Protocolo de recuperación mejorada después de cirugía (ERAS) atenúa el estrés y acelera la recuperación en pacientes después de resección radical por cáncer colorrectal: Experiencia en la Clínica Universitaria Colombia / Enhanced Recovery After Surgery (ERAS) protocol attenuates stress and accelerates recovery in patients after radical resection for colorectal cancer: Experience at Clínica Universitaria Colombia

Introducción. El conjunto de estrategias de recuperación mejorada después de la cirugía (ERAS, por sus siglas en inglés) constituye un enfoque de atención multimodal y multidisciplinario, cuyo propósito es reducir el estrés perioperatorio de la cirugía, disminuir la morbilidad y acortar la estancia hospitalaria. Este estudio tuvo como objetivo describir los resultados clínicos de pacientes sometidos a cirugía por cáncer colorrectal, identificando las complicaciones principales y los factores perioperatorios relacionados con el alta temprana. Métodos. Se analizaron los pacientes consecutivos sometidos a cirugía colorrectal entre los años 2020 y 2023, todos los cuales siguieron el protocolo ERAS institucional. Se evaluaron las características clínicas, los factores perioperatorios, los desenlaces postoperatorios y la tasa global de adherencia al protocolo. Resultados. Un total de 456 pacientes fueron sometidos a cirugía colorrectal, 51% de sexo masculino, con edad media de 60 años. La mayoría de las intervenciones se realizaron por laparoscopia (78 %), con una tasa de conversión del 14,5 %. Las complicaciones postoperatorias incluyeron fuga anastomótica (4,6 %), sangrado, infección intraabdominal y obstrucción intestinal. La estancia hospitalaria promedio fue de 4 días y la mortalidad del 2,8 %. La tasa global de adherencia al protocolo ERAS fue del 84,7 %. Conclusiones. El enfoque combinado de cirugía laparoscópica y protocolo ERAS es factible, seguro y se asocia con una estancia hospitalaria más corta. La implementación y adherencia al protocolo ERAS no solo mejora los resultados postoperatorios, sino que también resalta la importancia de acceder a datos sólidos, permitiendo mejorar la atención perioperatoria local.

Introduction. The Enhanced Recovery After Surgery (ERAS) protocol is a multimodal, multidisciplinary approach to care, the purpose of which is to reduce the perioperative stress of surgery, decrease morbidity, and shorten hospital stay. This study aimed to describe the clinical outcomes of patients undergoing surgery for colorectal cancer, identifying the main complications and perioperative factors related to early discharge. Methods. Consecutive patients undergoing colorectal surgery between 2020 and 2023 were analyzed, who followed the institutional ERAS protocol. Clinical characteristics, perioperative factors, postoperative outcomes, and overall protocol adherence rate were evaluated. Results. A total of 456 patients underwent colorectal surgery, 51% male, with a mean age of 60 years. Most interventions were performed laparoscopically (78%), with a conversion rate of 14.5%. Postoperative complications included anastomotic leak (4.6%), followed by bleeding, intra-abdominal infection, and intestinal obstruction. The average hospital stay was 4 days and mortality was 2.8%. The overall adherence rate to the ERAS protocol was 84.7%. Conclusions. The combined approach of laparoscopic surgery and ERAS protocol is feasible, safe, and associated with a shorter hospital stay. Implementation and adherence to the ERAS protocol not only improves postoperative outcomes, but also highlights the importance of accessing solid data, allowing for improved local perioperative care.

Modificación del corredor aorto-psoas para el acceso oblicuo lumbar intervertebral según los cambios posturales y la composición corporal. Estudio multicéntrico observacional mediante resonancia magnética / Modification of the safe corridor for oblique lumbar interbody fusion based on postural changes and body composition. An observational, multicenter study using MRI

Introducción: La cirugía mínimamente invasiva de columna se ha vuelto cada vez más popular en los últimos años. Se han desarrollado técnicas nuevas y menos invasivas que se han convertido en procedimientos de elección para determinadas enfermedades. El tamaño del corredor aorto-psoas es un factor determinante al elegir la técnica oblicua de fusión intersomática. Objetivos: Describir las modificaciones en el tamaño del corredor aorto-psoas en decúbito lateral derecho y decúbito supino mediante resonancia magnética y su asociación con el índice de masa corporal. materiales y métodos: Se realizó una resonancia magnética de los espacios discales de L1-L2 a L4-L5 a 13 voluntarios en decúbito supino y decúbito lateral derecho. Se midió el corredor y se comparó el tamaño en cada nivel. Resultados: El tamaño del corredor aorto-psoas y de la distancia arteria-disco tuvo un aumento estadísticamente significativo al posicionar al paciente en decúbito lateral derecho. Conclusiones: La resonancia magnética es de suma importancia en la planificación prequirúrgica, pues deja en evidencia la movilidad de las estructuras abdominales. Se producen cambios significativos en el corredor aorto-psoas y la distancia arteria-disco al ubicar al paciente en decúbito lateral derecho. Sin embargo, estos cambios no tienen una relación significativa con el índice de masa corporal. Nivel de Evidencia: IV

Introduction: Minimally invasive spine surgery (MISS) has gained popularity in recent years. New and less invasive techniques have emerged as the preferred procedures for certain pathologies. The size of the aorta-psoas corridor is decisive when choosing the oblique interbody fusion technique. Objectives: To describe the changes in the size of the aorta-psoas corridor in the right lateral decubitus and supine decubitus positions by magnetic resonance imaging and their association with body mass index. materials and methods: 13 volunteers underwent MRI of the disc spaces from L1-L2 to L4-L5 in the supine and right lateral decubitus positions. The corridor was measured, and the sizes at each level were compared. Results: A statistically significant increase in the size of the aorta-psoas corridor and the artery-disc distance was obtained when positioning the patient in the right lateral decubitus position. However, these have no significant relationship with BMI. Conclusions: The use of MRI in pre-surgical planning is extremely important. This study reveals the mobility of the abdominal structures. We can conclude that, as stated in the objective of the study, significant changes occur in the aorta-psoas corridor and the artery-disc distance when the patient is positioned in the right lateral decubitus position. Level of Evidence: IV

