bluuebunny/crossref_metadata_2025 huggingface dataset:
Two-dimensional laser-induced periodic surface structures formed on crystalline silicon by GHz burst mode femtosecond laser pulses
Authors: Kawabata Shota , Bai Shi , Obata Kotaro , Miyaji Godai , Sugioka Koji
Published: January 2023

Femtosecond laser pulses with GHz burst mode that consist of a series of trains of ultrashort laser pulses with a pulse interval of several hundred picoseconds offer distinct features in material processing that cannot be obtained by the conventional irradiation scheme of femtosecond laser pulses (single-pulse mode). However, most studies using the GHz burst mode femtosecond laser pulses focus on ablation of materials to achieve high-efficiency and high-quality material removal. In this study, we explore the ability of the GHz burst mode femtosecond laser processing to form laser-induced periodic surface structures (LIPSS) on silicon. It is well known that the direction of LIPSS formed by the single-pulse mode with linearly polarized laser pulses is typically perpendicular to the laser polarization direction. In contrast, we find that the GHz burst mode femtosecond laser (wavelength: 1030 nm, intra-pulse duration: 220 fs, intra-pulse interval time (intra-pulse repetition rate): 205 ps (4.88 GHz), burst pulse repetition rate: 200 kHz) creates unique two-dimensional (2D) LIPSS. We regard the formation mechanism of 2D LIPSS as the synergetic contribution of the electromagnetic mechanism and the hydrodynamic mechanism. Specifically, generation of hot spots with highly enhanced electric fields by the localized surface plasmon resonance of subsequent pulses in the bursts within the nanogrooves of one-dimensional LIPSS formed by the preceding pulses creates 2D LIPSS. Additionally, hydrodynamic instability including convection flow determines the final structure of 2D LIPSS.
Laser machining fundamentals: micro, nano, atomic and close-to-atomic scales
Authors: Wang Jinshi , Fang Fengzhou , An Haojie , Wu Shan , Qi Huimin , Cai Yuexuan , Guo Guanyu
Published: January 2023

With the rapid development in advanced industries, such as microelectronics and optics sectors, the functional feature size of devises/components has been decreasing from micro to nanometric, and even ACS for higher performance, smaller volume and lower energy consumption. By this time, a great many quantum structures are proposed, with not only an extreme scale of several or even single atom, but also a nearly ideal lattice structure with no material defect. It is almost no doubt that such structures play critical role in the next generation products, which shows an urgent demand for the ACSM. Laser machining is one of the most important approaches widely used in engineering and scientific research. It is high-efficient and applicable for most kinds of materials. Moreover, the processing scale covers a huge range from millimeters to nanometers, and has already touched the atomic level. Laser–material interaction mechanism, as the foundation of laser machining, determines the machining accuracy and surface quality. It becomes much more sophisticated and dominant with a decrease in processing scale, which is systematically reviewed in this article. In general, the mechanisms of laser-induced material removal are classified into ablation, CE and atomic desorption, with a decrease in the scale from above microns to angstroms. The effects of processing parameters on both fundamental material response and machined surface quality are discussed, as well as theoretical methods to simulate and understand the underlying mechanisms. Examples at nanometric to atomic scale are provided, which demonstrate the capability of laser machining in achieving the ultimate precision and becoming a promising approach to ACSM.
Trying to adjunct without knowing how: adjunction and the adoption problem
Authors: Susanszky Peter
Published: January 2023

The adoption question asks whether there are logical rules that cannot be adopted if one does not already infer in accordance with them. Several philosophers, most famously Saul Kripke and Romina Padró, agree that there are such rules. Accordingly, they agree that there is an adoption problem. However, there is disagreement over which rules are unadoptable. In particular, while most agree that if there is an adoption problem, modus ponens and universal instantiation are in its scope, many would exclude adjunction from the list. In this paper, I argue that adjunction is in the scope of the adoption problem. Then I show that the most straightforward counterargument against adjunction being in the scope of the problem, which tries to reformulate the adjunction rule into a more palatable one, does not work.
RANDOMIZED STUDY ON THE EFFICACY OF NEGATIVE PRESSURE WOUND THERAPY (NPWT) IN THE PREVENTION OF SURGICAL SITE COMPLICATIONS
Authors: Suárez Sánchez A , de Santiago Álvarez I , García Munar M , García González L A , Cifrian Canales I , Díaz Vico T , Moreno Gijón M , Sanz Álvarez L
Published: January 2023

Introduction

The secondary consequences of SSC worsen patient's quality of life, while increasing healthcare costs considerably. Applying preventive measures to reduce this complication rate should be one of the priorities of improving healthcare.

Methods

We conducted a prospective randomized study between March 2019 and March 2021 in a General Surgery Department of a tertiary hospital. Operated patients with risk factors for developing (SSC) were included according to the established protocol, and were randomized to the use of NPWT or conventional dressing (CD). The aim of our study was to compare SSC (skin dehiscence, seroma, hematoma, edge necrosis, and wound infection) in both groups, and to assess the benefit of NPWT.

Results

We studied 267 patients, 124 (46.4%) in the NPWT group and 143 (53.6%) in the CD group, with a mean age of 68 (±12.9) years. 96.2% of the patients corresponded to the ASA II or III classification.

A total of 72 (27%) SSC were observed, being significantly lower in the NPWT group (odds ratio [OR] 0.49; confidence interval [CI] 0.28–0.85; p <0.05). The median hospital stay was 10 (7–20) days.

Relative risk reduction (RRR) was 41.5% and absolute risk reduction (ARR) was 14%, with a number needed to treat (NNT) of 6.9.

