The Use of Tactile Sensors in Oral and Maxillofacial Surgery: An Overview

Background: This overview aimed to characterize the type, development, and use of haptic technologies for maxillofacial surgical purposes. The work aim is to summarize and evaluate current advantages, drawbacks, and design choices of presented technologies for each field of application in order to address and promote future research as well as to provide a global view of the issue. Methods: Relevant manuscripts were searched electronically through Scopus, MEDLINE/PubMed, and Cochrane Library databases until 1 November 2022. Results: After analyzing the available literature, 31 articles regarding tactile sensors and interfaces, sensorized tools, haptic technologies, and integrated platforms in oral and maxillofacial surgery have been included. Moreover, a quality rating is provided for each article following appropriate evaluation metrics. Discussion: Many efforts have been made to overcome the technological limits of computed assistant diagnosis, surgery, and teaching. Nonetheless, a research gap is evident between dental/maxillofacial surgery and other specialties such as endovascular, laparoscopic, and microsurgery; especially for what concerns electrical and optical-based sensors for instrumented tools and sensorized tools for contact forces detection. The application of existing technologies is mainly focused on digital simulation purposes, and the integration into Computer Assisted Surgery (CAS) is far from being widely actuated. Virtual reality, increasingly adopted in various fields of surgery (e.g., sino-nasal, traumatology, implantology) showed interesting results and has the potential to revolutionize teaching and learning. A major concern regarding the actual state of the art is the absence of randomized control trials and the prevalence of case reports, retrospective cohorts, and experimental studies. Nonetheless, as the research is fast growing, we can expect to see many developments be incorporated into maxillofacial surgery practice, after adequate evaluation by the scientific community

Our supramicrosurgical experience of lymphaticovenular anastomosis in lymphoedema patients to prevent cellulitis

OBJECTIVE: Aim of this paper is to present our reduction of the frequency of cellulitis before and after supramicrosurgical lymphaticovenular anastomosis (s-LVA) in lymphoedema patients, and discuss the possibility to perform this technique outside Japan. PATIENTS AND METHODS: 37 patients affected by lymphoedema were enrolled. All patients received preoperative indocyanine green lymphography. Under local anaesthesia s-LVA was performed on all patients. All patients were followed for 1 year. Lymphoedema was staged using the lymphoedema staging classification recommended by the International Society of Lymphology. Cellulitis rate was recorded for all patients the year before and after the s-LVA. A t-test was used to evaluate differences in the frequency of cellulitis the year before surgery and the year following surgery. RESULTS: Cellulitis incidence decreased in all patients, with a mean 1.7 cases the year before s-LVA and 0.1 the year after s-LVA. A significant difference between preoperative and postoperative cellulitis rate was found (p = 0.0012). CONCLUSIONS: This study reports our s-LVA case series of lymphoedema patients. With the proper learning curve, s-LVA may be reproduced and lymphoedema patients may gain a better quality of life and a reduced cellulitis rate

Surveillance imaging modality does not affect detection rate of asymptomatic secondary interventions following EVAR.

OBJECTIVES: Literature reports that surveillance imaging following endovascular aortic aneurysm repair (EVAR) gives rise to asymptomatic secondary interventions (SI) in 1.4-9% of cases. This retrospective study aimed to evaluate whether the modality of surveillance imaging influences the detection rate of asymptomatic SI. MATERIALS AND METHODS: Two EVAR surveillance protocols were compared at the same vascular centre. Protocol I, performed from January 2003 to December 2006, consisted of colour duplex ultrasound scan (CDU) plus CT angiography (CTA) 1 month after procedure and every 6 months thereafter. Protocol II, performed from January 2007 to June 2010, consisted of CDU plus CTA 1 month after operation and CDU plus plain abdominal films (XR) every 6 months thereafter. In the second protocol, CTA was carried out only during follow-up in specific conditions. The term 'asymptomatic SI' was used when the necessity for SI was detected by imaging alone on an elective basis, prior to development of any symptoms. RESULTS: Enrolment included 376 and 341 consecutive patients with a mean follow-up of 1148 days (range 1-3204 days) and 942 days (range1-1512 days) in Protocols I and II, respectively (p < 0.001). Freedom rates from aneurysmal rupture, freedom from SI and detection rate for asymptomatic SI at 3 years were 98.3% and 98.7% (p = 0.456), 82% and 83.5%(p = 0.876) and 8.8% (n = 33/376) and 8.5%(n = 25/341) (p = 0.49) in Protocols I and II, respectively. Estimated comparison of the costs, radiation exposure and contrast used at 3 years in Protocol I versus Protocol II showed that Protocol II allowed for a three-, four- and six fold reduction in overall costs, radiation exposure and contrast used, respectively (p < 0.0001). CONCLUSIONS: The detection rate of asymptomatic SI following EVAR is not affected by the type of surveillance imaging. A surveillance schedule based primarily on CDU and XR appears to be justified

