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Surg. Tech. Dev., Volume 12, Issue 4 (December 2023) – 5 articles

Cover Story (view full-size image): This work was a retrospective analysis of our first 100 robotic hepatectomies from March 2020 to July 2022. Patient demographic characteristics and intra- and postoperative outcomes were analyzed. A total of 59 males and 41 females, with a median age of 68 years, underwent a robotic liver resection. The indications for robotic liver resections were malignant lesions in 86% of patients. Anatomical resection was undertaken in 27% of cases and non-anatomical resection in 63% of cases. Postoperative complications were as follows: 1% with biliary leakage, 5% with ascites, 6% with pulmonary infections, and 3% with other site infections. Our results showed the satisfactory experience of a tertiary HPB center with its first 100 robotic liver resections. The opportunity to make the robotic approach a routine provided the global growth of a surgical team, improving the quality of patient outcomes. View this paper

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13 pages, 2241 KiB

Open AccessReview

Complications Associated with Oblique Lumbar Interbody Fusion: A Systematic Review

by Quan Rui Tan, Russell Andrew Wong, Arun-Kumar Kaliya-Perumal and Jacob Yoong-Leong Oh

Surg. Tech. Dev. 2023, 12(4), 211-223; https://doi.org/10.3390/std12040020 - 20 Nov 2023

Cited by 1 | Viewed by 993

Abstract

The main advantage of Oblique Lumbar Interbody Fusion (OLIF) is its ability to provide safe access to the lumbar spine while being a robust interbody fusion technique through a minimally invasive approach. This study reviews the postoperative complications of OLIF, offering a comprehensive understanding of its advantages and disadvantages. A total of 27 studies with 1275 patients were shortlisted based on our selection criteria. Complications were categorized into intra-operative, immediate post-operative, and delayed post-operative and were interpreted based on surgical procedure into stand-alone OLIF, OLIF with posterior stabilisation, and unspecified. Major complications exhibited a pooled prevalence of just 1.7%, whereas the overall pooled prevalence of complications was 24.7%. Among the subgroups, the stand-alone subgroup had the lowest prevalence of complications (14.6%) compared to the unspecified subgroup (29.6%) and the OLIF L2-5 with posterior stabilisation subgroup (25.8%). Similarly, for major complications, the stand-alone subgroup had the lowest prevalence (1.4%), while the OLIF L2-5 with posterior stabilisation subgroup (1.8%) and the unspecified OLIF L2-5 subgroup (1.6%) had higher rates. However, the differences were not statistically significant. In conclusion, the rate of major complications after OLIF is minimal, making it a safe procedure with significant benefits outweighing the risks. The advantages of OLIF L2-5 with posterior stabilisation over stand-alone OLIF L2-5 is a subject of discussion. Full article

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12 pages, 2902 KiB

Open AccessCase Report

Anterior Lumbar Interbody Fusion (ALIF) for Lumbar Hemivertebra in an Adult Using Three-Dimensional-Printed Patient-Specific Implants and Virtual Surgery Planning: A Technical Report

by Tajrian Amin, William C. H. Parr, Pragadesh Natarajan, Andrew Lennox, Lianne Koinis and Ralph J. Mobbs

Surg. Tech. Dev. 2023, 12(4), 199-210; https://doi.org/10.3390/std12040019 - 08 Nov 2023

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Abstract

Introduction: Hemivertebrae are a common defect of vertebral formation, potentially resulting in debilitating congenital scoliosis and necessitating highly traumatic surgery. Virtual surgical planning (VSP) and 3D-printed patient-specific implants (PSIs) have increasingly been applied to complex spinal surgery, and offer a range of potential benefits. Research Question: We report the use of 3D-printed PSIs and VSP as part of a two-level anterior lumbar interbody fusion (ALIF) for the management of lateral hemivertebra and congenital scoliosis. Material and Methods: A 53-year-old male with chronic low-back pain, due to L4 hemivertebra and mild congenital scoliosis, presented with new-onset leg pain. CT revealed L4/5 and L5/S1 degeneration and foraminal stenosis. Given the complex anatomy and extensive multi-level osteophytosis, 3D-printed PSIs were designed, manufactured, and implanted as part of a two-level ALIF. Results: Excellent implant fit was achieved intraoperatively, confirmed via postoperative imaging. VSP assisted with navigating challenging bony and vascular anatomy. Three-month postoperative imaging demonstrated construct stability, early signs of bony fusion, with implant placement, spinal curvature, and disc height corrections closely matching the VSP. Clinically, the patient’s pain and functional impairment had effectively resolved by nine-month follow up, as demonstrated through subjective and objective measures. Discussion and Conclusions: Virtual surgical planning and 3D-printed PSIs can be useful surgical aids in the management of the often-complex cases involving hemivertebrae and congenital scoliosis. This case of congenital pathology adds to the growing reports of PSI application to a variety of complex spinal pathologies, with analyses showing a close match of the postoperative construct to the preoperative VSP. Full article

