Outcomes and Postoperative Complications of Robot-Assisted Laparoscopic Hysterosacropexy: Initial Experience

2015 ◽  
Vol 95 (1) ◽  
pp. 44-49 ◽  
Author(s):  
Maria Angela Cerruto ◽  
Carolina D'Elia ◽  
Francesca Maria Cavicchioli ◽  
Stefano Cavalleri ◽  
Matteo Balzarro ◽  
...  
Keyword(s):  
Uterine Prolapse ◽  
Pelvic Organ ◽  
Consecutive Series ◽  
Complication Rates ◽  
Early Complications ◽  
Robot Assisted ◽  
Female Patients ◽  
The Mean ◽  
Record Review

Background: Pelvic organ prolapse is a common condition, affecting about 50% of women with children. The aim of our study was to evaluate results and complication rates in a consecutive series of female patients undergoing robot-assisted laparoscopic hysterosacropexy (RALHSP). Materials and Methods: We performed a medical record review of female patients with uterine prolapse who had consecutively undergone RALHSP from February 2010 to 2013 at our department. Results: Fifteen patients were included in the analysis. All patients had uterine prolapse stage ≥II and urodynamic stress urinary incontinence. The mean age was 58.26 years. According to the Clavien-Dindo system, 4 out of 15 patients (26.6%) had grade 1 early complications and 1 patient had a grade 2 complication. At a median follow-up of 36 months, there was a significant prolapse relapse rate of 20% (3/15). Conclusion: In our hands RALHSP is easy to perform, with satisfying mid-term outcomes and a low complication rate.

scholarly journals High re-operation and complication rates 11 years after arthrodesis of the wrist for non-inflammatory arthritis

2019 ◽  
Vol 101-B (7) ◽  
pp. 852-859 ◽  
Author(s):  
O. Reigstad ◽  
T. Holm-Glad ◽  
J. Korslund ◽  
C. Grimsgaard ◽  
R. Thorkildsen ◽  
...  
Keyword(s):  
Inflammatory Arthritis ◽  
Standard Treatment ◽  
Substantial Reduction ◽  
Pinch Strength ◽  
Consecutive Series ◽  
Complication Rates ◽  
Wrist Arthrodesis ◽  
Operation Rate ◽  
The Mean

Aims Plate and screw fixation has been the standard treatment for painful conditions of the wrist in non-rheumatoid patients in recent decades. We investigated the complications, re-operations, and final outcome in a consecutive series of patients who underwent wrist arthrodesis for non-inflammatory arthritis. Patients and Methods A total of 76 patients, including 53 men and 23 women, with a mean age of 50 years (21 to 79) underwent wrist arthrodesis. Complications and re-operations were recorded. At a mean follow-up of 11 years (2 to 18), 63 patients completed questionnaires, and 57 attended for clinical and radiological assessment. Results Of the 76 patients, 46 (60.5%) had complications, resulting in 65 re-operations, mainly related to the plate and screws. In the 63 patients who completed the questionnaires, the mean Quick Disabilities of Arm, Shoulder and Hand (QuickDASH) score was 36 (0 to 91), the mean Patient-Rated Wrist and Hand Evaluation (PRWHE) score was 40 (0 to 96), and 14 patients (22%) reported no wrist pain. Grip strength, pinch strength, and pronation and supination were significantly reduced compared with the contralateral forearm. The outcome was worse in patients who had previously undergone surgery to the wrist, and those with complications. A total of 13 are awaiting further re-operations, giving a total re-operation rate of 63% (40/63). Conclusion We observed complications and re-operations throughout the follow-up period and therefore consider wrist arthrodesis to be more complicated than previously assumed. Many of the patients never got used to or accepted their stiff wrists and reported a substantial reduction in function and residual pain. Motion-sparing surgery should be offered prior to wrist arthrodesis. Cite this article: Bone Joint J 2019;101-B:852–859.

scholarly journals Management of Distal 1/3rd Closed Forearm Fractures in Children above Elbow Plaster Cast versus Below Elbow Plaster Cast

