Correlation between forceps grasp count and skill proficiency in single-incision laparoscopic percutaneous extraperitoneal closure: A retrospective single-center study.

INTRODUCTION: This study aimed to investigate the correlation between forceps grasp count and procedure time in single-incision laparoscopic percutaneous extraperitoneal closure surgeries and the evolution of these metrics with accumulated experience. METHODS: We retrospectively reviewed 741 procedures performed by surgeons between 2015 and 2023. Surgical videos were analyzed to calculate the procedure time, defined as the time required for suturing around the hernial orifice, and the forceps grasp count. Correlations were evaluated using Spearman's rank correlation coefficients. Changes in experience were assessed using linear regression. RESULTS: Surgeons demonstrated a significantly longer procedure time (585 s vs. 437 s, p < .001) and higher grasp counts (22 times vs. 17 times, p < .001) for surgeries performed on male patients than on female patients. Grasp count was strongly correlated with procedure time (male patients: r = .800; female patients: r = .758, p < .001). With accumulated experience, both procedure time and grasp count decreased, although novice surgeons showed delayed improvement in forceps manipulation compared with improvement in procedure time. CONCLUSION: Grasp count was strongly correlated with procedure time in single-incision laparoscopic percutaneous extraperitoneal closure. Accumulated experience improved both metrics, with novice surgeons possibly requiring more time to acquire efficient forceps manipulation skills. Efficient forceps manipulation is a valuable metric for evaluating surgical skills.

Comparison of three different methods for stump closure in laparoscopic appendectomy: Endoloop, Hem-o-lok clip, and endostapler.

BACKGROUND: Acute appendicitis is a common surgical emergency that causes acute abdominal pain and affects approximately 7-8% of the population during their lifetime. The closure of the appendix stump during laparoscopic appendectomy is one of the most critical steps of the surgery to prevent life-threatening complications such as postoperative fistula, peritonitis, and sepsis. The mate-rial chosen for appendix stump closure must be effective, safe, and economical. However, there is still no consensus on the optimal method for stump closure. In this study, we aimed to compare the advantages and reliability of three different methods used for appendix stump closure. METHODS: At Istanbul University-Cerrahpasa, Cerrahpasa Medical Faculty, Department of General Surgery, cases that underwent laparoscopic appendectomy for acute appendicitis between January 2022 and April 2024 were retrospectively analyzed using the hospital's data system. The patients' demographic data, laboratory values, pathology reports, surgical notes, duration of hospital stay, duration of surgery, total hospital costs, complications related to the surgery within 30 days postoperatively, and the management of these complications were examined. RESULTS: The study included a total of 150 individuals, with 83 (55.33%) males and 67 (44.67%) females. The average age of the participants was 38.45±14.48 years. In terms of the materials used for stump closure, endoloop was used in 82 (54.67%) cases, Hem-o-lok clip in 30 (20.00%) cases, and endostapler in 38 (25.33%) cases. In 144 (96%) cases, no Clavien-Dindo (CD) complications were observed, while complications occurred in six (4%) cases. These six complications included two intra-abdominal abscesses (CD Grade 3), two wound infections (CD Grade 1), one case of bleeding (CD Grade 2), and one pulmonary embolism (CD Grade 4). CONCLUSION: The use of endoloop, polymeric clips, and endostapler in laparoscopic appendectomy is safe and effective for appendectomy. All three methods can be successfully applied without an increase in intraoperative or postoperative complications. However, due to the higher treatment costs associated with endostapler, its use should be reserved for situations where securing the appendix stump cannot be achieved with endoloop or Hem-o-lok clip.

Factors regulating the gripping force and stiffness of 25- and 27-gauge internal limiting membrane forceps.

