-
Progres En Urologie : Journal de... Sep 2023The subinguinal microsurgical varicocelectomy is considered as the gold standard surgical technique for the treatment of varicocele. The objective of this study is to...
INTRODUCTION
The subinguinal microsurgical varicocelectomy is considered as the gold standard surgical technique for the treatment of varicocele. The objective of this study is to evaluate the results of this technique on the resolution of pain and the parameters of sperm analysis.
METHODS
Single-center, retrospective study that includes 22 patients who have been operated over a period of six months for a clinically palpable varicocele via the microsurgical subinguinal technique. Nine patients were operated for pain and 13 patients for infertility with an abnormality of their sperm analysis.
RESULTS
All the patients operated for pain had a complete resolution of pain at the postoperative follow-up (3 months). Concerning the patients operated for infertility, 76.92% of the patients had a normal sperm analysis, 7.69% of the patients presented a partial improvement, and 15.39% of the patients without any improvement. Analysis of sperm's parameters at 3 months showed a significant improvement in the morphology (4.3% vs 6.69% of typical forms according to Kruger ; P<0.05) and mobility (progressive mobility 15.6% vs 23% postoperatively; P<0.01). A non-significant improvement (low sample) in the concentration was noted (21.58 million/mL preoperative vs 34.9 million/mL postoperative, P=0.08). Pregnancies are noted in 38.5% of patients. A postoperative complication was noted with surgical site infection resolved with antibiotics.
CONCLUSION
This single-center study confirms that the treatment of varicocele by subinguinal microsurgical route is an effective therapeutic strategy on symptomatic varicocele and in infertile men. This technique is associated with few complications.
Topics: Pregnancy; Female; Humans; Male; Infertility, Male; Varicocele; Retrospective Studies; Microsurgery; Semen; Pain; Treatment Outcome
PubMed: 37537033
DOI: 10.1016/j.purol.2023.07.004 -
Microsurgery Jul 2023Blood pressure regulation is critical in patients undergoing microsurgical free tissue transfer; however, guidelines for addressing and preventing perioperative... (Review)
Review
Blood pressure regulation is critical in patients undergoing microsurgical free tissue transfer; however, guidelines for addressing and preventing perioperative hypotension remain highly debated, with two current thought paradigms: (1) intravenous fluid administration with a balanced salt solution (e.g., lactate ringer and normal saline) and/or colloid (e.g., albumin) and (2) vasoactive pharmacological support with vasopressors (e.g., dobutamine, norepinephrine, epinephrine), with fluid administration being the preferred conventional approach. Here, we review the most up to date available literature and summarize currents perspectives and practices for fluid resuscitation and vasopressor use, while offering evidence-based guidelines to each.
Topics: Humans; Microsurgery; Vasoconstrictor Agents; Epinephrine; Norepinephrine; Fluid Therapy
PubMed: 37052570
DOI: 10.1002/micr.31047 -
Journal of Plastic Surgery and Hand... Dec 2023In this report, we describe a super microsurgical technique that enables rapid and accurate anastomosis while adjusting for caliber differences when anastomosing a...
In this report, we describe a super microsurgical technique that enables rapid and accurate anastomosis while adjusting for caliber differences when anastomosing a small-caliber lymphatic vessel and a vein with a larger caliber, which is frequently encountered in surgeries such as lymphaticovenous anastomosis (LVA). The suture size adjustment technique was performed in 30 anastomoses of lymphatic vessels and veins, whose diameter of lymph duct was at least two times smaller than that of the vein. The type of lymphedema, caliber of lymphatic vessels and veins anastomosed, caliber ratio, vein wall thickness, modified caliber ratio after vein wall thickness subtracted, presence of additional anastomosis, and anastomosis time were examined. On average, the lymphatic vessels had a diameter of 0.61 mm, while the veins were 1.43 mm in diameter. The mean caliber ratio of vein to lymphatic vessel was 2.3, while the modified caliber ratio of vein-to-lymphatic vessel was 1.5 on average. The average venous wall thickness was 0.51. The average anastomosis time was 9.1 min and no additional anastomosis due to leakage was necessary in any case. We successfully performed an anastomosis of lymphatic vessels and veins with different calibers, which can maintain long-term patency while adjusting the caliber difference and suppressing leakage at the anastomosis site. Finally, the caliber of the vein is commonly larger than that of the lymphatic vessel to be anastomosed in many cases of LVA surgery, indicating that the proposed anastomosis method could be of therapeutic use in many cases.
Topics: Humans; Veins; Lymphedema; Lymphatic Vessels; Anastomosis, Surgical; Lymphography; Microsurgery
PubMed: 38130209
DOI: 10.2340/jphs.v58.18384 -
International Journal of Computer... Jul 2023Robotic ophthalmic microsurgery has significant potential to help improve the success of challenging procedures and overcome the physical limitations of the surgeon....
PURPOSE
Robotic ophthalmic microsurgery has significant potential to help improve the success of challenging procedures and overcome the physical limitations of the surgeon. Intraoperative optical coherence tomography (iOCT) has been reported for the visualisation of ophthalmic surgical manoeuvres, where deep learning methods can be used for real-time tissue segmentation and surgical tool tracking. However, many of these methods rely heavily on labelled datasets, where producing annotated segmentation datasets is a time-consuming and tedious task.