Conclusion

NPWT decreases the risk of SSC, so its use should be considered in patients with risk factors.
MANAGEMENT OF BILE DUCT INJURY IN A REFERRAL CENTER, 10 YEARS OF EXPERIENCE
Authors: Hinojosa Ugarte D , Montiel Hinojosa L , Lozada Hernandez E E , Crocco Quiros B , Nieves Condoy J , Cethorth Fonseca R
Published: January 2023

Introduction

Bile duct injury represents major morbidity and mortality, and in the last two decades in which laparoscopy cholecystectomy has been universally available several factors associated with bile duct injury have been described: one of them being the surgeon's training and experience in laparoscopic cholecystectomy. Some authors have reported that the training curve stabilizes the risk of bile duct injury from 1.7 to 0.17% by procedure number 50. Given that most surgical residency programs don't have enough experience in laparoscopy, this likely contributes to the development of bile duct injury. Therefore, it is important to elucidate the risk factors for bile duct injury in our country.

Methods

In a referral center we collected the data from 10 years of experience in bile duct repair for bile duct injury. The clinical records for 83 patients were obtained and analyzed.

Results

High-quality hepaticojejunostomy was performed in all 117 cases, 89.8% open, 8.5% laparoscopic and 1.7% was converted from laparoscopic to open. In 41% of patients, partial resection of the IV segment was necessary. the main post-operatory complication was surgical site infection in 19.6%, overall mortality was 3.4%. according to McDonald Classification for Group A 56.4%, Group B 28.2%, Group C 10.2%, Group D 5.2%, in long-term follow-up.

Conclusions

Surprisingly, the open cholecystectomy was the most common procedure associated with bile duct injury in our population. Postoperative injury detection was the most frequent, and the most common injury location was near the confluence. We obtained good long-term results even the type of injuries. The disproportion between training centers and hospitals all around the country may impact these results due to the lack of experience of the young surgeons that have only had training in laparoscopic surgery and the lack of universal laparoscopic availability for emergencies. The patients that suffer from this complication are of middle age, and there is a significant disproportion between males and females, with females being the most affected group. It has an impact on their quality of life. High-quality hepaticojejunostomy with Hepp-couinaud technique provides good long-term results, with no difference between the 1–5 year and the 6–10 year groups. The segment IV hepatectomy represents a good option to access the hilar plate. It is important to continue to expose surgeons during their residencies to open cholecystectomy. Prevention is the cheapest and safest way to decrease the incidence of bile duct injury.

The implementation of high-volume centers such as ours is important to bring early and high-quality solutions to problems like these.
ASSESSMENT OF THE RISK OF UROTHELIAL CANCER IN THE BLADDER AND UPPER URINARY TRACT WITH THE IDENTIFY STUDY CALCULATOR: MONOCENTRIC PROSPECTIVE STUDY
Authors: Abad López P , Gómez Rivas J , Alonso Bartolomé S , Gutiérrez Hidalgo B , Martín Monterrubio J , de la Parra Sánchez I , Galante Romo I , Moreno Sierra J
Published: January 2023

Introduction

The British Urology Researchers in Surgical Training (BURST) collaborative group developed a urothelial cancer risk calculator based on the IDENTIFY study, in patients with gross or microscopic hematuria. Our objective is the validation of this calculator in our environment.

Methods

Descriptive and ambispective study of 88 patients with hematuria, from June 2020 to November 2021. Demographic aspects, positivity of imaging tests, classification of the IDENTIFY risk calculator and the need for treatment were compared.

Results

53 presented with macrohematuria (60.2%) and 35 with microhematuria (39.8%). 58 were men (65.9%) and 30 women (34.1%). The mean age was 64.66 years (SD: 15) and the median follow-up was 7 months.

Of the 26 patients with high risk in the calculator, 17 had bladder tumors (65.4%), being 57.1% cTa and 35% cT2. Of the 38 patients with intermediate risk, 3 patients had tumors (7.9%). Of the 24 with low risk, none had tumors.

Among the high-risk patients, 48.1% presented an ultrasound with lesions, of the intermediate-risk patients, 3% presented an ultrasound with lesions, and of the low-risk patients, none (p<0.05). With regard to high-risk patients, 58.8% presented cystoscopy with lesions, with 4% of intermediate-risk patients and only 2% of low-risk patients (p<0.05).

Conclusions

In our series, there are statistically significant differences according to the risk group of the IDENTIFY calculator and the finding of tumors in conventional diagnostic tests.
ENDOSCOPIC AND PERCUTANEOUS MANAGEMENT OF AN IATROGENIC DISTAL PANCREATIC FISTULA DURING VASCULAR SURGERY
Authors: Solar García L , Miyar de León A , Cadenas F , García Bernardo C , Contreras Saiz E , Merayo Álvarez M , González Pinto I
Published: January 2023

Introduction

Traumatic pancreatic fistulas are, normally, secondary to a partial or complete rupture of the pancreatic duct. Pancreatic surgery is associated with high morbidity and mortality, thus a step-up approach, with priorization of a conservative or endoscopic management, is useful in selected cases.

Clinical case

A 74-year-old man underwent resection of a thoraco-abdominal aneurysm with placement of a vascular graft and reimplantation of visceral arteries. In the immediate postoperative period, he presented with febrile syndrome and abdominal pain. Abdominal CT was performed, observing a retroperitoneal collection of 7cm. Ultrasound-guided percutaneous drainage of the collection was performed. Amylase levels in the drainage were analyzed, which were compatible with a pancreatic fistula. Pancreatomagnetic resonance imaging confirmed partial disruption of the pancreatic duct. In successive radiological studies, the persistence of the collection was observed, and the removal of the drain was prevented. ERCP was performed with insertion of a pancreatic stent (photo 1) and papillotomy with good clinical evolution. In subsequent ambulatory CT, the progressive decrease of the retroperitoneal collection was evident. The percutaneous drainage was removed. After 3 months, the pancreatic stent was removed.

