Hasil untuk "Orthopedic surgery"

Seifeddine Sellemi, Abdelbadia Chaker, Tanguy Vendeuvre et al.

Robotic-assisted surgery has emerged as a promising approach to improve surgical ergonomics, precision, and workflow efficiency, particularly in complex procedures such as cervical spine surgery. In this study, we evaluate the performance of a collaborative robotic system designed to assist surgeons in drilling tasks by assessing its accuracy in executing predefined trajectories. A total of 14 drillings were performed by eight experienced cervical surgeons, utilizing a robotic-assisted setup aimed at ensuring stability and alignment. The primary objective of this study is to quantify the deviations in the position and orientation of the drilling tool relative to the planned trajectory, providing insights into the system's reliability and potential impact on clinical outcomes. While the primary function of robotic assistance in surgery is to enhance surgeon comfort and procedural guidance rather than solely optimizing precision, understanding the system's accuracy remains crucial for its effective integration into surgical practices part of this primary experimental feedback, the study offers an in-depth analysis of the co-manipulated robotic system's performance, focusing on the experimental setup and error evaluation methods. The findings of this study will contribute to the ongoing development of robotic-assisted cervical surgery, highlighting both its advantages and areas for improvement in achieving safer and more efficient surgical workflows

Soheil Azarpendar

Liu and Piccirillo developed a combinatorial argument that employs the 10/8-theorem to demonstrate that certain manifolds cannot be obtained via Dehn surgery on a knot. We extend their approach by creating additional examples using chainmail links.

Saadiq El-Amin MD, PhD, Joseph Caporusso DPM, Ira Gottlieb DPM et al.

Research Type: Level 1 - Randomized controlled trial (RCT), Meta-analysis of randomized trials with homogeneous results Introduction/Purpose: Improved nonsurgical treatment options are needed for PFA, the most common cause of heel pain. CCH is approved in the United States for the treatment of adults with Dupuytren’s contracture with a palpable cord and adult men with Peyronie’s disease with a palpable plaque and curvature deformity of at least 30°. A phase 1, randomized, dose-escalating study of CCH for PFA was conducted. Methods: Adults with painful, chronic PFA (duration >8 weeks; unresponsive after 6-12 months of conservative therapy) were eligible. Planned treatments included placebo and 3 CCH doses by intrafascial injection. Primary endpoints were the incidence, severity, and duration of treatment-emergent adverse events (TEAEs) through Day 84. Secondary endpoints included patient-reported measures of foot-related pain and treatment satisfaction. Outcomes were analyzed by comparing mean changes from baseline between treatment groups. Results: Sixty-two patients received placebo (n=14) or CCH treatment (n=48). Although the study was not powered to assess treatment efficacy, an improvement in mean pain scores was observed among CCH treatment groups from baseline to Day 84 (range, -4.0 to -4.3) vs placebo ( 2.8). A positive treatment satisfaction response was seen in 56.3%-66.7% of CCH patients compared to 35.7% of placebo patients. No treatment-related deaths or withdrawals occurred. Most TEAEs were mild to moderate in severity, resolving within 21 days. TEAEs were reported with a higher frequency and severity for the highest CCH dose. Most frequent TEAEs were similar to those seen in the approved indications: injection site pain, swelling, and bruising. Conclusion: Results warranted further evaluation in a phase 2, double-blind, placebo-controlled study (NCT06169319).

Songyang Liu, Qingsong Li, Kai Xiao et al.

