The impact of preventable disruption on the operative time for minimally invasive surgery

INTRODUCTION Surgeon-based ultrasonography (SUS) for parathyroid disease has not been widely adopted by British endocrine surgeons despite reports worldwide of accuracy in parathyroid localisation equivalent or superior to radiology-based ultrasonography (RUS). The aim of this study was to determine whether SUS might benefit parathyroid surgical practice in a British endocrine unit. METHODS Following an audit to establish the accuracy of RUS and technetium sestamibi (MIBI) in 54 patients, the accuracy of parathyroid localisation by SUS and RUS was compared prospectively with operative findings in 65 patients undergoing surgery for primary hyperparathyroidism (pHPT). RESULTS The sensitivity of RUS (40%) was below and MIBI (57%) was within the range of published results in the audit phase. The sensitivity (64%), negative predictive value (86%) and accuracy (86%) of SUS were significantly greater than RUS (37%, 77% and 78% respectively). SUS significantly increased the concordance of parathyroid localisation with MIBI (58% versus 32% with RUS). CONCLUSIONS SUS improves parathyroid localisation in a British endocrine surgical practice. It is a useful adjunct to parathyroid practice, particularly in centres without a dedicated parathyroid radiologist, and enables more patients with pHPT to benefit from minimally invasive surgery.

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Initial CT blend sign is not associated with poor outcome in patients following stereotactic minimally invasive surgery

10.21203/rs.3.rs-37415/v3 ◽

2021 ◽

Author(s):

Xu Yang ◽

Yan Zhu ◽

Linshan Zhang ◽

Likun Wang ◽

Yuanhong Mao ◽

...

Keyword(s):

Minimally Invasive Surgery ◽

Minimally Invasive ◽

Invasive Surgery ◽

Cardiac Complications ◽

Control Group ◽

Haematoma Expansion ◽

Poor Outcomes ◽

The Impact ◽

The Relationship

Abstract Background: The initial computed tomography (CT) blend sign has been used as an imaging marker to predict haematoma expansion and poor outcomes in patients with a small volume intracerebral haemorrhage (ICH). However, the relationship between the blend sign and outcomes remains elusive. The present study aimed to retrospectively measure the impact of initial CT blend signs on short-term outcomes in patients with hypertensive ICH who underwent stereotactic minimally invasive surgery (sMIS). Methods: We enrolled 242 patients with spontaneous ICH. Based on the initial CT features, the patients were assigned to a blend sign group (91 patients) or a nonblend sign (control) group (151 patients). The NIHSS, GCS and mRS were used to measure the effects of sMIS. The rates of severe pulmonary infection and cardiac complications were also compared between the two groups. Results: No significant differences in NIHSS and GCS scores were observed between the two groups. The proportion of patients with good outcomes during follow-up was not different between the two groups. The rate of rehaemorrhaging increased in the blend sign group. No significant differences in severe pulmonary infections and cardiac complications were noted between the two groups. Conclusions: The initial CT blend sign was not associated with poor outcomes in patients with hypertensive ICH who underwent sMIS. ICH patients with CT blend signs should undergo sMIS if they are suitable candidates for surgery.

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Quality and Safety of Minimally Invasive Surgery: Past, Present, and Future

Biomedical Engineering and Computational Biology ◽

10.4137/becb.s10967 ◽

2014 ◽

Vol 6 ◽

pp. BECB.S10967 ◽

Cited By ~ 17

Author(s):

Bernadette McCrory ◽

Chad A. LaGrange ◽

M.S. Hallbeck

Keyword(s):

Minimally Invasive Surgery ◽

Adverse Events ◽

Minimally Invasive ◽

Invasive Surgery ◽

Human Performance ◽

Motor Vehicle ◽

The United States ◽

Quality And Safety ◽

Surgical Errors ◽

The Impact

Adverse events because of medical errors are a leading cause of death in the United States (US) exceeding the mortality rates of motor vehicle accidents, breast cancer, and AIDS. Improvements can and should be made to reduce the rates of preventable surgical errors because they account for nearly half of all adverse events within hospitals. Although minimally invasive surgery (MIS) has proven patient benefits such as reduced postoperative pain and hospital stay, its operative environment imposes substantial physical and cognitive strain on the surgeon increasing the risk of error. To mitigate errors and protect patients, a multidisciplinary approach is needed to improve MIS. Clinical human factors, and biomedical engineering principles and methodologies can be used to develop and assess laparoscopic surgery instrumentation, practices, and procedures. First, the foundational understanding and the imperative to transform health care into a high-quality and safe system is discussed. Next, a generalized perspective is presented on the impact of the design and redesign of surgical technologies and processes on human performance. Finally, the future of this field and the research needed to further improve the quality and safety of MIS is discussed.

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Re: Packiam et al: The Impact of Minimally Invasive Surgery on Major Iatrogenic Ureteral Injury and Subsequent Ureteral Repair During Hysterectomy: A National Analysis of Risk Factors and Outcome (Urology 2016;doi:10.1016/j.urology.2016.06.041)

Urology ◽

10.1016/j.urology.2016.07.039 ◽

2016 ◽

Vol 97 ◽

pp. 280-281

Author(s):

Jovo Bogdanović ◽

Vuk Sekulić ◽

Senjin Djozić

Keyword(s):

Risk Factors ◽

Minimally Invasive Surgery ◽

Minimally Invasive ◽

Invasive Surgery ◽

Ureteral Injury ◽

National Analysis ◽

The Impact ◽

Iatrogenic Ureteral Injury

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CT Blend Signs are not Associated with Poor Outcome in Patients with ICH Following a Stereotactic Minimally Invasive Surgery

10.21203/rs.3.rs-37415/v1 ◽

2020 ◽

Author(s):

Xu Yang ◽

Linshan Zhang ◽

Likun Wang ◽

Yuanhong Mao ◽

Yinghui Li ◽

...

Keyword(s):

Minimally Invasive Surgery ◽

Minimally Invasive ◽

Invasive Surgery ◽

Cardiac Complications ◽

Control Group ◽

Term Outcome ◽

Poor Outcome ◽

Group Control Group ◽

The Impact

Abstract Backgrounds: The initial CT blend sign has been used as an imaging maker to predict haematoma expansion and poor outcome in patients with small volume intracerebral haemorrhage (ICH). However, the relationship between the blend sign and the outcome of patients remains elusive. The present study aimed to retrospectively observe the impact of initial CT blend signs on the short-term outcome of patients with hypertensive ICH underwent a stereotatic minimally invasive surgery (sMIS). Methods: Two hundreds and forty-two patients with spontaneous ICH were enrolled. Based on the initial CT features, the patients were assigned to a blend sign group (including 91 patients) or a non-blend sign group (control group, including 151 patients). The NIHSS, GCS and the mRS were used to observe the efficacy of the sMIS. The rates of severe pulmonary infection, cardiac complications were also compared between the two groups. Results: No significant differences in NIHSS and GCS in one week or two weeks after surgery were observed between the two groups. The proportion of patients with good outcome during follow-up did not show any difference between the two groups. However, both the two groups displayed good functional outcome over admission. The rate of rehaemorrhage increased in the blend sign group. No significant differences in severe pulmonary infections and cardiac complications were noted between the two groups. Conclusions：The initial CT blend sign are not associated with poor outcome of patients with hypertensive ICH underwent sMIS. ICH patients with CT blend sign should be also treated by performing sMIS if they are candidates for surgery.

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