scholarly journals Learning curve analysis of applying Seprafilm hyaluronic acid/carboxymethylcellulose membrane during laparoscopic hysterectomy

2020 ◽  
Vol 10 (1) ◽  
Author(s):  
Yi-Ting Huang ◽  
Yu-Ying Su ◽  
Kai-Yun Wu ◽  
Hui-Yu Huang ◽  
Yu-Shan Lin ◽  
...  
Keyword(s):  
Hyaluronic Acid ◽  
Learning Curve ◽  
Abdominal Cavity ◽  
Laparoscopic Hysterectomy ◽  
Complete Removal ◽  
Experienced Surgeon ◽  
Subtotal Hysterectomy ◽  
Plastic Sleeve ◽  
Time Required ◽  
Incision Wound

Abstract This study was designed to evaluate the learning curve of applying Seprafilm (modified hyaluronic acid and carboxymethylcellulose; Genzyme, Cambridge, MA, USA) during laparoscopic hysterectomy or subtotal hysterectomy with or without adnexectomy. In this retrospective cohort study, 35 patients who underwent laparoscopic hysterectomy or subtotal hysterectomy with or without adnexectomy were enrolled. The Seprafilm was cut into 4 pieces, rolled up with a trimmed plastic sleeve and delivered through an incision wound made for the 5-mm ancillary trocar. The membrane was unrolled and placed on the rough surface after hysterectomy or subtotal hysterectomy with or without adnexectomy. The time from the insertion of the first piece of membrane into the abdominal cavity to the complete removal of the trimmed plastic sleeve was recorded. The median time for Seprafilm placement was 3 min. The learning curve was analyzed using the power-law method and suggested that 10 cases were required to achieve proficiency in the procedure. The presence of adnexectomy was significantly associated with the time required for Seprafilm placement (P < 0.001). Although Seprafilm placement is more complicated compared to the liquid and gel forms of anti-adhesion barriers, surgical proficiency seemed to be attained after 10 cases for an experienced surgeon.

scholarly journals Late presentation of extrauterine adenomyomas after laparoscopic morcellation at hysterectomy: a case report

2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Mohammed Nagdi Zaki ◽  
Aafia Mohammed Farooq Gheewale ◽  
Nada Ibrahim ◽  
Ibrahim Abd Elrahman
Keyword(s):  
Case Report ◽  
Transvaginal Ultrasound ◽  
Iliac Fossa ◽  
Abdominal Cavity ◽  
Laparoscopic Hysterectomy ◽  
Pathology Report ◽  
Presacral Space ◽  
Gnrh Analogue ◽  
Power Morcellation ◽  
The Right

Abstract Background An adenomyoma is a well circumscribed form of adenomyosis and can be located within the myometrium, in the endometrium as a polyp, or extrauterine with the last being the rarest presentation amongst the three. With the ongoing advancement in gynecological surgery, the use of electromechanical morcellators have made the removal of large and dense specimens possible with minimally invasive techniques. However, it has also caused an increase in complications which were previously rare. Whilst the tissue is being grinded within the abdominal cavity, residual tissue can spread and remain inside, allowing for implantation to occur and thereby giving rise to recurrence of uterine tissue as a new late postoperative complication. Case presentation A 45-year-old woman presented with worsening constipation and right iliac fossa pain. Her past surgical history consists of laparoscopic supra-cervical hysterectomy that was indicated due to uterine fibroids. Computerized tomography and magnetic resonance imaging were done, which showed an irregular lobulated heterogeneous mass seen in the presacral space to the right, located on the right lateral aspect of the recto-sigmoid, measuring 4.5 × 4.3 × 4.3 cm in size. A transvaginal ultrasound revealed a cyst in the left ovary. The patient had a treatment course over several months that included Dienogest (progestin) and Goserelin (GnRH analogue) with add-back therapy. In line with the declining response to medications, the patient was advised for a laparoscopic ovarian cystectomy. During the surgery, an additional lesion was found as a suspected fibroid and the left ovarian cyst was identified as pockets of peritoneal fluid which was sent for cytology. The surgical pathology report confirmed adenomyosis in both specimens, namely the right mass and the initially suspected fibroid. Conclusion In this case report, we showcase a rare occurrence of an extrauterine adenomyoma presenting two years post laparoscopic morcellation at hysterectomy. This poses questions regarding the benefits versus risks of power morcellation in laparoscopic hysterectomy.

scholarly journals Learning curve in laparoscopic hysterectomy: yuva experience

2020 ◽  
Vol 7 (1) ◽  
pp. 48-51
Author(s):  
Anshu Sharma ◽  
Priyanka Chaudhary ◽  
Prachi Singhal ◽  
Rajiv Acharya ◽  
Alok Sharma ◽  
...  
Keyword(s):  
Learning Curve ◽  
Laparoscopic Hysterectomy

scholarly journals Learning curve for laparoscopic Roux-en-Y gastric bypass based on the experience of a newly created bariatric center

