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

ABSTRACT Purpose: We reported, as a referral center in prostate cancer, our perspectives and experience performing Telesurgery using robotic surgery and 5G network. Material and methods: We described and illustrated the Telesurgery applications and outcomes to treat a patient with prostate cancer located 1300 kilometers away from the surgeon (Beijing-Harbin) in China. We used the Edge Medical Robot (MP1000) in November 2023 in a 71-year-old patient with Gleason 6 (ISUP 1) in 8 cores from 13, PSA of 14 ng/dL, and clinical stage cT2a. MRI described a PIRADS 5 nodule on the left peripheral zone at the base, and 20gr prostate. We described details about the connection between centers, perioperative outcomes, and our perspectives as a referral center in prostate cancer. Results: We had no delays, or problems with network connection between the centers. The procedure was performed in 60 minutes, with no intra- or postoperative complications. Estimated blood loss was 100 mL. The patient was ambulating soon after anesthesia recovery. Final pathology described a Gleason 6 (ISUP 1) involving the left base and left seminal vesicle, negative surgical margins, and no lymph node involvement (pT3bN0). The patient was continent soon after catheter removal (7 days). Conclusion: As technological progress introduced novel robotic platforms and high-speed networks, the concept of Telesurgery became a tangible reality while 5G technology solved latency and transmission concerns. However, with these advancements, ethical considerations and regulatory frameworks should underline the importance of transparency and patient safety with responsible innovation in the field.

Evaluation of suburethral transobturator sling procedure on urinary incontinence and quality-of-life

Background: Urinary incontinence has an estimated incidence of 25-50% in the adult female population. It has a profound physical and psychosocial impact, compromising women抯 quality-of-life (QoL). The suburethral sling is currently considered the surgical treatment of choice for stress urinary incontinence (SUI). The present study aimed to evaluate the impact of urinary incontinence on women抯 QoL before and after transobturator suburethral sling surgery, as well as the effectiveness of surgical treatment.Methods: A prospective longitudinal, observational and analytical study was performed between June and December 2021. The study population included 64 women with urinary incontinence, to whom the King's Health Questionnaire (KHQ) was applied, before and after surgery.Results: Of the 64 women included in the study, 59.4% (n=38) had SUI and 40.6% (n=26) had mixed urinary incontinence (MUI). There was an improvement in the global KHQ score in 96.9% (n=62) of subjects, with a statistically and clinically significant impact on QoL (p<0.001). Patients with MUI had higher preoperative KHQ global scores, reflecting a more substantial impact on their QoL. Surprisingly, postoperative improvement in QoL was equally significant, both clinically and statistically (p<0.001), with no differences when comparing to isolated sui patients (p>0.05).Conclusions: QoL assessment questionnaires help to quantify individual impact of urinary incontinence and identify which patients benefited most from treatment. This study not only enhances our understanding of the true impact of urinary incontinence on QoL, but also emphasizes the effectiveness and importance of this minimally invasive surgery in improving the QoL of patients with SUI as well as MUI.

The 2012 Briganti nomogram not only predicts lymph node involvement but also disease progression in surgically treated intermediate-risk prostate cancer patients with PSA <10 ng/mL, ISUP grade group 3, and clinical stage up to cT2b

ABSTRACT Purpose We assessed the prognostic impact of the 2012 Briganti nomogram on prostate cancer (PCa) progression in intermediate-risk (IR) patients presenting with PSA <10ng/mL, ISUP grade group 3, and clinical stage up to cT2b treated with robot assisted radical prostatectomy eventually associated with extended pelvic lymph node dissection. Materials and Methods From January 2013 to December 2021, data of surgically treated IR PCa patients were retrospectively evaluated. Only patients presenting with the above-mentioned features were considered. The 2012 Briganti nomogram was assessed either as a continuous and a categorical variable (up to the median, which was detected as 6%, vs. above the median). The association with PCa progression, defined as biochemical recurrence, and/or metastatic progression, was evaluated by Cox proportional hazard regression models. Results Overall, 147 patients were included. Compared to subjects with a nomogram score up to 6%, those presenting with a score above 6% were more likely to be younger, had larger/palpable tumors, presented with higher PSA, underwent tumor upgrading, harbored non-organ confined disease, and had positive surgical margins at final pathology. PCa progression, which occurred in 32 (21.7%) cases, was independently predicted by the 2012 Briganti nomogram both considered as a continuous (Hazard Ratio [HR]:1.04, 95% Confidence Interval [CI]:1.01-1.08;p=0.021), and a categorical variable (HR:2.32; 95%CI:1.11-4.87;p=0.026), even after adjustment for tumor upgrading. Conclusions In IR PCa patients with PSA <10ng/mL, ISUP grade group 3, and clinical stage up to cT2b, the 2012 Briganti nomogram independently predicts PCa progression. In this challenging subset of patients, this tool can identify prognostic subgroups, independently by upgrading issues.

Abordagem estética e conservadora para fechamento de múltiplos diastemas: relato de caso / Aesthetic and conservative approach to multiple diastema closure: case report / Enfoque estético y conservador para el cierre de múltiples diastemas: relato de caso

Introdução:Na odontologia moderna, a estética vem ocupando um espaço cada vez mais expressivo, e o desejo por dentes mais brancos, a insatisfação com o alinhamento dos dentes e com a anatomia dentária, têm sido os motivos mais relevantes de procura dos pacientes nos consultórios odontológicos.Objetivo:O presente artigo tem como objetivo descrever, através de relato de caso clínico, uma abordagem terapêutica estética e conservadora para fechamento de múltiplos diastemas anterossuperiores com a utilização de facetas de resina composta.Relato de caso:Paciente do sexo masculino, 21 anos de idade, procurou atendimento queixando-se de insatisfação estética pelos diastemas apresentados. Por meio de um planejamento digital das facetas em resina, com mockup e modelo impresso em 3D, as restaurações foram feitas respeitando anatomia, forma, opacidade e cores dos dentes naturais do paciente. O resultado dos procedimentos adotados foi satisfatório, demonstrando que a técnica empregada foi eficaz, sendo capaz de devolver um sorriso estético e biológico ao paciente. A odontologia contemporânea tem ofertado cada vez mais materiais com capacidade de devolver estética e função em dentes de forma minimamente invasivas, além de passar total confiabilidade em tratamentos a longo prazo, agradando o paciente desde a apresentação digital do planejamento traçado pelo cirurgião dentista com previsibilidade dos resultados, até o momento final do tratamento.Conclusões:O recontorno estético com resina composta representa uma opção funcional e de baixo custo para o tratamento de pacientes que apresentam diastemas múltiplos, principalmente em pacientes jovens pela preservação daestrutura dentária e possibilidade de reparo, sendo considerado um procedimento reversível, rápido e de baixo custo (AU).

