Surgical Techniques Development

Background/Objectives: Inguinal hernia (IH) is a common complication after robot-assisted radical prostatectomy (RARP), significantly impacting patients’ quality of life. This study aimed to evaluate whether peritoneal closure reduces the incidence of IH after RARP. Methods: A retrospective analysis was conducted on 772 patients who underwent transperitoneal RARP between April 2018 and March 2023. Patients with a history of IH surgery were excluded. Peritoneal closure, introduced in December 2021, was performed during the final steps of RARP in 144 patients. The incidence of IH was compared between patients with and without peritoneal closure. Multivariate analysis was performed to identify significant predictors of IH. Results: IH occurred in 73 patients (9.5%)—5 (3.5%) in the peritoneal closure group and 68 (10.8%) in the no peritoneal closure group. Multivariate analysis revealed that the absence of peritoneal closure (hazard ratio [HR] = 4.55, p = 0.04) and low body mass index (BMI < 23 kg/m²; HR = 2.51, p = 0.001) were significant predictors of IH. The two-year IH-free survival rate was 96.5% in the peritoneal closure group and 89.2% in the no peritoneal closure group. Conclusions: Peritoneal closure significantly reduces the incidence of IH after RARP. This simple and effective technique may serve as a valuable preventive measure against postoperative IH, potentially improving surgical outcomes and patient quality of life. Further studies are warranted to confirm these results in diverse patient populations. Full article

Background/Objectives: An 80-year-old man was admitted to our department after a salvage radical cystectomy for actinic cystitis due to radiotherapy for prostate cancer. He presented with a two-month history of feculent debris in the right stoma and deteriorated general conditions, after a long past medical history of recurrent complicated urinary infections. Methods: Computer tomography (CT) of the abdomen revealed a ureterocolic fistula along the right ureteral pelvic tract. A right percutaneous nephrostomy tube was placed. Due to multiple previous surgeries, several lines of intravenous antibiotic therapies and the overall condition of the patient, a conservative management was preferred. Results: A bovine serum albumin-glutaraldehyde (BioGlue^®) adhesive was inoculated into the right ureter through the stoma to close the fistula. After 24 months, the patient remained asymptomatic with negative follow-up imaging. Conclusions: Given the uniqueness of the management of a ureterocolic fistula, this case offers insight into conservative treatment in frail patients not suitable for major surgery. Full article

Background: Facial features are the first basic sign of medical knowledge of children and adults with congenital malformations. Children born with multiple contractures almost always receive the misdiagnosis of arthrogryposis multiplex. Larsen syndrome can easily be diagnosed at birth via the proper interpretations of its characteristic facial features and multiple dislocations. Comprehensive clinical diagnosis can facilitate an orthopedic strategy for early treatment and can enhance the recognition of unreported craniocervical malformation complexes. Material and Methods: Six children (four boys and two girls, with ages ranging from a few months to 7 years old) were referred to our department for diagnosis and treatment. All children received their first misdiagnosis by the pediatricians as manifesting arthrogryposis multiplex congenita. The clinical phenotype was our first decisive tool for diagnosis. All children exhibited the classical phenotype of dish-like facies associated with multiple joint dislocations. Radiological phenotypic characteristics confirmed our clinical diagnosis of Larsen syndrome. Three children out of six showed unpleasant cervical spine deformities. The first child, a 2-year-old, became tetraplegic after minor trauma. One child presented with progressive rigid cervical kyphosis. The third child was a product of a first-relative marriage and was born with congenital tetraplegia. A genotype was carried out for confirmation. Results: Three children underwent open reduction for congenital hip and knee dislocations. One child underwent spinal fusion CO-C7 because of tetraplegia. A 3D-reformatted and reconstruction CT scan of the craniocervical junction showed two forms of unusual dys-segmentation, firstly along C2-3 effectively causing the development of acute-angle cervical kyphosis. Secondly, an infant with congenital tetraplegia showed a serious previously undescribed atlanto–axial malformation complex. Namely, atlanto–axial maldevelopment (dys-segmentation) of (C1/C2) was associated with hypoplasia of the anterior and the posterior rings of the atlas. Genetic tests of these children were compatible with the autosomal dominant type of Larsen syndrome and manifested a heterozygous mutation in FLNB mapped 3p14.3, encoding an actin-binding protein, filamin B. The child with congenital tetraplegia showed no mutations in FLNB, though his clinical and radiological phenotype and his family history of first-relative marriage were totally compatible with the diagnosis of the autosomal recessive type of Larsen syndrome. Conclusions: Our strategy was and still is based on a coherent clinical and radiological diagnosis, which is based on comprehensive clinical and radiological phenotypic characterizations. We implemented a 3D-reformatted CT scan to further understand the craniocervical junction pathology in three children. Strikingly, prenatal onset of lethal maldevelopment (dys-segmentation) of the atlanto–axial spine segments has been diagnosed in an infant with congenital tetraplagia. A less serious cervical spine malformation was detected in two children who presented with progressive acute-angle cervico and cervico-thoracic kyphosis. Our clinical strategy can form the basis for a thorough clinical assessment for infants and children born with multiple malformation complexes and can lead to recognition of novel understandings. Full article