Discussion

Diagnosis of iatrogenic traumatic pancreatic injury is difficult and requires a high degree of caution. Pancreatoresonance is the gold-standard for imaging. The transpapillary placement of pancreatic stents, in selected patients, has a high success rate.
LAPAROSCOPIC LIVER RESECTION FOR METASTASIS OF RETROPERITONEAL LEIOMYOSARCOMA
Authors: Solar García L , Silva Cano D W , Miyar de León A , García Bernardo C , Contreras Saiz E , Michi Campos J L , González Pinto I
Published: January 2023

Introduction

Soft tissue leiomyosarcomas represents 0.7% of all malignant tumors. The most common location is the retroperitoneum, and the appearance of local or distant recurrences after resection is not uncommon. Pathological study is important to establish the confirmatory diagnosis and the prognosis of this type of lesion.

Clinical case

We present the clinical case of a patient with retroperitoneal leiomyosarcoma that was resected associated with ipsilateral nephrectomy. An 11-month follow-up revealed a hepatic lesion in segment 5, suggestive of metastasis. We decided on surgical resection of this lesion.

Liver segmentectomy was performed by laparoscopic approach. The pathological study of the liver lesion showed a tumor of about 5 centimeters, compatible with leiomyosarcoma metastasis, presenting abundant mitoses (8/10), 15% necrosis in the central area and a Ki67 of 20%.

Discussion

Leiomyosarcoma is a very aggressive tumor. Its treatment is fundamentally based on the surgical resection of the primary and its possible metastases. The pathological study of the piece, with special emphasis on the number of mitoses, as well as the Ki- 67%, are indicators of the aggressiveness of the tumor and the prognosis. Given the low incidence of these tumors, it is recommended that the approach of these tumors be done in multidisciplinary teams and in specialized centers.
EMPHYSEMATOUS PANCREATITIS: A RARE COMPLICATION OF ACUTE PANCREATITIS
Authors: Solar García L , García Munar M , Ibero Casadiego D P , Contreras Saiz E , Navarro Sanz S , Miyar de León A , García Bernardo C , González Pinto I
Published: January 2023

Introduction

Emphysematous pancreatitis (EP) is a serious and rare complication within the spectrum of acute pancreatitis (AP). The diagnosis is based on clinical and radiological data, that presents intraparenchymal pancreatic air in the setting of necrotizing infection.

This clinical and radiological manifestation of infected pancreatic necrosis has mortality rates of over 40%.

Clinical case

A 71-year-old male came to the emergency department due to epigastric pain of 48h duration associated with hypotension, bradycardia with elevated pancreatic enzymes, requiring admission to the Intensive Care Unit. Initial resuscitation treatment was established, and a CT scan was performed which showed abundant air in the retroperitoneum, associated with signs of inflammation of the pancreatic gland as well as obstructive choledocholithiasis and without being able to radiologically rule out an intestinal perforation.

After fluid resuscitation and stabilization of the patient, urgent surgery was performed, which showed necrosis of the entire pancreatic gland with abscessed peripancreatic collections. Wide open necrosectomy, exploration of the bile duct with extraction of lithiasis, and cholecystectomy were performed. The patient had a slow and prolonged postoperative period, progressively improving until he was discharged home.

Discussion

Therapeutic options for EP range from conservative management to surgery. Surgery, in these patients, is the last therapeutic step, after endoscopic or percutaneous drainage. The video-assisted retroperitoneal approach is the better procedure to be considered, since it entails less morbidity and mortality than open necrosectomy.
MANAGEMENT OF OBSTRUCTIVE JAUNDICE IN PATIENTS WITH PERIAMPULLARY TUMORS IN A COVID-19 PANDEMIC SITUATION
Authors: Carrasco Aguilera B , Solar García L , Miyar de León A , García Alonso L , del Val Ruiz P , García Bernardo C , Contreras Saiz E , González Pinto I
Published: January 2023

Introduction

The redistribution of hospital resources secondary to SARS-CoV-2(COVID19) produced a reduction and delay in surgical activity.

Analysis of the management of obstructive jaundice (OI) in a reference centre during COVID19 in patients with potentially resectable periampullary tumours.

Methods

Observational study, limited to the year 2021, on the management of OI in periampullary pathology.

Analysis of the different biliary drainage (BD) techniques (endoscopic/transhepatic) and the associated complications.

The indication criteria for BD were: bilirubin levels >10 mg/dl, cholangitis or expectation of surgery >2 weeks from inclusion on the waiting list. Patients with criteria of unresectability or those with neoadjuvant indication were excluded from the study.

Results

Thirty-five patients were analyzed, with an age range between 45–80 years, who were indicated to undergo a pancreaticoduodenectomy.

51% of these patients required preoperative DB. DB was performed endoscopically (ERCP) in 10 patients and by transparietohepatic approach (TPHD) in 8 patients. In endoscopic approach the majority of stents used were expandable coated metallic (eight patients).

The most frequent complications associated with ERCP were cholangitis and acute cholecystitis. The most frequent complication associated with TPHD was cholangitis.

