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Surgical Techniques Development
Volume 13
Issue 2
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Surg. Tech. Dev., Volume 13, Issue 2 (June 2024) – 9 articles

Cover Story (view full-size image): Our study introduces Poly-Ether-Ether-Ketone (PEEK) expandable vertebral body replacement (VBR) for anterior cervical and upper thoracic column reconstruction. PEEK’s radiolucency allows for excellent post-operative imaging, precise CT planning for irradiation, and reliable radiographic follow-ups for tumorous diseases. The expandable design minimizes the intraoperative endplate damage risk. In our analysis of twenty-eight patients, the PEEK-VBR significantly improved the bisegmental kyphotic angle, maintained stable height with no relevant subsidence, and provided marked pain relief and functional improvements. Patients showed significant gains in the Karnofsky Performance Status Scale and good to excellent outcomes per Odom’s criteria, highlighting PEEK-VBR's effectiveness in enhancing spinal stability and quality of life. View this paper
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10 pages, 3779 KiB  
Brief Report
Modified Tension Band Wiring Using Only Non-Absorbable Braided Polyblend Sutures for the Treatment of Patellar Fractures
by Annalisa Itro, Annalisa De Cicco, Gianluca Conza, Luca Schiavo, Niccolò Garofalo, Adriano Braile, Francesco Nappi and Giuseppe Toro
Surg. Tech. Dev. 2024, 13(2), 227-236; https://doi.org/10.3390/std13020015 - 13 Jun 2024
Viewed by 387
Abstract
Patellar fractures represent approximately 1% of all fractures and the pattern is influenced by the quality of the bone and the energy of the trauma. Transverse fractures are associated with extensor mechanism failure and interruption of joint congruence. Patellar fractures are generally fixed [...] Read more.
Patellar fractures represent approximately 1% of all fractures and the pattern is influenced by the quality of the bone and the energy of the trauma. Transverse fractures are associated with extensor mechanism failure and interruption of joint congruence. Patellar fractures are generally fixed using tension band principles, through K-wires and metal cerclage. The tension band was conceived to transform the considerable tensile force applied to the patella into a compressive one to obtain a stable fixation. The use of metal implants might be associated with a significant discomfort, mostly related to the irritating action of K-wires and cerclage on the surrounding soft tissues, often leading to the need for implant removal. Therefore, we introduced an original technique for fix patellar fractures by using only a non-adsorbable braided polyblend suture. Postoperative care included progressive range of motion recovery using an articulated knee brace and a specific protocol. The suture-only tension band technique seems to be a useful technique in terms of complications and reoperation rate while allowing secure and early mobilization. Full article
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13 pages, 14834 KiB  
Technical Note
The Method of 3D C-arm Navigated AC Joint Stabilization-Surgical Technique
by Alexander Böhringer, Carlos Pankratz, Alexander Eickhoff, Florian Gebhard and Konrad Schütze
Surg. Tech. Dev. 2024, 13(2), 214-226; https://doi.org/10.3390/std13020014 - 8 Jun 2024
Viewed by 509
Abstract
Background: The arthroscopically assisted stabilization of AC joint dislocations with a suture button system is an established procedure that is widely and successfully used in everyday practice. The main advantages of this one-step method are the minimally invasive procedure and the anatomical reconstruction [...] Read more.
Background: The arthroscopically assisted stabilization of AC joint dislocations with a suture button system is an established procedure that is widely and successfully used in everyday practice. The main advantages of this one-step method are the minimally invasive procedure and the anatomical reconstruction of the ruptured coracoclavicular ligaments with a permanent implant. With this technical note study, for the first time, the new method of navigated suture button implantation in everyday clinical practice is described with the future goal of further reducing invasiveness and increasing precision. Materials and Methods: The surgical technique is explained using precise descriptions and illustrations, photos, X-rays, and 3D reconstructions based on clinical cases. The step-by-step system setup and patient positioning, AC joint reduction and retention, 3D scan and drill tunnel planning, stab incision and Kirschner wire navigation, and cannulated drilling and implant positioning, as well as closure and documentation are described in detail. Results: The standard coracoclavicular stabilization of AC joint dislocations with the 3D C-arm navigated suture button method is described in detail. Furthermore, the feasibility of an additive horizontal acromioclavicular suture cerclage, the implantation of an additional coracoclavicular suture button system, and the single-stage cannulated screw fixation of non-displaced fractures is demonstrated. Conclusion: The navigated suture button method aims to be simple, safe, minimally invasive, and precise. Prospective clinical studies with a long follow-up should be carried out to determine the clinical and radiological outcome in comparison with current methods. Full article
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9 pages, 1211 KiB  
Case Report
Retrograde Endovascular Recanalization of the Superior Mesenteric Artery for the Treatment of Acute Bowel Ischemia: Case Report
by Pawel Latacz, Piotr Piekorz and Marian Simka
Surg. Tech. Dev. 2024, 13(2), 205-213; https://doi.org/10.3390/std13020013 - 24 May 2024
Viewed by 229
Abstract
Acute bowel ischemia is a life-threatening abdominal emergency. In many patients, percutaneous endovascular repair of visceral arteries in an antegrade direction across occluding lesions is challenging and sometimes not possible. We present the case of technically successful percutaneous retrograde recanalization of an occluded [...] Read more.
