Search Results (652)

Background/Objectives: Surgical aortic valve replacement effectively relieves left ventricular afterload and promotes reverse remodeling in patients with severe aortic stenosis. The Perceval prosthesis offers a hybrid approach, combining complete annular decalcification with sutureless deployment. This design allows for reduced operative times and potentially larger effective orifice areas. However, comparative data with conventional stented bioprosthetic valves remain limited, particularly regarding reverse remodeling, hemodynamic performance, and long-term clinical outcomes. Methods: In this retrospective cohort study, 115 patients underwent aortic valve replacement with either the Perceval valve (n = 44) or conventional stented bovine pericardial valves (n = 71). Results: The Perceval group showed a 100% procedural success rate with no in-hospital mortality, significantly shorter cardiopulmonary bypass and cross-clamp times, larger effective orifice areas, and a lower incidence of patient–prosthesis mismatch. Both groups demonstrated favorable left ventricular mass regression and reverse remodeling. The rates of paravalvular leakage, permanent pacemaker implantation, and redo aortic valve replacement were comparable between groups. Multivariate Cox regression identified the follow-up indexed left ventricular mass as an independent predictor of major adverse cardiac and cerebral events. Conclusions: In this study, the Perceval valve was associated with promising hemodynamic characteristics and procedural efficiencies, particularly in cases with small aortic annuli and during minimally invasive procedures. The valve was associated with reverse ventricular remodeling and clinical outcomes that appeared similar to those of conventional stented bioprostheses. These observations suggest it may represent a potential alternative option for surgical aortic valve replacement in appropriate clinical scenarios. However, randomized control trials are needed to confirm these associations. Full article

Background: Near-Infrared Spectroscopy (NIRS) and Electrical Cardiometry (EC) are promising non-invasive techniques for monitoring tissue oxygenation and hemodynamics, particularly in surgically ill infants who struggle to maintain cerebral oxygenation and systemic perfusion. There is limited data regarding the combined use of these techniques during respiratory procedures such as endotracheal suction in intubated infants. Methods: The effects of 38 endotracheal suction maneuvers on cerebral oxygenation and cardiovascular hemodynamics were investigated in seven intubated infants following non-cardiac surgery. Parameters such as cerebral oxygenation and EC-derived metrics including heart rate, stroke volume, and cardiac output were assessed. Results: Gestational and postnatal age were 31 weeks and 16 days. During endotracheal suction, the heart rate decreased but returned to baseline afterward. After the procedure, the cerebral oxygenation, stroke volume, and cardiac output increased. Conclusions: Cerebral and systemic hemodynamics were altered during endotracheal suction maneuvers in ventilated infants. Combining NIRS and EC for monitoring cardiovascular and cerebrovascular physiology may enable more individualized therapy, helping to minimize cerebral injury in this vulnerable population. Full article

Background: Transcatheter aortic valve implantation (TAVI) is becoming the most important treatment strategy for aortic valve disease. With its dramatic increase, the rate of major complications and the impact of TAVI on long term outcomes is becoming a pressing issue, especially in terms of comparison with surgical aortic valve replacement (SAVR). PVE is a severe complication that can arise post-procedure, leading to significant morbidity and mortality. The aim of this meta-analysis is to compare the incidence of PVE and 30-day mortality rates between TAVI and SAVR. Methods: A comprehensive literature review was conducted, identifying studies that reported the incidence and outcomes of PVE in patients undergoing TAVI and SAVR. The selected studies were assessed for heterogeneity using the χ² test and I² statistic. A random effect model was applied to account for variability among studies. The Odds Ratios (ORs) for 30-day mortality and the incidence of PVE were calculated. Funnel plots were utilized to assess the reliability of the data and potential publication bias. Results: The analysis showed no significant difference in 30-day mortality of PVE in TAVI and SAVR, with an OR of 1.29 (CI 0.98–1.69). However, there was a significant difference in the incidence of PVE (HR 0.76, CI 0.61–0.96), with TAVI demonstrating a protective effect attributed to its lesser invasiveness and shorter procedural times. The funnel plots indicated high reliability of the data, with low standard errors and minimal publication bias. Conclusions: TAVI and SAVR carry similar 30-day mortality rates for patients with PVE; on the other hand, TAVI shows a lower incidence of PVE due to its minimally invasive nature. These findings suggest that TAVI might be a preferable option for certain patient populations, though further randomized clinical trials are needed to confirm these results and address the limitations of the current study. Full article

