Penoscrotal Incision for the Primary Implantation of an Artificial Urinary Sphincter

Background: The artificial urinary sphincter (AUS) has become the gold standard to treat severe stress urinary incontinence in men. The traditional placement of an AUS requires 2 incisions. The cuff is placed through a perineal incision and the reservoir and pump are placed via an inguinal incision. The implantation of an AUS is also possible via a single penoscrotal approach. Objectives: The objective is to demonstrate that the penoscrotal approach is not inferior to the perineal approach. Methods: Retrospective review of a single surgeon database from 2014 to 2019 was performed. A total of 40 patients have undergone implantation of an AUS via a penoscrotal incision. The outcome of patients was followed for an average of 31.3 months for adverse outcomes. Results: A primary American Medical Systems 800 sphincter was placed in 40 patients via a penoscrotal incision. The average age was 72 years. The average operating time was 35 minutes. The average cuff size was 4 cm. There were no infections of the prothesis so far. Three patients required a revision, 2 other patients needed an explant of the AUS, 1 patient underwent a cystectomy because of persistent radiocystitis. After activation of the sphincter, 33 patients (82.5%) were completely dry or using 1 pad per day for accidents. The remainder were all improved. Conclusions: AUS implantation via a single penoscrotal approach is not inferior to the perineal approach and has several advantages. The operating time is shorter and the procedure requires only 1 incision which both reduce the risk of infections, while the continence results are similar for both approaches.

Download Full-text

Minilaparotomy Cholecystectomy as a Day Surgery Procedure: A Prospective Clinical Pilot Study

Scandinavian Journal of Surgery ◽

10.1177/145749690709600304 ◽

2007 ◽

Vol 96 (3) ◽

pp. 206-208 ◽

Cited By ~ 8

Author(s):

J. Harju ◽

M. Pääkkönen ◽

M. Eskelinen

Keyword(s):

Randomised Trial ◽

Operating Time ◽

Day Surgery ◽

Prospective Randomised Trial ◽

Wound Pain ◽

Average Operating ◽

Average Operating Time ◽

Study Support ◽

The Mean

Background and Aims: In some studies minilaparotomy cholecystectomy (MC) has been shown to be as good as laparoscopic cholecystectomy (LC) in the surgical treatment of cholecystolithiasis. To our knowledge, the MC operation is rarely considered as a day surgery procedure. Patients and Methods: Thirty elective symptomatic non-complicated patients were included in the study during the end of the year 2004 to June 2005. The mean age of patients was 52 years (range 27–68), the mean body mass index 29 kg/m2 (range 19–41). Gallstones were confirmed with ultrasound and the pre-operative liver laboratory tests were normal in all patients. A five (+/-2) centimetre-long incision was used avoiding to split the rectus abdominis muscle. All patients were re-evaluated four weeks postoperatively with the follow-up letter. Results: The average operating time was 51 minutes (range 30–105 minutes). Day surgery was possible in 25 cases (83%). Five patients (17%) stayed over night at the hospital. There were four (13%) conversions to conventional cholecystectomy. The average postoperative sick leave was 16 days (range 14–30). Two patients returned to hospital. One patient had wound pain, but no complication was found, and the patient was not admitted. One patient had a wound infection and spent 6 days in the hospital. Twenty-nine (97%) patients were satisfied with the operation and were ready to recommend it for other patients. Conclusions: The results of this study support the suitability of MC as a day surgery procedure, but a prospective randomised trial is needed to evaluate the relative advantages of MC and LC.

Download Full-text

Video assisted resections. Increasing access to minimally invasive liver surgery?

Revista do Colégio Brasileiro de Cirurgiões ◽

10.1590/0100-69912015005009 ◽

2015 ◽

Vol 42 (5) ◽

pp. 318-324 ◽

Cited By ~ 2

Author(s):

Fabricio Ferreira Coelho ◽

Marcos Vinícius Perini ◽

Jaime Arthur Pirola Kruger ◽

Renato Micelli Lupinacci ◽

Fábio Ferrari Makdissi ◽

...