Abstract Objective This study aimed to assess the bone ingrowth and in vivo safety of a novel designed 3D-printed porous stand-alone cage (PSAC) for Cervical Fusion in a Sheep Model. Methods PASC was designed and fabricated by 3D-printing technology. We implanted the PSAC at the C2/C3 level and control cages at the C3/C4 level in 18 sheep. After 4, 12, and 24 weeks, X-ray was used to assess DSH, Micro-CT to evaluate bone volume fraction (BV/TV), biomechanical testing to determine bone-implant interface strength, and toluidine blue staining to assess bone ingrowth depth and new bone formation. Sheep health, blood markers, vital organ pathology and local tissue reaction (HE staining) were monitored to evaluate its safety. Results (1) X-ray results showed that both cages maintained stable DSH. (2) Micro-CT revealed greater bone volume within the porous structure of the PSAC group compared to the control group (BV1/TV1(%): 50.37 ± 4.79 vs. 43.98 ± 6.27, p = 0.076). (3) In terms of bone ingrowth, toluidine blue staining showed that new bone formation in the PSAC group was higher to the control at 4 and 12 weeks (1.64 ± 0.85 mm² vs. 2.86 ± 1.81 mm², p = 0.35) and was not inferior at 24 weeks. The bone ingrowth depth was consistent between the PSAC and control groups (24 weeks: 1116.28 ± 152.28 μm vs. 1161.36 ± 368.45 μm, p = 0.85). (4) The bone-implant interface strength of the PSAC was not inferior to the control group (24 weeks: maximum failure load 309.65 ± 47.13 vs. 302.93 ± 43.33 N, p = 0.88; failure displacement 2.20 ± 0.30 mm vs. 2.05 ± 0.40 mm, p = 0.70). (5) Safety: Blood tests and HE staining showed no significant toxic or inflammatory pathological changes. All animals remained in good health, with no infections or deaths. Conclusion Our findings suggest that the intervertebral PSAC are safe and effective for cervical fixation, showing no adverse effects on the cervical spine or animal bodies, and demonstrating equivalent fixation and healing capabilities compared to control devices.

Sarah Poirier MD, Lauren Grobaty MD, Sara Lyn Miniaci-Coxhead MD et al.

Category: Other Introduction/Purpose: Non-orthopaedic surgical specialties have demonstrated steady increases in female resident composition. Female participation in orthopaedics continues to lag behind. Prior surveys disseminated only to female orthopaedic surgeons have attempted to understand this deficit through an internal review approach. A survey of current female surgical residents across all specialties attempting to understand this discrepancy, to our knowledge, has not been conducted. We sought to address the following questions 1) What factors are most influential towards selection of surgical subspecialty? 2) What salient experiences and exposures among orthopaedic residents differ from those observed in the general surgery and other subspecialty cohorts? 3) What actionable steps can we as a profession take to ensure orthopaedic surgery is an open avenue to all who would like to pursue it? Methods: A 38-item survey was developed with the following subsections: Demographics, Pre-Clinical Exposures to Orthopaedics, Attitudes Towards Surgical Environments, Factors Influencing Specialty Choice, Dissuaders to a Career in Orthopaedics, and Work Experiences Related to Gender. Surveys were disseminated to current and incoming female surgical residents at university-affiliated surgical residencies in Ohio. Data collection occurred over 45 days during the 2022-2023 academic year. Continuous outcome measures were assessed using ANOVA. Categorical outcomes were compared using chi-square testing. Results: 76 surveys were included for final analysis with a response rate of 23.5% (76/324) including 23 (30.3%) orthopaedic surgery residents, 33 (43.4%) general surgery residents, and 20 (26.3 %) from other surgical subspecialties. Orthopaedic residents were more likely to have attended medical schools that offered orthopaedics as an elective rotation during their third year (p=0.04) and expressed more interest in the application of biomechanical principles to surgery compared to general surgery residents (p< 0.01) and other subspecialties (p=0.03). Low interest in orthopaedic conditions was the most cited dissuader to pursuing orthopaedics amongst general surgery (33.3%) and other subspecialties (40.9%). Interest in surgical techniques unique to specialty and exposure to them in medical school were uniformly ranked as the top two influential factors on specialty choice. Conclusion: Choosing a residency is a complex and multifactorial process. Lack of interest in orthopaedic pathology was found to be a primary driver in the decision not to pursue the field, though lack of exposure to orthopaedics was also ranked as a common dissuader. All female orthopaedic residents reported having the option for an elective third year medical school rotation in orthopaedic surgery. This option was relatively deficient amongst non-orthopaedic residents. Such findings may suggest that early exposure and purposeful mentorship incorporated into the fabric of medical school curricula, may result in increased consideration of orthopaedics as a future career.

Alessandro Bensa, Alessandro Sangiorgio, Luca Deabate et al.