Introduction:Aesthetics have been occupying an increasingly significant role in modern dentistry, and the desire for whiter teeth, dissatisfaction with tooth alignment, and dental anatomy concerns have been the most relevant reasons for patients seeking dental care. Objective:This article aims to describe an aesthetic and conservative therapeutic approach for closing multiple anterior upper diastemas using composite resin veneers in a clinical case report. Case report:A 21-year-old male patient sought treatment, expressing dissatisfaction with the diastemas he had. The restorations were performed using digital planning of the resin veneers with a mockup and a 3D-printed model, while respecting the patient's natural tooth anatomy, shape, opacity, and colors. The results of the adopted procedures were satisfactory, demonstrating effectiveness of the employed technique in restoring an aesthetic and biologically harmonious smile to the patient. Contemporary dentistry has been offering increasingly more materials capable of providing aesthetics and function to teeth through minimally invasive approaches. This not only ensures long-term treatment reliability, but also pleases the patient with a digital presentation of the treatment plan outlined by the dentist, predicting the results up to the final stages of the treatment. Conclusions:Aesthetic contouring using composite resin presents a functional and cost-effective option for treating patients with multiple diastemas, especially among young patients due to its preservation of dental structure, repair potential, and being considered a reversible, fast, and low-cost procedure (AU).

Introducción: En la odontología moderna, la estética viene ocupando un espacio cada vez más destacado, y las ganas de tener dientes más blancos, la insatisfacción con el alineamiento de los dientes, y la anatomía dental son las razonesmás relevantes por las cuales los pacientes acuden a las consultas odontológicas. Objetivo:El presente artículo tiene como objetivo describir, a través de un relato de caso clínico, un abordaje terapéutico estético y conservador para el cierre de múltiples diastemas anterosuperiores mediante el uso de carillas de resina compuesta. Informe de caso:Paciente del sexo masculino, 21 años de edad, buscó atendimiento quejándose de insatisfacción estética debido a los diastemas presentados. A través de una planificación digital de las carillas en resina, con un mockup y un modelo impreso en 3D, las restauraciones fueron ejecutadas, respetándose la anatomía, forma, opacidad y colores de los dientes naturales del paciente. El resultado de los procedimientos adoptados fue satisfactorio y demostró que la técnica utilizada fue eficaz, siendo capaz de restituir una sonrisa estética y funcional al paciente. La odontología contemporánea viene ofreciendo cada vez más materiales con la capacidad de devolver estética y función a los dientes de maneras mínimamente invasivas, además de brindar total confiabilidad en tratamientos a largo plazo, satisfaciendo al paciente desde la presentación digital del plan trazado por el cirujano dentista con la previsibilidad de los resultados, hasta el momento final del tratamiento. Conclusiones:El recontorneado estético con resina compuesta representa una opción funcional y de bajo costo para el tratamiento de pacientes con múltiples diastemas, especialmente en pacientes jóvenes, debido a la preservación de la estructura dental y la posibilidad de reparación. Se considera, de este modo, que se trata de un procedimiento reversible, rápido y económico (AU).

Prospective Study of the Assessment of Anxiety Symptoms after Minimally Invasive Lumbar Decompression / Estudo prospectivo da avaliação dos sintomas de ansiedade após descompressão lombar minimamente invasiva

Summary Objective To analyze associations between anxiety and postsurgical clinical outcomes in patients who underwent minimally invasive lumbar decompression surgery in addition to comparing symptoms of anxiety and depression before and after surgery. Methods This prospective cohort study of patients who underwent minimally invasive lumbar decompression surgery. Clinical outcomes were measured before and 6 months after surgery using the Visual Analog Scale (VAS), Global Perceived Effect of Change (GPE), Hospital Anxiety and Depression Scale (HADS), and Oswestry Disability Index (ODI). Based on the presurgical anxiety score, patients were categorized into anxious and non-anxious patients, and the outcomes were compared. Results The patients of both groups obtained similar results concerning the clinical outcomes evaluated. Preoperative HADS scores decreased significantly 6 months after surgery in both anxiety (8.70 ± 3.48 vs. 5.75 ± 3.91) and depression (6.95 ± 3.54 vs. 5.50 ± 2.99). The VAS scale for the back (-2.8 ± 3.64) and legs (-5.5 ± 3.5) showed a reduction in pain. Conclusion Minimally invasive lumbar decompression surgery promoted clinical and functional improvement, not being affected by preoperative anxiety symptoms. Mental health indicators showed a significant reduction in symptoms 6 months after surgery.

