3D reconstruction in endonasal pituitary surgery

PURPOSE: Endoscopic transsphenoidal surgery for pituitary tumors is hindered by limited visibility and maneuverability due to the narrow nasal corridor, increasing the risk of complications. To address these challenges, we present a pipeline for 3D reconstruction of the sellar anatomy from monocular endoscopic videos to enhance intraoperative visualization and navigation. METHODS: Data were collected through a user study with trainee surgeons, and the procedure was conducted on 3D printed, anatomically correct phantom devices. To overcome limitations posed by the uniform, textureless surfaces of these devices, learned feature detectors and matchers were leveraged to extract meaningful information from the images. The matched features were reconstructed using COLMAP, and the resulting surfaces were evaluated using the iterative closest point algorithm against the CAD ground-truth surface of the printed phantoms. RESULTS: Most methods resulted in accurate reconstructions with moderate variability in cases with high blur or occlusions. Average RMSE values of 0.33 mm and 0.41 mm, for the two best methods, Dense Kernelized Feature Matching and SuperPoint with LightGlue, respectively, were obtained in the surface registrations across all test sequences, with a significantly higher computation time for Dense Kernelized Feature Matching. CONCLUSION: The proposed pipeline was able to accurately reconstruct anatomically correct 3D models of the phantom devices, showing potential for the use of learned feature detectors and matchers in real time for AR-guided navigation in pituitary surgery

Impact of opioid-free analgesia on pain severity and patient satisfaction after discharge from surgery: multispecialty, prospective cohort study in 25 countries

Background: Balancing opioid stewardship and the need for adequate analgesia following discharge after surgery is challenging. This study aimed to compare the outcomes for patients discharged with opioid versus opioid-free analgesia after common surgical procedures.Methods: This international, multicentre, prospective cohort study collected data from patients undergoing common acute and elective general surgical, urological, gynaecological, and orthopaedic procedures. The primary outcomes were patient-reported time in severe pain measured on a numerical analogue scale from 0 to 100% and patient-reported satisfaction with pain relief during the first week following discharge. Data were collected by in-hospital chart review and patient telephone interview 1 week after discharge.Results: The study recruited 4273 patients from 144 centres in 25 countries; 1311 patients (30.7%) were prescribed opioid analgesia at discharge. Patients reported being in severe pain for 10 (i.q.r. 1-30)% of the first week after discharge and rated satisfaction with analgesia as 90 (i.q.r. 80-100) of 100. After adjustment for confounders, opioid analgesia on discharge was independently associated with increased pain severity (risk ratio 1.52, 95% c.i. 1.31 to 1.76; P < 0.001) and re-presentation to healthcare providers owing to side-effects of medication (OR 2.38, 95% c.i. 1.36 to 4.17; P = 0.004), but not with satisfaction with analgesia (beta coefficient 0.92, 95% c.i. -1.52 to 3.36; P = 0.468) compared with opioid-free analgesia. Although opioid prescribing varied greatly between high-income and low- and middle-income countries, patient-reported outcomes did not.Conclusion: Opioid analgesia prescription on surgical discharge is associated with a higher risk of re-presentation owing to side-effects of medication and increased patient-reported pain, but not with changes in patient-reported satisfaction. Opioid-free discharge analgesia should be adopted routinely

Predicting opioid consumption after surgical discharge: a multinational derivation and validation study using a foundation model

Opioids are frequently overprescribed after surgery. We applied a tabular foundation model to predict the risk of post-discharge opioid consumption. The model was trained and internally validated on an 80:20 training/test split of the ‘Opioid PrEscRiptions and usage After Surgery’ (ACTRN12621001451897p) study cohort, including adult patients undergoing general, orthopaedic, gynaecological and urological operations (n = 4267), with external validation in a distinct cohort of patients discharged after general surgical procedures (n = 826). The area under the receiver operator curve was 0.84 (95% confidence interval [CI] 0.81–0.88) at internal testing and 0.77 (95% CI 0.74–0.80) at external validation. Brier scores were 0.13 (95% CI 0.12–0.14) and 0.19 (95% CI 0.17–0.2). Patients with a <50% predicted risk of opioid consumption consumed a median of 0 oral morphine equivalents in the first week after surgery. Applying this model would reduce opioid prescriptions by 4.5% globally, and counterfactual modelling suggests without increasing time in severe pain (−4.3%, 95% CI −17.7 to 8.6)