La interdisciplinariedad en la cirugía urológica mínimamente invasiva / Interdisciplinarity in Minimally Invasive Urologic Surgery

Introducción: La interdisciplinariedad es el resultado de la puesta en práctica de varias disciplinas, que permite afrontar el objeto de estudio de modo integral y promover el desarrollo de nuevas intervenciones para la solución de problemas. En el campo de la medicina involucra la contribución de diversas disciplinas y la participación de especialistas de diversas áreas que integra el pensamiento de diferentes profesiones o tecnologías para lograr un resultado común. Objetivos: Exponer una visión integral acerca de cómo la interdisciplinariedad ha permitido el desarrollado de la cirugía mínimamente invasiva en la especialidad de urología. Métodos: Se realizó una revisión sistemática y crítica de artículos reportados sobre la interdisciplinariedad en el campo de la cirugía mínimo invasiva, en idioma español e inglés, desde 2005 hasta 2022, en sitios Web (PubMed, SciELO, MedLine, Lilacs y Science Direct. Se referenciaron 22 artículos de los consultados. Conclusiones: Las evidencias reportadas y consultadas ofrecen una visión integral de las diversas intervenciones que certifican la interdisciplinariedad en el campo de la cirugía urológica mínimamente invasiva, que fortalece el marco curricular de la especialidad y permite alcanzar un nivel de profesionalidad significativo, evidenciado en un excelente desempeño profesional(AU)

Introduction: Interdisciplinarity results from implementing several disciplines, allowing to address the object of study comprehensively, as well as promote the development of new interventions to solve problems. In the field of medicine, it involves the contribution of various disciplines and the participation of specialists from different areas, integrating the thinking from different professions or technologies to achieve a common result. Objectives: To present a comprehensive perspective of how interdisciplinarity has allowed the development of minimally invasive surgery in the specialty of urology. Methods: A systematic and critical review was carried out with reported articles on interdisciplinarity in the field of minimally invasive surgery, in Spanish and English, from 2005 to 2022, in Web sites (PubMed, SciELO, MedLine, Lilacs and Science Direct). Twenty-two of the consulted articles were referenced. Conclusions: The reported and consulted evidence offers a comprehensive perspective of the various interventions certifying interdisciplinarity in the field of minimally invasive urologic surgery, which strengthens the curricular framework of the specialty and allows to achieve a significant level of professionalism, evidenced through excellent professional performance(AU)

Endoscopic Release of the Ulnar Nerve at the Elbow: Technique Description and Case Series / Liberação endoscópica do nervo ulnar no cotovelo: Descrição da técnica e série de casos

Abstract Objective The endoscopic release of the ulnar nerve reproduces a simple (in situ) procedure with smaller incisions, less soft tissue damage, and higher preservation of nerve vascularization. Endoscopy allows the clear visualization of the entire path of the nerve and surrounding noble structures. Moreover, it reveals any signs of compression and allows a safe release of 10cm distally or proximally to the medial epicondyle. Methods A retrospective survey revealed that 15 subjects (1 with a bilateral injury) underwent an ulnar nerve compression release at the elbow using the endoscopic technique with Agee (Micro-Aire Sugical Instruments, Charlottesville, VA, EUA) equipment from January 2016 to January 2020. Results Symptoms of ulnar nerve compression improved in all patients; on average, they resumed their work activities in 26.5 days. There was no recurrence or need for another procedure. In addition, there were no severe procedure-related complications, such as infection and nerve or vascular injury. One patient had transient paresthesia of the sensory branches to the forearm, with complete functional recovery in 8 weeks. Conclusion Our study shows that the endoscopic release of the ulnar nerve at the elbow with the Agee equipment is a safe, reliable technique with good outcomes.

Resumo Objetivo A liberação endoscópica do nervo ulnar permite reproduzir uma liberação simples (in situ), mas através de incisões menores e com menor lesão de partes moles e uma maior preservação da vascularização do nervo. A visualização clara através da endoscopia permite observar todo o trajeto do nervo e das estruturas nobres circundantes, mostrando os sinais de compressão, possibilitando realizar a liberação de forma segura em um trajeto de 10 cm nos sentidos distal e proximal ao epicôndilo medial. Método Foram encontrados, de forma retrospectiva, no período entre janeiro de 2016 e janeiro de 2020, 15 pacientes (sendo 1 com lesão bilateral) submetidos a liberação da compressão do nervo ulnar no cotovelo pela técnica endoscópica com equipamento de Agee (Micro-Aire Sugical Instruments, Charlottesville, VA, EUA). Resultados Todos os pacientes tiveram melhora dos sintomas de compressão do nervo ulnar e o período de retorno ao trabalho foi de em média 26,5 dias. Não houve recidivas e não houve a necessidade de outro procedimento. Também não houve complicações graves decorrentes do procedimento, como infecção, lesão nervosa ou vascular. Em um paciente, houve parestesia transitória dos ramos sensitivos para o antebraço, com retorno completo da função em 8 semanas. Conclusão Os resultados mostram que a liberação endoscópica do nervo ulnar no cotovelo comoequipamentodeAgeeéuma técnica segura, confiável e com bons resultados.

Panorama atual do ensino em cirurgia ginecológica minimamente invasiva / Current overview of teaching in minimally invasive gynecologic surgery

A evolução contínua das áreas cirúrgicas se deve a estudos e pesquisas, avanços tecnológicos e desenvolvimento de equipamentos mais avançados. A cirurgia minimamente invasiva, incluindo a videolaparoscopia, histeroscopia e cirurgia robótica, tem sido impactada significativamente pelos avanços cirúrgicos. As técnicas minimamente invasivas têm se tornado padrão-ouro no diagnóstico e tratamento de doenças ginecológicas, proporcionando benefícios como redução do tempo cirúrgico, menor dor no pós-operatório e melhoria na qualidade de vida. O treinamento adequado do cirurgião e da equipe é fundamental para o sucesso do tratamento cirúrgico, e o desenvolvimento tecnológico e aprimoramento dos equipamentos impulsionam a cirurgia minimamente invasiva como uma área específica da Ginecologia. Métodos seguros de treinamento, como laboratórios de simulação, permitem o aprimoramento gradual das habilidades dos cirurgiões em formação, preparando-os para uma prática segura e eficaz. A literatura fornece ferramentas e conceitos para o treinamento em cirurgia minimamente invasiva, visando formar residentes e novos cirurgiões.