Resumo Objetivo Analisar associações entre ansiedade e desfecho clínico pós-cirúrgico em pacientes que realizaram a cirurgia de descompressão lombar minimamente invasiva, além de comparar sintomas de ansiedade e depressão antes e após a cirurgia. Métodos Trata-se de um estudo de coorte prospectiva de pacientes que realizaram a cirurgia de descompressão lombar minimamente invasiva. Os desfechos clínicos foram mensurados antes e 6 meses após a cirurgia, utilizando a escala visual analógica de dor (EVA); Global Perceived Effect of Change (GPE); Hospital Anxiety and Depression Scale (HADS) e o Oswestry Disability Index (ODI). A partir do escore de ansiedade précirúrgico, os pacientes foram categorizados em pacientes ansiosos e não ansiosos e os desfechos comparados. Resultados Os pacientes de ambos os grupos obtiveram resultados similares em relação aos desfechos clínicos avaliados. Os escores HADS pré-operatório diminuíram significantemente 6 meses após a cirurgia, tanto em ansiedade (8,70 ± 3,48 vs. 5,75 ± 3,91) quanto em depressão (6,95 ± 3,54 vs. 5,50 ± 2,99). Houve redução da dornaescalaEVA dascostas(-2,8 ± 3,64) e das pernas (-5,5 ± 3,5). Conclusão A cirurgia de descompressão lombar minimamente invasiva promoveu melhora clínica e funcional, não sendo afetada por sintomas pré-operatórios de ansiedade. Os indicadores de saúde mental evidenciaram redução significativa dos sintomas 6 meses após a cirurgia.

Extensive Pancreatic Necrosis, Successful Management with Percutaneous Endoscopic Necrosectomy / Necrosis pancreática extensa, manejo exitoso con necrosectomía endoscópica percutánea

Abstract Percutaneous endoscopic necrosectomy is a procedure indicated for managing extensive pancreatic necrosis. Different endoscopic and surgical alternatives have been described for drainage of peripancreatic collections and debridement of necrosis, and minimally invasive approaches have lower complications and mortality rates. We presented the case of a patient with severe pancreatitis associated with pancreatic necrosis extending to both paracolic gutters, who underwent percutaneous endoscopic necrosectomy, after unsuccessful percutaneous and laparoscopic drainage, and a complete resolution of the clinical picture was achieved. Management should consider the clinical condition of the patient, the location of the collections, and the time of evolution of the pancreatitis, and thus choose which intervention will be the most effective, considering also the experience of the medical team and the available resources.

Resumen La necrosectomía endoscópica percutánea es un procedimiento indicado para el manejo de la necrosis pancreática extensa. Se han descrito diferentes alternativas endoscópicas y quirúrgicas para el drenaje de colecciones peripancreáticas y el desbridamiento de la necrosis, y los abordajes mínimamente invasivos tienen menores tasas de complicaciones y mortalidad. Se presenta el caso de un paciente con pancreatitis grave asociada a necrosis pancreática con extensión a ambas goteras parietocólicas, que fue llevado a necrosectomía endoscópica percutánea, luego de drenajes percutáneos y laparoscópicos no exitosos, y se logró una resolución completa del cuadro clínico. Para determinar el manejo, se debe considerar el estado clínico del paciente, la localización de las colecciones y el tiempo de evolución de la pancreatitis, y de este modo elegir qué intervención será la más efectiva, considerando además la experiencia del equipo médico y los recursos disponibles.

Outcomes of ablative therapy and radical treatment for prostate cancer: a systematic review and meta-analysis

ABSTRACT Purpose: To compare biochemical recurrence, sexual potency and urinary continence outcomes of ablative therapy and radical treatment (radical prostatectomy or radiotherapy with androgen deprivation therapy). Material and methods: A systematic review and meta-analysis followed the PRISMA guidelines were performed. We searched MEDLINE/PubMed. Biochemical recurrence at three and five years; incontinence rate (patients who used one pad or more) and erectile dysfunction rate at 12 and 36 months (patients who did not have sufficient erection to achieve sexual intercourse) were evaluated. The Mantel-Haenszel method was applied to estimate the pooled risk difference (RD) in the individual studies for categorical variables. All results were presented as 95% confidence intervals (95%CI). Random effects models were used regardless of the level of heterogeneity (I²). (PROSPERO CRD42022296998). Results: Eight studies comprising 2,677 men with prostate cancer were included. There was no difference in biochemical recurrence between ablative and radical treatments. We observed the same biochemical recurrence between ablative therapy and radical treatment within five years (19.3% vs. 16.8%, respectively; RD 0.07; 95%CI=-0.05, 0.19; I2=68.2%; P=0.08) and continence rate at 12 months (9.2% vs. 31.8%, respectively; RD −0.13; 95%CI, −0.27, 0.01; I2=89%; P=0.32). When focal treatment was analyzed alone, two studies with 582 patients found higher erectile function at 12 months in the ablative therapy group than in the radical treatment (88.9% vs. 30.8%, respectively; RD −0.45; 95%CI −0.84, −0.05; I2=93%; P=0.03). Conclusion: Biochemical recurrence and urinary continence outcomes of ablative therapy and radical treatment were similar. Ablative therapy appears to have a high rate of sexual potency.

Resistencia a la Fractura de Premolares Según el Diseño de Cavidad de Acceso Endodóntico. Estudio in vitro

La preparación de la cavidad de acceso es el primer paso y un requisito esencial, para la instrumentación y obturación de los conductos radiculares durante el tratamiento endodóntico. El objetivo del presente estudio fue comparar la resistencia a la fractura in vitro de premolares con cavidad de acceso tradicional (CAT), cavidad de acceso conservador (CAC) y cavidad de acceso ultraconservador (CAU). Esta fue una investigación transversal, prospectiva y experimental pura. Se realizó con 40 segundos premolares superiores, divididos en 4 grupos. Todas las muestras fueron desinfectadas y almacenadas en recipientes con suero fisiológico al 0,9 %. Al primer grupo se designó como el control, al segundo grupo CAT, al tercer grupo CAC y al cuarto grupo CAU. Se realizaron todos los accesos endodónticos con una pieza de mano de alta velocidad con refrigeración respetando el protocolo de cada uno de los diseños, posterior a ello se realizó el tratamiento endodóntico y restauración de los especímenes. Una vez preparadas todas las muestras, estas fueron sometidas a una prueba de fatiga en una máquina de ensayo universal y los resultados se registraron en Newtons. La prueba estadística usada fue ANOVA con un nivel de significancia de 5 %. Las CAT obtuvieron el menor valor de resistencia a la fractura en comparación con el grupo control. Sin embargo, no se observaron diferencias estadísticamente significativas entre los grupos CAT, CAC Y CAU. Entre los grupos CAC y CAU, no se encontraron diferencias estadísticamente significativas en comparación con el grupo control.