Conclusions

Preoperative BD associates a greater number of perioperative complications. At present, there is consensus in avoiding preoperative DB, except in cases with cholangitis or hyperbilirubinemia. If DB is necessary, the endoscopic approach (ERCP) would be indicated. Coated Metal stents should be considered for patients with resectable pancreatic cancer, especially if surgery is not immediate.
ROBOTIC APPROACH TO THE MAIN BILE DUCT IN THE TREATMENT OF CHOLEDOCOLITIASIS. EXPERIENCE OF A BILIO-PANCREATIC UNIT
Authors: Sánchez-Bueno F , Gil Vázquez P J , Ferreras Martínez D , Gómez Pérez B , Gómez Boch F , Alcaraz Solano Á
Published: January 2023

Introduction

The aim of this paper is to analyze the validity and safety of a new program for the implementation of a robotic approach in the treatment of choledocholithiasis (CD) in a Bilio-Pancreatic Unit, evaluating morbi-mortality and hospital stay.

Methods

Given the controversy of which is the best therapeutic option in CD: preoperative ERCP followed by laparoscopic cholecystectomy (LC) or laparoscopic approach to the bile duct, we designed this prospective, non-randomized and single-center study with a robotic approach to the bile duct. 25 patients were included (14 women /11 males), with a mean age of 71.4 years. Preoperative abdominal ultrasound and cholangioresonance were performed in all patients.

Results

The robotic approach was effective in all cases: cholecystectomy and cleaning the bile duct. In the first three cases a radiological exploration was performed through the cystic duct during intervention. In all cases an exploration of the bile duct with a flexible choledoscope after choledochotomy was performed too. The mean operative time was 128.8 +/-16.9 minutes. Choledocholithiasis was confirmed in all patients. Furthermore, a patient had a papillary tumor of the distal common bile duct associated. One patient who had advanced cholecystitis had a biliary fistula. It was resolved conservatively by placing an endoscopic plastic biliary prosthesis. If we exclude the patient with the biliary fistula, the hospital stay postoperative period was 2 days.

Conclusions

Robotic approach in the treatment of choledocholithiasis is an effective and safe technique. In addition, postoperative morbidity and hospital stay decreases.
ANTIOXIDANT TREATMENTS IN THE PROPHYLAXIS OF INTESTINAL REPERFUSION DAMAGE
Authors: Velasco Oraa X , García-Alonso Montoya I , Cearra Guezuraga I , Ruiz Montesinos I , Herrero de la Parte B
Published: January 2023

Introduction

Intestinal ischemia-reperfusion is still a relevant clinical problem, especially in newborns and in the elderly. In this piece of work, we check the utility of curcumin and dexmedetomidine to overcome the damage induced by reperfusion, both locally and in distant organs, using α-tocopherol as a comparison.

Methods

In female Wag/RijHsd rats, the superior mesenteric artery was clamped for 1 h; then, animals were allowed 4 h of reperfusion. Curcumin (200 mg/kg, oral) was given 24 h and 2 h before clamping; α-tocopherol (20 mg/kg, i.p.) was administered 2 h before ischemia, and dexmedetomidine (10 or 40 mg/kg, s.c.; dex-10 and dex-40, respectively) was given 15 minutes before ischemia. Blood samples and terminal ileum were collected. Additionally, a D-xylose absorption test was performed to evaluate intestinal absorption; 1h after D-xylose administration, D-xylose plasma levels were quantified (mg/ml).

Results

All of the treatments reduced histological damage assessed with Chiu's scale (non-treated, 2.6 ± 0.75; curcumin, 1.54 ± 0.8; dex-10, 1.47 ± 0.7; dex-40 1.43 ± 0.9; α-tocopherol, 1.01 ± 0.8) and improved absorption of D-xylose (healthy rats 2.06 ± 0.07; non-treated, 1.18 ± 0.07; curcumin 1.76 ± 0.30; dex-10, 2.29 ± 0.20; dex-40, 2.25 ± 0.26; α-tocopherol 1.66 ± 0.21). Dexmedetomidine improved renal function (it reduced both creatinine and urea in serum). The elevation of liver enzymes in serum was not improved by any of the drugs.

Conclusions

The three drugs proved to be useful, though α-tocopherol was more efficient regarding histological damage, and only dexmedetomidine restored D-xylose absorption to normal values.
CHALLENGING THE DOGMAS: LAPAROSCOPIC COMMON BILE DUCT EXPLORATION THROUGH DIATHERMY, CHOLEDOCHOTOMY AND PRIMARY CLOSURE. LONG TERM OUTCOMES IN A REFERRAL CENTER
Authors: Gómez D , Mendoza A , Pedraza M , Salcedo Miranda D F , Mantilla-Sylvain F , Lozada-Martínez I D , Domínguez-Alvarado G , Cabrera Vargas L F
Published: January 2023

Introduction

Choledocholithiasis is a frequent pathology, unfortunately when its endoscopic management fails there is no consensus on how it should be addressed. The aim of this study was to evaluate the safety, feasibility and long-term outcomes of laparoscopic common bile duct exploration (LCDBE) using electrosurgery (coagulation) for choledochotomy followed by primary closure after endoscopic treatment failure.

Methods

A retrospective cohort of 168 patients who underwent LCDBE from 2013 to 2018 which was conducted all by choledochotomy. Clinical demographics, operative outcomes, recurrence rate of CBD stones, and long-term bile duct complications were analyzed.

Results

The male/female ratio was 90/78 and mean age was 73 years. Stone clearance was successful in 167 patients (99.4%). Nonlethal complications were noted in 3 patients during the surgery or in the immediate postoperative (1.79%) and managed with T-tube or endoscopically. No cases of surgery-related mortality were observed. There were no signs of any type of biliary injury or stricture observed in any of the patients during the 24-month follow-up period.

