Periodontal therapy for hopeless mandibular anterior teeth: a retrospective case report with a multidisciplinary approach and a 20-year follow-up

Introduction: This case report presents the intentional periodontal maintenance of two periodontal hopeless lower central incisors with a multidisciplinary approach and 20-year follow-up. Case presentation: A 36-year-old male, in 2001, was diagnosed with aggressive periodontitis, gingival swelling, bleeding, and mandibular central incisors with mobility and poor prognosis. Following periodontal therapy (phase I), root canal treatment, and occlusal adjustment, #31 and #41 were gently extracted to remove the granulation tissues, calculus, and infected cementum from the root surface. Then, tetracycline-HCl was applied for 5 minutes on the root surfaces. The teeth were repositioned into the sockets and splinted with a lingual bar. At 3 months, the bar was removed, and a free gingival autogenous graft was done to improve the local keratinized tissue width. Mobility scores, pocket depths, and clinical attachment levels were recorded, and radiographs were taken at 1, 5, and 20 years. The 5-year follow-up showed that the teeth were clinically and radiographically in function. There was a reduction in probing depth and a gain in clinical attachment and radiographic alveolar bone levels. After 20 years, #41 was stable, but #31 had external root resorption, leading to a new treatment plan (dental implants) and extraction. Conclusion: The clinical result of this case was satisfactory for 20 years. Intentional periodontal maintenance of the teeth may be an alternative treatment, even considering the high level of complexity.

Robot-assisted, laparoscopic and open radical cystectomy for bladder cancer: A systematic review and network meta-analysis

ABSTRACT Objectives: To evaluate the safety and effectiveness of robot-assisted radical cystectomy (RARC), laparoscopic radical cystectomy (LRC), and open radical cystectomy (ORC) in bladder cancer. Methods: A literature search for network meta-analysis was conducted using international databases up to February 29, 2024. Outcomes of interest included baseline characteristics, perioperative outcomes and oncological outcomes. Results: Forty articles were finally selected for inclusion in the network meta-analysis. Both LRC and RARC were associated with longer operative time, smaller amount of estimated blood loss, lower transfusion rate, shorter time to regular diet, fewer incidences of complications, and fewer positive surgical margin compared to ORC. LRC had a shorter time to flatus than ORC, while no difference between RARC and ORC was observed. Considering lymph node yield, there were no differences among LRC, RARC and ORC. In addition, there were statistically significant lower transfusion rates (OR=-0.15, 95% CI=-0.47 to 0.17), fewer overall complication rates (OR=-0.39, 95% CI=-0.79 to 0.00), fewer minor complication rates (OR=-0.23, 95% CI=-0.48 to 0.02), fewer major complication rates (OR=-0.23, 95% CI=-0.68 to 0.21), fewer positive surgical margin rates (OR=0.22, 95% CI=-0.27 to 0.68) in RARC group compared with LRC group. Conclusion: LRC and RARC could be considered as a feasible and safe alternative to ORC for bladder cancer. Notably, compared with LRC, RARC may benefit from significantly lower transfusion rates, fewer complications and lower positive surgical margin rates. These data thus showed that RARC might improve the management of patients with muscle invasive or high-risk non-muscle invasive bladder cancer.

Retrograde intrarenal surgery with or without ureteral access sheath: a systematic review and meta-analysis of randomized controlled trials

