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surgical technique and Efficacy Analysis of Extra-pseudocapsular Transnasal Transsphenoidal Surgery for Pituitary Microprolactinoma

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Current Medical Science 2022年第6期42卷 1140-1147页

作者： Xue-yan WAN Lin-han LI Juan CHEN Jun-wen WANG Yan-chao LIU Yi-min HUANG Kai SHU Michael Buchfelder Rudolf Fahlbusch Ting LEI Department of Neurosurgery Tongji HospitalTongji Medical CollegeHuazhong University of Science and TechnologyWuhan 430030China Department of Neurosurgery University Hospital ErlangenSchwabachanlage 6Erlangen 91054Germany International Neuroscience Institute(INI) Rudolf-Pichelmayr-Str.4Hannover 30625Germany

Objective To elucidate the role of transsphenoidal surgery in the treatment of pituitary microprolactinoma.Methods The clinical data of 107 prolactinoma cases treated by extra-pseudocapsular transnasal transsphenoidal surgery(ETTS)for different indications in our department since 2011 was retrospectively analyzed.Results The most common indication was the ineffectiveness of oral medication(41.1%),followed by the personal willingness of the patient(35.5%),and 20.6%of the patients were young women with clear tumor boundaries.The pseudocapsule was not observed in 63 cases(58.9%),incomplete pseudocapsule was observed in 26 cases(24.3%),and complete pseudocapsule in 18 cases(16.8%).A total of 97 patients(90.7%)obtained 1-year post-operation remission.According to the relative location of the adenoma and pituitary gland on the MRI scan,46 patients were classified into a central type,59 a lateral type,and 2 a supra-pituitary type.Two patients developed hypogonadism,one patient developed hypocortisolism,and one patient developed post-operative hypothyroidism.Two patients were administrated with hormone replacement treatment,and the treatment was stopped within one week.There was no permanent hypopituitarism.Further investigation demonstrated that the adenoma types could affect the remission rates of hyperprolactinemia and gross total resection rate in microprolactinoma.Conclusion ETTS was an effective treatment for pituitary microprolactinomas.This could be the first choice for patients who presented enclosed adenoma on the MRI and were potentially curable in a preoperative evaluation.Maximal safe removal of the adenoma by ETTS with the aim to increase the sensitivity of the drugs was also recommended for patients with invasive dopamine agonist resistant prolactinomas and patients with difficulty in childbirth.

关键词： pituitary microprolactinoma extra-pseudocapsular transsphenoidal surgery adenoma types surgical technique surgery indication

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A novel surgical technique of internal limiting membrane peeling for high myopic foveoschisis:a wide range of whole piece consecutive peeling without preservation of epi-fovea

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International Journal of Ophthalmology(English edition) 2022年第2期15卷 284-290页

作者： Shuai He Tong Su Zhong-Yi Zhou Xiao-Meng Li Wu Xu Qing-Hua Qiu Department of Ophthalmology Shanghai General HospitalShanghai Jiao Tong University School of MedicineShanghai 200080China National Clinical Research Center for Eye Diseases Shanghai Key Laboratory of Ocular Fundus DiseasesShanghai Engineering Center for Visual Science and PhotomedicineShanghai Engineering Center for Precise Diagnosis and Treatment of Eye DiseasesShanghai 200080China School of Aeronautics and Astronautics Shanghai Jiao Tong UniversityShanghai 200241China Department of Ophthalmology Shigatse People's HospitalShigatse 857000Tibet Autonomous RegionChina

