Objective To assess the clinical efficacy of TiRobot‐assisted percutaneous cannulated screw fixation in the treatment of femoral neck fractures. Methods From September 2015 to July 2017, 26 patients with unilateral femoral neck fractures were treated with TiRobot‐assisted percutaneous cannulated screw fixation. The femoral necks were fixed using three cannulated screws with robot assistance applying the following procedure: image acquisition, path planning, and needle and screw placement. The results of the treatment, including operation duration, frequency of fluoroscopy use, implant placement accuracy, intraoperative bleeding, total drilling, surgical complications, fracture healing time, fracture healing rate, and Harris scores at the last follow‐up, were recorded and compared with 23 similar patients who underwent conventional manual positioning surgery. Results A total of 147 cannulated screws were placed in all patients. The TiRobot group had shorter operation duration (62.6 ± 8.7 min vs 72.4 ± 10.3 min) and fracture healing time (5.1 ± 2.4 months vs 5.9 ± 2.8 months) than the conventional group ( P > 0.05). The robot group had significantly less use of fluoroscopy (26.5 ± 7.4 times vs 51.3 ± 9.4 times), intraoperative bleeding (8.2 ± 5.3 mL vs 36.4 ± 12.5 mL), and total drilling (9.4 ± 4.2 times vs 18.3 ± 9.1 times) than the conventional group (all P < 0.05). The screw parallelism was significantly improved (24.0 ± 0.6 points vs 21.5 ± 1.2 points) and the neck‐width coverage (72.0 ± 6.7 mm 2 vs 53.8 ± 10.4 mm 2 ) was significantly enlarged compared to the conventional group ( P < 0.05). Only three guiding needles were used to penetrate the femoral head during manual insertion in the TiRobot group, which was significantly lower than that in the conventional group (3/78, 3.8% vs 9/69, 13.0%; P < 0.05). Other complications such as wound infection, vascular or nerve injury, screw loosening, and secondary screw displacement, did not occur in the two groups. There was no significant difference between the two groups in fracture healing rate (88.4% vs 82.6%) and Harris scores at the last follow up (88.2 ± 3.6 points vs 87.3 ± 4.7 points; P > 0.05). Conclusion TiRobot‐assisted percutaneous cannulated screw fixation of femoral neck fractures is advantageous over conventional surgery with manual positioning due to easier manipulation, more accurate screw insertion, less invasion, and less radiation exposure, suggesting that it is a better method to stabilize femoral neck fra...

PurposeThe purpose of this study was to investigate the safety and efficacy of the combination of robot‐assisted percutaneous screw placement and pelvic internal fixator (INFIX) for minimally invasive treatment of unstable anterior and posterior pelvic ring injuries.MethodsFrom September 2016 to June 2017, twenty‐four patients with unstable anterior and posterior pelvic ring injuries were treated with TiRobot‐assisted percutaneous sacroiliac cannulated screw fixation on the posterior pelvic ring combined with robot‐assisted pedicle screw placement in the anterior inferior iliac spine along with INFIX on the anterior pelvic ring. The results of the treatment, including surgery duration, fluoroscopy frequency, total drilling, amount of blood loss, fracture healing time, and postoperative functional outcomes were recorded and compared with another 21 similar patients who underwent conventional manual positioning surgery.ResultsThe TiRobot group incurred significantly shorter duration of surgery; less fluoroscopy frequency, intraoperative bleeding, and total drilling than in the conventional group (P < 0.05). Postoperative radiological follow‐up showed that all screws were in the safe area and no screw penetrated the cortex. All wounds healed by primary intention and no iatrogenic damage to the blood vessels, nerves, and organs occurred. Patients showed good tolerance to INFIX and reported no discomfort. The mean follow‐up duration was 5.4 months; the fractures were all healed, no loss of reduction occurred, and the mean Majeed score at the last follow‐up did not show any difference.ConclusionTiRobot‐assisted percutaneous screw placement combined with INFIX for the anterior and posterior pelvic ring injuries is accurate, safe, less invasive, and shows satisfactory efficacy, suggesting it is a better method for minimally invasive treatment of unstable pelvic ring fractures.

