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Topic Review
Relevance of Digitalization in Spine Surgery
Machine learning is a subset of artificial intelligence and refers to computer techniques that allow complex tasks to be solved in a reproducible and standardized way. Healthcare systems worldwide generate vast amounts of data from many different sources. Although of high complexity for a human being, it is essential to determine the patterns and minor variations in the genomic, radiological, laboratory, or clinical data that reliably differentiate phenotypes or allow high predictive accuracy in health-related tasks. Convolutional neural networks (CNN) are increasingly applied to image data for various tasks. Its use for non-imaging data becomes feasible through different modern machine learning techniques, converting non-imaging data into images before inputting them into the CNN model. Considering also that healthcare providers do not solely use one data modality for their decisions, this approach opens the door for multi-input/mixed data models which use a combination of patient information, such as genomic, radiological, and clinical data, to train a hybrid deep learning model. Thus, this reflects the main characteristic of artificial intelligence: simulating natural human behavior. 
  • 669
  • 16 May 2022
Topic Review
3D Printing and Nanotechnologies in Biofilms
Biofilms remain one of the most pervasive complications of the medical field, representing 50–70% of all nosocomial infections and up to 80% of total microbial infections. Since biofilms contain intricately small matrices, different microenvironments, and accumulations of biodiverse microorganisms of different resistances, these structures end up being difficult to target.
  • 669
  • 08 Oct 2023
Topic Review
Peri-Operative Antibiotic Prophylaxis for Groin Surgical Site Infection
Surgical site infections (SSIs) in lower extremity vascular surgeries, post-groin incision, are not only common complications and significant contributors to patient mortality and morbidity, but also major financial burdens on healthcare systems and patients. In spite of recent advances in pre- and post-operative care, SSI rates in the vascular surgery field remain significant. However, compliant antibiotic therapy can successfully reduce the SSI incidence pre- and post-surgery. Antibiotic therapy, administered according to all peri-operative protocols described, is useful in reducing groin SSI rate in vascular surgery.
  • 668
  • 13 Apr 2022
Topic Review
Lung Segmentectomy in Non-Small Cell Lung Cancer Surgery
Current guidelines recommend surgery for early-stage non-small cell lung cancer (NSCLC). The standard treatment for patients with cT1N0 NSCLC has been lobectomy with lymph-node dissection, with sublobar resection used only in patients with inadequate cardio-respiratory reserve, with poor performance status, or who are elderly. The results of two randomized controlled trial recently had changed the point of view, giving a new important role to the sublobar resections.
  • 667
  • 15 Jun 2023
Topic Review
Oncolytic Viruses for the Treatment of Bladder Cancer
Bladder cancer is one of the most prevalent cancers. Despite advancements in bladder cancer therapy, new strategies are still required for improving patient outcomes, particularly for those who experienced Bacille Calmette–Guerin failure and those with locally advanced or metastatic bladder cancer. Oncolytic viruses are either naturally occurring or purposefully engineered viruses that have the ability to selectively infect and lyse tumor cells while avoiding harming healthy cells. In light of this, oncolytic viruses serve as a novel and promising immunotherapeutic strategy for bladder cancer. A wide diversity of viruses, including adenoviruses, herpes simplex virus, coxsackievirus, Newcastle disease virus, vesicular stomatitis virus, alphavirus, and vaccinia virus, have been studied in many preclinical and clinical studies for their potential as oncolytic agents for bladder cancer.
  • 663
  • 20 Feb 2023
Topic Review
Wide Local Excision in Primary Cutaneous Melanoma Management
Surgical wide local excision (WLE) is an elective procedure involving the excision of a larger area of tissue surrounding the scar left after diagnostic excision of a primary cutaneous melanoma. It remains the current standard of care for primary cutaneous melanoma and aims to achieve locoregional disease control with minimal functional and cosmetic impairment. Despite several prospective randomised trials, the optimal extent of excision margin remains controversial, and this is reflected in the persistent lack of consensus in guidelines globally.
  • 663
  • 01 Mar 2024
Topic Review
Leaping the Boundaries in LLR for Hepatocellular Carcinoma
Recent advances in surgical techniques and perioperative management lead to a redefinition of the actual frontiers of Laparoscopic Liver Resection (LLR) by including patients with more advanced disease. Nonetheless, because of both underlying liver conditions and technical difficulty, LLR for Hepatocellular Carcinoma (HCC) is still considered as a challenging procedure. Specific concerns exist about LLR in cirrhotic patients, posterosuperior segments, giant and multiple tumors, as well as repeat resections.