This study aimed to identify the factors affecting the gripping force and stiffness of 25-gauge and 27-gauge (25G and 27G, respectively) internal limiting membrane (ILM) forceps and to compare the effect of these factors on various ILM forceps manufactured by different companies. This study evaluated 25G and 27G ILM forceps with two different types of tip shapes, Eckardt and Maxgrip, manufactured by Alcon (A), DORC (B), VitreQ (C), and Katalyst (D). The gripping force was defined as the force required to move the ILM forceps away from a thin paper by pulling the paper. Shaft stiffness was determined by measuring the shaft displacement under a known force. Multiple regression analysis revealed that the gripping force showed significant correlations with the gauge (P<0.001), type of shaft tip (Eckardt/Maxgrip) (P<0.001), and contact area of the tip (P<0.001). The shaft stiffness showed significant correlations with the gauge (P<0.001), length of the base (P<0.001), thickness of the metal of the shaft (P = 0.05), and lumen area of the shaft (P = 0.01). The gripping force and shaft stiffness differed for each product. Thus, vitreoretinal surgeons must select the appropriate type of ILM forceps based on their characteristics.

Closed-chest robotic mitral repair using a semi-rigid ring inserted through a trocar.

There are several types of annuloplasty devices for mitral repair. We present a totally-thoracoscopic robotic mitral repair using a new semi-rigid ring with a nitinol core that makes it malleable so that it can be inserted through a trocar. This technique combines the advantages of semi-rigid rings and a totally-thoracoscopic approach, which may further expand this approach to other aetiologies.

Efficacy and Safety of Single Clip Traction Assisted Endoscopic Submucosal Dissection for Colonic Neoplasms: A Propensity Score Matching Analysis.

AIM: Endoscopic submucosal dissection (ESD) for colonic neoplasms is a technically intricate procedure. Internal traction using a single clip has emerged as a promising supportive technique for colonic ESD. Therefore, this study aimed to comprehensively evaluate and compare the efficacy and safety of ESD with and without the aid of single-clip traction. METHODS: This retrospective study encompassed 36 patients who underwent single clip traction-assisted colonic ESD and 66 who underwent the traditional method of colonic ESD at Nanjing Drum Tower Hospital Clinical College of Nanjing Medical University. We employed the propensity score-matching method to mitigate disparities in resected specimen size and tumor location. Post-matching, we comprehensively assessed treatment outcomes and incidence of adverse events between the two treatment groups (single clip traction-assisted ESD (scESD) and conventional ESD (cESD)). RESULTS: After propensity score matching, we observed 34 matched pairs. There were no significant differences between the two treatment groups regarding the en bloc resection rate, complete resection rate, and curative rate. However, the procedure duration was significantly shorter in the single clip traction-assisted ESD group compared to the conventional ESD group (20.00 [Interquatile Range (IQR)] (16.00-32.50) minutes vs 31.50 [IQR] (17.00-54.00) minutes, p = 0.0474). Furthermore, there was a significant increase in dissection speed in the single clip traction-assisted ESD group compared to the conventional ESD group (0.29 [IQR] (0.20-0.45) mm2/min vs 0.19 [IQR] (0.11-0.35) mm2/min, p = 0.0015). All lesions were resected in a single piece. Among the propensity-score-matched patients, only those treated with single clip traction-assisted ESD exhibited faster dissection speeds (p = 0.015). Furthermore, there were no substantial differences in adverse events such as intraoperative perforation, delayed perforation, or delayed bleeding. CONCLUSIONS: Our findings suggest that single clip traction-assisted colonic ESD is preferable to traditional colonic ESD, owing to its shorter procedure duration and faster dissection speed.

Role of clipping in aneurysmal subarachnoid hemorrhage: a post hoc analysis of the Earlydrain trial.