2021 ◽  
pp. 37-46
Author(s):  
Abbas Memon ◽  
Amir Zaffar Abro ◽  
Shakeel Ahmed Memon ◽  
Irshad Ahmed Bhutto ◽  
Ashfaq Hussain Mirjat ◽  
...  
Keyword(s):  
Cost Effective ◽  
Plaster Cast ◽  
Complication Rates ◽  
Forearm Fractures ◽  
Cast Immobilization ◽  
Female Patients ◽  
Fractures In Children ◽  
The Mean ◽  
Cast Group

Objective: To determine if below-elbow casts are as effective as above-elbow casts in the treatment of the distal third closed forearm fractures in children. Materials and Methods: This was a prospective comparative study and was conducted at orthopaedic department of Liaquat University of Medical and Health Sciences (LUMHS). Children 4 to 12 years of age who presented to, distal 1/3rd fractures of the forearm were randomized in order to manage with either an above-elbow or below-elbow cast after closed reduction under fluoroscopic guidance. Radiographic analysis was done for angulation and displacement at the injury time, following reduction, and at subsequent intervals of follow-up. At the fracture level, the cast index for evaluating the cast moulding quality was assessed from the post-reduction radiographs. Variations between post-reduction and final values for displacement and angulation, the range of motion of elbow, forearm and wrists and cast indices between the two groups were compared. Results: Of total 50 study subjects, 26 underwent above-elbow cast and 24 subjects underwent below-elbow cast techniques. Mean age of above-elbow cast group patients was 9.42 year and the mean age in of below-elbow cast group patients was 9.13 years. 15 male and 11 female patients were present in above-elbow cast group; 14 male and 10 female patients were present in below-elbow cast group. The mean cast index of above-elbow cast group was 0.71 and the mean cast index of below-elbow cast was 0.70. In terms of patient demographics, injury mechanism, characteristics of initial fracture, cast index or shift in displacement and angulation during treatment, no significant variances were observed between both groups. In above-elbow cast group, the mean elbow arc of motion on cast removal at six weeks was only 78° compared to 141.6° in below-elbow cast group. There was a significant decline in arc of motion of elbow joint in above-elbow cast group compared to below-elbow cast group in six weeks which became normal at final follow-up in three months. The complication rates in both the groups were similar. Conclusion: Below-elbow cast is the safe reliable and cost-effective method of cast immobilization in distal third forearm fractures in the children of 4 to 12 years of age.

scholarly journals Evaluation of the efficacy and patient satisfaction of the intracavernosal alprostadil in the treatment of erectile dysfunction following robot-assisted radical prostatectomy

2021 ◽  
Author(s):  
Hüseyin Kocatürk ◽  
Mehmet Sefa Altay ◽  
Fevzi Bedir ◽  
Banu Bedir
Keyword(s):  
Patient Satisfaction ◽  
Erectile Dysfunction ◽  
Radical Prostatectomy ◽  
Therapeutic Option ◽  
Complication Rates ◽  
Robot Assisted ◽  
General Satisfaction ◽  
The Mean ◽  
Keywords Erectile Dysfunction

Objective: Erectile dysfunction (ED) following robot-assisted radical prostatectomy (RARP) is an important problem. The purpose of this study was to evaluate the effectiveness of and patient satisfaction with intracavernosal alprostadil used in the treatment of ED. Material and Methods: Patients using intracavernosal alprostadil in the treatment of ED following RARP were assessed retrospectively. Patients’ demographic characteristics, pre- and postoperative International Index of Erectile Function (IIEF) scores, and general satisfaction evaluated using questions 13 and 14 of the IIEF form were all recorded. Complications developing during treatment, dosages used, and reasons for discontinuation were investigated. Results: Thirty-four patients with a mean age of 61.73±5.80 years were included in the study. Preoperative ED was determined in 52.9% (n=18) of patients. The mean IEFF of the patients who used preoperative, postoperative 1st month, postoperative 3 months after tadalafil use and intracavernosal alprostadil was 20.64 ± 3.46, 15.08 ± 2.09, 15.32 ± 2.18, 26.67 ± 2.30, respectively. The mean length of use of intracavernosal alprostadil was 8.20±2.48 months, and full erection was achieved in 70.58% of patients. Hematoma associated with intracavernosal alprostadil use developed in 2.9% of patients, ecchymosis in 8.8%, and pain in 8.8%. In addition, 73.5% of patients continued to take their medication during the follow-up process. Patients’ general satisfaction following alprostadil therapy was statistically significantly high. Conclusion: Intracavernosal alprostadil therapy following RARP represents a good therapeutic option due to its high success in achieving full erection, low complication rates, and high patient satisfaction. Keywords: erectile dysfunction, Alprostadil, robot-assisted radical prostatectomy