Conclusions

LCBDE through choledochotomy with diathermy and primary closure can be performed without increased risk of operative complications such as important and visual-impairment bleeding as well as long-term complications such as bile duct stricture or recurrent CBD stones. LCBDE with diathermy and primary closure is a safe and effective treatment option for choledocholithiasis for failed ERCP in terms of long-term outcome as well as short-term outcome.
RHEOLOGICAL CHARACTERISATION OF DIFFERENT ALGINATE-BASED HYDROGELS FOR A BIOMIMETIC REPRESENTATION OF A TOOTH
Authors: Mendoza Cerezo L , Rodríguez Rego J M , Macías García A , Carrasco Amador J P , Marcos Romero A C , Díaz Parralejo A
Published: January 2023

Introduction

In bioprinting, it is essential to correctly characterise the materials to be used in order to ensure the highest cell viability while maintaining the best structural properties of the hydrogels.

Methods

Alginate-based hydrogels with different concentrations have been characterised because they are currently the ones with the best printing properties according to the literature.

The concentrations chosen were 3.5%, 4% and 5% alginate, and then a scaffold was bioprinted with the one with the best mechanical properties.

Finally, a 3D model of a tooth was bioprinted to check the integrity of the hydrogel characterised as a somewhat more complex structure than a simple scaffold.

Results

It could be observed that, despite suffering a similar viscosity loss to the rest, the sample with the best viscosity properties when subjected to shear stresses was the one containing 5% alginate concentration.

When a simple scaffold was bioprinted, it was observed that the result was positive, as the visual analysis corresponded to the parameters programmed in 3D design software. Likewise, the subsequent bioprinting of the dental model showed good results.

Conclusions

The hydrogels characterised by rheometry showed similar behaviour with respect to viscosity. Furthermore, it was found that the hydrogel with higher viscosity allowed for higher quality bioprints.
RELATIONSHIP BETWEEN RHEOLOGICAL PROPERTIES OF HYDROGELS, BIOPRINTING PARAMETERS AND 3D SCANNER TECHNOLOGY
Authors: Rodríguez Rego J M , Mendoza Cerezo L , Macías García A , Carrasco Amador J P , Marcos Romero A C , Díaz Parralejo A
Published: January 2023

Introduction

In bioprinting techniques, tissue engineering from 3D models to generate the desired geometry is as important as cell proliferation, as it will be key to the survival of the printed tissue and its functional success.

Methods

Alginate-based hydrogels were used because they are the most widely used by the scientific community for bioprinting.

The alginate-based hydrogels used were characterised using a rheometer to obtain the boundary conditions to be applied in the computational software.

A 2D axisymmetric model together with a two-phase flow level set interface of a bioprinting nozzle and a computational model of a human tooth were carried out to verify the results obtained.

Results

The data showed that droplet detachment occurs at lower pressures based on the higher the percentage of alginate. In addition, samples with a higher percentage of alginate were less sensitive to pressure during extrusion.

Conclusions
CONTENT VALIDATION OF THREE MODULES FOR ONLINE TRAINING OF MINIMALLY INVASIVE SURGERY
Authors: Sánchez-Peralta L F , Ortega-Morán J F , Sánchez-González P , Oropesa I , Juhos K , Tiu C , Pagador J B , Sánchez-Margallo F M
Published: January 2023

Introduction

Training tools should follow a thorough validation process that assure their value before their wider use. In this regard, three online modules for laparoscopic cholecystectomy, lumbar punction and knee arthroscopy have been created for an integrative Learning Management System (LMS) that connects external assets, therefore allowing training of technical and nontechnical skills. This work focuses on the content validation of the modules to determine the appropriateness of the material for learning purposes.

Methods

The contents for the three modules have been developed following a 3D pedagogical model designed for e-learning in minimally invasive surgery. Experts were requested to rate 10 items about the contents and the activities included within the modules. Rating was done on a 5-point Likert scale (5-Strongly agree, 1-Strongly disagree).

Results

Six experts took part in the study. Contents were well rated as unique (4.17), sufficient to cover the learning objectives (4.50), up to date (4.33), realistic and relevant (4.83), professional (4.67), with adequate assessment (4), useful forum (4.33), good quality multimedia contents (4) but not so innovative (3.83). Lastly, external assets provided added value to the courses (4.5).

Conclusions

In general, experts were satisfied with the structure and the quality of the education material and found them to be well prepared according to the best practice of each profession. Therefore, the modules will be incorporated in the LMS for training, which will be further validated to prove its utility as a training tool.
EXVIVO AND IN VIVO PORCINE ANIMAL MODEL FOR VALIDATION OF UNIVEC TRANSANAL DEVICE
Authors: Gómez Dovigo A , Noguera Aguilar J F , Aguirrezabalaga González J , Centeno Cortés A
Published: January 2023

Introduction

Colorectal cancer screening has led to a greater number of early lesions being diagnosed. At the rectal level, minimally invasive surgery has become more important since major surgery increases morbimortality. This experimental study evaluates the feasibility, safety, and effectiveness of the UNIVEC® device for both abdominal and transanal procedures and compares it to other devices prior to its commercialization and use in the clinical setting.

Methods

UNIVEC® is a transanal device with a pneumatically sealed channel that allows the introduction of the flexible endoscope and 2 accessory channels. Thirty-two porcine models were used in the 2-phase study.

Results

Phase I: 18 models and 2 procedures (hysterectomy and cystectomy) were used and UNIVEC® was compared with 2 devices (SILS®, GelPOINT®). Phase II: 14 models and 3 procedures (polypectomy, EMR, DSE). The final prototype design was satisfactory and met the established minimum performance requirements.