Aim: This study aims to assess the suitability of the Göttingen Mini-pig (G-MP) as a large animal model for preclinical research on articular cartilage treatment procedures. Additionally, this study compares the G-MP to the domestic pig (DP) regarding surgical anatomy, postoperative care, and the challenges associated with the follow-up period. Materials and methods: Six G-MPs and four DPs underwent a two-stage surgical procedure: first, cartilage was harvested using a superolateral approach, followed by cartilage implantation via a medial parapatellar tendon approach. Results: The superolateral approach exposed 11% (SD ± 5) of the trochlea in G-MPs and 20% in DPs. The medial parapatellar tendon approach exposed 63% (SD ± 4) of the trochlear surface and 34% (SD ± 13) of the medial femoral condyle in G-MPs, allowing for the creation of four 6 mm trochlear lesions and one medial condyle lesion in four out of six G-MPs and all DPs. Cartilage thickness was less than 1 mm in G-MPs, compared to over 2 mm in DPs. Weight gain was +4 kg/week in DPs and +0.2 kg/week in G-MPs. Conclusion: Overall, the G-MP proves to be a viable model for cartilage research, offering sufficient joint access via the dual approach, which allows for 4–5 lesions of 6 mm each. However, the thinner cartilage in G-MPs should be taken into account. Full article

Background: Despite ongoing efforts to improve the pancreaticoduodenectomy technique and perioperative care, surgical site infection (SSI) remains a contributor to morbidity. Efforts to reduce SSI include the use of negative pressure wound therapy (NPWT), but studies and meta-analyses have been met with conflicting results. We aimed to provide an up-to-date large-scale cohort study to assess the impact of NPWT on SSIs. Methods: Utilizing the National Surgical Quality Improvement Program database, we included patients undergoing a pancreaticoduodenectomy between 2017 and 2021 and divided patients into the NPWT and non-NPWT cohorts. A bivariate analysis was performed to compare baseline characteristics and complication rates between the cohorts. Multivariate logistic regression analysis was performed to assess the independent effect of NPWT on 30-day serious complication, 30-day mortality, and the development of deep or superficial SSI. A priori sensitivity analyses were performed in high-risk and malignancy cohorts. Results: Of the 14,044 included patients, 1689 (12.0%) patients had a prophylactic NPWT device, while 12,355 (88.0%) did not. Patients were more likely to have NPWT if they had higher ASA scores, had diabetes, were dialysis-dependent, or had a hard pancreas, but they were less likely if they were a smoker, had steroid use, or had a bleeding disorder. Most complications occurred similarly between the two cohorts, including superficial and deep SSI, but NPWT patients had a longer length of stay (10.4 d vs. 9.5 d, p < 0.001) and higher organ space SSI (22.6% vs. 17.4%, p < 0.001). Following multivariable modeling to control for demographic differences, NPWT was not independently associated with a difference in likelihood of SSI (aOR 0.94, p = 0.691) or serious complications (aOR 0.958, p = 0.669). Furthermore, the sensitivity analyses of both high-risk and malignant subgroup also did not see an independent association of NPWT on the rate of SSI (aOR 0.98, p = 0.898 and 0.96, p = 0.788, respectively). Conclusion: NPWT is used infrequently and is not significantly associated with improved outcomes including in the high-risk or malignant subgroups based on multivariable analysis for surgical site infections nor did it improve the outcomes of 30-day serious complications in these subgroups. Considering this and other studies showing the limited benefit of NPWT in all-comers and in high-risk cohorts, it remains unclear whether NPWT offers benefits following PD. Full article

