Rotation of Anatomical Implants: A Single Surgeon's Experience of over 1500 Patients.

Breast augmentation surgery (BAS) is one of the commonest plastic surgery procedures worldwide. A long-standing debate on the use of anatomical implants versus round implants in terms of complications, especially implant rotation, monopolizes relevant bibliography in recent years. A retrospective cohort study was conducted. All patients' records undergoing primary breast augmentation with anatomical implants from January 2010 to December 2023 by a single surgeon (V.K.), who implemented a novel surgical technique, were assessed for eligibility. Patients' demographics, and preoperative and operative data were recorded. Statistical analysis was conducted using IBM® SPSS® Statistics version 25.0. In total, 622 patients underwent breast augmentation surgery with anatomical implants during the study period (median age 34years, median body mass index 22.3, median follow-up time 43.8months). Ten implants were rotated (0.8%) and correlated in univariate analysis with implant projection type (p=0.003). Twelve implants (0.96%) were complicated by capsular contracture, six (0.48%) by bottoming-out deformity, two patients (0.32%) developed a unilateral hematoma in the first 24h and one patient (0.16%) developed a double-bubble deformity. The use of the proposed surgical technique minimizes complication rates, making anatomical implants an optimal choice for breast augmentation surgery. This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266 .

Plastic Surgery of the Breast: A 75-Year Journey.

Learning Curve of Robotic Rectal Surgery With Lateral Lymph Node Dissection: Cumulative Sum and Multiple Regression Analyses

There is a paucity of literature comparing laparoscopic to robotic inguinal hernia repair. We present a single surgeon's transition from laparoscopic totally extraperitoneal (L-TEP) to robotic transabdominal preperitoneal (R-TAPP) inguinal hernia repair and compare outcomes from the two approaches. This retrospective review and analysis of prospectively collected data compare outcomes during the transition from L-TEP to R-TAPP inguinal hernia repair by a single surgeon at one institution. Operating times and surgical outcomes and complications are analyzed. All consecutive L-TEP cases from November 2012 to August 2014 and all consecutive R-TAPP cases from March 2013 to October 2015 were included in the analysis. A total of 157 and 118 patients underwent L-TEP and R-TAPP inguinal hernia repair, respectively. The groups were similar regarding demographics and ASA class. A significantly higher number of complex cases were performed in the R-TAPP group compared to L-TEP group (n=11 vs. n=1, p=0.0001). Mean surgical times were nearly identical (69.12±35.13min, R-TAPP; 69.05±26.31, L-TEP) as were intraoperative and postoperative complication rates-despite the significantly higher number of complex cases in the R-TAPP group. This is the largest study in the literature comparing a single surgeon's experience transitioning from L-TEP to R-TAPP inguinal hernia repair. Results from the R-TAPP cases were similar to those achieved from laparoscopic cases. The robotic platform may have facilitated the execution of complex hernia cases during the proficiency phase.

The PIP mammary prosthesis: A product recall study

There is increased interest in robotic techniques for colon resection, but the role of robotics in colorectal surgery has not yet been defined. The purpose of this study was to compare our recent experience with robotic right colectomy to that with laparoscopic right colectomy. From November 2008 to June 2011, a total of 47 consecutive patients underwent elective, right colectomy: 25 laparoscopic right colectomies (LRC) and 22 robotic right colectomies (RRC). All procedures in this study were performed by a single, board-certified colon and rectal surgeon (H.J.L.). Main outcomes recorded included conversion rate, operative time (OT), estimated blood loss (EBL), length of extraction sites, length of stay (LOS), and complications. Data studied were prospectively recorded in a database and were retrospectively reviewed. Mean OT for LRC was 107±36.7min (median 98, range 48-207) and for RRC was 189.1±38.1min (median 185, range 123-288, P<0.001). Mean total operating room time (TORT) for LRC was 158.6±38.1min (median 149, range 104-274) and for RRC was 258.3±40.9 (median 251, range 182-372, P<0.001). The tendency lines for both OT and TORT decreased over time for RRC. EBL for LRC was 70.2±52.9ml (median 50, range 10-200) and for RRC was 60.8±71.3ml (median 40, range 10-300, P=0.037). The mean extraction site length for the laparoscopic group was 5.3±1.3cm (median 5, range 4-11) and for the robotic group was 4.6±0.7cm (median 4.5, range 3.5-6, p=0.008). LOS was similar for both groups, as were complications. No cases were converted to open. No leaks occurred and there was no 30-day mortality. RRC is safe and feasible, with similar outcomes to LRC. Operative times were longer for RRC; however, they compare favorably with times for LRC published in the literature. Extraction site length and EBL were less for RRC. However, further study is necessary to demonstrate the clinical relevance of these findings. We are optimistic that OT and TORT will continue to improve.