Aims: Robotic-assisted unicompartmental knee arthroplasty (R-UKA) has been proposed as an approach to improve the results of the conventional manual UKA (C-UKA). The aim of this meta-analysis was to analyze the studies comparing R-UKA and C-UKA in terms of clinical outcomes, radiological results, operating time, complications, and revisions. Methods: The literature search was conducted on three databases (PubMed, Cochrane, and Web of Science) on 20 February 2024 according to the guidelines for Preferred Reporting Items for Systematic Reviews and Meta-Analysis (PRISMA). Inclusion criteria were comparative studies, written in the English language, with no time limitations, on the comparison of R-UKA and C-UKA. The quality of each article was assessed using the Downs and Black Checklist for Measuring Quality. Results: Among the 3,669 articles retrieved, 21 studies on 19 series of patients were included. A total of 3,074 patients (59.5% female and 40.5% male; mean age 65.2 years (SD 3.9); mean BMI 27.4 kg/m2 (SD 2.2)) were analyzed. R-UKA obtained a superior Knee Society Score improvement compared to C-UKA (mean difference (MD) 4.9; p < 0.001) and better Forgotten Joint Score postoperative values (MD 5.5; p = 0.032). The analysis of radiological outcomes did not find a statistically significant difference between the two approaches. R-UKA showed longer operating time (MD 15.6; p < 0.001), but reduced complication and revision rates compared to C-UKA (5.2% vs 10.1% and 4.1% vs 7.2%, respectively). Conclusion: This meta-analysis showed that the robotic approach for UKA provided a significant improvement in functional outcomes compared to the conventional manual technique. R-UKA showed similar radiological results and longer operating time, but reduced complication and revision rates compared to C-UKA. Overall, R-UKA seems to provide relevant benefits over C-UKA in the management of patients undergoing UKA. Cite this article: Bone Jt Open 2024;5(5):374–384.

Veysi Adin, Chunwoo Kim

As the more sensors and actuators are used in the robotic systems to provide more features, complexity of the system is increasing. When it comes to medical robotics, it becomes harder to ensure safety and determinism in the system. To deal with increasing complexity and ensure precise periodicity and execution timing for a medical robot, in this paper we report development of EtherCAT master as a part of software framework for spine surgery robot. We implemented multi-axis controller using open-source EtherCAT master running in real-time preemptive Linux. We evaluated the real-time performance of the system in terms of periodicity, jitter and execution time in our first prototype of spine surgery robot.

Michinobu Umakoshi, Akiko Nakamura, Hiroyuki Tsuchie et al.

Abstract Even when treated comprehensively by surgery, chemotherapy, and radiotherapy, soft-tissue sarcoma has an unfavorable outcome. Because soft-tissue sarcoma is rare, it is the subject of fewer clinicopathological studies, which are important for clarifying pathophysiology. Here, we examined tumor-associated macrophages in the intratumoral and marginal areas of sarcomas to increase our knowledge about the pathophysiology. Seventy-five sarcoma specimens (not limited to a single histological type), resected at our institution, were collected, and the number of CD68-, CD163-, and CD204-positive macrophages in the intratumoral and marginal areas was counted. We then performed statistical analysis to examine links between macrophage numbers, clinical factors, and outcomes. A high number of macrophages positive for all markers in both areas was associated with worse disease-free survival (DFS). Next, we divided cases according to the FNCLCC classification (Grade 1 and Grades 2/3). In the Grade 1 group, there was no significant association between macrophage number and DFS. However, in the Grade 2/3 group, high numbers of CD163- and CD204-positive macrophages in the marginal area were associated with poor DFS. By contrast, there was no significant difference between the groups with respect to high or low numbers of CD68-, CD163-, or CD204-positive macrophages in the intratumoral area. Multivariate analysis identified the number of CD163- and CD204-positive macrophages in the marginal area as an independent prognostic factor. Macrophage numbers in the marginal area of soft-tissue sarcoma may better reflect clinical behavior.

V. Liu, Efren Rosas, J. Hwang et al.

David Vier MD, Rasikh N. Hamid, Susan M. Odum PhD et al.