Acute bowel ischemia is a life-threatening abdominal emergency. In many patients, percutaneous endovascular repair of visceral arteries in an antegrade direction across occluding lesions is challenging and sometimes not possible. We present the case of technically successful percutaneous retrograde recanalization of an occluded superior mesenteric artery in a critically ill 82-year-old patient. The superior mesenteric artery was recanalized via the branches of the celiac trunk; the guidewires were navigated to the target artery through the gastroduodenal and pancreaticoduodenal arteries. Retrograde percutaneous recanalization of the superior mesenteric artery is technically feasible, even in hemodynamically unstable patients. Full article
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13 pages, 1749 KiB  
Article
Locoregional vs. General Anaesthesia for Minimally Invasive Video-Assisted Parathyroidectomy (MIVAP) Using Propensity Score Matching Analysis: A Feasibility Study
by Francesco Pennestrì, Priscilla Francesca Procopio, Francesca Prioli, Pierpaolo Gallucci, Luca Sessa, Annamaria Martullo, Antonio Laurino, Luca Revelli, Cristina Modesti, Carmela De Crea and Marco Raffaelli
Surg. Tech. Dev. 2024, 13(2), 192-204; https://doi.org/10.3390/std13020012 - 11 May 2024
Viewed by 480
Abstract
Focused parathyroidectomy is the preferred surgical method for treating primary hyperparathyroidism (pHPT) sustained by the pre-operatively well-localized parathyroid adenoma. We aimed to compare the effectiveness, safety, and short-term clinical outcome of minimally invasive video-assisted parathyroidectomy (MIVAP) in locoregional anaesthesia (LA) vs. general anaesthesia [...] Read more.
Focused parathyroidectomy is the preferred surgical method for treating primary hyperparathyroidism (pHPT) sustained by the pre-operatively well-localized parathyroid adenoma. We aimed to compare the effectiveness, safety, and short-term clinical outcome of minimally invasive video-assisted parathyroidectomy (MIVAP) in locoregional anaesthesia (LA) vs. general anaesthesia (GA) by means of propensity score matching (PSM) analysis. Retrospective research of patients who underwent MIVAP between January 2014 and December 2022 was carried out. Patients were divided into two groups based on the anaesthesiologic procedure (LA vs. GA). Overall, 553 patients underwent MIVAP. After PSM, 115 patients in the LA group and 230 patients in the GA group were included. MIVAP under LA was associated with shorter median operative time (16 vs. 35 min, p < 0.001), shorter median operative room occupation time (44 vs. 73 min, p < 0.001), and lesser median post-operative visual analogue scale pain, with comparable post-operative hospital stay and complication rate. MIVAP under LA is a safe and feasible procedure with significant advantages over GA in terms of post-operative pain and operative room occupation time. This last step can finally result in more efficient utilisation of the operative room and the health care system’s resources. Full article
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14 pages, 1299 KiB  
Article
Analysing Pre-Operative Gait Patterns Using Inertial Wearable Sensors: An Observational Study of Participants Undergoing Total Hip and Knee Replacement
by Pragadesh Natarajan, Ashley Lim Cha Yin, R. Dineth Fonseka, David Abi-Hanna, Kaitlin Rooke, Luke Sy, Monish Maharaj, David Broe, Lianne Koinis and Ralph Jasper Mobbs
Surg. Tech. Dev. 2024, 13(2), 178-191; https://doi.org/10.3390/std13020011 - 6 May 2024
Viewed by 712
Abstract
Background. Knee and hip arthroplasty are two of the most frequently performed procedures in orthopaedic surgery. They are associated with positive patient-reported outcomes and significant improvements in quality of life for patients. Despite this, there may be room for further progress by quantifying [...] Read more.
