Microlobectomy: A Novel Form of Endoscopic Lobectomy

2017 ◽  
Vol 12 (4) ◽  
pp. 247-253 ◽  
Author(s):  
Joel Dunning ◽  
Mohamed Elsaegh ◽  
Marco Nardini ◽  
Erin A. Gillaspie ◽  
Rene Horsleben Petersen ◽  
...  
Keyword(s):  
Cohort Study ◽  
Blood Loss ◽  
Thoracic Surgery ◽  
Operative Time ◽  
Wound Infections ◽  
Inclusion Criteria ◽  
Strict Inclusion ◽  
Stapling Devices ◽  
Early Experiences ◽  
Early Results

Objective Microlobectomy is a novel form of videoscopic-assisted thoracic surgery lobectomy. Strict inclusion criteria consist of the following: no intercostal incisions greater than 5 mm, 12 mm subxiphoid port, subxiphoid removal of the specimen, total endoscopic technique with CO2 insufflation, vision through a 5-mm camera, stapling via the subxiphoid port, or with 5-mm stapling devices. Methods The combined early experiences of six hospitals from three countries were combined from September 2014 to May 2016. During that time, the study represents a consecutive cohort study of this technique. Results Seventy-two patients underwent microlobectomy. The median (range) age was 66 (27–82). Half of the patients were female. There were 48 right-sided resections and 24 on the left. There were four segmental resections and there was one right pneumonectomy. Four operations were performed robotically (with 8-mm intercostal incisions). The median (range) operative time was 180 (94–285) minutes and the blood loss was 118 (5–800) mL. There were three conversions to thoracotomy and two conversions to videoscopic-assisted thoracic surgery by means of an intercostal utility incision to complete the operation. The median (range)length of stay was 3(1–44) days and 30 patients (42%) when home by day 2 and 16 patients (22%) were discharged on day 1. There were no deaths. Five patients (7%) had a prolonged airleak. There were no wound infections and there was one incisional hernia. Conclusions We believe that microlobectomy is an interesting novel form of videoscopic-assisted thoracic surgery lobectomy and has several theoretical advantages. We have presented our early results and hope that this will stimulate others to investigate this type of videoscopic-assisted thoracic surgery lobectomy further.

scholarly journals Quantitative comparison of clinical outcomes and decompression parameters between extreme lateral lumbar interbody fusion and transforaminal lumbar interbody fusion in treating lumbar spinal stenosis: a 3-year retrospective cohort study

2020 ◽  
Author(s):  
Junchao Xing ◽  
Peng Cheng ◽  
Jianzhong Xu ◽  
Hongwei Lu ◽  
Qingyi He
Keyword(s):  
Cohort Study ◽  
Blood Loss ◽  
Retrospective Cohort Study ◽  
Retrospective Cohort ◽  
Interbody Fusion ◽  
Operative Time ◽  
Transforaminal Lumbar Interbody Fusion ◽  
Fusion Rate ◽  
Lumbar Interbody Fusion ◽  
Lumbar Spinal

Abstract Background This retrospective cohort study was conducted to compare the clinical efficacy and decompression parameters of extreme lateral lumbar interbody fusion (XLIF) with transforaminal lumbar interbody fusion (TLIF) in treating lumbar spinal stenosis (LSS). Methods From January 2012 to June 2016, 1455 patients with LSS who underwent surgery were reviewed and 83 cases were included (40 cases for XLIF and 43 cases for TLIF). The operative time, blood loss, accumulated fluoroscopy time, visual analogue scale (VAS), Oswestry Disability Index (ODI), fusion rate and complications were evaluated. Moreover, decompression parameters were compared, including the sagittal disc height (DH), the foraminal height (FH) and area (FA), the lumbar lordosis (LL), the transverse area of the dural sac (DS), as well as the rate of change loss of these parameters. Results The baseline was consistent between two groups. The mean follow-up time was 36.9 months. Both of XLIF and TLIF yielded clinical improvements. XLIF had advantages over TLIF in blood loss, operative time, hospital stay and complication. The fusion rate, postoperative VAS and ODI scores were comparable. Particularly, XLIF showed analogous, or even better, capacity of ameliorating decompression parameters to TLIF, especially regarding DH, LL and the maintenance of decompression. Conclusions Compared with TLIF, XLIF is advantageous to avoid blood loss, shorten the operative time, hospital stay and maintain the decompressive effect in treating LSS.

