Search Results (923)

Background: Endobronchial ultrasound-guided transbronchial needle aspiration (EBUS-TBNA) is the standard minimally invasive technique for mediastinal lymph node sampling; however, its diagnostic performance is limited in diseases requiring preserved tissue architecture, such as lymphoma and granulomatous disorders. EBUS-guided transbronchial mediastinal cryobiopsy (EBUS-TBMC) has emerged as a technique capable of obtaining larger, histologically intact samples. Evidence comparing these modalities in isolated mediastinal lymphadenopathy is limited. Methods: In this prospective, single-center, head-to-head cohort study, 89 consecutive patients with isolated mediastinal lymphadenopathy without parenchymal lung masses were enrolled. All patients underwent sequential EBUS-TBNA followed by EBUS-TBMC within the same session. The primary outcome was diagnostic yield; secondary outcomes included tissue adequacy and procedure-related complications. Results: EBUS-TBMC demonstrated a significantly higher diagnostic yield than EBUS-TBNA (83.1% vs. 28.0%, p < 0.001). TBMC established a diagnosis in 74/89 patients, whereas TBNA was diagnostic in 25/89. TBMC provided an additional diagnosis in 49 patients with non-diagnostic TBNA, while no case was diagnosed exclusively by TBNA. Superiority was consistent across malignant and benign conditions, particularly lymphoma and granulomatous diseases. Diagnostic yield was higher when ≥3 cryobiopsy samples were obtained (86.6% vs. 42.8%). Bleeding events were more frequent with TBMC but were mild-to-moderate, managed bronchoscopically, and no major complications or life-threatening events occurred. Conclusions: In isolated, mass-negative mediastinal lymphadenopathy, EBUS-TBMC provides a substantially higher diagnostic yield than TBNA. Early integration of TBMC may improve diagnostic efficiency and reduce the need for repeat or surgical procedures. Full article

Background: Pelvic organ prolapse (POP) is a prevalent condition that often requires surgical correction of apical support. Vaginal approaches that restore anatomy while minimizing synthetic material are of increasing clinical interest. Bilateral sacrospinous colposuspension with sling has been proposed as a minimally invasive technique; however, evidence from large clinical cohorts remains limited. Objectives: This study aimed to evaluate the anatomical, functional, and safety outcomes of this procedure in women with symptomatic advanced POP. Methods: This retrospective single-center cohort study included 235 consecutive women who underwent bilateral sacrospinous colposuspension with sling for symptomatic POP between 2018 and 2024. The primary outcomes were anatomical success (Baden stage ≤ II) and functional success (absence of vaginal bulge symptoms). Secondary outcomes included urinary, bowel, and sexual function, patient satisfaction, and postoperative complications classified according to the Clavien–Dindo system. Results: At a median follow-up of 20 months, anatomical success was achieved in 87.1% of patients and functional success in 93.6%. Significant improvements were observed in POP-Q points Ba and C (p < 0.001). Among symptomatic patients, stress urinary incontinence improved in 66%, urgency in 63%, and constipation in 71%. Overall morbidity was low (5.5%), with most complications classified as Clavien–Dindo grade I–II. Mesh extrusion occurred in 2.1% of cases, and reintervention was required in 2.1%. Functional recurrence was observed in 6.4% of patients, with 26% requiring surgical reintervention. Patient satisfaction was high (median score: 9/10). Conclusions: These findings support bilateral sacrospinous colposuspension with sling as a safe and effective vaginal approach for symptomatic advanced POP; however, the retrospective design and absence of a control group should be considered when interpreting the results. Full article

