A Retrospective Comparative Study of Endoscopic Treatment of Gastrocnemius Contracture using the Modified Soft Tissue Release Kit.

Background and Objectives: This study aimed to evaluate the effectiveness and safety of endoscopic gastrocnemius recession using the self-developed Modified Soft Tissue Release Kit. Materials and Methods: This retrospective review followed up 22 patients (34 feet) who underwent endoscopic surgery and 20 patients (30 feet) who received open surgery between January 2020 and January 2022. The American Orthopedic Foot and Ankle Society (AOFAS) ankle-hindfoot score and the maximum ankle dorsiflexion angle were evaluated preoperatively and at the last follow-up. Postoperative complications were recorded. Patient satisfaction was surveyed at the last follow-up. The comparison between quantitative data was analyzed with the Wilcoxon signed-rank test. The comparison between qualitative data was analyzed with the chi-square test. Results: There was no significant difference in the baseline characteristics between the two groups. The AOFAS score in the endoscopic group increased from 50 (18) points preoperatively to 90 (13) points at the last follow-up; the maximum ankle dorsiflexion angle increased from -7.7 (2.8) degrees to 10.6 (3.6) degrees. The AOFAS score in the open group improved from 47 (15) points preoperatively to 90 (18) points at the last follow-up; the maximum ankle dorsiflexion angle increased from -7.6 (4.0) degrees to 10.7 (3.3) degrees. The change values of the AOFAS scores in the endoscopic and open groups were 39 (15) and 40.5 (11) points, respectively, and there was no significant difference between them. The change values of the maximum ankle dorsiflexion angles in the endoscopic and open groups were 19.5 (4.3) and 19.1 (4.9) degrees, respectively, and there was no significant difference between them. There were no complications, such as sural nerve injury, in both groups. There was no significant difference between the two groups in satisfaction with the surgical outcome. Conclusions: Endoscopic gastrocnemius recession using the Modified Soft Tissue Release Kit can significantly improve the foot function with significant mid-term efficacy and high safety.

Precise Control of Customized Macrophage Cell Robot for Targeted Therapy of Solid Tumors with Minimal Invasion.

Injecting micro/nanorobots into the body to kill tumors is one of the ultimate ambitions for medical nanotechnology. However, injecting current micro/nanorobots based on 3D-printed biocompatible materials directly into blood vessels for targeted therapy is often difficult, and mistakes in targeting can cause serious side effects, such as blood clots, oxidative stress, or inflammation. The natural affinity of macrophages to tumors, and their natural phagocytosis and ability to invade tumors, make them outstanding drug delivery vehicles for targeted tumor therapy. Hence, a magnetically controlled cell robot (MCR) based on a macrophage drug carrier is proposed. Here, living macrophages are converted into MCRs through endocytosis of specially-designed magnetic nanoparticles loaded with doxorubicin and indocyanine green. Following this, the MCRs can be transported to tumors through the blood vessels using external magnetic fields, and penetrate the blood vessels into the interior of the tumor due to their deformability. With the MCR's cascaded drug release, targeted killing of tumors in mice is demonstrated, with minimal effects on the normal surrounding tissue. The ability to impart precise drug doses onto natural cells, such as macrophages, and load various functional components into the MCRs, offers an efficient method for precise targeted therapy.

Biomechanical comparison of three minimally invasive fixations for unilateral pubic rami fractures.