Ứng dụng dao siêu âm Sonastar trong phẫu thuật cắt gan

2020 ◽  
Author(s):  
Hien Pham Nhu
Keyword(s):  
Liver Resection ◽  
Blood Loss ◽  
Operative Time ◽  
Resection Margin ◽  
Operation Time ◽  
Bile Leakage ◽  
Hepatic Veins ◽  
Early Results ◽  
Solitary Liver ◽  
The Mean

Background: Researching specification and evaluating early results after hepatectomy that it’s used with Sonastar ultrasonic tool. Materials and methods: We prospectively examined data of 19 patients who underwent hepatectomy at Hue Central Hospitalfrom 7/2019to 7/2020. Results: The mean ages was 60,7 ± 10,5 range (19 – 90) and males/females was 6:1.. Patients with solitary liver tumor accounted for 79%; while tumors that have satellite cores accounted for 21% of all cases. 68,4% of all patients have tumor that is more than 5cm in size. Blocking hepatic blood flow by clamping of hepatoduodenal ligament accounts for 57,9%, while right and left hepatic vein clamp accounted for 68,4% and 36,8% respectively. In 78,9% of the cases, surgicel was used to cover the liver resection margin, while the in the remainder 21,5% of the cases, BioGlue was used. Large liver resection (2 and more lobes resected) accounted for 73,7% of all cases. Mean liver resection time was 50 ( 45-110) minutes, mean operation time was 125 (90-280) minutes, mean blood loss amount was 250 (150-650)ml. On average, post-operative time was 8 days (7-23). Post-operative complications was observed in 15,9% of cases, and there was 5,3% deceased. Conclusion: Application of Sonastar ultrasonic tool in hepatectomy reduces blood loss, help better manage hepatic veins, thus reducing complications such as bile leakage. It also helps surgeons manage the liver resection margin, minimalizing recurrences cancer

scholarly journals Retrospective Cohort Study Comparing Current Third Stage Management to Expedient Squatting Third Stage Management

2021 ◽  
Author(s):  
Judy Slome Cohain ◽  
Rina Buxbaum
Keyword(s):  
Cohort Study ◽  
Blood Loss ◽  
Retrospective Cohort Study ◽  
Postpartum Hemorrhage ◽  
Retrospective Cohort ◽  
Active Management ◽  
Stage Management ◽  
Inclusion Criteria ◽  
Manual Removal ◽  
Third Stage

Abstract Background: Active management of the delivery of the placenta results in 5% postpartum hemorrhage, 1% blood transfusions and an average blood loss of 500 cc. Shorter third stages are associated with decreased hemorrhage rates. The third stage can be shortened by instructing the birthing woman to squat and push out the placenta at 3 minutes postpartum. The objective of this study was to compare blood loss and PPH rates using Judy's 3,4,5 minute third stage expedient squatting protocol to variations of active and expectant third stage management among similar populations.Methodology: A retrospective cohort study was carried out comparing 1,098 planned homebirths attended in Israel, in which Judy’s 3,4,5 expedient squatting third stage technique was practiced, to 2,899 planned homebirths attended by midwives in British Columbia, Canada, where currently accepted third stage management was used. The inclusion criteria for both groups were: Singleton fetus in cephalic presentation; gestational age 37+0 to 41+6 weeks; spontaneous onset of labor; history of up to one previous cesarean; absence of significant pre-existing disease and absence of significant disease arising during pregnancy. The main outcomes were postpartum hemorrhage and manual removal of the placenta. Results: Using identical inclusion criteria and similar management, variations of active and expectant management resulted in 4% PPH over 1000 cc and 1.0% manual removal. Expedient squatting resulted in 2/1098 cases of PPH>500 cc, zero cases of PPH over 1000 cc and 0.7% manual removal. Conclusion: Judy’s 3,4,5 minute third stage management minimizes postpartum bleeding compared to other third stage protocols, reproducing postpartum hemorrhage rates indigenous to primates.