Background: Acute colonic pseudo-obstruction (ACP) is a life-threatening, rare condition of non-mechanical colon dilatation that can result in bowel ischaemia and perforation. The aetiology is relatively unknown but includes older age coupled with high comorbidity, decreased parasympathetic activity, certain medications, chemoradiotherapy and recent surgery. There are limited research data on ACP following reversal of ileostomy after ultra-low anterior resections (ULAR), thus this systematic review included cases from various types of bowel surgeries. Methods: A comprehensive literature search of relevant articles was conducted using the EMBASE, Medline, PubMed, Cochrane, and Scopus databases. Two cases of ACP following ileostomy reversal after ULAR for rectal cancer were also reported from the authors’ rural institution. This systematic review was conducted according to PRISMA 2020 guidelines. Results: A total of 522 studies were screened of which five case reports were included. Two case series (six patients) and the two patients from the authors’ rural institution developed ACP following reversal of ileostomy post-ULAR with potential causes being the > 6 months’ time from initial surgery to reversal causing prolonged colonic mucosal inflammation and reduced wall contractile strength. Anastomotic leak and chemoradiotherapy were other considerations. One of the rural patients developed right colon ischaemia and perforation needing urgent laparotomy, right hemicolectomy and formation of end ileostomy and mucous fistula. Conservative treatment included aperients, enemas, flatus tube, bedside or endoscopic decompression, and neostigmine. Conclusions: Early recognition is vital to treat ACP with medical therapy and decompression to prevent bowel ischaemia and perforation. Further research is needed to better characterise the aetiology, incidence and management strategies for this rare condition. Full article

Background: Patients with no-option chronic limb-threatening ischemia (NoCLTI), lacking suitable distal arteries for conventional revascularization, face major limb amputation. The 1-year mortality rate after major amputation is 48.3%, increasing to 70.9% in 3 years. Open deep venous arterialization (DVA) offers a promising alternative for limb salvage, achievable through open, endovascular, or hybrid approaches. We aim to provide a comprehensive, step-by-step guide to performing open DVA in NoCLTI patients, addressing preoperative and postoperative considerations as well as the technical details of the procedure. Methods: Patient selection for open DVA focuses on individuals with NoCLTI at high risk for amputation. Preoperative assessments include evaluating risk factors, determining limb threat severity using the Wound, Ischemia, and foot Infection (WIfI) score, and mapping anatomical patterns via the Global Limb Anatomic Staging System (GLASS). The procedure involves identifying the target artery using Doppler ultrasound, performing microdissection to expose the artery and vein, ligating proximal vein branches, and creating a side-to-side anastomosis. Venous valves are disrupted with a valvulotome to allow antegrade flow. A proximal bypass graft may be applied if necessary. Results: Postoperatively, patients are monitored for 2–4 days with frequent Doppler assessments. Anticoagulation therapy begins with a heparin drip, transitioning to oral agents and/or dual antiplatelet therapy. Wound care includes deferred debridement for 2–4 weeks and may involve negative-pressure therapy. Follow-up involves weekly visits for the first month, and then at 3 months, and every 6 months thereafter, with surveillance using transcutaneous oxygen measurement, the toe–brachial index, and arterial duplex ultrasound. Conclusions: Open DVA represents a viable limb salvage option for patients with NoCLTI, potentially avoiding major amputations and improving quality of life. Success depends on careful patient selection, a meticulous surgical technique, and comprehensive postoperative care. Full article

