Search Results (2,606)

This review summarizes the base materials, joining methods, filler materials, and principal technical challenges in endoscope joining fabrication, and proposes practical strategies to improve joint reliability under clinical constraints. We conducted a comprehensive search in multiple databases, including Web of Science, Google Scholar, patent databases, Scopus databases, and Medline (via PubMed), for articles on the joining for precision endoscope fabrication, covering the period from 1950 to 2026. We employed the combinations of keywords, “endoscopy”, “minimally invasive surgery”, “welding”, “joining”, “sealing”, “soldering”, “bonding”, and “brazing”. Approximately 500 references were retrieved. After excluding duplicates and irrelevant studies, 158 publications met the inclusion criteria. Data on base materials, joining, processes, filler materials, and technical issues related to sterilization, corrosion, and microstructural evolution were extracted and analyzed. Endoscopes are multi-material systems, involving metallic biomaterials (stainless steels (SSs), titanium alloys, nickel-based alloys, etc.), optical functional materials (glass, sapphire, quartz, etc.), engineering plastics, ceramics, composite materials, and coatings. Joining, sealing, and functional integration have been achieved via adhesive bonding, laser soldering, laser brazing, wave soldering, reflow soldering, fusion welding, and other joining techniques. The main challenges include how to reliably join highly mismatched dissimilar materials, how to fabricate low-residual-stress joints, and how to increase the long-term resistance to sterilization-induced degradation and thermal aging over repeated 100–200 °C thermal cycles. Conventional joining techniques struggle to balance mechanical integrity, joint hermeticity, and long-term stability under such harsh cyclic conditions. The resulting joints may suffer surface yellowing, interfacial debonding, microcracking, delamination, or progressive property degradation during service. We propose the following three strategies to achieve reliable, low-residual-stress, and sterilization-resistant joining of dissimilar materials for endoscopes: (1) A synergistic design that combines thin-film engineering (including evaporation, sputtering, and electroplating) with silver anti-oxidation layers is proposed to reduce residual stresses and to enhance the joint hermeticity. (2) To develop principles for the selection of multi-joining processes to achieve the multi-material integration and functional assembly of dissimilar material components. (3) To develop the laser-based joining methods (fusion, brazing, or braze-welding) for precision control of heat input, bonding quality, and the least damage to the heat-sensitive components. Full article

Background: Hysterectomy is one of the most common gynecological surgical procedures for benign conditions. In clinical practice, the choice of approach is often influenced by technology availability, leading to selection bias rather than to a decision based on standardized clinical criteria. The study aims to propose a standardized decision-making algorithm, based on objective clinical criteria, for selecting the surgical approach in total hysterectomy. Methods: This is a prospective, observational, analytical study conducted from November 2021 to June 2025, including a cohort of 332 patients who underwent total hysterectomy (LH, VH, AH) for benign gynecological pathology at two major centers in Bucharest. We proposed a decision algorithm based on the results obtained from predictive modelling and the quantified risk factors. Results: The choice of surgical approach is a critical factor in hematological stability, and the presence of comorbidities was associated with the type of approach (p < 0.001). Patients without comorbidities predominantly benefited from laparoscopy (48.85%), but as the anesthetic risk increased (ASA III and IV), the vaginal or abdominal routes were preferred. Conclusions: The convergence of these elements suggests that such a tool can standardize therapeutic decisions and improve the efficiency of interventions, offering a modern and predictable framework for gynecological surgery. Full article