BACKGROUND: To compare the mechanical characteristics of a percutaneous superior pubic intramedullary screw, percutaneous bridging plate and percutaneous screw-rod system of the anterior ring for the treatment of unilateral vertical pubic fractures to provide a reference for clinical application. METHODS: A finite element model of pelvic anterior ring injury (unilateral vertical pubic fracture) was produced. The fractures were fixed with a percutaneous superior pubic intramedullary screw, percutaneous bridging plate and percutaneous screw-rod system of the anterior ring and their combinations in 5 types of models. The fracture stabilities under vertical, bilateral and anterior-posterior load were quantified and compared based on the displacement of the hip joints' midpoint as quantificational index of fracture stability. RESULTS: In the condition of bilateral and anterior-posterior load, the vertical, bilateral and anterior-posterior displacements of the hip joints' midpoint of different models were significantly different respectively. In general, the displacements of the 5 pelvic anterior ring fixations were ranked from maximum to minimum as follows: bridging plate, pelvic anterior screw-rod system, combination of bridging plate and pelvic anterior screw-rod system, superior pubic intramedullary screw and combination of superior pubic intramedullary screw and pelvic anterior screw-rod system. CONCLUSION: For the fixation in unilateral pubic fractures of pelvic ring injury, the percutaneous superior pubic intramedullary screw is optimal, the percutaneous pelvic anterior screw-rod system is the second choice, and percutaneous bridging plate ranks the third. The percutaneous pelvic anterior screw-rod system can significantly increase fixation stability of the percutaneous superior pubic intramedullary screw and the percutaneous bridging plate.

[Study on the precision of the robot-assisted sacroiliac screw placement].

Objective: To evaluate the precision of the robot-assisted sacroiliac screw placement for posterior pelvis injury and the impacting factors. Methods: The clinical data of twenty-four cases of posterior pelvic fractures treated by percutaneous sacroiliac screw placement in Yantai shan Hospital from August 2016 to May 2018 were studied retrospectively. There were 17 males and 7 females with a mean age of 44.1 years (ranged from 17 to 71 years). According to AO classification, 17 cases were type B fractures (9 cases of type B1 and 8 type B2), and 7 cases were type C factures (3 cases of type C1, 2 type C2 and 2 type C3). All cases were treated by robot-assisted percutaneous sacroiliac screw placement (AO cannulated screws with a diameter of 7.3 mm). In the posterior pelvic surgeries for the 24 cases, 26 S(1) sacroiliac screws fixations and 18 S(2) sacroiliac screw fixations were placed in total, with single S(1) segmental fixation in 8 cases, single S(2) segmental fixation in 3 cases, S(1) and S(2) combined fixation in 13 cases, S(1) unidirectional one-sided fixation in 18 cases, S(1) bidirectional two-sided fixation in 3 cases, S(2) unidirectional one-sided fixation in 14 cases, S(2) bidirectional two-sided fixation in 2 cases and S(1) unidirectional double screws fixation in 2 cases. X-ray and CT examinations were taken for all 24 cases after operation. The visual analogue scale (VAS) of pain were performed before and after the operation. Results: All the sacroiliac screws were successfully implanted at once as planned with the assistance of the robot. The postoperative X-ray films and CT showed that none of the sacroiliac screws broke through the sacral body and the contralateral sacral wing's frontal cortex nor did they stray into the sacral canal and the intervertebral space. In 3 cases, the sacroiliac screws went closely against and wore out the front edge of iliac cortical density line and sacral alar slope and finally re-entered the sacral body. In 3 cases, sacroiliac screws touched upon the sacral nerve canals but did not break through the nerve canals. The mean VAS of pain was improved from 7.1 points (4-10 points) before the operation to 1.9 points (0-3 points) after. Conclusions: The robot-assisted sacroiliac screw placement shows high precision, and hence is worthy of clinical promotion; however the primary role of the surgeon could not be replaced.

Arthroscopic reduction of an irreducible distal radioulnar joint in Galeazzi fracture-dislocation due to a fragment of the ulnar styloid: a case report.

