First impressions of Telesurgery robotic-assisted radical prostatectomy using the Edge medical robotic platform

ABSTRACT Purpose: We reported, as a referral center in prostate cancer, our perspectives and experience performing Telesurgery using robotic surgery and 5G network. Material and methods: We described and illustrated the Telesurgery applications and outcomes to treat a patient with prostate cancer located 1300 kilometers away from the surgeon (Beijing-Harbin) in China. We used the Edge Medical Robot (MP1000) in November 2023 in a 71-year-old patient with Gleason 6 (ISUP 1) in 8 cores from 13, PSA of 14 ng/dL, and clinical stage cT2a. MRI described a PIRADS 5 nodule on the left peripheral zone at the base, and 20gr prostate. We described details about the connection between centers, perioperative outcomes, and our perspectives as a referral center in prostate cancer. Results: We had no delays, or problems with network connection between the centers. The procedure was performed in 60 minutes, with no intra- or postoperative complications. Estimated blood loss was 100 mL. The patient was ambulating soon after anesthesia recovery. Final pathology described a Gleason 6 (ISUP 1) involving the left base and left seminal vesicle, negative surgical margins, and no lymph node involvement (pT3bN0). The patient was continent soon after catheter removal (7 days). Conclusion: As technological progress introduced novel robotic platforms and high-speed networks, the concept of Telesurgery became a tangible reality while 5G technology solved latency and transmission concerns. However, with these advancements, ethical considerations and regulatory frameworks should underline the importance of transparency and patient safety with responsible innovation in the field.

Esofagectomía mínimamente invasiva: Resultados posoperatorios en 99 pacientes intervenidos en un hospital universitario / Minimally invasive esophagectomy: Postoperative results in 99 patients operated at a university hospital

Introducción. La esofagectomía mínimamente invasiva (EMI) ha venido ganando popularidad debido a los resultados obtenidos en términos de seguridad, mortalidad, complicaciones y calidad de vida, así como los resultados oncológicos comparables a los obtenidos con la cirugía por vía abierta. Métodos. Estudio de cohorte de pacientes en quienes se llevó a cabo una EMI en la Sociedad de Cirugía de Bogotá Hospital de San José, en Bogotá, D.C., Colombia, entre enero de 2008 y diciembre de 2020. Resultados. Se incluyeron 99 pacientes, 52 hombres y 47 mujeres, con una edad media de 56 años; 58 tenían enfermedades benignas y 41 neoplasias del esófago. En 76 se llevó a cabo un abordaje de McKeown y en 23 una esofagectomía transhiatal por laparoscopia con anastomosis cervical. El tiempo quirúrgico promedio fue de 240 minutos y la media del sangrado de 140 ml. Seis pacientes fallecieron (6 %) y hubo 21 complicaciones en 14 pacientes (14 %), con 8 fugas de la anastomosis esofagogástrica (8 %) y 4 pacientes con neumonía (4 %). Conclusiones. Los resultados obtenidos confirman que la EMI es un procedimiento factible y seguro, cuyos beneficios la han convertido en el abordaje de elección para la resección y reconstrucción del esófago. No obstante, se trata de una cirugía compleja, con una curva de aprendizaje prolongada, que debe ser realizada en centros con altos volúmenes y por cirujanos expertos. La selección de los pacientes debe hacerse de manera individual teniendo en cuenta las comorbilidades, los recursos disponibles y la experticia del grupo quirúrgico.

Introduction. Minimally invasive esophagectomy (MIE) has been gaining popularity due to the results obtained in terms of safety, mortality, complications and quality of life, as well as oncologic results comparable to those obtained with open surgery. Methods. Cohort study of patients in whom MIE was performed at Hospital de San José, in Bogotá, D.C., Colombia, between January 2008 and December 2020. Results. Ninety-nine patients were included, 52 men and 47 women, with a mean age of 56 years; 58 had benign diseases and 41 had neoplasms of the esophagus. A McKeown approach was performed in 76 and a laparoscopic transhiatal esophagectomy with cervical anastomosis in 23. The average surgical time was 240 minutes and the average bleeding was 140 ml. Six patients died (6%) and there were 21 complications in 14 patients (14%), with eight esophagogastric anastomosis leaks (8%) and four patients with pneumonia (4%). Conclusions. The results obtained confirm that MIE is a feasible and safe procedure, whose benefits have made the approach of choice for resection and reconstruction of the esophagus. However, it is a complex surgery, with a long learning curve, which must be performed in centers with high volumes and by expert surgeons. Patient selection must be done individually taking into account comorbidities, available resources and expertise of the surgical group.

Esofagectomía mínimamente invasiva: impacto de la curva de aprendizaje. Experiencia en un centro de alto volumen / Minimally invasive esophagectomy: Impact of the learning curve. Experience in a high volume center