Background and Objectives: Previous comparisons between right anterior mini-thoracotomy (RAT) and partial upper sternotomy (PS) for aortic valve replacement (AVR) have shown similar clinical outcomes. This study aims to assess the potential in-hospital cost differences in one technique over the other. Materials and Methods: Between 2018 and 2023, 303 patients at our institution underwent minimally invasive isolated AVR (241 PS vs. 62 RAT). Endocarditis, emergencies, and reinterventions were excluded. A 1:1 nearest neighbor propensity-matched analysis without replacement was performed. Perioperative clinical outcomes and hospital costs were analyzed, comparing total and average (per patient) direct, indirect, and total hospital costs between the two groups. Multivariable linear regression identified significant predictors of hospital costs. Results: Sixty-two well-matched pairs were analyzed. Significant differences were found in intraoperative (PS: 27/62, 43.5% vs. RAT: 10/62, 16.1%, p = 0.002) and postoperative transfusions (PS: 33/62, 53.2% vs. RAT: 16/62, 25.8%, p = 0.003), and median intensive care unit (ICU) hours (PS: 52.2 vs. RAT: 45.7, p = 0.007). Average direct, indirect, and total hospital costs were significantly higher for PS (p = 0.038, p = 0.040, and p = 0.035, respectively), with significant blood bank cost differences favoring RAT (p = 0.010). Multivariable linear regression showed that intraoperative and postoperative transfusions, ICU, and hospital length of stay were significantly associated with hospital costs, but not the surgical approach. Conclusions: PS and RAT have comparable perioperative clinical outcomes, with differences observed only in the number of transfusions and ICU stay, both favoring RAT. Given the significant perioperative differences and regression analysis results, the cost advantage of RAT is likely mediated through its impact on these perioperative outcomes. Full article

Purpose: The treatment of proximal humerus fractures (PHFs) remains debated, and similar fracture patterns may be managed with different strategies. The aim of this retrospective single-center case series without a control group was to evaluate clinical and radiographic outcomes after treatment of selected PHFs with the Galaxy Fixation System. The primary endpoint was functional recovery at 12 months, assessed using the Constant Shoulder Score and QuickDASH. Secondary endpoints included radiographic maintenance of reduction, quality of life, treatment-related complications, and need for revision surgery. Methods: We retrospectively analyzed 48 consecutive patients with proximal humeral fractures treated at the Orthopaedic and Traumatology Unit of Versilia Hospital, Viareggio, Italy, between November 2017 and February 2022. Fractures were assessed using trauma-series radiographs and computed tomography when required, and were classified by two senior surgeons according to the Neer, AO/OTA, and Hertel classifications. Eligible patterns included 2-part, 3-part, and selected 4-part fractures with at least two-thirds of intact metaphyseal bone stock. Results: Forty-six patients completed the 12-month follow-up; two patients died during follow-up from causes unrelated to the index procedure. The mean Constant Shoulder Score improved from 62.7 at 6 months to 69.3 at 12 months, and the mean QuickDASH improved from 9.4 to 8.1. The mean postoperative head-shaft angle was 137.2 degrees and remained substantially stable at 135.1 degrees at 12 months. Pin-tract infection occurred in 5 patients, pin migration in 4, algodystrophic syndrome in 1, and avascular necrosis requiring revision arthroplasty in 1. Conclusions: In this retrospective uncontrolled series, external fixation with the Galaxy system was associated with progressive functional recovery, satisfactory radiographic maintenance of reduction, and a low rate of revision surgery in carefully selected PHFs. These findings should be interpreted cautiously because of the retrospective design, limited sample size, absence of a control group, incomplete availability of some baseline variables, and lack of formal comparative or cost-effectiveness analyses. Full article

Background: Reintervention after mitral valve repair represents a relevant clinical challenge, yet the mechanisms and timing of repair failure remain incompletely defined. Understanding how the interval between index repair and reoperation affects failure mechanisms and the feasibility of repeat repair may help refine surgical strategies. Methods: We retrospectively analyzed 194 patients undergoing repeat mitral valve surgery between 2010 and 2025 after prior repair. Median age was 70 years and 61.3% were male. Patients were stratified by time to reoperation: 0–5 years (n = 91), 6–10 years (n = 42), and >10 years (n = 61). Median left ventricular ejection fraction was 58%, atrial fibrillation prevalence 32.5%, minimally invasive approach 21.6%, and EuroSCORE II 4.8%. Results: Baseline characteristics and operative risk were comparable across groups. However, mechanisms of repair failure differed significantly. Early failures were more commonly due to recurrent leaflet prolapse (47.8%), whereas late failures showed a higher incidence of mitral stenosis (63.9%). The rate of repeat mitral repair decreased over time, being higher in early failures compared with intermediate and late failures (17.6% vs. 14.3% vs. 8.2%). Conclusions: Timing of mitral repair failure is associated with distinct mechanisms and influences surgical management. Early failures are more frequently related to prolapse recurrence and are more amenable to re-repair, whereas late failures are characterized by structural degeneration and more often require valve replacement. Full article