The preparation of the access cavity is the first step and an essential requirement for the instrumentation and obturation of the root canals during endodontic treatment. The objective of the present study was to compare the in vitro fracture resistance of premolars with traditional access cavity (CAT), conservative access cavity (CAC) and ultraconservative access cavity (CAU). This was a cross-sectional, prospective and pure experimental research. It was carried out with 40 upper second premolars, divided into 4 groups. All samples were disinfected and stored in containers with 0.9 % physiological saline. The first group was designated as the control, the second group CAT, the third group CAC and the fourth group CAU. All endodontic accesses were carried out with a high-speed handpiece with refrigeration, respecting the protocol of each of the designs, after which the endodontic treatment and restoration of the specimens was carried out. Once all the samples were prepared, they were subjected to a fatigue test in a universal testing machine and the results were recorded in Newtons. The statistical test used was ANOVA with a significance level of 5 %. The CAT obtained the lowest fracture resistance value, presenting statistically significant differences with the control group. However, no statistically significant differences were observed between the CAT, CAC, and CAU groups. Furthermore, between the CAC and CAU groups, no statistically significant differences were found compared to the control group.

Duodenopancreatectomía cefálica con resección vascular laparoscópica / Laparoscopic cephalic pancreaticoduodenectomy with laparoscopic vascular resection

RESUMEN Antecedentes: la duodenopancreatectomía cefálica (DPC) con resección vascular venosa está indicada para el tratamiento del adenocarcinoma ductal y de tumores neuroendocrinos de páncreas, tanto por laparoscopia como por laparotomía. Objetivo: describir los resultados de una serie de pacientes operados de DPC con resección vascular venosa y comparar la morbimortalidad entre los abordados por laparoscopia y por laparotomía. Material y métodos: se realizó un estudio observacional, comparativo, retrospectivo de pacientes con DPC con resección vascular entre enero de 2022 y agosto de 2023. El abordaje laparoscópico fue determinado en menores de 80 años, invasión venosa tumoral igual a 180° o menor en la tomografía, buen performance status, y no haber realizado tratamiento neoadyuvante. Resultados: fueron realizadas 23 DPC con resección vascular venosa: 11 por laparoscopia y 12 por laparotomía. Las 11 realizadas por laparoscopia fueron resecciones laterales, y, en los 12 abordados por laparotomía, se realizó resección total de vena porta en 5 y en el resto, resección lateral. El tiempo de "clampeo" (pinzamiento) portal y la necesidad de transfusiones fue similar en ambos grupos. El estudio patológico reveló R0 en el 78,2% de los pacientes e invasión venosa en el 40.9%. La morbilidad con laparoscopia y con laparotomía consistió, respectivamente, en: fístula pancreática en 7 (4 y 3), vaciamiento gástrico retardado en 4 (1 y 4), fístula biliar en uno (1 y 0), neumonía en dos (1 y 1) e infección de herida en uno (0 y 1). La mortalidad fue de 8,6% por el fallecimiento de dos pacientes, uno en cada grupo. Conclusión: de acuerdo con los criterios empleados, la morbimortalidad de la DPC con resección vascular fue similar por laparoscopia y por laparotomía.

ABSTRACT Background: Cephalic pancreaticoduodenectomy (CPD) with venous resection is indicated for the treatment of ductal adenocarcinoma and neuroendocrine tumors of the pancreas, either through laparoscopy or laparotomy. Objective: The aim of this study was to describe the results of a series of patients undergoing CPD with venous vascular resection and compare morbidity and mortality between the laparoscopic approach and open surgery. Material and methods: We conducted a retrospective, comparative and observational study of patients who underwent CPD with venous vascular resection between January 2022 and July 2023. Criteria for laparoscopic surgery were age < 80 years, interface between tumor and vein of 180° of the circumference of the vessel wall or less on computed tomography, good performance status, and no previous neoadjuvant treatment. Results: A total of 23 CPD procedures with venous vascular resection were performed: 11 by laparoscopy and 12 by laparotomy. The 11 laparoscopic procedures were lateral resections, and in the 12 patients approached by laparotomy, 5 were total portal vein resections and 7 were lateral resections. Portal vein clamping time and need for transfusion was similar in both groups. The pathological examination reported R0 resections in 78.2% and venous invasion in 40.9%. The complications associated with laparoscopy and laparotomy were pancreatic fistula in 4 and 3 patients, respectively, delayed gastric emptying in 1 and 4 patients, respectively, biliary fistula in 1 and 0 patients, respectively, aspiration pneumonia i 1 and 1 patients, respectively and surgical site infection in 0 and 1 patients, respectively. Mortality was 8.6% (n =2), one in each group. Conclusion: According to the criteria used, the morbidity and mortality of CPD with vascular resection were similar for laparoscopy and laparotomy.

Beyond the scalpel: unveiling the transformative landscape of robotic gynecologic procedures

This review aims to present a comprehensive assessment of the current status and impact of robotic-assisted laparoscopy (RAL) in gynecological surgery across various subspecialties, exploring its benefits, applications, and challenges. This included studies evaluating RAL in general gynecology, urogynecology, and gynecological oncology. RAL has emerged as a transformative technology, demonstrating efficacy in procedures ranging from routine gynecologic tasks to complex oncological surgeries. The adoption of RAL has facilitated improved surgical outcomes, reduced learning curves, and enhanced visualization. Superior dexterity, 3D vision, and filtered tremor contribute to its precision. The ergonomic advantages, including intuitive instrument movements and a third assisting arm, further enhance positive outcomes. Notably, RAL has shown promise in managing challenging patient demographics, such as morbidly obese individuals and those with intricate pelvic anatomy. In gynecological oncology, RAL has become integral, manifesting benefits in endometrial, cervical, and ovarian cancer surgeries. Despite challenges like cost considerations, RAL continues to shape the landscape of gynecological surgery, promising improved patient outcomes and contributing to the paradigm shift toward minimally invasive approaches. Ongoing research should focus on long-term cost-effectiveness, patient perspectives, and attitudes toward RAL, ensuring its continued integration into the evolving field of gynecological surgery.

