Hasil untuk "Surgery"

R. K. Gilchrist, R. Medal, W. Shorey et al.

Santosh Borkar, Rajiv Munde, Shrirang Godbole et al.

Background. Intra-articular calcaneal fractures, particularly of the joint depression type, present significant surgical challenges. The traditional lateral extensile approach (LEA), although providing excellent exposure, is associated with notable soft tissue complications, such as wound necrosis and infection. The sinus tarsi approach (STA), a minimally invasive technique, aims to minimize these complications while maintaining comparable outcomes. This study aimed to compare the functional, radiological outcomes, and complications of STA with cannulated cancellous (CC) screw fixation versus LEA with plating in the management of joint depression-type intra-articular Sanders Type 2 and 3 calcaneal fractures. Methodology. A prospective, non-randomized comparative study was conducted at a tertiary care center (BSTRH and MIMER Medical College, Talegaon Dabhade), involving 56 adult patients (aged >18 years) with acute (<three weeks) intra-articular joint depression (Sanders Type 2 and 3) calcaneal fractures, diagnosed via radiographs and CT scan. All surgeries were performed by a senior orthopaedic trauma surgeon with more than 10 years of experience. Patients were allocated into two groups of 28 each: Group A underwent STA with CC screw fixation, while Group B received LEA with plate fixation. Surgical intervention was performed after soft tissue readiness, followed by standard postoperative care. Patients were evaluated at one, three, six, nine, and 12 months postoperatively using the American Orthopaedic Foot and Ankle Society hindfoot score (AOFAS), Visual Analogue Scale (VAS), and radiological parameters including Bohler’s angle, Gissane angle, and calcaneal height and width. Complication rates, operative time, and hospital stay were also analyzed. Results. STA resulted in significantly shorter operative times (59.1 vs. 98.4 minutes, p < 0.001) and hospital stays (4.7 vs. 7.42 days, p < 0.001). AOFAS scores at 12 months were comparable between STA (mean 80.57) and LEA (mean 77.33). Postoperative VAS scores were significantly better in the STA group (1.67 vs. 2.04; p = 0.044). Radiographic outcomes were similar between groups. STA demonstrated fewer complications, including superficial infection (3 vs. 5), deep infection (0 vs. 2), and sural nerve injury (0 vs. 1). Conclusion. The sinus tarsi approach with cannulated screw fixation offers equivalent functional and radiological outcomes to the lateral

Biao Yi, Jiahao Li, Baolei Zhang et al.

Fine-tuning-as-a-Service introduces a critical vulnerability where a few malicious examples mixed into the user's fine-tuning dataset can compromise the safety alignment of Large Language Models (LLMs). While a recognized paradigm frames safe fine-tuning as a multi-objective optimization problem balancing user task performance with safety alignment, we find existing solutions are critically sensitive to the harmful ratio, with defenses degrading sharply as harmful ratio increases. We diagnose that this failure stems from conflicting gradients, where the user-task update directly undermines the safety objective. To resolve this, we propose SafeGrad, a novel method that employs gradient surgery. When a conflict is detected, SafeGrad nullifies the harmful component of the user-task gradient by projecting it onto the orthogonal plane of the alignment gradient, allowing the model to learn the user's task without sacrificing safety. To further enhance robustness and data efficiency, we employ a KL-divergence alignment loss that learns the rich, distributional safety profile of the well-aligned foundation model. Extensive experiments show that SafeGrad provides state-of-the-art defense across various LLMs and datasets, maintaining robust safety even at high harmful ratios without compromising task fidelity.

Davide Luglietto, Alessandro De Benedictis, Alessandra Marasi et al.

Over the last decade, the quality of neurosurgical procedures dramatically improved, also thanks to the development and increased accessibility of several technological recourses (e.g., imaging, neuronavigation, neurophysiology, microscopy), allowing to plan increasingly complex approaches, while reducing the risk of postoperative complications. Among these resources, three-dimensional rendering and simulation systems, such as virtual and augmented reality, provide a high-quality visual reconstruction of brain structures and interaction with advanced anatomical models. Although the usefulness of these systems is now widely recognized, the additional availability of proprioceptive (haptic) feedback might help to further enhance the realism of surgical simulation. A systematic literature review on the application of haptic technology in simulation of cranial neurosurgical procedures was made. Inclusion criteria were the usage of simulators with haptic feedback for specific neurosurgical procedures whereas the studies that did not include an evaluation of the surgical simulation system by a surgeon were excluded. According to inclusion and exclusion criteria, 10 studies were selected. Simulation in neurosurgery still lacks a system capable of rehearsing the entire procedure—from skin incision to skin closure—while providing both visual and proprioceptive feedback. Consequently, further advancements in this area are necessary.