BACKGROUND: There are only a few published case reports of irreducible Galeazzi fracture-dislocation, and patients in these studies had undergone reduction by open surgical methods. Arthroscopy for the distal radioulnar joint of the wrist joint has recently been used for wrist pathology. We aim to describe the surgical procedure involved in arthroscopic reduction of irreducible Galeazzi fracture-dislocation and clinical outcome and review the literature. CASE PRESENTATION: We present the case of a 26-year-old man, a professional athlete, who sustained Galeazzi fracture-dislocation during a bicycle race. The distal radioulnar joint was irreducible because the fragment of the ulnar styloid was trapped between the sigmoid notch and ulnar head after a doctor had previously reduced it manually. Operative treatment was performed using a 30° oblique, 1.9-mm arthroscope. Reduction of the fragment of the ulnar styloid was achieved using distal radioulnar joint arthroscopy. The metaphyseal and intra-articular fracture of the radius and the fragment of the ulnar styloid were fixed using a volar locking plate and tension band wiring technique, respectively. A daily injection of parathyroid hormone and low-intensity pulsed ultrasound were used postoperatively. The patient was asymptomatic and returned to the preinjury level of athletic activity 2 months postoperatively, and bone union of the radius and ulna was achieved without distal radioulnar joint instability 15 months postoperatively. CONCLUSIONS: Less invasive reduction of the dorsal anatomical structure enabled our patient to return early to sports. We consider arthroscopic reduction to be superior to the open surgical method in terms of evaluating interpositions; additionally, arthroscopic reduction is minimally invasive and does not need immobilization because it does not cause significant damage to the dorsal capsule and subsheath of the extensor carpi ulnaris, which comprise the triangular fibrocartilage complex.

[Robot assisted sacroiliac screw placement with a modified method of screw path planning].

Objective: To introduce a robot-assisted modified method of sacroiliac screw path planning in order to reduce the incidence of screw misplacement. Methods: The study involved 13 patients suffering from posterior pelvic injuries treated by percutaneous sacroiliac screw in Yantai Shan Hospital from August 2016 to May 2018. The patients included 9 males and 4 females, aged from 18 to 70 years (mean age 46.2 years). Causes of injury were traffic accidents (n=7), crushing injury (n=4) and fall from height (n=2). According to AO classification, 8 cases were classified with type B fractures (3 with type B1 and 5 with type B2), and 5 cases with type C fractures (2 with type C1, 1 with type C2, 2 with type C3). All the patients were treated by robot-assisted percutaneous sacroiliac screws (AO cannulated screws with a diameter of 7.3 mm) with an improved method of screw path planning. The screw placement time, blood loss, postoperative neurological, vascular and visceral function etc were observed. X-ray and CT were checked in the follow-up after the operation. Visual analogue scale (VAS) score was used to assess the pain degree of patients one week after the surgery. Results: All the sacroiliac screws were successfully implanted once with the robot-assisted improved method of screw path planning. The mean placement time of single screw was 15.9 min and the mean blood loss for single screw placement was less than 1 ml. No clinical manifestations of injuries of blood vessels, internal organs and lumbosacral nerve was found after the operation. The postoperative X-ray films and CT showed that none of the sacroiliac screws wore out the sacral body or the sacral wing's frontal cortex. Also, it was found that none of the sacroiliac screws strayed into the sacral canal and the intervertebral space. The mean VAS score decreased from preoperative 6.9 (4-10) to postoperative 1.8(0-3). Conclusion: The robot-assisted improved method of screw path planning contributes to safe and accurate sacroiliac screw placement.

Application of a real-time three-dimensional navigation system to various oral and maxillofacial surgical procedures.

The aim of this study was to confirm the effectiveness of a real-time three-dimensional navigation system for use during various oral and maxillofacial surgeries. Five surgeries were performed with this real-time three-dimensional navigation system. For mandibular surgery, patients wore acrylic surgical splints when they underwent computed tomography examinations and the operation to maintain the mandibular position. The incidence of complications during and after surgery was assessed. No connection with the nasal cavity or maxillary sinus was observed at the maxilla during the operation. The inferior alveolar nerve was not injured directly, and any paresthesia around the lower lip and mental region had disappeared within several days after the surgery. In both maxillary and mandibular cases, there was no abnormal hemorrhage during or after the operation. Real-time three-dimensional computer-navigated surgery allows minimally invasive, safe procedures to be performed with precision. It results in minimal complications and early recovery.