Comparison of Outcomes between Obese and Nonobese Patients in Laparoscopic Adrenalectomy: A Cohort Study

2021 ◽  
pp. 1-10
Author(s):  
José Ignacio Rodríguez-Hermosa ◽  
Pere Planellas-Giné ◽  
Lídia Cornejo ◽  
Jordi Gironès ◽  
Mònica Recasens ◽  
...  
Keyword(s):  
Cohort Study ◽  
Blood Loss ◽  
Laparoscopic Adrenalectomy ◽  
Operative Time ◽  
Cushing Syndrome ◽  
Adrenal Tumors ◽  
Obese Patients ◽  
Estimated Blood Loss ◽  
Observational Cohort ◽  
Nonobese Patients

<b><i>Introduction:</i></b> Obesity is usually considered a risk factor for surgical complications. Laparoscopic adrenalectomy has replaced open adrenalectomy as the standard operation for adrenal tumors. <b><i>Objective:</i></b> To compare the safety of laparoscopic adrenalectomy to treat adrenal tumors in obese versus nonobese patients. <b><i>Methods:</i></b> This observational cohort study analyzed consecutive patients who underwent laparoscopic adrenalectomy with a lateral transperitoneal approach at a single center (2003–2020). Data and outcomes of obese (body mass index ≥30 kg/m<sup>2</sup>) and nonobese patients were compared. To analyze the association between operative time and other variables, we used simple and multivariate linear regression. <b><i>Results:</i></b> <i>N</i> = 160 (90 obese/70 nonobese) patients underwent laparoscopic adrenalectomy. Cushing syndrome and pheochromocytoma were the most frequent indications. Obese patients were older (58 vs. 52 years, <i>p</i> &#x3c; 0.001). A greater proportion of obese patients were ASA grade III + IV (71.1 vs. 48.6%, <i>p</i> = 0.004). Obesity was associated with a longer operative time (72.5 vs. 60 min, <i>p</i> &#x3c; 0.001) and greater blood loss (40 vs. 20 mL, <i>p</i> = 0.022). There were no differences in conversion, morbidity, or hospital stay. After adjustment for confounding factors, operative time was positively correlated with BMI ≥30 kg/m<sup>2</sup>, learning curve, estimated blood loss, 2D laparoscopy, and specimen size. <b><i>Conclusion:</i></b> Lateral transperitoneal laparoscopic adrenalectomy is safe in patients with a BMI 30–35 kg/m<sup>2</sup>, so these patients also benefit from this minimally invasive surgery.

scholarly journals LAPAROSCOPIC HYSTERECTOMY

2018 ◽  
Vol 25 (01) ◽  
pp. 26-29
Author(s):  
Sardar Alfareed Zafar ◽  
Javed Iqbal ◽  
Tasnim Tahira ◽  
Naureen Javed ◽  
Shagufta Noor
Keyword(s):  
Blood Loss ◽  
Operative Time ◽  
Laparoscopic Hysterectomy ◽  
Abdominal Hysterectomy ◽  
Inclusion Criteria ◽  
Time Duration ◽  
Surgical Time ◽  
Randomized Control ◽  
Medical University ◽  
Control Study

Hysterectomy is one of the most frequently performed gynaecological procedurein female. Objectives: The purpose of this study was to compare the outcome between totallaparoscopic hysterectomy and abdominal hysterectomy regarding blood loss during surgery,surgical time and postoperative hospital stay. Settings: Department of Gynecology & ObstetricsAllied Hospital, Faisalabad Medical University, Faisalabad. Period: 1st January 2016 - 31stDecember 2016 (1 Year). Study Design: Randomized control Study. Material & Methods: Theethical committee of Faisalabad Medical University, Faisalabad approved the study protocol. Thepatient demographical characteristics were similar in both groups. 112 patients were enrolled.Including 56 case of total laparoscopic hysterectomy and 56 cases of abdominal hysterectomywhich meets inclusion criteria. Result: Average blood loss in TLH was 83.09+10.74ml while itwas 387.88+59.54ml in TAH. When both groups were compared regarding operative time, itwas 76.73+20.2min in TLH while it was 84.7+19.9 in TAH. Postoperative stay in the hospitalwas 1.25+0.44 days in TLH while it was 5.72+0.83 in TAH. Conclusion: The laparoscopichysterectomy is a modern surgical method in current gynecological practice. With increasingexperience and good collaboration of surgical team, time duration can be shortened and bloodloss can be reduced to negligible.

