Simulating Surgical Skills in Animals: Systematic Review, Costs & Acceptance Analyses.

Modern surgery demands high-quality and reproducibility. Due to new working directives, resident duty hours have been restricted and evidence exists that pure on-the-job training provides insufficient exposure. We hypothesize that supplemental simulations in animal models provide a realistic training to augment clinical experiences.

Peripheral nerve transfers change target muscle structure and function.

Selective nerve transfers surgically rewire motor neurons and are used in extremity reconstruction to restore muscle function or to facilitate intuitive prosthetic control. We investigated the neurophysiological effects of rewiring motor axons originating from spinal motor neuron pools into target muscles with lower innervation ratio in a rat model. Following reinnervation, the target muscle's force regenerated almost completely, with the motor unit population increasing to 116% in functional and 172% in histological assessments with subsequently smaller muscle units.

Broadband Prosthetic Interfaces: Combining Nerve Transfers and Implantable Multichannel EMG Technology to Decode Spinal Motor Neuron Activity.

Modern robotic hands/upper limbs may replace multiple degrees of freedom of extremity function. However, their intuitive use requires a high number of control signals, which current man-machine interfaces do not provide. Here, we discuss a broadband control interface that combines targeted muscle reinnervation, implantable multichannel electromyographic sensors, and advanced decoding to address the increasing capabilities of modern robotic limbs.

Multiuse of Disposable Microsurgical Instruments as a Cost-Efficient Alternative for Training and Research.

Microsurgery demands significant preclinical training, often hampered by the high costs of the required microsurgery instruments. We hypothesized that recently available disposable microsurgery instruments provide sufficient quality and significantly reduced costs. In a comparative analysis with standard reusable instruments, participants performed equally with both instrument sets and recommended the disposable instruments for microsurgery training and research applications.

Power assisted liposuction to obtain adipose-derived stem cells: impact on viability and differentiation to adipocytes in comparison to manual aspiration.

Background: Adipose-derived stem cells (ASCs) play a key role in tissue engineering approaches and are probably of major importance in the context of autologous fat transfer. A number of different tools for harvesting ASCs-containing fat tissue have been established. Such devices should be easy to handle, time saving, low priced, safe and provide a high amount of viable ASCs in the aspirate.

Gastro-oesophageal reflux disease in type 2 diabetics: symptom load and pathophysiologic aspects - a retro-pro study.

Background: Information about gastro-oesophageal reflux disease (GERD) in patients with Diabetes mellitus type 2 (T2D) is scarce, although the incidence of both disorders is increasing.

Methods: This "retro-pro" study compared 65 T2D patients to a control group of 130 age- and sex-matched non-diabetics. GERD was confirmed by gastroscopy, manometry, pH-metry and barium swallow.

Anatomy of the sural nerve: cadaver study and literature review.

Background: The sural nerve is commonly used as donor for nerve grafting. Contrary to its constant retromalleolar position, formation and course of the proximal sural nerve show great variability. The coexistence of different and deceptive terminologies contributes to the complexity, and reviewing the international literature is confusing.

Neoadjuvant chemotherapy increases the rate of breast conservation in lobular-type breast cancer patients.

Introduction: Our study aims to determine whether patients with lobular-type breast cancer have significantly improved rates of breast conservation (BCT) after neoadjuvant chemotherapy (nCT).

Methods: Patients who received nCT and surgery within three prospective trials between 1995 and 2007 at the Medical University of Vienna were retrospectively analyzed.

Results: 325 patients had median follow-up of 53 months; 21% had lobular cancer, and 70% of these women were initially scheduled for mastectomy (MX).

Preoperative lower esophageal sphincter manometry data neither impact manifestations of GERD nor outcome after laparoscopic Nissen fundoplication.