Background/Objectives: The global adoption of minimally invasive surgery has generated extensive video repositories, creating new opportunities for data-driven surgical education and quality assessment. Automated surgical phase recognition enables objective trainee evaluation, standardized competency assessment, and systematic procedural documentation. However, class imbalance in surgical workflows, where certain phases comprise 30–35% of frames while others represent only 5–10%, remains a significant challenge. This imbalance causes models to underperform on underrepresented yet clinically important phases. Methods: A retrospective analysis of laparoscopic cholecystectomy videos is performed with the implementation of a frame—based deep learning framework to develop and validate a surgical phase recognition pipeline based on ResNet-50 architecture with transfer learning. The model was designed to extract features from surgical video frames and classify them into seven distinct phases, without incorporating temporal context. We used the Cholec80 dataset and applied class balancing techniques to address inherent class imbalance. Results: The model achieved a mean balanced accuracy of 91.80% across five folds with consistent performance across all surgical phases. Per-phase F1-scores ranged from 0.89 to 0.95, demonstrating balanced classification without significant performance degradation on underrepresented phases. The confusion matrix revealed prediction errors primarily among adjacent or visually similar phases, reflecting the inherent ambiguity of surgical phase transitions. In practical terms, the model correctly identified the surgical phase in more than 9 out of 10 frames, enabling reliable automated segmentation of the operative workflow. Conclusions: This study demonstrates that artificial intelligence can reliably analyze surgical video data, achieving consistent and accurate phase recognition in laparoscopic cholecystectomy. Full article

Background and Clinical Significance: Infective endocarditis is a disease of the endocardial surface of the heart, most often affecting heart valves (native or prosthetic) or intracardiac device. Although relatively rare, it carries high embolic risk of complications and mortality. Complete device extraction is recommended; however, conventional surgery may be prohibitive in frail patients with multiple comorbidities. Case presentation: We present a case of a 74-year-old male with implantable cardioverter-defibrillator (ICD)-related infective endocarditis and large lead-associated vegetation measuring approximately 3 cm in size. Due to a high operative risk assessed by Euro SCORE II, a minimally invasive percutaneous approach using the Penumbra vacuum-assisted aspiration system was selected. The procedure enabled successful debulking of the vegetation, followed by complete device removal and targeted antibiotic therapy. The patient’s clinical condition improved, with normalization of inflammatory markers and no recurrence of infection, and a new ICD was safely reimplanted after recovery. Conclusions: This case highlights the potential role of percutaneous vacuum-assisted aspiration as an effective and less invasive therapeutic option in high-risk patients with CIED-related infective endocarditis, particularly when conventional surgical management is contraindicated or requires bridging therapy until the patient’s status is stabilized. Full article

Trigeminal neuralgia (TN) ranks among the most excruciating neuropathic pain syndromes, characterized clinically by multiple daily episodes of unilateral, paroxysmal, electric shock-like facial pain. The daily activities and quality of life of affected patients are profoundly diminished. First-line pharmacological agents, such as carbamazepine and oxcarbazepine, provide initial relief for many patients. However, a significant proportion eventually develops refractory symptoms or experience intolerable adverse effects, leading to the discontinuation of traditional oral medications. For these patients with complex clinical phenotypes who fail to respond or are intolerant to these therapies, alternative pharmacological strategies are required before considering invasive surgical procedures. Over the past two decades, botulinumtoxin type-A (BoNTA) has become an effective and safe, minimally invasive therapeutic option for refractory TN. This review provides a practical framework for BoNTA use in the clinical setting of refractory TN. To connect the pathophysiological background with clinical patient care, we summarize the current understanding of TN pathophysiology, the proposed mechanisms by which BoNTA exerts its antinociceptive effects and the evolving clinical evidence supporting its efficacy and safety. We also critically examine dosing protocols, injection techniques, long-term outcomes and the integration of BoNTA into the management algorithm of refractory TN. Full article

