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Microsurgery Nov 2018
Topics: Adult; Breast Neoplasms; Cohort Studies; Female; Forecasting; Health Plan Implementation; Humans; Mammaplasty; Mastectomy; Mexico; Microsurgery; Middle Aged; Program Development; Program Evaluation; Retrospective Studies
PubMed: 30462855
DOI: 10.1002/micr.30383 -
International Journal of Surgery... Feb 2022Microsurgical anastomosis is technically difficult especially for less-experienced surgeons. Traditionally, surgeons in training could only accomplish these surgeries...
BACKGROUND
Microsurgical anastomosis is technically difficult especially for less-experienced surgeons. Traditionally, surgeons in training could only accomplish these surgeries under intensive guiding and supervision from senior surgeons. This study presents and characterises a new method for microsurgical trainees to objectively evaluating the quality of vascular anastomosis intraoperatively.
MATERIALS AND METHODS
We conducted a prospective study to determine the utility of patency test of vascular anastomosis with assistance of high-speed video recording (PTHVR) to evaluate the quality of vascular anastomosis during microsurgery. To determine whether the use of PTHVR outperformed traditional supervision from senior surgeons (historical control), we compared the outcomes of microsurgeries including free flap transfer and replantation between the two groups.
RESULTS
A total of 211 patients were enrolled, of which 98 underwent surgery under traditional supervision and 113 underwent surgery with PTHVR. Of the 211 patients, 102 underwent digit replantation (48%), 22 underwent limb replantation (10%), and 87 underwent free flap transfer (42%). There was no statistical difference between the two groups in age, gender, BMI, pre-existing comorbidities, smoking status, alcohol consumption, and duration of surgery. Use of PTHVR as an intraoperative guide significantly decreased the rate of re-exploration surgeries (PTHVR, 8.0% [9/113]; control, 23.5% [23/98]; P = 0.002) and replantation/free flap failures (PTHVR, 8.8% [10/113]; control, 19.4% [19/98]; P = 0.029) compared with historical control under traditional supervision.
CONCLUSIONS
PTHVR is a useful tool for improving the success rate of microsurgery for less-experienced surgeons when compared with traditional supervision mode.
Topics: Anastomosis, Surgical; Humans; Microsurgery; Prospective Studies; Replantation; Video Recording
PubMed: 34995808
DOI: 10.1016/j.ijsu.2021.106214 -
Medicine Aug 2017This study aimed to systemically evaluate the efficacy and safety of laparoscopy versus microsurgery in the surgical therapy of varicocele in male adults. (Meta-Analysis)
Meta-Analysis
OBJECTIVES
This study aimed to systemically evaluate the efficacy and safety of laparoscopy versus microsurgery in the surgical therapy of varicocele in male adults.
METHODS
Relevant literature, published between January 1995 and October 2012, were searched in Pubmed/Medline database, OVID, EMBASE, Chinese Biology Medicine disc (CBMdisc), CNKI, CEBM\CCD, and Cochrane database. The newly published papers were also manually searched. Randomized controlled trials (RCT) related to the surgical interventions of varicocele were included, and full texts were obtained. Each study was evaluated with the Cochrane Risk of Bias tool. Two investigators collected data independently to produce the meta-analysis.
RESULTS
Five RCTs met the inclusion criteria and included 554 patients. Data were merged by the RevMan5.1 software. The sperm concentration increased significantly after surgery (WMD = 4.28; 95% CI = 4.16, 6.99; P < .00001, Z = 7.72). There was no significant difference in the postoperative hospital stay between laparoscopy and microsurgery (WMD = 0.24, 95% CI = 0.44, 0.93; P = .49, Z = 0.69). The operation time of laparoscopy was significantly shorter than that of microsurgery (WMD = 40.31, 95% CI = 37.77, 42.86; P < .00001, Z = 31.03). The incidence of hydrocele reduced significantly after microsurgery as compared to laparoscopy (WMD = 0.05, 95% CI = 0.01, 0.27; P = .0005, Z = 3.49). The postoperative recurrence rate after microsurgery was significantly lower than that after laparoscopy (WMD = 0.10, 95% CI = 0.04, 0.25; P < .00001, Z = 5.01).
CONCLUSION
No significant differences were found between microsurgery and laparoscopy for the increase of sperm concentration and operation time. Compared to the laparoscopy group, the microsurgery group had lower postoperative incidence of hydrocele and recurrence rate, but longer in the operation time.