An Assessment of Ankle Function, Oxidative Damage, and Inflammatory Factor Levels in Minimally Invasive Ankle Joint Fusion Surgery for the Treatment of Traumatic Ankle Osteoarthritis

SUMMARY: Traumatic ankle osteoarthritis is a degenerative condition resulting from traumatic injuries. The objective of this study was to evaluate the impact of minimally invasive ankle joint fusion surgery on ankle function, oxidative damage, and inflammatory factor levels in traumatic ankle osteoarthritis patients. A total of 112 traumatic ankle osteoarthritis patients treated in our hospital from January 2022 to January 2023 were enrolled. They were randomly rolled into a control group (Group C) and an experimental group (Group E), with the former undergoing conventional open ankle joint fusion surgery and the latter receiving minimally invasive ankle joint fusion surgery. A comparison was made between the two groups based on American Orthopedic Foot and Ankle Society (AOFAS), bony fusion rates, and visual analog scale (VAS) scores at pre-operation, and at 1, 2, and 3 months post-operation. Additionally, serum oxidative damage indicators and inflammatory factor levels were measured to evaluate the recovery effects in both groups. Relative to Group C, Group E showed drastically increased AOFAS scores and bony fusion rates (P<0.05), as well as greatly decreased VAS scores (P<0.05). Moreover, Group E exhibited more pronounced improvements in oxidative damage indicators and inflammatory factors versus Group C (P<0.05). Minimally invasive ankle joint fusion surgery drastically improves ankle function in traumatic ankle osteoarthritis patients and reduces levels of oxidative damage and inflammatory response. This provides an important clinical treatment option.

La osteoartritis traumática del tobillo es una afección degenerativa resultante de lesiones traumáticas. El objetivo de este estudio fue evaluar el impacto de la cirugía mínimamente invasiva de fusión de la articulación talocrural sobre la función del tobillo, el daño oxidativo y los niveles de factor inflamatorio en pacientes con osteoartritis traumática del tobillo. Se inscribieron un total de 112 pacientes con artrosis traumática de tobillo tratados en nuestro hospital desde enero de 2022 hasta enero de 2023. Fueron divididos aleatoriamente en un grupo de control (Grupo C) y un grupo experimental (Grupo E), donde el primero se sometió a una cirugía de fusión de la articulación talocrural abierta convencional y el segundo recibió una cirugía de fusión de la articulación talocrural mínimamente invasiva. Se realizó una comparación entre los dos grupos según la Sociedad Estadounidense de Ortopedia de Pie y Tobillo (AOFAS), las tasas de fusión ósea y las puntuaciones de la escala visual analógica (EVA) antes de la operación y 1, 2 y 3 meses después de la operación. Además, se midieron los indicadores de daño oxidativo sérico y los niveles de factor inflamatorio para evaluar los efectos de la recuperación en ambos grupos. En relación con el grupo C, el grupo E mostró puntuaciones AOFAS y tasas de fusión ósea drásticamente aumentadas (P <0,05), así como puntuaciones VAS muy disminuidas (P <0,05). Además, el grupo E exhibió mejoras más pronunciadas en los indicadores de daño oxidativo y factores inflamatorios en comparación con el grupo C (P <0,05). La cirugía de fusión de la articulación talocrural mínimamente invasiva mejora drásticamente la función del tobillo en pacientes con osteoartritis traumática del tobillo y reduce los niveles de daño oxidativo y la respuesta inflamatoria. Esto proporciona una importante opción de tratamiento clínico.

Caracterización de los desenlaces quirúrgicos a corto plazo en gastrectomía por laparoscopia en un centro de alto volumen: 10 años de experiencia / Short-term surgical outcomes of laparoscopic gastrectomy in a high-volume center: 10-year experience

Introducción. El cáncer gástrico en Colombia es la segunda neoplasia más común en hombres y la cuarta en mujeres. En los últimos años se han descrito ampliamente los beneficios del abordaje laparoscópico en el cáncer gástrico frente a sangrado, recuperación postoperatoria y complicaciones, sin afectar los resultados oncológicos. Métodos. Estudio observacional retrospectivo de pacientes llevados a gastrectomía laparoscópica en la Clínica Universitaria Colombia durante un período de diez años, entre 2013 y 2023. Se describieron los resultados perioperatorios en cuanto a estancia hospitalaria, sangrado operatorio, duración del procedimiento, complicaciones, causas de reintervención y mortalidad en los primeros 30 días. Resultados. Se incluyeron 418 pacientes, 58,9 % hombres, con una edad promedio de 60,8 años. Se documentó un tiempo quirúrgico promedio de 228,7 minutos, con un sangrado de 150 ml. La media de ganglios linfáticos resecados fue de 26,1 ± 11,4. La estancia hospitalaria en promedio fue de 4 ± 4 días, y se registraron complicaciones en 104 sujetos, con una tasa promedio de 24 %, de las cuales 29 (27,4 %) obtuvieron una clasificación Clavien-Dindo IIIB. Conclusiones. La gastrectomía por laparoscopia en un centro de alto volumen y con cirujanos experimentados en Colombia, tiene resultados perioperatorios similares a lo reportado en la literatura mundial. Aún se requiere de estudios de mayor fuerza de asociación para establecer recomendaciones sobre el uso rutinario de este abordaje en patología maligna avanzada.