Seguridad de los portales para la reparación endoscópica del ligamento calcaneonavicular: estudio cadavérico / Endoscopic Spring ligament repair. Anatomic evaluation of portal safety

Introducción: La lesión del ligamento calcaneonavicular ha sido descrita como una de las causas de la deformidad en el pie plano del adulto. El objetivo de este artículo es describir portales modificados para el diagnóstico y la reparación endoscópica de las lesiones del fascículo superomedial del ligamento calcaneonavicular y evaluar la seguridad de los portales utilizados. Materiales y Métodos:Se llevó a cabo un estudio cadavérico con seis preparados reproduciendo una lesión del fascículo superomedial del ligamento calcaneonavicular con una punta de corte de radiofrecuencia y la posterior reparación endoscópica. Se crearon dos portales modificados para el abordaje. Luego se procedió a la disección anatómica para evaluar la seguridad de los portales en relación con las estructuras anatómicas. El primer portal se realiza inmediatamente proximal a una línea trazada desde la punta del maléolo medial dirigida al centro del talón, el segundo portal se emplaza 0,5 cm proximal a la inserción del tendón tibial posterior en el escafoides por transiluminación. Si es necesario, se coloca un portal accesorio inmediatamente dorsal al tendón tibial posterior a mitad de camino entre los dos portales antes descritos. Resultados:En todos los casos, fue posible la reparación del ligamento con el procedimiento endoscópico. En la disección anatómica de los portales, se observó una distancia promedio a las estructuras vasculonerviosas de 11,83 mm del portal proximal y de 9,66 mm del portal distal. Conclusión: Los portales modificados son seguros y permiten la visualización directa del haz superomedial del ligamento calcaneonavicular y su reparación endoscópica. Nivel de Evidencia: IV

Introduction: Calcaneonavicular ligament injury has been described as a cause of adult flat foot deformity. The objective of this study is to describe modified portals for the diagnosis and treatment of injuries to the superomedial bundle of the calcaneonavicular ligament and to evaluate the safety of the portals used. Materials and Methods: We performed a cadaveric specimen study on 6 feet, where we reproduced a lesion of the superomedial bundle of the calcaneonavicular ligament with a radiofrequency ablation device and repaired it endoscopically. Two modified portals were created for the approach and an anatomical dissection was performed to assess the safety of the portals in relation to the anatomical structures. The first portal was placed immediately proximal to a line drawn from the tip of the medial malleolus toward the center of the heel; the second portal was placed 0.5 cm proximal to the posterior tibial tendon insertion into the navicular bone, guided by transillumination. If needed, an accessory portal was placed halfway between the two previously described portals immediately dorsal to the posterior tibial tendon. Results:In all cases, ligament repair was achieved with the endoscopic procedure. In the anatomical dissection of the portals, we observed an average distance of 11.83 mm from the proximal portal and 9.66 mm from the distal portal to neurovascular structures. Conclusion:Modified portals are safe and allow direct visualization of the superomedial bundle of the calcaneonavicular ligament to perform endoscopic repair. Level of Evidence: IV

Reparación meniscal: resultados en 234 pacientes con seguimiento mínimo de cuatro años / Meniscal repair

Introducción: Los meniscos juegan un papel crucial para la correcta biomecánica y función adecuada de la rodilla. Las lesiones, según sean traumáticas o degenerativas, tienen orígenes, algoritmos diagnósticos y tratamientos distintos. En el pasado, la meniscectomía era el tratamiento de elección; a medida que se fue comprendiendo la importancia de estas estructuras anatómicas estos fueron migrando hacia opciones de preservación, intentando resguardar la mayor cantidad de tejido meniscal, fomentar su reparación y así disminuir el riesgo de osteoartritis de manera temprana.El objetivo de este trabajo es mostrar los resultados de las reparaciones meniscales efectuadas entre 2012 y 2018, y complementar con una revisión de las técnicas quirúrgicas que hemos realizado en el trascurso de estos años, y las causas de fallas en nuestra serie de pacientes.Materiales y métodos: evaluamos doscientas treinta y cuatro reparaciones meniscales realizadas entre el 2012 y el 2018. El promedio de edad fue de veintiocho años. Un 72% se asoció a lesión y reconstrucción del ligamento cruzado anterior. Incluimos las reparaciones meniscales aisladas, como también asociadas a plástica de LCA, de ambos sexos, con técnicas dentro-fuera, fuera-dentro, todo-adentro y la asociación de estas técnicas. Por otra parte, excluimos pacientes con datos incompletos en la historia clínica, revisiones de suturas realizadas por otro equipo quirúrgico y por falta de seguimiento. La evaluación se basó en el examen físico, la escala visual análoga (EVA) para el dolor y la funcionalidad mediante los scores de IKDC, Lysholm y Tegner.Resultados: la reparación meniscal artroscópica estuvo asociada a la reconstrucción ligamentaria del LCA en un 72% (169 casos) y en un 28% (65 casos) la sutura meniscal como único procedimiento. Se repararon ciento setenta y un meniscos internos y sesenta y tres externos. Con respecto a la técnica utilizada, la distribución fue la siguiente: 151 fueron fuera-dentro; 31, todo-adentro y 52, híbrida (mixta). El promedio de puntos de sutura fue de 3.11 (rango 2 ­ 10). El seguimiento promedio fue de sesenta meses (rango 48 ­ 72). El score de Lysholm postoperatorio fue de 94 (rango 87 ­ 96), el IKDC postoperatorio de 88 (rango 84 ­ 92) y la escala EVA fue de 1/10. Se registraron veintitrés fallas de reparación meniscal (9.8% del total), trece asociadas a plástica de ligamento cruzado anterior (LCA) (56% de las fallas y el promedio de edad de esta población fue el mismo que el de la serie general, veintiocho años). Las fallas fueron consideradas con los criterios de Barret y se confirmaron en el intraoperatorio con visualización artroscópica.Conclusión: comprendiendo la biomecánica articular y la importancia de las estructuras meniscales en la prevención de lesiones degenerativas de la rodilla, debemos intentar la reparación meniscal en todos los casos que sean posibles. En nuestra serie utilizamos técnicas reproducibles con bajo índice de complicaciones, con un índice de falla del 9.8%. Es por eso que pregonamos la importancia de "salvar el menisco". Nivel de Evidencia: IV