Introducción. El tratamiento del cáncer de esófago ha evolucionado notablemente en los últimos años. Los nuevos abordajes permiten preservar el esófago en tumores tempranos, mediante técnicas endoscópicas, y en aquellos localmente avanzados, es posible realizar resecciones mínimamente invasivas en combinación con tratamiento oncológico. La innovación quirúrgica es necesaria para aumentar la eficacia terapéutica, sin embargo, ésta requiere un aprendizaje cuya curva impacta en los resultados obtenidos. El objetivo de este trabajo fue mostrar cómo incide la curva de aprendizaje en la morbimortalidad asociada al procedimiento. Métodos. Se tomó una cohorte de 128 pacientes con esofagectomía mínimamente invasiva por cáncer de esófago, realizadas entre enero de 2014 y diciembre de 2023. Se agruparon en dos etapas de manera cronológica, creando dos grupos de 64 pacientes cada uno. Se evaluaron variables demográficas, tipo de anastomosis realizada, tasa de complicaciones, anatomía patológica, días de internación y seguimiento. Resultados. No hubo una diferencia significativa entre los dos grupos en factores demográficos, como edad y sexo, tipos histológicos o sitio de la anastomosis. La morbilidad (complicaciones tipo III y IV de Clavien-Dindo) fue del 43,7 % en la primera etapa y del 23 % en la segunda, con una diferencia significativa (p=0,02). Conclusiones. En nuestra cohorte mostramos una diferencia estadísticamente significativa en cuanto a la morbilidad entre la primera y la segunda etapa, sin embargo, no hubo diferencias en la mortalidad. Los hallazgos sugieren así que la curva de aprendizaje de un procedimiento tiene un impacto negativo transitorio sobre los resultados.

Introduction. The treatment of esophageal cancer has evolved significantly in recent years. New approaches allow preserving the esophagus in early tumors, using endoscopic techniques, and in locally advanced tumors, it is possible to perform minimally invasive resections in combination with an oncological treatment. Surgical innovation is necessary to increase therapeutic efficacy; however, it requires learning curve whose impacts the results obtained. The objective of this work was to show how the learning curve affects the morbidity and mortality associated with the procedure. Methods. A cohort of 128 patients with minimally invasive esophagectomy due to esophageal cancer was included, performed between January 2014 and December 2023. They were grouped into two stages chronologically, creating two groups of 64 patients each. Demographic variables, type of anastomosis performed, complication rate, pathology types, hospital stay and follow-up were analyzed. Results. There was no significant difference between both groups in demographic variables, such as age and sex, histological types, or anastomosis site. Morbidity (Dindo-Clavien types III and IV complications) was 43.7% on the first stage and 23% in the second one, with a significant difference (p=0.02). Conclusions. In our cohort, we showed a statistically significant difference in morbidity between the first and second stages; however, there were no differences in mortality. The findings thus suggest that the learning curve of a procedure has a temporary negative impact on the results.

Complicated acute hiatal hernia after total gastrectomy / Hernia hiatal aguda complicada luego de gastrectomía total

Introduction. Surgery remains the mainstay of treatment for most esophagogastric junction (EGJ) tumors. After the surgical resection of EGJ tumors, the anatomy of the esophageal hiatus of the diaphragm is severely altered, increasing the risk of postoperative hiatal hernia (HH). While HH is more often reported after esophagectomy, HH is a rare complication after laparoscopic total gastrectomy and occurs in only approximately 0.5% of patients. Clinical case. A laparoscopic total gastrectomy with D2 lymphadenectomy was performed on a patient with an esophagogastric junction tumor. No intraoperative complications occurred and the patient had an uneventful postoperative course. Two months after the operation, the patient was admitted to the emergency room due to diffuse abdominal and chest pain, vomiting, and hematemesis. The chest and abdominal CT scan showed herniation of several bowel loops into the right hemithorax. Results. Due to hemodynamic instability, an emergent laparotomy was performed and the hiatal hernia was repaired with mesh. The patient recovered well from the operation and was discharged after 10 days. Conclusions. Clinical presentation is often non-specific and warrants a high level of suspicion. Elective surgical repair is recommended for large and/or symptomatic HH. Emergent repair might be needed for complicated HH with incarceration, strangulation, or bowel perforation. Overall, incarcerated HH after laparoscopic total gastrectomy is rare but should be considered in patients with abdominal pain or vomiting during the postoperative course. A prompt diagnosis and treatment are critical to obtain favorable outcomes.

Introducción. La cirugía sigue siendo el pilar del tratamiento para la mayoría de los tumores de la unión esofagogástrica (UEG). Después de la resección quirúrgica de los tumores de la UEG, la anatomía del hiato esofágico se altera severamente, aumentando el riesgo de hernia hiatal (HH) postoperatoria. Mientras que la HH se informa con mayor frecuencia después de la esofagectomía, la HH es una complicación rara después de una gastrectomía total laparoscópica y ocurre en solo aproximadamente 0,5 % de los pacientes. Caso clínico. Se realizó una gastrectomía total laparoscópica con linfadenectomía D2 en un paciente con un tumor en la UEG. No presentó complicaciones intraoperatorias y cursó su postoperatorio sin incidentes. Dos meses luego de la operación, fue admitido en la sala de emergencias debido a dolor abdominal y torácico difuso, vómitos y hematemesis. La tomografía computarizada de tórax y abdomen mostró herniación de asas intestinales en el hemitórax derecho. Resultados. Debido a la inestabilidad hemodinámica, se realizó una laparotomía de emergencia y se reparó la hernia hiatal con malla. El paciente fue dado de alta después de 10 días. Conclusiones. La presentación clínica suele ser inespecífica y justifica un alto nivel de sospecha. Se recomienda la reparación quirúrgica electiva para HH grandes y/o sintomáticas. La reparación de emergencia puede ser necesaria para HH complicadas con encarcelamiento, estrangulación o perforación intestinal. Generalmente, una HH encarcelada después de la gastrectomía total laparoscópica es infrecuente, pero debe considerarse en pacientes con dolor abdominal o vómitos durante el curso postoperatorio. Un diagnóstico y tratamiento oportunos son críticos para obtener resultados favorables.