Introduction: Single-port video-assisted techniques, such as one-trocar-assisted pyeloplasty (OTAP) or Round-Traction-Assisted Pyeloplasty (RoTAP), have proven helpful for correcting congenital ureteropelvic junction obstruction (UPJO), especially in infants. Surgical Technique: This manuscript presents a technical variation based on the gloveport system that allows bimanual endocavitary dissection and protects the surgical wound during the procedure without increasing the cost or technical difficulty. Comment: This new technique, called gloveport-assisted retroperitoneal pyeloplasty (GARP), could be a valuable alternative for this pathology. Full article

Cytoreductive surgery in the context of a multidisciplinary approach, including adjuvant and neoadjuvant therapy (when indicated), aims ideally to obtain complete resection and represents the cornerstone for long-term survival in patients with advanced ovarian cancer (AOC). Positive lymph nodes are a relatively frequent appearance during cytoreductive surgery for AOC and a widely accepted negative prognostic factor for long-term survival. However, the impact of systematic pelvic and paraaortic lymph node dissection (SPALND) on early and long-term outcomes in patients with cytoreductive surgery for AOC and no suspected positive lymph nodes remains highly controversial. The paper aims to review the relevant scientific literature exploring the role of SPALND in patients with AOC, focusing on peer-reviewed papers published before and after the LION study’s data release. The LION trial represents the only level 1 evidence study providing no scientific arguments for the routine using SPALND in AOC as part of complete cytoreductive surgery in patients without clinical suspicion of positive lymph nodes. The LION trial changed the practice of surgeons regarding SPALND, and current essential guidelines do not recommend it as a routine. Furthermore, SPALND may increase morbidity rates of cytoreductive surgery for AOC and negatively impact the patient’s quality of life. A comprehensive pelvic and paraaortic lymph node assessment is mandatory before and during cytoreductive surgery for AOC for proper disease staging, adequate management, and long-term prognosis. Further research is needed to identify patients with AOC at high risk for lymph node metastases; this group might benefit from SPALND. Full article

Background: Bronchial sleeve resection with complex reconstruction is a rare and intricate surgical procedure, particularly when addressing metastatic carcinoid tumors. This case report details the surgical management of a young male with a typical carcinoid tumor metastasized to the hilar and subcarinal lymph nodes. Case Presentation: A 28-year-old medically fit male presented with cough and occasional blood-tinged sputum for 2 months that was diagnosed to be due to a typical carcinoid tumor involving the left main bronchus, with metastasis to the hilar and subcarinal lymph nodes. The patient underwent a left bronchial sleeve resection with complex reconstruction of the left lower lobe bronchus. The reconstructed bronchus was then anastomosed to the main bronchus followed by hilar and subcarinal lymph nodes dissection. The surgical approach aimed to preserve lung parenchyma while ensuring complete tumor resection. Postoperative recovery was uneventful, with the patient demonstrating satisfactory respiratory function. Histopathological examination confirmed the complete resection of the carcinoid tumor and metastatic lymph nodes (hilar and inter-lobar LN (positive 2/5) and subcarinal LN (positive 1/6)). The patient had no signs of recurrence at the 3-month follow-up. Conclusions: This case highlights the feasibility and effectiveness of bronchial sleeve resection with bronchial reconstruction in managing metastatic carcinoid tumors. The successful outcome underscores the importance of meticulous surgical planning and execution in achieving favorable results in complex thoracic surgeries. Full article

Background/Objectives: Popliteal artery injury is a rare but devastating complication of knee dislocations, significantly increasing the risk of limb ischemia, amputation, and poor functional outcomes if not promptly managed. This systematic review primarily evaluates the functional outcomes associated with this injury but also reviews current research on diagnostic modalities and treatment strategies to provide a comprehensive understanding of this severe orthopedic and vascular injury. Methods: A systematic search of PubMed, in accordance with PRISMA Guidelines, identified 144 studies, of which 13 full-text articles were assessed for eligibility after excluding 131 during the title and abstract screening. Six studies were excluded due to missing vascular injury or functional outcome data or being written in a foreign language, leaving seven studies for inclusion. These studies were predominantly retrospective, focusing on knee dislocations with popliteal artery injury and reporting validated functional outcomes such as the Lysholm and International Knee Documentation Committee (IKDC) scores. The data were synthesized narratively due to heterogeneity in the study designs, interventions, and outcome reporting. Results: Patients with vascular injuries consistently demonstrated poorer functional outcomes compared to those without, with mean or median Lysholm and IKDC scores consistently being lower than non-vascular injury patients. Increased BMI, delayed intervention, and multi-ligamentous injury were associated with worse outcomes, highlighting the importance of timely surgical management. Early repair and grafting techniques improved functional recovery, while diagnostic modalities such as Doppler ultrasound and CT angiography showed high sensitivity in detecting vascular injury. Complications included limb ischemia, prolonged rehabilitation, and amputation, often linked to delayed diagnosis. Conclusions: Knee dislocations with popliteal artery injury require rapid diagnosis and early surgical intervention to optimize functional outcomes and reduce complications. Standardized outcome measures and high-quality prospective research are needed to refine management strategies and address patient-specific factors like BMI. Full article