Double-blind, randomized controlled trial of tranexamic acid in minor lumbar spine surgery: no effect on operative time, intraoperative blood loss, or complications

2019 ◽  
Vol 31 (2) ◽  
pp. 194-200 ◽  
Author(s):  
Signe Elmose ◽  
Mikkel Ø. Andersen ◽  
Else Bay Andresen ◽  
Leah Yacat Carreon
Keyword(s):  
Placebo Group ◽  
Lumbar Spine ◽  
Blood Loss ◽  
Tranexamic Acid ◽  
Spine Surgery ◽  
Operative Time ◽  
Decompressive Surgery ◽  
Lumbar Spine Surgery ◽  
Intraoperative Blood Loss ◽  
Double Blind

OBJECTIVEThe purpose of this study was to investigate the effect of tranexamic acid (TXA) compared to placebo in low-risk adult patients undergoing elective minor lumbar spine surgery—specifically with respect to operative time, estimated blood loss, and complications. Studies have shown that TXA reduces blood loss during major spine surgery. There have been no previous studies on the effect of TXA in minor lumbar spine surgery in which these variables have been evaluated.METHODSThe authors enrolled patients with ASA grades 1 to 2 scheduled to undergo lumbar decompressive surgery at Middelfart Hospital into a double-blind, randomized, placebo-controlled, parallel-group study. Patients with thromboembolic disease, coagulopathy, hypersensitivity to TXA, or a history of convulsion were excluded. Patients were randomly assigned, in blocks of 10, to one of 2 groups, TXA or placebo. Anticoagulation therapy was discontinued 2–7 days preoperatively. Prior to the incision, patients received either a bolus of TXA (10 mg/kg) or an equivalent volume of saline solution (placebo). Independent t-tests were used to compare differences between the 2 groups, with statistical significance set at p < 0.05.RESULTSOf the 250 patients enrolled, 17 patients were excluded, leaving 233 cases for analysis (117 in the TXA group and 116 in the placebo group). The demographics of the 2 groups were similar, except for a higher proportion of women in the TXA group (TXA 50% vs placebo 32%, p = 0.017). There was no significant between-groups difference in operative time (49.53 ± 18.26 vs 54.74 ± 24.49 minutes for TXA and placebo, respectively; p = 0.108) or intraoperative blood loss (55.87 ± 48.48 vs 69.14 ± 83.47 ml for TXA and placebo, respectively; p = 0.702). Postoperative blood loss measured from drain output was 62% significantly lower in the TXA group (13.03 ± 21.82 ml) than in the placebo group (34.61 ± 44.38 ml) (p < 0.001). There was no significant difference in number of dural lesions or postoperative spinal epidural hematomas, and there were no thromboembolic events.CONCLUSIONSTranexamic acid did not have a statistically significant effect on operative time, intraoperative blood loss, or complications. This study gives no evidence to support the routine use of TXA during minor lumbar decompressive surgery.Clinical trial registration no.: NCT03714360 (clinicaltrials.gov)

The impact of surgeon experience on perioperative complications and operative measures following thoracolumbar 3-column osteotomy for adult spinal deformity: overcoming the learning curve

2020 ◽  
Vol 32 (2) ◽  
pp. 207-220 ◽  
Author(s):  
Darryl Lau ◽  
Vedat Deviren ◽  
Christopher P. Ames
Keyword(s):  
Blood Loss ◽  
Operative Time ◽  
Surgical Complication ◽  
Perioperative Complications ◽  
Adult Spinal Deformity ◽  
Neurological Deficits ◽  
Complication Rates ◽  
Years Of Experience ◽  
Surgeon Experience ◽  
Operative Measures