scholarly journals Robot-assisted laparoscopic partial nephrectomy: Early single Canadian institution experience

2013 ◽  
Vol 7 (9-10) ◽  
pp. 348 ◽  
Author(s):  
Guillaume Ploussard ◽  
Richard Haddad ◽  
Evan Kovac ◽  
Patrick Richard ◽  
Maurice Anidjar ◽  
...  
Keyword(s):  
Renal Function ◽  
Partial Nephrectomy ◽  
Tumour Size ◽  
Admission Rate ◽  
Complication Rates ◽  
Robot Assisted ◽  
Nephrometry Score ◽  
Surgeon Experience ◽  
The Mean

Background: Although robot-assisted partial nephrectomy (RALPN) has been increasingly adopted, open procedures continue to be the reference nephron-sparing technique. We describe our initial surgical outcomes of RALPN in our single institution robotic program.Methods: Between January 2011 and February 2013, 65 consecutive patients underwent a RALPN by 2 surgeons. Preoperative characteristics, including the R.E.N.A.L. nephrometry score, perioperative parameters, and postoperative course, including renal function, were assessed from a retrospective database. The mean follow-up was 12 months.Results: The mean age was 60.2 years and the mean tumour size was 3.9 cm. According to the R.E.N.A.L. nephrometry score, the tumours were classified moderately and highly complex tumours in 51% and 18.5% of cases, respectively. Median warm ischemia time (WIT) was 21 minutes. Factors associated with WIT were R.E.N.A.L. nephrometry score, tumour size, complication rates and surgeon experience. No conversion or grade 4 to 5 complications were reported. The mean hospital stay was 3 days. The overall complication rate was 24.6% (re-admission rate 7.7%), and decreased to 12% after 20 cases. After these initial 20 cases, a trifecta rate (no margins, preserved renal function, no complications) of 64.3% was achieved in moderately and highly complex tumours. The mean change in estimated glomerular filtration rate was 6.7 mL/min without severe postoperative renal failure.Interpretation: RALPN is a safe and feasible procedure with low specific morbidity, even in moderately or highly complex renal masses. The WIT depends on tumour characteristics, mainly determined by the R.E.N.A.L. nephrometry score and is improved by surgeon experience. Longer follow-up is needed to assess the oncologic mid-term safety of the procedure. 

scholarly journals 63 Chronic Femoral Osteomyelitis Case Series: Outcomes and Economic Impact at A United Kingdom Based Tertiary Centre

2021 ◽  
Vol 108 (Supplement_2) ◽  
Author(s):  
E Lau ◽  
Z Arshad ◽  
A Aslam ◽  
A Thahir ◽  
M Krkovic
Keyword(s):  
Economic Impact ◽  
Treatment Protocol ◽  
Case Series ◽  
Consecutive Series ◽  
Financial Loss ◽  
Patient Demographics ◽  
Tertiary Centre ◽  
The Mean ◽  
Eq Vas