Background: Anterior cervical discectomy and fusion (ACDF) is a common procedure for cervical radiculopathy and myelopathy. Severe obesity (BMI ≥ 40 or BMI ≥ 35 with comorbidities) is associated with increased perioperative risks. This study examines the impact of severe obesity on outcomes in patients undergoing single-level ACDF. Methods: Data from the Nationwide Inpatient Sample (2016–2019) were analyzed, including 85,585 patients who underwent single-level ACDF. Patients were classified as severely obese (n = 4935) or non-obese (n = 80,650). Outcomes such as length of stay, complications, and in-hospital mortality were compared using SPSS and MATLAB, with a significance level of p < 0.05. Results: Severely obese patients were younger (54 vs. 55.7 years, p < 0.001) and had more comorbidities like type 2 diabetes (38% vs. 17.8%, p < 0.001) and obstructive sleep apnea (31.1% vs. 9.5%, p < 0.001). They experienced longer hospital stays (1.92 vs. 1.65 days, p < 0.001) but similar in-hospital mortality (0.1%, p = 0.506). Severe obesity was linked to higher odds of complications, including increased risks of dehiscence (OR 8.2), respiratory failure (OR 6.5), myocardial infarction (OR 5.5), Horner syndrome (OR 4.7), pulmonary edema (OR 4.5), and dural tears (OR 4.1). Risks of acute kidney injury, pulmonary embolism, and dysphonia were also elevated in severely obese patients. Conclusion: Severe obesity is associated with higher complication rates and longer hospital stays following ACDF. Tailored perioperative management is essential to mitigate these risks and improve outcomes in this high-risk population. Full article

Background/Objectives: Transanal irrigation (TAI) has been recognized as a safe and effective treatment for neurological bowel dysfunction, chronic constipation or fecal incontinence and has also been proposed for patients with low anterior resection syndrome (LARS). The aim of the present systematic review was to evaluate the feasibility and effectiveness of TAI in patients with significant LARS symptoms. Methods: We performed a systematic review according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) statement and guidelines in addition to the Cochrane Handbook for Systematic Reviews of Interventions. The protocol was registered with the International Prospective Register of Systematic Reviews (PROSPERO) (CRD42023436839). The risk of bias was assessed using a modified version of the Downs and Black checklist. The main outcome was improvement in low anterior resection syndrome after TAI assessed by change in LARS score. Results: After an initial screening of 3703 studies, 9 were included and underwent qualitative synthesis (among them, 3 were randomized clinical trials). All studies recorded an improvement in LARS score following TAI procedure and almost all studies showed an improvement in other bowel function outcomes (Memorial Sloan Kettering Cancer Center Bowel Function Instrument (MSKCC BFI, ), Cleveland Clinic Incontinence Score (CCIS), visual analog scale (VAS), Cleveland Clinic Florida Fecal Incontinence Score (CCFFIS), fecal incontinence score (FI score), Obstructed Defecation Syndrome (ODS) score) and quality of life (QoL) scores. The discontinuation rate ranged from 0% to 41%. The rate of adverse events was high (from 0 to 93%); moreover, no uniformity was found in the various protocols used among the different studies. Conclusions: The results of this review show that TAI is effective in the treatment of LARS, improving the LARS score, the other bowel function outcomes and the QoL scores. The absence of a treatment protocol validated by the scientific community is reflected in the high disparity in terms of adverse events and discontinuation of therapy, in addition to representing an intrinsic limitation to the study itself. Full article

