The aim of this study was to analyse the radiological and clinical outcomes of condylar reconstruction by fibula free flap (FFF), comparing conventional freehand and CAD/CAM techniques. Fifteen patients (nine CAD/CAM, six freehand) who underwent condylar reconstruction with a FFF were reviewed retrospectively regarding pre- and postoperative computed tomography/cone beam computed tomography scans and clinical function. After surgery, all patients were free of temporomandibular joint pain. Mean postoperative mouth opening was 30.80 mm, with no significant difference between the freehand and CAD/CAM groups. In all patients, laterotrusion was decreased to the contralateral side (P = 0.002), with no difference between freehand and CAD/CAM, while the axis of mouth opening deviated to the side of surgery (P < 0.001). All patients showed significant radiological deviation of the fibular neocondyle in the laterocaudal direction (lateral: P = 0.015; caudal: P = 0.001), independent of the technique. In conclusion, reconstruction of the mandibular condyle by FFF provided favourable functional results in terms of mouth opening, reduction of pain, and mandibular excursions. Radiological deviation of the neocondyle and deviation of laterotrusion and mouth opening did not impair clinical function. CAD/CAM planning facilitated surgery, decreased the surgery time, and improved the fit of the neocondyle in the fossa.

BACKGROUND: Control of the joints of robotic surgical instruments is difficult owing to hysteresis, and tendon twisting due to axial rotation of surgical tools also causes hysteresis. Therefore, a new mechanism is needed to prevent tendon twisting.
METHODS: Tendon tension and hysteresis change were analysed by observing the movement of the joint depending on whether the tendons twisted for the same input signal. An anti-twist tendon mechanism to prevent twisting was developed. A 3-mm needle driver applied with the proposed mechanism was manufactured.
RESULTS: The anti-twist mechanism makes no tension change because of twisting or friction between the tendon and the system, that is, the operating performance was the same regardless of rotation.
CONCLUSIONS: The proposed mechanism has been verified and can be applied to small surgical instruments 3 mm in size. These findings can be applied in the development of instruments for precise surgeries such as microsurgery.

BACKGROUND: Background Recently, a real-time system, named cancer diagnostic probe (CDP), has been developed to diagnose the presence of pre-neoplastic/neoplastic cells in breast cavity side margins. Detecting mechanism is real-time determination of the ROS/H2 O2 released from cancer or atypical cells, through reverse Warburg effect and hypoxia glycolysis pathways.
OBJECTIVE: Here, we designed a human model study based on real-time checking of 387 internal margins (IM) from 39 neoadjuvant breast cancer cases by CDP. MATERIALS & METHODS: Each lesion was checked by entered needle sensor and electrical scores were recorded. The permanent pathology result of each tested lesion was our gold standard to evaluate CDP scoring. CDP results were compared with permanent pathology of tumour side margins (as a conventional margin evaluation procedure).
RESULTS: Results showed that the sensitivity of CDP in scoring the cavity side margins of those cases is 91%. A total of 18 involved IM which had been detected by CDP were declared as free margins in pathology section of tumour side samples. Just five involved IM were missed by CDP.
CONCLUSIONS: Such sensitivity revealed that metabolism based (here: hypoxia glycolysis) tracing of cancer cells show distinct electrochemical responses between clear and involved cavity side margin evaluation.
CONCLUSIONS: This human study showed the promising role of CDP to achieve clear margins after BCS of neoadjuvant cases.

BACKGROUND: Tubal anastomosis has similar pregnancy rates regardless of approach. Historically, robotic anastomosis has been associated with increased cost and operative time. We sought to perform a contemporary study of these metrics.
METHODS: One hundred and nine patients were identified who underwent robotic-assisted laparoscopic tubal anastomosis. Retrospective analysis of medical records was performed. Phone survey was conducted.
RESULTS: The mean operative time decreased from 140.7 ± 27.0 min in 2013 to 60.0 ± 9.1 min in 2018, with significant downward trend (p < 0.001). The mean cost was $7153.46 ± $1484.41. The pregnancy rate was 59% (35/59), and tubal patency rate was 81% (42/52). Seventy-two percent of patients under 37 years became pregnant.
CONCLUSIONS: There is significant improvement in operative time of robotic-assisted tubal anastomosis with surgical experience. Robotic tubal anastomosis outperformed historical metrics of laparoscopy and laparotomy with regard to operative time and cost in this series.

The cerebellum communicates with the cerebral cortex via the superior, middle, and inferior cerebellar peduncles (CPs). To preserve the structure and function of the brainstem and cerebellum, which is compressed in various pathological conditions, it is important to delineate the spatial interrelationship of the CPs for presurgical planning and intraoperative guidance. Diffusion tensor tractography (DTT) is a technique capable of depicting the major fiber bundles in CPs. However, routine use of this technology for brainstem visualization remains challenging due to the anatomical smallness and complexity of the brainstem and susceptibility-induced image distortions. Here, we attempt to visualize CPs using high-resolution DTT in a commercial equipment for the application of this technique in normal clinical settings. DTT and fast imaging employing steady-state acquisition-cycled phases (FIESTA) of the whole brainstem were performed. We rendered the DTT fiber bundle using a region-of-interest-based fiber tracking method onto the structural image generated in FIESTA by automatic image coregistration. Fibers of the CPs were clearly visualized by DTT. The DTT-FIESTA overlaid image revealed the cross-sectional and three-dimensional anatomy of the pyramidal tract and the ascending sensory fibers, in addition to the CPs. This could indicate a geometrical relationship of these fibers in the brainstem. The CPs could be visualized clearly using DTT within clinically acceptable scanning times. This method of visualizing the exact pathway of fiber bundles and cranial nerves in the skull base helps in the planning of surgical approaches.

BACKGROUND: Autologous submandibular gland transfer for treatment of progressive dry eye symptoms requires a functionally intact submandibular gland. In cases of total function loss of both lacrimal and submandibular glands this procedure has to be modified. Here we report on the first two cases of the allogenic transplantation of a submandibular gland to treat patients suffering from complete functional loss of both glands due to graft-versus-host disease (GvHD) following stem cell transplantation.
METHODS: We carried out allogenic transplantation of the submandibular gland of the matched former stem cell donor to the temporal fossa of the stem cell recipient suffering from GvHD-induced dry eye. The treatment was carried out in two male patients who showed complete donor chimerism to the stem cell donors, so that no immunosuppressive therapy was applied.
RESULTS: Postoperative clinical assessment of the patients revealed primary success of the procedure. The ocular surface showed improvement of lubrication and reduction of inflammatory signs. In the long-term follow-up sialoscintigraphy revealed lower tracer activity than expected and secretion of saliva-tears decreased.
CONCLUSIONS: Even though the so-called total donor chimerism was assessed allogenic transplantation of the submandibular gland following GvHD-induced dry eye showed signs of organ rejection and therefore initial immunosuppressive therapy after allogenic transplantation has to be considered.