Background/Objectives: Simultaneous robotic-assisted radical cystectomy (RARC) and nephroureterectomy (RARNU) offers a minimally invasive alternative to open approach for patients with synchronous bladder and upper urinary tract cancers, as well as in selected benign conditions. This study presents our single-center experience and also includes a review of the relevant literature. Methods: All patients undergoing combined RARC and RARNU between 2016 and 2023 were retrospectively identified. Clinical and demographic data—including preoperative pathology, operative and re-docking times, estimated blood loss, complications (Clavien–Dindo system), surgical margins, recurrence, morbidity, and follow-up—were collected. A rapid review of the literature was also conducted. Results: From 2016 to 2023, 10 patients (mean age 67.4 years, range 56–77) underwent combined RARC and RARNU for upper/lower tract urothelial malignancy. Mean re-docking time was 68.2 min (range 51–100), mean operative time 524.5 min (range 380–690), and mean blood loss 427 cc (range 75–1170). A Pfannenstiel incision was used for en bloc specimen extraction, with no complications or incisional hernias. One case was converted to open surgery, and two required extracorporeal diversion. Postoperatively, five Grade 2 complications were reported, along with one Grade 3, and one Grade 5. All surgical margins were negative. Mean hospital stay was 11.5 days (range 5–29). At a mean follow-up of 21.7 months, one patient had become dialysis-dependent and one had experienced recurrence requiring further surgery. The review of the literature included 74 patients with comparable outcomes. Conclusions: Combined RARC and RARNU is a feasible, minimally invasive option for selected patients. Although technically demanding, it offers acceptable safety and should be performed in high-volume, specialized centers. Full article

Background and Objectives: Intraoperative assessment of tissue perfusion remains a decisive but imperfect step in abdominal surgery. Surgeons still rely heavily on visual judgement when choosing bowel transection lines, constructing anastomoses, judging intestinal viability, or assessing graft reperfusion, even though these decisions are directly linked to anastomotic leak, conduit ischemia, postoperative liver dysfunction, and graft failure. Hyperspectral imaging (HSI) is an emerging contrast-free optical technology that generates quantitative maps of tissue oxygenation, hemoglobin distribution, water content, and near-infrared perfusion. The present review was designed to evaluate whether clinical intraoperative HSI has matured sufficiently to support a focused systematic review topic in abdominal surgery and to synthesize the currently available human evidence. Methods: A literature search was conducted up to 20 February 2026 using combinations of the terms “hyperspectral imaging”, “HSI”, “abdominal surgery”, “colorectal”, “hepatectomy”, “transplantation”, “pancreatoduodenectomy”, “esophagectomy”, “mesenteric ischemia”, and “intraoperative”. Eligible records were original human clinical studies evaluating intraoperative HSI in abdominal or transplant-related operations with perfusion, oxygenation, or tissue viability as a central endpoint. Review articles, animal studies, non-surgical diagnostic studies, and single-patient case reports were excluded. Data were synthesized narratively because of major heterogeneity in indications, designs, devices, timing of measurements, and reported outcomes. Results: Thirteen studies published between 2019 and 2024 met the eligibility criteria, representing 391 patients. The literature covered colorectal resection, acute mesenteric ischemia, esophageal reconstruction with gastric or colonic conduits, pancreatoduodenectomy, pancreas transplantation, major hepatectomy, liver transplantation, and minimally invasive system validation. Across colorectal studies, HSI frequently demonstrated discordance between visually selected and objectively perfused transection lines, with clinically relevant strategy changes in a substantial proportion of patients. In ischemic and transplant settings, HSI discriminated poorly perfused tissue, identified low near-infrared perfusion values associated with early allograft dysfunction, and quantified reperfusion patterns after clamping or implantation. The evidence base was dominated by prospective single-center feasibility studies with small to moderate sample sizes, and no randomized trials were identified. Conclusions: Clinical intraoperative HSI in abdominal surgery is a genuinely niche yet rapidly expanding topic with a sufficient number of human studies to support a relevant systematic review. Current evidence consistently supports feasibility, quantitative perfusion discrimination, and plausible intraoperative utility, especially in colorectal and transplant-related surgery. However, the field remains methodologically heterogeneous, and the next research priority is multicenter standardization with clinically anchored thresholds and outcome-driven comparative studies. Full article