Salivary duct carcinoma and the concept of early carcinoma ex pleomorphic adenoma.

AIMS: The data on the histological type of carcinomatous component and the extent of extracapsular invasion for salivary carcinomas ex pleomorphic adenoma (PA) are conflicting. We aimed to determine the prognostic value of extracapsular invasion in salivary duct carcinomas (SDC) ex PA. METHODS AND RESULTS: A total of 117 patients with SDC were identified retrospectively; 44 cases involving major salivary glands had pre-existing PA (44 of 117, 37%). The morphological spectrum of SDC ex PA was characterized. The primary endpoint was overall survival (OS). Most SDC ex PA were widely invasive at presentation (27 of 44; 61%). Five patients with intracapsular SDC ex PA experienced no disease progression. The assessment of extracapsular invasion was precluded in eight cases (e.g. positive margins of resection). The rate of lymph node involvement was similar in cases with extracapsular invasion of ≤2 mm (two of three) and >7 mm (22 of 26). Only pT correlated with OS [116 months, 95% confidence interval (CI) 22-210 months for pT1 versus 20 months (95% CI 6-34) for pT4; P = 0.013]. CONCLUSIONS: Intracapsular SDC ex PA are potentially indolent. SDC ex PA with extracapsular invasion of ≤2 mm are rare, and appear to be clinically aggressive. Several histological parameters preclude assessment of extracapsular invasion.

Smile Renewal: Incisor Restoration Using the Strip Crown Technique.

Aesthetics has been an important aspect of dentistry along with functionality for decades but its significance is at an all-time high. Hence among techniques that contribute toward this goal, strip crown has shown convincing results. However, its acceptance did not reach its potential, especially among general dentists which could be attributed to its technique-sensitive nature. This case report sheds light on the practicality and reliability of this technique along with various modifications made by authors while striving to improve the quality of treatment provided by the clinician.

A Retrospective Clinical Study of Endoscopic Treatment of Carpal Tunnel Syndrome using the Modified Soft Tissue Release kit.

OBJECTIVE: Carpal tunnel syndrome (CTS) is the most common peripheral entrapment neuropathy, and endoscopic carpal tunnel release (ECTR) is one of the minimally invasive procedures for the treatment of CTS. Based on the shortcomings of ECTR, we designed the "Modified Soft Tissue Release Kit" to assist the endoscopic operation. This study aimed to evaluate the effectiveness and safety of endoscopic treatment of CTS using this kit. METHODS: This retrospective review included 57 patients (86 wrists) who underwent ECTR using the "Modified Soft Tissue Release Kit" at our department between January 2017 and August 2019. Three scale scores (i.e., Quick-Disabilities of the Arm, Shoulder, and Hand [QDASH]; Boston Carpal Tunnel Syndrome Questionnaire [BCTSQ]: symptom severity [BCTSQ-SS] and functional status [BCTSQ-FS]) were recorded to assess hand function and symptoms preoperatively, 1 month postoperatively, 3 months postoperatively, and at the last follow-up. We also asked patients to answer a satisfaction question during follow-up. Pre- and post-operation scores were compared using paired Wilcoxon signed-rank test. Spearman's rank-order correlation was used to evaluate the relationship between scale scores and patient satisfaction. RESULTS: A total of 55 patients (83 wrists) were followed up, with an average follow-up of 27.2 ± 9.3 months. The median preoperative QDASH score was 45.5; the scores at 1 month postoperatively, 3 months postoperatively, and the last follow-up were 4.5, 0, and 0, respectively, with a significant decrease noted compared with the preoperative scores (P < 0.001). The median preoperative BCTSQ-SS and BCTSQ-FS scores were 3.3 and 2.8, respectively; the scores at 1 month postoperatively, 3 months postoperatively, and the last follow-up were 1.2, 1.0, and 1.0, and 1.1, 1.0, and 1.0, respectively, all of which decreased significantly compared with the preoperative scores (P < 0.001). The incidence of nerve injury was 0. The incidence of pillar pain was 0 at the last follow-up. One patient showed no improvement in hand symptoms and function postoperatively, and two patients showed long-term recurrence despite postoperative symptom remission. Approximately 94.5% (52/55) of the patients were satisfied or very satisfied with the outcome. CONCLUSIONS: ECTR with the "Modified Soft Tissue Release Kit" can significantly relieve symptoms and improve function in patients with CTS, with significant short- and mid-term efficacy and high safety.