Introduction: Menisci play a crucial role in the proper biomechanics and adequate function of the knee. Traumatic and degenerative injuries have different origins, diagnostic algorithms, and treatments. In the past, meniscectomy was the treatment of choice. As we understood the importance of these anatomical structures, treatments shifted towards more reparative options, aiming to preserve the maximum amount of meniscal tissue, promoting its repair, and reducing the risk of early osteoarthritis.Our objective is to present the results of meniscal repairs performed between 2012 and 2018, complemented by a review of the surgical techniques we have performed over the course of these years and the causes of failures in our patient series.Materials and methods: we evaluated 234 meniscal repairs performed between 2012 and 2018. The average age was twenty-eight years. 72% were associated with anterior cruciate ligament (ACL) injury and reconstruction. We included both isolated meniscal repairs and those associated with ACL reconstruction, performed in both genders, using inside-out, outside-in, and all-inside techniques, as well as the combination of these techniques. Patients with incomplete medical records, suture revisions performed by another surgical team, and lack of follow-up were excluded. Evaluation was based on physical examination, pain assessment using the visual analog scale (VAS), and functionality using the IKDC, Lysholm and Tegner scores.Results: arthroscopic meniscal repair was associated with ACL reconstruction in 72% (169 cases) and meniscal repair as the only procedure in 28% (65 cases), which 171 were medial menisci and 63 lateral menisci. Regarding the technique used, the distribution was as follows: 151 outside-in, 31 all-inside, and 52 hybrids (mixed). The average number of sutures was 3.11, (range 2 ­ 10). The average follow-up was sixty months (range 48 ­ 72 months). The postoperative Lysholm score was 94 (range 87 ­ 96), postoperative IKDC was 88 (range 84 ­ 92), and the VAS score was 1/10. A total of 23 failures were recorded (9.8% of the total), 13 were associated with ACL reconstruction (56% of the failures), and the average age of this population was the same as the overall series (28 years old). Failures were assessed according to Barrett's criteria and confirmed intraoperatively with arthroscopic visualization.Conclusion: understanding joint biomechanics and the importance of meniscal structures in preventing degenerative knee injuries, we should attempt meniscal repair in all possible cases. In our series, we used reproducible techniques with a low complication rate, resulting in a failure rate of 9.8%. Therefore, we emphasize the importance of "save the meniscus". Level of Evidence: IV

Thoracic-lumbar arthrodesis via extreme lateral approach: a retrospective study / Artrodese com abordagem extremo lateral da coluna toracolombar: um estudo retrospectivo / Artrodesis por abordaje lateral extremo de la columna torácico-lumbar: un estudio retrospectivo

ABSTRACT: Objective: To evaluate the epidemiological, clinical, and radiological data of patients treated with XLIF, including the impact on quality of life, pain parameters, and improvement of lumbar lordosis. Methods: Retrospective longitudinal study, in which medical records of patients who underwent XLIF between 2017 and 2020 at Hospital do Trabalhador/UFPR were reviewed. Demographic characteristics and radiological aspects, such as the Cobb angle, were recorded. Clinical characteristics using parameters such as pain by VAS and the disability index by ODI were evaluated before surgery and 12 months after. Results: Female patients predominated (66.7%), with a mean age of 59.1 years (35-82 years). The length of stay, in the median, was three days, and the time to return to daily activities was three months. Only four patients (8.9%) had complications. The questionnaire analysis showed a significant difference between all scales' pre and postoperative scores. The ODI showed an average reduction of 39.2%, and the median score of VAS in the postoperative period was half the preoperative period (reduction of 50%; p <0.001). The lordosis angle increased by 26.3% in the postoperative period (p <0.001). Conclusion: XLIF presents low complication rates, improves lumbar lordosis, and allows recovery from daily activities in a short period, in addition to performing a statistically significant improvement in quality of life and pain according to the VAS and ODI scales, being, therefore, a viable and effective treatment technique. Level of Evidence II; Retrospective Study.

RESUMO: Objetivo: Avaliar o perfil epidemiológico dos pacientes tratados com a XLIF, dados clínicos e radiológicos, incluindo o impacto na qualidade de vida, parâmetros de dor e melhora da lordose lombar. Métodos: Estudo longitudinal retrospectivo, em que foram revisados prontuários de pacientes submetidos à XLIF entre 2017 e 2020 no Hospital do Trabalhador/UFPR. Foram registrados os aspectos demográficos, características clínicas através de parâmetros como dor pela EVA e o índice de incapacidade pelo ODI, aspectos radiológicos incluindo o ângulo de Cobb antes da cirurgia e 12 meses após. Resultados: Predominou o sexo feminino (66,7%), com média de idade de 59,1 anos (35-82 anos). O tempo de internação, em mediana, foi de 3 dias e o tempo de retorno às atividades diárias foi de 3 meses. Apenas quatro pacientes (8,9%) apresentaram complicações. A análise através de questionários demonstrou diferença significativa entre as pontuações pré e pós-operatórias em todas as escalas. No ODI, houve redução média na pontuação de 39,2% e na EVA, a pontuação mediana no pós operatório foi a metade da pontuação no pré-operatório (redução de 50%; p<0,001). O ângulo da lordose teve aumento de 26,3% no pós-operatório em relação ao valor basal (p<0,001). Conclusão: A XLIF apresenta baixos índices de complicação, melhora da lordose lombar e permite a recuperação às atividades diárias em curto período de tempo, além de desempenhar melhora estatisticamente significativa na qualidade de vida e no quadro álgico segundo as escalas EVA e ODI, sendo, portanto, uma técnica viável e eficaz de tratamento. Nível de Evidência II; Estudo Retrospectivo.