Background: Experience with laparoscopic antireflux surgery (LARS) in patients with gastroesophageal reflux disease (GERD) and manometrically intact lower esophageal sphincter (LES) is limited. The disease pattern may be different and LARS may fail to control reflux or result in higher rates of dysphagia. This is the first study investigating the impact of preoperative LES manometry data not only on manifestations of GERD and subjective outcome alone but also on objective outcomes 1 year after LARS.

The use of medication after laparoscopic antireflux surgery.

Background: Laparoscopic antireflux surgery (LARS) significantly improves symptoms of gastro-esophageal reflux disease (GERD) and quality of life. Nevertheless, 14-62% of patients report using antisecretory medication after surgery, although only a tiny percentage has proven recurrence of GERD. We sought to determine symptoms of GERD, quality of life, and use of medication before and after LARS, and to compare our findings with those from previous studies.

Is Endocrine Therapy Really Pleasant? Considerations about the Long-Term Use of Antihormonal Therapy and Its Benefit/Side Effect Ratio.

Endocrine therapy has become a key part in the adjuvant treatment of hormone responsive breast cancer. The positive effect on relapse risk reduction is well defined, but therapy is not free from bothersome side effects for which estrogen deprivation accounts to a great extent. Since endocrine therapy is usually prescribed for 5 years or longer to optimally display its protective effect, and because physical strain is missing, good tolerability and safety properties are important, particularly in low-risk patients.

Sural nerve harvesting beyond the popliteal region allows a significant gain of donor nerve graft length.

Background: The sural nerve is the nerve most commonly used for peripheral nerve reconstruction. According to requirements for nerve graft length, it is dissected from the retromalleolar up to the popliteal region, where the main root of the sural nerve fibers, the medial sural cutaneous nerve, arises from the tibial nerve. It has been recommended to complete sural nerve harvesting below this area, to avoid damage to the tibial nerve.

Metal-on-metal hip implants: do they impair renal function in the long-term? A 10-year follow-up study.

Introduction: The aim of our study was to investigate a potential influence of elevated serumcobalt and serumchromiumlevels on renal function at minimum 10 years after implantation of a metal-on-metal hip.

Materials And Methods: Between November 1992 and June 1994 98 patients (44 m, 54 f) with an average age of 56 (22-79) years received a metal-on-metal bearing Metasul. At the time of the 10-year follow-up, 15 patients had died and 8 were lost to follow-up.

A nonrandomized follow-up comparison between standard axillary node dissection and sentinel node biopsy in breast cancer.

Introduction: In many countries sentinel node biopsy (SNB) has become the standard of care in breast cancer based on a large number of observational studies but without results from prospective randomized trials. The goal of our study was to evaluate the oncological safety of the SNB in breast cancer in a multicenter, nonrandomized setting with comparable groups.

Patients And Methods: Between 1996/05 and 2004/11, 2942 patients from 14 departments in Austria with unicentric, unilateral, invasive disease without neoadjuvant therapy were collected in a database.

Breast-conserving surgery for T3/T4 breast cancer: an analysis of 196 patients.

Introduction: Breast conservation therapy (BCT) increases quality of life and self-esteem of breast cancer patients. In special cancer centers up to 90% of patients are treated with BCT. T3/T4 breast cancer is one of the few contraindications for BCT.

Quality of life in GERD patients: medical treatment versus antireflux surgery.

Medical and surgical treatments are able to improve symptoms in patients with gastroesophageal reflux disease (GERD). The aim of this study was to evaluate the outcome in GERD patients without therapy, under continuous medical treatment, and after laparoscopic antireflux surgery. Five hundred seventy-nine consecutive patients underwent medical or surgical treatment for GERD-induced symptoms.

Preoperative core needle biopsy does not increase local recurrence rate in breast cancer patients.

Objective: Several case reports and clinical studies in the literature demonstrate needle track seeding after core needle biopsy in patients with breast cancer in up to 50% of cases. The impact of this observation on local recurrence and overall survival rate is, however, not fully investigated.

Patients And Design: We retrospectively analysed 719 patients after breast conserving surgery and postoperative radiotherapy for stage I and II breast cancer.