Conclusions

UNIVEC® is a transanal device that allows for hybridization of laparoscopic and endoscopic instrumentation. A model anatomically similar to that of the human was needed to assess intraoperative complications arising during surgery before its clinical application. The porcine model, due to its anatomical characteristics and experience, was the model of choice in our project. The ex vivo model facilitates learning the technique of the device prior to its use in vivo, which offers greater final cost-effectiveness.
LIVER REGENERATION AND CHEMOTHERAPY, IS IT FEASIBLE?
Authors: Novo Sukia I , Mendia Bravo M , Gil Rodríguez E , García-Alonso I , Ruiz Montesinos I , Herrero de la Parte B
Published: January 2023

Introduction

Despite the known cytotoxic and hepatotoxic effects of the most common chemotherapy drugs, their use in the context of liver regeneration as part of antitumor treatment is controversial.

Methods

Thirty-six WAG/RijHsd rats were induced to selective portal ligation of 50% of the hepatic parenchyma, and divided into 3 experimental groups. 72 hours before, two of the groups were treated with 5-Fluorouracil (50mg/kg) (5FU) or with 5-FU (50mg/kg) + Oxaliplatin (10mg/kg) (5-FU+OX); the third was the untreated control. The weight of the animals and the liver remnant were quantified and the biochemical profile was determined after 24 hours (half of the animals) or 7 days (the other half).

Results

The treated animals did not show differences in the percentage of liver remnant after 24h or 7 days (control: 67±3.5; 5-FU: 66±2.9; 5-FU+OX: 65±1.1%). After 24 hours, an increase in AST and ALT was detected in the treated groups (5-FU and 5-FU+OX) compared to the control (1783±110 vs. 2306±516 vs. 1400±273 IU/L; and 1251 ±121 vs. 1822±386 vs. 949±145 IU/l, respectively, p<0.05). After 7 days, slight differences remained, but were not statistically significant. Albumin was significantly altered throughout the experimental process, without normalizing after 7 days.

Conclusion

The combined 5FU+OX treatment does not affect the regenerated liver volume, although it triggers an initial cytolytic reaction, which normalizes over time, with the nutritional deficit persisting.
AUTONOMOUS SPERMATOZOON-LIKE MICROROBOT WITH CHEMICAL PROPULSION
Authors: Mancha Sánchez E , Serrano Balbontín A J , Tejado Balsera I , Vinagre Jara B
Published: January 2023

Introduction

Robotics, as one of today's fastest growing disciplines and in support of surgeons, can generate significant advantages for both doctors and patients, such as increased automation of routine procedures or the performance of previously impossible procedures. Microrobotics is the use of microscale robots to be introduced into the body. The aim of this study is to develop a prototype of an autonomous spermatozoon-like microrobot propelled by chemical reactions for navigation in lumens.

Methods

To study the propulsion of the microrobot, a simulation was carried out in COMSOL. The movement of the microrobot was simulated by applying alternating forces emulating chemical actuation with and without a passive flagellum, in a fluid environment. In addition, a macro-scale prototype was developed. Two motors were used for propulsion with attached propellers. Their speed and the development of the programmed functions for movement were monitored. The microrobot's movement, propulsion and flagellum effect were studied in water.

Results

The simulations showed that without the flagellum, a drifting movement was generated, stabilising with its presence, as well as adding an additional impulse. The prototype showed similar behaviour to that obtained in the simulations, moving in the desired way.

Conclusions

It has been shown that the presence of the flagellum, without actuation, generates an additional impulse to the one developed by the initial propulsion. The prototype has also shown the feasibility of the simulations, and the possibility of manufacturing a microrobot on a sub-millimetre scale.
CORRELATION BETWEEN PATHOLOGIC AND INTRAOPERATIVE FINDINGS IN PATIENTS UNDERGOING PERITONEAL ONCOLOGIC SURGERY
Authors: García Alonso L , Rodríguez Uría R , González Turienzo E , Sanz Navarro S , Díaz Vico T , Contreras Saiz E , Turienzo Santos E O , Sanz Álvarez L
Published: January 2023

Introduction

Surgical Peritoneal Carcinomatosis Index (PCIq) subjectively calculated during surgery is a universally accepted value, both selective and prognostic. Calculation of PCI based on anatomopathological findings (PCIp) could be a more reliable value of tumor burden. We compare the differences between PCIq and PCIp by evaluating the prognostic significance and usefulness of PCIp.

Methods

We conducted a retrospective study of patients undergoing cytoreduction surgery and HIPEC between 2015 and 2019 in our General Surgery Department. Resected specimens were classified according to their definitive pathological anatomy for the calculation of PCIp, and compared with PCIq for each patient. ROC curves were applied to compare the prognostic value of both PCIs.

Results

Within the 68 procedures, the difference between PCIq and PCIp was 1.19 (0–8), with a total concordance in 53% of the cases. The discordance did not depend on the type of tumor, previous surgeries or neoadjuvant treatment. In 75% of the procedures there were negative samples for malignancy, which was associated with a higher disease-free survival (p = 0.017). ROC curves showed that PCIp was similar to PCIq as a predictor of survival or recurrence, with the number of positive resected specimens being the best predictor of recurrence (p = 0.035).

Conclusions

PCIq overestimates tumor burden, as the presence of negative specimens is frequent. PCIp does not seem to be a better tool for predicting recurrence or survival in our series. The number of positive samples more accurately estimates the probability of recurrence than PCIq, which may have prognostic significance.
PREHABILITATION THROUGH A MOBILE APPLICATION (PREHAPP) IN MAJOR COLON CANCER SURGERY
Authors: Lillo-García C , Lario Pérez S , Sánchez-Guillén L , Quinto Llopis S , Soler-Silva Á , Alcaide Quirós M J , López Rodríguez-Arias F , Arroyo A
Published: January 2023

Introduction

Prehabilitation aims to optimise functional capacity before surgery. We present the prehabilitation programme through a mobile app (PREHapp).