RESUMEN: Objetivo: Evaluar los datos epidemiológicos, clínicos y radiológicos de los pacientes tratados con XLIF, incluyendo el impacto en la calidad de vida, los parámetros de dolor y la mejoría de la lordosis lumbar. Métodos: Estudio longitudinal retrospectivo, revisando las historias clínicas de los pacientes que se sometieron a XLIF entre 2017 y 2020 en el Hospital do Trabalhador/UFPR. Se registraron características demográficas y radiológicas, como el ángulo de Cobb. Se evaluaron las características clínicas mediante parámetros como el dolor por EVA y el índice de discapacidad por ODI antes de la cirugía y 12 meses después. Resultados: Predominó el sexo femenino (66,7%), con una edad media de 59,1 años (35-82 años). La duración de la estancia, en promedio, fue de 3 días y el tiempo para volver a las actividades diarias fue de 3 meses. Solo cuatro pacientes (8,9%) presentaron complicaciones. Los cuestionarios mostraron una diferencia significativa entre las puntuaciones pre y postoperatorias. El ODI mostró una reducción media del 39,2% y la puntuación media de la EVA en el postoperatorio fue la mitad de la puntuación en el preoperatorio (p <0,001). El ángulo de lordosis aumentó un 26,3% en el postoperatorio (p <0,001). Conclusiones: XLIF presenta bajas tasas de complicaciones, mejora la lordosis lumbar y permite la recuperación de las actividades diarias en un corto período de tiempo, con una mejora estadísticamente significativa en la calidad de vida y el dolor según EVA y ODI, siendo una técnica de tratamiento viable y eficaz. Nivel de evidencia IV; Estudio Retrospectivo.

¿Existen discrepancias entre la planificación preoperatoria y la evaluación intraoperatoria realizada por el cirujano en la artroplastia total de rodilla con asistencia robótica? / Are there discrepancies between preoperative planning and intraoperative evaluation by the surgeon in robotically assisted total knee arthroplasty?

Introducción: Existe poca evidencia respecto de la concordancia entre el plan preoperatorio mediante artroplastia total de rodilla asistida por robot y el plan posterior al balance protésico realizado por el cirujano. El objetivo de este trabajo es evaluar el grado de concordancia entre la planificación preoperatoria de la artroplastia total de rodilla con asistencia robótica semiactiva (Mako) y la planificación efectuada por el traumatólogo durante la cirugía. Materiales y métodos: estudio retrospectivo y descriptivo de prótesis primarias instaladas entre octubre de 2018 y junio de 2019 con planificación preoperatoria realizada por el software MAKOplasty®. Se excluyeron las prótesis no colocadas por el sistema robótico o con información clínica incompleta. Esto se comparó con la planificación intraoperatoria del traumatólogo. Variables analizadas: alineación coronal y sagital, rotación y tamaño de los componentes e inserto. Los datos se analizaron con el softwareSTATA v.16.0. Se realizó un análisis descriptivo univariante cualitativo, con un intervalo de confianza del 95%. Resultados: se incluyeron cincuenta y una rodillas operadas de cuarenta y nueve pacientes, el 69% fueron mujeres. El nivel de concordancia para el componente femoral fue: axial 86.3% (IC = 73.7 - 94.2), coronal 88.2% (IC = 76.1 - 95.5), sagital 88.2% (IC = 76.1 - 95.5). Componente tibial: axial 98% (IC = 89.5 ­ 99.9), coronal 96.1% (IC = 86.5 ­ 99.5), sagital 96.1% (IC = 86.5 ­ 99.5). Tamaño del componente: fémur 94.1% (IC = 83.7 ­ 98.7), tibia 84.3% (IC = 71.4 ­ 92.9), inserto 27.4% (IC = 15.8 ­ 41.7). Conclusión: la planificación preoperatoria mediante el uso de la asistencia robótica semiactiva de Mako presenta un buen nivel de concordancia con la planificada intraoperatoriamente, a excepción del tamaño del inserto. El traumatólogo es determinante en la modificación del plan preoperatorio. Nivel de Evidencia: III

Introduction: There is little evidence regarding the concordance between the preoperative plan using robotic-assisted total knee arthroplasty and that after the prosthetic balance by the surgeon. Our aim is to evaluate the level of agreement between the preoperative planning of total knee arthroplasty with semiactive robotic assistance (Mako) and the planning made by the orthopedic surgeon during the surgery. Materials and methods: descriptive study of prostheses installed between October 2018 and June 2019 with preoperative planning performed by the MAKOplasty® software. This was compared with intraoperative planning by the Orthopedic Surgeon. Variables analyzed: coronal and sagittal alignment, rotation and size of the components and insert. The data was analyzed with the STATA v.16.0 software. A qualitative univariate descriptive analysis was performed, with a 95% confidence interval. Results: fifty-one operated knees from forty-nine patients were included, 69% were women. The level of agreement was: Femoral component: axial 86.3% [CI = 73.7 - 94.2], coronal 88.2% [CI = 76.1 - 95.5], sagittal 88.2% [CI = 76.1 - 95.5]. Tibial component: axial 98% [CI = 89.5 - 99.9], coronal 96.1% [CI = 86.5 - 99.5], sagittal 96.1% [CI = 86.5 - 99.5]. Component size: femur 94.1% [CI = 83.7 - 98.7], tibia 84.3% [CI = 71.4 - 92.9], insert 27.4% [CI = 15.8 - 41.7]. Conclusion: preoperative planning through the use of Mako semiactive robotic assistance presents a good level of agreement with that planned intraoperatively, with the exception of the insert size. The orthopedic surgeon is decisive in modifying the preoperative plan. Level of Evidence: III

Tratamiento artroscópico del síndrome de fricción femoroacetabular en pacientes con displasia limítrofe. Estudio comparativo / Arthroscopic treatment of femoroacetabular friction syndrome in patients with borderline dysplasia. Comparative study