The choice between clipping and coiling of ruptured cerebral aneurysms in subarachnoid hemorrhage (SAH) remains controversial. The recently published Earlydrain trial provides the opportunity to analyze the latest clip-to-coil ratio in German-speaking countries and to evaluate vasospasm incidence and explorative outcome measures in both treatment modalities. We performed a post hoc analysis of the Earlydrain trial, a multicenter randomized controlled trial investigating the use of an additional lumbar drain in aneurysmal SAH. The decision whether to clip or to coil the ruptured aneurysm was left to the discretion of the participating centers, providing a real-world insight into current aneurysm treatment strategies. Earlydrain was performed in 19 centers in Germany, Switzerland, and Canada, recruiting 287 patients with aneurysmal SAH of all severity grades. Of these, 140 patients (49%) received clipping and 147 patients (51%) coiling. Age and clinical severity based on Hunt-Hess/WFNS grades and radiological criteria were similar. Clipping was more frequently used for anterior circulation aneurysms (55%), whereas posterior circulation aneurysms were mostly coiled (86%, p < 0.001). In high-volume recruiting centers, 56% of patients were treated with clipping, compared to 38% in other centers. A per-year analysis showed a stable and balanced clipping/coiling ratio over time. Regarding vasospasm, 60% of clipped versus 43% of coiled patients showed elevated transcranial Doppler criteria (p = 0.007), reflected in angiographic vasospasm rates (51% vs. 38%, p = 0.03). In contrast to the Earlydrain main results establishing the superiority of an additional lumbar drain, explorative outcomes after clipping and coiling measured by secondary infarctions, mortality, modified Rankin Score, Glasgow Outcome Scale Extended, or Barthel-Index showed no significant differences after discharge and at six months. In clinical practice, aneurysm clipping is still a frequently used method in aneurysmal SAH. Apart from a higher rate of vasospasm in the clipping group, an exploratory outcome analysis showed no difference between the two treatment methods. Further development of periprocedural treatment modalities for clipped ruptured aneurysms to reduce vasospasm is warranted.

Keyhole Alternatives to Pterional Craniotomy for the Microsurgical Clipping of Anterior Circulation Aneurysms: Technical Pearls, Surgical Results, and a Case Selection Algorithm.

BACKGROUND: Despite a recent surge in keyhole approaches to aneurysm clipping, only few studies have compared these approaches, and none have laid any foundation or roadmap for surgeons newly venturing into these procedures. OBJECTIVES: To report a single surgeon's experience of multiple keyhole approaches to these aneurysms, and to highlight the case selection algorithm, technical nuances, and surgical results. MATERIAL AND METHODS: Twenty-four patients (25 aneurysms) underwent aneurysm clipping using either a mini-pterional approach (MPA), lateral supraorbital approach (LSO), or a supraorbital keyhole approach (SOKHA). Intraoperative premature rupture, adequacy of clipping, and immediate postoperative and long-term functional outcomes were recorded. RESULTS: All but five patients presented with ruptured aneurysms (Hunt and Hess grade 1 in 12 patients, grade 2 in 5 patients, and grade 3 in 2 patients). The anterior communicating artery (A-Comm; n = 14, 56%) was most frequently involved with aneurysms. The MPA was most frequently employed (n = 11, 45.8%), followed by the LSO (n = 9, 37.5%) and the SOKHA (n = 4, 16.7%). An intraoperative rupture (total n = 5, 20.8%) was most frequently seen in the SOKHA group (50%) and the only case of inadequate aneurysm clipping resulted from inadequate clipping ergonomics during the SOKHA for A-Comm aneurysm. Major complications occurred in the supraorbital approaches (one each in the LSO and SOKHA). Irrespective of the approach used, the long-term outcomes were excellent. CONCLUSION: In properly selected patients, keyhole approaches-particularly the MPA and the LSO-can provide excellent surgical outcomes. The learning curve in the SOKHA is steeper. A pragmatic case selection algorithm is proposed.

Fenestrated clipping of previously coiled posterior-superiorly projecting anterior communicating artery aneurysms: How I do it.