ABSTRACT Introduction: The ureteral access sheath (UAS) is a medical device that enables repeated entrance into the ureter and collecting system during retrograde intrarenal surgery (RIRS). Its impact on stone-free rates, ureteral injuries, operative time, and postoperative complications remains controversial. Therefore, we performed a systematic review and meta-analysis comparing RIRS with versus without UAS for urolithiasis management. Purpose: To compare outcomes from retrograde intrarenal surgery (RIRS) for stone extraction with or without ureteral access sheath (UAS); evaluating stone-free rate (SFR), ureteral injuries, operative time, and postoperative complications. Materials and Methods: We systematically searched PubMed, Embase, and Cochrane Library in June 2024 for randomized controlled trials (RCTs) evaluating the efficacy and safety outcomes of UAS use in RIRS for urolithiasis treatment. Articles published between 2014 and 2024 were included. Pooled risk ratios (RRs) and mean differences (MDs) were calculated for binary and continuous outcomes, respectively. Results: Five RCTs comprising 466 procedures were included. Of these, 246 (52.7%) utilized UAS. The follow-up ranged from 1 week to 1 month. UAS reduced the incidence of postoperative fever (RR 0.49; 95% confidence interval [CI] 0.29-0.84; p=0.009), and postoperative infection (RR 0.50; 95% CI 0.30-0.83; p=0.008). There were no significant differences between groups in terms of SFR (RR 1.05; 95% CI 0.99-1.11; p=0.10), ureteral injuries (RR 1.29; 95% CI 0.95-1.75; p=0.11), operative time (MD 3.56 minutes; 95% CI −4.15 to 11.27 minutes; p=0.36), or length of stay (MD 0.32 days; 95% CI −0.42 to 1.07 days; p=0.40). Conclusion: UAS leads to a lower rate of post-operative fever and infection. However, UAS did not significantly reduce or increase the SFR or the rate of ureteral injuries during RIRS for patients with urolithiasis. The use of UAS should be considered to decrease the risk of infectious complications, particularly in those who may be at higher risk for such complications.

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.

Robot-assisted radical nephroureterectomy using the KangDuo Surgical Robot-01 System versus the da Vinci System: a multicenter prospective randomized controlled trial

ABSTRACT Introduction: We aim to compare the safety and effectiveness of the KangDuo (KD)-Surgical Robot-01 (KD-SR-01) system and the da Vinci (DV) system for robot-assisted radical nephroureterectomy (RARNU). Materials and Methods: This multicenter prospective randomized controlled trial was conducted between March 2022 and September 2023. Group 1 included 29 patients undergoing KD-RARNU. Group 2 included 29 patients undergoing DV-RARNU. Patient demographic and clinical characteristics, perioperative data, and follow-up outcomes were collected prospectively and compared between the two groups. Results: There were no significant differences in patient baseline demographic and preoperative characteristics between the two groups. The success rates in both groups were 100% without conversion to open or laparoscopic surgery or positive surgical margins. No significant difference was observed in docking time [242 (120-951) s vs 253 (62-498) s, P = 0.780], console time [137 (55-290) min vs 105 (62-220) min, P = 0.114], operative time [207 (121-460) min vs 185 (96-305) min, P = 0.091], EBL [50 (10-600) mL vs 50 (10-700) mL, P = 0.507], National Aeronautics and Space Administration Task Load Index scores, and postoperative serum creatinine levels between the two groups. None of the patients showed evidence of distant metastasis, local recurrence, or equipment-related adverse events during the four-week follow-up. One (3.4%) patient in Group 2 experienced postoperative enterovaginal and enterovesical fistulas (Clavien-Dindo grade III). Conclusions: The KD-SR-01 system is safe and effective for RARNU compared to the DV Si or Xi system. Further randomized controlled studies with larger sample sizes and longer durations are required.

Abdominal complications of ascariasis in childhood

Abstract Objective Complications of ascariasis are a significant cause of abdominal pain in pediatric emergencies, especially where it is endemic. A literature review was conducted with the aim of improving diagnostic and therapeutic approaches for these patients. Data sources A PubMed search was conducted using the key terms "ascariasis complications" and "hepatobiliary ascariasis". The search strategy included meta-analyses, randomized controlled trials, clinical trials, observational studies, case reports, and reviews published up to December 2023. Summary of findings Obstruction of the small bowel is the most common complication. Others that are, rarer and more difficult to properly identify and treat, such as biliary, hepatic, and pancreatic complications, acute appendicitis, Meckel's diverticulitis, or peritoneal granulomas. Hepatic and pancreatic complications are rarer and more serious in children than in adults. While plain radiography is usually the only option in cases of intestinal obstruction, ultrasonography is the examination of choice in cases of hepatobiliary, pancreatic, and appendicular ascariasis complications in childhood. The treatment is clinical and conservative in most patients. Surgical treatment is indicated if conservative therapy fails, or if there are signs of complications. Laparoscopy has been used as an excellent technical alternative in adults with hepatobiliary complications of ascariasis, but further studies on its use in children are still needed. Conclusion The creation of protocols and greater debate on this subject should be encouraged for a better understanding of the disease and to establish an early diagnosis and adequate treatment for children with complications resulting from massive infestation by Ascaris lumbricoides.