Topics: Adult; Humans; Laparoscopy; Length of Stay; Male; Microsurgery; Operative Time; Postoperative Complications; Randomized Controlled Trials as Topic; Recurrence; Varicocele
PubMed: 28834886
DOI: 10.1097/MD.0000000000007818 -
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 -
Neurology India 2019Aneurysms arising from the proximal segment (A1) of the anterior cerebral artery (ACA) are relatively rare. Because of their small size, abnormal location in relation to...
BACKGROUND
Aneurysms arising from the proximal segment (A1) of the anterior cerebral artery (ACA) are relatively rare. Because of their small size, abnormal location in relation to the parent artery and the risk of damage to the surrounding perforators, their surgical management is a big challenge. We present our experience with 7 patients of A1 segment aneurysms.
SETTINGS AND DESIGN
Tertiary care referral center.
MATERIALS AND METHODS
Seven patients who were diagnosed with A1 aneurysms between 2009 and 2017 were included. Preoperative evaluation included Non-Contrast Computed Tomography (NCCT) head and angiography (Digital Subtraction Angiography with/without CT-Angiography). The clinicoradiological condition of the patients was graded as per World Federation of Neurological Surgeons (WFNS), Fisher and Hunt and Hess (H and H) Grading systems. A retrospective review of clinical features, radiological descriptions, surgical treatment, and outcomes was done.
RESULTS
All patients underwent microneurosurgical clipping. All aneurysms were saccular, ranging in size from 4 to 14 mm and neck size varied from 2 to10 mm. Most aneurysms 5 (71.4%) had a posterior direction. Anatomical variations were noticed in 3 (42.8%) patients. Posteroinferiorly directed aneurysms were difficult to clip. As per Glasgow Outcome scale (GOS), 6 (85.7%) patients had a good outcome, whereas 1 (14.2%) had poor outcome. As per the modified Rankin Scale (mRS) too, 6 (85.7%) had a favorable outcome. There were no deaths.
CONCLUSION
A1 aneurysms are frequently associated with vascular anomalies and generally rupture when small. A1 aneurysms with a superior and anterior direction are relatively easy to clip whereas those directed postero-inferiorly are difficult. Close association with critical perforators also compounds the situation. Due to the rarity of A1 aneurysms, large series are few in literature.
Topics: Adult; Aged; Aneurysm, Ruptured; Anterior Cerebral Artery; Female; Humans; Intracranial Aneurysm; Male; Microsurgery; Middle Aged; Neurosurgical Procedures; Surgical Instruments; Treatment Outcome
PubMed: 31744954
DOI: 10.4103/0028-3886.271266 -
Journal of Cancer Research and... Oct 2015To evaluate the efficacy and oncologic outcomes of transoral laser microsurgery (TLM) for recurrent laryngeal carcinoma after previous treatment. (Meta-Analysis)
Meta-Analysis Review
PURPOSE
To evaluate the efficacy and oncologic outcomes of transoral laser microsurgery (TLM) for recurrent laryngeal carcinoma after previous treatment.
MATERIALS AND METHODS
A systematic search in PubMed was performed using mesh word for "laryngeal cancer," crossed with "recurrent," and "TLM." The primary endpoints, including overall survival (OS) rate, local control rate, and disease-specific survival (DSS) were summarized using RevMan software. Adverse events and complications were recorded if reported.
RESULTS
The pooled odds ratios (ORs) for main outcomes, including local control, 5-year OS, and DSS were 3.08 (95% confidential indexed [95% CI], 1.88-5.05), 2.29 (95% CI, 1.42-3.67), and 5.05 (95% CI, 2.75-9.27), respectively. The pooled OR for functional outcome, larynx preservation, was 3.82 (95% CI, 2.46-5.94), whereas the pooled risk difference of local recurrence was 45% (95% CI, 26-64%).
CONCLUSIONS
It seems that TLM is an effective option for recurrent laryngeal cancer with regard to the high incidence of OS, local control, and especially organ preservation. However, more prospective studies are needed to confirm its efficiency.
Topics: Humans; Laryngeal Neoplasms; Microsurgery; Neoplasm Recurrence, Local; Odds Ratio; Postoperative Complications; Retreatment; Treatment Outcome
PubMed: 26506871
DOI: 10.4103/0973-1482.168180 -
British Medical Journal (Clinical... Jan 1987
Topics: Adult; Fallopian Tubes; Female; Humans; Microsurgery; Sterilization Reversal
PubMed: 3109540
DOI: 10.1136/bmj.294.6565.140 -
Hand (New York, N.Y.) Nov 2017Microsurgery is a specialized surgical technique with wide clinical application. The purpose of this study was to analyze case logs of graduating orthopedic surgery...