Abstract Introduction Osteomyelitis refers to an inflammatory process affecting bone and bone marrow. This study reviews chronic femoral osteomyelitis treatment and outcomes, including economic impact. Method We retrospectively collected data from a consecutive series of 14 chronic femoral osteomyelitis patients treated between January 2013 and January 2020. Data collected include patient demographics, comorbidities, pathogens, complications, treatment protocol and costs. Functional outcome was assessed using EuroQOL five-dimensional interview administration questionnaire (EQ-5D-5L™) and EuroQOL Visual Analogue Scale (EQ-VAS™). Results Of these, 92.9% had one or more osteomyelitis risk factor, including smoking and diabetes. Samples from 78.6% grew at least one pathogen. Only 42.9% achieved remission after initial treatment, but 85.7% were in remission at final follow-up, with no signs of recurrence throughout the follow-up period (mean: 21.4 months). The average treatment cost was £39,249.50 with a net mean loss of £19,080.10 when funding was considered. The mean-derived EQ-5D score was 0.360 and the mean EQ-VAS score was 61.7, lower than their values for United Kingdom’s general population, p = 0.0018 and p = 0.013 respectively. Conclusions Chronic femoral osteomyelitis treatment is difficult, resulting in significant economic burden. With previous studies showing cheaper osteomyelitis treatment at specialist centres, our net financial loss incurred suggests the need for management at specialised centres.

scholarly journals Comparison of treatment outcomes for native tissue repair and sacrocolpopexy as apical suspension procedures at the time of hysterectomy for uterine prolapse

2021 ◽  
Vol 11 (1) ◽  
Author(s):  
Sumin Oh ◽  
E. Kyung Shin ◽  
Sowoon Hyun ◽  
Myung Jae Jeon
Keyword(s):  
Treatment Outcomes ◽  
Tissue Repair ◽  
Uterine Prolapse ◽  
Reoperation Rate ◽  
Complication Rates ◽  
Native Tissue Repair ◽  
Apical Suspension ◽  
Native Tissue ◽  
Surgical Failure

AbstractConcomitant apical suspension should be performed at the time of hysterectomy for uterine prolapse to reduce the risk of recurrent prolapse. Native tissue repair (NTR) and sacrocolpopexy (SCP) are commonly used apical suspension procedures; however, it remains unclear which one is preferred. This study aimed to compare the treatment outcomes of NTR and SCP in terms of surgical failure, complication and reoperation rates. Surgical failure was defined as the presence of vaginal bulge symptoms, any prolapse beyond the hymen, or retreatment for prolapse. This retrospective cohort study included 523 patients who had undergone NTR (n = 272) or SCP (n = 251) along with hysterectomy for uterine prolapse and who had at least 4-month follow-up visits. During the median 3-year follow-up period, the surgical failure rate was higher in the NTR group (21.3% vs 6.4%, P < 0.01), with a low rate of retreatment in both groups. Overall complication rates were similar, but complications requiring surgical correction under anesthesia were more common in the SCP group (7.2% vs 0.4%, P < 0.01). As a result, the total reoperation rate was significantly higher in the SCP group (8.0% vs 2.6%, P = 0.02). Taken together, NTR may be a preferred option for apical suspension when hysterectomy is performed for uterine prolapse.

Constrained liners revisited: favourable mid-term results in patients with high-risk of dislocation: technical considerations for the optimal outcome

2021 ◽  
pp. 112070002110107
Author(s):  
Eustathios Kenanidis ◽  
Panagiotis Kakoulidis ◽  
Panagiotis Anagnostis ◽  
Michael Potoupnis ◽  
Eleftherios Tsiridis
Keyword(s):  
High Risk ◽  
Recurrent Dislocation ◽  
Deep Infection ◽  
Consecutive Series ◽  
Revision Thas ◽  
Hip Stability ◽  
Functional Scores ◽  
Revision Tha ◽  
The Mean