Cardiac tumors represent rare neoplasms, but they include a very wide range of neoplasia—first primary benign and malignant cardiac tumors, then cardiac metastases, with these latter ones being far more common in adulthood. These diagnoses may be challenging because of frequently non-specific signs and symptoms; for example, their clinical management may be difficult because of the site and because of possible hemodynamic or arrhythmogenic consequences, independent from their biology. Cardiac tumors may be asymptomatic and incidentally diagnosed, or they may cause heart failure, life-threatening arrhythmias, or even sudden cardiac death. Although they may still represent a post-mortem finding, the evolution and the larger use of cardiac imaging tools, initially echocardiography, has progressively and significantly increased their in vivo detection. Magnetic resonance imaging and computed tomography may give crucial information as to the composition and localization of cardiac masses, useful for investigating them and for planning surgery. Histology is mandatory for the definite and differential diagnosis of the cardiac masses, for assessing predictive factors in malignancies, and for then establishing the appropriate management of patients. Modern techniques applied to histology, including immunohistochemistry and molecular biology, may be required to characterize cardiac tumors, to properly classify them and to assess predictive and/or prognostic markers. Surgical procedures, including minimally invasive surgery, have also dramatically evolved in the last decades, allowing adequate treatment in most cardiac tumors. Finally, biopsy may be useful in selected cases, particularly when radical surgery is not feasible, and histological diagnosis is fundamental for other possible therapeutic approaches. The scope of this review covers advancements in the imaging diagnosis, histology, and treatment of primary and secondary cardiac tumors. Full article

Neuroendoscopy is a minimally invasive surgical technique used to treat brain pathologies such as hydrocephalus, arachnoid cysts, and skull base tumors. While it offers several advantages, including reduced tissue trauma and lower morbidity, it is associated with a high risk of postoperative nausea and vomiting (PONV). This paper provides a narrative review of the literature on the incidence, pathophysiology, and management of PONV in patients undergoing neuroendoscopic procedures. The review includes several studies published between 2001 and 2024, analyzing specific risk factors such as female gender, postoperative opioid use, extended endoscopic approaches, and cavernous sinus dissection. PONV prevention strategies include a multimodal approach combining total intravenous anesthesia (TIVA) with propofol, perioperative hydration, and pharmacological prophylaxis (5-HT3 receptor antagonists, NK1 antagonists, dexamethasone, and droperidol). Despite advances in surgical and anesthetic techniques, further research is needed to develop procedure-specific protocols and optimize PONV management in neuroendoscopy. Full article

Background/Objectives: Operating microscopes are becoming increasingly common tools in dentistry and dentoalveolar surgery due to their ability to enhance procedural precision and control. This case report aims to highlight the benefits of the operating microscope in minimizing surgical trauma and improving clinical outcomes during tooth extractions. Methods: Three clinical cases involving potentially complicated tooth extractions were treated using a dental operating microscope. The procedures were performed without flap elevation, extensive bone removal, or suturing, with the goal of reducing trauma to adjacent structures. Results: In all three cases, the use of the microscope facilitated minimally invasive extractions. The surrounding tissues were preserved, and the patients experienced uneventful healing. Clinical re-evaluation was performed several weeks postoperatively to confirm mucosal healing and absence of complications. Conclusions: The dental operating microscope allowed for precise, minimally traumatic extractions, resulting in favorable healing outcomes. Although limited, current literature and the presented cases suggest promising results and superior outcomes when incorporating a microscope into dentoalveolar surgical practice. This case report further supports the role of magnification in improving surgical precision and patient care. Full article

Introduction: Robotic-assisted (RA) spine surgery enhances pedicle screw placement accuracy through real-time navigation and trajectory guidance. However, the absence of traditional direct haptic feedback by freehand instrumentation remains a concern for some, particularly in minimally invasive (MIS) procedures where direct visual confirmation is limited. During RA spine surgery, navigation systems display three-dimensional data, but factors such as registration errors, intraoperative motion, and anatomical variability may compromise accuracy. This technical note describes a visuohaptic intraoperative phenomenon observed during RA spine surgery, its underlying mechanical principles, and its utility. During pedicle screw insertion with a slow-speed automated drill in RA spine procedures, a subtle and rhythmic variation in resistance has been observed both visually on the navigation interface and haptically through the handheld drill. This intraoperative pattern is referred to in this report as a cyclical insertional torque (CIT) pattern and has been noted across multiple cases. The CIT pattern is hypothesized to result from localized stick–slip dynamics, where alternating phases of resistance and release at the bone–screw interface generate periodic torque fluctuations. The pattern is most pronounced at low insertion speeds and diminishes with increasing drill velocity. CIT is a newly described intraoperative observation that may provide visuohaptic feedback during pedicle screw insertion in RA spine surgery. Through slow-speed automated drilling, CIT offers a cue for bone engagement, which could support intraoperative awareness in scenarios where tactile feedback is reduced or visual confirmation is indirect. While CIT may enhance surgeon confidence during screw advancement, its clinical relevance, reproducibility, and impact on placement accuracy have yet to be validated. Full article