Objective To investigate the indications, surgical strategy and techniques, safety, and efficacy of robot‐assisted minimally‐invasive internal fixation of pelvic ring injuries. Methods The clinical data of 86 patients with anterior and posterior pelvic ring injuries who underwent robot‐assisted minimally‐invasive internal fixation were retrospectively analyzed. The patients included 57 men and 29 women aged between 22 and 75 years, with an average age of (40.2 ± 13.6) years. According to the Tile classification, there were 5 (5.8%) type A2, 48 (55.8%) type B, and 33 (38.4%) type C fractures. The surgical plans were formulated based on the injury type of the pelvic ring, the effectiveness of the reduction, and the integrity of the osseous channel. Posterior pelvic ring injuries were treated with robot‐assisted percutaneous cannulated screw fixation of the sacroiliac joint. Anterior pelvic ring injuries were treated with robot‐assisted percutaneous cannulated screw fixation of the pubic ramus, INFIX fixation, or a “hybrid” fixation. The surgical complications and the efficacy of the surgical treatments were analyzed. Results A total of 274 screws were inserted with robotic assistance, of which 262 screws were successfully inserted to a satisfactory position on the first attempt. The number of screws placed per person was 3.2 on average, and the average operation time was 175 min (35–280 min). Fluoroscopies were performed an average of 29.1 times (range, 9–63 times), and it took 6.1 s to place each screw. There were 13 unsatisfactory guiding needle placements during the surgeries, among 7 of which cutting or penetration of the cortex was re‐planned until satisfactory insertions; 1 penetrated the pubic cortex, causing hemorrhage of the “crown of death,” and was changed to “hybrid surgery”. The robot‐assisted surgical wounds all healed by primary intention with satisfactory position and precision of screw insertions. All patients were followed up for 3–6 months, with an average of 4.2 months. There were two postoperative fixation failures, in which both patients had separated symphysis pubes after hybrid surgery. The average Majeed score at the last follow‐up was 92.4 points. Conclusions Robot‐assisted surgery is accurate and minimally invasive, with a high success rate for one‐time screw placement and satisfactory clinical results. The indications and surgical strategy should be rigorously selected, the level of surgical techniques mastered, and the operating procedures standardized, all of which may help to prevent surgical complications. Robot‐assisted surgery provides a novel modality for the minimally‐invasive treatment of pelvic ring injuries.

The aim of this study was to determine the feasibility of prosthetic mesh repair according to the degree of bowel necrosis in the emergency management of acutely strangulated groin hernias. Emergency prosthetic mesh repair versus primary suture repair was randomly performed in 208 consecutive strangulated groin hernia patients with bowel necrosis between January 2005 and August 2016. The degree of bowel necrosis of each patient was determined according to a modified three-grade classification system. Patient characteristics sorted by repair method were analyzed by using Pearson's chi-squared tests. Correlations between mortality and wound-related morbidity with bowel necrosis grade and repair method were analyzed. There was no difference in gender, age, body mass index, comorbid diseases, hernia type (left or right, primary or recurrent), necrosis grade, and mortality between the mesh repair and suture repair groups (all P > 0.05). However, with regard to wound-related morbidity, there was significant difference between the two groups ( P < 0.05). Mortality and wound-related morbidity showed significant relationship with necrosis grade, especially with regard to postoperative wound infection ( P < 0.001). The wound infection rate with mesh repair was significantly higher than that with primary suture in Grade II and III necrosis patients ( P < 0.05), but there was no difference in Grade I patients ( P > 0.05). The use of prosthetic mesh in the emergency repair of acutely strangulated groin hernias seems to be as safe as suture-only repair in patients with noninfected strangulated bowel (Grade I necrosis). The use of prosthetic mesh repair is a rational choice made based on the degree of bowel necrosis in the emergency management of acutely strangulated hernias.

The TriVex procedure for the removal of benign superficial masses is simple, safe, and effective with advantages of short operation time, small incisions, and good cosmetic outcome, which is predicted as a new minimally invasive surgery of superficial masses.