AIM:To demonstrate an improved surgical technique of whole piece consecutive internal limiting membrane(ILM) peeling without preservation of the epi-fovea to treat high myopic foveoschisis(MF).METHODS:A 23-gauge 3-port pars plana vitrectomy was performed on 16 patients with high MF.A parallel arc line along the vascular arcades was scraped out with a curved membrane scraper DSP.Next,an ILM forceps was used to catch hold of the incisal edge of the ILM flap,and the action of releasing and separating was subsequently taken toward the direction of the macular fovea.Next,the ILM forceps was used to grasp the released area,and the whole area coherent ILM peeling covering the macular fovea was implemented thereafter.Finally,the ILM was folded backwards and peeled off in the arc direction.RESULTS:At the final visit,the average central macular thickness decreased remarkably from 423.76±177.67 to 178.24±66.21 μm.The mean logarithm of the minimum angle of resolution best-corrected visual acuity of 1.37±0.59 was significantly alleviated to 0.74±0.59.CONCLUSION:The wide range of whole piece consecutive ILM peeling without preservation of the epifovea is proven to be effective and significantly reduced the occurrence of retinal tear and macular hole.

关键词： high myopic foveoschisis internal limiting membrane peeling surgical technique macular hole

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Robot-assisted adrenalectomy:Step-by-step technique and surgical outcomes at a high-volume robotic center

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Asian Journal of Urology 2023年第4期10卷 475-481页

作者： Federico Piramide Carlo Andrea Bravi Marco Paciotti Luca Sarchi Luigi Nocera Adele Piro Maria Peraire Lores Eleonora Balestrazzi Angelo Mottaran Rui Farinha Hubert Nicolas Pieter De Backer Frederiek D'hondt Peter Schatteman Ruben De Groote Geert De Naeyer Alexandre Mottrie Department of Urology Onze-Lieve-VrouwziekenhuisAalstBelgium ORSI Academy GhentBelgium Department of Oncology Division of UrologyUniversity of TurinSan Luigi Gonzaga HospitalTurinItaly Department of Urology Humanitas Research Hospital-IRCCSRozzanoItaly Department of Urology ASST Santi Paolo e CarloUniversity of MilanMilanItaly Unit of Urology Division of Experimental OncologyUrological Research InstituteIRCCS San Raffaele Scientific InstituteVita-Salute San Raffaele UniversityMilanItaly Department of Urology Ospedale Policlinico e Nuovo Ospedale Civile S.Agostino Estense ModenaUniversity of Modena and Reggio EmiliaModenaItaly Division of Urology IRCCS Azienda Ospedaliero-Universitaria di BolognaBolognaItaly Urological Department La CitadelleLiègeBelgium

Objective In the last years,robotic surgery was introduced in several different settings with good perioperative results.However,its role in the management of adrenal masses is still debated.In order to provide a contribution to this field,we described our step-by-step technique for robotic adrenalectomy(RA)and related modifications according to the type of adrenal mass treated.Methods We retrospectively analyzed 27 consecutive patients who underwent RA at Onze-Lieve-Vrouw hospital(Aalst,Belgium)between January 2009 and October 2022.Demographic,intra-and post-operative,and pathological data were retrieved from our prospectively maintained institutional database.Continuous variables are summarized as median and interquartile range(IQR).Categorical variables are reported as frequencies(percentages).Results Twenty-seven patients underwent RA were included in the study.Median age,body mass index,and Charlson's comorbidity index were 61(IQR:49-71)years,26(IQR:24-29)kg/m^(2),and 2(IQR:0-3),respectively,and 16(59.3%)patients were male.Median tumor size at computed tomography scan was 6.0(IQR:3.5-8.0)cm.Median operative time and blood loss were 105(IQR:82-120)min and 175(IQR:94-250)mL,respectively.No intraoperative complications were recorded.Overall postoperative complications rate was 11.1%,with a postoperative transfusion rate of 3.7%.A total of 10(37.0%)patients harbored malignant adrenal masses.Among them,3(11.1%)had adrenocortical carcinoma,6(22.2%)secondary metastasis,and 1(3.7%)malignant pheochromocytoma on final pathological exam.Only 1(10.0%)patient had positive surgical margins.Conclusion We described our step-by-step technique for RA,which can be safely performed even in case of high challenging settings as malignant tumors,pheochromocytoma,and large masses.The standardization of perioperative protocol should be encouraged to maximize the outcomes of this complex surgical procedure.