Introduction. Gastric cancer in Colombia is the second most common neoplasm in men and the fourth in women. In recent years, the benefits of the laparoscopic approach in gastric cancer against bleeding, postoperative recovery com and complications have been widely described, without affecting oncological results. Methods. Retrospective observational study of patients undergoing laparoscopic gastrectomy at the Clínica Universitaria Colombia over a period of ten years, between 2013 and 2023. Perioperative results were described in terms of hospital stay, operative bleeding, duration of the procedure, complications, causes of reintervention, and mortality in the first 30 days. Results. 418 patients were included, 58.9% men, with an average age of 60.88 years. An average surgical time of 228.7 minutes was documented, with a blood loss of 150 ml. The mean number of lymph nodes resected was 26.1 ± 11.4. The average hospital stay was 4 ± 4 days, and complications were recorded in 104 subjects, with an average rate of 24%, of which 29 (27.4%) obtained a Clavien-Dindo IIIB classification. Conclusions. Laparoscopic gastrectomy in a high-volume center and with experienced surgeons in Colombia has perioperative results similar to those reported in the world literature. Studies with greater strength of association are still required to establish recommendations on the routine use of this approach in advanced malignant pathology.

Comparación de desenlaces a corto plazo de gastrectomía laparoscópica mínimamente invasiva en adultos mayores con cáncer gástrico localmente avanzado / Comparison of short-term outcomes of minimally invasive laparoscopic gastrectomy in older adults with locally advanced gastric cancer

Introducción. El objetivo de este estudio fue comparar los desenlaces a corto plazo de la gastrectomía laparoscópica en adultos vs. adultos mayores con cáncer gástrico localmente avanzado en una cohorte de un país occidental. Métodos. Estudio de cohorte prospectivo en pacientes sometidos a gastrectomía laparoscópica por cáncer gástrico localmente avanzado, en el Hospital Universitario Erasmo Meoz, de Cúcuta, Colombia, entre noviembre de 2014 y diciembre de 2018. Se realizó análisis descriptivo, de comparación de grupos y bivariado. Resultados. De un total de 116 pacientes, 51 pacientes (44 %) tenían 65 años o más y 63 pacientes (54 %) eran hombres. No se encontró diferencia estadísticamente significativa al comparar los pacientes menores de 65 años con los de 65 años o más. La mediana del tiempo operatorio fue de 240 minutos en ambos grupos (p>0,05), la mediana de los márgenes de resección macroscópica fue 6 cm vs. 5 cm (p>0,05), la mediana de los ganglios linfáticos disecados fue 25 vs. 19 (p>0,05), la mediana de ganglios linfáticos positivos fue 4 vs. 3 (p>0,05), la mediana de estancia fue de 7 días en ambos grupos (p>0,05). La tasa general de complicaciones posoperatorias no difirió significativamente entre adultos (7%) y adultos mayores (11 %) (p>0,05) y no se observaron diferencias significativas en las tasas de complicaciones menores (Clavien-Dindo grado II; 3-5 % vs. 6-12 %; p>0,05) y graves (Clavien-Dindo ≥ IIIa; 3-5 % vs. 4-8 %; p>0,05). Conclusiones. No se encontraron diferencias estadísticamente significativas en los resultados a corto plazo entre los pacientes adultos y adultos mayores con cáncer gástrico localmente avanzado tratados con gastrectomía laparoscópica. Esta técnica es segura en ancianos.

Introduction. The objective of this study was to compare the short-term outcomes of laparoscopic gastrectomy in adults vs. older patients with locally advanced gastric cancer from a Western country cohort. Methods. Prospective cohort study in patients undergoing laparoscopic gastrectomy for locally advanced gastric cancer at the Hospital Universitario Erasmo Meoz, de Cúcuta, Colombia, between November 2014 and December 2018. Descriptive, group comparison and bivariate analysis was performed. Results. Of a total of 116 patients, 51 patients (44%) were 65 years or older and 63 patients (54%) were men. No statistically significant difference was found when comparing patients under 65 years of age with those 65 years of age or older. The median operating time was 240 minutes in both groups (p>0.05), the median macroscopic resection margins were 6 cm vs. 5 cm (p>0.05), the median number of lymph nodes dissected was 25 vs. 19 (p>0.05), the median number of positive lymph nodes was 4 vs. 3 (p>0.05), the median stay was 7 days in both groups (p>0.05). The overall rate of postoperative complications did not differ significantly between adults (7%) and older adults (11%) (p>0.05) and no significant differences were observed in the rates of minor (Clavien-Dindo grade II; 3-5% vs. 6-12%; p>0.05) and severe complications (Clavien-Dindo ≥ IIIa; 3-5% vs. 4-8%; p>0.05). Conclusions. No statistically differences were found in short-term outcomes between adult and older patients with locally advanced gastric cancer treated with laparoscopic gastrectomy. This technique is safe in the elderly.

Resultados de la esofaguectomía mínimamente invasiva por cáncer de esófago a medio y largo plazo

Introducción: La esofagectomía es actualmente el tratamiento curativo del cáncer de esófago. El objetivo de este trabajo es conocer los resultados de la esofaguectomía mínimamente invasiva a corto y medio plazo en pacientes intervenidos de carcinoma epidermoide y adenocarcinoma de esófago en nuestro hospital. Material y Métodos: Se recogieron 19 pacientes desde enero de 2020 hasta junio de 2021 y se realizó el seguimiento a todos ellos durante 20 meses. Se recogieron diferentes variables relacionadas con el paciente, el tumor, la cirugía y referentes al postoperatorio. Los datos fueron almacenados y procesados usando el software estadístico R-Comander asumiendo un error α de 0,05. Resultados: La mediana de estancia hospitalaria total fue de 29 días. Seis pacientes, precisaron de reingreso en Reanimación: dos por shock séptico secundario a la fuga de anastomosis grado III, uno por hemorragia digestiva alta y los tres por insuficiencia respiratoria. A los 90 días reingresaron un 5,3% del total de pacientes. No se produjeron fallecimientos en los tres meses siguientes a la cirugía. Todos los pacientes presentaron una supervivencia mayor de seis meses. La supervivencia global a seis, 12 y 18 meses se sitúa en 100, 84 y 63%. La supervivencia libre de enfermedad a los tres meses fue del 84%, a los 6 meses del 63% y al año el 58%. Discusión: Los resultados obtenidos en nuestro estudio coinciden con lo que hay reflejado en la literatura. Por tanto, la esofagectomía mínimamente invasiva es una técnica efectiva en el tratamiento del cáncer de esófago.

