Gasless, endoscopic trans-axillary thyroid surgery: our series of the first 51 human cases

Background The safety of gasless endoscopic trans-axillary thyroid surgery is still undetermined. Methods Clinical findings and postoperative complications of patients who had undergone trans-axillary thyroid surgery due to thyroid cancer and thyroid nodules were retrospectively studied. The sensory change and paralysis results from this technique and patients’ satisfaction with the cosmesis were also studied. Results Fifty-one patients (49 females and 2 males) received operations by gasless, endoscopic trans-axillary approaches with one patient whose operation was converted to open surgery because of internal jugular vein injury. Only two patients developed temporary vocal cord paralysis and no patients developed other severe complications. The alleviation of the discomfort in the anterior neck area and sternocleidomastoid, and the cosmetic effect of gasless endoscopic trans-axillary thyroid surgery were acceptable. No evidence of recurrence was found during the follow-up period. Conclusions Gasless, endoscopic trans-axillary thyroid surgery is a feasible procedure with acceptable safety and better cosmetic results in strictly selected patients.

Pigmented Lesions of the Eyelid Margin

The eyelid area poses a diagnostic and therapeutic challenge due to its specific anatomy. The eyelid is composed of skin, orbicularis muscle, tarsus, and the eyelid margin is continuous with palpebral conjunctiva. Among pigmented tumors, benign lesions such as epidermal or intradermal nevi, freckles, lentigo, or seborrheic keratosis are the most common. Melanoma is relatively rare in this location. A suspicious lesion may be biopsied or excised. Surgery in the eyelid area requires special considerations to maintain a safe surgical margin, vital function of the eyelid, and acceptable cosmetic effect due to the exposure of the eyelid region of the face.

Modification of the sling operation with the use of tubing vaginal scrapdue to urine incontinence in women

It is given in an article the description of the new modification technique for the sling operation with stipulating use of the tubing scrapfrom the front vaginal wall mucosa fixed in an ureterovesical segment zone. This intervention, in our opinion, especially convenient if II type of urine incontinence takes place where dislocation of the invariable urethra is combined with cystocele and there is excess of the vaginal wall, which may be easy used as plastic material. This operation elaborated by authors is performed exclusively by vaginal way, that allows decrease the traumas and complications number, increase the cosmetic effect, simplify the surgical intervention. Recent results of treatment according to this metho dies permit to hope on its efficiency also in days that are more far-off.

МОДИФИЦИРОВАННАЯ МАЛОИНВАЗИВНАЯ МЕТОДИКА ЛАПАРОСКОПИЧЕСКИХ ОПЕРАЦИЙ ПО ПОВОДУ ДОБРОКАЧЕСТВЕННЫХ ЗАБОЛЕВАНИЙ ПРИДАТКОВ МАТКИ

The article substantiates the feasibility of developing minimally invasive operations on the adnexa and minimizing surgical trauma. The technique of the modified laparoscopic surgery method proposed by the authors for benign diseases of the adnexa is described in details. The results of treatment of 37 patients operated on by the presented method are considered. The selection criteria for patients for the application of this method of surgical treatment are determined. It is shown that the presented method corresponds to the current trend of minimizing surgical trauma, has a good cosmetic effect, helps to reduce postoperative pain, and is also economically feasible, because it does not require the use of additional endoscopic instruments.

THE NEW APPLIANCE IS USED FOR CIRCUMCISION

Нами получен патент на полезную модель Республики Казахстан №5782 от 22.01.2021, который с большой эффективностью используется для обрезания крайней плоти. Для отсечения листков крайней плоти применяется устройство для пирографии Stayer, снабженный трансформатором, генерирующий напряжение от 0 до 5 В., с частотой тока 50Гц, мощностью 40Вт., с твердым рабочим наконечником, регулируемым температурой от 450ºС до 750ºС. Применение устройства для пирографии Stayer для обрезания крайней плоти позволяет сократить время оперативного вмешательства, уменьшить травматичность воздействия и улучшить косметический эффект. За 2018-2020 годы было выполнено 500 операций с применением устройства для пирографии Stayer. При этом, среднее время операции составляло 10 минут. У всех детей достигнут хороший непосредственный и отдаленный клинический результат. We have obtained a patent for a utility model of the Republic of Kazakhstan №5782, 22.01.2021., which is used with great efficiency in circumcision of the foreskin. To cut off the foreskin sheets, a Stayer pyrography device is used, equipped with a transformer that generates a voltage from 0 to 5 V., with a current frequency of 50 Hz, a power of 40 W., with a solid working tip, adjustable temperature from 450 ° C to 750 ° C. The use of the Stayer pyrography device for circumcision of the foreskin allows you to reduce the time of surgical intervention, reduce the traumatic impact and improve the cosmetic effect. In 2018-2020, 500 operations were performed using the Stayer pyrography device. The average operation time was 10 minutes. All children achieved a good immediate and long-term clinical outcome.

Analysis of Cosmetic Effect of Nanocomposite Resin on Anterior Teeth

The problems of anterior teeth include dental plaque, dental caries, and fracture, which are usually treated with common composite resin clinically. Although good repair effect can be achieved, patients are prone to anterior tooth sensitivity after surgery. Therefore, the purpose of this study is to analyze the cosmetic effect of nanocomposite resin on anterior teeth. Up to 176 patients (176 teeth) undergoing anterior dental cosmetic restoration in our hospital were selected and assigned to the LR group ( n = 88 ) and the NR group ( n = 88 ) according to patients’ voluntary choice of prosthetic materials. The LR group was cured with light-cured composite resin, while the NR group was cured with nanocomposite resin. By comparing the related indexes of patients in the two groups, it was discovered that in the NR group, the excellent and good rate and patients’ evaluation of the repair effect were higher, while the periodontal attachment, gingival index, dental plaque index, VAS score, and the incidence of tooth sensitivity were lower, all P < 0.05 . The results indicated that the nanocomposite resin had significant cosmetic effect on anterior teeth and had application value.