Keyword(s):

Operating Time ◽

Perioperative Outcomes ◽

Liver Lesions ◽

Minimally Invasive Liver Surgery ◽

Video Assisted ◽

Average Operating ◽

Average Operating Time ◽

Average Size ◽

Anesthesia Time ◽

Prospective Database

Objective: To evaluate perioperative outcomes, safety and feasibility of video-assisted resection for primary and secondary liver lesions. Methods : From a prospective database, we analyzed the perioperative results (up to 90 days) of 25 consecutive patients undergoing video-assisted resections in the period between June 2007 and June 2013. Results : The mean age was 53.4 years (23-73) and 16 (64%) patients were female. Of the total, 84% were suffering from malignant diseases. We performed 33 resections (1 to 4 nodules per patient). The procedures performed were non-anatomical resections (n = 26), segmentectomy (n = 1), 2/3 bisegmentectomy (n = 1), 6/7 bisegmentectomy (n = 1), left hepatectomy (n = 2) and right hepatectomy (n = 2). The procedures contemplated postero-superior segments in 66.7%, requiring multiple or larger resections. The average operating time was 226 minutes (80-420), and anesthesia time, 360 minutes (200-630). The average size of resected nodes was 3.2 cm (0.8 to 10) and the surgical margins were free in all the analyzed specimens. Eight percent of patients needed blood transfusion and no case was converted to open surgery. The length of stay was 6.5 days (3-16). Postoperative complications occurred in 20% of patients, with no perioperative mortality. Conclusion : The video-assisted liver resection is feasible and safe and should be part of the liver surgeon armamentarium for resection of primary and secondary liver lesions.

Download Full-text

Laparoscopic “en-bloc” ligation of spermatic veins

Urologia Journal ◽

10.1177/039156039606300322 ◽

1996 ◽

Vol 63 (3) ◽

pp. 384-388

Author(s):

C. Trombetta ◽

G. Savoca ◽

G. Liguori ◽

A. Tamai ◽

S. Siracusano ◽

...

Keyword(s):

General Anaesthesia ◽

Operating Time ◽

Case Histories ◽

En Bloc ◽

Optical Magnification ◽

Average Operating ◽

Average Operating Time ◽

The Right

Laparoscopic varicocelectomy is suggested only for II-III grade bilateral varicocele. The optical magnification granted by videosurgical techniques, prevents damaging testicular arteries; this possibility, however, requires a considerable amount of time. We performed a laparoscopic “en-bloc” ligation without sparing the artery on 13 patients with bilateral varicocele in order to assess eventual changes in gonadal volume. 10 patients underwent bilateral “en-bloc” ligation of spermatic vessels with an average operating time of 21 minutes. In 3 other patients, “en-bloc” ligation was performed on the right side while on the left side the artery was identified and saved; in these cases the average operating time was 33 minutes. After an average follow-up period of 19 months no cases of testicle atrophy nor of hydrocele were reported. ColorDoppler sonography, performed 3 months later on the 10 patients treated by bilateral “en-bloc” ligation, showed no persistent reflux. No case of homolateral persistent reflux was encountered in the 3 patients who underwent only right-side “en-bloc” ligation, but on the left side, where selective ligation had been performed, persistence of reflux was registered in one patient. Our experience has confirmed that laparoscopic “en-bloc” ligation of the internal spermatic pedicle, sparing vasa deferentia, prevents the persistence of reflux in all cases and allows a reduction in operating time. The opportunity of treating a pathology like bilateral varicocele by means of laparoscopy, which requires general anaesthesia, needs further confirmation and a larger number of case histories.