Introduction: Oesophagectomy is currently the curative treatment for oesophageal cancer. The aim of this study is to know the results of minimally invasive oesophagectomy in the short and medium term in patients operated on for squamous cell carcinoma and adenocarcinoma of the oesophagus in our hospital. Material and Methods: 19 patients were collected from January 2020 to June 2021 and all of them were followed up for 20 months. Different variables related to the patient, tumour, surgery and postoperative period were collected. Data were stored and processed using R-Comander statistical software assuming an α-error of 0.05. Results: The median total hospital stay was 29 days. Six patients required readmission to resuscitation: two for septic shock secondary to grade III anastomotic leak, one for upper gastrointestinal haemorrhage and three for respiratory failure. At 90 days, 5.3% of the total number of patients were re-admitted. There were no deaths in the three months following surgery. All patients had a survival of more than six months. Overall survival at six, 12 and 18 months was 100, 84 and 63%. Disease-free survival at three months was 84%, at six months 63% and at one year 58%. Discussion: The results obtained in our study coincide with those reported in the literature. Minimally invasive oesophagectomy is therefore an effective technique in the treatment of oesophageal cancer.

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.

Fluoruro de estaño en el control de cavidades sin restauración en dientes temporales / Stannous fluoride in nonrestorative cavity control in primary teeth

Introducción: el control de cavidades sin restauración (NRCC, por sus siglas en inglés), es una opción de tratamiento conservador y no invasivo para dentina cariosa, sobre todo en dentición temporal. Una de las estrategias del NRCC es la remineralización. El fluoruro de estaño (FDE) puede considerarse, como una opción viable ya que existe evidencia de su eficacia cariostática. Objetivo: valorar al FDE como remineralizante alternativo en dentina de molares temporales, asociado al NRCC. Material y métodos: se efectuó un estudio clínico, epidemiológico, y descriptivo con preescolares voluntarios de 3 a 5 años de edad con consentimiento firmado de participación en el estudio, y que presentaron molares con ICDAS 5 y 6. La aplicación del FDE a 0.8%, la evaluación de la dureza de la dentina con los criterios de Nyvad, y el diagnóstico del estado pulpar, la efectuó un operador entrenado para esta finalidad. Se aplicó un análisis estadístico descriptivo y uno no paramétrico. Resultados: el efecto cariostático producido por el FDE a 0.8%, sobre dentina afectada de molares temporales de niños mexicanos fue estadísticamente significativo durante cinco meses. Conclusiones: la aplicación de fluoruro de estaño puede considerarse como una alternativa de tratamiento cariostático asociado al NRCC para niños de 3 a 5 años de edad (AU)

Introduction: nonrestorative cavity control (NRCC), is a conservative and non-invasive treatment option for carious dentin, especially in primary dentition. One of the NRCC strategies is remineralization. Stannous Fluoride (SDF) can be considered as a viable option since there is evidence of its cariostatic efficacy. Objective: to evaluate FDE as an alternative remineralizing agent in the dentin of primary molars, associated with NRCC. Material and methods: a clinical, epidemiological, and descriptive study was carried out with preschool volunteers aged 3 to 5 years with signed consent to participate in the study, and who presented molars with ICDAS 5 and 6. The application of FDE at 0.8%, the evaluation of dentin hardness with the Nyvad criteria, and the diagnosis of pulp status, was carried out by an operator trained for this purpose. A descriptive and non-parametric statistical analysis was applied. Results: the cariostatic effect produced by 0.8% FDE on affected dentin of primary molars of Mexican children was statistically significant for five months. Conclusions: the application of stannous fluoride can be considered as an alternative cariostatic treatment associated with NRCC for children 3 to 5 years of age (AU)

Minimally invasive management of pyoperitoneum attributed by spontaneous perforated pyosalpinx and pyometra

Pyoperitoneum, apart from bowel perforation, can occur due to gynecologic causes like ruptured pyometra or ruptured tubo-ovarian abscess. Earlier, the management of pyoperitoneum included broad-spectrum antibiotics and emergency laparotomy with or without a hysterectomy and bilateral saphingo-oophorectomy. A higher rate of surgical complications like bowel or bladder injury was noted with surgery, and future fertility was also compromised in these patients. Later on, treatment strategies improved to laparoscopic drainage of pus with antibiotics without extensive surgery. However, such cases can be managed with an even more minimally invasive approach by image-guided pigtail drainage. In this report, we describe two cases of pyoperitoneum that were managed successfully with pigtail insertion and continuous drainage of pus along with antibiotics obviating the need for anaesthesia and surgery. It seems to be a promising approach for pyoperitoneum in a hemodynamically stable patient, not showing any features of severe sepsis.

Manejo clínico quirúrgico de la necrosis pancreática infectada en adultos: experiencia en un hospital especializado, Paraguay / Surgical clinical management of necrotizing pancreatitis in adults: experience in a specialized hospital, Paraguay