Incidence of aortic valve reintervention in patients with aortic stenosis undergoing transcatheter aortic valve implantation versus surgical aortic valve replacement: a systematic review and updated meta-analysis of randomized studies.

INTRODUCTION: Transcatheter aortic valve implantation (TAVI) and surgical aortic valve replacement (SAVR) are established interventions for alleviating symptoms and enhancing survival in individuals with severe aortic stenosis (AS). However, the long-term outcomes and incidence of reintervention associated with TAVI and SAVR remain uncertain. METHODS: We conducted a systematic review and meta-analysis to compare the incidence of reintervention in TAVI versus SAVR. PubMed, Embase, and Cochrane databases were searched for randomized controlled trials (RCTs). Risk ratios (RR) and 95% confidence intervals (CI) were pooled with a random-effects model. A p-value < 0.05 was considered statistically significant. RESULTS: Nine RCTs were included, with 5144 (50.9%) patients randomized to TAVI. Compared with SAVR, TAVI increased reinterventions (RR 1.89; 95% CI 1.29-2.76; p < 0.01) and the need for pacemakers (RR 1.91; 95% CI 1.49-2.45; p < 0.01). In addition, TAVI significantly reduced the incidence of new-onset atrial fibrillation (RR 0.43; 95% CI 0.32- 0.59; p < 0.01). There were no significant differences in all-cause mortality (RR 1.04; 95% CI 0.92-1.16; p = 0.55), cardiovascular mortality (RR 1.04; 95% CI 0.94-1.17; p = 0.44), stroke (RR 0.97; 95% CI 0.80-1.17; p = 0.76), endocarditis (RR 0.96; 95% CI 0.70-1.33; p = 0.82), and myocardial infarction (RR 1.06; 95% CI 0.79-1.41; p = 0.72) between groups. CONCLUSIONS: In patients with severe AS, TAVI significantly increased the incidence of reinterventions and the need for pacemakers as compared with SAVR.

Prognostic nutritional index as a predictor of surgical complications in women with gynecological cancer.

OBJECTIVE: To analyze the association between the prognostic nutritional index and surgical morbidity in women with gynecologic cancers. METHODS: This is a retrospective cohort study of women with ovarian, endometrial, or cervical cancer who underwent surgery between January 2013 and December 2020 at a cancer center. Demographic and clinical data were extracted from electronic medical records. The prognostic nutritional index was calculated during the immediate pre-operative period. Binomial logistic regression was conducted to identify the association of the prognostic nutritional index with the outcome of surgical complications after Clavien-Dindo classification, adjusting for confounding variables. RESULTS: A total of 1000 women were included: 114 (11.4%) were diagnosed with cervical cancer, 551 (55.1%) with ovarian cancer, and 335 (33.5%) with endometrial cancer. Patients with a prognostic nutritional index >40 had a decreased possibility of surgical complications (OR=0.39, 95% CI 0.29 to 0.52); basal blood hemoglobin, volume of surgical bleeding, operative time, and length of hospital stay were also explanatory factors. The prognostic nutritional index has a significant effect on patients with endometrial and cervical cancer, but conversely is not significant in patients with ovarian cancer. CONCLUSION: The prognostic nutritional index is associated with surgical morbidity in endometrial and cervical cancers and thus can be a useful tool for predicting morbidity and guide pre-operative interventions in patients with gynecological cancers.