Indocyanine green localization for laparoscopic duodenal web excision.

BACKGROUND: A duodenal web refers to partial or complete obstruction of the duodenum due to a membranous web. When looking at the serosal side of the intestine during duodenal web excision, especially during laparoscopic surgery, determining the web origin might be challenging. This study aimed to determine the efficacy of intraduodenum indocyanine green injection and near-infrared light during laparoscopic surgery in enhancing the ability to identify duodenal web localization. METHODS: We used intraduodenum indocyanine green injection to unequivocally recognize the duodenal web and facilitate laparoscopic excision. The clinical analysis was based on a male neonatal case with duodenal web admitted to our hospital. After the patient was placed in the supine position, 5 mL of ICG was injected via a 6-Fr nasogastric tube. The fluorescence was visualized in the white light and near-infrared light dual-mode of the camera system, localizing the duodenal precisely and in real-time. RESULTS: Laparoscopically, the duodenal web was accurately identified and removed with intraduodenum indocyanine green visualization under near-infrared light. The procedure was completed successfully, and the patient showed good postoperative outcomes. CONCLUSIONS: Intraduodenum indocyanine green injection during laparoscopic surgery is a feasible adjuvant for duodenal web localization, showing improvements in terms of outcomes compared to previous methods of determining the duodenal web location.

Endoscopic surgery for intraventricular hemorrhage: A comparative study and single center surgical experience.

BACKGROUND: Intraventricular hemorrhage is a neurosurgical emergency, and a dangerous condition associated with high morbidity and mortality. Previously, hematoma evacuation is generally executed by external intracranial drainage (EVD) or surgical evacuation. Nowadays, endoscopic evacuation is emerging as a good alternative because it brings relatively less invasion and injury. However, successful endoscopic evacuation requires skilled manipulation of endoscopic devices and the evidence supporting its efficacy differs in different reports. AIM: To improve the technique usage and provide more evidence of endoscopic evacuation efficacy, we summarize our surgical experience and compared the outcomes of the endoscopic evacuation with EVD using real-world data. METHODS: We retrospectively studied 96 consecutive patients with intraventricular hemorrhage who underwent either endoscopic surgery (n = 43) or non-endoscopic surgery (n = 53) for hemorrhage evacuation between November 2013 and September 2019 in our center. Patients' conditions prior to and after the operation were evaluated and analyzed to assess the efficacy of the operation. The consciousness status improvement and perioperative in-hospital parameters in the two types of operation groups were assessed and compared. RESULTS: Patients in the endoscopic and non-endoscopic groups presented with a similar state of consciousness, with a comparable Glasgow Coma Scale (GCS) index. The average operation time of the endoscopic group was longer than that of the non-endoscopic group (median 2.42 h vs 1.08 h, P < 0.001). Although the endoscopic group was older and had a baseline Graeb score that indicated more severe hemorrhage than the non-endoscopic group (Graeb median: Endoscopic group = 9 vs non-endoscopic group = 8, P = 0.023), the clearance rate of hematoma was as high as 60.5%. Both the endoscopic and non-endoscopic groups showed an improved GCS index after surgery. However, this improvement was more marked in patients in the endoscopic group (median improvement of GCS index: Endoscope group = 4 vs non-endoscopic group = 1, P < 0.001). Additionally, the endoscopic group had a lower Graeb score than the non-endoscopic group after the operation. The intensive care unit stay of the endoscopic group was significantly shorter than that of the non-endoscopic group (median: endoscopic group = 6 d vs non-endoscope group = 7 d, P = 0.017). CONCLUSION: Endoscopic evacuation of intraventricular hemorrhage was generally an effective and efficient way for hemorrhage evacuation, and contributed remarkably to the improvement of consciousness in patients with intraventricular hemorrhage.