Background: Femoral head fractures with osteochondral defects are rare injuries often resulting from traumatic hip dislocations. These injuries create a significant risk for post-traumatic osteoarthritis. Various surgical methods for repair have been utilized to restore these osteochondral defects, including mosaicplasty, autologous cartilage implantation, osteochondral allograft transplant (OAT), and demineralized bone matrix (DBM). Methods: We present a case of a 21-year-old male who sustained a fracture-dislocation of the left femoral head with impaction of the weight-bearing surface due to a motor vehicle collision. Due to the patient’s relatively young age, OAT plugs from a fresh-frozen proximal humerus with DBM supplementation during fracture fragment fixation were chosen to reduce the likelihood of post-traumatic arthritis. Results: The patient regained subjective function and full strength on exam with no pain at 2 years postoperatively. Conclusions: We propose that a proximal humerus allograft is a suitable alternative in an urgent setting when a femoral head allograft is not available. Full article

Introduction: Metatarsalgia is a very common pathology in podiatric consultations, whose main aetiological factor is biomechanical alterations. Given the failure of conservative treatments, minimally invasive osteotomies of the distal metatarsal are becoming more popular, providing comparable results to open surgical techniques and with a lower rate of complications. Objectives: To determine clinical improvement and patient satisfaction after minimally invasive distal metatarsal osteotomy (DMMO) as a surgical treatment for central metatarsalgia at present. Methodology: The databases used for this systematic review were PubMed, Scielo, Cochrane Library, WOS and Scopus. We included articles that studied the efficacy of DMMO for primary metatarsalgia and excluded studies whose patients had more than one pathology or used other surgical techniques. Results: We identified 10 articles, 5 prospective studies, 4 retrospective studies and 1 cross-sectional, non-randomized, analytical study published between 2015 and 2021. The total number of subjects was 366, with a mean age of 61 years. The majority of subjects were women. They presented with symptomatology compatible with primary metatarsalgia for a minimum of 6 months and had failed conservative treatment. Conclusions: DMMO osteotomies for central metatarsals offer excellent post-surgical results for the treatment of central metatarsalgia in the assessment scales (AOFAS, MOXFQ etc.) of the articles analyzed and therefore an evident clinical improvement with benefits in terms of MTF mobility and reduction of surgical time, as well as a high degree of satisfaction in the patients who received this intervention that can be considered as excellent. Full article

Background/Objectives: Acute ruptures of the Achilles Tendon (AT) are common injuries in the active population, in particular among men aged 30 to 50. Full functional recovery after this kind of injury is long and challenging and nowadays there is no universal “gold standard” strategy when dealing with them. Methods: When it comes to surgical treatment, various techniques have been described: in case of a typical lesion at the midportion of the tendon (which is the most common type), the basic principle of surgical repair is the end-to-end suture of the tendon stumps. The AT (“calcaneal tendon” according to the International Anatomical Terminology) is the strongest tendon of the human body, it is the conjunct tendon of the two Gastrocnemii Muscles and the Soleus Muscle and has a well-recognizable twisted structure: the subtendon from the Medial Head of the Gastrocnemius attaches postero-laterally on the calcaneal tendon footprint, the subtendon from the Lateral Head of the Gastrocnemius attaches antero-laterally and the subtendon from the Soleus attaches medially, therefore creating a 90° twist of the tendon structure. Results: the twisted structure of the human AT is of central importance to its biomechanics, since it gives the tendon a higher resistance to deformation and concurs in supination of the subtalar joint during gait. Conclusions: given the abovementioned anatomical and biomechanical premises, we believe that the restoration of the subtendons anatomy can lead to a better functional recovery of the Triceps Surae—Achilles Tendon complex, therefore we recently decided to adopt for open surgical repair the Direct Anatomical Reconstruction of the Achilles Tendon, which we describe in the present article. Full article