Background/Objectives: Well-leg compartment syndrome is a rare but potentially life-threatening complication associated with the lithotomy position during pelvic or lower abdominal surgery. While previous studies have examined this condition in specific surgical fields, comprehensive studies focusing on minimally invasive surgery, including laparoscopic and robot-assisted surgery, have not been conducted. This scoping review aimed to summarize the latest evidence on this condition, identify risk factors, and evaluate prevention strategies. Methods: This scoping review was conducted according to the PRISMA-ScR guidelines. A comprehensive literature search was performed using MEDLINE, Embase, and CENTRAL. Data were extracted from studies focusing on patients who underwent minimally invasive surgery in the lithotomy position. Results: A total of 25 studies, including cohort studies and case reports, were included. The majority of cases were observed in procedures exceeding 4 h in duration, with a notable prevalence in the left lower extremity during gastrointestinal surgical procedures. Fasciotomy was required in the majority of reported cases. Risk factors included high body mass index, large calf circumference, prolonged operative time, peripheral vascular disease, and specific surgical positions such as head-down or head-down plus right-sided tilting. Preventive measures included intraoperative lower limb pressure monitoring, leg positioning, use of improved support devices, and reduction of operative time in the lithotomy position. Conclusions: This review identified key risk factors and preventive measures for compartment syndrome of the unaffected lower limb in minimally invasive pelvic surgery. However, evidence for minimally invasive surgery is limited, and standardized guidelines do not exist. Further multicenter studies are needed to establish optimal preventive measures and improve patient safety. Full article

Background/Objectives: Contemporary implant dentistry is increasingly oriented toward minimally invasive regenerative strategies designed to reduce surgical morbidity while preserving or improving clinical outcomes. Conventional bone augmentation procedures remain effective and biologically well established, but they may be associated with greater patient burden, increased risk of complications, and higher technical demands in selected clinical scenarios. This narrative review critically examines minimally invasive bone regeneration approaches in implant dentistry, with particular focus on the Bone Core Technique, the Sub-Periosteal Peri-implant Augmented Layer (SPAL) technique, and Immediate Dentoalveolar Restoration (IDR), emphasizing their biological rationale, clinical indications, surgical workflows, limitations, and reported outcomes. Methods: A structured, non-systematic literature search was conducted in PubMed/MEDLINE, Scopus, and Web of Science to identify publications relevant to minimally invasive bone regeneration in implant dentistry. Priority was given to clinical studies, prospective cohorts, case series, technical descriptions, and biologically oriented conceptual papers addressing vascular preservation, flap limitation, donor-site morbidity, and peri-implant hard- and soft-tissue integration. Results: Available evidence suggests that minimally invasive regenerative protocols may offer favorable clinical and patient-centered outcomes only in carefully selected indications and when performed by experienced operators. The strength of support is uneven across techniques: the Bone Core Technique currently has the strongest dedicated prospective follow-up for localized peri-implant defects, SPAL is supported by limited retrospective and emerging histologic evidence, and IDR remains largely based on case reports, technique-driven descriptions, and broader immediate implant literature. Conclusions: Minimally invasive bone regeneration reflects a shift toward biologically guided and patient-centered treatment concepts in implant dentistry, but it should not be interpreted as a universal substitute for conventional augmentation. Its successful application depends on careful case selection, sound knowledge of wound healing and defect morphology, and advanced surgical and prosthetic expertise. Further research should prioritize standardized outcome measures, longer follow-up, and comparative prospective studies. Full article

Chronic subdural hematoma (CSDH) is a common neurological condition, particularly in the elderly, characterized by a complex pathophysiology involving inflammation, angiogenesis, and recurrent microhemorrhages rather than a purely mechanical process. Although surgical evacuation remains the standard treatment, recurrence rates remain considerable, prompting the search for alternative and adjunctive therapies. This narrative review summarizes current evidence on the pathophysiology, diagnostic approaches, and management of CSDH, with particular emphasis on middle meningeal artery embolization (MMAE). A comprehensive literature search of major medical databases, including PubMed, Scopus, and Web of Science, was performed to identify relevant randomized controlled trials (RCTs), observational studies, and meta-analyses. Available evidence suggests that MMAE may reduce recurrence rates and the need for reoperation, particularly when used as an adjunct to surgery. However, results from RCTs remain mixed, and not all studies have demonstrated significant benefit on primary clinical endpoints. While MMAE has emerged as a promising minimally invasive approach targeting the vascular supply of hematoma membranes, further high-quality studies are required to establish standardized indications, optimize procedural techniques, and clarify long-term outcomes and comparative effectiveness. Full article