Category: Ankle; Ankle Arthritis Introduction/Purpose: Total ankle arthroplasty (TAA) is a common treatment for ankle arthritis, but many challenges exist when attempting to correct and balance coronal plane deformity. Varus ankle arthritis tends to be stiffer and often leads to a more stable TAA, but valgus ankle arthritis tends to have more laxity especially in the setting of a progressive collapsing foot deformity. Failure to achieve appropriate deformity correction and soft tissue balance can result in recurrence of the deformity with valgus drift. The purpose of this study was to evaluate the longitudinal coronal plane alignment as well as outcomes in patients treated with TAA with resultant valgus drift. Methods: 98 patients who underwent TAA for valgus ankle arthritis were identified through a prospectively collected database. All patients had a minimum of 2 year follow-up. The tibiotalar angle was measured on preoperative radiographs to include patients with valgus ankle arthritis five degrees or greater. Radiographic alignment in the postoperative period was compared to the alignment at final follow-up. Complications, failures, revisions, and reoperations were recorded. Patients were categorized by severity of preoperative valgus deformity into 3 groups: 5-10 degrees, 11-20 degrees, and greater than 20 degrees. Valgus drift was defined as greater than 5 degrees of valgus shift at final follow-up when compared to the postoperative alignment. Median follow- up was 49.2 (37.2-68.3 inner quartile) months. Results: Patients with greater than 20 degrees of preoperative valgus deformity had an initial postoperative alignment of 2 degrees of valgus and ended with an average of 5.5 degrees of valgus at final follow-up. The groups of patients with 5-10 degrees as well as 11-20 degrees of valgus were corrected to neutral (0 degrees) in the initial post-op period and ended with a final postoperative valgus alignment of 2.5 degrees and 2 degrees, respectively. Overall, 16 patients (18%) had greater than 5 degrees of valgus drift after their surgery, of which 2 failed and were revised (13%) and 5 had reoperations (31%). Conclusion: All groups of preoperative valgus deformity severity had some valgus shift overall at final follow-up. The most severe preoperative valgus deformities were least likely to be corrected to neutral with the index procedure and also on average drifted back to over 5 degrees of valgus. Patients with valgus drift after TAA can still have a good result but should be monitored closely. Overall, they did not have a high failure rate. This study emphasizes the necessity of correcting both the ankle and foot deformity when performing TAA for valgus ankle arthritis in order to maintain deformity correction.

Samir Smajic, Aleksandar Vujadinovic, Adnan Kasapovic et al.

Abstract Background This study examined the impact of Mobidisc implant on spinopelvic parameters, with particular focus on the preservation of the lumbar lordosis (LL) and on the segmental lordosis (SL) of the treated and adjacent segments. Methods A prospective study was conducted on 63 consecutive patients with symptomatic degenerative disc disease who underwent Mobidisc implantation at the Clinic for Spinal Diseases in Strasbourg, France. Based on the profile images of the whole, the following static spinopelvic parameters were measured and analysed: lumbar lordosis L1-S1 (LL), SL for L3-L4, L4-L5 and L5-S1, sacral slope (SS), pelvic tilt (PT) and pelvic incidence. In the lumbar spine images, the anterior (ADH) and posterior disc height (PDH) were measured prior to surgery and at the different follow-up appointments. The preoperative and postoperative values were compared and statistically analysed at different time intervals. Results Sixty-three patients were included in the study. The average age of the patients was 41.4 years (range 27–59 years). The mean follow-up was 44 months (range 36–71 months). Overall, total disc replacement (TDR) led to an increase in LL which increased TED over time. The preoperative LL measured 48.9° ± 10.1° and 53.4° ± 9.9° at 3 years follow-up (p < 0.0001). In the cohort of patients who underwent TDR at L4-5, the LL increased from 51.6° ± 10° to 56.2° ± 9.2° at the last FU (p = 0.006). All other spinopelvic parameters remained stable between the preoperative values and the last follow-up. In the patients who underwent L5-S1 TDR, a significant increase in LL was also observed between preoperative data and at the last FU (from 47.8° ± 10.1° to 53.3° ± 10.1°, p < 0.0001). Following L5-S1 TDR, the SS increased from 32.9° ± 8.3° to 35.6° ± 7.4° (p = 0.05) and the PT decreased from 15.4° ± 6.2° to 11.6° ± 5.7° between preoperative values and the last follow-up. Considering the entire cohort, the SL L5-S1 increased significantly from 5.9° ± 4.2° preoperatively to 8.1° ± 4.4° (p < 0.01) at the last FU, while at the L4-L5 level, the SL remained stable from 9.9 ± 4.5° to 10.7° ± 3.8° (p = 0.3). After L4-5 TDR, an increase in ADH and PDH at the treated level was observed, while these parameters progressively decreased in the adjacent segment. In patients who underwent L5-S1 TDR, a significant increase in L5-S1 ADH and PDH was observed from 18.8 ± 9.1 to 28.4 ± 11.1 and from 9.5 ± 3.8 to 17.6 ± 9.5 pixels, respectively. ADH and PDH at the proximal adjacent levels L3-4 and L4-5 were reduced. We did not observe any case of implant failure or damage to the bone/implant interface. Conclusion TDR with Mobidisc allows for an improvement of LL and SL at the treated level. An increase in both anterior and posterior disc height was observed at the treated level. While disc height decreased at the adjacent level, further studies are required to investigate whether these changes are clinically relevant.

