[Development and research progress of suture button fixation Latarjet procedure].

Objective: To review the development and research progress of suture button fixation Latarjet procedure. Methods: A comprehensive literature review was conducted to summarize the development and related modified techniques of the suture button fixation Latarjet procedure. Results: Since the Latarjet procedure was first introduced by French scholar Latarjet in 1954, it has undergone three key transformations, resulting in suture button fixation Latarjet procedure, which has shown satisfactory outcomes in treatment of recurrent shoulder dislocation. However, there are still drawbacks such as the risk of impingement of the graft on surrounding tissues, and the surgical disruption of anatomical structures like the coracoclavicular ligament and the pectoralis minor muscle. The scholars have proposed several modified techniques based on the suture button fixation Latarjet procedure to further reduce complications from impingement of the graft, to lower the glenohumeral contact pressure, and to eliminate the impact of surgery on the physiological structures of the shoulder joint. The modified techniques include the arthroscopic suture button fixation Latarjet procedure using FiberTape Cerclage, reconstruction of the coracoacromial ligament during congruent-arc Latarjet procedures, and limit unique coracoid osteotomy suture button Latarjet procedure (LU-tarjet procedure). These modified techniques have also shown good clinical outcomes. Additionally, other related modified techniques for reconstruction of the glenoid, such as Chinese unique Inlay Bristow procedure (Cuistow procedure), arthroscopic glenoid bone grafting with soft fixation, and all-arthroscopic modified Eden-Hybinette procedure, have also demonstrated favorable efficacy. However, there is still a lack of long-term follow-up results for these techniques and comparative studies between them. Conclusion: Suture button fixation Latarjet procedure is an effective method for the treatment of recurrent shoulder dislocation. There are various techniques, but there is no recognized gold standard, and further clinical and basic research is needed.

Efficacy and safety of a modified lateral lumbar interbody fusion in L4-5 lumbar degenerative diseases compared with traditional XLIF and OLIF: a retrospective cohort study of 156 cases.

BACKGROUND: The authors designed a modified lateral lumbar interbody fusion (LLIF) procedure named as XOLIF and compared the efficacy and safety with traditional LLIF procedures. METHODS: Patients were divided into XLIF, OLIF, and XOLIF group according to the surgical approach. Cases of psoas major and vascular space stenosis, psoas major muscle elevation, psoas major muscle hypertrophy, and high iliac crest were recorded. Basic information, composition ratio of specific cases, Visual analog scale (VAS), Oswestry Disability Index (ODI), interbody fusion rate and complications were compared between the 3 groups. RESULTS: The study included 156 cases of L4-5 LLIF. There was no statistical difference in age, gender, BMI among the three groups. Cases with stenosis between psoas muscle and artery accounted for 11.8 and 18.4% of the XLIF and XOLIF group, respectively, while no case of this type had undergone OLIF surgery, the difference was statistically significant (P < 0.05). The proportions of high iliac crest cases in the OLIF and XOLIF group were 12.5 and 18.4%, respectively, while the XLIF group with vertical approach is not suitable for cases with high iliac crest. The postoperative VAS and ODI of the three groups were significantly improved compared with those before operation. There were 51 cases (32.7%) of complications including 21cases in XLIF group, 20 cases in OLIF Group and 10 cases in XOLIF group. XOLIF group has more advantages in reducing lumbar plexus injury and the risk of vascular injury. CONCLUSIONS: XOLIF showed good clinical efficacy and technical advantages with a low incidence of intraoperative and postoperative complications, especially in the specific cases.

A Modified Dura Puncture Procedure to Reduce Brain Shift in Deep Brain Stimulation Surgery: One Institution's Experience.

