Geometric planning in vertebral and pelvic complex surgery: sufficient number of evaluating parameters proving

2019 ◽  
Author(s):  
Anna S. Kolesnikova ◽  
Aleksander S. Fedonnikov ◽  
Irina V. Kirillova ◽  
Leonid Y. Kossovich ◽  
Andrey V. Teremshonok ◽  
...  
Keyword(s):  
Geometric Planning ◽  
Complex Surgery

scholarly journals Intraoperative Computed Tomography Scanner-Guided Craniovertebral Junction Surgery in a Patient with an Occipitalized C1

2021 ◽  
Author(s):  
Mohammad Ashraf ◽  
Usman Ahmad Kamboh ◽  
Naveed Ashraf
Keyword(s):  
Craniovertebral Junction ◽  
Facet Joints ◽  
Intraoperative Ct ◽  
Intraoperative Computed Tomography ◽  
Transoral Odontoidectomy ◽  
Posterior Subluxation ◽  
Lateral Mass Screws ◽  
Complex Surgery ◽  
Computed Tomography Scanner

AbstractCraniovertebral junction surgery is associated with unique difficulties. Type 2 odontoid fractures (Anderson and D Alonzo) have a great potential for nonunion and malunion. These fracture patients may require a circumferential decompression and fixation. The addition of intraoperative CT with neuronavigation greatly aids in craniovertebral junction surgery. We operated on a 59-year-old-male with a type 2 fracture with posterior subluxation of C1 anterior arch and a cranially displaced odontoid peg. First, a transoral odontoidectomy was performed followed by a craniocervical fixation. Occipital plates and C3–C4 lateral mass screws were used as C1 was discovered to be occipitalized intraoperatively and atlantoaxial facet joints could not be reduced as discovered by intraoperative CT resconstruction. Intraoperative CT scan was crucial to this circumferential decompression and fixation, allowed us to resect the odontoid peg safely and completely and to confirm adequate screw trajectory making this complex surgery easier for us and safer for the patient. The patient was discharged 4 months after admission with stable neurology. Intraoperative CT was fundamental to correct decision making.

scholarly journals Using Human Factors and Systems Engineering to Evaluate Readmission after Complex Surgery

2015 ◽  
Vol 221 (4) ◽  
pp. 810-820 ◽  
Author(s):  
Alexandra W. Acher ◽  
Tamara J. LeCaire ◽  
Ann Schoofs Hundt ◽  
Caprice C. Greenberg ◽  
Pascale Carayon ◽  
...  
Keyword(s):  
Human Factors ◽  
Systems Engineering ◽  
Complex Surgery

scholarly journals Restorative Proctocolectomy: When to Propose and When to Avoid

2021 ◽  
Author(s):  
Marisa D. Santos
Keyword(s):  
Ulcerative Colitis ◽  
Familial Adenomatous Polyposis ◽  
Restorative Proctocolectomy ◽  
Ileal Pouch ◽  
Adenomatous Polyposis ◽  
Entire Colon ◽  
Anal Anastomosis ◽  
Colon And Rectum ◽  
Complex Surgery ◽  
Over Time

Restorative proctocolectomy with ileal pouch-anal anastomosis (RPC-IPAA) is a surgical procedure performed when excising the entire colon and rectum is need and reconstitution of the intestinal transit through an ileal pouch is made with anastomosis to the anus. It is mainly used to treat patients with familial adenomatous polyposis (FAP) and ulcerative colitis (UC). It is a complex surgery with potential complications, and the functional outcomes can be worse over time. So, it is essential to select the appropriate patient, proceed to a correct surgical technique, and know-how to deal with and solve the main ileal pouch complications. This chapter intends to be a reflection on this subject.

Intercontinental Multidisciplinary Oncology Videoconferencing for Rare and Complex Cancer: An Alternative to Systematic Transfer

2021 ◽  
pp. OP.20.00525
Author(s):  
Charles Honoré ◽  
Olivier Mir ◽  
Arthur Geraud ◽  
Gianmaria Drovetti ◽  
Gabriel C. T. E. Garcia ◽  
...  
Keyword(s):  
Decision Making ◽  
Systemic Chemotherapy ◽  
Rare Cancer ◽  
Therapy Decision ◽  
Direct Benefits ◽  
Local Facility ◽  
Conference Service ◽  
Diagnostic Biopsy ◽  
Strategy Changes ◽  
Complex Surgery

PURPOSE: To report our experience of intercontinental multidisciplinary oncology videoconferencing between the French mainland and South Pacific to discuss rare and/or complex cancer cases. METHODS: On the first and third Friday of each month, all participants connected between 6:30 am and 8:00 am GMT to discuss using a web conference service. RESULTS: Between November 2019 and April 2020, 99 cases concerning 78 patients were discussed. Oncology subspecialties required were sarcoma (n = 36), digestive (n = 29), dermatology (n = 5), gynecology (n = 5), breast (n = 5), urology (n = 5), hematology (n = 5), ENT (n = 3), thoracic (n = 3), thyroid (n = 2), and pediatric (n = 1). Median patient age was 58 years, 41 were female (53%), 37 were male (47%), and 43 had a metastatic disease (55%). Following discussion, 16 patients (21%) were transferred to the French mainland. Reasons for transfer were requirement for complex surgery (n = 11) and need for specialized diagnostic biopsy (n = 5). Fifty-six patients were treated locally, with systemic chemotherapy (n = 36), surveillance (n = 8), surgery (n = 8), radiotherapy (n = 3), or endoscopy (n = 1). Direct benefits for patients treated in their local facility included strategy changes (surveillance or surgery contraindication, n = 9), targeted therapy decision (n = 14), immunotherapy decision (n = 9), and diagnostic or metastatic status corrections (n = 4). Six patients are still awaiting decision. CONCLUSION: Using real-time intercontinental multidisciplinary oncology videoconferencing to discuss complex or rare cancer cases is reliable and effective for decision making. This concept helped to limit to 21% the need for transfers to the mainland.