BACKGROUND: Anterior communicating artery (ACOM) aneurysms are among the most common aneurysms associated with aneurysmal subarachnoid hemorrhage (International Study of Unruptured Intracranial Aneurysms I (N Engl J Med 339:1725-1733, 1998), Wiebers (Lancet 362:103-110, 2003)). Surgical clipping of posterior-superiorly projecting ACOM aneurysms can be challenging, as the ipsilateral A2 can interfere with clip trajectory and ACOM perforating vessels obstructed from view. Intraluminal coils can further increase the difficulty of the procedure. METHOD: The relevant surgical anatomy with illustration is presented. A video detailing our technique on an illustrative case is provided. CONCLUSION: Surgical clipping of posterior-superiorly projecting ACOM aneurysms can require complex clip configurations. We describe the key steps of posterior-superiorly projecting ACOM aneurysm clipping through a lateral supraorbital craniotomy and fenestrated tandem clipping.

Practical, cost-effective removal of Hem-o-lok Weck clip: a novel technique.

The Hem-o-lok Weck clip is part of a polymer locking ligation system often employed for hemostasis in surgical practices. Its use is routine in a wide array of surgical subspecialties. Surgeons have limited options in removing these clips when they are aberrantly positioned. Herein, we describe a novel, cost-effective approach for removing a Hem-o-lok clip using standard robotic instruments. This simple approach will allow surgeons to remove a Hem-o-lok clip precisely and quickly if it is not adequately placed. During a routine robotic-assisted laparoscopic prostatectomy a Hem-o-lok Weck clip was noted to be in juxtaposition to the rectal wall, and it was deemed appropriate to remove it. Ultimately, the indwelling Prograsp forceps was moved from the right fourth arm position to the left arm position. This allowed the Prograsp forceps to compress the scissors in the right hand port, which was insufficient in cutting the hinge of the clip. This provided sufficient force to cut through the clip at its hinge with ease. The Hem-o-lok Weck clip is used in various surgical specialties. It is occasionally placed suboptimally and requires removal. Given the challenge of finding and using the clip removal device, surgeons should be aware of this simple and cost-effective way of removing a Hem-o-lok clip if desired.

[The instrument technician, responsible for the smooth running of the procedure and safety in the operating field]. / L'instrumentiste, garant du bon déroulement de l'intervention et de la sécurité sur le champ opératoire.

As a specialized nurse working as part of an operating room team, the ORN is at the heart of patient care: when the patient is admitted to the operating room, during the operation and postoperatively, in the recovery room. He or she plays a variety of roles within the team, and more specifically, works alongside the surgeon as an instrumentalist, one of the three roles of an operating room nurse.

Comparison of Early Postoperative Outcomes of Omentopexy and Clips along the Staple Line During Laparoscopic Sleeve Gastrectomy: A Randomized Study.

BACKGROUND: We aimed to compare the omentopexy and clipping reinforcement methods performed along the staple line during laparoscopic sleeve gastrectomy (LSG) in terms of the effectiveness on postoperative bleeding. METHODS: In this prospective randomized controlled study, patients were divided into two groups: clips group (CG) and omentopexy group (OG). The groups were compared in terms of postoperative bleeding, duration of surgery, length of hospital stay, hospital readmissions in the postoperative first 30-days. RESULTS: A total of 148 patients were included in the study. Postoperative bleeding was observed in 11 patients (14.9%) of CG and 2 patients (2.7%) of the OG, and the difference between the groups was found to be significant (p = 0.009). Similarly, the number of patients with bleeding that did not require intervention was 9 (12.2%) in CG and 2 (2.7%) in OG, and the difference between the groups was also significant (p = 0.028). The duration of surgery in the CG was 30 (27 to 36) minutes, whereas in the OG, it was 43 (39 to 45) minutes, with a significant difference noted (p < 0.001). Additionally, the rate of patients readmitted to the hospital within the first 30 days was 16 (21.6%) in the CG and 7 (9.5%) in the OG, with a significant difference observed (p = 0.041). CONCLUSION: In terms of bleeding requiring intervention, there was no difference between omentopexy and clipping techniques. In addition, omentopexy showed more satisfactory results than clipping in terms of non-interventional bleeding, but its clinical significance is unclear.

[Emphasizing the innovation of urological robotic-assisted surgical instruments and technology driven by new quality productivity forces].