Background. Knee and hip arthroplasty are two of the most frequently performed procedures in orthopaedic surgery. They are associated with positive patient-reported outcomes and significant improvements in quality of life for patients. Despite this, there may be room for further progress by quantifying functional improvements with gait analysis. Our study therefore aims to characterise the disease-specific gait pattern of participants with knee and hip osteoarthritis undergoing total joint replacement using a single chest-based wearable sensor. Methods. Twenty-nine participants awaiting total hip replacement and 28 participants awaiting total knee replacement underwent three-dimensional motion analysis with inertial wearable sensors. These gait metrics were then compared with 28 healthy controls of similar ages. Differences in gait metrics were evaluated using a T-test. The participants were recruited through a single centre to participate in this cross-sectional observational study. Participants with osteoarthritis severity sufficient to warrant surgical intervention were considered for inclusion in our study. The participants were instructed to walk 15–120 m in a hospital environment while fitted with a chest-based wearable sensor. Results. In total, three domains were evaluated, including spatiotemporal, variability and asymmetry parameters. There were marked variations in the gait asymmetry parameters and step length variation in both the hip and knee osteoarthritis patients compared with the healthy controls. The magnitude of gait deterioration in terms of step length asymmetry was greater on average in the hip osteoarthritis group than the knee group. The hip osteoarthritis (+180%, p < 0.001) and knee osteoarthritis (+129%, p = 0.001) groups demonstrated marked differences in step length asymmetry. Discussion. A single chest-based sensor was found to be capable of detecting pathological gait signatures in osteoarthritis patients when compared with age-matched controls. Future studies should compare pre- and postoperative changes to disease-specific gait impairments to validate the use of wearable sensors as a clinical adjunct. Full article
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16 pages, 6121 KiB  
Article
15-Year Experience in Maxillofacial Surgical Navigation with Tracked Instruments
by Giorgio Novelli, Filippo Santamato, Alejandro Juan Piza Moragues, Andrea Filippi, Federico Valsecchi, Gabriele Canzi and Davide Sozzi
Surg. Tech. Dev. 2024, 13(2), 162-177; https://doi.org/10.3390/std13020010 - 26 Apr 2024
Viewed by 427
Abstract
(1) Introduction and Aim: Surgical navigation has evolved as a vital tool in maxillofacial surgery, offering precise and patient-specific data. This study explores the clinical applications and accuracy of intraoperative tool tracking in maxillofacial surgery. (2) Materials and Methods: The research includes 42 [...] Read more.
(1) Introduction and Aim: Surgical navigation has evolved as a vital tool in maxillofacial surgery, offering precise and patient-specific data. This study explores the clinical applications and accuracy of intraoperative tool tracking in maxillofacial surgery. (2) Materials and Methods: The research includes 42 patients with various pathologies who underwent surgeries assisted by a surgical navigation system using tracked instruments. Four representative cases are exhibited in the study: the first case involving coronoid hyperplasia with mouth opening deficit, the second case addressing naso-orbital-ethmoidal-frontal ossifying fibroma resection, the third case showcasing a subapical osteotomy (Köle) for a class III dentoskeletal malocclusion, and the fourth one exposing the treatment of a recurrent ameloblastoma. (3) Results: The results indicate that surgical navigation with tracked instruments provides high precision (<1.5 mm error), reduced surgical time, and a less invasive approach. (4) Conclusions: This study highlights the potential for reproducible outcomes and increased safety, especially in complex cases. Despite some limitations, the synergy between surgical navigation and tracked instruments offers a promising approach in maxillofacial surgery, expanding its applications beyond current practices. Full article
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40 pages, 342 KiB  
Conference Report
Report on the 11th National Congress AICPE (Associazione Italiana di Chirurgia Plastica Estetica) Held in Rimini, Italy, 12–14 April 2024
by Egidio Riggio
Surg. Tech. Dev. 2024, 13(2), 122-161; https://doi.org/10.3390/std13020009 - 22 Apr 2024
Viewed by 433
Abstract
The annual congress of the Italian Association of Plastic Aesthetic Surgery (AICPE) is one of the most relevant conference meetings in Europe concerning aesthetic plastic surgery as there are a number of participants and a parterre of invited speakers chosen for their renowned [...] Read more.