Abordaje quirúrgico y endoscópico de un caso atípico de perforación esofágica espontánea / Surgical and endoscopic approach to an atypical case of spontaneous esophageal perforation

Introducción. La perforación esofágica se define como la ruptura transmural del esófago. Existen diferentes causas, como neoplásicas, traumáticas, lesión por cuerpos extraños, ingesta de cáusticos, iatrogénicas o espontáneas, denominadas Síndrome de Boerhaave. La tasa de mortalidad es alta y oscila entre 40-60 % con manejo óptimo, hasta el 100 % sin tratamiento. Caso clínico. Se presenta el caso de una paciente de 70 años, que ingresó por 5 días de sensación de globus faríngeo, disnea y dolor torácico. Se realizó una tomografía computarizada de tórax donde se visualizó un derrame pleural derecho, que fue manejado con toracostomía cerrada. Posteriormente, se visualizó la salida de material alimentario por la sonda de toracostomía, por lo que se hizo una nueva tomografía de tórax y abdomen encontrando una fístula esofagopleural. En una esofagografía por tomografía donde se vio extravasación del medio de contraste en la región infracarinal hacia espacio pleural derecho. Resultados. Fue llevada a toracotomía, encontrando empiema y atrapamiento del lóbulo inferior derecho por abundante fibrina, pus y restos alimentarios, secundario a perforación esofágica del tercio medio. Se practicó esofagorrafia, pleurectomía y decorticación. Se continuó manejo endoscópico con sistema de vacío de forma seriada. Conclusiones. Las perforaciones esofágicas son un desafío para los cirujanos, tanto en el enfoque diagnóstico inicial, como en el tratamiento. Conocer los abordajes endoscópico, quirúrgico y mixto ayuda a ampliar las opciones de manejo en estos pacientes. El tratamiento oportuno, las indicaciones no operatorias y las nuevas medidas endoscópicas para el manejo impactan en la mortalidad.

Introduction. Esophageal perforation is defined as a transmural rupture of the esophagus. There are different causes, such as neoplastic, traumatic, foreign body, caustic ingestion, iatrogenic or spontaneous, called Boerhaave Syndrome. The mortality rate is high and ranges between 40-60% with optimal management, up to 100% mortality without treatment. Clinical case. The case of a 70-year-old patient is presented, who was admitted after five days of pharyngeal globus sensation, dyspnea, and chest pain. A CT scan of the chest was performed were a right pleural effusion was observed, which was managed with closed thoracostomy. The exit of food material through the thoracostomy tube was observed. Subsequently, a new CT scan of chest and abdomen was performed, finding an esophagopleural fistula. In a CT esophagography where extravasation of contrast medium was seen in the infracarinal region into the right pleural space. Results. She was taken to thoracotomy, finding empyema and entrapment of the right lower lobe due to abundant fibrin, pus and food debris, secondary to esophageal perforation of the middle third. Esophagorrhaphy, pleurectomy and decortication were performed. Endoscopic management with a vacuum system was continued on a serial basis. Conclusions. Esophageal perforations are a challenge for surgeons, both in the initial diagnostic approach and in treatment. Knowing the endoscopic, surgical and mixed approaches helps to expand the management options in these patients. Timely treatment, non-operative indications and new endoscopic measures for management affect mortality.

Leiomiomas de la unión esofagogástrica y estómago proximal. Presentación de caso / Leiomyomas of the esophagogastric junction and proximal stomach. Case presentation

Introducción. Los leiomiomas son tumores mesenquimales benignos, con muy bajo potencial de malignidad, poco frecuentes, con una presentación clínica variable y en su mayoría asintomáticos. Su hallazgo es incidental; los estudios endoscópicos y patológicos son importantes para diferenciarlos de otros tumores estromales gastrointestinales. Caso clínico. Se presenta el caso clínico de una mujer de 50 años, con antecedente de resección en cuña gástrica por hallazgo de lesión en el fondo gástrico y funduplicatura de Nissen, con informe de patología de leiomioma. La paciente ingresó remitida a nuestra institución con disfagia y dolor epigástrico. La endoscopia mostró una lesión en la unión esofagogástrica, que se extendía a la región subcardial subepitelial, que fue confirmada por ultrasonografía endoscópica y tomografía. Resultado. Se consideró que la paciente presentaba recaída tumoral después de una resección laparoscópica, que requirió deshacer una funduplicatura previa y enucleación parcial por vía laparoscópica, con resección en cuña de la mucosa firmemente adherida a la unión esofagogástrica, con una funduplicatura tipo Dor. Tuvo adecuada evolución posoperatoria. Conclusiones. Los leiomiomas son tumores benignos infrecuentes, con rara transformación maligna. Generalmente son asintomáticos y su hallazgo es incidental. Los estudios endoscópicos y la confirmación histológica permiten su diagnóstico para definir el mejor manejo.

Introduction. Leiomyomas are benign mesenchymal tumors, with very low malignant potential, infrequent, with a variable clinical presentation and mostly asymptomatic. Its discovery is incidental; endoscopic and pathological studies are important to differentiate them from other gastrointestinal stromal tumors. Clinical case. A clinical case of a 50-year-old woman with a history of gastric wedge resection due to the discovery of a lesion in the gastric fundus and Nissen fundoplication is presented, with a pathology report of leiomyoma. The patient was admitted to our institution with dysphagia and epigastric pain. Endoscopy showed a lesion at the esophagogastric junction, extending to the subcardial subepithelial region, which was confirmed by endoscopic ultrasonography and tomography. Result. It was considered that the patient had tumor relapse after a laparoscopic resection, which required undoing a previous fundoplication and partial enucleation, with a wedge resection of mucosa firmly adhered to the esophagogastric junction, with a Dor-type fundoplication. He had an adequate postoperative evolution. Conclusions. Leiomyomas are rare benign tumors, with rare malignant transformation. They are generally asymptomatic and their discovery is incidental. Endoscopic studies and histological confirmation allow its diagnosis to define the best management.