Intestinal tuberculosis (ITB) is a complex form of extrapulmonary tuberculosis characterized by nonspecific gastrointestinal symptoms and substantial overlap with conditions such as Crohn’s disease and gastrointestinal malignancies. These similarities frequently lead to diagnostic uncertainty, delayed diagnosis, and inappropriate management. This systematic review summarizes current evidence on the clinical presentation, diagnostic approaches, and therapeutic strategies for ITB, with particular emphasis on emerging diagnostic technologies and their role in reducing surgical interventions. A systematic literature search was conducted using PubMed, Scopus, and Google Scholar following PRISMA guidelines to identify relevant studies published from 2000 to 2025. The review focused on clinical manifestations, imaging findings, endoscopic features, histopathological characteristics, molecular diagnostics, pharmacological therapy, and minimally invasive therapeutic interventions. Accurate diagnosis requires an integrated approach combining clinical assessment with imaging, endoscopic evaluation, and histopathological confirmation. Molecular techniques such as GeneXpert MTB/RIF and GeneXpert MTB/RIF Ultra and multiplex polymerase chain reaction assays improve diagnostic accuracy and shorten detection time. Emerging technologies including artificial intelligence-assisted radiologic interpretation and CRISPR-based stool sequencing platforms show promise for earlier detection. Standard anti-tubercular therapy remains the cornerstone of treatment, while minimally invasive endoscopic and surgical procedures are effective for managing complications such as strictures, obstruction, and perforation. Early and precise diagnosis of intestinal tuberculosis is essential to prevent complications and optimize patient outcomes. Integrating conventional diagnostic approaches with emerging molecular and artificial intelligence-based technologies may enhance diagnostic precision and support individualized treatment strategies. Further ITB-specific clinical studies are needed to validate novel diagnostic tools and refine therapeutic approaches for improved patient care. Full article

Background/Objectives: The minimally invasive posterior deltoid-sparing (MIPDS) approach has been described for glenoid fractures; however, its outcomes for Ideberg type Ib, II, III, IV, and V fractures and the influence of concomitant injuries on functional recovery remain poorly understood. This study aimed to report minimum 2-year functional outcomes of these fracture types treated with the MIPDS approach using mini-plates, and to investigate the effect of concomitant thoracic trauma on clinical outcomes. Methods: Thirty-one patients with operatively treated glenoid fossa fractures were stratified into three groups: isolated glenoid fracture, concomitant thoracic trauma, and concomitant ipsilateral upper extremity fracture. Functional outcomes were assessed using the Constant, UCLA, and DASH scores at a minimum follow-up of 2 years. Results: No postoperative infection or nonunion occurred. Mean union time was 9.4 ± 2.4 weeks. Patients with thoracic trauma demonstrated significantly worse functional outcomes across all three scores compared to both other groups: lower Constant scores (70.9 ± 7.5 vs. 85.5 ± 5.9 and 82.6 ± 11.7; p = 0.012 and p = 0.042), lower UCLA scores (24.6 ± 7.9 vs. 32.5 ± 3.0 and 31.1 ± 3.2; p = 0.010 and p = 0.012), and higher DASH scores (29.3 ± 14.2 vs. 7.9 ± 9.2 and 9.5 ± 9.9; p = 0.003 and p = 0.006). Multivariate linear regression confirmed thoracic trauma as an independent predictor of higher DASH scores (β = 12.75, 95% CI: 2.00–23.50, p = 0.031, R² = 0.344). Conclusions: The MIPDS approach provides safe and effective fixation for Ideberg type Ib, II, III, IV, and V glenoid fractures with satisfactory functional outcomes at minimum 2-year follow-up. Concomitant thoracic trauma is a significant negative predictor of functional recovery, and the possibility of inferior functional outcomes in this patient group should be considered. Full article