关键词： Robotics Adrenalectomy Pheochromocytoma Malignant surgical technique

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The SUPER reporting guideline suggested for reporting of surgical technique

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Hepatobiliary Surgery and Nutrition 2023年第4期12卷 534-544,I0024-I0026页

作者： Kaiping Zhang Yanfang Ma Jinlin Wu Qianling Shi Leandro Cardoso Barchi Marco Scarci Rene Horsleben Petersen Calvin S.H.Ng Steven Hochwald Ryuichi Waseda Fabio Davoli Robert Fruscio Giovanni Battista Levi Sandri Michel Gonzalez Benjamin Wei Guillaume Piessen Jianfei Shen Xianzhuo Zhang Panpan Jiao Yulong He Nuria M.Novoa Benedetta Bedetti Sebastien Gilbert Alan D.L.Sihoe Alper Toker Alfonso Fiorelli Marcelo F.Jimenez Toni Lerut Aung Y.Oo Grace S.Li Xueqin Tang Yawen Lu Hussein Elkhayat Tomaz Stupnik Tanel Laisaar Firas Abu Akar Diego Gonzalez-Rivas Zhanhao Su Bin Qiu Stephen D.Wang Yaolong Chen Shugeng Gao Editorial Office AME Publishing CompanyHong KongChina School of Chinese Medicine Hong Kong Baptist UniversityHong KongChina Department of Cardiovascular Surgery Guangdong Provincial People’s HospitalGuangdong Academy of Medical SciencesGuangzhouChina Evidence-based Medicine Center School of Basic Medical SciencesLanzhou UniversityLanzhouChina Lanzhou University Institute of Health Data Science LanzhouChina Digestive Surgery Division Department of GastroenterologyUniversity of Sao Paulo School of MedicineSão PauloBrazil Department of Cardiothoracic Surgery Imperial College Healthcare NHS TrustLondonUK Department of Cardiothoracic Surgery University Hospital of CopenhagenRigshospitaletCopenhagenDenmark The Chinese University of Hong Kong Prince of Wales HospitalShatinNew TerritoriesHong KongChina Department of surgical Oncology Roswell Park Cancer InstituteBuffaloNYUSA Department of General Thoracic Breast and Pediatric SurgeryFukuoka UniversityFukuokaJapan Department of Thoracic Surgery AUSL RomagnaS.Maria delle Croci Teaching HospitalRavennaItaly Clinic of Obstetrics and Gynecology University of Milan-BicoccaSan Gerardo HospitalMonzaItaly Division of General Surgery and Liver Transplantation S.Camillo HospitalRomeItaly Service of Thoracic Surgery Lausanne University Hospital(CHUV)LausanneSwitzerland Division of Cardiothoracic Surgery Department of SurgeryUniversity of Alabama BirminghamBirminghamALUSA University of Lille CNRSInsermCHU LilleUMR9020-U1277-CANTHER-Cancer Heterogeneity Plasticity and Resistance to TherapiesLilleFrance Department of Cardiothoracic Surgery Taizhou Hospital of Zhejiang Province Affiliated to Wenzhou Medical UniversityLinhaiChina The First School of Clinical Medicine Lanzhou UniversityLanzhouChina Thoracic Surgery Service University Hospital of SalamancaBiomedical Institute of SalamancaSalamancaSpain Department of Thoracic Surgery Helios Clinic Bonn/Rhein SiegBonnGermany Division of Thoracic Surgery Department of SurgeryThe Ottawa