METHODS
To address this challenge, we propose a robust and efficient semi-supervised method for boundary segmentation in retinal OCT to guide a robotic surgical system. The proposed method uses U-Net as the base model and implements a pseudo-labelling strategy which combines the labelled data with unlabelled OCT scans during training. After training, the model is optimised and accelerated with the use of TensorRT.
RESULTS
Compared with fully supervised learning, the pseudo-labelling method can improve the generalisability of the model and show better performance for unseen data from a different distribution using only 2% of labelled training samples. The accelerated GPU inference takes less than 1 millisecond per frame with FP16 precision.
CONCLUSION
Our approach demonstrates the potential of using pseudo-labelling strategies in real-time OCT segmentation tasks to guide robotic systems. Furthermore, the accelerated GPU inference of our network is highly promising for segmenting OCT images and guiding the position of a surgical tool (e.g. needle) for sub-retinal injections.
Topics: Humans; Retina; Ophthalmologic Surgical Procedures; Tomography, Optical Coherence; Microsurgery; Image Processing, Computer-Assisted
PubMed: 37233893
DOI: 10.1007/s11548-023-02928-9 -
European Journal of Ophthalmology Sep 2023To evaluate the influence of the corneal tunnel length on surgically induced astigmatism (SIA) after 3 phacoemulsification techniques.
PURPOSE
To evaluate the influence of the corneal tunnel length on surgically induced astigmatism (SIA) after 3 phacoemulsification techniques.
METHODS
Patients who underwent a planned phacoemulsification surgery with an implantation of a foldable, acrylic IOL were selected for the study. All surgeries were performed under topical anaesthesia, with the same phaco machine. Group I consisted of 30 eyes of 30 patients after bimanual 1.4 mm microincision cataract surgery (B-MICS). Group II consisted of 30 eyes of 30 patients after coaxial 1.8 mm microincision cataract surgery (C-MICS). Group III consisted of 30 eyes of 30 patients after coaxial 2.4 mm small incision cataract surgery (C-SICS).Best corrected visual acuity, autorefractometry, tonometry, a slit lamp examination and anterior segment OCT were performed preoperatively and 1, 7, 30 and 90 days postoperatively. The temporal peripheral corneal thickness and the chord length of the main incision were measured. Vector method was used to calculate SIA.
RESULTS
Mean preoperative BCVA was 0.52 ± 0.19 and it improved to 0.98 ± 0.05 (p < 0.05). Mean corneal tunnel chord length was 1.30 ± 0.16 mm 90 days postoperatively in group I, 1.30 ± 0.19 mm in group II and 1.48 ± 0.22 mm in group III. SIA was 0.54 ± 0.48 mm in group I, 0.45 ± 0.21 mm in group II and 0.62 ± 0.30 mm in group III. There were no correlations between the chord length of the corneal tunnel and SIA calculated with using vector analysis method.
CONCLUSIONS
Unlike the incision width, the length of the clear corneal tunnel in small incisions and microinicions, has no significant influence on SIA.
Topics: Humans; Phacoemulsification; Astigmatism; Visual Acuity; Microsurgery; Prospective Studies; Cornea; Surgical Wound; Cataract
PubMed: 36851812
DOI: 10.1177/11206721231160387 -
Journal of Plastic, Reconstructive &... Aug 2023The microsurgical literature reports the vascular calibers of the vessels studied even though the method of measurement of these vessels is very rarely reported.
INTRODUCTION
The microsurgical literature reports the vascular calibers of the vessels studied even though the method of measurement of these vessels is very rarely reported.
MATERIAL AND METHOD
We performed a metrological study evaluating three methods to measure the external calibers of catheters corresponding to microsurgical and super-microsurgical vessels (1.2 mm, 0.8 mm, and 0.6 mm). Six evaluators measured 15 catheters of three different hidden diameters by each of the three methods applicable in clinical practice: standard graduated ruler, Shinwa® micrometric ruler, and ImageJ® software from a photograph. Accuracy and reliability of the measurements were assessed by studying the inter- and intra-rater and inter-method coefficients (variants of the intra-class coefficient (ICC)) and analysis of the IC95% of the ICCs.
RESULTS
Intra class correlation ICC "intra-rater" coefficient finds for the standard rule 0.81 [0.65-0.93], Shinwa® rule 0.86 [0.67-0.96], and for the ImageJ® software 0.97 [0.94-0.99]. The "Inter-rater" ICC shows respectively the coefficient 0.51 [0.23 and max 0.93], 0.87 [0.75-0.95], and 0.95 [0.89-0.98]. It appears that the graduated decimeter is the least reliable method of measurement, the Shinwa® ruler presents acceptable reliability but requires the purchase of equipment. The reliability of ImageJ® software is the best and appears to be the most reliable method.
CONCLUSION
Our original study, with no equivalent in the scientific literature, demonstrates objectively the great accuracy and reliability of a method of measurement of vascular calibers in micro and super microsurgery using intraoperative photography and the use of free computer software.