Background: A microsurgical auricular flap represents a single-step technique for the reconstruction of full-thickness defects of the ala nasi. To achieve the best surgical outcomes, it is essential to have an exhaustive knowledge of the vascular network to improve the management of the surgical flap. This study aimed to provide an anatomical and surgical guide for a well-designed reconstruction of the ala nasi using a free preauricular flap. Methods: In this study, three fresh-frozen and two formalin-fixed human head specimens injected with red silicone rubber to enhance the arterial facial system were used. The reconstruction of the full-thickness defect of the ala nasi was performed using a microsurgical auricular flap technique, with the dimensions of the ala nasi and the preauricular flap duly noted. In addition, anatomical dissections were conducted, during which the positions and diameters of the main donor and recipient vessels were measured. Results: A presurgical evaluation was performed to define the flap design. A comparison of the shape and mean dimensions of the ala nasi defect (height 9.66 ± 1.40 mm; thickness 3.52 ± 0.53 mm) and the preauricular flap (height 8.50 ± 2.68 mm; thickness 3.92 ± 1.29 mm) indicated that this flap was an optimal option for the reconstruction of the ala nasi. The surgical procedure involved the full-thickness removal of the ala nasi, and the harvesting and insertion of the preauricular flap. The anatomical measurements demonstrated that the facial artery and veins were the optimal recipient vessels, with a diameter of >1 mm (2.08 ± 0.56 and 2.85 ± 0.74 mm), suitable for anastomosis with the superficial temporal artery and vein (1.86 ± 0.58 and 1.66 ± 0.15 mm). In addition, the postsurgical evaluations indicated a slight mean difference in the thickness (1.14 ± 0.65 mm) and height (1.68 ± 1.18 mm) between the ala nasi and helix and a satisfactory VAS score (7.9 ± 0.57). Conclusions: Our surgical and anatomical data provide compelling evidence in favour of free preauricular flap reconstructions of the ala nasi. This procedure allows for the correct choice of recipient vessels and the creation of a well-designed surgical flap. Full article

Background/Objectives: Temporary artery ligation or compression is commonly used to reduce intraoperative blood loss in various surgeries, including uterine procedures. In head and neck surgery, the external carotid artery (ECA) typically branches into eight vessels, supplying most of the head and neck except for the brain. Severe and uncontrolled bleeding can occur if these branches are inadvertently damaged during surgery. However, limited research exists on temporary arterial ligation during head and neck surgeries. This study aimed to evaluate the effects of temporary ECA restriction and internal maxillary artery (IMA) ligation on minimizing intraoperative blood loss during head and neck surgery. Methods: This study involved 25 patients with terminal-stage maxillary tumors who underwent total maxillectomy. The effectiveness of IMA ligation and ECA restriction using a Rummel tourniquet in controlling intraoperative bleeding was compared. Results: The average blood loss was significantly lower in the ECA restriction (467 mL) and IMA ligation (461 mL) groups than in the control group (794 mL). However, no significant difference was observed between the IMA ligation and ECA restriction methods. Conclusions: Overall, our results suggest that either method is effective; however, ECA restriction is preferred for tumors involving the infratemporal fossa. Full article

(1) Background: The aim of this study was to investigate potential translational factors for optical 3D reconstruction in an in vivo setting using a newly developed computerized bowel length measurement system (BMS) as a real-time application. (2) Methods: The BMS was evaluated in an in vivo porcine experiment for the influence of light source power (Watt), laparoscope-to-bowel distance (cm), bowel rotation, image background, and surgical objects in the image. Endpoints were robustness, calculated as success rate (SR) in percent, and accuracy, defined as relative error (RE) in percent of BMS measurement result to ground truth. (3) Results: A total of 1992 bowel measurements were performed on n = 7 pigs using the BMS. Bowel measurements were robust and accurate regardless of light source power, at a laparoscope-to-bowel distance of 5 cm (SR 100%, RE 18 ± 38.5%), when the small bowel was aligned horizontally (SR 100%, RE 7.3 ± 36.2%) or in the image background (SR 100%, RE 15.2 ± 23.4%), and when no additional instruments were in the image. (4) Conclusions: Applications based on optical 3D reconstruction are feasible for intraoperative use and could enable quantitative laparoscopy. Full article