Background:Existing reporting guidelines pay insufficient attention to the detail and comprehensiveness reporting of surgical technique.The surgical technique rePorting chEcklist and standaRds(SUPER)aims to address this gap by defining reporting standards for surgical technique.The SUPER guideline intends to apply to articles that encompass surgical technique in any study design,surgical discipline,and stage of surgical innovation.Methods:Following the EQUATOR(Enhancing the QUAlity and Transparency Of health Research)Network approach,16 surgeons,journal editors,and methodologists reviewed existing reporting guidelines relating to surgical technique,reviewed papers from 15 top journals,and brainstormed to draft initial items for the SUPER.The initial items were revised through a three-round Delphi survey from 21 multidisciplinary Delphi panel experts from 13 countries and regions.The final SUPER items were formed after an online consensus meeting to resolve disagreements and a three-round wording refinement by all 16 SUPER working group members and five SUPER consultants.Results:The SUPER reporting guideline includes 22 items that are considered essential for good and informative surgical technique reporting.The items are divided into six sections:background,rationale,and objectives(items 1 to 5);preoperative preparations and requirements(items 6 to 9);surgical technique details(items 10 to 15);postoperative considerations and tasks(items 16 to 19);summary and prospect(items 20 and 21);and other information(item 22).Conclusions:The SUPER reporting guideline has the potential to guide detailed,comprehensive,and transparent surgical technique reporting for surgeons.It may also assist journal editors,peer reviewers,systematic reviewers,and guideline developers in the evaluation of surgical technique papers and help practitioners to better understand and reproduce surgical technique.

关键词： surgical technique surgical innovation reporting guideline reporting checklist surgical technique rePorting chEcklist and standaRds(SUPER)

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Hydromassage of macular hole edges for large and persistent full-thickness macular holes

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International Journal of Ophthalmology(English edition) 2024年第3期17卷 551-557页

作者： Yi Cai Wen-Bo Liu Duo Wei Xun Deng Xiao-Xin Li Ming-Wei Zhao Xuan Shi Jian-Hong Liang Department of Ophthalmology Peking University People’s HospitalBeijing 100044China Eye Diseases and Optometry Institute Beijing 100044China Beijing Key Laboratory of Diagnosis and Therapy of Retinal and Choroid Diseases Beijing 100044China College of Optometry Peking University Health Science CenterBeijing 100044China Xiamen Eye Center of Xiamen University Xiamen 361102Fujian ProvinceChina Department of Ophthalmology the Second Hospital of Lanzhou UniversityLanzhou 730030Gansu ProvinceChina

●AIM:To introduce the macular hole(MH)hydromassage technique as a potentially beneficial approach for the treatment of large or persistent MH.●METHODS:This retrospective observational case series comprised 16 consecutive patients(17 eyes)diagnosed with MH.Inclusion criteria involved a hole aperture diameter larger than 600μm or the presence of an unclosed MH larger than 600μm following the previous vitrectomy.Standard MH repair procedures were administered in all cases,involving the manipulation and aspiration of the hole margin through the application of water flow with a soft-tip flute needle.A comprehensive assessment was conducted for each case before and after surgery,and optical coherence tomography(OCT)images were captured at every follow-up point.●RESULTS:The mean preoperative aperture diameter was 747±156μm(range 611-1180μm),with a mean base diameter of 1390±435μm(range 578-2220μm).Following surgery,all cases achieved complete anatomical closure of MH,with 13 cases(76.5%)exhibiting type 1 closure and 4 cases(23.5%)demonstrating type 2 closure.No significant differences were observed in the preoperative OCT variables between the two closure types.Eyes with type 1 closure showed a significantly improved visual acuity(0.70±0.10,range 0.50-0.80)compared to those with type 2 closure(0.90±0.12,range 0.80-1.00,P=0.014).●CONCLUSION:The MH hydromassage technique demonstrates promising results,achieving acceptable closure rates in cases of large or persistent MH.This technique may serve as an effective adjunctive maneuver during challenging MH surgery.