Yutthana Khanasuk, Srihatach Ngarmukos, Aree Tanavalee

Abstract Introduction The benefit of the femoral canal bone plug during total knee arthroplasty (TKA) in reducing blood loss has never been proven. The aim of this meta-analysis was to determine whether the femoral canal bone plug significantly reduces blood loss in primary TKA. Method All studies published before December 2021 were searched. The inclusion criteria were randomized controlled trials comparing blood loss between TKA with plugged and unplugged femoral intramedullary canal, respectively. The primary outcome was postoperative hemoglobin reduction. Results Five studies with a total of 717 patients (361 in the plugged group, 356 in the unplugged group) met the criteria for inclusion in the meta-analysis. The mean difference in hemoglobin level between the two groups was 0.92 g/dL, with significantly less hemoglobin reduction in the plugged group (95% confidence interval [CI] − 1.64 to − 0.21, p = 0.01). The patients in the plugged group also had a significantly lower risk of receiving a blood transfusion (risk ratio 0.58, 95% CI 0.47–0.73, p < 0.00001). Conclusions This meta-analysis demonstrates that using a femoral canal bone plug can significantly reduce blood loss and lower the risk ratio of blood transfusion in patients undergoing TKA.

T. Keating, J. Jacobs

Augmented reality (AR) technology enhances a user's perception through the superimposition of digital information on physical images while still allowing for interaction with the physical world. The tracking, data processing, and display technology of traditional computer-assisted surgery (CAS) navigation have the potential to be consolidated to an AR headset equipped with high-fidelity cameras, microcomputers, and optical see-through lenses that create digital holographic images. This article evaluates AR applications specific to total knee arthroplasty, total hip arthroplasty, and the opportunities for AR to enhance arthroplasty education and professional development.

Junpei Dan, Masashi Izumi, Hiroko Habuchi et al.

Abstract Purpose Mast cells are multifunctional in osteoarthritis (OA), and infiltration of activated mast cells likely contributes to disease severity and progression. However, the detailed mechanisms of action are unclear. The purpose of this study was to elucidate the role of mast cell infiltration in OA at histological level using a new mice model and to investigate pharmacological inhibitory effects of existing mast cell stabilizers in this model. Methods Mice were injected intra‐articularly with monosodium iodoacetate (MIA 0.5 mg) or PBS on day 0, and PBS, with or without mast cells (MC: 1 × 106 cells) on day 14. They were divided into four groups: OA flare (MIA + MC), OA (MIA + PBS), MC non‐OA (PBS + MC), and PBS non‐OA (PBS + PBS). In OA flare, the MC stabilizer drug (tranilast: 400 mg/kg/day) or PBS was administered intraperitoneally from days 15 to 21. Results Histologically, modified Mankin score of the OA flare was significantly higher than that of OA (7.0 [1.8] vs. 3.3 [1.3], P < 0.05), and a larger number of mast cells was observed in OA flare than in OA (34.5 [6.3]/mm2 vs. 27.2 [2.3]/mm2, P < 0.05) on day 22. OA flare also showed acute exacerbation of pain and increased gene expression of pro‐inflammatory cytokines and aggrecanase compared with OA. Administration of tranilast to OA flare‐up provoked significant improvements in term of histological changes, pain, and gene expression at day 22. Conclusion Our novel model possibly mimics OA flare conditions, which may open a new strategy of disease‐modifying treatment for OA, focused on controlling the multiple functions of mast cells.

