive method to learn microsurgery in a low-risk environment. However, courses are often limited by cost, accessibility, and their one-time, nonlongitudinal nature. Our aims were to (1) describe our institution's microsurgical training course for hand surgery fellows, which is longitudinal and integrated within our fellowship curriculum and (2) investigate how this course affects the microsurgical confidence and competence of trainees throughout their fellowship year.
METHODS
All hand fellows who trained in our 1-year combined hand surgery fellowship from 2016 through 2018 participated in this study. Baseline data on the type and duration of residency training, previous microsurgery experience and self-reported confidence, knowledge, and interest in microsurgery were recorded. Self-reported scores were documented using a continuous scale ranging from 0 to 10. An initial 3-day laboratory course combining the use of didactic teaching, a nonliving synthetic model, and a live rat model was conducted. Repeat laboratory training occurred thereafter at 6 and 12 months. At the end of each session, fellows repeated the baseline questionnaire and faculty assessed their microsurgical competence using a standardized global rating scale (GRS).
RESULTS
A total of six fellows (2 years) were enrolled. At the end of the initial course, there was a statistically significant increase in mean self-reported confidence in microsurgery from 4.3 to 6.2 and knowledge from 4.7 to 6.5. Mean scores in interest were unchanged, from 9.2 to 9.3. There was also an increase in mean GRS score from day 3 to months 6 and 12.
CONCLUSION
A longitudinal microsurgical training course integrated within a hand surgery fellowship is associated with increased confidence and microsurgical skill. This study describes our approach and its feasibility.
Topics: Animals; Clinical Competence; Curriculum; Fellowships and Scholarships; Hand; Humans; Internship and Residency; Microsurgery; Rats; Simulation Training
PubMed: 31140188
DOI: 10.1055/s-0039-1691784 -
The Laryngoscope Sep 2023Among the transsphenoidal (TSS) approaches to pituitary tumors, the microscopic approach (MA) has historically been the predominant technique with the increasing...
OBJECTIVES
Among the transsphenoidal (TSS) approaches to pituitary tumors, the microscopic approach (MA) has historically been the predominant technique with the increasing adoption of the endoscopic approach (EA). This study investigates national trends in TSS approaches and postoperative outcomes for MA and EA through 2021.
METHODS
The TriNetX database was queried for patients undergoing TSS (MA and EA) between 2010 and 2021. Data were collected on demographics, geographic distribution of surgical centers, postoperative complications, stereotactic radiosurgery (SRT), repeat surgery, and postoperative emergency department (ED) visits.
RESULTS
8644 TSS cases were queried between 2010 and 2021. MA rates were highest until 2013 when rates of EA (52%) surpassed MA (48%) and continued to increase through 2021 (81%). From 2010 to 2015 EA had higher odds of a postoperative CSF leak (OR 3.40) and diabetes insipidus (DI (OR 2.30)) versus MA (p < 0.05); from 2016 to 2021 differences were not significant. Although there was no significant difference among approaches from 2010 to 2015 for syndrome of inappropriate antidiuretic hormone (SIADH), hyponatremia, or bacterial meningitis, from 2016 to 2021 EA had lower odds of SIADH (OR 0.54) and hyponatremia (OR 0.71), and higher odds of meningitis (OR 1.79) versus MA (p < 0.05). EA had higher odds of additional surgery (either EA or MA) after initial surgery from 2010 to 2021. From 2010 to 2015 EA had lower odds of postoperative SRT compared to MA, whereas in 2016-2021 there was no statistical difference among approaches.
CONCLUSION
This study demonstrates increasing EA adoption for TSS in the United States since 2013. Complication rates have overall improved for EA compared to MA, potentially as a result of improving surgeon familiarity and experience.