Objective: The therapeutic effect of deep brain stimulation (DBS) surgery mainly depends on the accuracy of electrode placement and the reduction in brain shift. Among the standard procedures, cerebrospinal fluid (CSF) loss or pneumocephalus caused by dura incision (DI) is thought to be the main reason for brain shift and inaccuracy of electrode placement. In the current study, we described a modified dura puncture (DP) procedure to reduce brain shift and compare it with the general procedure of DBS surgery in terms of electrode placement accuracy. Materials and Methods: We retrospectively analyzed a series of 132 patients who underwent DBS surgery in Wuhan Union Hospital from December 2015 to April 2021. According to the different surgery procedures, patients were classified into two cohorts: the DI group (DI cohort) had 49 patients who receive the general procedure, and the DP group (DP cohort) had 83 patients who receive the modified procedure. Postoperative pneumocephalus volume (PPV) and CSF loss volume, electrode fusion error (EFE), and trajectory number were calculated. Meanwhile, intraoperative electrophysiological signal length (IESL), electrode implantation duration, and other parameters were analyzed. Results: In the current study, we introduced an improved electrode implantation procedure for DBS surgery named the DP procedure. Compared with the general DI cohort (n = 49), the modified DP cohort (n = 83) had a shorter electrode implantation duration (p < 0.0001), smaller PPV, lower CSF leakage volume (p < 0.0001), and smaller EFE (p < 0.0001). There was no significant difference in IESL (p > 0.05) or adverse events (perioperative cerebral haematoma, skin erosion, epilepsy, p > 0.05) between the two cohorts. Conclusion: The DP procedure is a modified procedure that can reduce brain shift and ensure implantation accuracy during DBS surgery without adverse events.

Clinical effect of Brisson operation modified by Y-shaped incision for treatment of concealed penis in adolescents.

OBJECTIVE: To analyze the clinical effect of the Brisson operation modified by a Y-shaped incision in treating adolescent concealed penis. METHODS: We retrospectively analyzed clinical data of 27 adolescents with a concealed penis treated with the Brisson operation modified by a Y-shaped incision in our hospital from January 2017 to March 2020. RESULTS: The operation went smoothly in all 27 patients. Postoperative foreskin edema occurred in 12 patients and spontaneously resolved within 1 month postoperatively. Two patients developed postoperative retropubic infection. After administering antibiotics and symptomatic treatment, both patients' conditions improved within 1 week. All operations obtained satisfactory results. Postoperatively, when the penis was in a non-erect state, it was clearly exposed without retraction or concealment; thus, demonstrating good surgical results. The prepuce was distributed naturally without obvious accumulation of redundant preputial tissue. The penile scar resembled that after circumcision. The postoperative follow-up period was 6 months, during which no patients developed recurrence. CONCLUSION: The Brisson operation modified by a Y-shaped incision is effective for treating a concealed penis in adolescent patients. This technique may relieve the pathological abnormalities and retain the penile skin's integrity to the greatest extent with minimal scarring and a satisfactory appearance.

X-Ray-Free Endoscopic Combined Intrarenal Surgery for Complex Proximal Ureteral Stone: A Case Report.

X-ray-free endoscopic combined intra renal surgery (ECIRS) is a feasible alternative to avoid radiation exposure to both surgical teams and patients, but has not been reported prior. The aim of this report is to present our first-hand experience of performing X-ray-free ECIRS for complex ureteral stone. A 57-year-old female presented with right flank pain, fever, dysuria, and leukocytosis. The computed tomography scan showed right impacted proximal ureteral stone sized 33 ´17 mm and grade IV hydronephrosis. Percutaneous nephrostomy was performed immediately. With improvement of clinical symptoms two days after nephrostomy, X-ray-free ECIRS was performed. The patient was placed in a Galdakao-modified supine position. During ureteroscopy (URS), there was noted right ureteral stenosis in the distal part of the stone, which could be passed. However, the stone was impacted and the semi-rigid URS was not able to push it. Therefore, antegrade approach with percutaneous nephrolithotomy was performed. Previous nephrostomy tract was used as percutaneous access. Tract dilatation was performed under direct visualization from the URS. The 28 Fr rigid nephroscope was used during the ECIRS procedure. The stone was fragmented using shock-pulse lithotripters. There was no residual stone or infundibular laceration after the procedure. A 6 Fr double J stent was inserted retrogradely due to ureteral stenosis. There was no complication during and after the procedure. The patient was discharged on post-operative day three. X-ray free ECIRS for complex proximal ureteral stone was possible and showed good results.

Modified peroral endoscopic myotomy: a "Push and Pull" technique.