Junaid Aamir MBChB MRes MRCS, Chijioke Orji MBBS, MRCS, Lyndon Mason BMBS MRCS FRCS

Research Type: Level 3 - Retrospective cohort study, Case-control study, Meta-analysis of Level 3 studies Introduction/Purpose: Occult posterior malleolar fractures (PMFs) are reported commonly in tibial shaft fractures. Presurgical identification is necessary to negate possible complications during tibial fracture surgical treatment (e.g. PMF fracture displacement. The aims of this study was to determine the most relevant factors predicting PM fractures by applying the AI "Minimum Redundancy Maximum Relevance" (mRMR) feature selection method to investigate the predictive power of various clinical and demographic factors. Methods: This was a historic cohort study, employing the mRMR method to identify the most relevant features associated with occult PMF in tibial shaft fractures . The inclusion criteria for this study were any patient who had sustained a diaphyseal tibial fracture who had undergone surgery during the study period who had also undergone a CT scan in addition to plain radiographs. The selected features were then used to train a machine learning model for identifying occult PMF. The model's performance was evaluated by measuring classification accuracy across different combinations of features. Results: Out of 764 diaphyseal fractures identified 442 met the inclusion criteria. A total of 107 patients had PMF extensions (24.21%). The analysis revealed that tibia the most relevant fractures were tibia fracture type, fibular fracture morphology, tibia fracture level, fibular fracture level and mechanism. On further analysis, tibial spiral fracture was the most significant predictor, with a classification accuracy of 0.78 with other factor clusters not reaching the same significance. Low energy mechanisms and tibial fracture comminution were the best predictors of no occult PMF. Conclusion: This study demonstrates that AI can effectively be used to identify prediction factors of occult PMF in tibial fractures. Spiral tibia fractures being the most relevant predictor. The findings highlight the potential of using AI-driven methods, such as mRMR, to enhance the accuracy of injury prediction, and these findings are in keeping with results from traditional statistics.

C. Zarins, Rodney A. White, D. Schwarten et al.

Durgesh Haribhau Salunkhe, Guillaume Michel, Shivesh Kumar et al.

This work presents the development of a parallel manipulator used for otological surgery from the perspective of co-design. Co-design refers to the simultaneous involvement of the end-users (surgeons), stakeholders (designers, ergonomic experts, manufacturers), and experts from the fields of optimization and mechanisms. The role of each member is discussed in detail and the interactions between the stakeholders are presented. Co-design facilitates a reduction in the parameter space considered during mechanism optimization, leading to a more efficient design process. Additionally, the co-design principles help avoid unforeseen errors and help in quicker adaptation of the proposed solution.

Tetsuya Abe, Marc Kegel, Nicolas Weiss

We say that two knots are friends if they share the same 0-surgery. Two friends with different sliceness status would provide a counterexample to the 4-dimensional smooth Poincaré conjecture. Here we create a census of all friends with small crossing numbers c and tetrahedral complexities t, and compute their smooth 4-genera. In particular, we compute the minimum of c(K)+c(K') and of t(K)+t(K') among all friends K and K'. Along the way, we classify all 0-surgeries of prime knots of at most 15 crossings. Moreover, we determine for many friends in our census if their traces are equivalent or not. For that, we develop a new obstruction for two traces being homeomorphic coming from symmetry-exceptional slopes of hyperbolic knots. This is enough to also determine the minimum value of c(K)+c(K') among all friends K and K' whose traces are not homeomorphic.

C. Ryan-Anderson, N. C. Brown, C. H. Baldwin et al.

Quantum state teleportation is commonly used in designs for large-scale fault-tolerant quantum computers. Using Quantinuum's H2 trapped-ion quantum processor, we implement the first demonstration of a fault-tolerant state teleportation circuit for a quantum error correction code - in particular, the planar topological [[7,1,3]] color code, or Steane code. The circuits use up to 30 trapped ions at the physical layer qubits and employ real-time quantum error correction - decoding mid-circuit measurement of syndromes and implementing corrections during the protocol. We conduct experiments on several variations of logical teleportation circuits using both transversal gates and lattice surgery protocols. Among the many measurements we report on, we measure the logical process fidelity of the transversal teleportation circuit to be 0.975(2) and the logical process fidelity of the lattice surgery teleportation circuit to be 0.851(9). Additionally, we run a teleportation circuit that is equivalent to Knill-style quantum error correction and measure the process fidelity to be 0.989(2).