Oguz Ozdemir, Erhan Coskunol, Tackın Ozalp

Abstract Objectives: We compared anatomic variations in the first compartment in patients with de Quervain’s tenosynovitis and randomly selected cadaver wrists and examined their effects on the disease.\nMethods: Thirty-five patients (mean age 46.7 years) with tenosynovitis (n=39) underwent surgical treatment. An anatomical study was also performed, of 41 cadaver wrists randomly selected. The first compartment of the wrists were exposed and the number of tendons and the presence of septa were explored.\nResults: The study revealed more than one abductor pollicis longus tendon in 24 patients. In the clinical sample, the abductor pollicis longus and extensor pollicis brevis tendons were in the same channel in 57% and in two separate channels in 43%. In cadavers, the presence of two separate channels was 4%.\nConclusion: The differences in the number of channels and existence of septa suggest an increased risk for tenosynovitis in patients with two separate channels. These should be considered in preventing surgery-associated complications. Özet Amaç: De Quervain tenosinovitli hastalarda ve rastgele seçilmiş kadavra el bileklerinde birinci dorsal kompartmandaki anatomik varyasyonları karşılaştırmak ve bunların hastalık üzerindeki etkilerini incelemek.\nÇalışma planı: Otuz beş olgunun (ort. yaş 46.7) 39 tenosinoviti cerrahi olarak tedavi edildi. Anatomik çalışmada ise rastgele seçilen 25 olgunun 41 el bileğinde inceleme yapıldı. Tüm olgularda el bileği birinci dorsal kompartmanı ortaya konarak tendon sayıları ve septa varlığı araştırıldı.\nSonuçlar: Olguların 24’ünde abduktor pollicis longus tendonunun birden fazla sayıda olduğu saptandı. Klinik çalışmada abduktor pollicis longus ve ekstansör pollicis brevis tendonları %57 oranında aynı kanalda , %43 oranında iki ayrı kanalda bulundu. Kadavra çalışmasında ise iki ayrı kanal varlığı %4 idi.\nÇıkarımlar: Kanal sayılarının ve septa oluşumunun farklılığı, iki ayrı kanal olan olgularda tenosinovitisin daha sık olmasını desteklemektedir; bu durum cerrahi diseksiyon la ilgili komplikasyonlarının önlenmesi açısından önemlidir.

Sergio Bergese, Richard Berkowitz, Paul Rider et al.

Background. Oliceridine, an investigational IV opioid, is a first-in-class G-protein selective agonist at the μ-opioid receptor. The G-protein selectivity results in potent analgesia with less recruitment of β-arrestin, a signaling pathway associated with opioid-related adverse events (ORAEs). In randomized controlled studies in both hard and soft tissue models yielding surgical pain, oliceridine provided effective analgesia with a potential for an improved safety and tolerability profile at equianalgesic doses to morphine. The phase 3, open-label, single-arm, multicenter ATHENA trial demonstrated the safety, tolerability, and effectiveness of oliceridine in moderate to severe acute pain in a broad range of patients undergoing surgery or with painful medical conditions warranting use of an IV opioid. This retrospective, observational chart review study compared respiratory depression events associated with oliceridine administration as found in the ATHENA trial to a control cohort treated with conventional opioids. Methods. Patients at 18 years of age or older, who underwent colorectal, orthopedic, cardiothoracic, bariatric, or general surgeries between June 2015 and May 2017 in 11 sites participating in the ATHENA trial who received postoperative analgesia either with IV oliceridine or with IV conventional opioids (e.g., morphine alone or in combination with other opioids) (CO cohort); and had a hospital stay >48 hours, were included in this retrospective analysis. Data from the ATHENA trial was used for the oliceridine cohort; and additional baseline characteristics were collected from medical charts. Data from medical charts were collected for all CO cohort patients. The two cohorts were balanced using an inverse probability weighting method. The primary outcome was the incidence of operationally defined opioid-induced respiratory depression (OIRD) in the two cohorts. Secondary outcomes included between-group comparison of the incidence of OIRD events among a subset of high-risk patients. Results. OIRD was significantly less in the oliceridine cohort compared to the CO cohort (8.0% vs. 30.7%; odds ratio: 0.139) (95% confidence interval [CI] 0.09–0.22; P<0.0001). Likewise, the incidence of OIRD was lower among high-risk patients in the oliceridine cohort (9.1% vs. 34.7%; odds ratio: 0.136) (95% CI [0.09–0.22]; P<0.0001) compared to the CO cohort. Conclusion. In this retrospective chart review study, patients receiving IV oliceridine for moderate to severe acute pain demonstrated a lower incidence of treatment emergent OIRD compared to patients who were treated with IV morphine either alone or with concomitant administration of other opioids.