Learning Styles of Medical Students, Surgical Residents, Medical Staff, and General Surgery Teachers When Learning Surgery: Protocol for a Scoping Review.

BACKGROUND: Learning styles are biological and developmental configurations of personal characteristics that make the same teaching method effective for some and ineffective for others. Studies support a relationship between learning style and career choices in medicine, resulting in learning style patterns being observed in different residency programs, including in general surgery, from medical school to the last stages of training. The methodologies, populations, and contexts of the few studies pertinent to the matter are very different from one another, and a scoping review on this theme will enhance and organize what is already known. OBJECTIVE: The goal of this study is to identify and map out data from studies on the learning styles of medical students, surgical residents, medical staff, and surgical teachers. METHODS: The review will consider studies on the learning styles of medical students in a clinical cycle or internship, surgical residents with no restriction on year of residency, medical staff in general surgery, or general surgery's medical faculty. Primary studies published in English, with no specific time frame, will be considered. The search will be carried out in four databases, and reference lists will be searched for additional studies. Duplicates will be removed, and two independent reviewers will screen the titles, abstracts, and full texts of the selected studies. Data collection will be performed using a tool developed by the researchers. A results summary will be presented with figures, narratives, and tables. A quantitative and qualitative analysis will be carried out and further results will be shared. RESULTS: The search was funded on September 25, 2023. Data collection was performed in the two following months. Of the 213 articles found, 135 were excluded due to duplication. The remaining 78 articles will have their titles and abstracts analyzed by three of the researchers independently to select those that meet the eligibility criteria. This data is expected to be published in the first semester of 2025. CONCLUSIONS: Conducting a scoping review is the best way to map what is known about a subject. Understanding how students, residents, staff, and even teachers prefer to learn surgery is key to staying up to date and knowing how to best educate those pursuing a surgical career. TRIAL REGISTRATION: Open Science Framework 75ku4; https://osf.io/75ku4. INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID): DERR1-10.2196/57229.

IMPACT OF THE COVID-19 PANDEMIC ON EMERGENCY UPPER LIMB SURGERIES IN A QUATERNARY HOSPITAL.

The COVID-19 pandemic has triggered a global crisis in health systems worldwide. Emergency care services have been overloaded, and there have been different changes in the patient's profile and the most frequent diagnoses. The aim of the study was to compare the number of emergency surgeries in the Hand and Microsurgery group of the quaternary hospital (IOT-FMUSP) from March 2020 to February 2022, the pandemic period, with the previous two years, March 2018 to February 2020. Two hundred and seventy-two patients were evaluated, with a mean age of 39.54 ± 17 years (range 1 to 90 years), 12.50% (n = 34) women and 87.50% (n = 238) men. Between March 2018 and February 2020, 142 (52.21%) emergency upper limb surgeries were performed; between March 2020 and February 2022, 130 surgeries were performed (47.79%). There was a reduction in upper limb surgeries in patients between 26-45 years and blunt injury surgeries. There was also an increase in surgeries in patients over 46, amputations, fractures, re-implantation procedures, and open fracture fixation. Level of evidence III, Retrospective Comparative Study.

A pandemia por COVID-19 desencadeou uma crise global nos sistemas de saúde ao redor do mundo. Serviços de atendimento de urgência sofreram sobrecarga e diferentes mudanças no perfil do paciente atendido bem como dos diagnósticos mais frequentes. O objetivo do estudo foi comparar o número de cirurgias de urgência, no grupo de Mão e Microcirurgia, do hospital quaternário (IOT-FMUSP) ocorridos de março de 2020 a fevereiro de 2022, período pandêmico; com os dois anos anteriores, de março de 2018 a fevereiro de 2020. No total foram avaliados 272 pacientes com idade média de 39,54 ± 17 anos (variação 1 a 90 anos), sendo 12,50% (n = 34) de mulheres e 87,50 % (n = 238) de homens. Entre março de 2018 a fevereiro de 2020 foram realizadas 142 (52,21%) cirurgias de urgência em membro superior e de março de 2020 a fevereiro de 2022, 130 cirurgias foram realizadas (47,79%). Identificou-se redução do número de cirurgias em membro superior em pacientes entre 26-45 anos e do número de cirurgias por ferimentos corto contusos. Além do aumento no número de cirurgias em pacientes acima de 46 anos, número de casos de amputações, fraturas, procedimentos de reimplante e fixação por fraturas expostas. Nível de evidência III, Estudo restrospectivo comparativo.