2020 ◽  
Vol 92 (4) ◽  
pp. 23-30
Author(s):  
Jadwiga Dworak ◽  
Michał Wysocki ◽  
Anna Rzepa ◽  
Michał Pędziwiatr ◽  
Dorota Radkowiak ◽  
...  
Keyword(s):  
Morbid Obesity ◽  
Gastric Bypass ◽  
Adverse Events ◽  
Learning Curve ◽  
Operative Time ◽  
Perioperative Complications ◽  
Safe Procedure ◽  
Experienced Surgeon ◽  
Institutional Learning ◽  
Complications And Mortality

ntroduction: Laparoscopic Roux-en-Y gastric bypass (LRYGB) is one of the most common treatments for morbid obesity. The learning curve for this procedure is 50–75 cases for an independent surgeon, and it is considered the most important factor in decreasing complications and mortality. We present our experience and learning curve with LRYGB for a newly established bariatric center in Poland. Material and methods: A prospectively collected database containing 285 LRYGB procedures performed in the II Department of General Surgery of the Jagiellonian University MC in Krakow between 06.2010 and 03.2019 was retrospectively reviewed. Patients were divided into groups of 30 (G1–G10) in the order of the procedures performed by each surgeon. The study analyzed the course of the operation and patient hospitalization, comparing those groups. Learning curve for the newly created bariatric center was established. Results: Operative time in G1–G3 differed significantly from G4–G10 (P < 0.0001). The stabilization point was the 90th procedure. Perioperative complications were observed in 36 (12.63%) patients. Perioperative complications, intraoperative difficulties and adverse events did not differ importantly among groups. Liberal use of “conversions of the operator” from a surgeon to a senior surgeon provides reasonable safety and prevents complications. Conclusions: The institutional learning process stabilization point for LRYGB in a newly established bariatric center is around the 90th operation. LRYGB can be a safe procedure from the very beginning in newly established bariatric centers. Specific bariatric training with active proctoring by an experienced surgeon in a bariatric centre can improve the laparoscopic gastric bypass outcome during the learning curve.

scholarly journals On-Site Monitoring of Postoperative Bile Leakage Using Bilirubin-Inducible Fluorescent Protein

2020 ◽  
Vol 44 (12) ◽  
pp. 4245-4253
Author(s):  
Yoshiharu Kono ◽  
Takeaki Ishizawa ◽  
Norihiro Kokudo ◽  
Yugo Kuriki ◽  
Ryu J. Iwatate ◽  
...  
Keyword(s):  
Fluorescence Imaging ◽  
Fluorescent Protein ◽  
Imaging Techniques ◽  
Abdominal Cavity ◽  
Bile Leakage ◽  
Indirect Bilirubin ◽  
Site Monitoring ◽  
Real Time Identification ◽  
Time Required ◽  
Bile Leaks

Abstract Background Bile leakage is the most common postoperative complication associated with hepatobiliary and pancreatic surgery. Until now, however, a rapid, accurate diagnostic method for monitoring intraoperative and postoperative bile leakage had not been established. Method Bilirubin levels in drained abdominal fluids collected from 23 patients who had undergone hepatectomy (n = 22) or liver transplantation (n = 1) were measured using a microplate reader with excitation/emission wavelengths of 497/527 nm after applying 5 µM of UnaG to the samples. UnaG was also sprayed directly on hepatic raw surfaces in swine hepatectomy models to identify bile leaks by fluorescence imaging. Results The bilirubin levels measured by UnaG fluorescence imaging showed favorable correlations with the results of the conventional light-absorptiometric methods (indirect bilirubin: rs = 0.939, p < 0.001; direct bilirubin: rs = 0.929, p < 0.001). Approximate time required for bilirubin measurements with UnaG was 15 min, whereas it took about 40 min with the conventional method at a hospital laboratory. Following administration of UnaG on hepatic surfaces, the fluorescence imaging identified bile leaks not only on the resected specimens but also in the abdominal cavity of the swine hepatectomy models. Conclusion Fluorescence imaging techniques using UnaG may enable real-time identification of bile leaks during hepatectomy and on-site rapid diagnosis of bile leaks after surgery.

Hyaluronic acid in incision wound fluid: A clinical study with the CellstickR device in children

2001 ◽  
Vol 9 (3) ◽  
pp. 200-204 ◽  
Author(s):  
Olli T. Pajulo ◽  
Kari J. Pulkki ◽  
Kaarlo K. Lertola ◽  
Markku S. Alanen ◽  
Mikko S. Reunanen ◽  
...  
Keyword(s):  
Hyaluronic Acid ◽  
Clinical Study ◽  
Wound Fluid ◽  
Incision Wound

scholarly journals Giant lymphatic malformation causing abdominal compartment syndrome in a neonate: a rare surgical emergency