Xiao‐feng Le, Zhan Shi, Qi‐long Wang et al.

Objective To compare the incidence and risk factors of superior facet joint violation (FJV) during cortical bone trajectory screw placement in robot‐assisted approach versus conventional technique. Methods A retrospective study, including 69 patients having cortical bone trajectory (CBT) screw instrumentation for symptomatic degenerated diseases or trauma, was conducted between June 2015 to January 2019. All patients underwent CBT surgery performed by the same team of experienced surgeons. Patients were randomly divided into two groups: a conventional group (CG, 46 cases) and a robot group (RG, 23 cases). The surgical robotic system was used for screw instrumentation in the robot group and the traditional screw instrumentation with fluoroscopic guidance was used in the conventional group. Cortical screws followed a medio‐to‐lateral path in the transverse plane and a caudal‐to‐cephalad path in the sagittal plane. Preoperative and postoperative computed tomography (CT) scans were obtained to determine the degree and incidence of FJV. The violation status of facet joint was evaluated according to the modified classification: grade 0, no violation; grade 1, screw shaft, screw head or rod within 1 mm of or abutting the facet joint, but did not enter the articular facet joint; grade 2, screw shaft, screw head or rod clearly in the facet joint. The following factors that may contribute to the occurrence of FJV were analyzed: age, sex, body mass index (BMI), proximal fusion level, fusion length, the side of screw, preoperative vertebral slip, superior facet angle, and degenerative scoliosis. The chi‐squared test and Student's t‐test were used for analysis of the variables for significance (P < 0.05). Results FJV occurred in 41.3% of patients in CG and 17.3% of patients in RG. A chi‐squared analysis revealed a significantly lower rate of FJV for RG compared with CG (P = 0.04). In the CG, 17 of the 109 cephalad screws were grade 1 (15.6%), and five were grade 2 (4.6%). In the RG, three of the 46 cephalad screws were grade 1 (6.5%), and three were grade 2 (6.5%). There was a statistically significant difference in the incidence of FJV between the left and right screw with fluoroscopy‐assisted CBT screw instrumentation (P < 0.05). A significant correlation between scoliosis with the FJV was found in CG (P < 0.05) and in RG (P < 0.05). With regard to superior facet angle, a measurement ≥45° was a significant risk factor of FJV in CG (P < 0.05) and in RG (P < 0.05). Conclusions A robot‐assisted approach could reduce the incidence of FJV compared with the conventional approach in CBT technique.

Yusuke Okanoue, Koji Aso, Junpei Dan et al.

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

Sebastián Salazar-Colores, Hugo Alberto-Moreno, Gerardo Flores et al.

Laparoscopic surgery uses a thin tube with a camera called a laparoscope, which is inserted into the abdomen through a small incision in the skin during surgery. This allows to a surgeon to see inside of the body without causing significant injury to the patient. These characteristics make laparoscopy a widely used technique. In laparoscopic surgery, image quality can be severely degraded by surgical smoke caused by the use of tissue dissection tools which reduces the visibility of the observed organs and tissues. This lack of visibility increases the possibility of errors and surgery time with the consequences that this may have on the patient's health. In this paper, we introduce a novel hybrid approach for computational smoke removal which is based on the combination of a widely dehazing method used: the dark channel prior (DCP) and a pixel-to-pixel neural network approach: Generative Adversary Network (GAN). The experimental results have proven that the proposed method achieves a better performance than the individual results of the DCP and GAN in terms of restoration quality, obtaining a PSNR value of 25 and SSIM index of 0.88 over a test set of synthetic images.

James Conway, John B. Etnyre

In this note we show that a closed oriented contact manifold is obtained from the standard contact sphere of the same dimension by contact surgeries on isotropic and coisotropic spheres. In addition, we observe that all closed oriented contact manifolds admit symplectic caps.