BACKGROUND: Peroral endoscopic myotomy (POEM) is a minimally invasive yet challenging procedure for achalasia. Additional technological innovations and improvements are important for simplifying the procedure. METHODS: We report the successful use of a modified POEM procedure, which utilized a "Push and Pull" technique, on a patient with achalasia. RESULTS: Our modifications resulted in a short operation time of only 35 min. No complications arose during or after the procedure, up to a follow-up period of 6 months, and symptoms were significantly and quickly improved. CONCLUSIONS: This modified procedure shortens operation time and lowers the difficulty of the operation, while leaving the safety and efficacy uncompromised.

Modified associating liver partition and portal vein ligation for staged hepatectomy: a systematic review / 中华肝胆外科杂志

Objective To evaluate the feasibility,safety and effectiveness of modified associating liver partition and portal vein ligation for staged hepatectomy (ALPPS).Methods The published literatures associated with modified ALPPS were pooled from Embase,Pubmed,Medline,Google Scholar databases.The studies were included or excluded depends on our predetermined criteria.We selected data and performd descriptive analysis from the included studies.Results Five articles were included and reviewed.A total of 62 patients underwent five modified procedures,including monosegment ALPPS (m-ALPPS),anterior approach ALPPS,partial-ALPPS,radiofrequency-assisted liver partition with portal vein ligation (RALPP) and associating liver tourniquet and portal ligation for staged hepatectomy (ALTPS).There were 50 (80.6％) patients diagnosed liver metastatic colorectal cancer.The average operation interval of modified ALPPS was between 8 ～ 22 days and growth rate of future liver remnant (FLR) ranged from 48.7％ to 62.3％,the feasibility to perform ALPPS stage 2 was 98.4％.The incidence of severe postoperative complications were between 11.8％ ～33.3％.The 90-day mortality for monosegment ALPPS,partial-ALPPS and RALPP was 0,while the figure was 8.3％ in ALTPS.The in-hospital morbidities were 5.9％ and 8.3％ for anterior approach ALPPS and ALTPS,respectively,which were 0 in the other three modified groups.Clinical response evaluation,including R0 resection rate,overall survival rate,disease-free and recurrence rates were merely presented 83.3％,80％,50％,50％ in m-ALPPS group,while 100％,100％,95％,5％ in modified ALTPS group.Conclusion Modified ALPPS with improved safety is feasible in clinical practice.However,the effectiveness still needs further studies.

Cirugía de Nikaidoh modificada: experiencia inicial y resultados a corto y a mediano plazos / The Modified Nikaidoh Procedure: Initial Experience and Short and Mid-term Outcomes

Introducción: El tratamiento convencional de los pacientes con transposición de los grandes vasos con comunicación interventricular y estenosis pulmonar es la cirugía de Rastelli. Sin embargo, sus resultados son subóptimos, razón por la cual se han propuesto otras alternativas quirúrgicas. El procedimiento de Nikaidoh es una técnica reciente que surge como una opción terapéutica atractiva. Objetivo: Analizar nuestra experiencia inicial con la cirugía de Nikaidoh modificada: translocación aórtica y reconstrucción de ambos tractos de salida ventriculares. Material y métodos: Se analizaron 11 pacientes consecutivos operados con técnica de Nikaidoh modificada en nuestra institución en el período 2005-2014, con edad mediana de 3 años (intervalo intercuartil 25-75%: 1-5,5 años) y peso medio de 13,8 ± 5,4 kg, 9 de ellos con transposición de los grandes vasos con comunicación interventricular y estenosis pulmonar y 2 con doble salida del ventrículo derecho con estenosis pulmonar y fisiología de transposición. Todos tenían comunicación interventricular no relacionada con la aorta y un paciente tenía además ventrículo derecho hipoplásico. Resultados: En el posquirúrgico inmediato no hubo mortalidad, un paciente desarrolló endocarditis infecciosa y requirió reoperación. Seis pacientes tuvieron disfunción ventricular transitoria; solo uno necesitó asistencia ventricular. No se registró obstrucción a los tractos de salida ventriculares ni insuficiencia aórtica mayor que leve. En el seguimiento a mediano plazo, con una media de seguimiento de 5,5 ± 2,1 años (rango: 2-8,6 años), no hubo mortalidad ni reoperaciones. Se efectuó un cateterismo intervencionista para dilatación del conducto ventrículo derecho-arteria pulmonar. Todos los pacientes permanecían en clase funcional I, con buena función biventricular, sin arritmias, sin obstrucción al tracto de salida ventricular izquierdo y sin insuficiencia aórtica significativa. Conclusiones: La cirugía de Nikaidoh y sus modificaciones constituyen una buena opción quirúrgica para los pacientes con transposición de los grandes vasos con comunicación interventricular y estenosis pulmonar, que por su morfología son malos candidatos para cirugía de Rastelli. En esta serie no hubo mortalidad y todos los pacientes se encuentran en clase funcional I. En el seguimiento a mediano plazo, el tracto de salida del ventrículo izquierdo permaneció sin obstrucción y no se registró insuficiencia aórtica significativa.