To let experts evaluate a single surgeon's experience with a combined transconjunctival and intraoral upper vestibular approach in the repair of zygomatic fractures encountered in 46 East Asian patients whom he treated over the past 20 years. Patients were identified from a database, and a retrospective case note review was conducted. A total of 67 conjunctival and secondary incisions were made on 46 patients for repair of zygomatic fractures. All operative procedures were performed using a combination of transconjunctival and intraoral upper vestibular approaches to repair zygomatic fractures. The infraorbital rim and/or lateral buttress and/or lateral orbit was stabilized with titanium miniplates in 28 patients and absorbable miniplates in 11 patients. Seven patients required only reduction technique with no need of plates. Four cases needed additional canthotomy besides a conjunctival approach. No ectropion or entropion developed in any of the patients. Complications included eyelid laceration during surgery (n = 1), herniation of the conjunctiva (n = 1), temporary pyogenic granuloma of the conjunctiva after surgery (n = 1), and temporary entropion in a secondary incision (n = 1). A combined transconjunctival and intraoral upper vestibular approach in repairing zygomatic fractures is simple, easy, and effective, leaving no conspicuous facial scars. It is vitally important, however, that the surgeon masters the technique of transconjunctival approach well before he has good results in East Asian patients.

Wednesday, September 26, 2018 7:35 AM–9:00 AM ePosters

Total Knee Arthroplasty (TKA) is a leading treatment for severe knee osteoarthritis, offering improved function and pain relief. While conventional TKA is well-established, robotic-assisted TKA provides enhanced precision in implant placement and soft tissue balance, potentially reducing surgery time and cost. However, its effectiveness and complication rates require further study to validate its benefits over conventional methods. This study aims to report the outcomes of CTKA and RTKA performed for the same patient as a bilateral staged TKA. It is a cross-sectional design conducted at a tertiary center. It includes collecting retrospective data on patients undergoing bilateral staged TKA performed by a single senior arthroplasty surgeon, analyzed using IBM SPSS 29.0.0. Our study analyzed 38 knee surgeries for 19 patients, split equally between robotic (RTKA) and conventional (CTKA) methods. Both groups showed similar demographics and surgical settings. RTKA had a longer mean operative time (105.3 minutes, SD=12.9) compared to CTKA (81.4 minutes, SD=10.8, p<0.001) and a shorter hospital stay (4.2 days vs.5.6 days, p=0.006). Complications were minimal, with no significant differences in blood loss, post-operative complications, or narcotic use after three weeks between the groups. Both groups showed significant functional gains with KOOS improved from 14.2-16.8 to 84.4-87.0 (p < 0.001), and WOMAC decreased from 83.9-85.3 to 18.5-26.2 (p < 0.001). Subdomain analysis revealed greater pain improvement in conventional TKA and superior daily activity and QoL gains in robotic TKA (p < 0.001). Our study reveals that robotic-assisted TKA results in longer operative periods, but shorter hospital stays compared to conventional TKA. Both methods show similar rates of blood loss, complications, and post-operative narcotic use. Robotic TKA offered better recovery in daily activities and quality of life while conventional TKA achieved greater pain reduction. Overall, both methods proved safe and effective for functional improvement after knee replacement.