Adrenal tumors are increasingly diagnosed due to widespread use of cross-sectional imaging and an aging population, making adrenalectomy a progressively more common surgical procedure. Over the past three decades, adrenal surgery has undergone a paradigm shift from open adrenalectomy to minimally invasive (MI) techniques, with laparoscopic adrenalectomy becoming the standard approach for most benign and selected malignant adrenal tumors. More recently, retroperitoneoscopic and robotic approaches have expanded the armamentarium available to adrenal surgeons, allowing for tailored, patient-specific surgical strategies. This review summarizes current evidence on MI adrenalectomy techniques, including transperitoneal and retroperitoneal laparoscopic approaches, hand-assisted adrenalectomy, and robotic adrenalectomy, with particular emphasis on their role in pheochromocytoma and adrenocortical carcinoma. In addition, evolving ancillary technologies such as laparoscopic ultrasound, indocyanine green fluorescence imaging, artificial intelligence, and virtual and augmented reality are reviewed, highlighting their potential to enhance intraoperative decision-making, safety, and surgical precision. Current controversies, including the role of preoperative alpha-blockade, partial versus total adrenalectomy in hereditary pheochromocytoma, the oncologic adequacy of MI surgery for adrenocortical carcinoma, and the selective use of lymph node dissection, are discussed. Available evidence supports MI adrenalectomy as a safe and effective approach in carefully selected patients when performed by experienced surgeons in high-volume centers. Technological innovations continue to refine surgical planning, execution, and training, suggesting that the future of adrenal surgery will increasingly rely on precision-guided, personalized, and data-driven strategies. This review offers a timely and comprehensive synthesis of the evolving landscape of MI adrenalectomy, uniquely integrating current evidence across the full spectrum of surgical techniques with a critical appraisal of emerging ancillary technologies while addressing unresolved clinical controversies relevant to contemporary surgical practice. Full article

Background: Metabolic and bariatric surgery is an established therapeutic option for severe obesity and obesity-related medical problems. Although minimally invasive techniques and enhanced recovery pathways have reduced postoperative morbidity, infectious complications remain clinically relevant because they may lead to readmission, reoperation, prolonged antimicrobial therapy, and mortality. Methods: We conducted a narrative review of the literature on infectious complications after metabolic and bariatric surgery. Evidence was synthesized across five clinically relevant domains: host-related pathophysiology, microbial epidemiology, preoperative optimization, antimicrobial prophylaxis and pharmacokinetic considerations, and diagnosis and management of postoperative infectious complications. Results: Patients with obesity present specific infection-related vulnerabilities, including chronic low-grade inflammation, altered immune responses, impaired tissue oxygenation, obesity-related medical problems, and procedure-specific risks. Contemporary prevention relies on multidisciplinary preoperative optimization, appropriate skin antisepsis, weight-based antimicrobial prophylaxis, intraoperative redosing when indicated, and adherence to enhanced recovery principles. Anastomotic leaks and intra-abdominal abscesses represent the most severe organ/space infections and require early recognition, source control, antimicrobial therapy, nutritional support, and coordinated surgical, radiological, and endoscopic management. Conclusions: Infectious complications after metabolic and bariatric surgery result from the interaction between host physiology, microbial factors, pharmacological considerations, and surgical technique. A structured approach integrating prevention, early diagnosis, and multidisciplinary management may improve outcomes. Further bariatric-specific studies are needed to strengthen the evidence base for several preventive and therapeutic strategies. Full article