The annual congress of the Italian Association of Plastic Aesthetic Surgery (AICPE) is one of the most relevant conference meetings in Europe concerning aesthetic plastic surgery as there are a number of participants and a parterre of invited speakers chosen for their renowned scientific value [...] Full article
15 pages, 7082 KiB  
Article
Anterior Cervical and Upper Thoracic Column Reconstruction Using an Expandable Poly-Ether-Ether-Ketone Vertebral Body Replacement: A Retrospective Single Center Cohort Analysis
by Martin Štefanides, Katharina A. C. Oswald, Anaïs K. Luyet, Christoph E. Albers, Lorin M. Benneker and Moritz C. Deml
Surg. Tech. Dev. 2024, 13(2), 107-121; https://doi.org/10.3390/std13020008 - 12 Apr 2024
Viewed by 621
Abstract
This study aimed to evaluate the safety and efficacy of a novel Poly-Ether-Ether-Ketone (PEEK) expandable vertebral body replacement (VBR) for anterior cervico-thoracic vertebral column reconstruction in patients with metastatic, traumatic, or degenerative diseases. Radiographic and clinical outcomes, as well as complication rates, were [...] Read more.
This study aimed to evaluate the safety and efficacy of a novel Poly-Ether-Ether-Ketone (PEEK) expandable vertebral body replacement (VBR) for anterior cervico-thoracic vertebral column reconstruction in patients with metastatic, traumatic, or degenerative diseases. Radiographic and clinical outcomes, as well as complication rates, were analyzed in a retrospective analysis of 28 patients (61 ± 13 years; 64% female) who underwent an anterior cervical corpectomy and fusion (ACCF) with the Expandable Corpectomy Device (ECD) from DePuy/Synthes (2011–2020). Correction of the bisegmental kyphotic angle (BKA) was chosen as the primary outcome. Bony fusion, loss of device height, and implant subsidence were evaluated additionally. Clinical outcome was assessed using Odom’s criteria, the numerical pain rating scale (NRS), the American Spinal Injury Association Impairment Scale (AIS), and the Karnofsky Performance Status Scale (KPSS). Our study found a significant improvement in the BKA (12.3° ± 9.6°; p = 0.0002) at the last follow-up with no statistically relevant loss of device height (p = 0.96) or implant subsidence (p = 0.99). Successful bony fusion was observed in all patients. The KPSS significantly improved in patients with a tumorous disease at the time of discharge (p = 0.0009), and the sensation of pain showed significant improvement at six months post-operatively and at the final follow-up (p = 0.004; p = 0.021). However, four patients needed further secondary posterior stabilization, and one ECD was explanted due to a severe surgical site infection after an accidental esophageal lesion. In conclusion, the ECD proofed the radiographic stability for the anterior column reconstruction of the cervico-thoracic spine with significantly improved clinical outcome. Full article
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10 pages, 2512 KiB  
Technical Note
Novel Concept for the Expansion of the Fibula Bone as an Autologous Bone Graft: Experimental Tests on an Animal Implant Prototype—In Memoriam Volker Buehren
by Matthias Militz, Volker Buehren, Christoph Miethke, Carolin Gabler, Josephine Mauck, Wolfram Mittelmeier, Robert Bialas and Rainer Bader
Surg. Tech. Dev. 2024, 13(2), 97-106; https://doi.org/10.3390/std13020007 - 22 Mar 2024
Viewed by 524
Abstract
The current reconstructive surgical procedures implemented after the resection of extended bone segments are associated with high complication rates and long-term treatments. By transplanting an autologous, vascularized and stabilized bone segment, these challenges can be managed. Thus, we propose a novel procedure to [...] Read more.
The current reconstructive surgical procedures implemented after the resection of extended bone segments are associated with high complication rates and long-term treatments. By transplanting an autologous, vascularized and stabilized bone segment, these challenges can be managed. Thus, we propose a novel procedure to expand the currently available autologous bone grafts to the dimensions of the recipient bone using an implantable device. The objective of the present study was to characterize the feasibility of developing an implant prototype for fibula expansion in an in vitro model using a porcine fibula. A balloon catheter, as the part of the implant responsible for expansion, was proven to expand while being periodically filled with sodium chloride. Therefore, the expansion of the balloon catheter was analyzed in an experimental test setup with a 3D-printed porcine fibula with a closure film simulating callus formation to simulate the in vivo situation. Our experimental testing proved the successful expansion of the porcine fibula by the balloon catheter. Hence, the feasibility of the concept for subsequent animal testing was confirmed. Full article
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