New quality productivity force is an advanced form of productive force that is innovation-driven, characterized by high technology, high efficiency, and high quality. It aligns with the new development philosophy and represents an advanced state of productivity. Within the medical sphere, this concept is epitomized by the progressive evolution of surgical instruments and techniques. In recent years, the rapid development of new quality productivity forces in the medical field has generated significant anticipation for innovations in urological robotic surgery instruments and techniques. Advancements in domestically produced robotic surgery systems, remote robotic surgery, single-port robotic surgery, and pediatric-specific robotic surgery exemplify the critical application of new quality productivity forces in urology. The integration of artificial intelligence, haptic feedback technology, and sensory enhancement technologies has further enhanced the safety and precision of surgeries. Driven by these new quality productivity forces, the development of urological robotic surgery instruments and techniques has reached a new milestone, potentially setting a new gold standard for urological surgeries and providing patients with safer, more efficient, and personalized medical care. However, certain emerging technologies still face challenges in their application, necessitating further research and clinical validation.

[The application effect of a new type of laparoscopic multi-freedom surgical instrument in the training of basic surgical skills].

Objective: To evaluate the application effect of a new type of laparoscopic multi-degree-of-freedom surgical instrument in the training of basic surgical skills and analyze the learning curve. Methods: The teaching records of the trainees who received training in the training base of laparoscopic surgeons in Chinese People's Liberation Army General Hospital from January to October, 2023 were collected. The 50 trainees were randomly divided into conventional instrumentation group and new instrumentation group with 25 trainees in each group according to the random number table method before the training. According to the research design, five modules such as "accurate bean clamping, plum blossom pile bean clamping, ferrule positioning, threading with both hands, sewing and knotting" were trained. After the training, they were assessed and the completion time of each module was recorded. The comparison of the changes of the completion time of the two groups of students before and after training was statistically analyzed by differences-in-differences(DID) method, and the fitting analysis of learning curve was analyzed by cumulative summation method. Results: Before the training, there was no statistically significant difference in the time required to complete five modules between the two groups of trainees (all P>0.05). After the training, the time to complete the five modules in both groups was reduced compared to before the training (accurate bean clamping: (63.7±9.3) seconds vs. (85.4±18.2) seconds, t=2.38, P=0.035; plum blossom pile bean clamping: (45.2±6.8) seconds vs. (103.1±57.2) seconds, t=8.77, P=0.047; ring positioning: (78.5±19.1) seconds vs. (126.2±26.3) seconds, t=6.96, P=0.019; threading with both hands: (63.3±21.2) seconds vs. (105.8±27.9) seconds, t=3.43, P=0.015; sewing and knotting: (160.2±79.5) seconds vs. (228.9±96.6) seconds, t=4.58, P=0.008).The average time required to complete the five modules was shorter in the new instrument group compared to the conventional instrument group (DID for accurate bean clamping=37.66, t=2.43, P=0.007; DID for plum blossom pile bean clamping=58.42, t=3.03, P=0.013; DID for ferrule positioning=28.33, t=2.83, P=0.031; DID for threading with both hands=48.89, t=2.10, P=0.042; DID for sewing and knotting=54.78, t=3.57, P=0.012). In the learning curves for the plum blossom pile bean clamping, ferrule positioning, and sewing and knotting modules, the new instrument group required fewer class hours to reach proficiency compared to the conventional instrument group (plum blossom pile bean clamping: 3 class hours vs. 4 class hours; ferrule positioning: 4 class hours vs. 5 class hours; sewing and knotting: 3 class hours vs. 5 class hours). In the accurate bean clamping and threading with both hands modules, both the conventional and new instrument groups crossed the learning curve at the 5th class hour, but there was a statistically significant difference in the slopes of the curves between the two groups (accurate bean clamping: t=-2.85,P=0.004; threading with both hands:t=-2.66,P=0.008). Conclusion: The new type of laparoscopic multi-degree-of-freedom surgical instruments can improve the learning effect and shorten the learning curve in laparoscopic training teaching, which shows good application effect and has the possibility of clinical trial.