  • 662
  • 05 May 2022
Topic Review
Applications of Advancing Prone-Transpsoas Spine Surgery
The Prone Transpsoas (PTP) approach to lumbar spine surgery, emerging as an evolution of lateral lumbar interbody fusion (LLIF), offers significant advantages over traditional methods. PTP has demonstrated increased lumbar lordosis gains compared to LLIF, owing to the natural increase in lordosis afforded by prone positioning. Additionally, the prone position offers anatomical advantages, with shifts in the psoas muscle and lumbar plexus, reducing the likelihood of postoperative femoral plexopathy and moving critical peritoneal contents away from the approach. Furthermore, operative efficiency is a notable benefit of PTP. 
  • 658
  • 26 Feb 2024
Topic Review
History of Preoperative Planning for Breast Reconstruction
Breast reconstruction is an essential component in the multidisciplinary management of breast cancer patients. Over the years, preoperative planning has played a pivotal role in assisting surgeons in planning operative decisions prior to the day of surgery. The evolution of preoperative planning can be traced back to the introduction of modalities such as ultrasound and colour duplex ultrasonography, enabling surgeons to evaluate the donor site’s vasculature and thereby plan operations more accurately. However, the limitations of these techniques paved the way for the implementation of modern three-dimensional imaging technologies. With the advancements in 3D imaging, including computed tomography and magnetic resonance imaging, surgeons gained the ability to obtain detailed anatomical information. Moreover, numerous adjuncts have been developed to aid in the planning process. The integration of 3D-printing technologies has made significant contributions, enabling surgeons to create complex haptic models of the underlying anatomy. Direct infrared thermography provides a non-invasive, visual assessment of abdominal wall vascular physiology. Additionally, augmented reality technologies are poised to reshape surgical planning by providing an immersive and interactive environment for surgeons to visualize and manipulate 3D reconstructions. Still, the future of preoperative planning in breast reconstruction holds immense promise. 
  • 654
  • 17 Aug 2023
Topic Review
Frontline Extended Surgery
Surgery is the only curative treatment for localized disease in retroperitoneal sarcoma (RPS). Frontline extended surgery, or compartmental surgery, is a surgical strategy consisting of resecting the tumor together with adjacent organs, with the aim of minimizing marginality. 
  • 653
  • 08 Sep 2022
Topic Review
Local Aggressive Treatment in Oligometastatic NSCLC
In oligometastatic NSCLC, the treatment of all tumor sites should be technically feasible with tolerable toxicity. It was thus proposed that oligometastatic NSCLC should include five or fewer metastases in three or fewer organs. Notably, the primary tumor and an involvement of mediastinal lymph nodes are excluded as a metastatic site, while pulmonary or pleural metastases are counted as a metastatic site. Patients with diffuse serosal metastases (meningeal, pericardial, pleural, or peritoneal) or bone marrow involvement are as well excluded from the definition of oligometastatic NSCLC, for they cannot be treated with radical intent. In general, most (oligo) metastases of NSCLC are found in the brain (35.5%), followed by the contralateral lung (33.6%), the adrenal glands (10%), bones (8.5%), and the liver (2.4%). One-fourth of all patients with metastatic non-small cell lung cancer presents with a limited number of metastases and relatively low systemic tumor burden. This oligometastatic state with limited systemic tumor burden may be associated with remarkably improved overall and progression-free survival if both primary tumor and metastases are treated radically combined with systemic therapy. This local aggressive therapy (LAT) requires a multidisciplinary approach including medical oncologists, radiation therapists, and thoracic surgeons.
  • 650
  • 06 Jan 2022
Topic Review
Mesothelioma Surgery
Mesothelioma is an aggressive disease arising from parietal pleura. Surgery is a valuable option in the frame of a multimodality treatment. Several surgical approaches have been standardized with the aim of a macroscopic complete resection; these often require homolateral diaphragm and pericardial resection and reconstruction. Extrapleural pneumonectomy (EPP) and extended pleurectomy decortication (EPD) have been recognized as radical surgical procedures. Nevertheless, both operations are technically challenging and associated with a significant rate of peri-operative morbidity and non-negligible mortality. The diaphragmatic and pericardial reconstruction technique is mandatory to avoid respiratory impairment and to reduce post-operative complications like gastric and cardiac herniation. Moreover, in the case of localized chest wall recurrence, surgery might be considered a valuable therapeutical option for highly selected and fit patients. All the technical aspects of the resection and reconstruction of the diaphragm, pericardium, and chest wall are described as well as the possible use of new minimally invasive techniques. In addition, the choice of different prosthetic materials, considering the most recent innovations in the field, are discussed.
  • 649
  • 25 Jun 2021
Topic Review
Esophagogastric Cancer Surgery
Esophagogastric cancer is among the most common malignancies worldwide. Surgery with or without neoadjuvant therapy is the only potentially curative treatment option. Although esophagogastric resections remain associated with major surgical trauma and significant postoperative morbidity. Prehabilitation has emerged as a novel strategy to improve clinical outcomes by optimizing physical and psychological status before major surgery through exercise and nutritional and psychological interventions.