Background: The outcomes of constrained liners (CLs) in total hip arthroplasty (THA) remain inconclusive. We evaluated the mid-term performance of CLs in a consecutive series of high-risk dislocation patients undergoing primary or revision THA performed by a single surgeon. The survival, dislocation rate, complications, and functional patients’ scores were assessed. Surgical tips to enhance outcomes were reviewed. Methods: 45 patients who received the Trident Tripolar CL between 2010 to 2019 were retrospectively evaluated from Arthroplasty Registry Thessaloniki. There were 17 primary and 28 revision THAs. The primary indications for using CL were severe abductor insufficiency or comorbidities, increasing the dislocation risk in primary, and recurrent dislocation or abductor insufficiency in revision THAs. The mean patient’s age was 68.5 (±14.5) years, and the mean follow-up 3.81 (±1.66) years. Results: There were 2 dislocations and 1 deep infection in the revision group. For any reason, the cumulative 6-year survival rate was 93.3%, 100% for primary, and 89.3% for revision THAs. The mean overall CL survival was 76.3 months for any reason (95% CI, 68.1–84.5) and 80.5 months for dislocation (95% CI, 75.8–85.2). The mean postoperative functional scores were significantly improved ( p < 0.001) at the latest follow-up. Conclusions: CLs can provide hip stability and durable fixation in selected low-demand patients with high-risk for dislocation after primary and revision THA at mid-term follow-up. Careful patient selection and the refined surgical technique aiming at the neutral liner position and considering the high CLs’ offset relative to stem-neck impingement are necessary to maximise outcomes.

scholarly journals Is Allograft Reconstruction of the Medial Ulnar Collateral Ligament of the Elbow a Viable Option for Nonelite Athletes? Outcomes at a Mean of 8 Years

2020 ◽  
Vol 8 (10) ◽  
pp. 232596712095914
Author(s):  
Justin C. Kennon ◽  
Erick M. Marigi ◽  
Chad E. Songy ◽  
Chris Bernard ◽  
Shawn W. O’Driscoll ◽  
...  
Keyword(s):  
Clinical Outcomes ◽  
Case Series ◽  
Ulnar Collateral Ligament ◽  
Ulnar Neuropathy ◽  
Complication Rates ◽  
Collateral Ligament ◽  
Level Of Evidence ◽  
Functional Scores ◽  
The Mean

Background: The rate of elbow medial ulnar collateral ligament (MUCL) injury and surgery continues to rise steadily. While authors have failed to reach a consensus on the optimal graft or anchor configuration for MUCL reconstruction, the vast majority of the literature is focused on the young, elite athlete population utilizing autograft. These studies may not be as applicable for the “weekend warrior” type of patient or for young kids playing on high school leagues or recreationally without the intent or aspiration to participate at an elite level. Purpose: To investigate the clinical outcomes and complication rates of MUCL reconstruction utilizing only allograft sources in nonelite athletes. Study Design: Case series; Level of evidence, 4. Methods: Patient records were retrospectively analyzed for individuals who underwent allograft MUCL reconstruction at a single institution between 2000 and 2016. A total of 25 patients met inclusion criteria as laborers or nonelite (not collegiate or professional) athletes with a minimum of 2 years of postoperative follow-up. A review of the medical records for the included patients was performed to determine survivorship free of reoperation, complications, and clinical outcomes with use of the Summary Outcome Determination (SOD) and Timmerman-Andrews scores. Statistical analysis included a Wilcoxon rank-sum test to compare continuous variables between groups with an alpha level set at .05 for significance. Subgroup analysis included comparing outcome scores based on the allograft type used. Results: Twenty-five patients met all inclusion and exclusion criteria. The mean time to follow-up was 91 months (range, 25-195 months), and the mean age at the time of surgery was 25 years (range, 12-65 years). There were no revision operations for recurrent instability. The mean SOD score was 9 (range, 5-10) at the most recent follow-up, and the Timmerman-Andrews scores averaged 97 (range, 80-100). Three patients underwent subsequent surgical procedures for ulnar neuropathy (n = 2) and contracture (n = 1), and 1 patient underwent surgical intervention for combined ulnar neuropathy and contracture. Conclusion: Allograft MUCL reconstruction in nonelite athletes demonstrates comparable functional scores with many previously reported autograft outcomes in elite athletes. These results may be informative for elbow surgeons who wish to avoid autograft morbidity in common laborers and nonelite athletes with MUCL incompetency.

scholarly journals Clinical epidemiological study of uterine prolapse

2018 ◽  
Vol 8 (1) ◽  
pp. 79
Author(s):  
Parvathavarthini K. ◽  
Vanusha A.
Keyword(s):  
Risk Factors ◽  
Pelvic Organ Prolapse ◽  
Social Issues ◽  
Uterine Prolapse ◽  
Epidemiological Data ◽  
Pelvic Organ ◽  
Life Threatening ◽  
The Mean ◽  
Awareness Programme