关键词： macular hole large macular hole persistent macular hole optical coherence tomography surgical technique hydromassage

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Dual mobility in primary total hip arthroplasty:A temptation from the devil or a blessing from above

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World Journal of Orthopedics 2024年第6期15卷 512-519页

作者： Raymond Klumpp Linda Boerci Francesco Buonanotte Marco Zeppieri Unita Operativa Complessa Ortopedia e Traumatologia Ospedale Treviglio-Caravaggio ASSTBergamo Ovest 24047Italy Department of Orthopedics Universitàdegli Studi di Milano-BicoccaMonza 20090Italy Department of Ophthalmology University Hospital of UdineUdine 33100Italy

Dual mobility(DM)bearings have gained significant attention in the field of total hip arthroplasty(THA)as a valid treatment option in cases of revision for instability after THA whereas its use in primary THA is still a matter of debate.This manuscript explores the pathology,incidence,diagnosis,treatment options,prognosis,ongoing studies in the literature,and future perspectives related to the use of DM bearings employed in primary THA.DM bearings are primarily designed to address one of the major concerns in THA:Instability of the prosthetic hip.Instability is both for the surgeon and the patient a devastating postoperative complication,leading to significant pain and subsequent apprehension by the patient and may require revision surgeries.The use of DM implants poses the worry of wear-related complications,such as accelerated polyethylene wear and osteolysis,which also pose challenges to long-term implant survival.This technique has seen a steady rise in recent years,with multiple studies reporting favorable outcomes.The incidence of their utilization varies among institutions and surgeons,reflecting differing preferences and patient populations.The diagnosis of instability and wear-related complications in THA often involves clinical assessment,imaging modalities such as X-rays,computed tomography scans,and sometimes advanced imaging techniques like magnetic resonance imaging.DM bearings can be considered as an option when patients present neurologic pathologies such as Parkinson's disease or recurrent dislocations after THA.DM bearings provide an additional articulation point within the implant,facilitating a greater range of motion and inherent stability.This design allows for reduced risk of dislocation and improved functional outcomes.Various implant manufacturers offer different designs and sizes of DM bearings to suit individual patient needs.Current literature suggests that the use of DM bearings in primary THA has demonstrated promising outcomes in terms of enhanced stability,reduced dislocation rates

关键词： Dual mobility First implant Hip arthroplasty surgical technique Differential diagnosis

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Transsphenoidal approach to pituitary adenoma： surgical technique of the Peking Union Medical College Hospital

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Chinese Medical Journal 2009年第24期122卷 3086-3090页

作者： LI Yong-Ning WANG Ren-zhi LI Gui-lin Department of Neurosurgery Peking Union Medical College Hospital Chinese Academy of Medical Sciences Beijing 100730 China

Although presented over one hundred years ago, the transsphenoidal approach to pituitary adenoma is still the most suitable and safe route to pituitary adenoma, with a series of significant evolutional steps. The transsphenoidal approach to pituitary adenoma is still a non-universal approach used in different centers of different areas in our country. The transsphenoidal approach has a number of variations, including the endonasal rhinoseptoplastic, transnasal displacement,

关键词： transsphenoidal approach surgical technique pituitary adenoma

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Direct anterior compared to posterior approach for hip hemiarthroplasty following femoral neck fractures

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World Journal of Orthopedics 2024年第6期15卷 605-607页

作者： Kevin A Wu Alexandra N Krez Albert T Anastasio Department of Orthopaedic Surgery Duke University HospitalDurhamNC 27710United States Department of Orthopaedic Surgery Duke University School of MedicineDurhamNC 27710United States

The differences in complication rates between the direct anterior and posterior approaches for hemiarthroplasty in elderly patients with femoral neck fractures are not yet fully understood.Dislocation,a severe complication associated with increased mortality and often requiring additional surgery,may occur less frequently with the direct anterior approach compared to the posterior approach.Careful consideration of patient demographics is essential when planning the surgical approach.Future research in this area should focus on robust randomized controlled trials involving elderly patients recovering from femoral neck fractures.