Tripke Verena, Sommer Nils

Liver surgery is the cornerstone of the curative treatment of malignant liver tumors. However, the liver anatomy is very complex, and liver surgery is still associated with relevant morbidity despite many technical advances. The Brisbane nomenclature is used worldwide to classify liver resection. However, this nomenclature has several limitations as multiple terms are used for the same type of resection. Non-anatomical resections, multiple resections, and combined bilio-vascular resections were not mentioned. Therefore, new terminologies have been proposed for the precise and simple classification of liver resection. Furthermore, in recent years, many technical innovations have been introduced in liver surgery, such as 3D imaging systems and indocyanine green fluorescence, for better preoperative and intraoperative identification of tumor localization and critical vascular structures. Minimally invasive techniques are used more frequently in liver surgery. Potential benefits include less intraoperative blood loss, less pain, and a shorter hospital stay. The implementation of robotic systems also has an impact on liver surgery, and the number of cases reported in the literature is constantly increasing. The potential benefits of robotic liver resection over laparoscopic liver resection will be the subject of future studies.

R. Riley, N. Powell, C. Guilleminault

D. Lindström, O. S. Azodi, A. Wladis et al.

A. Fink, D. Campbell, R. Mentzer et al.

Mohammed Majthoub Almoghrabi, Guillaume Sagnol

We study the elective surgery planning problem in a hospital with operation rooms shared by elective and emergency patients. This problem can be split in two distinct phases. First, a subset of patients to be operated in the next planning period has to be selected, and the selected patients have to be assigned to a block and a tentative starting time. Then, in the online phase of the problem, a policy decides how to insert the emergency patients in the schedule and may cancel planned surgeries. The overall goal is to minimize the expectation of a cost function representing the assignment of patient to blocks, case cancellations, overtime, waiting time and idle time. We model the offline problem by a two-stage stochastic program, and show that the second-stage costs can be replaced by a convex piecewise linear surrogate model that can be computed in a preprocessing step. This results in a mixed integer program which can be solved in a short amount of time, even for very large instances of the problem. We also describe a greedy policy for the online phase of the problem, and analyze the performance of our approach by comparing it to either heuristic methods or approaches relying on sampling average approximation (SAA) on a large set of benchmarking instances. Our simulations indicate that our approach can reduce the expected costs by as much as 30% compared to heuristic methods and is able to solve problems with $1000$ patients in about one minute, while SAA-approaches fail to obtain near-optimal solutions within 30 minutes, already for $100$ patients.

Soroush Sadeghnejad, Mojtaba Esfandiari, Farshad Khadivar

Simulated training platforms offer a suitable avenue for surgical students and professionals to build and improve upon their skills, without the hassle of traditional training methods. To enhance the degree of realistic interaction paradigms of training simulators, great work has been done to both model simulated anatomy in more realistic fashion, as well as providing appropriate haptic feedback to the trainee. As such, this chapter seeks to discuss the ongoing research being conducted on haptic feedback-incorporated simulators specifically for Endoscopic Sinus Surgery (ESS). This chapter offers a brief comparative analysis of some EES simulators, in addition to a deeper quantitative and qualitative look into our approach to designing and prototyping a complete virtual-based haptic EES training platform.

B. K. Shreyamsha Kumar, K. C. Anandakrishan, Manish Sumant et al.

Wound care is a critical aspect of healthcare that involves treating and managing various types of wounds, typically caused by injuries, surgery, or chronic diseases such as diabetes. Chronic wounds can be particularly challenging to manage and often require 3 to 6 months of long-term care. In a few instances, healing durations are highly unpredictable and can vary depending on the severity of the wound, the patient&#x2019;s overall health, and other factors such as medication, nutrition, age, comorbidity, environment, etiology, and immune system function. A chronic wound can significantly impact the quality of life, causing pain, discomfort, limited mobility, higher healthcare cost, and even mortality in severe cases. Effective wound care is crucial for promoting complete and timely healing and reducing the risk of complications that may lead to amputation, infection, and other potentially life-threatening outcomes. This work aims to develop a system that automizes to determine the wound boundaries leveraging the DeepLabV3&#x002B;SE, measures the wound characteristics such as size and area, and wound shape using a pipeline of morphological operations and connected component analysis modules. The proposed system&#x2019;s performance was evaluated using the publicly available dataset. Results demonstrate that the DeepLabV3&#x002B;SE has outperformed with significantly high dice and IOU scores of 0.923 and 0.924, respectively, compared with several state-of-the-art methods.

Fei Liu, Qing Xu, Parbatraj Regmi et al.