Anatomical implants continue to be a particularly useful tool in breast surgery, offering an excellent result for certain indications. However, to ensure fixation and prevent rotation, traditional alternatives have medium to high surface roughness and have been controversial in recent years. A retrospective assessment of 122 prosthetic augmentation and reconstruction patients over a period of 5 years was conducted. Patients were treated with tabbed anatomical implants with a smooth surface and followed up for a period of 12 months. Demographics, complications, and patient satisfaction were captured. A subgroup of 101 patients were assessed with chest radiographs at 1-year follow-up. Technical recommendations are discussed. Primary breast augmentation, revision augmentation, augmentation-mastopexy, and breast reconstruction were the main indications for surgery. All implants were inserted through an inframammary incision and placed in the subpectoral space using dual-plane techniques, except in one mastectomy case. Rotation of the implants was radiographically observed in only two cases of revision augmentation. None of the 122 patients developed capsular contracture, seroma, rupture, infection, hematoma, or malposition following breast surgery. Smooth anatomical implants with a fixation system offer reliable and satisfactory results for patients with various diagnoses and indications. The tab system and the fixation technique are essential to provide long-term stability, which was verified by radiographs because of the radiopaque lines present in the device for that purpose. Therapeutic, IV.

A single surgeon's experience with the ergonomic, hybrid approach in primary and secondary breast reconstructions is presented. The hybrid approach is based on tissue expansion followed by serial sessions of fat grafting to augment the residual autologous (subcutaneous) compartment. The last step included the insertion of a prepectoral, ergonomic implant to obtain central core projection and additional volume. Fifty-six hybrid breast reconstructions were performed with a mean follow-up of 24.1 months. Aesthetic outcomes and patient satisfaction have been good with pleasing breast projection, natural breast motion, and optimal coverage of the prepectoral implants. The hybrid reconstructive approach is a reliable technique to improve the outcomes in implant-based breast reconstructions. The 2-step, prepectoral approach with expander-to-implant exchange allows better control of the final breast shape, and complications related to submuscular approaches are avoided. Fat grafting adds an autologous benefit to obtain natural results.

Vasoepididymostomy (VE), as the most challenging procedure in microsurgeries, is often carried out with a double-armed two-suture technique. In this study, we evaluated the efficacy and safety of the single-armed two-suture VEs on humans and studied the factors that could possibly affect the patency rates. From July 2012 to July 2013, we reviewed 81 patients with consecutive primary epididymal obstruction who underwent single-armed two-suture longitudinal intussusception microsurgical VEs by a single surgeon, Kai Hong (KH). At the same time, we analyzed seven factors that possibly related to the patency rates. With the single-armed technique, a total of 81 men underwent the microsurgical VEs. Data on 62 patients were completely recorded. 19 patients were lost to follow-up. Mean age was 31 years old. Mean follow-up time was 8.8 (2-17) months. The patency rate was 66.1% (41/62). Natural pregnancy rate was 34.1% (14/41). Overall pregnancy rate was 22.6% (14/62). No severe surgical complications were noted. With logistic regression test analysis, there were two factors related to a higher patency rate: anastomosis sites (P = 0.035) and motile sperm found in the epididymal fluid (P = 0.006). Motile sperm found in the epididymal fluid were associated with a higher patency rate (OR = 11.80, 95% CI = 1.79, 77.65). The single-armed two-suture longitudinal VE technique is feasible for microsurgical practice. The patency and pregnancy rates are comparable to the doubled-armed technique. Anastomosis sites and motile sperm found in the epididymal fluid were the most two important factors related to higher patency.

223. A single surgeon's experience of thoracoscopic VBT: 5- to 8-year follow-up results

Perioperative Complications of the Agility Total Ankle Replacement in 50 Initial, Consecutive Cases

Although introduced more than 20 years ago, endoscopic carpal tunnel release (ECTR) continues to generate debate and controversy among surgeons. This review examines a single surgeon's technique for ECTR over the past 13 years to better understand the effects of a surgeon's experience on outcomes. A retrospective review was performed on a case series of 129 patients ages 25 to 89 years old who underwent an ECTR at Duke University. Ninety-six percent of patients reported improvement in nerve symptoms. There were no nerve complications in the series. The billed cost of ECTR at Duke University was 9% less than standard open release and the average return to work by report by patients was 3 weeks. Previous recommendations against ECTR have focused on increased complication rates and cost, with no reported differences in long-term clinical outcomes. The results demonstrate increased success and lower complication rates for this series of patients. This may indicate a significant correlation between a surgeon's expertise and outcomes for ECTR.