Background: Solid pseudopapillary neoplasms of the pancreas (SPN-P) are rare, low-grade malignancies primarily affecting young women. While surgical resection is definitive, the optimal balance between oncological radicality and functional preservation remains a clinical challenge. This study evaluates tailored surgical strategies utilizing minimally invasive and parenchyma-preserving techniques. Patients and Methods: We conducted a multi-institutional retrospective analysis of SPN-P cases treated between March 2020 and May 2023. Out of 167 pancreatic resections, five paradigmatic cases were identified. We analyzed the decision-making process for preoperative staging (CT/MRI/EUS-FNB), surgical approach (open, laparoscopic, or robotic), and the implementation of parenchyma-preserving versus formal resections. Results: The cohort included four females and one male (mean age 40.6 years; range 13–73). Surgical approaches were tailored to tumor location and patient characteristics: two patients underwent pancreatoduodenectomy (one laparotomic, one laparoscopic), two underwent distal pancreatectomy (one robotic, one laparoscopic), and one pediatric patient underwent laparoscopic parenchyma-preserving central pancreatectomy. R0 resection was achieved in all cases. No Grade B/C postoperative pancreatic fistulas (POPF) or complications Clavien-Dindo ≥III occurred. At a mean follow-up (FU) of 38.4 months (range 20–58), the disease-free survival rate was 100%. One patient developed new-onset diabetes mellitus following distal pancreatectomy. Conclusions: A tailored surgical approach—integrating robotic, laparoscopic, and parenchyma-preserving techniques—may enable excellent oncological outcomes while minimizing morbidity. For SPN-P, the choice of procedure should prioritize the preservation of pancreatic function, particularly in young patients, without compromising surgical margins. Full article

Background: Cervical pregnancy and cesarean scar pregnancy are rare forms of non-tubal ectopic pregnancy associated with a high risk of severe hemorrhage, surgical intervention, and potential loss of fertility. We describe a unique case of sequential abnormal implantation in which a cervical pregnancy was followed by a cesarean scar pregnancy one year later. The occurrence of two distinct forms of non-tubal ectopic pregnancy in a single patient represents an exceptionally uncommon clinical scenario, underscoring the importance of early diagnosis and carefully planned treatment. Case presentation: A 39-year-old woman, gravida 4 para 3, was diagnosed with two distinct non-tubal ectopic pregnancies over a 1-year period. The first pregnancy was implanted in the cervical canal, whereas the second was located within the cesarean section scar. In each episode, the diagnosis was established early by transvaginal ultrasound. As the patient was hemodynamically stable and wished to preserve fertility, minimally invasive hysteroscopic evacuation was performed in both pregnancies. The procedures were completed without significant intraoperative bleeding, and no additional hemostatic interventions were required. Follow-up serum β-hCG levels became negative after treatment, confirming complete resolution of pregnancies. Conclusions: This case demonstrates that early ultrasonographic diagnosis and careful individualized management may enable successful fertility-preserving treatment even in exceptionally rare cases. It also supports the potential role of minimally invasive approaches in selected hemodynamically stable patients and highlights the need for standardized management protocols for cervical and cesarean scar pregnancy. Full article

Background and Objectives: Minimally invasive cervical spine surgery (MIS-CSS) relies heavily on intraoperative fluoroscopic imaging, raising concerns about radiation exposure to patients and surgical staff. Unlike lumbar MIS, cervical-specific radiation exposure has not been systematically reviewed, despite distinct anatomical considerations, including proximity to the thyroid gland and lens of the eye. This review aims to quantify intraoperative radiation exposure during MIS cervical spine procedures and evaluate available dose-reduction strategies. Materials and Methods: A systematic literature search was conducted across PubMed/MEDLINE, Scopus, and Google Scholar in April 2026 following PRISMA 2020 guidelines. Studies reporting original quantitative radiation data during minimally invasive cervical spine procedures in adult patients (≥10 patients) were included. Quality was assessed using the MINORS tool and the JBI checklist. Results: Seven studies encompassing 380 patients were included. Procedures comprised ACDF (four studies), minimally invasive posterior cervical laminoforaminotomy (two studies), and CT-navigated cervical instrumentation (one study). Patient effective doses during ACDF ranged from 0.015 to 1.3 mSv, with thyroid doses of 0.194–0.290 mGy. Standalone ACDF reduced patient dose by 36–58% compared to plated ACDF (p < 0.001). Navigation-assisted posterior cervical foraminotomy achieved a median fluoroscopy time of 10 s with negligible staff exposure. Surgeon per-procedure exposure during cervical discectomy (chest 0.122 µSv, lens 3.1 µSv, hands 7.1 µSv) was approximately half that of lumbar discectomy. Conclusions: Radiation doses during individual MIS cervical procedures appear to be within occupational safety limits, though the current evidence is insufficient to establish definitive dose thresholds. Standalone implant designs and intraoperative navigation represent effective, complementary dose-reduction strategies. Standardized prospective research is needed to establish cervical-specific radiation safety benchmarks. Full article