Endovascular Abdominal Aortic Aneurysm Repair With Ovation Alto Stent Graft: Protocol for the ALTAIR (ALTo endogrAft Italian Registry) Study

Background: Since 2010, the Ovation Abdominal Stent Graft System has offered an innovative sealing option for abdominal aortic aneurysm (AAA) by including a sealing ring filled with polymer 13 mm from the renal arteries. In August 2020, the redesigned Ovation Alto, with a sealing ring 6 mm closer to the top of the fabric, received CE Mark approval. Objective: This registry study aims to evaluate intraoperative, perioperative, and postoperative results in patients treated by the Alto stent graft (Endologix Inc.) for elective AAA repair in a multicentric consecutive experience. Methods: All consecutive eligible patients submitted to endovascular aneurysm repair (EVAR) by Alto Endovascular AAA implantation will be included in this analysis. Patients will be submitted to EVAR procedures based on their own preferences, anatomical features, and operators experience. An estimated number of 300 patients submitted to EVAR with Alto stent graft should be enrolled. It is estimated that the inclusion period will be 24 months. The follow-up period is set to be 5 years. Full data sets and cross-sectional images of contrast-enhanced computed tomography scan performed before EVAR, at the first postoperative month, at 24 or 36 months, and at 5-year follow-up interval will be reported in the central database for a centralized core laboratory review of morphological changes. The primary endpoint of the study is to evaluate the technical and clinical success of EVAR with the Alto stent graft in short- (90-day), mid- (1-year), and long-term (5-year) follow-up periods. The following secondary endpoints will be also addressed: operative time; intraoperative radiation exposure; contrast medium usage; AAA sac shrinkage at 12-month and 5-year follow-up; any potential role of patients' baseline characteristics, valuated on preoperative computed tomography angiographic study, and of device configuration (number of component) in the primary endpoint. Results: The study is currently in the recruitment phase and the final patient is expected to be treated by the end of 2023 and then followed up for 5 years. A total of 300 patients will be recruited. Analyses will focus on primary and secondary endpoints. Updated results will be shared at 1- and 3-5-year follow-ups. Conclusions: The results from this registry study could validate the safety and effectiveness of the new design of the Ovation Alto Stent Graft. The technical modifications to the endograft could allow for accommodation of a more comprehensive range of anatomies on-label

Second asymptomatic carotid surgery trial (ACST-2): a randomised comparison of carotid artery stenting versus carotid endarterectomy

Background: Among asymptomatic patients with severe carotid artery stenosis but no recent stroke or transient cerebral ischaemia, either carotid artery stenting (CAS) or carotid endarterectomy (CEA) can restore patency and reduce long-term stroke risks. However, from recent national registry data, each option causes about 1% procedural risk of disabling stroke or death. Comparison of their long-term protective effects requires large-scale randomised evidence. Methods: ACST-2 is an international multicentre randomised trial of CAS versus CEA among asymptomatic patients with severe stenosis thought to require intervention, interpreted with all other relevant trials. Patients were eligible if they had severe unilateral or bilateral carotid artery stenosis and both doctor and patient agreed that a carotid procedure should be undertaken, but they were substantially uncertain which one to choose. Patients were randomly allocated to CAS or CEA and followed up at 1 month and then annually, for a mean 5 years. Procedural events were those within 30 days of the intervention. Intention-to-treat analyses are provided. Analyses including procedural hazards use tabular methods. Analyses and meta-analyses of non-procedural strokes use Kaplan-Meier and log-rank methods. The trial is registered with the ISRCTN registry, ISRCTN21144362. Findings: Between Jan 15, 2008, and Dec 31, 2020, 3625 patients in 130 centres were randomly allocated, 1811 to CAS and 1814 to CEA, with good compliance, good medical therapy and a mean 5 years of follow-up. Overall, 1% had disabling stroke or death procedurally (15 allocated to CAS and 18 to CEA) and 2% had non-disabling procedural stroke (48 allocated to CAS and 29 to CEA). Kaplan-Meier estimates of 5-year non-procedural stroke were 2·5% in each group for fatal or disabling stroke, and 5·3% with CAS versus 4·5% with CEA for any stroke (rate ratio [RR] 1·16, 95% CI 0·86–1·57; p=0·33). Combining RRs for any non-procedural stroke in all CAS versus CEA trials, the RR was similar in symptomatic and asymptomatic patients (overall RR 1·11, 95% CI 0·91–1·32; p=0·21). Interpretation: Serious complications are similarly uncommon after competent CAS and CEA, and the long-term effects of these two carotid artery procedures on fatal or disabling stroke are comparable. Funding: UK Medical Research Council and Health Technology Assessment Programme

Relative productivity of six local varieties of lucerne in northern Italy

RESP-430