Download Full-text

007 Device Survival Following Primary Implantation of the AMS 800 Artificial Urinary Sphincter for Male Stress Urinary Incontinence

Journal of Sexual Medicine ◽

10.1016/j.jsxm.2016.12.020 ◽

2017 ◽

Vol 14 (2) ◽

pp. e3-e4

Author(s):

F.A. Yafi ◽

K.J. DeLay ◽

C. Stewart ◽

J. Chiang ◽

P. Sangkum ◽

...

Keyword(s):

Urinary Incontinence ◽

Stress Urinary Incontinence ◽

Artificial Urinary Sphincter ◽

Urinary Sphincter ◽

Male Stress Urinary Incontinence ◽

Primary Implantation

Download Full-text

Laparoscopic Adrenalectomy for Adrenal Tumors

International Journal of Endocrinology ◽

10.1155/2014/241854 ◽

2014 ◽

Vol 2014 ◽

pp. 1-4 ◽

Cited By ~ 8

Author(s):

Sun Chuan-yu ◽

Ho Yat-faat ◽

Ding Wei-hong ◽

Gou Yuan-cheng ◽

Hu Qing-feng ◽

...

Keyword(s):

Blood Loss ◽

Laparoscopic Adrenalectomy ◽

Benign Tumor ◽

Operating Time ◽

Adrenal Tumors ◽

Benign Tumors ◽

Intraoperative Blood Loss ◽

First Choice ◽

Average Operating ◽

Average Operating Time

Objective. To evaluate the indication and the clinical value of laparoscopic adrenalectomy of different types of adrenal tumor.Methods. From 2009 to 2014, a total of 110 patients were diagnosed with adrenal benign tumor by CT scan and we performed laparoscopic adrenalectomy. The laparoscopic approach has been the procedure of choice for surgery of benign adrenal tumors, and the upper limit of tumor size was thought to be 6 cm.Results. 109 of 110 cases were successful; only one was converted to open surgery due to bleeding. The average operating time and intraoperative blood loss of pheochromocytoma were significantly more than the benign tumors (P<0.05). After 3 months of follow-up, the preoperative symptoms were relieved and there was no recurrence.Conclusions. Laparoscopic adrenalectomy has the advantages of minimal invasion, less blood loss, fewer complications, quicker recovery, and shorter hospital stay. The full preparation before operation can decrease the average operating time and intraoperative blood loss of pheochromocytomas. Laparoscopic adrenalectomy should be considered as the first choice treatment for the resection of adrenal benign tumor.

Download Full-text

Long-term outcomes of primary implantation and revisions of artificial urinary sphincter in men with stress urinary incontinence

Neurourology and Urodynamics ◽

10.1002/nau.23221 ◽

2017 ◽

Vol 36 (7) ◽

pp. 1930-1937 ◽

Cited By ~ 11

Author(s):

Yoon Seok Suh ◽

Kwang Jin Ko ◽

Tae Heon Kim ◽

Hyun Hwan Sung ◽

Kyu-Sung Lee

Keyword(s):

Urinary Incontinence ◽

Stress Urinary Incontinence ◽

Artificial Urinary Sphincter ◽

Long Term Outcomes ◽

Urinary Sphincter ◽

Primary Implantation

Download Full-text

Device Survival after Primary Implantation of an Artificial Urinary Sphincter for Male Stress Urinary Incontinence

The Journal of Urology ◽

10.1016/j.juro.2016.08.107 ◽

2017 ◽

Vol 197 (3 Part 1) ◽

pp. 759-765 ◽

Cited By ~ 20

Author(s):

Faysal A. Yafi ◽

Kenneth J. DeLay ◽

Carrie Stewart ◽

Jason Chiang ◽

Premsant Sangkum ◽

...