Introducción: El tratamiento artroscópico del síndrome de fricción femoroacetabular (SFFA) en displasia de cadera es controversial. Inicialmente, algunos estudios demostraron una tasa elevada de fallas, mientras que otros más recientes describieron una mejoría clínica comparable con pacientes sin falta de cobertura acetabular. El propósito de este estudio fue comparar los resultados clínicos y funcionales de la artroscopía de cadera en dos cohortes: pacientes con displasia borderline y pacientes con ángulo centro-borde normal. Materiales y métodos: evaluamos los resultados clínicos y funcionales utilizando el Harris Hip Score (HHS), Hip Outcome Score (HOS) y l Escala Visual Análoga del Dolor (EVA) del tratamiento artroscópico del SFFA para dos grupos de pacientes: el grupo 1 conformado por aquellos que presentaban displasia borderline (DB) y el grupo 2, compuesto por pacientes con un valor del ángulo centro-borde normal (ACBN). Resultados: los valores postoperatorios de las escalas de HHS y EVA no mostraron diferencias estadísticamente significativas entre los grupos (87.0 ± 5.3 versus 85.8 ± 3.6; p = 0.200 y 1.5 ± 0.6 versus 1.3 ± 0.5; p = 0.07, respectivamente).No se observaron diferencias significativas con respecto a las actividades de la vida diaria del score de HOS (91.8 ± 6.6 versus 93.2 ± 5.9; p = 0.28), ni de deportes, (85.1 ± 7.7 ± 8.3 versus 88.3 ± 11.9; p = 0.19). Conclusión: los pacientes sometidos a una artroscopía de cadera con displasia borderline, alcanzan resultados clínicos y funcionales similares que aquellos con ACBN con una media de seguimiento de tres años. Nivel de Evidencia: III

Introduction: Arthroscopic treatment of femoral-acetabular impingement syndrome in patients with hip dysplasia is controversial. There are some reports that observed an increased failure rate in this type of patients. More recent studies described good patients clinical and functional outcomes, comparable with patients with a normal acetabular coverage. The purpose of this study was to assess functional and clinical outcomes of arthroscopic treatment of FAI in two cohorts: patients with Borderline Dysplasia and patients with a normal lateral center-edge angle. Materials and methods: we assessed patients reported outcomes of two groups of patients: group 1 that consisted in patients with Borderline Dysplasia and group 2, with patients with a normal lateral center-edge angle. The minimum follow-up required was three years. Results: there were no statistically significant differences regarding Harris Hip Score and Visual Analogue Scale of Pain respectively (87.0 ± 5.3 versus 85.8 ± 3.6; p = 0.200 y 1.5 ± 0.6 versus 1.3 ± 0.5; p = 0.07) after surgery between both groups. We didn't observe differences regarding Daily Living Activities (91.8 ± 6,6 versus 93.2 ± 5.9; p = 0.28) or Sports of Hip Outcome Score (85.1 ± 7.7 ± 8.3 versus 88.3 ± 11.9; p = 0.19).Conclusion: arthroscopic treatment of FAI syndrome in patients with borderline dysplasia, achieves good clinical and functional outcomes, comparable with patients with a normal lateral center-edge angle. Level of Evidence: III

Técnica quirúrgica para la reconstrucción del ligamento patelofemoral medial / Surgical technique for medial patellofemoral ligament reconstruction

La inestabilidad patelofemoral es uno de los problemas más frecuentes en pacientes jóvenes, y representa del 2 al 3% de todas las lesiones de rodilla. Significa una causa importante de morbilidad debido a la limitación de varias actividades de la vida diaria, y a largo plazo el surgimiento de artrosis. La inestabilidad patelofemoral es descripta como la deficiencia de la constricción pasiva que genera un desplazamiento lateral de la patela total o parcial de su posición normal con respecto a la tróclea. Los desórdenes patelofemorales son el resultado de una anatomía aberrante, están dados por una alteración en la alineación ósea y generan un desequilibrio biomecánico. Existen cuatro factores clásicos que generan inestabilidad patelar: patela alta, displasia troclear, alteración en la distancia (TT-TG) y excesiva inclinación patelar. Al generarse una luxación, el ligamento patelofemoral medial (LPFM) se ve afectado en al menos el 25% de los casos. El complemento diagnóstico se realiza a través de rayos X, tomografía computarizada y resonancia magnética. La restauración de la función por tratamiento quirúrgico ha mostrado resultados similares al conservador en primoluxaciones, sin embargo, se ha visto que la reconstrucción del ligamento patelofemoral medial presenta mejores resultados clínicos para el paciente. Hasta el momento, hemos intervenido diecinueve pacientes con la técnica descripta, para los cuales no hay reportada una reluxación de rótula y tienen una escala de Lysholm de 87 puntos que se encuentra dentro del parámetro "bueno".

Patellofemoral instability is one of the most frequent problems in young patients, and represents 2 to 3% of all knee injuries. It denotes an important cause of morbidity due to the limitation of various activities of daily living and in the long term the appearance of osteoarthritis. Patellofemoral instability is defined as the deficiency of passive constriction that generates a total or partial lateral displacement of the patella from its normal position with respect to the trochlea. Patellofemoral disorders are the result of an aberrant anatomy, they are given by an alteration in bone alignment and generates a biomechanical imbalance. There are four classic factors that generate patellar instability: high patella, trochlear dysplasia, alteration in distance (TT-TG) and excessive patellar inclination. When generating the dislocation, the medial patellofemoral ligament is affected in at least 25% of cases. The diagnostic complement is carried out through X-rays, computed tomography and nuclear magnetic resonance.Restoration of function surgical treatment has shown similar results to conservative treatment in primoluxations, however it has been seen that reconstruction of the medial patellofemoral ligament presents better clinical results for the patient.To date, nineteen patients we have been operated on with the technique described of whom there is no reported reluxation of the patella and who have a Lysholm scale of 85 points that is within a good parameter.