Background: The Rastelli operation is the conventional procedure for transposition of the great vessels with ventricular septal defect and pulmonary stenosis. Its results, however, are suboptimal and other surgical alternatives have been postulated. A recent surgical technique, the Nikaidoh procedure, appears as a new therapeutic option. Objective: The aim of this study was to review our initial experience using the modified Nikaidoh procedure consisting in aortic translocation and biventricular outflow tract reconstruction. Methods: The study analyzed 11 consecutive patients operated on with the modified Nikaidoh procedure at our institution between 2005 and 2014. Median age was 3 years (25-75% interquartile range: 1-5.5 years) and mean weight was 13.8 ± 5.4 kg. Nine patients had transposition of the great vessels with ventricular septal defect and pulmonary stenosis and 2 had double outlet right ventricle with pulmonary stenosis and transposition physiology. All patients had a ventricular septal defect unrelated to the aorta and one patient also had a hypoplastic right ventricle. Results: There were no deaths in the immediate postoperative period. One patient developed infective endocarditis needing reoperation. Six patients had some degree of transient left ventricular dysfunction, and one patient only needed ventricular assistance. There was no involved right or left ventricular outflow tract obstruction and only mild aortic regurgitation. At mid-term follow-up (mean of 5.5 ± 2.1 years, range: 2-8.6 years) there were no deaths or reoperations. An interventional cardiac catheterization to dilate the right ventricle to pulmonary artery conduit was performed in one patient. All patients remained in functional class I, with good biventricular function, free from arrhythmias, no left ventricular outflow tract obstruction and no significant aortic regurgitation. Conclusions: The Nikaidoh operation and its variants are a satisfactory surgical option for patients presenting transposition of the great vessels with ventricular septal defect and pulmonary stenosis, who due to their morphology are inadequate candidates for a Rastelli procedure. In the mid-term follow-up, the left ventricular outflow tract remained without obstruction and there was no significant aortic valve regurgitation.

Modified Procedure of Noncultured Epidermal Suspension Transplantation: Changes are the Core of Vitiligo Surgery.

Epidermal cell suspensions are being increasingly used in the surgical management of vitiligo. The procedure suffers from several drawbacks such as high cost of the procedure, difficulty of procuring the reagents etc. We hereby describe modifications which allow the use of cheaper, more commonly available alternatives.

Modified Microsurgical and Standard Lumbar Discectomy ; Comparative Study

To obtain wider versatility and greater reach in microsurgical lumbar discectomy, modified procedure has been performed on 263 patients in 1979-1983. It consisted of a smaller midline incision, removal of lateral half of the spinous process, partial but sufficient microdrilling of the lamina, use of a modified slender Taylor retractor, flavotomy, preservation of epidural adipose-areolar tissue etc. Particularly a slender Taylor-Chung retractor offered yielding surgical opening and therefore secured free of pituitary forceps to every direction. The microsurgical results including 72 bisegmental and 8 trisegmental discectomies were compared with those of standard operations of same number performed by same surgeon in 1972-1979, for the good contrast. Mean blood loss per operation was 94 ml with the standard discectomy and 46 ml with microsurgery. Dural tear occured in 17 cases undergoing standard operation and in 3 undergoing microsugery. The mean time until return to duty was 8.6 weeks with standard, compared with 4.2 weeks. In the microsurgical group, 3 patients had postoperative discitis while 2 had in the standard. In this series, the results of microsurgery surpasses the standard in the convalescent phase. Major advantages of this modified microsurgical technique were its ability to secure the greater reach to remove disc material as much as possible and to preserve the integrity of normal tissue better.