Re-Expansion Pulmonary Edema Following Minimally Invasive Cardiac Surgery: A Case Report

Re?expansion pulmonary edema (RPE) is a rare complication of minimally invasive cardiac surgery (MICS). We present a case of RPE following atrial septal defect (ASD) closure using a thoracotomy approach and cardiopulmonary bypass (CPB). REP contributes to significant morbidity and extends the length of stays in the intensive care unit. Understanding the pathophysiology and risk factors of RPE allows us to prevent or minimize the incidence.

Giant rare esophageal malignancy in adolescent boy: a case report

Synovial sarcoma is rare soft tissue tumour affecting mostly extremities and less commonly head and neck, lungs, heart and digestive system in adult age group. Only about 20 such cases arising from oesophagus have been reported in literature but none have been reported in adolescent age group with large size in Indian population. So here we present a case report of synovial sarcoma of oesophagus seen in a 14-year-old boy and successful management. Our patient was a 14-year boy who came to our outpatient department (OPD) department with complaints of dysphagia to and retrosternal pain from past 2 months. A contrast enhanced computed tomography (CT) scan showed vertically oriented long and large hypodense lesion arising from right anterolateral wall of pharyngoesophageal junction to upper two-thirds of esophagus from C6 to D8 causing >50% narrowing of trachea. Upper gastrointestinal (GI) endoscopy was done which showed linear submucosal lesion from 17 to 28 cm from incisors. After anaesthetic clearance patient was planned and taken up for minimally invasive esophagectomy. Intraoperatively bulky submucosal growth extending from just cricopharynx to lower thoracic esophagus till inferior pulmonary ligament. Histopathology report came out as synovial sarcoma spindle cell type with F閐閞ation Nationale des Centres de Lutte Contre le Cancer (FNCLCC) grade 2. After tumor board discussion, adjuvant therapy with doxorubicin and ifosfamide was given for five courses. After Six months follow up, the boy is free from tumor recurrence. Synovial sarcoma in esophagus is very rare with nearly 20 reported cases, of which most were polypoid and located in upper and mid esophagus and biphasic histology. The treatment for patients with localized disease is surgery with an adequate wide margin combined with adjuvant chemotherapy and/or radiation is regarded as the preferable treatment. Esophagectomy mostly with minimally invasive approach is preferred surgical option. Robotic minimally invasive surgery is also a safe and feasible option. Clinical follow-up has been limited, and synovial sarcoma is widely known to recur or metastasize after long disease-free intervals.

Laparoscopic repair of a symptomatic right congenital morgagni hernia in an elderly patient: a rare case report

Morgagni hernia is a rare form of congenital diaphragmatic defect on the anterior part of the diaphragm with a prevalence of 2-3%. We report a case of a 70-year-old female who presented with burning chest pain, intermittent and colicky upper abdominal pain occasionally associated with nausea and vomiting, and constipation for 4 months. Imaging studies, including X-ray, ultrasound, CT scan, and MRI, were suggestive of a right-sided congenital Morgagni hernia. Late diagnosis of this condition in adults is extremely rare, and in the elderly, it is even rarer. The patient underwent successful laparoscopic diaphragmatic hernia repair with prosthetic mesh placement. The postoperative period was uneventful, and the patient was discharged on the fifth postoperative day. Minimally invasive surgical techniques provide definitive treatment for patients with uncomplicated Morgagni hernia cases, offering a shorter recovery time and a low complication rate.

Evaluation of suburethral transobturator sling procedure on urinary incontinence and quality-of-life

Background: Urinary incontinence has an estimated incidence of 25-50% in the adult female population. It has a profound physical and psychosocial impact, compromising women抯 quality-of-life (QoL). The suburethral sling is currently considered the surgical treatment of choice for stress urinary incontinence (SUI). The present study aimed to evaluate the impact of urinary incontinence on women抯 QoL before and after transobturator suburethral sling surgery, as well as the effectiveness of surgical treatment.Methods: A prospective longitudinal, observational and analytical study was performed between June and December 2021. The study population included 64 women with urinary incontinence, to whom the King's Health Questionnaire (KHQ) was applied, before and after surgery.Results: Of the 64 women included in the study, 59.4% (n=38) had SUI and 40.6% (n=26) had mixed urinary incontinence (MUI). There was an improvement in the global KHQ score in 96.9% (n=62) of subjects, with a statistically and clinically significant impact on QoL (p<0.001). Patients with MUI had higher preoperative KHQ global scores, reflecting a more substantial impact on their QoL. Surprisingly, postoperative improvement in QoL was equally significant, both clinically and statistically (p<0.001), with no differences when comparing to isolated sui patients (p>0.05).Conclusions: QoL assessment questionnaires help to quantify individual impact of urinary incontinence and identify which patients benefited most from treatment. This study not only enhances our understanding of the true impact of urinary incontinence on QoL, but also emphasizes the effectiveness and importance of this minimally invasive surgery in improving the QoL of patients with SUI as well as MUI.