BACKGROUND
Microsurgery is a specialized surgical technique with wide clinical application. The purpose of this study was to analyze case logs of graduating orthopedic surgery residents to assess trends in case volume for microsurgery procedures.
METHODS
Accreditation Council for Graduate Medical Education case log reports were analyzed for microsurgery experience from 2007 to 2013. The mean number of adult, pediatric, and total microsurgery cases was noted. In addition, the median number of microsurgery procedures performed by the 90th, 50th, and 10th percentiles of residents (by case volume) was recorded. Temporal changes in case volume were calculated utilizing linear regression analyses.
RESULTS
The proportion of microsurgery procedures increased significantly (1.3% to 2%; P = .024). The mean number of adult (24.5 to 41.9; P = .01), pediatric (1.9 to 3.4; P = .011), and total (26.3 to 45.3; P = .01) microsurgery procedures also increased significantly. Similarly, residents in both the 90th (63 to 109; P = .01) and 50th (10 to 21; P = .036) percentiles sustained significant increases in the median number of microsurgery procedures. No change was noted for residents in 10th percentile (0 to 0; P > .999). Graduating residents in the 90th percentile performed over 6 times more microsurgery procedures than residents in the 50th percentile.
CONCLUSIONS
Microsurgical caseload is increasing among graduating orthopedic residents. However, there is substantial variability in resident microsurgery case volume. Future investigations are needed to explore the educational implications of these findings and should seek to correlate microsurgical caseload with competency.
Topics: Education, Medical, Graduate; Humans; Internship and Residency; Linear Models; Microsurgery; Orthopedics; United States
PubMed: 29091488
DOI: 10.1177/1558944716675128 -
Journal of Visualized Experiments : JoVE Jul 2011Mouse bladder wall injection is a useful technique to orthotopically study bladder phenomena, including stem cell, smooth muscle, and cancer biology. Before starting...
Mouse bladder wall injection is a useful technique to orthotopically study bladder phenomena, including stem cell, smooth muscle, and cancer biology. Before starting injections, the surgical area must be cleaned with soap and water and antiseptic solution. Surgical equipment must be sterilized before use and between each animal. Each mouse is placed under inhaled isoflurane anesthesia (2-5% for induction, 1-3% for maintenance) and its bladder exposed by making a midline abdominal incision with scissors. If the bladder is full, it is partially decompressed by gentle squeezing between two fingers. The cell suspension of interest is intramurally injected into the wall of the bladder dome using a 29 or 30 gauge needle and 1 cc or smaller syringe. The wound is then closed using wound clips and the mouse allowed to recover on a warming pad. Bladder wall injection is a delicate microsurgical technique that can be mastered with practice.
Topics: Animals; Injections; Mice; Microsurgery; Urinary Bladder
PubMed: 21775962
DOI: 10.3791/2523 -
Lasers in Medical Science Jan 2011Transoral laser microsurgery (TLM) is an emerging technique for the management of laryngeal and other head and neck malignancies. It is increasingly being used in place... (Review)
Review
Transoral laser microsurgery (TLM) is an emerging technique for the management of laryngeal and other head and neck malignancies. It is increasingly being used in place of traditional open surgery because of lower morbidity and improved organ preservation. Since the surgery is performed from the inside working outward as opposed to working from the outside in, there is less damage to the supporting structures that lie external to the tumor. Coupling the laser to a micromanipulator and a microscope allows precise tissue cutting and hemostasis; thereby improving visualization and precise ablation. The basic approach and principles of performing TLM, the devices currently in use, and the associated dosimetry parameters will be discussed. The benefits of using TLM over conventional surgery, common complications and the different settings used depending on the location of the tumor will also be discussed. Although the CO(2) laser is the most versatile and the best-suited laser for TLM applications, a variety of lasers and different parameters are used in the treatment of laryngeal cancer. Improved instrumentation has lead to an increased utilization of TLM by head and neck cancer surgeons and has resulted in improved outcomes. Laser energy levels and spot size are adjusted to vary the precision of cutting and amount of hemostasis obtained.
Topics: Head and Neck Neoplasms; Humans; Laryngeal Neoplasms; Laryngectomy; Laryngoscopes; Laryngoscopy; Laser Therapy; Lasers, Gas; Microsurgery; Neoplasm Staging; Photochemotherapy
PubMed: 20835840
DOI: 10.1007/s10103-010-0834-5