Background/Objectives: Prostatic artery embolization (PAE) has emerged as a minimally invasive alternative for treating lower urinary tract symptoms (LUTS) secondary to benign prostatic hyperplasia (BPH), particularly in high-risk surgical candidates. This study aims to evaluate the efficacy, safety, and clinical outcomes of PAE, combining a retrospective case series with a narrative review of the literature. Methods: A single-center retrospective analysis was conducted on 10 patients aged ≥ 70 years with moderate-to-severe LUTS due to BPH who underwent PAE between January 2021 and January 2024. Inclusion criteria included IPSS > 18, Qmax < 12 mL/s, prostate volume > 45 cc, and resistance to medical therapy. Embolization was performed using 300–500 µm tris-acryl gelatin microspheres via the PErFecTED technique. Follow-up included IPSS, Qmax, prostate volume (PV), PSA levels, and complications. A narrative review of 18 studies (n = 1539 patients) was also conducted to contextualize findings. Results: Technical success was achieved in all patients (100%), and clinical success (IPSS reduction ≥ 50%) in 90%. At 12 months, the following significant improvements were observed: mean IPSS decreased from 24 to 12 (p < 0.0001), Qmax increased from 8.7 to 12.6 mL/s (p < 0.0001), PV reduced from 66.4 to 49.4 cc (p < 0.0001), and PSA from 5.0 to 3.4 ng/mL (p < 0.0001). Outcomes remained stable up to 36 months. Two patients developed transient post-procedural fever; no major complications were recorded. Conclusions: PAE is a safe and effective treatment for LUTS related to BPH, offering durable symptom relief and minimal morbidity, particularly in elderly and comorbid patients. While the evidence supports its role as an alternative to TURP, larger prospective trials are necessary to confirm its long-term efficacy and optimize patient selection. Full article

Robotic pancreaticoduodenectomy (RPD) has emerged as a viable alternative to open and laparoscopic approaches, offering potential advantages in precision and dexterity. However, its complexity and lack of standardization remain as barriers to widespread adoption. We present a step-by-step surgical approach to RPD, emphasizing key technical strategies to enhance safety, efficiency, and reproducibility. Our technique is structured into defined surgical steps, facilitating learning curve optimization and intraoperative consistency. Key refinements include an optimized trocar placement, the strategic suspension of vascular structures, and specific reconstructive techniques to reduce the operative time and improve surgical ergonomics. These improvements may contribute to a reduction in perioperative morbidity and procedural standardization. Standardizing RPD through defined surgical steps and structured learning pathways may improve its feasibility, safety, and broader adoption. Further studies are needed to validate these strategies in high-volume centers. Full article

Osteoarthritis (OA) is a leading cause of disability worldwide, with its prevalence rising due to aging populations. Management ranges from conservative treatments such as weight management and pharmacologic therapy to surgical interventions such as total joint replacement. However, treating moderate knee OA remains challenging for patients unresponsive to conservative care but not yet surgical candidates. Genicular artery embolization (GAE) has emerged as a minimally invasive procedure targeting abnormal angiogenesis and inflammation in OA. This article explores GAE’s mechanism, patient-selection criteria, and effectiveness in pain reduction and functional improvement. Studies suggest that GAE has the potential to significantly improve pain and function in mild to moderate OA, with sustained benefits. Patient selection is crucial for optimal outcomes, with imaging playing a key role. While conventional MRI assesses structural damage, Dynamic Contrast-Enhanced MRI (DCE-MRI) offers superior insights by evaluating synovitis, quantifying cartilage degradation, and monitoring treatment response. Due to its strong correlation with pain scores and status as the best surrogate marker for inflammation in synovitis, DCE-MRI holds significant potential to enhance patient selection and treatment monitoring for GAE. Full article

