Outcomes After Laparoscopic Splenectomy

Author(s):  
Rachel J. Kwon

This chapter provides a summary of a landmark study in minimally invasive surgery. Compared with open splenectomy, what is the benefit of laparoscopic splenectomy? Starting with that question, it describes the basics of the study, including year study began, year study was published, study location, who was studied, who was excluded, how many patients, study design, study intervention, follow-up, endpoints, results, and criticism and limitations. The chapter briefly reviews other relevant studies and information, gives a summary and discusses implications, and concludes with a relevant clinical case involving laparoscopic spleen removal in a patient with immune thrombocytopenia (ITP).

Author(s):  
Rachel J. Kwon

This chapter provides a summary of a landmark study in minimally invasive surgery. Compared with open appendectomy, does laparoscopic appendectomy for acute appendicitis offer any advantage with respect to recovery, complications, or return to normal activities? Starting with that question, it describes the basics of the study, including year study was published, study location, who was studied, who was excluded, how many patients, study design, study intervention, follow-up, endpoints, results, and criticism and limitations. The chapter briefly reviews other relevant studies and information, gives a summary and discusses implications, and concludes with a relevant clinical case involving laparoscopic appendectomy for a patient with acute appendicitis.


Author(s):  
Rachel J. Kwon

This chapter provides a summary of a landmark study in minimally invasive surgery. How does laparoscopic Nissen fundoplication compare to an open surgical procedure in patients with gastroesophageal reflux disease with respect to reflux symptoms and reoperation rates? Starting with that question, it describes the basics of the study, including funding, year study began, year study was published, study location, who was studied, who was excluded, how many patients, study design, study intervention, follow-up, endpoints, results, and criticism and limitations. The chapter briefly reviews other relevant studies and information, discusses implications, and concludes with a relevant clinical case on laparoscopic Nissen fundoplication.


Author(s):  
Michael Thomaschewski ◽  
Hamed Esnaashari ◽  
Anna Höfer ◽  
Lotta Renner ◽  
Claudia Benecke ◽  
...  

Abstract Background Simulation-based practice has become increasingly important in minimally invasive surgery (MIS) training. Nevertheless, personnel resources for demonstration and mentoring simulation-based practice are limited. Video tutorials could be a useful tool to overcome this dilemma. However, the effect of video tutorials on MIS training and improvement of MIS skills is unclear. Methods A prospective randomised trial (n = 24 MIS novices) was conducted. A video-trainer with three different tasks (#1 – 3) was used for standardised goal-directed MIS training. The subjects were randomised to two groups with standard instructional videos (group A, n = 12) versus comprehensive video tutorials for each training task watched at specific times of repetition (group B, n = 12). Performance was analysed using the MISTELS score. At the beginning and following the curriculum, an MIS cholecystectomy (CHE) was performed on a porcine organ model and analysed using the GOALS score. After 18 weeks, participants performed 10 repetitions of tasks #1 – 3 for follow-up analysis. Results More participants completed tasks #1 and #2 in group B (83.3 and 75%) than in group A (66.7 and 50%, ns). For task #2, there was a significant improvement in precision in group B (p < 0.001). For the entire cohort, the GOALS-Scores were 12.9 before and 18.9 after the curriculum (p < 0.001), with no significant difference between groups. Upon follow-up, 84.2% (task#1), 26.3% (task#2) and 100% (task#3) of MIS novices were able to reach the defined goals (A vs. B ns). There was a trend for a better MISTELS score in group B upon follow-up. Conclusions Standardised comprehensive video tutorials watched frequently throughout practice can significantly improve precision in MIC training. This aspect should be incorporated in MIS training.


2021 ◽  
Author(s):  
Xu Yang ◽  
Yan Zhu ◽  
Linshan Zhang ◽  
Likun Wang ◽  
Yuanhong Mao ◽  
...  

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.