How I do it-Dolenc approach for clipping of ventral wall paraclinoid ICA aneurysm.

BACKGROUND: Ventral wall ICA aneurysms are a type of Paraclinoid aneurysms which arise from ventral surface of ICA opposite to the origin of the ophthalmic artery. These are technically challenging owing to its close proximity to the anterior clinoid process, difficulty in getting proximal control, difficulty in preserving ophthalmic artery and maintaining the patency of ICA. METHOD: A 38 year old patient with a Ventral wall ICA aneurysm by Dolenc approach. CONCLUSION: Tailored dural peeling and extradural anterior clinoidectomy exposes proximal part of Paraclinoid ICA allowing better proximal control and a wider exposure, which is crucial for clipping these aneurysms.

An open comparative randomized prospective study: Direct trocar insertion vs Veress needle technique in laparoscopic surgeries.

Laparoscopy is a minimally invasive technique utilized for both diagnostic and surgical approaches. Minimally invasive procedures compared to laparotomy offer the advantages of reduced hospital stay, lower morbidity, decreased pain, and faster recovery. Common methods for laparoscopic entry include Veress needle insertion (VNI), direct optical trocar entry, direct trocar insertion (DTI), and the Hasson technique. This study aims to compare the efficacy and safety of VNI and DTI in laparoscopic gynecological surgeries. An open comparative randomized prospective study was conducted involving 200 women aged 18 to 70 years, scheduled for laparoscopic surgery at 2 tertiary centers. Participants were randomized into 2 groups: 1 using VNI and other using DTI. The groups were homogeneous regarding age, parity, and body mass index. The mean age of the VNI group is 45.22 ±â€…11.65 and the DTI group is 44.89 ±â€…10.5 (P = .833). There were no statistical significance in terms of the presence of chronic diseases and history of previous abdominal surgery between the groups (P = .802 and P = .510, respectively). Entry time to the abdomen, the decrease in hemoglobin values, and hospitalization length were found to be statistically significant between the entry methods (P < .001, P = .002, and P < .001, respectively). Entry time, the decrease in hemoglobin value, and hospitalization length were higher in the VNI group. In conclusion, although there is no definitive consensus on the optimal laparoscopic entry technique, direct trocar entry is an effective alternative to the Veress needle insertion technique. Direct trocar entry is associated with shorter entry times, fewer perioperative complications, less reduction in hemoglobin levels, and shorter hospitalization duration compared to VNI.

Robotic Left Hepatectomy Using the Glissonean Approach and Saline-Linked Bipolar Clamp-Crush Technique.

BACKGROUND: We have previously reported a saline-linked bipolar clamp-crush technique as a novel robotic liver resection method. Herein, we present the surgical techniques and outcomes of robotic left hepatectomy using the Glissonean approach and our liver transection technique. METHODS: The key procedures included the following: (1) encircling the left Glissonean pedicle using the Tip-Up fenestrated grasper, (2) dissecting the liver parenchyma using the saline-linked bipolar clamp-crush technique, (3) moving the endoscope one trocar to the right to facilitate visualisation of the liver transection plane, and (4) stapling the left pedicle and left hepatic vein. Seven robotic left hepatectomies were performed. RESULTS: The median operative time and estimated blood loss were 395 min and 50 mL, respectively. The median length of postoperative hospital stay was 9 days. Pneumothorax was the only severe postoperative complication. CONCLUSIONS: Robotics left hepatectomy using the Glissonean approach and the saline-linked bipolar clamp-crush technique appears safe and feasible.

[F-type forceps for assisted reduction in femoral shaft fractures surgery].