Methods

Patients with resectable colon cancer, ≥18 years old, without comorbidities and with Android Smartphones are selected. The following programme is proposed through PREHapp during the 4 week pre- and postoperative period. Depending on the results of the 6-minute test and the initial ergospirometry, the programme would be individualised with different objectives.

The app allows the patient to record their activities and synchronises with a website designed for the surgeon through which he/she can monitor compliance.

Results

The impact of prehabilitation on outcomes depended on compliance. Studies show that high compliance rates in ERAS programmes are associated with fewer postoperative complications. In this aspect, telemedicine could have great potential, as it has enabled the design of new health programmes that improve accessibility, including the creation of apps. The use of these apps favours therapeutic compliance and patient education, which enhances their empowerment in disease management.

Conclusions

There are few studies on the use of telemedicine in the field of prehabilitation. The PREHapp application could improve compliance and thus improve functional capacity before surgery.
PRELIMINARY RESULTS OF lncRNAs AS BIOMARKERS FOR COLORECTAL CANCER DIAGNOSIS
Authors: Fernández Hevia M , Fernández Martínez D , Cobzariu M A , García Santos G , Díaz Vico T , Miranda Castro R , Lobo Castañón M J , García Flórez L J
Published: January 2023

Introduction

lncRNAs are strands larger than 200 nucleotides that do not encode proteins. They have regulatory functions in cell proliferation, apoptosis and migration. They are stable over a long period and may have diagnostic value in colorectal cancer (CRC). Their availability as effective biomarkers for CRC screening would represent a substantial advance, as tests could be performed with minimal risk and wide acceptance. The aim of this study is to evaluate selected lncRNAs in plasma as potential diagnostic biomarkers in CRC.

Methods

Prospective cohort study between patients operated on for CRC (cases) and healthy patients (controls). Blood samples were processed in the biobank to obtain plasma by centrifugation. Subsequently, the levels of three CRC-related lncRNAs (HOTAIR, CCAT2 and PVT1) were determined in the laboratory of the Electroanalysis Group of the University of Oviedo (GEUO).

Results

In the initial results, an overexpression of the three genes (HOTAIR, CCAT2 and PVT1) was observed in CRC patients, with HOTAIR being the one that best differentiates between CRC and healthy patients. In addition, the combined determination of the three lncRNAs could obtain better results than the individual determination of each of them.

Conclusions

The lncRNAs studied are overexpressed in the CRC patient sample. The sample size needs to be increased to confirm this trend. It is logical to postulate that molecular technologies will lead to the development of better screening modalities and individualised treatments.
SMALL BOWEL INTUSSUSCEPTION CAUSED BY METASTASIS FROM A LOWER LIMB LIPOSARCOMA
Authors: Soto Dopazo M , Arango Bravo A , Lora Cumplido P , Nuño Iglesias C , Mateos Palacios C , Antuña Villa S , Lezana Pérez M Á , Fernández Fernández J C
Published: January 2023

Introduction

Liposarcoma represents one of the most frequent types of soft tissue sarcomas, constituting a heterogeneous group of lesions. There are four different subtypes: well-differentiated; dedifferentiated; myxoid and pleomorphic. Its main locations are the retroperitoneum, extremities, trunk and the cervical area.

Clinical case

A 90-year-old male with a pleomorphic liposarcoma in the left thigh in 2012, local recurrence from a dedifferentiated liposarcoma in 2018 and 2021, presented to our emergency department with abdominal pain and vomiting. CT scan revealed an image of intestinal intussusception in the distal jejunum due to a 5 cm intraluminal polyp.

Emergency laparotomy revealed a change in the distal jejunum caliber caused by the intussusception finding a 5 cm polypoid mass. We made an intestinal resection with a L-L anastomosis. Histopathological examination showed evidence of metastasis from dedifferentiated liposarcoma.

Discussion

A sarcoma is a malignant tumor, an infrequent type of cancer from connective tissue. The liposarcoma is the most frequent subtype and the dedifferentiated type can occur as dedifferentiation from other subtypes. The most common sites of metastasis include the lung, liver, and bone. Metastasis to the small bowel is rare with few reported cases.

Intestinal intussusception is an infrequent cause of mechanical intestinal obstruction in adults. Etiology is diverse and it is often caused by benign lesions in the small bowel and malignant lesions in the colon. The diagnostic technique of choice is the CT scan with contrast and treatment usually requires surgery. Intestinal reduction is controversial because of the risk of perforation or tumor spread.
MANAGEMENT OF HEMORRHAGE IN LAPAROSCOPIC COLORECTAL SURGERY
Authors: Silva Cano D W , López-Negrete Cueto E , Rodríguez García J I , Fernández Martínez D , Ibero Casadiego G P , García Alonso L , García Flórez L J , Granero Trancón J E
Published: January 2023

Introduction

Laparoscopic colorectal surgery (LCRS) offers similar oncologic outcomes to the open approach along with early postoperative recovery but is not without complications, with bleeding being uncommon but with variable impact and technical resource demand.

Methods

A descriptive and retrospective study of bleeding in patients undergoing elective LCRS in our center between 01/012018 and 31/12/2021. The data analysis was performed using the SPSS statistical software.

