Sofia Di Lorenzo

Adrenal abnormalities are common imaging findings requiring comprehensive workup. Invasive diagnostic and therapeutic procedures, including adrenal surgery, demand expertise to mitigate risks of severe complications. Recent applications of 3D image analyses range from enhanced diagnosis to therapeutic guidance with anatomical visualisation. This study assesses the efficacy and clinical utility of 3D image analyses in managing adrenal disease. This systematic review, registered with PROSPERO (CRD42024500783), adheres to PRISMA guidelines. Searches of PubMed, Google Scholar and ClinicalTrials.gov up to August 2024 identified eligible studies. Extracted data included imaging modalities, 3D applications for diagnosis or treatment, volumetric segmentation techniques, and differentiation between pathologic and normal adrenal glands. Technological maturity was assessed with the IDEAL framework. Of 1813 studies screened, 30 met inclusion criteria, encompassing 5304 imaging exams (2060F/2106M, and 10 studies with 1115 cases), predominantly CT (27 CT, 90%; 2 MRI, 6.7%; 1 CT/MRI 3.3%). Volumetric reconstructions employed manual, semiautomatic and automatic methods for digital visualisation, and subsequent 3D printing. 3D analyses of normal vs. neoplastic adrenal tissue supported diagnosis in 18 studies (60%), and treatment in 12 (40%), improving understanding of respective anatomical features and planning for operative and interventional procedures. These applications represented early IDEAL stages of surgical innovation (0—preclinical, 1—idea and 2—development/exploration). 3D image analyses show promise in optimising adrenal disease management by aiding adrenal lesion characterisation and treatment optimisation through pre- and intraprocedural guidance. Further clinical assessment and long-term studies are warranted to establish the broader clinical impact. Graphical Abstract

The implementation of barbed sutures appears to enhance the process of suturing and knot tying, particularly in the field of bariatric surgery, where they can offer significant advantages. The objective of this study is to evaluate the safety and effectiveness of utilising barbed sutures for gastric pouch-jejunal anastomosis (GPJA) and jejuno-jejunal anastomosis (JJA) anastomosis in Roux-en-Y Gastric Bypass (RYGB). Data from patients who underwent primary RYGB between January 2012 and October 2018 were retrospectively collected using Propensity Score Matching (PSM) to randomise groups (barbed sutures—BS-G and conventional sutures—CS-G). The primary outcome was postoperative early complications. The secondary outcomes were late complications (internal hernias and small bowel obstructions), operative time and postoperative hospital stay. A total of 969 patients were included. After PSM, 322 (161 in BS-G vs. 161 in CS-G) patients were compared (chi-square 0.287, p = 0.862). Postoperative early and late complications were comparable between the two groups. BS-G had a significantly shorter median operative time (65 vs. 95 min p < 0.001). Median postoperative hospital stay was significantly shorter for BS-G (2 vs. 5 days, p < 0.001). Barbed sutures effectively reduce the operation duration and are as safe as conventional sutures for closing anastomotic defects during RYGB.

Background: Predicting definitive outcomes of post‐thyroidectomy vocal fold paralysis (VFP) is challenging. We aimed to identify reliable predictors based on intraoperative neuromonitoring (IONM) and flexible fiberoptic laryngostroboscopy (FFL) findings.Methods: Among 1172 thyroid operations performed from April to December 2021, all patients who exhibited vocal fold paralysis (VFP) at post‐operative laryngoscopy were included. IONM data, including type of loss of signal (LOS), were collected. Patients underwent FFL, with arytenoid motility assessment, at 15, 45 and 120 days post‐operatively. Patients were divided into two groups: those who recovered vocal fold motility (VFM) by the 120th post‐operative day (recovery group) and those who did not (non‐recovery group).Results: Fifty‐nine VFP cases (5.0% of total patients) met the inclusion criteria. Eight patients were lost at follow‐up and were excluded. Overall, 9 patients were included in the non‐recovery group (0.8% of total patients) and 42 in the recovery group. Among various predictive factors, only arytenoid fixation (AF) at the 15th post‐operative day and Type I LOS were significant predictors for no VFM recovery (p = 0.007, RR = 9.739, CI:1.3–72.3 and p = 0.001, RR = 9.25, CI:2.2–39.3 for AF and Type I injury, respectively). The combination of type of LOS and arytenoid motility at the 15th post‐op day yielded satisfactory predictive values for the progression of transient VFP to permanent.Conclusions: Arytenoid motility at the 15th post‐op day and type II LOS are associated with recovery of VFM. Type of LOS and FFL could be included in the follow‐up protocols of patients with VFP to reliably predict clinical outcomes.