PREGABALIN AS A PREOPERATIVE ADJUVANT IN PATIENTS WITH CARPAL TUNNEL SYNDROME.

Objective: To evaluate the pregabalin adjuvant effect in patients with carpal tunnel syndrome (CTS) surgically treated, analyzing postoperative pain and the incidence of complex regional pain syndrome (CRPS). Methods: Outpatient surgical candidates with CTS were selected and followed for 12 months, divided into three groups. The Control Group received a placebo, the Pregabalin 75mg Group received a daily dose, and the Pregabalin 150mg Group received a daily dose of the medication. Patient progress was evaluated using the visual analog scale (VAS) for pain and the DN4 neuropathic pain score before surgery, one month and three months after. Results: The administration of pregabalin to surgical patients with CTS did not demonstrate significant differences in immediate postoperative pain relief. Additionally, there were no statistically significant variations in the incidence of complications, such as CRPS, among the groups. Conclusion: This study did not show a significant impact of pregabalin on postoperative pain relief or the reduction of CRPS incidence in patients undergoing surgery for CTS. These results suggest that pregabalin might not be an effective adjuvant in these surgical situations. Level of evidence II (Oxford), Prospective Comparative Study.

Objetivo: Avaliar o efeito adjuvante da pregabalina em pacientes com síndrome do túnel do carpo (STC) tratados cirurgicamente, analisando a dor pós-operatória e a incidência da síndrome da dor complexa regional (SDCR). Métodos: Foram selecionados pacientes com acompanhamento ambulatorial e indicação de tratamento cirúrgico para STC, sendo acompanhados ao longo de 12 meses e divididos em três grupos. O Grupo Controle recebeu placebo, o Grupo Pregabalina 75 mg tomou uma dose diária da medicação citada e o Grupo Pregabalina 150 mg também recebeu uma dose diária da medicação, em maior quantidade. A evolução dos pacientes foi avaliada mediante aplicação da escala visual analógica de dor (EVA) e escore de dor neuropática DN4 antes da cirurgia, um mês e três meses após essa. Resultados: A administração de pregabalina em pacientes cirúrgicos com STC não demonstrou diferenças significativas no alívio da dor pós-operatória imediata. Além disso, não houve variações estatisticamente significativas na incidência de complicações, como a SDCR, entre os grupos. Conclusão: Este estudo não evidenciou um impacto significativo da pregabalina no alívio da dor pós-operatória ou na redução da incidência da SDCR em pacientes submetidos a cirurgia para STC. Estes resultados sugerem que a pregabalina pode não ser um adjuvante eficaz nessas situações cirúrgicas. Nível II de Evidência (Oxford), Estudo prospectivo comparativo.

Experience of endoscopy versus surgery as initial management of chronic pancreatitis.

INTRODUCTION AND AIM: Chronic pancreatitis is a pathologic fibroinflammatory syndrome of the pancreas. Treatment includes medical management and endoscopic and/or surgical interventions. Our aim was to describe progression in patients with chronic pancreatitis whose initial management was either endoscopic or surgical. MATERIAL AND METHODS: A retrospective, analytic, observational, and longitudinal study was conducted that included patients diagnosed with chronic pancreatitis treated at the Hospital de Especialidades of the Centro Médico Nacional Siglo XXI from 2015 to 2021. RESULTS: Twenty-two patients were included in the study; 12 underwent endoscopy and 10 underwent surgery. The mean number of interventions performed was 3 in the endoscopic management group and 1.1 in the surgical management group (p = 0.001). Regarding pain remission (partial or total), results were statistically significant in favor of surgical management (p = 0.035). Of the 12 patients that initially underwent endoscopy, 7 (58.3%) eventually required surgery during follow-up. There were no statistically significant differences with respect to opioid and pancreatin use, readmissions, weight loss, steatorrhea, newly diagnosed diabetes, or deaths during follow-up. CONCLUSION: Pain is the main indication for invasive treatment, whether endoscopic or surgical, in patients with chronic pancreatitis. Slightly more than half of the patients that were initially managed endoscopically required surgery during follow-up. Management decisions should be multidisciplinary and individualized for each patient.