scholarly journals Hybrid-ALPPS followed by Ante Situm with Cardiopulmonary Bypass: Rapid Liver Augmentation and Complex Surgery

2020 ◽  
Vol 27 (9) ◽  
pp. 3341-3341 ◽  
Author(s):  
K. J. Oldhafer ◽  
K. C. Wagner ◽  
A. Kantas ◽  
M. Schmoeckel ◽  
M. H. Fard-Aghaie
Keyword(s):  
Cardiopulmonary Bypass ◽  
Complex Surgery

scholarly journals Current Concepts in the Biopsy of Musculoskeletal Tumors

2013 ◽  
Vol 2013 ◽  
pp. 1-7 ◽  
Author(s):  
Costantino Errani ◽  
Francesco Traina ◽  
Fabrizio Perna ◽  
Carlotta Calamelli ◽  
Cesare Faldini
Keyword(s):  
Treatment Options ◽  
Joint Space ◽  
Needle Aspiration ◽  
Soft Tissue Tumors ◽  
Tissue Area ◽  
Histological Data ◽  
Definitive Surgery ◽  
Aspiration Core ◽  
Musculoskeletal Oncology ◽  
Complex Surgery

In the management of bone and soft tissue tumors, accurate diagnosis, using a combination of clinical, radiographic, and histological data, is critical to optimize outcome. On occasion, diagnosis can be made by careful history, physical examination, and images alone. However, the ultimate diagnosis usually depends on histologic analysis by an experienced pathologist. Biopsy is a very important and complex surgery in the staging process. It must be done carefully, so as not to adversely affect the outcome. Technical considerations include proper location and orientation of the biopsy incision and meticulous hemostasis. It is necessary to obtain tissue for a histological diagnosis without spreading the tumor and so compromise the treatment. Furthermore, the surgeon does not open compartmental barriers, anatomic planes, joint space, and tissue area around neurovascular bundles. Nevertheless, avoid producing a hematoma. Biopsy should be carefully planned according to the site and definitive surgery and should be performed by an orthopedic surgeon with an experience in musculoskeletal oncology who will perform the definitive surgery. Improperly done, it can complicate patient care and sometimes even eliminate treatment options. Different biopsy techniques are suitable: fine-needle aspiration, core-needle biopsy, and incisional biopsy. The choice of biopsy depends on the size, the location of the lesion, and the experience of the pathologist.

Multiple Preoperative Endoscopic Retrograde Cholangiopancreatography and Large Common Bile Duct Diameter Predict the Need for Complex Surgery

2016 ◽  
Vol 82 (2) ◽  
pp. 122-127
Author(s):  
Holly Rochefort ◽  
Lea Matsuoka ◽  
Konstantinos Chouliaras ◽  
Didi Mwengela ◽  
James Buxbaum ◽  
...  
Keyword(s):  
Laparoscopic Cholecystectomy ◽  
Bile Duct ◽  
Common Bile Duct ◽  
Confidence Interval ◽  
Endoscopic Retrograde Cholangiopancreatography ◽  
Odds Ratio ◽  
Adjusted Odds Ratio ◽  
Academic Medical Center ◽  
Endoscopic Retrograde ◽  
Complex Surgery

Endoscopic retrograde cholangiopancreatography (ERCP) is frequently used to clear the common bile duct (CBD) in patients with choledocholithiasis. While a single ERCP is usually effective, many patients undergo multiple ERCP attempts before cholecystectomy. Here we sought to identify preoperative factors predictive of surgical complexity beyond routine laparoscopic cholecystectomy after ERCP. Data were prospectively collected for all ERCPs between September 2010 and February 2012 at a public academic medical center including demographics, indication, stone presence, CBD diameter, sphincterotomy, stent placement, and ERCP number. A total of 124 ERCPs were attempted in 73 patients with choledocholithiasis, 10 per cent of whom presented with cholangitis. Fifty-six per cent of patients underwent one ERCP, whereas 16 per cent required ≥ 3 procedures. Laparoscopic cholecystectomy was performed in 58 (79%) patients whereas 15 (21%) patients required more complex operations including eight open CBD explorations and two hepaticojejunostomies. The likelihood of requiring more complex surgery correlated with increasing number of ERCPs with an adjusted odds ratio of 5.75 (95% confidence interval: 2.31–14.3, P ≤ 0.001). Increased CBD diameter also correlated with complex surgery with adjusted odds ratio of 1.5 (95% confidence interval: 1.10–2.06, P = 0.012) for each millimeter. The number of pre-operative ERCPs and CBD diameter in choledocholithiasis patients are strong predictors of the need for open surgery and CBD exploration and should be considered in surgical planning and consent for patients requiring more than one ERCP procedure.

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