  • 647
  • 27 Apr 2022
Topic Review
Primary Skull Base Chondrosarcomas
Primary skull base chondrosarcomas (SBCs) may carry significant tumor-burden by causing severe cranial nerve neuropathies. Current treatment strategies mainly focus on surgical resection and radiotherapy protocols, with a wide range of findings in terms of efficacy and safety. 
  • 642
  • 12 Jan 2022
Topic Review
Known Factors of Acute Pancreatitis
Pancreatitis is regarded by clinicians as one of the most complicated and clinically challenging of all disorders affecting the abdomen. It is classified on the basis of clinical, morphological, and histological criteria. Causes of acute pancreatitis can easily be identified in 75–85% of patients. The main causes of acute, recurrent acute, and chronic pancreatitis are gallstone migration and alcohol abuse. Other causes are uncommon, controversial, or unexplained. For instance, cofactors of all forms of pancreatitis are pancreas divisum and hypertriglyceridemia. Another factor that should be considered is a complication of endoscopic retrograde cholangiopancreatography: post-endoscopic retrograde cholangiopancreatography acute pancreatitis. 
  • 636
  • 11 Oct 2022
Topic Review
Augmented Reality in Minimally Invasive Surgery Procedures
Augmented reality (AR) technology is gaining increasing interest in the development of minimally invasive surgery (MIS) procedures. The main application areas can be divided into three main groups: Navigation, education and training, and user-environment interfaces. Although AR-guided navigation systems do not yet offer a precision advantage, benefits include improved ergonomics and visualization, as well as reduced surgical time and blood loss. Benefits are also seen in improved education and training conditions and improved user environment interfaces, which may indirectly influence MIS procedures. Controlled studies with large case numbers and standardized outcome parameters and reporting are lacking to confirm the added value for clinical use.
  • 634
  • 04 May 2023
Topic Review
Minimally Invasive Approach for Multiple Hepatocellular Carcinoma
The best therapy for patients with multiple hepatocellular carcinoma (HCC) within the Milan Criteria is liver transplantation (LT). Unluckily, LT cannot be offered to all the patients. For the intermediate staged multiple HCC trans-arterial chemoembolization (TACE) still remains the treatment of choice. However, a growing body of evidence is showing better outcomes after surgery than TACE. Trans-arterial radioembolization and stereotaxic body radiation therapy can also play an important role in this setting. Furthermore, the role of minimally invasive liver surgery (MILS) for patients with multiple HCC is still debated.
  • 629
  • 27 Dec 2022
Topic Review
Biomarkers and Therapeutic Targets for Melanoma
Malignant melanoma is one of the most common cancers in the world. In the disease’s early stages, treatment involves surgery, in advanced stages however, treatment options were once scarce. There has been a paradigm shift in advanced melanoma treatment with the introduction of immunotherapy and targeted therapies. Understanding the molecular pathways and their pathologic counterparts helped identifying specific biomarkers that lead to the development of specific targeted therapies.
  • 628
  • 25 Oct 2022
Topic Review
Precision Medicine for Hepatocellular Carcinoma
Hepatocellular carcinoma (HCC) is one of the major malignant diseases worldwide, characterized by growing incidence and high mortality rates despite apparent improvements in surveillance programs, diagnostic and treatment procedures, molecular therapies, and numerous research initiatives. Most HCCs occur in patients with liver cirrhosis, and the competing mortality risks from the tumor and the cirrhosis should be considered. Presently, previously identified risk factors, such as hepatitis virus infection, hepatic inflammation and fibrosis, and metabolic syndrome, may be used as chemoprevention targets. The application of precision medicine for HCC management challenges the one-size-fits-all concept; moreover, patients should no longer be treated entirely according to the histology of their tumor but based on molecular targets specific to their tumor biology. Next-generation sequencing emphasizes HCC molecular heterogeneity and aids our comprehension of possible vulnerabilities that can be exploited. 
  • 625
  • 05 May 2022
Topic Review
Autologous Breast Reconstruction versus Implant-Based Breast Reconstruction
The autologous method for breast reconstruction has been determined by researchers throughout the field as providing comparable benefits and positive long-term outcomes with more natural results compared to implant-based breast reconstruction which can often result in firmer, less natural breast mounds and increase the risks associated with foreign material in the body. The traditional method of using the abdomen, thigh, or gluteus region as a donor site has been a suitable, if not preferred, option for patients undergoing unilateral or bilateral non-implant-based reconstruction. By utilizing the rectus abdominus, latissimus dorsi, transverse or diagonal upper gracilis, gluteal, or any other appropriate muscle flap with transposable vasculature, surgeons are able to recreate a warm, soft, and natural breast mound in the place of removed breast tissue and skin that may be necessary for patients with locally involved breast cancer.
  • 615
  • 27 Jun 2023
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