Morbidity associated with emergency surgery versus scheduled surgery in patients with placenta accreta spectrum.

Objective: This study aims to evaluate the clinical outcomes of surgical management for placenta accreta spectrum in a Latin American reference hospital specializing in this condition. The evaluation involves a comparison between surgeries performed on an emergent and scheduled basis. Methods: A retrospective cohort study was conducted on patients with placenta accreta spectrum who underwent surgery between January 2011 and November 2021 at a hospital in Colombia, using data from the institutional PAS registry. The study included patients with intraoperative and/or histological confirmation of PAS, regardless of prenatal suspicion. Clinical outcomes were compared between patients who had emergent surgeries and those who had scheduled surgeries. Descriptive analysis involved summary measures and the Shapiro-Wilk test for quantitative variables, with comparisons made using Pearson's Chi-squared test and the Wilcoxon rank sum test, applying a significance level of 5%. Results: A total of 113 patients were included, 84 (74.3%) of them underwent scheduled surgery, and 29 (25.6%) underwent emergency surgery. The emergency surgery group required more transfusions (72.4% vs 48.8%, p=0.047). Patients with intraoperative diagnosis of placenta accreta spectrum (21 women, 19.5%) had a greater volume of blood loss than patients taken into surgery with known presence of placenta accreta spectrum (3500 ml, IQR 1700 - 4000 vs 1700 ml, IQR 1195-2135. p <0.001). Conclusion: Patients with placenta accreta spectrum undergoing emergency surgery require transfusions more frequently than those undergoing scheduled surgery.

Immediate prepectoral versus submuscular breast reconstruction in nipple-sparing mastectomy: a retrospective cohort analysis.

Objective: To evaluate early complications in prepectoral breast reconstruction. Methods: A retrospective cohort study including 180 consecutive cases of nipple-sparing mastectomy, comparing immediate breast reconstruction with subpectoral to prepectoral mammary implants in 2012-2022. Clinical and demographic characteristics and complications in the first three months following surgery were compared between the two techniques. Results: The prepectoral technique was used in 22 cases (12.2%) and the subpectoral in 158 (87.8%). Median age was higher in the prepectoral group (47 versus 43.8 years; p=0.038), as was body mass index (25.1 versus 23.8; p=0.002) and implant volume (447.5 versus 409 cc; p=0.001). The prepectoral technique was more associated with an inframammary fold (IMF) incision (19 cases, 86.4% versus 85, 53.8%) than with periareolar incisions (3 cases, 13.6% versus 73, 46.2%); (p=0.004). All cases in the prepectoral group underwent direct-to-implant reconstruction compared to 54 cases (34.2%) in the subpectoral group. Thirty-eight complications were recorded: 36 (22.8%) in the subpectoral group and 2 (9.1%) in the prepectoral group (p=0.24). Necrosis of the nipple-areola complex/skin flap occurred in 27 patients (17.1%) in the subpectoral group (prepectoral group: no cases; p=0.04). The groups were comparable regarding dehiscence, seroma, infection, and hematoma. Reconstruction failed in one case per group (p=0.230). In the multivariate analysis, IMF incision was associated with the prepectoral group (aOR: 34.72; 95%CI: 2.84-424.63). Conclusion: The incidence of early complications was comparable between the two techniques and compatible with previous reports. The clinical and demographic characteristics differed between the techniques. Randomized clinical trials are required.