Author(s):  
Laurie O. Mark ◽  
Jean Kwo

This chapter provides a summary of the landmark study “Comparison of 8 versus 15 days of antibiotic therapy for ventilator-associated pneumonia in adults: a randomized trial.” In adult patients with ventilator-associated pneumonia (VAP), is treatment with an 8-day course of antimicrobials as effective as a 15-day course? Starting with that question, the chapter describes the basics of the study, including funding, study location, who was studied, how many patients, study design, study intervention, follow-up, endpoints, results, and criticism and limitations. The chapter briefly reviews other relevant studies and information, discusses implications, and concludes with a relevant clinical case. In ICU patients who develop microbiologically proven VAP, an 8-day antimicrobial course is not inferior to a 15-day course with respect to all-cause mortality or recurrence of pulmonary infection. However, these findings may not apply to patients who are immunocompromised, and shorter or longer duration of antibiotics may sometimes be indicated.


Author(s):  
Nikhil Gupta ◽  
Catherine Chiles

This chapter provides a summary of a landmark study in psychiatry in primary care to mediate the effect of depression on overall health status . In the treatment of patients with major depression and coronary artery disease, what is the short-term efficacy of a selective serotonin reuptake inhibitor (citalopram) and/or interpersonal therapy? Starting with that question, it describes the basics of the study, including funding, study location, who was studied, how many patients, study design, study intervention, follow-up, endpoints, results, and criticism and limitations. The chapter briefly reviews other relevant studies and information, discusses implications, and concludes with a relevant clinical case.


Author(s):  
Daniel Barron ◽  
Robert Ostroff

This chapter provides a summary of a landmark study on major depressive disorder. Is paroxetine or cognitive therapy more effective in treating patients with moderate to severe major depressive disorder? Starting with that question, it describes the basics of the study, including funding, study location, who was studied, how many patients, study design, study intervention, follow-up, endpoints, results, and criticism and limitations. The chapter briefly reviews other relevant studies and information, discusses implications, and concludes with a relevant clinical case.


Author(s):  
Robert Ross ◽  
Rajesh R. Tampi

This chapter provides a summary of a landmark study on short and longterm treatment of insomnia. Should older patients with insomnia be managed with cognitive behavioral therapy, benzodiazepines, or both? Starting with that question, it describes the basics of the study, including funding, study location, who was studied, how many patients, study design, study intervention, follow-up, endpoints, results, and criticism and limitations. The chapter briefly reviews other relevant studies and information, discusses implications, and concludes with a relevant clinical case. The study shows that bensodiazepines and cognitive behavioral therapy are equally effective for shorterm treatment of insomnia in otherwise healthy elderly participants but cognitive behavioral therapy is far more effective for longterm treatment of insomnia.


Author(s):  
Stephanie Yarnell ◽  
Ellen Edens

Chapter 20—The Prevalence and Severity of Psychiatric Comorbidities provides a summary of a landmark study in epidemiology, the The National Comorbidity Survey Replication (NCS-R). This chapter study sought to answer some fundamental questions. How common are comorbid psychiatric conditions? What are the prevalence and severity rates for comorbid anxiety, mood, impulse control, and substance use disorders? Starting with these questions, this chapter describes the basics of the study, including funding, study location, who was studied, how many patients, study design, study intervention, follow-up, endpoints, results, and criticism and limitations. The chapter briefly reviews other relevant studies and information, discusses implications, and concludes with a relevant clinical case.


Author(s):  
Stephanie Yarnell ◽  
Ellen Edens

This chapter provides a summary of a landmark study in epidemiology. The Global Burden of Disease Study was a ground breaking venture in answering the question regarding the prevalence of various diseases. By analyzing this database, the current study was sought to determine the burden of disease attributable to mental and substance use disorders. With this in mind, it describes the basics of the study, including funding, study location, who was studied, how many patients, study design, study intervention, follow-up, endpoints, results, and criticism and limitations. The chapter briefly reviews other relevant studies and information, discusses implications, and concludes with a relevant clinical case.


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