The 2012 Briganti nomogram not only predicts lymph node involvement but also disease progression in surgically treated intermediate-risk prostate cancer patients with PSA <10 ng/mL, ISUP grade group 3, and clinical stage up to cT2b

ABSTRACT Purpose We assessed the prognostic impact of the 2012 Briganti nomogram on prostate cancer (PCa) progression in intermediate-risk (IR) patients presenting with PSA <10ng/mL, ISUP grade group 3, and clinical stage up to cT2b treated with robot assisted radical prostatectomy eventually associated with extended pelvic lymph node dissection. Materials and Methods From January 2013 to December 2021, data of surgically treated IR PCa patients were retrospectively evaluated. Only patients presenting with the above-mentioned features were considered. The 2012 Briganti nomogram was assessed either as a continuous and a categorical variable (up to the median, which was detected as 6%, vs. above the median). The association with PCa progression, defined as biochemical recurrence, and/or metastatic progression, was evaluated by Cox proportional hazard regression models. Results Overall, 147 patients were included. Compared to subjects with a nomogram score up to 6%, those presenting with a score above 6% were more likely to be younger, had larger/palpable tumors, presented with higher PSA, underwent tumor upgrading, harbored non-organ confined disease, and had positive surgical margins at final pathology. PCa progression, which occurred in 32 (21.7%) cases, was independently predicted by the 2012 Briganti nomogram both considered as a continuous (Hazard Ratio [HR]:1.04, 95% Confidence Interval [CI]:1.01-1.08;p=0.021), and a categorical variable (HR:2.32; 95%CI:1.11-4.87;p=0.026), even after adjustment for tumor upgrading. Conclusions In IR PCa patients with PSA <10ng/mL, ISUP grade group 3, and clinical stage up to cT2b, the 2012 Briganti nomogram independently predicts PCa progression. In this challenging subset of patients, this tool can identify prognostic subgroups, independently by upgrading issues.

Abordagem estética e conservadora para fechamento de múltiplos diastemas: relato de caso / Aesthetic and conservative approach to multiple diastema closure: case report / Enfoque estético y conservador para el cierre de múltiples diastemas: relato de caso

Introdução:Na odontologia moderna, a estética vem ocupando um espaço cada vez mais expressivo, e o desejo por dentes mais brancos, a insatisfação com o alinhamento dos dentes e com a anatomia dentária, têm sido os motivos mais relevantes de procura dos pacientes nos consultórios odontológicos.Objetivo:O presente artigo tem como objetivo descrever, através de relato de caso clínico, uma abordagem terapêutica estética e conservadora para fechamento de múltiplos diastemas anterossuperiores com a utilização de facetas de resina composta.Relato de caso:Paciente do sexo masculino, 21 anos de idade, procurou atendimento queixando-se de insatisfação estética pelos diastemas apresentados. Por meio de um planejamento digital das facetas em resina, com mockup e modelo impresso em 3D, as restaurações foram feitas respeitando anatomia, forma, opacidade e cores dos dentes naturais do paciente. O resultado dos procedimentos adotados foi satisfatório, demonstrando que a técnica empregada foi eficaz, sendo capaz de devolver um sorriso estético e biológico ao paciente. A odontologia contemporânea tem ofertado cada vez mais materiais com capacidade de devolver estética e função em dentes de forma minimamente invasivas, além de passar total confiabilidade em tratamentos a longo prazo, agradando o paciente desde a apresentação digital do planejamento traçado pelo cirurgião dentista com previsibilidade dos resultados, até o momento final do tratamento.Conclusões:O recontorno estético com resina composta representa uma opção funcional e de baixo custo para o tratamento de pacientes que apresentam diastemas múltiplos, principalmente em pacientes jovens pela preservação daestrutura dentária e possibilidade de reparo, sendo considerado um procedimento reversível, rápido e de baixo custo (AU).

Introduction:Aesthetics have been occupying an increasingly significant role in modern dentistry, and the desire for whiter teeth, dissatisfaction with tooth alignment, and dental anatomy concerns have been the most relevant reasons for patients seeking dental care. Objective:This article aims to describe an aesthetic and conservative therapeutic approach for closing multiple anterior upper diastemas using composite resin veneers in a clinical case report. Case report:A 21-year-old male patient sought treatment, expressing dissatisfaction with the diastemas he had. The restorations were performed using digital planning of the resin veneers with a mockup and a 3D-printed model, while respecting the patient's natural tooth anatomy, shape, opacity, and colors. The results of the adopted procedures were satisfactory, demonstrating effectiveness of the employed technique in restoring an aesthetic and biologically harmonious smile to the patient. Contemporary dentistry has been offering increasingly more materials capable of providing aesthetics and function to teeth through minimally invasive approaches. This not only ensures long-term treatment reliability, but also pleases the patient with a digital presentation of the treatment plan outlined by the dentist, predicting the results up to the final stages of the treatment. Conclusions:Aesthetic contouring using composite resin presents a functional and cost-effective option for treating patients with multiple diastemas, especially among young patients due to its preservation of dental structure, repair potential, and being considered a reversible, fast, and low-cost procedure (AU).