BackgroundLymphoepithelioma-like intrahepatic cholangiocarcinoma (LEL-ICC) is a rare variant of intrahepatic cholangiocarcinoma. Epstein–Barr virus (EBV) infection was considered to play a pivotal role in the tumorigenesis of LEL-ICC. It is difficult to diagnosis of LEL-ICC due to the lack of specific features regarding the laboratory test results and imaging findings. At present, the diagnosis of LEL-ICC mainly depends on the histopathologic and immunohistochemical examinations. In addition, the prognosis of LEL-ICC was better than classical cholangiocarcinomas. To our knowledge, only few cases of LEL-ICC have been reported in the literature.Case presentationWe presented a case of a 32-year-old Chinese female with LEL-ICC. She had a 6-month history of upper abdominal pain. The magnetic resonance imaging (MRI) showed a 1.1× 1.3 cm lesion in the left lobe of liver, appearing low signal intensity on T1-weighted images and high signal intensity on T2-weighted images. The patient underwent laparoscopic left lateral sectionectomy. The postoperative histopathologic and immunohistochemical examinations results allowed for the definitive diagnosis of LEL-ICC. The patient was free from tumor recurrence after a 28 months follow-up.ConclusionIn this study, we reported a rare case of LEL-ICC associated with both HBV and EBV infection. EBV infection might play a pivotal role in the carcinogenesis of LEL-ICC, and surgical resection is still the most effective treatment at present. Further research on the etiology and treatment strategies of LEL-ICC is required.

Antonio Franco, Devin Rogers, Savio D. Pandolfo et al.

ABSTRACT Aim: Renal leiomyoma is a rare benign mesenchymal tumor arising from the smooth muscle cells of the kidney. Renal capsule is its most common location (1). Large tumor may require surgical excision which can be challenging in case of proximity to major vessels (2). Indications of robotic partial nephrectomy (RPN) have exponentially expanded over the past few years (3). We aim to report a case of large renal leiomyoma successfully managed with RPN. Methods: A 59-year-old female patient with BMI 51 presented with chief complaint of abdominal discomfort. The patient underwent a CT scan that revealed a massive circumscribed exophytic complex solid cystic mass of 4.5 × 7.7 × 6.2 cm, arising from the lower pole of right kidney and abutting the inferior vena cava. RENAL score was 11ah (high complexity). Past surgical history included mid-urethral sling, breast reduction, and hysterectomy with salpingectomy. Preoperative creatinine and eGFR were 0.9 (mg/dL) and 77 (mL/min), respectively. A robotic excision of this mass was successfully performed by using Da Vinci Xi platform. Main steps of the procedure are illustrated in the present video. Results: Dissection and isolation of the tumor were carefully performed after identifying key anatomical structures such as the ureter, the IVC and the renal hilum. Intraoperative ultrasound was used to confirm the margins of the mass. The renal artery was clamped and then the tumor was resected/enucleated. Renal parenchyma was re-approximated with a single layer of interrupted CT-1 Vicryl 0 with sliding clip technique. Warm ischemia time was 19 min. Estimated blood loss (EBL) was 250 ml. Operative time was 165 min. No intraoperative complications occurred. No drain was placed. Patient was discharged on postoperative day 2. Post-operative hypotension was managed with fluid bolus. Postoperative creatinine and eGFR were 1,0 (mg/dL) and 69 (mL/min/1.72m2), respectively. Pathology revealed a leiomyoma of genital stromal origin with hyalinization and calcification. Conclusions: To the best of our knowledge, this is the first description of RPN for the management of a large (about 8 cm) renal leiomyoma. Robotic assisted surgery allows to expand the indications of minimally invasive conservative renal surgery whose feasibility becomes even more clinically significant in case of benign masses which can be managed without sacrificing healthy renal parenchyma.

Christian Hoffmann, Christopher Mohr, Patricia Johansson et al.

Abstract We systematically analyzed the kinetics of tumor regression, the impact of residual lesions on disease control and the applicability of the Lugano classification in follow-up MRI of orbital non-Hodgkin lymphomas that were irradiated with photons. We retrospectively analyzed a total of 154 pre- and post-irradiation MRI datasets of 36 patients with low-grade, Ann-Arbor stage I, orbital non-Hodgkin lymphomas. Patients with restricted conjunctival involvement were excluded. Lymphoma lesions were delineated and volumetrically analyzed on T1-weighted sequences. Tumor residues were present in 91.2% of all cases during the first six months after treatment. Volumetric partial response rates (> 50% volume reduction) were 75%, 69.2%, and 50% at 12–24 months, 36–48 months and > 48 months after the end of treatment. The corresponding complete response (CR) rates according to the Lugano classification were 20%, 23.1% and 50%. During a median clinical follow-up of 37 months no significant differences in progression free survival (PFS) rates were observed between the CR and non-CR group (p = 0.915). A residual tumor volume below 20% of the pretreatment volume should be expected at long-term follow-up beyond one year after radiotherapy.

C. Grimes, K. Bowman, Christopher M. Dodgion et al.