Minimally invasive right infra-axillary thoracotomy for transaortic modified Morrow procedure: a series of 60 cases / 中华外科杂志

Objective: To examine the short-term curative effect with minimally invasive right infra-axillary thoracotomy for transaortic modified Morrow procedure. Methods: The clinical data of 60 patients who underwent video-assisted thoracoscopic transaortic modified Morrow procedure from August 2021 to August 2022 at Department of Cardiovascular Surgery, Zhejiang Provincial People's Hospital were retrospectively analyzed. There were 31 males and 29 females, with the age (M (IQR)) of 54.0(22.3) years (range: 15 to 71 years). The echocardiography confirmed the diagnosis of moderate mitral regurgitation in 30 patients, and severe mitral regurgitation in 13 patients. Systolic anterior motion (SAM) was present preoperatively in 54 patients. All 60 patients underwent transaortic modified Morrow procedure through a right infra-axillary thoracotomy using femorofemoral cardiopulmonary bypass. Surgical procedures mainly included transverse aortic incision, exposure of left ventricular outflow tract (LVOT), septal myectomy, and correction of the abnormal mitral valve and subvalvular structures. Results: All 60 patients underwent the programmatic procedures successfully without conversion to full sternotomy. The cardiopulmonary bypass time was (142.0±32.1) minutes (range: 89 to 240 minutes), while the cross-clamp time was (95.0±23.5) minutes (range: 50 to 162 minutes). The patients had a postoperative peak LVOT gradient of 7.0 (5.0) mmHg (range: 0 to 38 mmHg) (1 mmHg=0.133 kPa). A total of 57 patients were extubated on the operating table. The drainage volume in the first 24 h was (175.9±57.0) ml (range: 60 to 327 ml). The length of intensive care unit stay was 21.0 (5.8)h (range: 8 to 120 h) and postoperative hospital stay was 8 (5) days (range: 5 to 19 days). The postoperative septal thickness was 11 (2) mm (range: 8 to 14 mm). All patients had no iatrogenic ventricular septal perforation or postoperative residual SAM. The patients were followed up for 4 (9) months (range: 1 to 15 months), and none of them needed cardiac surgery again due to valve dysfunction or increased peak LVOT gradient during follow-up. Conclusion: Using a video-assisted thoracoscopic transaortic modified Morrow procedure through a right infra-axillary minithoracotomy can provide good visualization of the LVOT and hypertrophic ventricular septum, ensure optimal exposure of the mitral valve in the presence of complex mitral subvalvular structures, so that allows satisfactory short-term surgical results.

Chinese expert consensus on minimally invasive radical surgery for pancreatic ductal adenocarcinoma (version 2022) / 中华外科杂志

Although there are still controversies over the efficiency and safety of minimally invasive radical surgery for pancreatic ductal adenocarcinoma (PDAC), most available studies have suggested a promising application of minimally invasive radical surgery. This consensus, referring to Chinese expert opinions and worldwide researches, aimed to discuss the related issues on minimally invasive radical surgery for PDAC to ensure the perioperative and oncological outcomes. Quality of evidence and strength of recommendations were evaluated based on the GRADE approach. The 15 recommendations covered 5 topics: oncological outcomes and patient safety of laparoscopic and robotic pancreatoduodenectomy, left-side pancreatectomy for PDAC, learning curve, safety of neoadjuvant therapy, and vascular resection in minimally invasive radical surgery for PDAC. This consensus gives reference and guidance to surgeons on the use of minimally invasive radical surgery for PDAC. Although this consensus is not sufficient to answer all the questions about minimally invasive radical surgery for PDAC, it represents the current consensus on the application of the techniques in the treatment of PDAC on the Chinese mainland.

Building world leading surgical oncology for gastric cancer in China / 中华外科杂志

This century has seen significant advances in the treatment and research of gastric cancer in China. Chinese scholars have made a series of key technological breakthroughs in minimally invasive surgery, perioperative treatment and artificial intelligence diagnosis. These world-leading clinical researches have improved treatment outcomes and reduced surgical trauma. Global surveillance of trends in cancer survival 2000-14 reported that survival of gastric cancer in China has significantly improved during the last 20 years. This paper reviews the research history of surgical oncology for gastric cancer in China, summarises the experience and attempts to explore the future direction.

Six novel minimally invasive therapies for benign prostatic hyperplasia / 浙江大学学报·医学版

Benign prostatic hyperplasia (BPH) is the most common cause of lower urinary tract symptoms in men. When drug treatment is ineffective or conventional surgery is not suitable, novel minimally invasive therapies can be considered. These include prostatic urethral lift, prostatic artery embolisation, water vapor thermal therapy, Aquablation-image guided robotic waterjet ablation, temporary implantable nitinol device and prostatic stents. These novel therapies can be performed in outpatient setting under local anesthesia, with shorter operative and recovery times, and better protection of ejaculatory function and erectile function. General conditions of the patient and advantages and disadvantages of the each of these therapies should be fully considered to make individualized plans.

Causes of asymptomatic side limb pain after minimally invasive transforaminal lumbar interbody fusion / 中国骨伤

OBJECTIVE@#To investigate possible causes and preventive measures for asymptomatic pain in the limbs after minimally invasive transforaminal lumbar interbody fusion(MIS-TLIF).@*METHODS@#Clinical data from 50 patients with lumbar degenerative disease who underwent MIS-TLIF between January 2019 and September 2020 were retrospectively analyzed. The group included 29 males and 21 females aged from 33 to 72 years old, with an average age of (65.3±7.13) years. Twenty-two patients underwent unilateral decompression, and 28 underwent bilateral decompression. The side(ipsilateral or contralateral) and site(low back, hip, or leg) of the pain were recorded before surgery, 3 days after surgery, and 3 months after surgery. The pain degree was evaluated using the visual analogue scale(VAS) at each time point. The patients were further grouped based on whether contralateral pain occurred postoperatively (8 cases in the contralateral pain group and 42 in the no contralateral pain group), and the causes and preventive measures of pain were analyzed.@*RESULTS@#All surgeries were successful, and the patients were followed up for at least 3 months. Preoperative pain on the symptomatic side improved significantly, with the VAS score decreasing from (7.00±1.79) points preoperatively to (3.38±1.32) points at 3 days postoperatively and (3.98±1.17) points at 3 months postoperatively. Postoperative asymptomatic side pain (contralateral pain) occurred in 8 patients within 3 days after surgery, accounting for 16% (8/50) of the group. The sites of contralateral pain included the lumbar area (1 case), hip(6 cases), and leg (1 case). The contralateral pain was significantly relieved 3 months after surgery.@*CONCLUSION@#More cases of contralateral limb pain occur after unilateral decompression MIS-TLIF, and the reason may include contralateral foramen stenosis, compression of medial branches, and other factors. To reduce this complication, the following procedures are recommended: restoring intervertebral height, inserting a transverse cage, and withdrawing screws minimally.

