Surgical technology international
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The SARS-CoV-2 pandemic has affected millions across the world. Significant patient surges have caused severe resource allocation challenges in personal protective equipment, medications, and staffing. The virus produces bilateral lung infiltrates causing significant oxygen depletion and respiratory failure thus increasing the need for ventilators. ⋯ To manage risk of exposure, coordination of ventilation controlled by an anesthesiologist or a critical care physician with a surgeon during the procedure can minimize aerosolization to the team. Risk management and resource allocation is of the utmost importance in any global crisis and procedures must be appropriately planned and benefits to patients, as well as minimized exposure to healthcare providers, must be considered. Early tracheostomy could be a beneficial procedure for severe SARS-CoV-2 patients to minimize long-term virus aerosolization and exposure for healthcare workers while decreasing sedation, allowing for earlier transfer out of the ICU, and improving hospital resource utilization.
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Unicompartmental knee arthroplasty (UKA) is a feasible alternative to total knee arthroplasty (TKA) for selected patients with severe single-compartment knee osteoarthritis. Robotic-assisted UKA (rUKA) has recently emerged as a complementary tool to ameliorate previous difficulties with manual UKA (mUKA). However, the influence of rUKA compared to mUKA on patient outcomes are still largely unknown. ⋯ In conclusion, unicompartmental knee arthroplasty implants demonstrated comparable survivorship rates whether performed manually or with robotic assistance. However, compared to the manually performed procedure, robotic-assisted unicompartmental knee arthroplasty were found to offer benefits including shorter lengths of hospital stays, decreased postoperative pain scores, and improved functional outcomes.
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Total knee arthroplasty (TKA) in patients with established knee osteoarthritis and major varus, mostly due to constitutional proximal deformity, remains a challenging procedure. Orthogonal cuts result in asymmetric bone resection and subsequent bone-related laxity or difficult release. A procedure that combines opening high tibial osteotomy (HTO) and TKA in the same sitting to address such major deformities is possible. But for this combined operation, precise planning and an exact intraoperative transformation of the planning is required. The assumption that the results could be predicted better by means of a navigation system was analyzed. ⋯ Computer navigation improved precision with less radiation. The findings of this study suggest that computer navigation may be safely used in a complex procedure when combined with total knee arthroplasty and opening wedge high tibial osteotomy in one sitting.
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Median sternotomy is the most common access for cardiac surgery. Deep surgical wound infection (DSWI) and mediastinitis after median sternotomy remain significant clinical problems after cardiac surgery in terms of mortality, morbidity and healthcare-associated costs. Despite recent advances in medical management and consensus papers, their incidence ranges from 1% to 5%, and the associated mortality ranges from 20% to 50%. ⋯ Early aggressive surgical debridement, vacuum-assisted closure (VAC) therapy, muscle flap and newer technologies are revolutionizing the paradigm of treatment of DSWI. Also, recent advances in tissue engineering have been refining potential approaches to tissue regeneration or substitution for enhanced wound repair. This editorial aims to briefly summarize the current and future techniques in DSWI prevention and treatment after cardiac surgery.
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Due to the COVID-19 pandemic, important elective procedures, such as screening colonoscopy, have been delayed or cancelled, and there may be a very long waitlist for rescheduling once the moratorium is lifted. However, DNA-based stool sample tests may be useful for colorectal cancer screening when colonoscopy is not available. The aim of this review is to demonstrate the potential utility of enhanced DNA-based stool testing for colorectal cancer screening and diagnosis during crises that strain available healthcare resources, such as the current COVID-19 pandemic. This review shows that DNA-based stool sample tests have the potential to enable colorectal cancer screening to prioritize patients to elective colonoscopy procedures, the continued delay of which during the COVID-19 pandemic has already placed a burden on future elective procedures.