Topics: Humans; Reproducibility of Results; Microsurgery; Software; Photography; Observer Variation
PubMed: 37271002
DOI: 10.1016/j.bjps.2023.05.014 -
Journal of Reconstructive Microsurgery Jun 2024While the number of female plastic surgeons has continued to increase over time, plastic surgery has historically been a male-dominated profession with only 15% of...
BACKGROUND
While the number of female plastic surgeons has continued to increase over time, plastic surgery has historically been a male-dominated profession with only 15% of practicing plastic surgeons being female. Microsurgery, as a subspecialty, has been long perceived as an even more male-centric career path. The objective of this study was to determine the representation of females in the subspecialty field of microsurgery and the impact of microsurgical fellowship training.
METHODS
A review of all microsurgery fellowship programs participating in the microsurgery fellowship match from 2010 to 2019 were analyzed. Fellows were identified through fellowship Web site pages or direct contact with fellowship program coordinators and directors. The current type of practice and performance of microsurgery were also identified through a Web search and direct contact with fellowship program coordinators and directors.
RESULTS
A total of 21 programs and 317 fellows over a 10-year period were analyzed. Over this 10-year period, there was a total of 100 (31.5%) female microsurgery fellows and 217 (68.5%) male microsurgery fellows. There was a small, statistically insignificant increase in the yearly percentage of female microsurgery fellows over this 10-year period with an average yearly increase of 2.7% ( = 0.60; 95% confidence interval: -6.9 to 13.2%). There were significantly fewer females who continued to practice microsurgery compared to males (75 [75.0%] vs. 186 [85.7%], = 0.02). There was no significant difference in the current practice types (academic, private, and nonacademic hospital) between females and males ( = 0.29).
CONCLUSION
Women are underrepresented in the field of microsurgery to a similar extent as they are underrepresented in overall plastic surgery. While there is a small insignificant increase in the number of female microsurgery fellows every year, a significantly smaller proportion of females continue to practice microsurgery compared to males.
Topics: Humans; Microsurgery; Female; Fellowships and Scholarships; Physicians, Women; Male; United States; Practice Patterns, Physicians'; Career Choice; Surgery, Plastic; Education, Medical, Graduate
PubMed: 37751878
DOI: 10.1055/a-2182-0902 -
Journal of Plastic, Reconstructive &... Jul 2023
Topics: Humans; Lower Extremity; Treatment Outcome; Lymphatic Vessels; Anastomosis, Surgical; Lymphedema; Microsurgery
PubMed: 37156108
DOI: 10.1016/j.bjps.2023.04.034 -
Journal of Wound Care Dec 2023
Topics: Humans; Skin Neoplasms; Hand; Upper Extremity; Mohs Surgery
PubMed: 38175764
DOI: 10.12968/jowc.2023.32.Sup12a.S20 -
The American Journal of Gastroenterology Oct 2023Cold snare polypectomy (CSP) is strongly recommended as the optimal technique for the complete removal of small polyps. Though significant variability in polypectomy... (Randomized Controlled Trial)
Randomized Controlled Trial
INTRODUCTION
Cold snare polypectomy (CSP) is strongly recommended as the optimal technique for the complete removal of small polyps. Though significant variability in polypectomy technique and quality has been established, the learning curve and impact of targeted training on CSP are unknown. Video feedback has shown promise as an effective pedagogy to improve performance among surgical trainees. We aimed to compare CSP performance between trainees who received video-based feedback and those who received conventional apprentice-based concurrent feedback. We hypothesized that video-based feedback would accelerate competence.
METHODS
We conducted a single-blinded, randomized controlled trial on competence for CSP of polyps <1 cm, comparing video-based feedback with conventional feedback. We randomly assigned deidentified consecutively recorded CSP videos to blinded raters to assess using the CSP Assessment Tool. We shared cumulative sum learning curves every 25 CSP with each trainee. The video feedback trainees also received biweekly individualized terminal feedback. Control trainees received conventional feedback during colonoscopy. The primary outcome was CSP competence. We also assessed competence across domains and change over polypectomy volume.
RESULTS
We enrolled and randomized 22 trainees, 12 to video-based feedback and 10 to conventional feedback, and evaluated 2,339 CSP. The learning curve was long; 2 trainees (16.7%) in the video feedback achieved competence, after a mean of 135 polyps, and no one in the control ( P = 0.481) achieved competence. Overall and in all steps of CSP, a higher percentage of the video feedback group met competence, increasing 3% every 20 CSP ( P = 0.0004).
DISCUSSION
Video feedback aided trainees to competence in CSP. However, the learning curve was long. Our findings strongly suggest that current training methods are not sufficient to support trainees to competency by the completion of their fellowship programs. The impact of new training methods, such as simulation-based mastery learning, should be assessed to determine whether such methods can result in achievement of competence at a faster rate; ClinicalTrials.gov : NCT03115008.
Topics: Humans; Colonoscopy; Colonic Polyps; Microsurgery
PubMed: 37307537
DOI: 10.14309/ajg.0000000000002368