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11 pages, 5275 KiB

Open AccessArticle

Intraoperative Complications of the Anterior Retroperitoneal Approach to the Lumbosacral Spine in the Supine Position: A Proposal for an Algorithm to Predict the Degree of Difficulty of the Surgical Procedure

by Francesco Caiazzo, Lucas Capo and Juan Bago

Surg. Tech. Dev. 2023, 12(4), 188-198; https://doi.org/10.3390/std12040018 - 19 Oct 2023

Viewed by 839

Abstract

The main concern in anterior exposure of the lumbosacral spine is the risk of vascular injury during mobilization and retraction of the blood vessels. Preoperative planning is considered essential to reducing the incidence of vascular injury, although no consensus has been reached on the preferred methodology for such planning. This is a retrospective study, including all patients operated on by a single surgeon, who received anterior lumbar-spine surgery in the supine position as a primary procedure before undergoing an anterior lumbar interbody fusion (ALIF) or an artificial disc replacement (ADR). The aim of this study was to list the intraoperative complications observed. We included 156 patients (87 women; mean age, 48 years) who met the inclusion criteria. The overall complication rate was 6.4% (10/156). The most frequent complications were an incidental peritoneal opening (seven patients, 4.4%); two left–iliac-vein injuries (1.28%) that were sutured; and one dural tear during a decompression maneuver of the canal. No neurological, arterial, or ureteral injury or retrograde ejaculation was reported. The use of a sound protocol that includes planning, assessment of approach difficulty, and step-by-step surgical technique can reduce the rate of vascular injury in anterior lumbosacral-spine surgery. Full article

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12 pages, 1508 KiB

Open AccessArticle

Robotic Liver Resection: Report of Institutional First 100 Cases

by Maria Conticchio, Antonella Delvecchio, Valentina Ferraro, Matteo Stasi, Annachiara Casella, Rosalinda Filippo, Michele Tedeschi, Alba Fiorentino and Riccardo Memeo

Surg. Tech. Dev. 2023, 12(4), 176-187; https://doi.org/10.3390/std12040017 - 12 Oct 2023

Cited by 1 | Viewed by 934

Abstract

Backgrounds: Liver surgery has developed progressively during the last 10 years, especially in minimally invasive approaches. Robotic surgery seemed to overcome laparoscopic limitations with 3D visualization, the increased degrees of freedom given with Endowrist instruments, tremor filtering, better dexterity, and improved ergonomics for the surgeon. Methods: This work was a retrospective analysis of our first 100 robotic hepatectomies from March 2020 to July 2022. Patient demographics characteristics and intra- and postoperative outcomes were analyzed. Results: A total of 59 males and 41 females, with a median age of 68 years, underwent a robotic liver resection. The indications for robotic liver resections were malignant lesions in 86% of patients. Anatomical resection (AR) was undertaken in 27% of cases and non-anatomical resection (NAR) in 63% of cases. None of the patients were converted to the ‘open’ approach. Postoperative complications were as follows: 1% of biliary leakage, 5% of ascites, 6% of pulmonary infections, and 3% of other sites’ infections. CONCLUSIONS Our results showed the satisfactory experience of a tertiary HPB center with its first 100 robotic liver resections. The opportunity to make the robotic approach routinary provided global growth of a surgical team, improving the quality of patient outcomes. Full article

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12 pages, 2006 KiB

Open AccessArticle

Keystone Flap in Amniotic Band Syndrome—Innovative Approach of an Established Operative Technique for an Unusual Entity

by Dominik Promny, Raymund E. Horch and Theresa Promny

Surg. Tech. Dev. 2023, 12(4), 164-175; https://doi.org/10.3390/std12040016 - 22 Sep 2023

Viewed by 791

Abstract

Amniotic Band Syndrome (ABS) is a complex condition characterized by constricting rings and tissue synechiae, resulting in tissue necrosis and congenital anomalies. In newborns and infants with ABS, tissue necrosis can be profound, requiring a tissue defect reconstruction, realized by a Keystone Perforator Island Flap (KF). Primarily used for reconstruction after skin cancer excisions, KF’s applications expanded to defects of various etiologies and disorders throughout the body. Subsequently, additional KF types adapted to the particular tissue defects were developed. The KF’s preparation is relatively simple to perform leading to shorter operative times, and the postoperative monitoring is less laborious. Individualized surgical approaches and timing are essential for addressing the varied manifestations of ABS, with immediate treatment recommended for vascular compression, all-layered tissue necrosis, and nerve compression cases. To our knowledge, there is no published case in which a KF was used for the reconstruction of tissue defects and release of constriction rings in the context of an amniotic band syndrome. Therefore, the purpose of this article is to introduce the established surgical technique of KFs as an innovative surgical approach with satisfying reconstructive results for tissue defects and constriction ring release in ABS. Full article

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