Authors' reply: Randomized controlled trial of ultrasonic dissection versus standard surgical technique in open left hemicolectomy or total gastrectomy (Br J Surg 2011; 98: 220-227)

2011 ◽  
Vol 98 (6) ◽  
pp. 886-886
Author(s):  
D. Wilhelm
Keyword(s):  
Randomized Controlled Trial ◽  
Surgical Technique ◽  
Total Gastrectomy ◽  
Controlled Trial ◽  
Left Hemicolectomy ◽  
Ultrasonic Dissection ◽  
Randomized Controlled

Randomized Controlled Trial to Evaluate Splenectomy in Total Gastrectomy for Proximal Gastric Carcinoma

2017 ◽  
Vol 265 (2) ◽  
pp. 277-283 ◽  
Author(s):  
Takeshi Sano ◽  
Mitsuru Sasako ◽  
Junki Mizusawa ◽  
Seiichiro Yamamoto ◽  
Hitoshi Katai ◽  
...  
Keyword(s):  
Randomized Controlled Trial ◽  
Gastric Carcinoma ◽  
Total Gastrectomy ◽  
Controlled Trial ◽  
Randomized Controlled ◽  
Proximal Gastric Carcinoma

scholarly journals Fetal Myelomeningocele Closure: Technical Considerations

2014 ◽  
Vol 37 (3) ◽  
pp. 166-171 ◽  
Author(s):  
Gregory G. Heuer ◽  
N. Scott Adzick ◽  
Leslie N. Sutton
Keyword(s):  
Randomized Controlled Trial ◽  
Surgical Technique ◽  
General Surgery ◽  
Congenital Malformations ◽  
Controlled Trial ◽  
Spinal Fluid ◽  
Fetal Period ◽  
Randomized Controlled ◽  
Technical Considerations ◽  
Postnatal Closure

Myelomeningocele (MMC) is one of the most common serious congenital malformations. Typically this condition has been treated with closure of the MMC defect shortly after birth. In general, surgery for MMC aims to provide a multilayered closure to provide protection to the neural elements, prevent leakage of spinal fluid and reduce infection risks. A randomized controlled trial, the Management of Myelomeningocele Study (MOMS), has shown that closure during the fetal period can be performed relatively safely and can result in significant benefit to the child. Whereas the surgical technique of prenatal closure of an MMC defect is similar to a postnatal closure, there are some important technical differences. The goal of this paper is to describe the technique of fetal closure of MMC defects, highlight the unique steps that are needed for this surgery and delineate some potential pitfalls.

scholarly journals A randomized controlled trial of stapled versus ultrasonic transection in distal pancreatectomy

2021 ◽  
Author(s):  
Luca Landoni ◽  
Matteo De Pastena ◽  
Martina Fontana ◽  
Giuseppe Malleo ◽  
Alessandro Esposito ◽  
...  
Keyword(s):  
Randomized Controlled Trial ◽  
Pancreatic Fistula ◽  
Distal Pancreatectomy ◽  
Controlled Trial ◽  
Intraoperative Ultrasound ◽  
Postoperative Pancreatic Fistula ◽  
Ultrasonic Dissection ◽  
Randomized Controlled ◽  
Significant Difference ◽  
Secondary Endpoints

Abstract Background The pancreatic transection method during distal pancreatectomy is thought to influence postoperative fistula rates. Yet, the optimal technique for minimizing fistula occurrence is still unclear. The present randomized controlled trial compared stapled versus ultrasonic transection in elective distal pancreatectomy. Methods Patients undergoing distal pancreatectomy from July 2018 to July 2020 at two high-volume institutions were considered for inclusion. Exclusion criteria were contiguous organ resection and a parenchymal thickness > 17 mm on intraoperative ultrasound. Eligible patients were randomized in a 1:1 ratio to stapled transection (Endo GIA Reinforced Reload with Tri-Staple Technology®) or ultrasonic transection (Harmonic Focus® + or Harmonic Ace® + shears). The primary endpoint was postoperative pancreatic fistula. Secondary endpoints included overall complications, abdominal collections, and length of hospital stay. Results Overall, 72 patients were randomized in the stapled transection arm and 73 patients in the ultrasonic transection arm. Postoperative pancreatic fistula occurred in 23 patients (16%), with a comparable incidence between groups (12% in stapled transection versus 19% in ultrasonic dissection arm, p = 0.191). Overall complications did not differ substantially (35% in stapled transection versus 44% in ultrasonic transection arm, p = 0.170). There was an increased incidence of abdominal collections in the ultrasonic dissection group (32% versus 14%, p = 0.009), yet the need for percutaneous drain did not differ between randomization arms (p = 0.169). The median length of stay was 8 days in both groups (p = 0.880). Intraoperative blood transfusion was the only factor independently associated with postoperative pancreatic fistula on logistic regression analysis (OR 4.8, 95% CI 1.2–20.0, p = 0.032). Conclusion The present randomized controlled trial of stapled versus ultrasonic transection in elective distal pancreatectomy demonstrated no significant difference in postoperative pancreatic fistula rates and no substantial clinical impact on other secondary endpoints.

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