Background and Purpose: Undescended testes (UDT) is recognized as the most prevalent anomaly of the male genitalia and presents a significant risk factor for long-term complications, including infertility and testicular cancer. Currently, there is no consensus on the necessity of imaging in the management of UDT, nor is there agreement on which imaging modality is preferred or to what extent these tests offer real added value in the clinical setting. This review aims to evaluate the various imaging options available in the management of cryptorchidism, discussing their utility, advantages, and disadvantages compared to exploratory laparoscopy. Methods: We conducted a PubMed search using the following search terms: [“undescended testis”] OR [(“cryptorchidism”) OR (“diagnostic imaging”)] OR [(“Ultrasound”), OR (“CT scan”) OR (“MRI”)] AND [“laparoscopy”]. We analyzed 90 full articles, excluding irrelevant ones, and, in total, 18 publications were included in this review. Results: Ultrasound (US) is the most commonly used technique due to its non-invasive nature and absence of ionizing radiation. It is particularly beneficial in cases of non-palpable UDT. However, its main limitation lies in the difficulty in accurately locating UDT, especially when they are situated outside the inguinal region. Computed tomography (CT) scans serve as a crucial diagnostic tool, particularly for testes located below the internal inguinal ring. While CT exhibits comparable accuracy in detecting UDT, the need for sedation or general anesthesia, along with the costs and potential risks of secondary malignancy due to radiation exposure, does not favor its routine use. Magnetic resonance imaging (MRI) offers higher sensitivity than US and does not utilize ionizing radiation or intravascular contrast agents. It allows for the generation of multiplanar images, thereby providing improved tissue characterization. However, limitations include prolonged scan durations, the potential for motion artifacts during imaging, the need for sedation, and higher costs. Laparoscopy has been shown to provide better accuracy, offering both diagnostic and therapeutic benefits, particularly in cases of non-palpable UDT. It is widely regarded as the gold standard in achieving clear diagnostic and definitive therapeutic procedures and has demonstrated its utility in determining the anatomical position of intra-abdominal testes, owing to its magnification capabilities and minimally invasive approach. Conclusions: Achieving a correct and comprehensive diagnosis of cryptorchidism requires the medical team to decide on the appropriate imaging studies, as these will not significantly influence or alter the therapeutic decision-making process. It is unlikely that medical practice will eliminate imaging studies before a surgical decision is made in the near future. Therefore, a multidisciplinary approach that includes clinical examination, imaging, and diagnostic laparoscopy remains essential for the accurate management of UDT. Full article

Stress urinary incontinence (SUI) is characterized by the involuntary leakage of urine when bladder pressure exceeds urethral closing pressure during routine activities such as physical exertion, coughing, exercise, or sneezing. SUI is the most prevalent form of urinary incontinence, with a reported prevalence ranging from 10% to 70%, and its incidence increases with age. As the global population continues to age, the prevalence and clinical significance of SUI are expected to rise accordingly. The pathophysiology of SUI is primarily driven by two mechanisms: urethral hypermobility, resulting from compromised supporting structures, and intrinsic urethral sphincter deficiency, characterized by the deterioration of urethral mucosa and muscle tone. Current treatment options for SUI include conservative management strategies, which heavily rely on patient adherence and are associated with high recurrence rates, and surgical interventions, such as sling procedures, which offer effective solutions but are costly and carry the risk of adverse side effects. These limitations highlight the urgent need for more effective and comprehensive treatment modalities. Exosomes, nano-sized (30–150 nm) extracellular vesicles secreted by nearly all cell types, have emerged as a novel therapeutic option due to their regenerative, anti-fibrotic, pro-angiogenic, anti-apoptotic, anti-inflammatory, and anti-hypoxic properties. These biological functions position exosomes as a promising alternative to conventional therapies for SUI. Exosome therapy has the potential to enhance tissue regeneration, restore urethral function, and repair nerve and muscle damage, thereby reducing symptom burden and improving patients’ quality of life. Additionally, exosome-based treatments could offer a less invasive alternative to surgery, potentially decreasing the need for repeated interventions and minimizing complications associated with current procedures. In this literature review, we critically assess the current state of research on the potential use of exosomes in treating SUI, highlighting their therapeutic mechanisms and potential clinical benefits. Full article