OBJECTIVE: To explore clinical efficacy of F-type forceps for assisted reduction in femoral shaft fracture reduction. METHODS: Forty-five patients with femoral shaft fracture treated with intramedullary nail and internal fixation from January 2019 to December 2021 were retrospectively analyzed and divided into two groups according to different reduction methods. In observation group, there were 21 patients, included 15 males and 6 females, aged from 27 to 92 years old with an average of (53.38±18.81) years old;9 patients on the left side, 12 patients on the right side;7 patients were type A, 8 patients were type B and 6 patients were type C according to AO fracture classification;the time from injury to operation ranged from 7 to 13 days with an average of (4.62±3.34) days;reduction was assisted by F-shaped forceps. In control group, there were 24 patients, including 17 males and 7 females, aged from 20 to 92 years old with an average of (51.96±20.43) years old;12 patients on the left side, 12 patients on the right side;11 patients were type A, 8 patients were type B and 5 patients were type C according to AO fracture classification;the time from injury to operation ranged from 2 to 13 days with an average of (6.29±3.04) days;traditional reset mode was adopted. Operative time, intraoperative blood loss, intraoperative fluoroscopy times, intraoperative open reduction ratio, clinical healing time of fracture, postoperative complications, hospital stay, hospital cost and Lysholm score of knee joint at 6 and 12 months after surgery were compared between two groups to evaluate clinical effect. RESULTS: All patients were followed up for 12 to 24 months with an average of (16.60±3.45) months. In observation group, operative time, intraoperative blood loss, intraoperative fluoroscopy times, open reduction cases, and clinical healing time of fractures were (58.19±7.93) min, (88.10±44.45) ml, (25.29±5.54) times, 0 case, (4.76±0.77) months, respectively;while in control group was (79.33±22.94) min, (222.92±144.45) ml, (47.46±26.25) times, 5 cases, (7.13±1.80) months, and the difference between two groups were statistically significant (P<0.05). There were no significant difference in postoperative complications, length of stay and hospitalization cost between two groups (P>0.05). At 6 months after surgery, Lysholm score of knee joint in observation group (88.62±4.48) was better than that in control group (79.21±8.91) (F=21.948, P=0.000). There were no significant difference in support use, pain and squat score between two groups (P>0.05). At 12 months after surgery, Lysholm scores of stair climbing and pain in observation group were (9.62±1.20) and (19.76±1.92), which were better than those in control group (7.83±2.04) and (21.88±2.88) (P<0.05). There were no significant difference in scores and total scores of other items between two groups (P>0.05). CONCLUSION: Compared with traditional reduction method, F-type forceps instrument could shorten operation time, reduce intraoperative blood loss, reduce intraoperative fluoroscopy times, accelerate clinical healing of fracture, and promote earlier functional recovery of knee joint.

Development of microsurgical forceps equipped with haptic technology for in situ differentiation of brain tumors during microsurgery.

The stiffness of human cancers may be correlated with their pathology, and can be used as a biomarker for diagnosis, malignancy prediction, molecular expression, and postoperative complications. Neurosurgeons perform tumor resection based on tactile sensations. However, it takes years of surgical experience to appropriately distinguish brain tumors from surrounding parenchymal tissue. Haptics is a technology related to the touch sensation. Haptic technology can amplify, transmit, record, and reproduce real sensations, and the physical properties (e.g., stiffness) of an object can be quantified. In the present study, glioblastoma (SF126-firefly luciferase-mCherry [FmC], U87-FmC, U251-FmC) and malignant meningioma (IOMM-Lee-FmC, HKBMM-FmC) cell lines were transplanted into nude mice, and the stiffness of tumors and normal brain tissues were measured using our newly developed surgical forceps equipped with haptic technology. We found that all five brain tumor tissues were stiffer than normal brain tissue (p < 0.001), and that brain tumor pathology (three types of glioblastomas, two types of malignant meningioma) was significantly stiffer than normal brain tissue (p < 0.001 for all). Our findings suggest that tissue stiffness may be a useful marker to distinguish brain tumors from surrounding parenchymal tissue during microsurgery, and that haptic forceps may help neurosurgeons to sense minute changes in tissue stiffness.