This narrative review evaluates the current role of interventional radiology in the diagnosis and treatment of parathyroid disorders. In patients with biochemically confirmed hyperparathyroidism but inconclusive or discordant preoperative localization imaging, image-guided interventions can help establish a diagnosis that can alter management. This review outlines the current diagnostic and therapeutic modalities for the study of parathyroid pathology from the interventional radiologist’s perspective, highlighting novel techniques and their growing clinical adoption. The combination of ultrasound-guided fine-needle aspiration biopsy and measurement of parathyroid hormone (PTH) in the needle washout fluid can improve diagnostic specificity by providing biochemical evidence of parathyroid tissue. This is particularly useful for lesions that are difficult to differentiate from thyroid nodules or cervical lymph nodes based solely on imaging characteristics. Despite this, no widely accepted cut-off washout PTH level has yet been established. Due to the differences in assay techniques and laboratory procedures, results should be interpreted in conjunction with clinical findings and concomitant biochemical parameters. Ultrasound-guided thermal ablation techniques, especially radiofrequency and microwave ablation, have recently been reported as minimally invasive alternatives or adjuvants to surgery in appropriately selected patients. Evidence supporting parathyroid embolization is limited, but it may be considered a potential salvage option for persistent or recurrent disease. Given that most of the current evidence is derived from retrospective case series, multicenter prospective studies for technical standardization and long-term outcomes evaluation are clearly needed. Full article

Background/Objectives: Accurate intraoperative tumour localisation remains challenging in minimally invasive colorectal surgery, where conventional tattooing methods suffer from marker migration, tissue diffusion, and potential allergic reactions. Radio frequency identification (RFID) technology offers a promising alternative through implantable passive transponders detectable via electromagnetic coupling, eliminating ionising radiation exposure. Methods: This preclinical feasibility study evaluated three RFID frequency bands for surgical tumour marking: 134 kHz (low frequency, LF), 13.56 MHz (high frequency, HF), and 868 MHz (ultra-high frequency, UHF). Finite element electromagnetic simulations characterised antenna field distributions, while experimental validation employed glass-encapsulated transponders in air and tissue-simulating saline (0.9% NaCl, σ ≈ 1.5 S/m). Detection ranges were measured across 28 angular configurations with expanded measurement uncertainty (k = 2) ranging from ±0.9 to ±3.2 mm. Results: Maximum detection distances in air were 25.0 ± 0.9 mm (LF), 23.0 ± 1.1 mm (HF), and 68.0 ± 2.3 mm (UHF). In saline, ranges decreased to 22.5 ± 1.0 mm, 20.7 ± 1.2 mm, and 18.0 ± 1.4 mm, respectively, demonstrating tissue attenuation of 10% at LF/HF vs. 74% at UHF. Angular characterisation revealed 64–70% range reduction at orthogonal orientation for LF/HF systems. Computational–experimental correlation yielded r² = 0.975 across 154 paired observations. Conclusions: The 13.56 MHz HF band emerges as the optimal candidate for clinical translation, offering adequate tissue penetration (20.7 mm), superior antenna miniaturisation potential (5 mm diameter), established biocompatibility pathways, and mature near-field communication ecosystem support. Future development should address angular sensitivity through multi-axis antenna configurations and validation in anatomically realistic tissue phantoms. This study establishes the electromagnetic evidence base for clinical system development; translation to clinical practice requires sequential preclinical and clinical evaluation. Full article

Background: Although minimally invasive glaucoma surgery (MIGS), including trabecular micro-bypass stent implantation, is safe, its surgical outcomes remain variable, with limited reliable success predictors. We evaluated whether preoperative trabecular meshwork (TM) thickness is associated with surgical outcomes after iStent inject^® W implantation. Methods: Patients with open-angle glaucoma (n = 28) who underwent iStent inject^® W implantation were included. Preoperative AS-SS-OCT was used to measure TM thickness and conventional angle parameters, including angle opening distance, angle recess area, trabecular–iris space area, and trabecular–iris angle. Surgical success was IOP ≤ 15 mmHg with ≥25% reduction or final IOP ≤ 12 mmHg under specified conditions. Logistic regression analyses were performed to identify factors associated with surgical outcomes. Results: At 12 months, 22 eyes (78.6%) achieved surgical success. Mean TM thickness was significantly greater in the unsuccessful than in the successful group (250.62 ± 32.05 μm vs. 180.75 ± 30.61 μm, p = 0.001), with similar findings for nasal and temporal TM thickness. Conventional angle parameters were not associated with surgical outcomes. In univariable analysis, both mean and nasal TM thickness were significantly associated with an increased risk of failure (per 10 μm increase; mean TM: OR = 2.77, 95% CI = 1.12–6.86, p = 0.027; nasal TM: OR = 1.64, 95% CI = 1.04–2.58, p = 0.034). Conclusions: Increased preoperative mean and nasal TM thickness was significantly associated with surgical failure following iStent inject^® W implantation. TM’s microstructural properties are more relevant than angular configuration in determining MIGS outcomes. Preoperative assessment of TM thickness using AS-SS-OCT may serve as a useful imaging biomarker for optimizing patient selection. Full article

