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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 -
Journal of Plastic, Reconstructive &... Feb 2021
Topics: Education, Medical, Graduate; Fellowships and Scholarships; Humans; Microsurgery; Scotland; Specialization; Surgery, Plastic
PubMed: 32855099
DOI: 10.1016/j.bjps.2020.08.029 -
Urology Jun 2022Testicular replantation represents a unique circumstance. There are very few reports documenting their experience with testicle replantation and to the best of the... (Review)
Review
Testicular replantation represents a unique circumstance. There are very few reports documenting their experience with testicle replantation and to the best of the authors' knowledge, this is the first case that has been reported in the peer-reviewed literature following a wrong site surgery. Therefore, we detail our technique and outcome when faced with such a rare event. In addition we review the literature, in order to compare and report the experience of others. This case highlights the value of applied microsurgical knowledge and the importance of cross-disciplinary efforts to improve patient outcomes.
Topics: Amputation, Traumatic; Humans; Male; Medical Errors; Microsurgery; Replantation; Testis
PubMed: 35114199
DOI: 10.1016/j.urology.2021.11.044 -
Radiographics : a Review Publication of... 2020Lymphedema, the accumulation of lymphatic fluid in the tissues, is a chronic disease and a major cause of long-term morbidity and disability. Lymphedema is usually a... (Review)
Review
Lymphedema, the accumulation of lymphatic fluid in the tissues, is a chronic disease and a major cause of long-term morbidity and disability. Lymphedema is usually a secondary condition, often caused by prior oncologic therapy, such as surgery for cancers, radiation therapy, and chemotherapy. Treatment for lymphedema has traditionally been conservative and limited, but new surgical and microsurgical procedures have arisen in recent years. Vascularized lymph node transfer (VLNT) is one of the most promising new microsurgeries. VLNT involves the transfer of functional lymph nodes (LNs) from a healthy donor site to an area of the body with damaged or diseased lymphatic drainage. The goal of the transplant is to restore physiologic LN drainage and improve lymphedema. Donor LNs are commonly found in the groin, axilla, neck, omentum, or submental region. Imaging can be used for preoperative planning to identify donor sites with the richest number of LNs. This can help identify those patients who may be candidates for VLNT and can help identify the best anatomic site for surgical harvest in those candidates. Imaging can be performed with US, CT, or MRI. VLNT preoperative imaging often requires acquisition techniques and reconstruction parameters that differ from those used in routine diagnostic imaging. Furthermore, to properly identify target LNs, the radiologist must be aware of surgical anatomic landmarks. RSNA, 2020.
Topics: Anatomic Landmarks; Humans; Lymph Nodes; Lymphedema; Microsurgery
PubMed: 32412827
DOI: 10.1148/rg.2020190118 -
Hand Surgery & Rehabilitation Apr 2023A neuroma-in-continuity is a neuroma resulting from a nerve injury in which internal neuronal elements are partially disrupted (with a variable degree of disruption to... (Review)
Review
A neuroma-in-continuity is a neuroma resulting from a nerve injury in which internal neuronal elements are partially disrupted (with a variable degree of disruption to the endoneurium and perineurium) while the epineurium typically remains intact. The portion of injured axons are misdirected and embedded in connective tissue, which may give rise to local neuroma pain and a distal nerve deficit. The lesion may result from a multitude of injury mechanisms, and clinical presentation is often variable depending on the nerve affected. Clinical, electrodiagnostic, and imaging examinations are helpful in assessing the extent and degree of the lesion. If no clear evidence of recovery is identified within 3-4 months post-injury, the patient may benefit from operative exploration. Surgical management options include neurolysis, neuroma resection, nerve grafting, and nerve transfer, or a combination of modalities. A primary consideration of surgery is the possibility of further downgrading nerve function in the pursuit of more, thereby highlighting the need to carefully weigh the advantages and disadvantages prior to surgical intervention. The objective of this review article is to describe the current understanding of the pathophysiology of neuroma-in-continuity lesions, and to review the approach to the affected patient including clinical evaluation, ancillary testing, and intraoperative assessment and treatment options.
Topics: Humans; Microsurgery; Nerve Transfer; Neuroma; Neurosurgical Procedures; Peripheral Nerves
PubMed: 36758942
DOI: 10.1016/j.hansur.2023.01.010 -
Journal of Reconstructive Microsurgery May 2024Microsurgery is essential in modern reconstructive surgery and plastic surgery training. Surgeon's proficiency and experience are crucial for effective microsurgical...
BACKGROUND
Microsurgery is essential in modern reconstructive surgery and plastic surgery training. Surgeon's proficiency and experience are crucial for effective microsurgical interventions. Despite anecdotal evidence of varying quality of microsurgery training globally, no empirical studies have investigated this. We conducted a global survey to investigate microsurgical training and clinical case exposure among plastic surgery trainees worldwide.
METHODS
An online survey was conducted using a secure platform to gather information on microsurgical case exposure and training among plastic surgery trainees between August 2020 and April 2021. Participants provided consent and completed a 37-question survey across four themes: clinical caseload, surgical exposure to microsurgery, microsurgical simulation training exposure, and barriers and opportunities.