Introducción: En la odontología moderna, la estética viene ocupando un espacio cada vez más destacado, y las ganas de tener dientes más blancos, la insatisfacción con el alineamiento de los dientes, y la anatomía dental son las razonesmás relevantes por las cuales los pacientes acuden a las consultas odontológicas. Objetivo:El presente artículo tiene como objetivo describir, a través de un relato de caso clínico, un abordaje terapéutico estético y conservador para el cierre de múltiples diastemas anterosuperiores mediante el uso de carillas de resina compuesta. Informe de caso:Paciente del sexo masculino, 21 años de edad, buscó atendimiento quejándose de insatisfacción estética debido a los diastemas presentados. A través de una planificación digital de las carillas en resina, con un mockup y un modelo impreso en 3D, las restauraciones fueron ejecutadas, respetándose la anatomía, forma, opacidad y colores de los dientes naturales del paciente. El resultado de los procedimientos adoptados fue satisfactorio y demostró que la técnica utilizada fue eficaz, siendo capaz de restituir una sonrisa estética y funcional al paciente. La odontología contemporánea viene ofreciendo cada vez más materiales con la capacidad de devolver estética y función a los dientes de maneras mínimamente invasivas, además de brindar total confiabilidad en tratamientos a largo plazo, satisfaciendo al paciente desde la presentación digital del plan trazado por el cirujano dentista con la previsibilidad de los resultados, hasta el momento final del tratamiento. Conclusiones:El recontorneado estético con resina compuesta representa una opción funcional y de bajo costo para el tratamiento de pacientes con múltiples diastemas, especialmente en pacientes jóvenes, debido a la preservación de la estructura dental y la posibilidad de reparación. Se considera, de este modo, que se trata de un procedimiento reversible, rápido y económico (AU).

Advancements in Surgical Techniques for Limb Deformity Corrections

Background: Limb deformities present significant challenges in orthopedic surgery, necessitating precise and effective corrective techniques. Recent advancements in surgical methods have enhanced the outcomes for patients, offering superior functional and radiographic results. This study aims to compare traditional and advanced surgical techniques for limb deformity corrections, evaluating their efficacy, safety, and recovery outcomes. Methods: A retrospective and prospective cohort study was conducted on 200 patients with limb deformities treated surgically between January 2020 and December 2023. Participants aged 5-65 years with congenital or acquired limb deformities were included. Data were collected on patient demographics, deformity characteristics, surgical techniques, and postoperative outcomes. Advanced techniques such as the Ilizarov method, hexapod external fixators, minimally invasive procedures, 3D printing technology, and the use of biologics were compared with traditional methods. Outcomes were assessed using LEFS, SF36, radiographic evaluations, complication rates, and recovery times. Statistical analyses were performed using SPSS. Results: The advanced techniques group demonstrated significantly better functional outcomes with higher LEFS and SF-36 scores. Radiographic assessments showed more accurate deformity corrections and better alignment. Complication rates were lower in the advanced group, with fewer instances of infection, nonunion, hardware failure, and revision surgeries. Recovery times were shorter, with faster return to full weight-bearing and daily activities. Conclusion: Advancements in surgical techniques significantly improve outcomes for patients with limb deformities. The adoption of these innovative methods in clinical practice can lead to better patient care, reduced complications, and quicker recoveries, ultimately enhancing the quality of life for affected individuals.

The Most Cited Articles in Resinous Infiltrates: A Bibliometric Analysis

Aims: To identify trends and growth in knowledge related to Resin Infiltrants, through a bibliometric review. Study Design: Bibliometric review. Methodology: A search was carried out in the Clarivate Analytics Web of Science database, using the terms (infiltrative resin OR resin infiltration) AND (white spot lesions OR white spots OR WSL OR Enamel demineralization OR orthodon* OR defect* OR hypoplas* OR discolor * OR dental fluorosis OR tooth demineralization OR calcification, tooth OR tooth discoloration OR dental enamel). Paired selection of manuscripts was carried out. The initial search identified 599 articles. After comparing titles and abstracts, the 50 most cited manuscripts involving Resinous Infiltrants were listed in order of classification. Results: The most cited article in the top 50 was Frencken et al. in [1]. The earliest manuscript of this bibliometric analysis was published in 2001 by Robinson et al. in Caries Research and was cited 72 times, while two articles were the most recent, published in 2019 by Urquhart et al. in the Journal of Dental Research, it was cited 112 times and by Coelho Ased et al. in the Journal of Esthetic and Restorative Dentistry, cited 35 times. The citation distribution line shows high peaks in 2010 and 2012. The institutions that stood out the most were Charité Universitat Medizin Berlin, followed by Universitat zu Kiel. The main country was Germany. Among the main journals are the Journal of Dentistry and the publisher Elsevier. In total, 274 keywords were used. The period of 2010 was the period with the greatest concentration of publications and the most productive. Conclusion: The bibliometric review carried out in this study revealed the growing interest and research around the use of Resinous Infiltrants as an effective and minimally invasive alternative to address white spot lesions and tooth decay.

Endoscopic thyroidectomy – A case report

Minimally invasive surgery is increasingly employed in the treatment of thyroid diseases. Several minimal access approaches to the thyroid gland have been described. Minimally invasive surgery is rapidly expanding its role in almost all the surgical sub-specialties. There is also a growing demand for minimally invasive approaches, as nowadays, patients are more concerned about cosmesis in addition to their original surgery. Although its role in thyroid surgery has already been proven earlier, it is not yet accepted as a routine approach amongst many thyroid surgeons. The commonly performed surgeries have been endoscopic lobectomies. We have done one such procedure in our institution with a successful outcome.