Transdermal Insulin Delivery and Microneedles-based Minimally Invasive Delivery Systems.

Diabetes has become a serious threat to human health, causing death and pain to numerous patients. Transdermal insulin delivery is a substitute for traditional insulin injection to avoid pain from the injection. Transdermal methods include non-invasive and invasive methods. As the non-invasive methods could hardly get through the stratum corneum, minimally invasive devices, especially microneedles, could enhance the transappendageal route in transcutaneous insulin delivery, and could act as connectors between the tissue and outer environment or devices. Microneedle patches have been in quick development in recent years and with different types, materials and functions. In those patches, the smart microneedle patch could perform as a sensor and reactor responding to glucose to regulate the blood level. In the smart microneedles field, the phenylboronic acid system and the glucose oxidase system have been successfully applied on the microneedle platform. Insulin transdermal delivery strategy, microneedles technology and smart microneedles' development would be discussed in this review.

Surgical Treatment of Andersson Lesion of the Lumbar Spine with Minimal Invasion: A Case Report.

BACKGROUND: Andersson lesion (AL) refers to a destructive vertebral or disco-vertebral lesion of the spine in patients with ankylosing spondylitis (AS). Against the backdrop that the best surgical option for AL remains controversial, this work serves as the first case report of oblique lateral interbody fusion (OLIF) combined with posterior pedicle screw fixation to treat AL of the lumbar spine under minimal invasion. CASE PRESENTATION: In this case report, the patient involved was a female aged 37 diagnosed with AL (L3-L4). OLIF combined with pedicle screw fixation was carried out to achieve stabilization of the lumbar spine. It turned out that the patient experienced significant pain relief in her excellent post-operative recovery, with her post-surgical radiographs indicating good stability and bony fusion. The patient now remains disease-free with no low back pain or neurological deficit at the two-year follow-up. CONCLUSION: OLIF combined with pedicle screw fixation thus has proven to be an ideal therapeutic option for treating AL of the lumbar spine.

An off-pump biatrial mini-maze procedure for long-standing persistent atrial fibrillation.

OBJECTIVES: The goal of the present study was to determine the safety and efficacy of a modified off-pump biatrial mini-maze procedure to treat long-standing persistent atrial fibrillation (AF). METHODS: Patients with long-standing persistent AF underwent our modified mini-maze procedure using bipolar radiofrequency ablation. Those patients first underwent a mini-maze procedure using the Dallas lesion set protocol. Second, a purse-string suture was performed on the right atrium, and then 4 ablation lesions were made to the superior vena cava, the inferior vena cava, the appendix of the right atrium and the tricuspid valve annulus from the purse-string suture point by the bipolar radiofrequency clamp. After the operation, the patients were followed up at 3, 6 and 12 months and every year thereafter. RESULTS: A total of 102 patients were included in the study. There were no deaths, no surgical re-exploration for bleeding and no permanent pacemaker implants. The intraoperative cardioversion rate was 42.2% (43/102). A follow-up at intervals of 3, 6, 12, 24, 36 and 48 months showed that a success rate free from long-standing persistent AF was 95.1% (97/102), 94.4% (85/90), 94.8% (73/77), 91.5% (54/59), 90.3% (28/31) and 86.4% (19/22), whereas freedom from AF in patients off antiarrhythmic drugs was 88.2% (90/102), 85.6% (77/90), 81.8% (63/77), 78.0% (46/59), 74.2% (23/31) and 68.2% (15/22), respectively. CONCLUSIONS: The modified biatrial mini-maze procedure proved to be safe and feasible. Early follow-up demonstrated an acceptable success rate free from AF.