Introducción: la necrosis pancreática se presenta entre 10 y 20 % de los pacientes con pancreatitis aguda, tiene una mortalidad de 10 a 25 % y si se agrega infección a la necrosis entre 40 y 70 %. Objetivo: describir el manejo clínico quirúrgico de la necrosis pancreática infectada en el Servicio de Cirugía General del Hospital Nacional entre el periodo 2021-2022. Metodología: estudio observacional descriptivo de corte temporal transversal. En pacientes internados en el Servicio de Cirugía General del Hospital Nacional por pancreatitis aguda grave con necrosis pancreática infectada. Resultados: se analizaron un total de 30 pacientes. La media de edad fue de 39 años. Predominó en nuestra población pacientes de sexo masculino en el 56.67 %. En cuanto a las comorbilidades asociadas un 33.3 % los pacientes presentaron principalmente Diabetes mellitus tipo 2 e Hipertensión arterial; en menor medida Obesidad en un 23.3 %. De la población en estudio 76.6 % recibieron tratamiento quirúrgico y 23.33% tratamiento médico principalmente antibiótico terapia. De los pacientes sometidos a tratamiento quirúrgico 9 fueron a necrosectomia abierta, 7 a drenaje percutáneo, y en menor medida drenaje biliar y endoscópico. En cuanto a la mortalidad por necrosis pancreática infectada encontramos un 10 % de mortalidad. Discusión: la mayor parte de los pacientes con pancreatitis aguda grave sufren de necrosis pancreática; la necrosis pancreática infectada se asocia con mayor riesgo de mortalidad y en su mayoría requieren tratamientos invasivos. Conclusión: el manejo mínimamente invasivo en el tratamiento inicial de la necrosis pancreática infectada podría resolver la mayoría de los casos sin necesidad de realizar necrosectomia; reservando esta última solo a los que fracasan en el tratamiento inicial.

Introduction: pancreatic necrosis occurs between 10 and 20 % of patients with pancreatitis, has a mortality of 10 to 25 % and if infection is added to the necrosis between 40 and 70 %. Objective: to describe the surgical and clinical management of infected necrotizing pancreatitis in patients admitted to the General Surgery Service of the Hospital Nacional between the period 2021-2022. Methodology: this was an observational, descriptive and cross-section study with a temporal cut. We included patients admitted to the general surgery service of the National Hospital with severe acute pancreatitis with infected necrotizing pancreatitis. Results: a total of 30 patients were included. The mean age was 39 years. Male patients prevailed in our population in 56.67 %. Regarding the associated comorbidities, 33.3 % of the patients presented mainly type 2 diabetes mellitus and arterial hypertension; to a lesser extent Obesity in 23.3 %. In the study population, 76.6 % received surgical treatment and 23.33 % medical treatment, mainly antibiotic therapy. Of the patients who underwent surgical treatment, 9 were open necrosectomy, 7 had percutaneous drainage, and to a lesser extent biliary and endoscopic drainage. Regarding mortality due to infected necrotizing pancreatitis, we found a 10% mortality. Discussion: most of the patients with severe acute pancreatitis suffer from necrotizing pancreatitis; infected necrotizing pancreatitis is associated with increased risk of mortality and most require invasive treatment. Conclusion: minimally invasive management in the initial treatment of infected necrotizing pancreatitis, which could resolve most cases without the need to perform necrosectomy; the latter should be reserved for those who fail the initial treatment.

Minimally invasive ureteroplasty with lingual mucosal graft for complex ureteral stricture: analysis of surgical and patient-reported outcomes

ABSTRACT Objective: To evaluate objective treatment efficacy and safety, and subjective patient-reported outcomes in patients with complex ureteral strictures (US) undergoing minimally invasive lingual mucosal graft ureteroplasty (LMGU). Materials and Methods: We prospectively enrolled patients underwent robotic or laparoscopic LMGU between May 2020 and July 2022. Clinical success was defined as symptom-free and no radiographic evidence of re-obstruction. Patient-reported outcomes, including health-related quality of life (HRQoL), mental health status and oral health-related quality of life (OHRQoL), were longitudinally evaluated before surgery, 6 and 12 months postoperatively. Results: Overall, 41 consecutive patients were included. All procedures were performed successfully with 32 patients in robotic approach and 9 in laparoscopic. Forty (97.56%) patients achieved clinical success during the median follow-up of 29 (range 15-41) months. Although patients with complex US experienced poor baseline HRQoL, there was a remarkable improvement following LMGU. Specifically, the 6-month and 12-month postoperative scores were significantly improved compared to the baseline (p < 0.05) in most domains. Twenty-eight (68.3%) and 31 (75.6%) patients had anxiety and depression symptoms before surgery, respectively. However, no significant decrease in the incidence of these symptoms was observed postoperatively. Moreover, there was no significant deterioration of OHRQoL at 6 months and 12 months postoperatively when compared to the baseline. Conclusions: LMGU is a safe and efficient procedure for complex ureteral reconstruction that significantly improves patient-reported HRQoL without compromising OHRQoL. Assessing patients' quality of life enables us to monitor postoperative recovery and progress, which should be considered as one of the criteria for surgical success.

Clinical application of lithium disilicate glass ceramic cantilever resin-bonded fixed partial denture in the restoration of single anterior tooth loss / 口腔疾病防治

Objective@#To investigate the clinical effect of lithium disilicate glass ceramic cantilever resin-bonded fixed partial dentures (CRBFPDs) on single anterior tooth loss to provide a reference for the selection of restoration methods for single anterior tooth loss.@*Methods@#This study was reviewed and approved by the Ethics Committee, and informed consent was obtained from the patients. Forty-two patients with less than two anterior teeth with monomaxillary loss were included in this study. After 6 months, 1 year, 2 years, and 3 years, the aesthetic and functional effects of the restorations and the periodontal health status were evaluated, and the visual analog scale (VAS) was used to assess patient satisfaction.@*Results@#During the observation period, the connector fractured in one case within 3 months. One case had debonded within 2 years. The aesthetic restoration effect of all lithium disilicate glass ceramic CRBFPDs was categorized as Class A. The periodontal health was good, there was no clinical absorption in the soft and hard tissues of the abutment or subbridge, periodontal status according to the evaluation indices was classified as class A, and the total satisfaction rate of the patient was 100%.@*Conclusion@#For single anterior tooth loss patients, lithium disilicate glass ceramic cantilever resin-bonded fixed partial denture can achieve the restoration effect of less invasion, better adhesion, aesthetics, comfort and good biocompatibility. With high patient satisfaction, it can be considered an ideal restoration method for replacing a single anterior tooth.