关键词： Direct anterior approach Posterior approach Hemiarthroplasty Femoral neck fractures Arthroplasty Dislocation surgical technique

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Modified malleable prosthesis with a fixed mesh:case series for the Ghattas technique

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Asian Journal of Andrology 2022年第2期24卷 167-170页

作者： Osama Ghattas Mohamed Fahmy Doheim Hossam Kotb Arthur L Burnett Dar-elzokora Center of Andrology Alexandria 21500Egypt Alexandria Faculty of Medicine Alexandria UniversityAlexandria 21131Egypt Department of Urology Johns Hopkins University School of MedicineBaltimoreMD 21287USA

Penile prosthetic implantation represents a cornerstone for patients with organic erectile dysfunction(ED)that is refractory,unsatisfactory,or contra-indicated for other approved medical or mechanical options.In this study,we introduce the“Ghattas technique,”wherein we constructed a polypropylene mesh sheath that surrounds and is fixed to a 13-mm malleable prosthesis cylinder,which can increase the cylinder diameter for cases that need a larger prosthesis.All patients underwent preoperative evaluation and completed the five-item International Index of Erectile Function questionnaire(IIEF-5).Postoperative outcomes were evaluated by IIEF-5 and Erectile Dysfunction Inventory of Treatment Satisfaction(EDITS)questionnaires at final follow-up.The mean age of the 23 included patients was 57.9(standard deviation[s.d.]:11.4)years and the mean duration of ED was 8.5(s.d.:7.9)years.Erection improvement was determined by comparing mean preoperative and postoperative IIEF-5 scores(8.3[s.d.:3.9]vs 24.6[s.d.:0.6],Ptechnique was safe and effective in our patients,and provides opportunity for cases that need a diameter larger than 13 mm.Further studies are needed to confirm these results.

关键词： erectile dysfunction mesh penile prosthesis surgical technique

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Extra-pseudocapsular Transnasal Transsphenoidal Resection of Pituitary Macroadenoma:technique Note and Evaluation of Endocrine Function

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Current Medical Science 2022年第6期42卷 1148-1156页

作者： Yu XU Xue-yan WAN Lin-han LI Juan CHEN Jun-wen WANG Kai SHU Michael Buchfelder Rudolf Fahlbusch Ting LEI Department of Neurosurgery Tongji HospitalTongji Medical CollegeHuazhong University of Science and TechnologyWuhan430030China Department of Neurosurgery University Hospital ErlangenSchwabachanlage 6Erlangen91054Germany International Neuroscience Institute(INI) Rudolf-Pichelmayr-Str.4Hannover30625Germany

Objective In this study,we investigated the surgical technique and endocrine assessment of pituitary function of patients with macroadenoma treated by extra-pseudocapsular transnasal transsphenoidal surgery(ETTS).Methods Clinical data of 144 patients with pituitary macroadenomas in the same surgical group at the Department of Neurosurgery,Tongji Hospital,Tongji Medical College,Huazhong University of Science and Technology were retrospectively analyzed from January 2019 to June 2021.Based on the results of the endocrinological evaluation and MRI examinations before and after surgery,the fluctuation of pituitary function and the extent of resection were analyzed.Multiple Logistic regression analysis was used to determine the predictors affecting postoperative tumor residual.Results Among the 144 patients with pituitary macroadenomas,72(50.0%)were female and 72(50.0%)were male,the median age was 50 years,26(18.1%)had invasiveness grade 0,46(31.9%)had grade I,57(39.6%)had grade II,and 15(10.4%)had grade III according to Lu’s classification method.Based on observation during surgery,37 cases(25.7%)had no pseudocapsule,54 cases(37.5%)had incomplete pseudocapsule,and 53 cases(36.8%)had intact pseudocapsule.In addition,91(63.2%)patients had total resection,39(27.1%)had subtotal resection,and 14(9.7%)had partial resection.As for anterior pituitary function,13 of 19 hypothyroid patients had recovery after surgery,with a remission rate of 68.4%.Eighteen of the 26 decreased cortisol patients got back to normal,with a remission rate of 69.2%.A total of 27 of 51 patients with hypogonadism improved,with a remission rate of 52.9%.Univariate and multivariate analyses indicated that gender,tumor size,and invasiveness were predictors of postoperative residual in patients(Psurgical resection and postoperative resi

关键词： pseudocapsule pituitary macroadenoma surgical technique transsphenoidal microsurgery

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