OBJECTIVEPosterior-based thoracolumbar 3-column osteotomy (3CO) is a formidable surgical procedure. Surgeon experience and case volume are known factors that influence surgical complication rates, but these factors have not been studied well in cases of adult spinal deformity (ASD). This study examines how surgeon experience affects perioperative complications and operative measures following thoracolumbar 3CO in ASD.METHODSA retrospective study was performed of a consecutive cohort of thoracolumbar ASD patients who underwent 3CO performed by the senior authors from 2006 to 2018. Multivariate analysis was used to assess whether experience (years of experience and/or number of procedures) is associated with perioperative complications, operative duration, and blood loss.RESULTSA total of 362 patients underwent 66 vertebral column resections (VCRs) and 296 pedicle subtraction osteotomies (PSOs). The overall complication rate was 29.4%, and the surgical complication rate was 8.0%. The rate of postoperative neurological deficits was 6.2%. There was a trend toward lower overall complication rates with greater operative years of experience (from 44.4% to 28.0%) (p = 0.115). Years of operative experience was associated with a significantly lower rate of neurological deficits (p = 0.027); the incidence dropped from 22.2% to 4.0%. The mean operative time was 310.7 minutes overall. Both increased years of experience and higher case numbers were significantly associated with shorter operative times (p < 0.001 and p = 0.001, respectively). Only operative years of experience was independently associated with operative times (p < 0.001): 358.3 minutes from 2006 to 2008 to 275.5 minutes in 2018 (82.8 minutes shorter). Over time, there was less deviation and more consistency in operative times, despite the implementation of various interventions to promote fusion and prevent construct failure: utilization of multiple-rod constructs (standard, satellite, and nested rods), bone morphogenetic protein, vertebroplasty, and ligament augmentation. Of note, the use of tranexamic acid did not significantly lower blood loss.CONCLUSIONSSurgeon years of experience, rather than number of 3COs performed, was a significant factor in mitigating neurological complications and improving quality measures following thoracolumbar 3CO for ASD. The 3- to 5-year experience mark was when the senior surgeon overcame a learning curve and was able to minimize neurological complication rates. There was a continuous decrease in operative time as the surgeon’s experience increased; this was in concurrence with the implementation of additional preventative surgical interventions. Ongoing practice changes should be implemented and can be done safely, but it is imperative to self-assess the risks and benefits of those practice changes.

scholarly journals Psychological Traits and Behavioural Influences in Patients with Dystonia—An Observational Cohort Study in a Romanian Neurology Department

Life ◽  
2021 ◽  
Vol 11 (7) ◽  
pp. 612
Author(s):  
Eugenia Irene Davidescu ◽  
Irina Odajiu ◽  
Delia Tulbă ◽  
Iulia Mitrea ◽  
Camelia Cucu ◽  
...  
Keyword(s):  
Cohort Study ◽  
Informed Consent ◽  
Personality Traits ◽  
Patient Group ◽  
Observational Cohort Study ◽  
Control Group ◽  
Inclusion Criteria ◽  
Control Subjects ◽  
Observational Cohort ◽  
Idiopathic Dystonia

(1) Background: Emerging evidence indicates that non-motor symptoms significantly influence the quality of life in dystonic patients. Therefore, it is essential to evaluate their psychological characteristics and personality traits. (2) Methods: Subjects with idiopathic dystonia and a matched control group were enrolled in this prospective observational cohort study. Inclusion criteria for patient group included idiopathic dystonia diagnosis, evolution exceeding 1 year, and signed informed consent. Inclusion criteria for the control group included lack of neurological comorbidities and signed informed consent. All subjects completed the DECAS Personality Inventory along with an additional form of demographic factors. Data (including descriptive statistics and univariate and multivariate analysis) were analyzed with SPSS. (3) Results: In total, 95 participants were included, of which 57 were in the patient group. Females prevailed (80%), and the mean age was 54.64 ± 12.8 years. The most frequent clinical features of dystonia were focal distribution (71.9%) and progressive disease course (94.73%). The patients underwent regular treatment with botulinum toxin (85.95%). In addition, patients with dystonia obtained significantly higher openness scores than controls, even after adjusting for possible confounders (p = 0.006). Personality traits were also different between the two groups, with patients more often being fantasists (p = 0.007), experimenters (p = 0.022), sophists (p = 0.040), seldom acceptors (p = 0.022), and pragmatics (p = 0.022) than control subjects. (4) Conclusion: Dystonic patients tend to have different personality profiles compared to control subjects, which should be taken into consideration by the treating neurologist.

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