Comparison of clinical effect and muscle injury imaging between oblique lateral lumbar interbody fusion and transforaminal lumbar interbody fusion in the treatment of single-segment degenerative lumbar spinal stenosis / 中国骨伤

OBJECTIVE@#To compare the efficacy and muscle injury imaging between oblique lateral lumbar interbody fusion (OLIF) and transforaminal lumbar interbody fusion (TLIF) in the treatment of single-segment degenerative lumbar spinal stenosis.@*METHODS@#The clinical data of 60 patients with single-segment degenerative lumbar spinal stenosis who underwent surgical treatment from January 2018 to October 2019 was retrospectively analyzed. The patients were divided into OLIF groups and TLIF group according to different surgical methods. The 30 patients in the OLIF group were treated with OLIF plus posterior intermuscular screw rod internal fixation. There were 13 males and 17 females, aged from 52 to 74 years old with an average of (62.6±8.3) years old. And 30 patients in the TLIF group were treated with TLIF via the left approach. There were 14 males and 16 females, aged from 50 to 81 years old with an average of (61.7±10.4) years old. General data including operative time, intraoperative blood loss, postoperative drainage volume, and complications were recorded for both groups. Radiologic data including disc height (DH), the left psoas major muscle, multifidus muscle, longissimus muscle area, T2-weighted image hyperintensity changes and interbody fusion or nonfusion were observed. Laboratory parameters including creatine kinase (CK) values on postoperative 1st and 5th days were analyzed. Visual analogue scale(VAS) and Oswestry disability index(ODI) were used to assess clinical efficacy.@*RESULTS@#There was no significant difference in the operative time between two groups(P>0.05). The OLIF group had significantly less intraoperative blood loss and postoperative drainage volume compared to the TLIF group(P<0.01). The OLIF group also had DH better recovery compared to the TLIF group (P<0.05). There were no significant differences in left psoas major muscle area and the hyperintensity degree before and after the operation in the OLIF group (P>0.05). Postoperativly, the area of the left multifidus muscle and longissimus muscle, as well as the mean of the left multifidus muscle and longissimus muscle in the OLIF group, were lower than those in the TLIF group (P<0.05) .On the 1st day and the 5th day after operation, CK level in the OLIF group was lower than that in the TLIF group(P<0.05). On the 3rd day after operation, the VAS of low back pain and leg pain in the OLIF group were lower than those in the TLIF group (P<0.05). There were no significant differences in the ODI of postoperative 12 months, low back and leg pain VAS at 3, 6, 12 months between the two groups(P>0.05). In the OLIF group, 1 case of left lower extremity skin temperature increased after the operation, and the sympathetic chain was considered to be injured during the operation, and 2 cases of left thigh anterior numbness occurred, which was considered to be related to psoas major muscle stretch, resulting in a complication rate of 10% (3/30). In the TLIF group, one patient had limited ankle dorsiflexion, which was related to nerve root traction, two patients had cerebrospinal fluid leakage, and the dural sac was torn during the operation, and one patient had incision fat liquefaction, which was related to paraspinal muscle dissection injury, resulting in a complication rate of 13% (4/30). All patients achieved interbody fusion without cage collapse during the 6- month follow-up.@*CONCLUSION@#Both OLIF and TLIF are effective in the treatment of single-segment degenerative lumbar spinal stenosis. However, OLIF surgery has obviously advantages, including less intraoperative blood loss, less postoperative pain, and good recovery of intervertebral space height. From the changes in laboratory indexes of CK and the comparison of the left psoas major muscle, multifidus muscle, longissimus muscle area, and high signal intensity of T2 image on imaging, it can be seen that the degree of muscle damage and interference of OLIF surgery is lower than that of TLIF.

Clinical and radiologic comparison between oblique lateral interbody fusion and minimally invasive transforaminal lumbar interbody fusion for degenerative lumbar spondylolisthesis / 中国骨伤

OBJECTIVE@#To compare the short-term clinical efficacy and radiologic differences between oblique lateral interbody fusion(OLIF) and minimally invasive transforaminal lumbar interbody fusion (MIS-TLIF) for degenerative lumbar spondylolisthesis.@*METHODS@#A retrospective analysis was performed on 58 patients with lumbar spondylolisthesis treated with OLIF or MIS-TLIF from April 2019 to October 2020. Among them, 28 patients were treated with OLIF (OLIF group), including 15 males and 13 females aged 47 to 84 years old with an average age of (63.00±9.38) years. The other 30 patients were treated with MIS-TLIF(MIS-TLIF group), including 17 males and 13 females aged 43 to 78 years old with an average age of (61.13±11.10) years. General conditions, including operation time, intraoperative blood loss, postoperative drainage, complications, lying in bed, and hospitalization time were recorded in both groups. Radiological characteristics, including intervertebral disc height (DH), intervertebral foramen height (FH), and lumbar lordosis angle (LLA), were compared between two groups. The visual analogue scale (VAS) and Oswestry disability index (ODI) were used to evaluate the clinical effect.@*RESULTS@#The operation time, intraoperative blood loss, postoperative drainage, lying in bed, and hospitalization time in OLIF group were significantly less than those in the MIS-TLIF group (P<0.05). The intervertebral disc height and intervertebral foramen height were significantly improved in both groups after the operation (P<0.05). The lumbar lordosis angle in OLIF group was significantly improved compared to before the operation(P<0.05), but there was no significant difference in the MIS-TLIF group before and after operation(P>0.05). Postoperative intervertebral disc height, intervertebral foramen height, and lumbar lordosis were better in the OLIF group than in the MIS-TLIF group (P<0.05). The VAS and ODI of the OLIF group were lower than those of the MIS-TLIF group within 1 week and 1 month after the operation (P<0.05), and there were no significant differences in VAS and ODI at 3 and 6 months after the operation between the two groups(P>0.05). In the OLIF group, 1 case had paresthesia of the left lower extremity with flexion-hip weakness and 1 case had a collapse of the endplate after the operation;in the MIS-TLIF group, 2 cases had radiation pain of lower extremities after decompression.@*CONCLUSION@#Compared with MIS-TLIF, OLIF results in less operative trauma, faster recovery, and better imaging performance after lumbar spine surgery.