Keyword(s):

Urinary Incontinence ◽

Stress Urinary Incontinence ◽

Artificial Urinary Sphincter ◽

Urinary Sphincter ◽

Male Stress Urinary Incontinence ◽

Primary Implantation

Download Full-text

URBAN PUBLIC TRANSPORT: MARGINAL VALUE OF THE CAPACITY FACTOR

The Russian Automobile and Highway Industry Journal ◽

10.26518/2071-7296-2019-3-290-301 ◽

2019 ◽

Vol 16 (3) ◽

pp. 290-301

Author(s):

A. I. Fadeev ◽

Ye. V. Fomin ◽

S. Alhusseini

Keyword(s):

Public Transport ◽

Operating Time ◽

Capacity Utilization ◽

Utilization Factor ◽

Marginal Value ◽

Passenger Traffic ◽

Urban Public Transport ◽

Speed Fluctuation ◽

Average Operating ◽

Average Operating Time

Introduction. One of the most important indicators determining the public transport service quality is the capacity utilization factor of transport fleet. This parameter directly effects on the economic efficiency of the transport organization. For the carrier it is desirable from an economic point of view that the value of the capacity utilization factor takes on the greatest value. Passengers, on the contrary, prefer to transfer without overfull capacity of transport vehicles. Moreover, this factor is used in determining travel fares, analyzing the executed movement regarding the availability of reserves in carrying capacity and planning transportation process. The paper discusses the method of marginal value calculation of the transport fleet’s capacity utilization factor of urban public transport based on ensuring standard vehicle's cabin filling limits.Materials and methods. The authors solved the task of determining the filling marginal value for transport fleet while working on regular urban routes by analyzing the dependence of the capacity utilization factor on the passenger traffic parameters, the average operating time of the transport fleet on the route and the speed fluctuation during public transport operation. The authors also proposed the indicator of the transportation speed fluctuation during the operation of urban public transport.Results. The authors found out that the capacity utilization factor of transport fleet substantially depended on the passenger traffic parameters, on the average operating time of the transport fleet and on the speed fluctuation during public transport operation.Discussion and conclusion. The obtained dependences allow us calculating the marginal values of capacity utilization factor with taking into account the parameters of the planned transport process. The standard capacity utilization factor varies within considerable limits from 0.2 to 0.4, depending on the operating conditions.

Download Full-text

833 Hyper Acute Dialysis Access Pathway (HADAP) – Undertaking Creation of Arteriovenous Fistulae in The Renal Ward

British Journal of Surgery ◽

10.1093/bjs/znab135.004 ◽

2021 ◽

Vol 108 (Supplement_2) ◽

Author(s):

S Shetty ◽

P Chowdary ◽

D Dabare ◽

C Seet ◽

R Ahmed ◽

...

Keyword(s):

Operating Time ◽

Surgical Site Infections ◽

Primary Patency ◽

Successful Implementation ◽

Dialysis Access ◽

Arteriovenous Fistulae ◽

Surgical Assistance ◽

Average Operating ◽

Average Operating Time ◽

Duration Of Operation

Abstract Introduction The impetus to apply the “lean method” to creation of arteriovenous fistulae came with the pandemic restricting access to theatres. Here we present HADAP implemented in a dedicated procedure room in the Renal ward. Method Between April and September 2020, 44 patients underwent ward-based arteriovenous fistula operations with no more than 3 people in the room – surgeon, runner and patient. The parameters assessed were duration of operation, complications, patency, patient and surgeon feedback and financial implications. Results The service was predominantly registrar-led who created 91% of the fistulae. 95% operations were completed successfully with a 2-week primary patency of 73% and no surgical site infections. 40% of the procedures were radiocephalic fistulae. 14% procedures required surgical assistance by the runner. The average operating time reduced from 90 minutes for the first 10 cases to 50 minutes for the last 9. A structured questionnaire showed positive feedback from both patients and surgeons (4-5 out of 5). This service has cleared potentially 9 main theatre lists for more complex procedures. Conclusions Our study demonstrates the successful implementation of a novel operating environment allowing expedited care for renal failure patients. It has enhanced our ability to deliver a dialysis access program despite the challenges of COVID.

Download Full-text