Application of digital positioning guide plates for the surgical extraction of multiple impacted supernumerary teeth: A case report and review of literature.

BACKGROUND: An extra tooth in the normal tooth sequence in any region of the dental arch is regarded as a supernumerary tooth (SNT). Due to the large variation in location and morphology, the extraction of impacted SNTs is an extensive and complex procedure with high risks of several complications. This report presents a rare case of seven impacted SNTs in the bilateral upper and lower arch that were successfully extracted with the use of digital positioning guide plates. CASE SUMMARY: In January 2022, a 21-year-old male was referred to our department with a chief complaint of pain in relation to tooth #36. Clinical examination showed a deep carious lesion with pulpal involvement in tooth #36 and lingual swelling of the bilateral mandibular posterior area. Radiographic examination revealed seven deeply impacted SNTs in the bilateral posterior area and bilateral impacted mandibular third molars. Based on these findings, the patient was diagnosed with bilateral, multiple impacted SNTs and tooth #36 chronic pulpitis. A root canal treatment and an all-ceramic crown restoration for tooth #36 were performed. An individualized digital positioning guide plate was designed by computer-aided design/computer-aided manufacturing technology and cone-beam computed tomography for extraction of the impacted SNTs. During the operation, the digital positioning guide plate allowed rapid positioning and exposure of the SNTs while avoiding adjacent important anatomical structures. At 3-month follow-up, regeneration of bone and soft tissues was visible. CONCLUSION: The application of digital positioning guide plates is useful for the individualized and minimalized extraction of impacted supernumerary teeth.

Intraoperative Endoscopy as an Adjuvant to Minimally Invasive Surgery in Pediatrics.

Background: Minimally invasive surgery has a different visual and tactile perception compared with conventional surgery, which could lead to complications, especially in complex procedures. In these cases, flexible endoscopy can facilitate and prevent complications in minimally invasive procedures in children. The study aimed to clarify the utility of intraoperative endoscopy as an adjuvant to minimally invasive surgery in children. Materials and Methods: This retrospective study reviewed the medical records of pediatric patients who had undergone endoscopy during a minimally invasive surgery to treat an upper digestive pathology between January 2000 and December 2020. Results: The study included 83 patients who underwent a laparoscopic procedure with simultaneous endoscopy. The diagnosis was peptic stenosis in 9 patients, achalasia in 23, congenital embryonic tracheobronchial remnants in 4, re-fundoplication in 42, esophageal duplication in 2, superior mesenteric artery syndrome in 2, and giant gastric hemangioma in 1 patient. With adjuvant endoscopy, 7 digestive perforations were noted, 11 cases of short esophagus were diagnosed, and the permeability of the anastomosis was confirmed in 6 cases. No complications were related with the endoscopy procedures. Discussion: Minimally invasive surgery has a few special and tactile limitations that can lead to complications in certain procedures. Simultaneous digestive endoscopy in the upper gastrointestinal tract facilitates organ identification and dissection. Conclusion: Digestive endoscopy is an excellent adjunct to minimally invasive surgery in children because it facilitates and identifies complications and ensures safer minimally invasive surgeries. Future prospective studies are required to assess this conclusion.

Percutaneous Endoscopic Intercostal Neurectomy for Refractory Intercostal Neuralgia.