Duodenopancreatectomía cefálica con resección vascular laparoscópica / Laparoscopic cephalic pancreaticoduodenectomy with laparoscopic vascular resection

RESUMEN Antecedentes: la duodenopancreatectomía cefálica (DPC) con resección vascular venosa está indicada para el tratamiento del adenocarcinoma ductal y de tumores neuroendocrinos de páncreas, tanto por laparoscopia como por laparotomía. Objetivo: describir los resultados de una serie de pacientes operados de DPC con resección vascular venosa y comparar la morbimortalidad entre los abordados por laparoscopia y por laparotomía. Material y métodos: se realizó un estudio observacional, comparativo, retrospectivo de pacientes con DPC con resección vascular entre enero de 2022 y agosto de 2023. El abordaje laparoscópico fue determinado en menores de 80 años, invasión venosa tumoral igual a 180° o menor en la tomografía, buen performance status, y no haber realizado tratamiento neoadyuvante. Resultados: fueron realizadas 23 DPC con resección vascular venosa: 11 por laparoscopia y 12 por laparotomía. Las 11 realizadas por laparoscopia fueron resecciones laterales, y, en los 12 abordados por laparotomía, se realizó resección total de vena porta en 5 y en el resto, resección lateral. El tiempo de "clampeo" (pinzamiento) portal y la necesidad de transfusiones fue similar en ambos grupos. El estudio patológico reveló R0 en el 78,2% de los pacientes e invasión venosa en el 40.9%. La morbilidad con laparoscopia y con laparotomía consistió, respectivamente, en: fístula pancreática en 7 (4 y 3), vaciamiento gástrico retardado en 4 (1 y 4), fístula biliar en uno (1 y 0), neumonía en dos (1 y 1) e infección de herida en uno (0 y 1). La mortalidad fue de 8,6% por el fallecimiento de dos pacientes, uno en cada grupo. Conclusión: de acuerdo con los criterios empleados, la morbimortalidad de la DPC con resección vascular fue similar por laparoscopia y por laparotomía.

ABSTRACT Background: Cephalic pancreaticoduodenectomy (CPD) with venous resection is indicated for the treatment of ductal adenocarcinoma and neuroendocrine tumors of the pancreas, either through laparoscopy or laparotomy. Objective: The aim of this study was to describe the results of a series of patients undergoing CPD with venous vascular resection and compare morbidity and mortality between the laparoscopic approach and open surgery. Material and methods: We conducted a retrospective, comparative and observational study of patients who underwent CPD with venous vascular resection between January 2022 and July 2023. Criteria for laparoscopic surgery were age < 80 years, interface between tumor and vein of 180° of the circumference of the vessel wall or less on computed tomography, good performance status, and no previous neoadjuvant treatment. Results: A total of 23 CPD procedures with venous vascular resection were performed: 11 by laparoscopy and 12 by laparotomy. The 11 laparoscopic procedures were lateral resections, and in the 12 patients approached by laparotomy, 5 were total portal vein resections and 7 were lateral resections. Portal vein clamping time and need for transfusion was similar in both groups. The pathological examination reported R0 resections in 78.2% and venous invasion in 40.9%. The complications associated with laparoscopy and laparotomy were pancreatic fistula in 4 and 3 patients, respectively, delayed gastric emptying in 1 and 4 patients, respectively, biliary fistula in 1 and 0 patients, respectively, aspiration pneumonia i 1 and 1 patients, respectively and surgical site infection in 0 and 1 patients, respectively. Mortality was 8.6% (n =2), one in each group. Conclusion: According to the criteria used, the morbidity and mortality of CPD with vascular resection were similar for laparoscopy and laparotomy.

Outcomes of ablative therapy and radical treatment for prostate cancer: a systematic review and meta-analysis

ABSTRACT Purpose: To compare biochemical recurrence, sexual potency and urinary continence outcomes of ablative therapy and radical treatment (radical prostatectomy or radiotherapy with androgen deprivation therapy). Material and methods: A systematic review and meta-analysis followed the PRISMA guidelines were performed. We searched MEDLINE/PubMed. Biochemical recurrence at three and five years; incontinence rate (patients who used one pad or more) and erectile dysfunction rate at 12 and 36 months (patients who did not have sufficient erection to achieve sexual intercourse) were evaluated. The Mantel-Haenszel method was applied to estimate the pooled risk difference (RD) in the individual studies for categorical variables. All results were presented as 95% confidence intervals (95%CI). Random effects models were used regardless of the level of heterogeneity (I²). (PROSPERO CRD42022296998). Results: Eight studies comprising 2,677 men with prostate cancer were included. There was no difference in biochemical recurrence between ablative and radical treatments. We observed the same biochemical recurrence between ablative therapy and radical treatment within five years (19.3% vs. 16.8%, respectively; RD 0.07; 95%CI=-0.05, 0.19; I2=68.2%; P=0.08) and continence rate at 12 months (9.2% vs. 31.8%, respectively; RD −0.13; 95%CI, −0.27, 0.01; I2=89%; P=0.32). When focal treatment was analyzed alone, two studies with 582 patients found higher erectile function at 12 months in the ablative therapy group than in the radical treatment (88.9% vs. 30.8%, respectively; RD −0.45; 95%CI −0.84, −0.05; I2=93%; P=0.03). Conclusion: Biochemical recurrence and urinary continence outcomes of ablative therapy and radical treatment were similar. Ablative therapy appears to have a high rate of sexual potency.

