Factors predicting technical difficulties during endoscopic submucosal excavation for gastric submucosal tumor

Objective Endoscopic submucosal excavation (ESE) has been established as an effective method for removal of gastric submucosal tumors (SMTs). The aim of the present study was to explore risk factors for technical difficulties in ESE. Methods In this retrospective study, we collected clinical data from patients who underwent ESE for gastric SMTs. Difficult ESE was defined as a procedure time ≥90 minutes, piecemeal resection, and/or occurrence of major adverse events. Univariate and multivariate analyses were performed to explore the risk factors for a difficult ESE. Results ESE was successfully performed in 96.5% (195/202) of patients from April 2011 to December 2019. The average tumor size was 17.41 mm, and en bloc resection was achieved in 97.4% of patients (190/195). Five patients (2.56%, 5/195) had complications, including two with delayed bleeding, two with fever, and one with chest pain accompanying ST-T changes in an electrocardiogram. Twenty-four patients (11.88%, 24/202) had a difficult ESE. Logistic analysis showed that outgrowth behavior and an inexperienced surgeon were risk factors for a difficult ESE. Conclusion ESE may be safe and effective to treat patients with gastric SMTs. Outgrowth behavior and an inexperienced surgeon were risk factors for a difficult ESE.

Rehabilitation of A Patient with Iatrogenesis After Facial Trauma - Case Report

The objective of this study is to report a clinical case of a female patient, melanoderma, 18 years old, referred to the FOA-UNESP surgery and traumatology team in 2013, reporting being a victim of a high-level fall in the attempted suicide. Clinical examination revealed loss of teeth 33, 32, 31, 41, 42, 43 and 44 and CT scan of the face revealed NOE, Lefort I and II and Lanelong fractures. The patient underwent a surgical procedure to reduce and fix fractures. The case was followed up after hospital discharge. A mandible CT was requested to install dental implants. Surgical planning was performed to install implants and make a surgical guide. 4 implants were installed in the region of teeth 32, 31, 41, 42, 43. Two years after the implant was installed, the patient returned to the institution reporting pain in tooth 45. The patient was referred by the screening sector to the endodontic team, which requested a new CT examination of the mandible, noting that the implants installed in the regions of teeth 33 and 44 had reached teeth 34 and 45, indicating the extraction of these teeth and removal of 2 implants. Surgical planning was performed and the extraction and removal surgery of the implants performed. After waiting for the healing period, the patient was referred to the dental prosthesis team and it was defined that reverse planning would be carried out to install the new implants and oral rehabilitation using a supported implant prosthesis. Thus, the impressions left by the case allow us to conclude that the use of a surgical guide, without prosthetic planning, provides the inexperienced surgeon with false security for the procedure, with reverse planning and professional experience essential for implant dentistry.

Predictive Factors Associated with Complications after Laparoscopic Distal Pancreatectomy

Although laparoscopic distal pancreatectomy (LDP) has become more popular, the postoperative complication rate remains high. We sought to identify the risk factors for post-LDP complications. We examined 1227 patients who underwent LDP between March 2005 and December 2015 at a single large-volume center. We used logistic regression for the analysis. The overall (13.2%) and major (3.3%) complication rates were determined. Postoperative pancreatic fistula was the most frequent complication, and 58 patients (4.7%) had clinically significant (grade B) pancreatic fistulas. No 90-day mortality was recorded. Long operative time (≥200 min), large estimated blood loss (≥320 mL), LDP performed by an inexperienced surgeon (<50 cases), and concomitant splenectomy were identified as risk factors for overall complications using a logistic regression model. For major complications, male sex (p = 0.020), long operative time (p = 0.005), and LDP performed by an inexperienced surgeon (p = 0.026) were significant predictive factors. Using logistic regression analysis, surgery-related factors, including long operative time and LDP performed by an inexperienced surgeon, were correlated with overall and major complications of LDP. As LDP is a technically challenging procedure, surgery-related variables emerged as the main risk factors for postoperative complications. Appropriate patient selection and sufficient surgeon experience may be essential to reduce the complications of LDP.

Accuracy of acetabular cup placement using an angle-adjusting alignment guide with laser pointer in total hip arthroplasty

Purpose: To evaluate cup-positioning accuracy in total hip arthroplasty (THA) using a novel angle-adjusting alignment guide with laser pointer and determine whether level of surgical experience affects accuracy of cup placement or not. Methods: We included 117 hips in 104 patients who underwent THA using the novel guide. We retrospectively reviewed 44 hips in 40 patients who underwent THA before the novel guide was introduced. We compared differences in cup angles between the novel guide group and the conventional guide group as well as the discrepancies in targeted angles between the experienced surgeon group and the inexperienced surgeon group. Results: There were 114/117 hips (97.4%) within the Lewinnek safe zone in the novel guide group and 32/44 hips (72.7%) within the safe zone in the conventional guide group. There were significantly fewer outliers in the novel guide group ( p < 0.001). In the experienced surgeon group, the mean absolute errors in inclination and anteversion were 2.0 ± 1.7° and 2.1 ± 2.3°, respectively; which were not significantly different from those in the inexperienced surgeon group (2.3 ± 2.1° and 2.8 ± 2.3°, respectively). Conclusion: The novel angle-adjusting alignment guide with laser pointer is a simple tool that provides better accuracy of cup position than that obtained using conventional guides. Accurate cup placement is possible using the novel guide, regardless of surgeons’ experience.

Augmented Reality Guided Osteotomy in Hallux Valgus Correction

Background An optimal osteotomy angle avoids shortening of the first metatarsal bone after hallux valgus surgery and therefore reduces the risk of transfer-metatarsalgia. The purpose of the present ex-vivo study was to investigate whether augmented reality (AR) would improve accuracy of the distal osteotomy during hallux valgus surgery. Methods Distal osteotomies of the first metatarsals were performed on a foot model by two surgeons with different levels of surgical experience each with (AR, n=15x2) or without (controls, n=15x2) overlay of a hologram depicting an angle of osteotomy perpendicular to the second metatarsal. Subsequently, the deviation of the osteotomy angle in the transverse plane was analyzed. Results Overall, the AR decreased the range of impression and the AR guided osteotomies were more accurate (4.9 ± 4.2°) compared to the freehand cuts (6.7± 6.1°) by tendency (p=0.2). However, while the inexperienced surgeon performed more accurate osteotomies with AR with a mean angle of 6.4± 3.5° compared to freehand 10.5 ± 5.5° (p=0.02), no significant difference was noticed for the experienced surgeon with an osteotomy angle of around 3° in both cases. Conclusion This pilot-study suggests that AR guided osteotomies can potentially improve accuracy during hallux valgus correction, particularly for less experienced surgeons.

Realizing Multilayered Soft Tissue Model Using Multithreading in Python

Interactive Virtual Reality based surgical simulators are gaining popularity where an inexperienced surgeon can practice the surgery irrespective of time and cost which is an effective way in medical training. In order to guarantee the real time performance, a multi-threading technique is applied to the model in different languages. This results in increased utilization of the processor resources and high update rate is achieved with a realistic rendering of the proposed graphics model for the virtual reality simulation. This paper presents a comparative analysis of the model’s performance using multithreading process. This is based on addition of matrices of the 3D model simulation with large dimensions in C and python programming languages implementations.