LEVEL OF EVIDENCE
4 Laryngoscope, 133:2135-2140, 2023.
Topics: Humans; Pituitary Gland; Pituitary Neoplasms; Postoperative Complications; Retrospective Studies; Treatment Outcome; Endoscopy; Microsurgery; Cohort Studies; Male; Female; Adult; Middle Aged; Aged
PubMed: 37318105
DOI: 10.1002/lary.30820 -
Expert Review of Medical Devices Feb 2020: The current gold standard technique for lumbar disc herniation (LDH) is open lumbar microdiscectomy. The use of a tubular retractor system in the microdiscectomy... (Review)
Review
: The current gold standard technique for lumbar disc herniation (LDH) is open lumbar microdiscectomy. The use of a tubular retractor system in the microdiscectomy technique can minimize tissue trauma by muscle-splitting sequential dilation during the surgical approach. This review aimed to describe the devices and surgical procedure of this minimally invasive microdiscectomy (MI-MD) and to discuss the pros and cons of the use of tubular retractors.: Published medical literatures were extensively reviewed to summarize the practical devices and techniques related to the MI-MD for LDH. The placement of the tubular retractor by gradual muscle-splitting dilation technique may reduce muscle damage and postoperative wound pain. The use of flexible arm may easily change the tube direction and create a wide surgical field.: With reference to published literature, the MI-MD provides comparable clinical outcomes with less tissue trauma and early recovery. Development of devices for MI-MD is still ongoing. Extensive studies, including high-quality randomized trials, are required to establish a more practical and relevant MI-MD technique.
Topics: Diskectomy; Humans; Inflammation; Inventions; Microsurgery; Minimally Invasive Surgical Procedures; Muscles
PubMed: 31865755
DOI: 10.1080/17434440.2020.1708189 -
Journal of Neurological Surgery. Part... Jul 2019Although the indications for endoscopic procedures have increased in recent times, there are also some limitations. This review discusses the practical points to... (Review)
Review
INTRODUCTION
Although the indications for endoscopic procedures have increased in recent times, there are also some limitations. This review discusses the practical points to prevent and treat complications in microendoscopic spine surgery.
MATERIAL AND METHODS
A literature search was conducted for the relevant articles after a topic search on PubMed, Google Scholar, and Medline. The review is based on the experience of 1,574 spinal endoscopic procedures performed by the senior author.
RESULTS
Advantages of endoscopic surgery include better visualization, panoramic vision, and the ability to work around corners. Limitations with endoscopic procedures include proximal blind areas, obstruction in instrument handling due to a narrow corridor, disorientation, frequent lens fogging, loss of depth perception, and difficulty in achieving hemostasis, leading to complications and longer operative time during the learning curve.
CONCLUSION
Surgeons need to learn endoscopic skills in addition to microsurgical ones to perform microendoscopic procedures properly. Attending live workshops, watching operative videos, visiting various departments, watching an experienced and accomplished endoscopic surgeon, proper case selection, a multidisciplinary team approach, practicing on models, hands-on cadaveric workshops, laboratory training, and simulators can improve results and shorten the learning curve.
Topics: Endoscopy; Humans; Learning Curve; Microsurgery; Operative Time; Postoperative Complications; Spine
PubMed: 30965374
DOI: 10.1055/s-0039-1677825 -
CNS Oncology 2015Pituitary adenomas are among the most common central nervous system tumors. They represent a diverse group of neoplasms that may or may not secrete hormones based on... (Review)
Review
Pituitary adenomas are among the most common central nervous system tumors. They represent a diverse group of neoplasms that may or may not secrete hormones based on their cell of origin. Epidemiologic studies have documented the incidence of pituitary adenomas within the general population to be as high as 16.7%. A growing body of work has helped to elucidate the pathogenesis of these tumors. Each subtype has been shown to demonstrate unique cellular changes potentially leading to tumorigenesis. Surgical advancements over several decades have included microsurgery and the employment of the endoscope for surgical resection. These advancements increase the likelihood of gross-total resection and have resulted in decreased patient morbidity.
Topics: Adenoma; History, 19th Century; Humans; Microsurgery; Neurosurgical Procedures; Pituitary Neoplasms
PubMed: 26497533
DOI: 10.2217/cns.15.21 -
Journal of Reconstructive Microsurgery Sep 2016Background While other surgical specialties have embraced virtual reality simulation for training and recertification, microsurgery has lagged. This study aims to...