BACKGROUND: Refractory intercostal neuralgia is a troublesome disease with long treatment cycle and short-term therapeutic effects. No treatment modality has given effective pain relief. The authors present here a safe and effective endoscopic surgical option for refractory intercostal neuralgia. OBJECTIVES: To introduce the surgical techniques of percutaneous endoscopic intercostal neurectomy used for refractory intercostal neuralgia and to evaluate its safety and efficacy. STUDY DESIGN: A retrospective study. SETTING: The Department of Orthopedics at the Hebei General Hospital in China. METHODS: Thirteen patients with refractory intercostal neuralgia were treated with percutaneous endoscopic intercostal neurectomy. Patients were followed up to 12 months postoperatively. The pain was measured by the Visual Analog Scale (VAS) score. Complications, such as aspiration, dysfunction, infection, and local hematoma were analyzed. RESULTS: Pain was relieved in all 13 patients, with only 1 patient reporting burning sensation along the intercostal nerve distribution area after operation. No other complications were found. All patients had significant improvement, with significantly lower VAS scores recorded postoperatively. No recurrence was reported during the follow-up period. LIMITATIONS: The retrospective nature of this study is a limitation, as well as the small sample size and short observation time. CONCLUSIONS: Endoscopic intercostal neurotomy is an effective and safe minimally invasive surgical treatment for refractory intercostal neuralgia.

[Application of digital positioning guide plate in extraction of impacted supernumerary teeth].

OBJECTIVE: To explore the application of digital positioning guide plate in extraction of impacted supernumerary teeth and evaluate its clinical efficacy. METHODS: From March to August, 2019, 30 patients with labial impacted supernumerary teeth treated in the Department of Oral and Maxillofacial Surgery, Stomatological Hospital, Southern Medical University were enrolled in this study. Fifteen of the patients were treated with digital positioning guide plate to remove the impacted supernumerary teeth (test group). According to the CBCT data and the dentition model of the patients, the positioning guide plate was positioned by avoiding the important anatomical structure with the tooth-bone surface as the support to design the soft tissue incision line and bone tissue exposure range. The other 15 patients who were treated without the use of the guide plate for operation served as the control group. The design time, tooth searching time, operation time and complications were compared between the two groups. RESULTS: The positioning guide plate was well attached during the operation and allowed quick location of the supernumerary teeth while helping to expose the supernumerary teeth and avoid the damage of the adjacent important anatomical structures. The pre-operative design time was 50 ± 5 min in the test group and 0 min in the control group. The average time of tooth finding in the test group was 5±2 min, as compared with 10±3 min in the control group (t=15.40, P < 0.01); the average time of operation was significantly shorter in the test group than in the control group (25±4 min vs 45±6 min; t=35.50, P < 0.01). No intraoperative complications occurred in the test group, and slight deviation occurred in one case in the control group. CONCLUSIONS: The application of digital positioning guide plate in extraction of embedded supernumerary teeth can significantly shorten the time of tooth finding, reduce the difficulty of operation, and improve the quality of operation.

Definitions of Computer-Assisted Surgery and Intervention, Image-Guided Surgery and Intervention, Hybrid Operating Room, and Guidance Systems: Strasbourg International Consensus Study.

OBJECTIVE: To develop consensus definitions of image-guided surgery, computer-assisted surgery, hybrid operating room, and surgical navigation systems. SUMMARY BACKGROUND DATA: The use of minimally invasive procedures has increased tremendously over the past 2 decades, but terminology related to image-guided minimally invasive procedures has not been standardized, which is a barrier to clear communication. METHODS: Experts in image-guided techniques and specialized engineers were invited to engage in a systematic process to develop consensus definitions of the key terms listed above. The process was designed following review of common consensus-development methodologies and included participation in 4 online surveys and a post-surveys face-to-face panel meeting held in Strasbourg, France. RESULTS: The experts settled on the terms computer-assisted surgery and intervention, image-guided surgery and intervention, hybrid operating room, and guidance systems and agreed-upon definitions of these terms, with rates of consensus of more than 80% for each term. The methodology used proved to be a compelling strategy to overcome the current difficulties related to data growth rates and technological convergence in this field. CONCLUSIONS: Our multidisciplinary collaborative approach resulted in consensus definitions that may improve communication, knowledge transfer, collaboration, and research in the rapidly changing field of image-guided minimally invasive techniques.