Results

Out of 945 LCRS, 45 patients (4.8%) presented some hemorrhagic event. The main diagnosis was colorectal cancer (35), followed by diverticular disease (6). The procedures most frequently associated with bleeding were sigmoidectomy (13), TATME (7) and right hemicolectomy (7). Five patients presented moderate (4) or severe (1) intraoperative bleeding, controlled during surgery. The most commonly used hemostatic devices were biopolar energy (29.5%) and combined (34.1%). The diagnosis of postoperative bleeding was clinical in 20 cases (45.5%), 17 by CT angiography (38.6%) and 7 by endoscopy (15.9%). In 36.4% the origin of hemorrhage was in the anastomosis, demonstrated by endoscopy or radiological study. Eleven patients (25%) required reintervention: seven by open approach and four by laparoscopy (two conversions). Therapeutic endoscopy was performed in 7 patients (15.9%), in 1 patient interventional radiology-surgery was combined, and in another patient endoscopy-surgery. There was no mortality due to this cause. The mean length of stay after surgery was 19.52 days.

Conclusions

Hemorrhage in LCRS is a rare but potentially serious complication that requires early diagnosis and staged multidisciplinary approaches, including advanced therapeutic endoscopy and interventional radiology procedures.
DEVELOPMENT OF A NATURAL POLYMER-BASED HYDROGEL FOR BIOENGINEERED VASCULAR GRAFTS
Authors: Loureiro J , Miguel S P , Galván-Chacón V P , Patrocinio D , Sánchez-Margallo F M , Pagador J B , Ribeiro M P , Coutinho P
Published: January 2023

Introduction

Cardiovascular diseases are a main cause of death globally, and their treatment implies various vascular repairs through different techniques like angioplasty, stent placement in the blocked artery, or bypass surgery. Artificial grafts would significantly reduce the number of non-treated patients, but middle and long-term failures compromise their clinical use.

Methods

Herein, we developed a hydrogel composed of gellan gum, gelatin, and sodium alginate for bioengineered vascular graft production. The vascular grafts were characterized by their swelling, porosity, biodegradability, and cytotoxic profile.

Results

The bioengineered materials were easily assembled due to the thermoresponsive nature of the hydrogel and had a vessel-like structure resembling the native vasculature. These vessels had a very controlled swelling degree, and notably, the hydrogel structure was stable and maintained its morphology. The vascular grafts had a porosity of 82.6 ± 4.3% and exhibited a controlled biodegradation rate with a maximum of 24.2 ± 3.0%. As expected, the natural materials used showed no cytotoxicity toward HUVECs cells since they are natural polymers described as biocompatible.

Conclusions

This developed natural hydrogel showed promising potential to be used to develop bioengineered vascular grafts.
INITIAL EVALUATION OF A REAL-TIME ERGONOMIC POSTURE ASSESSMENT SYSTEM IN LAPAROSCOPIC SURGERY
Authors: González Nuño F M , Plaza de Miguel C , Sánchez Margallo J A , López Agudelo I , González Portillo M R , Sánchez Margallo F M
Published: January 2023

Introduction

The objective of this study is to perform an initial evaluation of a system for assessment and visual feedback of the surgeon's posture during laparoscopic practice.

Methods

In order to monitor the surgeon's posture, we used the XSens motion tracking system. The neck, shoulder, elbow, and wrist joints were analyzed during laparoscopic practice. A visual feedback method was designed using Unity3D which indicates in real time if any of the analyzed joints suffers from an inadequate posture, allowing for its possible correction. The system was evaluated with a group of seven novice laparoscopic surgeons who performed several repetitions of two basic training tasks (eye-hand coordination and transfer). The participants were randomly organized into group A (4 subjects), who received visual feedback, and group B (3 subjects), as a control group.

Results

Regarding the coordination task, group A exhibited lower ergonomically inappropriate posture time for the left shoulder and elbow, being significant for the left shoulder posture. Similarly, this group showed a positive evolution during the training process for the different joints. Regarding the transfer task, both groups presented a positive evolution.

Conclusions

Preliminary results show that the presented method allows novice surgeons to improve their posture during laparoscopic practice. The use of the non-dominant hand and the complexity of the task seem to be conditioning aspects in the surgeon's ergonomics.
ROBOTIC PLATFORMS FOR MICROSURGERY: A SYSTEMATIC REVIEW
Authors: Pires Louçã L C , Jara Muriel M J , Plaza de Miguel C , González Francisco M , Abellán Rubio E , Sánchez Margallo J A , Sánchez Margallo F M
Published: January 2023

Introduction

Microsurgery involves procedures that demand maximum precision and dexterity, as well as the absence of tremor. In this regard, new robotic-assisted microsurgery solutions have emerged in recent years. The objective of this review is to analyze the current status of the robotic platforms in microsurgery.

Methods

This systematic review has been focused on the PubMed database over the last seven years (2015–2022), using keywords related to robotic platforms for microsurgery. Articles including clinical/preclinical studies were considered, and non-English language articles, abstracts, conference proceedings, reviews and letters were excluded.

Results

A total of 324 articles were identified, 27 of which passed the eligibility criteria.

Of the 14 platforms analyzed, da Vinci, MM3 and the easyMicro prototype incorporate their own vision system. The majority of the systems have tremor filtering and provide haptic feedback. The da Vinci system is the most widely used system in vascular and nerve microsurgery, reconstructive and lymph node dissection, eye surgery and urology. The MUSA and Symani systems have been used in reconstructive supermicrosurgery, the neuroarm in neurosurgery, the Surgical Robotic System and the easyMicro prototype in reconstructive and ocular surgery. The MM-3 (vascular), SMART (ocular) and smartARM (neurosurgery) have been tested in artificial models.

Conclusions

Among the platforms analyzed, da Vinci was the most widely used, specifically in ocular and reconstructive surgery. MUSA and neuroARM are rapidly progressing in reconstructive microsurgery and neurosurgery, respectively.