Dried blood spot (DBS) sampling has emerged as a promising microsampling technique in biomedical and clinical research, offering advantages such as reduced invasiveness, minimal blood volume requirements, and enhanced analyte stability. Although well established in human medicine for neonatal screening and diagnostic applications, its potential in veterinary pharmacology remains underexplored. This study investigated the feasibility of using DBS samples to quantify anesthetic agents—ketamine and medetomidine in cats and lidocaine in horses—during routine surgical procedures at a veterinary teaching hospital. A standardized DBS collection protocol was developed, and LC-MS/MS methods were validated for the quantification of target analytes in both DBS and plasma samples. These methods were subsequently applied to real samples collected during anesthesia to conduct pharmacokinetic analyses. Comparative evaluations, including Bland–Altman analysis, assessed the suitability of DBS samples for pharmacokinetic studies in veterinary medicine. Preliminary results indicated satisfactory agreement for medetomidine, meeting EMA guidelines, with 75.6% of mean values falling within ±20% of paired measurements. Results for ketamine (46.9%) were promising but require further optimization, while those for lidocaine (21.4%) highlighted the need for additional investigation. These findings underscore the potential of DBS sampling as a minimally invasive alternative for pharmacokinetic studies in veterinary medicine, particularly for medetomidine, while identifying areas for further methodological refinement. Future research should optimize DBS techniques and expand their application to other drugs and species, broadening their impact on veterinary pharmacology. Full article

Background: Transforaminal endoscopic lumbar discectomy (TELD) is a minimally invasive and popular surgical method for the treatment of lumbar disc herniation. Although TELD offers favourable outcomes and enables fast recovery, some patients experience rebound pain and transient postoperative pain, which can delay rehabilitation and decrease patient satisfaction. Methods: This narrative review was conducted based on a comprehensive literature search of the MEDLINE database, supplemented by the author’s clinical experience. Relevant articles were identified using the keywords “rebound pain” and “transforaminal endoscopic lumbar discectomy” or “percutaneous endoscopic lumbar discectomy”. A thorough examination of rebound pain after TELD was performed by reviewing what has currently been published about its clinical traits. It was also compared with what could be observed in open lumbar discectomy and proposed preventive measures. Results: Rebound pain typically occurs within 2 weeks postoperatively and resolves spontaneously within 3 weeks. The proposed pathologies include inflammatory edema, transient ischemia, neural hypersensitivity, and increased pressure inside the disc. Risk factors include early unreasonable activity, incomplete release, and psychological predispositions. Rebound pain must be distinguished from recurrent herniation. Prevention strategies include adequate decompression, minimal neural irritation, postoperative medications, and early mobilization protocols. Conclusions: Rebound pain after TELD is self-limiting but has a clinical effect that may delay timely rehabilitation and raise concerns for surgeons and patients. Awareness and early recognition can enhance postoperative care and optimize clinical outcomes after TELD. Full article

Background: Gonioscopy-assisted transluminal trabeculotomy (GATT) is a minimally invasive, ab interno conjunctival-sparing glaucoma surgery aimed at the trabecular meshwork and the inner wall of Schlemm’s canal. The goal of this study is to report on the success of GATT in a large group of patients with a wide variety of open- and closed-angle glaucomas with or without cataract extraction and to report on risk factors for failure. Methods: A retrospective chart review of consecutive patients with primary or secondary open- or closed-angle glaucoma who underwent GATT, with or without concomitant phacoemulsification. Demographics, baseline clinical characteristics, and postoperative outcomes were collected from patients’ medical records. Primary outcomes were success rates (IOP of 18 mmHg or lower and one of the following: IOP reduction > 30% from baseline on the same or fewer medications or an IOP ≤ baseline with fewer medications as compared to baseline) and complication rates. Intraocular pressure (IOP) and the number of glaucoma medications were secondary outcome measures. Results: GATT was performed on 126 eyes of 121 patients. Mean follow-up was 583 ± 266 days. Cumulative success at 1Y was 0.88 for GATT combined with cataract extraction, 0.96 for GATT alone, 0.88 for primary open-angle glaucoma (POAG), 0.89 for secondary open-angle glaucoma (SOAG), and 0.76 for primary angle-closure glaucoma (PACG). IOP decreased from a mean of 20.65 mmHg to 14.1 mmHg, and medication decreased from a mean of 3.47 to 1.4 at the last follow-up. Forty-four eyes (34%) were classified as failures. Factors associated with an increased risk of failure were worse preoperative corrected visual acuity (OR = 2.46, p = 0.024) and a postoperative IOP spike (OR = 2.62, p = 0.028). Twelve eyes (9.5%) required further surgery for IOP control. Risk factors for requiring further surgery for IOP control were preoperative maximal IOP (OR = 1.066, p = 0.047) and a postoperative IOP spike (OR = 4.531, p = 0.036). Conclusions: GATT achieved good surgical success with good IOP and medication reduction across a wide range of glaucomas, in combination with lens extraction or as a standalone procedure. GATT should be considered early in the treatment paradigm of medically uncontrolled glaucoma. Full article