Background: Pelvic organ prolapse is one of the common gynaecological problem in India among the parous and aged women. Though the pelvic organ prolapse is not life threatening if left untreated it can lead to many social issues and also it reduces the quality of life of a woman. Thus, this study aims at generating epidemiological data on uterine prolapse in a clinical setting and identifying its risk factors so that appropriate measures can be taken to prevent the same.Methods: It was a descriptive case control study. Using a study proforma the required information was collected from the patients admitted with uterine prolapse (case) and from amongst the patient’s attendees of Gynaecology ward (control). Obtained data were compared and analyzed using appropriate statistical methods.Results: Uterine prolapse contributes to about 5.9% of the total gynecological patients admitted during the study period. The mean age of presentation with uterine prolapse was 50.1years the mean number of deliveries was higher in case compared to the control with the mean of 4 deliveries. Out of 130 patients, only 13.9% of them had institutional delivery while the others had home delivery.Conclusions: Uterine prolapse is strongly associated with age, parity and place of delivery. As the risk factors for uterine prolapse are easily preventable public health awareness programme must be conducted on its risk factors there by reducing the incidence of prolapse and decreasing the morbidity caused by it.

scholarly journals Endoscopic Mucosal Resection: Early Experience in British Columbia

2010 ◽  
Vol 24 (4) ◽  
pp. 239-244 ◽  
Author(s):  
Mayur Brahmania ◽  
Eric Lam ◽  
Jennifer Telford ◽  
Robert Enns
Keyword(s):  
British Columbia ◽  
Barrett’S Esophagus ◽  
Endoscopic Mucosal Resection ◽  
Barrett's Esophagus ◽  
Low Grade ◽  
Complication Rates ◽  
The Third ◽  
Mucosal Resection ◽  
The Mean

BACKGROUND: Endoscopic mucosal resection (EMR) has been proposed as a primary method of managing patients with dysplasia- or mucosal-based cancers of the esophagus.OBJECTIVES: To evaluate the use of EMR for the treatment of Barrett’s esophagus with dysplasia or early adenocarcinoma, assessing efficacy, complication rates and long-term outcomes.METHODS: All patients who underwent EMR at St Paul’s Hospital (Vancouver, British Columbia) were reviewed. Eligible patients were assessed with aggressive biopsy protocols. Detected cancers were staged with both endoscopic ultrasound imaging and computed tomography. Appropriate patients were offered EMR using a commercially available mucosectomy device. EMR was repeated at six- to eight-week intervals until complete. Patients with less than one year of follow-up or who were undergoing other ablative methods were excluded.RESULTS: Twenty-two patients (all men) with a mean (± SD) age of 67±10.6 years were identified. The mean duration of gastroesophageal reflux disease was 17 years (range four to 40 years) and all were receiving proton pump inhibitor therapy. The mean length of Barrett’s esophagus was 5.5±3.5 cm. One patient had no dysplasia (isolated nodule), three had low-grade dysplasia, 15 had high-grade dysplasia (HGD) and three had adenocarcinoma. A mean of 1.7±0.83 endoscopic sessions were performed, with a mean of 6±5.4 sections removed. Following EMR, three patients developed strictures; two of these patients had pre-existing strictures and the third required two dilations, which resolved his symptoms. There were no other complications. Three patients underwent esophagectomy. Two had adenocarcinoma or HGD in a pre-existing stricture. The third patient had an adenocarcinoma not amenable to EMR. One patient with a long segment of Barrett’s esophagus underwent radiofrequency ablation. At a median follow-up of two years (range one to three years), the remaining 18 patients (82%) had no evidence of HGD or cancer.CONCLUSION: Most patients with esophageal dysplasia can be managed with EMR. Individuals with pre-existing strictures require other endoscopic and/or surgical methods to manage their dysplasia or adenocarcinoma.

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