2020 ◽  
Vol 2020 (8) ◽  
Author(s):  
Paolo Gasparella ◽  
Georg Singer ◽  
Christoph Castellani ◽  
Erich Sorantin ◽  
Emir Q Haxhija ◽  
...  
Keyword(s):  
Compartment Syndrome ◽  
Abdominal Compartment Syndrome ◽  
Abdominal Cavity ◽  
Complete Removal ◽  
Lymphatic Malformation ◽  
Ileocecal Resection ◽  
Lymphatic Malformations ◽  
Gestational Week ◽  
Immediate Surgery ◽  
Abdominal Compartment

Abstract Abdominal lymphatic malformations in neonates require sophisticated management. In symptomatic cases, acute complications may necessitate immediate surgery. We present the case of a giant abdominal lymphatic malformation diagnosed in the 18th gestational week. Sonographic concerns about intestinal hypoperfusion in the 33rd week of gestation indicated caesarean section. Postnatal imaging confirmed a macrocystic lymphatic malformation occupying almost the complete abdominal cavity; the intestinal perfusion was normal. Clinical deterioration on Day 13 of life required laparotomy. Intraoperatively, the lymphatic mass was located in the ileocecal mesentery. Two major cysts showed recent hemorrhage explaining the onset of abdominal compartment syndrome. The malformation was completely removed. An ileocecal resection with an ileocolic anastomosis was performed. The postoperative course was uneventful. In neonates with abdominal lymphatic malformations, an onset of abdominal compartment syndrome requires surgical exploration. If feasible, the complete removal of the lesion represents a curative option.

Totally Laparoscopic Aortic Surgery: Comparison of the Apron and Retrocolic Techniques in a Porcine Model

2007 ◽  
Vol 41 (3) ◽  
pp. 230-238 ◽  
Author(s):  
Hai Huynh ◽  
Stephane Elkouri ◽  
Nathalie Beaudoin ◽  
Luc Bruneau ◽  
Cathie Guimond ◽  
...  
Keyword(s):  
Learning Curve ◽  
Ex Vivo ◽  
Aortic Surgery ◽  
Open Conversion ◽  
Initial Learning ◽  
Second Year ◽  
Time Required ◽  
Surgery Resident ◽  
Totally Laparoscopic ◽  
Laparoscopic Anastomosis

This study evaluated the learning curve for a second-year general surgery resident and compared 2 totally laparoscopic aortic surgery techniques in 10 pigs: the transretroperitoneal apron approach and the transperitoneal retrocolic approach. Five end points were compared: success rate, percentage of conversion, time required, laparoscopic anastomosis quality, and learning curve. The first 3 interventions required an open conversion. The last 7 were done without complications. Mean dissection time was significantly higher with the apron approach compared with the retrocolic approach. The total times for operation, clamping, and arteriotomy time were similar. All laparoscopic anastomoses were patent and without stenosis. The initial learning curve for laparoscopic anastomosis was relatively short for a second-year surgery resident. Both techniques resulted in satisfactory exposure of the aorta and similar mean operative and clamping time. Training on an ex vivo laparoscopic box trainer and on an animal model seems to be complementary to decrease laparoscopic anastomosis completion time.

scholarly journals Adopting Ultrasound Guidance for Prone Percutaneous Nephrolithotomy: Evaluating the Learning Curve for the Experienced Surgeon

2016 ◽  
Vol 30 (8) ◽  
pp. 856-863 ◽  
Author(s):  
Manint Usawachintachit ◽  
Selma Masic ◽  
Isabel E. Allen ◽  
Jianxing Li ◽  
Thomas Chi
Keyword(s):  
Learning Curve ◽  
Percutaneous Nephrolithotomy ◽  
Ultrasound Guidance ◽  
Experienced Surgeon

scholarly journals The Learning Curve for a Fetal Cardiac Intervention Team

2010 ◽  
Vol 2010 ◽  
pp. 1-5 ◽  
Author(s):  
Stephen P. Emery ◽  
Jacqueline Kreutzer ◽  
Frances M. McCaffrey ◽  
Fredrick S. Sherman ◽  
Hyagriv N. Simhan ◽  
...  
Keyword(s):  
Minimally Invasive ◽  
Learning Curve ◽  
Aortic Root ◽  
Multidisciplinary Team ◽  
Intervention Program ◽  
Needle Insertion ◽  
Cardiac Intervention ◽  
Team Members ◽  
Pregnant Sheep ◽  
Time Required

Objectives. Multiple technical difficulties are encountered when a multidisciplinary team of subspecialists begins a minimally-invasive fetal cardiac interventional program. We describe the learning curve.Study Design. Ten pregnant sheep underwent ultrasound-guided balloon valvuloplasty of the aortic valve. Team members and their roles remained constant through the trial. The time between needle insertion and entrance of the left ventricle at the aortic root was recorded.F-test was used to assess significance (P≤.05).Results. The time required to accurately position the needle tip at the aortic root decreased significantly over the course of the trial, from 12 minutes with the first attempt to one minute with the last (P=.003).Conclusion. A significant learning curve is encountered when a multidisciplinary team begins a minimally-invasive fetal cardiac intervention program. However, technical proficiency can be achieved with practice. Institutions interested in developing such a program should consider practice in an animal model before proceeding to the human fetus.

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