Introduction: Plantar fasciitis is a common cause of heel pain in adults, with a significant impact on quality of life and athletic performance. While conservative treatments are effective in most cases, a subset of patients remains symptomatic and may require surgical intervention. Minimally invasive techniques, such as bipolar radiofrequency (RF) coblation using the TOPAZ system, have emerged as promising alternatives to traditional open or endoscopic procedures. Methods: This retrospective study evaluated the clinical outcomes of 49 consecutive patients (20 males and 29 females; mean age 54.3 ± 11.4 years; mean BMI 25.3 ± 3.2, range 21.5–34.7) with chronic plantar fasciitis unresponsive to at least six months of conservative treatment. The affected side was left in 24 patients and right in 25, and 35 patients were regularly engaged in sports prior to symptom onset. All patients underwent percutaneous bipolar RF coblation using the TOPAZ device between July 2019 and November 2024. Patient-reported outcome measures—including the Visual Analog Scale (VAS), AOFAS Ankle–Hindfoot Score, SF-36, and Tegner Activity Scale—were collected at the final follow-up (mean 41.7 ± 18.3 months, range 6–71). Results: Statistically significant improvements were observed in pain and function: mean VAS decreased from 8.5 to 3.1 (p < 0.001), and American Orthopaedic Foot and Ankle Society (AOFAS) pain and function scores improved from 2.5 and 12.75 to 28.75 and 38.75, respectively (p < 0.001). The mean Tegner score increased from 1.3 to 4.1 (p < 0.001), with 100% of previously active patients returning to sport. No major complications or reoperations were reported. Conclusions: Percutaneous bipolar RF coblation appears to be a safe and effective treatment for recalcitrant plantar fasciitis, offering significant pain relief, functional improvement, and a high return-to-sport rate with minimal morbidity. This technique may represent a valuable intermediate option between conservative care and open surgery. Full article

Intrabody cage augmentation has emerged as a minimally invasive technique for anterior column reconstruction in Kümmell disease and osteoporotic burst fractures. These osteoporotic conditions lead to progressive vertebral collapse, kyphosis, and instability. While cement augmentation provides rapid pain relief, it often fails to reliably restore sagittal balance or ensure biological integration in advanced stages of collapse. Although conventional anterior corpectomy with long-segment posterior fusion can achieve satisfactory deformity correction, these procedures are associated with substantial surgical morbidity. In contrast, screw fixation alone often fails to withstand anterior loading, resulting in loss of correction or hardware failure. By adapting standard interbody devices for off-label intravertebral use, this technique utilizes the intravertebral cleft as a natural cavity to restore vertebral height and sagittal alignment while preserving adjacent intervertebral discs and reducing stress on posterior instrumentation. The surgical technique involves transpedicular access, meticulous curettage of necrotic tissue, and insertion of a cage packed with osteoinductive material. This approach minimizes surgical trauma and operative time compared with conventional corpectomy procedures. Reported outcomes from retrospective series suggest promising pain relief, maintenance of correction, and low complication rates. Collectively, current evidence suggests that intrabody cage augmentation may serve as a potential, less invasive surgical option, acting as an intermediate approach between cement augmentation and corpectomy. However, as the existing evidence remains preliminary, high-quality prospective comparative studies are required to establish definitive indications and long-term efficacy. Full article