Background While other surgical specialties have embraced virtual reality simulation for training and recertification, microsurgery has lagged. This study aims to assess the opinions of microsurgeons on the role of simulation in microsurgery assessment and training. Methods We surveyed faculty members of the American Society of Reconstructive Microsurgery to ascertain opinions on their use of simulation in training and opinions about the utility of simulation for skills acquisition, teaching, and skills assessment. The 21-question survey was disseminated online to 675 members. Results Eighty-nine members completed the survey for a 13.2% response rate. Few microsurgeons have experience with high-fidelity simulation, and opinions on its utility are internally inconsistent. Although 84% of respondents could not identify a reason why simulation would not be useful, only 24% believed simulation is a useful measure of clinical performance. Nearly three-fourths of respondents were skeptical that simulation would improve their skills. Ninety-four percent had no experience with simulator-based assessment. Conclusion Simulation has been shown to improve skills acquisition in microsurgery, but our survey suggests that unfamiliarity may foster bias against the technology. Failure to incorporate simulation may adversely affect training and may put surgeons at a disadvantage should these technologies be adopted for recertification by regulatory agencies.
Topics: Attitude of Health Personnel; Clinical Competence; Computer Simulation; Computer-Assisted Instruction; Curriculum; Faculty, Medical; Humans; Internship and Residency; Microsurgery; Plastic Surgery Procedures; Task Performance and Analysis
PubMed: 27077211
DOI: 10.1055/s-0036-1582263 -
Journal of Dentistry Jun 2023The study aimed to develop and validate machine learning models for case difficulty prediction in endodontic microsurgery, assisting clinicians in preoperative analysis.
OBJECTIVES
The study aimed to develop and validate machine learning models for case difficulty prediction in endodontic microsurgery, assisting clinicians in preoperative analysis.
METHODS
The cone-beam computed tomographic images were collected from 261 patients with 341 teeth and used for radiographic examination and measurement. Through linear regression (LR), support vector regression (SVR), and extreme gradient boosting (XGBoost) algorithms, four models were established according to different loss functions, including the L1-loss LR model, L2-loss LR model, SVR model and XGBoost model. Five-fold cross-validation was applied in model training and validation. Explained variance score (EVS), coefficient of determination (R), mean absolute error (MAE), mean squared error (MSE) and median absolute error (MedAE) were calculated to evaluate the prediction performance.
RESULTS
The MAE, MSE and MedAE values of the XGBoost model were the lowest, which were 0.1010, 0.0391 and 0.0235, respectively. The EVS and R values of the XGBoost model were the highest, which were 0.7885 and 0.7967, respectively. The factors used to predict the case difficulty in endodontic microsurgery were ordered according to their relative importance, including lesion size, the distance between apex and adjacent important anatomical structures, root filling density, root apex diameter, root resorption, tooth type, tooth length, root filling length, root canal curvature and the number of root canals.
CONCLUSIONS
The XGBoost model outperformed the LR and SVR models on all evaluation metrics, which can assist clinicians in preoperative analysis. The relative feature importance provides a reference to develop the scoring system for case difficulty assessment in endodontic microsurgery.
CLINICAL SIGNIFICANCE
Preoperative case assessment is a crucial step to identify potential risks and make referral decisions. Machine learning models for case difficulty prediction in endodontic microsurgery can assist clinicians in preoperative analysis efficiently and accurately.
Topics: Humans; Microsurgery; Root Canal Therapy; Cone-Beam Computed Tomography; Algorithms
PubMed: 37080531
DOI: 10.1016/j.jdent.2023.104522 -
World Neurosurgery Oct 2020
Topics: Betacoronavirus; COVID-19; Coronavirus Infections; Eye Protective Devices; Humans; Microsurgery; Neuroendoscopes; Neurosurgical Procedures; Pandemics; Personal Protective Equipment; Pneumonia, Viral; SARS-CoV-2; Surveys and Questionnaires
PubMed: 32413563
DOI: 10.1016/j.wneu.2020.04.251 -
Injury Dec 2019
Topics: Congresses as Topic; Education; Europe; Global Health; Humans; Internship and Residency; Microsurgery; Musculoskeletal System; Plastic Surgery Procedures; Societies, Medical; Wounds and Injuries
PubMed: 31787328
DOI: 10.1016/j.injury.2019.10.036