Patient positioning in minimally invasive gynecologic surgery: strategies to prevent injuries and improve outcomes.

Effective patient positioning is a critical factor influencing surgical outcomes, mainly in minimally invasive gynecologic surgery (MIGS) where precise positioning facilitates optimal access to the surgical field. This paper provides a comprehensive exploration of the significance of strategic patient placement in MIGS, emphasizing its role in preventing intraoperative injuries and enhancing overall surgical success. The manuscript addresses potential complications arising from suboptimal positioning and highlights the essential key points for appropriate patient positioning during MIGS, encompassing what the surgical team should or shouldn't do. In this perspective, the risk factors associated with nerve injuries, sliding, compartment syndrome, and pressure ulcers are outlined to guide clinical practice. Overall, this paper underscores the critical role of precise patient positioning in achieving successful MIGS procedures and highlights key principles for the gynecological team to ensure optimal patient outcomes.

The top hat procedure does not impact the management of women treated by LEEP in cervical cancer screening.

Objective: To describe Top-hat results and their association with margin status and disease relapse in a referral facility in Brazil. Methods: A retrospective study of 440 women submitted to LEEP to treat HSIL, in which 80 cases were complemented immediately by the top hat procedure (Top-hat Group - TH). TH Group was compared to women not submitted to Top-hat (NTH). The sample by convenience included all women that underwent LEEP from January 2017 to July 2020. The main outcome was the histological result. Other variables were margins, age, transformation zone (TZ), depth, and relapse. The analysis used the Chi-square test and logistic regression. Results: The TH Group was predominantly 40 and older (NTH 23.1% vs. TH 65.0%, p<0.001). No difference was found in having CIN2/CIN3 as the final diagnosis (NTH 17.0% vs. TH 21.3%, p=0.362), or in the prevalence of relapse (NTH 12.0% vs. TH 9.0%, p=0.482). Of the 80 patients submitted to top hat, the histological result was CIN2/CIN3 in eight. A negative top hat result was related to a negative endocervical margin of 83.3%. A CIN2/CIN3 Top-hat result was related to CIN2/CIN3 margin in 62.5% (p=0.009). The chance of obtaining a top hat negative result was 22.4 times higher (2.4-211.0) when the endocervical margin was negative and 14.5 times higher (1.5-140.7) when the ectocervical margin was negative. Conclusion: The top hat procedure did not alter the final diagnosis of LEEP. No impact on relapse was observed. The procedure should be avoided in women of reproductive age.

Fontes de energia externa no contorno corporal / External energy sources in body contouring

Durante a 39a Jornada Sulbrasileira de Cirurgia Plástica, em abril de 2024, um debate acalorado surgiu em torno da divulgação do uso de tecnologias para cirurgia de contorno corporal nas redes sociais. Um importante questionamento foi feito: elas estão sendo divulgadas prematuramente nas redes sociais antes de serem rigorosamente avaliadas? A frase do Dr. Ian Malcolm, célebre criação de Michael Chrichton, "Vou te dizer o problema com o poder que você está usando aqui, ele não exigiu nenhuma disciplina para obtê-lo" se aplica perfeitamente a essa situação. A divulgação de técnicas em redes sociais deveria exigir a mesma disciplina rigorosa que a pesquisa científica. A ausência de protocolos de pesquisa aprovados pelo Conselho Nacional de Ética em Pesquisa e de publicações de alto nível de evidência em revistas revisadas por pares levanta preocupações. O poder de aprimorar nossos resultados com o uso dessas fontes de energia externa é real e seu uso consiste em um grande avanço dentro da cirurgia plástica. No entanto, é imperativo que os cirurgiões plásticos exerçam cautela ao promover novas tecnologias. A disciplina científica deve ser o alicerce de qualquer avanço, e a divulgação responsável deve preceder a popularização. Somente assim, poderemos garantir que os pacientes se beneficiem de tratamentos seguros e eficazes, sem comprometer a integridade da nossa especialidade.