Introduction: The management of resectable non-small cell lung cancer has long relied on a relatively limited set of determinants, primarily anatomical resectability and pathological stage. Although these parameters remain central to therapeutic planning, accumulating clinical and translational evidence indicates that they do not fully explain variability in outcomes observed after lung cancer surgery. The primary aim of this review is to evaluate whether current evidence supports the need for a novel heuristic framework in resectable NSCLC. Secondary aims are to examine how host-related, clinical, and data-driven factors contribute to prognosis and treatment selection beyond conventional staging systems. Methods: This review integrates evidence from clinical studies, national registries, and translational analyses to examine how these dimensions contribute to prognosis and treatment selection. Results: Over the past two decades, advances in surgical techniques, perioperative management, systemic therapies, and large-scale clinical databases have revealed additional determinants of prognosis beyond tumor burden, including physiological reserve, nutritional condition, systemic inflammatory state, comorbidities, and socioeconomic environment. Developments in multimodal strategies and minimally invasive surgery have reshaped the therapeutic landscape. Data-driven approaches have identified clinically meaningful subgroups not captured by conventional staging systems. Conclusions: A heuristic framework integrating tumor biology, patient characteristics, and treatment context may better reflect the complexity of contemporary thoracic oncology practice. Full article

Background and Clinical Significance: The management of large benign ovarian cysts in women of reproductive age requires balancing minimally invasive surgery with oncologic safety and preservation of ovarian function. Laparoscopic cystectomy for large cysts is technically challenging and carries an increased risk of intraoperative rupture and spillage; Case Presentation: We describe a novel hybrid laparoscopic–extracorporeal technique in which controlled cyst decompression is performed using a balloon-tipped trocar through a suprapubic port under direct laparoscopic visualization. The ovary is then carefully mobilized and exteriorized through the same incision, allowing extracorporeal cystectomy and ovarian reconstruction before returning the adnexa to the abdominal cavity. This approach was applied in a series of six patients with large benign-appearing ovarian cysts, including one 42-year-old patient with an 18 cm multilocular mature cystic teratoma. There were no intraoperative or postoperative complications, no conversions to laparotomy, and all patients were discharged on postoperative day 1. Follow-up at six weeks and subsequent imaging at nine months demonstrated preserved ovarian architecture, normal menstrual function, and high patient satisfaction; Conclusions: The hybrid laparoscopic–extracorporeal approach appears feasible and may offer a safe surgical option in carefully selected patients, allowing fertility preservation while minimizing the risk of spillage. Further studies are needed to evaluate reproducibility, oncologic safety, and long-term reproductive outcomes. Full article

Background: De novo (pretreatment) EGFR T790M mutation is a rare molecular finding in non-small cell lung cancer (NSCLC) and has historically been associated with primary resistance to first- and second-generation EGFR tyrosine kinase inhibitors (TKIs). Evidence guiding optimal first-line management in this subgroup, particularly in elderly patients, remains limited. Case Presentation: We report a case of an elderly patient with treatment-naïve advanced non-squamous NSCLC harboring a concurrent EGFR exon 19 deletion and de novo EGFR T790M mutation. Given the patient’s age, significant cardiopulmonary comorbidities, and absence of rapidly progressive disease, a multidisciplinary tumor board recommended first-line osimertinib monotherapy. Treatment was well tolerated, with rapid improvement in performance status and no clinically significant adverse events. Serial contrast-enhanced CT restaging demonstrated RECIST 1.1–defined stable disease, without development of new visceral, nodal, cerebral, or osseous metastases. The patient remains on continuous osimertinib therapy with durable disease control at the time of manuscript preparation. Conclusion: Primary EGFR T790M–positive NSCLC can achieve durable disease control with first-line osimertinib, even in advanced age. While combination strategies with chemotherapy may improve survival outcomes in selected patients, treatment decisions in elderly individuals must carefully balance efficacy, toxicity, and quality of life. Chronological age alone should not discourage active targeted treatment when guided by molecular profiling and comprehensive clinical assessment. Full article