Conduct high-quality clinical studies in rectal cancer surgery based upon the IDEAL frame-work and recommendations / 中华消化外科杂志

The idea, development, exploration, assessment, and long-term follow-up (IDEAL) framework and recommendations provide a guiding path for high-quality research and practice for surgical technology innovation. Transanal total mesorectal excision, as a new technology in the field of colorectal surgery, has evolved step by step following the IDEAL framework. At the technical design and development stage, the technique feasibility is verified. At the exploratory stage, small-scale clinical practice is conducted, standardized diagnosis and treatment and surgical technique are developed, and structured training is carried out. During the assessment stage, large-scale rando-mized controlled studies are conducted to confirm the safety and efficacy. Subsequently, long-term monitoring and follow-up of the technique is carried out in clinical practice. All the processes become good example in the field of surgical clinical research. The authors summarize the pioneering works of the research team in quality control, in order to provide references for peers.

The methodological framework of surgical innovation: the introduction of IDEAL framework and recommendation / 中国胸心血管外科临床杂志

@#Surgical innovation is an important part of surgical research and practice. The evaluation of surgical innovation through the stages is similar to those for drug development, but with important differences. The Idea, Development, Exploration, Assessment, and Long-term follow-up (IDEAL) Framework and Recommendations represent a new paradigm for the evaluation of surgical intervention and devices which was developed in 2009. The IDEAL is a five-stage framework involving the nature stages of surgical innovation, together with recommendations for surgical research pathway. The Framework and Recommendations were updated and published in 2019, which added a pre-IDEAL stage if necessary. The updated IDEAL also underlines the purpose, key question and ethical issues for each stage. In the first paper of IDEAL Framework and Recommendations series, we conducted a comprehensive introduction of IDEAL (e.g. the development, updates and application of IDEAL) to promote the dissemination and application of IDEAL in China.

Development of magnetic spiderman to optimize the procedures of repairment of donor liver from organ donation / 器官移植

Objective To develop a pulling device using magnetic positioning to optimize the procedures of repairment of donor liver from organ donation . Methods The pig liver specimens were used to measure the pull force of repairment of donor liver, magnetic spiderman was developed based on the measurement results. The magnetic spiderman was applied to simulate the repairment of donor liver from organ donation on the pig liver specimens. The effectiveness of magnetic spiderman was also evaluated. Results The pulling force was required all less than 2 N during the repairment of donor liver. The magnetic spiderman was successfully manufactured. The magnets of magnetic spiderman could generate 3 N magnetic forces with paramagnetic basin of hepatic repairment. The self-retraction pull wire of the magnetic spiderman could provide 2.5 N pulling forces. The magnetic spiderman was successfully applied to the simulated experiment of repairment of donor liver from organ donation in 6 cases. The operation time was (54±5) min. No clip slippage,displacement and slippage of the base occurred during the operation. With the cooperation of multiple magnetic spidermen,the remaining surgical procedures were performed by one single surgeon except for the vascular ligation. Conclusions The magnetic spiderman has small volume and implements flexible positioning, can perform pulling operation and nottake up operational space. It can effectively optimize the procedures of repairment of donor liver from organ donation and reduce the quantity of surgeons.

Temporalis muscle-coronoid swing and forehead skin island flap reconstruction of the orbit after maxillectomy

The use of local regional flaps is often the most practical and easy means of reconstruction in the management of head and neck tumors. The temporalis muscle coronoid swing has been used to reconstruct the orbital floor and is described in literature as early as 1983. Difficulty is encountered when the medial wall and orbital floor are completely removed and a temporalis muscle-coronoid swing is rendered insufficient for orbital reconstruction. Objective: To describe a combination of forehead island flap and temporalis muscle-coronoid swing in orbital reconstruction. Design: Surgical Innovation/ Case Report. Subject: 12-year-old female with recurrent maxillary chondroblastic osteosarcoma one year after chemotherapy. Methods: The course of tumor excision and defect reconstruction is described. Results:There was no diplopia or other morbidity.There was minimal added operative time for reconstruction with acceptable results. Conclusion: Local flaps can be combined in order to repair the orbital floor. Acceptable function with minimal cosmetic deformity can be achieved with less extensive surgery. (Author)

Open reduction and fixation in acute laryngeal trauma under endoscopic guidance

Acute laryngeal trauma is a great challenge for the otoloaryngologist. Early recognition, accurate evaluation and proper treatment may be crucial to immediate survival and long-term function. Objective:To describe an endoscopically-guided open reduction and adaptation plate fixation of an acute laryngeal fracture secondary to vehicular accident. Methods: a. Study Design: Surgical Innovation/ Case Report b. Setting:Tertiary Hospital in Metro Manila Results: Post-operative follow-up showed good vocal fold function and arytenoid position, with no food regurgitation, signs of aspiration or penetration on fiberoptic endoscopic evaluation of swallowing Conclusion: Endoscopic guidance allows higher magnification minimizing iatrogenic mucosal damage during manipulation. (Author)

Suture ligation technique in hemangioma of the head and neck

Intra-operative bleeding is what most surgeons want to avoid in any surgery. Excessive blood loss and compromise of vital structures are possible morbidities when this happens. This paper presents a method that will minimize intra-operative bleeding during excision of hemangiomas. "Suture ligation technique" is the application of simple interrupted overlapping sutures using silk 2.0 with an atraumatic needle around the hemangiomas prior to the skin incision. Although a number of cases have been done three were documented. It was observed that the technique provides a less bloody and clearer operative fields hence resulting in a faster and less stressful operation with lesser complications. (Author)

The rhombotrapezius myocutaneous flap: Surgical innovation for closure of wide and deep temporo-facial defects

OBJECTIVE: To present two cases in which an improved rhombotrapezius flap design was utilized maximally to cover a wide and deep surgical defect after extirpation of a malignant tumor in the temporo-facial area. SETTING: Tertiary Hospital. PATIENTS AND METHODOLOGY: Two cases of malignancy involving the temporo-facial area of the head are presented. Surgical design for the reconstruction of this defect using rhombotrapezius flap is presented. RESULTS AND DISCUSSION: Large and deep temporo-facial defects are adequately closed by rhombotrapezius flap with adequate tissue coverage. Surgical design proved to be acceptable with good flap take and overall cosmetic result. CONCLUSION: Rhombotrapezius flap can be used to cover a large deep defect and can provide more than adequate tissue coverage and bulk to any temporo-facial defects. (Author)