RESULTS
A total of 202 responses were received, with most respondents in formal training programs (86.7%). The data highlighted regional variation in microsurgery case indications and flap types, with North America and Europe exhibiting the highest activity levels in microsurgery. Trainees in Asia have the highest cumulative practical exposure in microsurgery, followed by Australia and Oceania, and North America. Only 39.6% of respondents reported formal microsurgical simulation training, and almost one-third (29.7%) received no simulation training. Trainee access to practical experience is limited by several factors, including insufficient time and procedure complexity. Notably, practical experience was most commonly denied without reason being given.
CONCLUSION
Our study highlights significant disparities in microsurgical training and exposure among plastic surgery trainees globally. Further research is needed to identify strategies for addressing these issues, given the growing demand for complex reconstructive microsurgery and its impact on health care inequalities.
Topics: Humans; Microsurgery; Clinical Competence; Plastic Surgery Procedures; Surgery, Plastic; Surveys and Questionnaires
PubMed: 37643823
DOI: 10.1055/a-2161-8135 -
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 -
World Neurosurgery Apr 2021In microneurosurgery, the operating microscope plays a vital role. The classical neurosurgical operation is bimanual, that is, the microsurgical instruments are operated...
BACKGROUND
In microneurosurgery, the operating microscope plays a vital role. The classical neurosurgical operation is bimanual, that is, the microsurgical instruments are operated with both hands. Often, operations have to be carried out in narrow corridors at the depth of several centimeters. With current technology, the operator must manually adjust the field of view during surgery-which poses a disruption in the operating flow. Until now, technical adjuncts existed in the form of a mouthpiece to move the stereo camera unit or voice commands and foot pedals to control other interaction tasks like optical configuration. However, these have not been widely adopted due to usability issues. This study tests 2 novel hands-free interaction concepts based on head positioning and gaze tracking as an attempt to reduce the disruption during microneurosurgery and increase the efficiency of the user.
METHODS
Technical equipment included the Pentero 900 microscope (Carl Zeiss Microscopy GmbH, Jena, Germany), HTC Vive Pro (HTC, Taoyuan District (HQ), Taiwan), and an inbuilt 3D-printed target probe. Eleven neurosurgeons including 7 residents and 4 consultants participated in the study. The tasks created for this study were with the intention to mimic real microneurosurgical tasks to maintain applicative accuracy while testing the interaction concepts. The tasks involved visualization system adjustment to the specific target and touching the target. The first trial was conducted in a virtual reality setting applying the novel hands-free interaction concepts, and the second trial was conducted performing the same tasks on a 3D-printed target probe using manual field of view adjustment. The participants completed both trials with the same predetermined tasks, in order to validate the feasibility of the novel technology. The data collected for this study were obtained with the help of review protocols, detailed post-trial interviews, video and audio recordings, along with time measurements while performing the tasks.
RESULTS
The user study conducted at the Charité Hospital in Berlin found that the gaze-tracking and head-positioning- based microscope adjustment were 18% and 29% faster, respectively, than the classical bimanual adjustment of the microscope. Focused user interviews showed the users' proclivity for the new interaction concepts, as they offered minimal disruption between the simultaneous target selection and camera position adjustment.
CONCLUSIONS
The hands-free interaction concepts presented in this study demonstrated a more efficient execution of the microneurosurgical tasks than the classical manual microscope and were assessed to be more preferable by both residents and consultant neurosurgeons.
Topics: Clinical Competence; Eye-Tracking Technology; Humans; Microsurgery; Neurosurgeons; Neurosurgical Procedures; User-Computer Interface; Virtual Reality
PubMed: 33385607
DOI: 10.1016/j.wneu.2020.12.092 -
Journal of Clinical Neuroscience :... Aug 2021Performing a successful microsurgical vascular anastomosis (MVA) is challenging and requires lots of practice. However, the most efficient practice protocol is yet to be... (Randomized Controlled Trial)
Randomized Controlled Trial
Performing a successful microsurgical vascular anastomosis (MVA) is challenging and requires lots of practice. However, the most efficient practice protocol is yet to be found. We aimed to compare and analyze two major practice patterns for fine motor tasks as applied to learning MVA: distributed and mass practice protocols. Ten neurosurgeons with comparable experience in microsurgery (but no experience in vascular anastomosis) were randomized to practice MVA either using a distributed (1 session/day) or a mass practice (6 sessions/day) protocol. A total of 24 sessions of practice and 2 recall test sessions were given. Anastomosis score, time to complete a single stitch and the total time to complete an anastomosis were recorded. Mass practice protocol caused a clear fatigue effect observed toward the end of each mass practice trial block. Statistical comparison using one-way analysis of variance showed significantly higher anastomosis scores and shorter times to place a single stitch as well as to complete the anastomosis in distributed practice group for the last 3 acquisition practice trials, and the 2 recall tests (p < 0.05). The relative advantage of the distributed practice protocol could be attributed to forgetting/spacing effect. Although mass practice protocol resulted in worse performance, it still showed a gradual improvement trend in performance from beginning to the end. Therefore, certain adjustments to a mass practice protocol (such as increasing the number of practice blocks) could potentially lead to an eventual performance level comparable to a distributed protocol. This point is a subject of further investigation.
Topics: Anastomosis, Surgical; Clinical Competence; Humans; Learning; Microsurgery; Neurosurgeons; Simulation Training
PubMed: 34275552
DOI: 10.1016/j.jocn.2021.06.001 -
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