Resistencia a la Fractura de Premolares Según el Diseño de Cavidad de Acceso Endodóntico: estudio in vitro / Resistance to Fracture of Premolars According to the Design of the Endodontic Access Cavity: in vitro Study

La preparación de la cavidad de acceso es el primer paso y un requisito esencial, para la instrumentación y obturación de los conductos radiculares durante el tratamiento endodóntico. El objetivo del presente estudio fue comparar la resistencia a la fractura in vitro de premolares con cavidad de acceso tradicional (CAT), cavidad de acceso conservador (CAC) y cavidad de acceso ultraconservador (CAU). Esta fue una investigación transversal, prospectiva y experimental pura. Se realizó con 40 segundos premolares superiores, divididos en 4 grupos. Todas las muestras fueron desinfectadas y almacenadas en recipientes con suero fisiológico al 0,9 %. Al primer grupo se designó como el control, al segundo grupo CAT, al tercer grupo CAC y al cuarto grupo CAU. Se realizaron todos los accesos endodónticos con una pieza de mano de alta velocidad con refrigeración respetando el protocolo de cada uno de los diseños, posterior a ello se realizó el tratamiento endodóntico y restauración de los especímenes. Una vez preparadas todas las muestras, estas fueron sometidas a una prueba de fatiga en una máquina de ensayo universal y los resultados se registraron en Newtons. La prueba estadística usada fue ANOVA con un nivel de significancia de 5 %. Las CAT obtuvieron el menor valor de resistencia a la fractura en comparación con el grupo control. Sin embargo, no se observaron diferencias estadísticamente significativas entre los grupos CAT, CAC Y CAU. Entre los grupos CAC y CAU, no se encontraron diferencias estadísticamente significativas en comparación con el grupo control.

The preparation of the access cavity is the first step and an essential requirement for the instrumentation and obturation of the root canals during endodontic treatment. The objective of the present study was to compare the in vitro fracture resistance of premolars with traditional access cavity (CAT), conservative access cavity (CAC) and ultraconservative access cavity (CAU). This was a cross-sectional, prospective and pure experimental research. It was carried out with 40 upper second premolars, divided into 4 groups. All samples were disinfected and stored in containers with 0.9 % physiological saline. The first group was designated as the control, the second group CAT, the third group CAC and the fourth group CAU. All endodontic accesses were carried out with a high-speed handpiece with refrigeration, respecting the protocol of each of the designs, after which the endodontic treatment and restoration of the specimens was carried out. Once all the samples were prepared, they were subjected to a fatigue test in a universal testing machine and the results were recorded in Newtons. The statistical test used was ANOVA with a significance level of 5 %. The CAT obtained the lowest fracture resistance value, presenting statistically significant differences with the control group. However, no statistically significant differences were observed between the CAT, CAC, and CAU groups. Furthermore, between the CAC and CAU groups, no statistically significant differences were found compared to the control group.

Prospective Study of the Assessment of Anxiety Symptoms after Minimally Invasive Lumbar Decompression / Estudo prospectivo da avaliação dos sintomas de ansiedade após descompressão lombar minimamente invasiva

Summary Objective To analyze associations between anxiety and postsurgical clinical outcomes in patients who underwent minimally invasive lumbar decompression surgery in addition to comparing symptoms of anxiety and depression before and after surgery. Methods This prospective cohort study of patients who underwent minimally invasive lumbar decompression surgery. Clinical outcomes were measured before and 6 months after surgery using the Visual Analog Scale (VAS), Global Perceived Effect of Change (GPE), Hospital Anxiety and Depression Scale (HADS), and Oswestry Disability Index (ODI). Based on the presurgical anxiety score, patients were categorized into anxious and non-anxious patients, and the outcomes were compared. Results The patients of both groups obtained similar results concerning the clinical outcomes evaluated. Preoperative HADS scores decreased significantly 6 months after surgery in both anxiety (8.70 ± 3.48 vs. 5.75 ± 3.91) and depression (6.95 ± 3.54 vs. 5.50 ± 2.99). The VAS scale for the back (-2.8 ± 3.64) and legs (-5.5 ± 3.5) showed a reduction in pain. Conclusion Minimally invasive lumbar decompression surgery promoted clinical and functional improvement, not being affected by preoperative anxiety symptoms. Mental health indicators showed a significant reduction in symptoms 6 months after surgery.

Resumo Objetivo Analisar associações entre ansiedade e desfecho clínico pós-cirúrgico em pacientes que realizaram a cirurgia de descompressão lombar minimamente invasiva, além de comparar sintomas de ansiedade e depressão antes e após a cirurgia. Métodos Trata-se de um estudo de coorte prospectiva de pacientes que realizaram a cirurgia de descompressão lombar minimamente invasiva. Os desfechos clínicos foram mensurados antes e 6 meses após a cirurgia, utilizando a escala visual analógica de dor (EVA); Global Perceived Effect of Change (GPE); Hospital Anxiety and Depression Scale (HADS) e o Oswestry Disability Index (ODI). A partir do escore de ansiedade précirúrgico, os pacientes foram categorizados em pacientes ansiosos e não ansiosos e os desfechos comparados. Resultados Os pacientes de ambos os grupos obtiveram resultados similares em relação aos desfechos clínicos avaliados. Os escores HADS pré-operatório diminuíram significantemente 6 meses após a cirurgia, tanto em ansiedade (8,70 ± 3,48 vs. 5,75 ± 3,91) quanto em depressão (6,95 ± 3,54 vs. 5,50 ± 2,99). Houve redução da dornaescalaEVA dascostas(-2,8 ± 3,64) e das pernas (-5,5 ± 3,5). Conclusão A cirurgia de descompressão lombar minimamente invasiva promoveu melhora clínica e funcional, não sendo afetada por sintomas pré-operatórios de ansiedade. Os indicadores de saúde mental evidenciaram redução significativa dos sintomas 6 meses após a cirurgia.