During the 39th South Brazilian Plastic Surgery Conference, in April 2024, a heated debate arose regarding the promotion of the use of technologies for body contouring surgery on social media. An important question was raised: are they being prematurely promoted on social media before being rigorously evaluated? The quote from Dr. Ian Malcolm, a famous creation of Michael Chrichton, "I'll tell you the problem with the power you're using here, it didn't require any discipline to attain it" applies perfectly to this situation. Promoting techniques on social media should require the same rigorous discipline as scientific research. The absence of research protocols approved by the National Research Ethics Council and high-level evidence publications in peer- reviewed journals raises concerns. The power to enhance our results using these external energy sources is real, and its use represents a significant advancement within plastic surgery. However, it is imperative that plastic surgeons exercise caution when promoting new technologies. Scientific discipline should be the foundation of any advancement, and responsible disclosure should precede popularization. Only then can we ensure that patients benefit from safe and effective treatments without compromising the integrity of our specialty.

Association between sociodemographic variables and delayed patient presentation among surgical neuro-oncology patients in Mexico City: a single institution experience.

PURPOSE: Mexico has the second highest incidence of central and peripheral nervous system cancer cases in Latin America, but clinical and research resources to improve oncologic care are biased towards high-income countries. We carried out a retrospective study to identify sociodemographic factors associated with more severe clinical presentation among surgical neuro-oncology who underwent surgery at a major public referral hospital in Mexico City. METHODS: The hospital electronic medical record was reviewed to identify all surgical neuro-oncology patients who underwent surgery between January 1 and December 31, 2022. Descriptive statistics were used to characterize the patient population and outcomes; statistical analysis was performed to determine association between sociodemographic variables and advanced clinical presentation. RESULTS: A total of 366 neuro-oncology patients underwent surgery during the study period. The median patient age was 48 (IQR 17-83). The majority of patients were female (60.1, n = 220), single (51.4%, n = 188), and 29.2% (n = 107) endorsed being the primary provider for their family. The median number of dependents per patient was 4 (IQR 2-50), while the median monthly income was 10269 Mexican pesos (MXN) (IQR 2000-13500] and the median travel distance to INNN was 49 km (IQR 22-174). On multivariate analyses, having a higher number of dependents was associated with increased odds of presenting with longer symptom duration (p = 0.01). Divorced/separated status was associated with increased odds of presenting with tumors > 35mL in volume (p = 0.04). Primary provider (p = 0.01) and higher average monthly income (p = 0.03) was associated with decreased odds of presenting with tumors > 35mL. CONCLUSIONS: This is the first study to recognize that certain sociodemographic factors are associated with more severe clinical presentation among surgical neuro-oncology patients. Further studies are needed in order to decern specific causes for delayed presentation in this patient population in order to create targeted interventions and decrease delays in care.

Case report: persistent bilateral complete sciatic artery associated with aneurysmal degeneration.

Persistent sciatic artery is a rare congenital anomaly, with few cases described in the literature. This study presents a case of this embryological variation observed in a patient's lower limb circulatory system. The anatomical description is based on a review of medical records and imaging exams. This case report describes a 63-year-old female patient admitted to the emergency department complaining of severe pain in the right lower limb, with a cold, pale extremity and ecchymosis on the dorsum of the foot. Duplex ultrasound showed no detectable flow in the anterior tibial and fibular arteries and a tardus parvus pattern in the posterior tibial artery. The patient developed loss of movement and fixed cyanosis in the right foot and was referred for urgent thromboembolectomy. However, adequate reperfusion was not seen after the procedure. Angiotomography was performed on the first postoperative day, showing bilateral persistence of the sciatic artery, with aneurysmal degeneration, partially thrombosed, and no opacification of the arterial system downstream of the aneurysm. By the third postoperative day, the patient had developed areas of dry necrosis in the limb, with no perfusion to the ankle, and underwent transfemoral amputation. Despite being a rare condition, it is of great clinical importance because of the high complication rates.

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

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.