Simultaneous repair of the skull base and the frontal lobe defect using CAD-CAM technology

Many patients with traumatic brain injury develop complications in the postoperative period. The article describes a case of revision surgery in a female patient with cerebrospinal fluid rhinorrhea following a severe car accident. During one surgery, the skull base and the frontal bone defect were repaired and a lumboperitoneal shunt was placed. The skull base was repaired using an autologous musculoaponeurotic graft. For a better cosmetic effect, the implant was designed using CADCAM technologies. The patient had a relapse of the leak in the postoperative period, which required revision surgery (multilayer reconstruction using a fibrin-thrombin sponge). The patient was followed up for 2 years, with no relapse. The desired clinical and cosmetic effects were successfully achieved.

P002 POST-PARTUM ABDOMINAL WALL INSUFFICIENCY SYNDROME. LESSON LEARNED FROM THE SINGLE SURGEON'S EXPERIENCE BASED ON 200 CASES

Aim Post-partum abdominal wall insufficiency with rectus diastasis is present in over 30% of women after pregnancy. Little is known about how PPAWI affects the social, sexual life and self-esteem of patients. This study was designed to evaluate the safety of onlay mesh combined with abdominoplasty and its impact on the well-being of the patients. Material and Methods Two hundred patients with PPAWI underwent surgery with onlay mesh and abdominoplasty. The safety of the procedure was assessed by postoperative complications, time of hospitalization and time of drainage. Before the operation and 6 months later, a questionnaire asking about the patient’s sexual and social life and the presence of back pain was completed. The cosmetic effect was assessed separately. Results The onlay procedure with abdominoplasty was found to be safe and fast. The mean operation time was 82 min, and the drainage time was 2.1 days. In this group &lt;2% postoperative complications were noted. There were no recurrences within the 6 month.p. Significant improvements in social and sexual life and the level of self-esteem were noted. Back pain was relieved or minimalized in all patients. The cosmetic effect was insufficient for 2 patients (1%). Conclusions PPAWI can be treated safely with onlay mesh and abdominoplasty. The patients’ symptoms were strongly correlated with the morphological status of the front abdominal wall and improved after the procedure. The authors are the first to propose PPAWI syndrome as a complex disorder with a disease classification, which can help patients with their choice of proper surgical intervention.

Results of organ-preserving treatment of breast cancer using intraoperative radial therapy

Objective: to compare the immediate and long-term outcomes of patients with early breast cancer treated with intraoperative radial therapy depending on the biological subtype of breast cancer.Materials and methods. We prospectively evaluated number of recurrences, cosmetic effect and early treatment results of 104 patients with early breast cancer aged 66.72 ± 0.68 years old. The mean follow-up period was 36 months. The mean dose on the surface of applicator was 17.8 Gy, on the depth 0.5 cm – 8.8 Gy, on the depth 1.0 cm – 5 Gy. The mean time of radiation was 22.15 min ± 28.09 sec.Results. The local recurrence was in 3 patients. The first patient had triple negative breast cancer subtype, the second patient had luminal B HER2+, and the third one had luminal B HER2– subtype. Relapses occurred in 7, 14 and 20 months after the end of treatment respectively. The recurrence rate in patients with luminal B biological subtype was 10.71 %; in patients with triple negative subtype was 20 %. All recurrences were found in the area of the postoperative scar.Conclusion. The obtained results question the rationale for the use of the demonstrated method in patients with luminal B and triple negative molecular subtypes of tumors.

Ultrasound Image Features under Deep Learning in Breast Conservation Surgery for Breast Cancer

This study was to analyze the effect of the combined application of deep learning technology and ultrasound imaging on the effect of breast-conserving surgery for breast cancer. A deep label distribution learning (LDL) model was designed, and the semiautomatic segmentation algorithm based on the region growing and active contour technology (RA) and the segmentation model based on optimized nearest neighbors (ON) were introduced for comparison. The designed algorithm was applied to the breast-conserving surgery of breast cancer patients. According to the difference in intraoperative guidance methods, 102 female patients with early breast cancer were divided into three groups: 34 cases in W1 group (ultrasound guidance based on deep learning segmentation model), 34 cases in W2 group (ultrasound guidance), and 34 cases in W3 group (palpation guidance). The results revealed that the tumor area segmented by the LDL algorithm constructed in this study was closer to the real tumor area; the segmentation accuracy (AC), Jaccard, and true-positive (TP) values of the LDL algorithm were obviously greater than those of the RA and ON algorithms, while the false-positive (FP) value was significantly lower in contrast to the RA and ON algorithms, showing statistically observable differences ( P < 0.05); the actual resection volume of the patients in the W1 group was the closest to the ideal resection volume, which was much smaller in contrast to that of the patients in the W2 and W3 groups, showing statistical differences ( P < 0.05); the positive margins of the patients in the W1 group were statistically lower than those in the W2 and W3 groups ( P < 0.05). In addition, 1 patient in the W1 group was not satisfied with the cosmetic effect, 3 patients in the W2 group were not satisfied with the cosmetic effect, and 9 patients in the W3 group were not satisfied with the cosmetic effect. Finally, it was found that the ultrasound image based on the deep LDL model effectively improved the AC of tumor resection and negative margins, reduced the probability of normal tissue being removed, and improved the postoperative cosmetic effect of breast.