Robotic vs. Laparoscopic Splenectomy in Management of Non-traumatic Splenic Pathologies: A Systematic Review and Meta-Analysis

2021 ◽  
pp. 000313482199505
Author(s):  
Pratik Bhattacharya ◽  
Liam Phelan ◽  
Simon Fisher ◽  
Shahab Hajibandeh ◽  
Shahin Hajibandeh
Keyword(s):  
Blood Loss ◽  
Hospital Stay ◽  
Wound Infection ◽  
Laparoscopic Splenectomy ◽  
Length Of Hospital Stay ◽  
Perioperative Outcomes ◽  
Procedure Time ◽  
Open Procedure ◽  
Operative Complications ◽  
Post Operative Complications

We aimed to evaluate comparative outcomes of robotic and laparoscopic splenectomy in patients with non-traumatic splenic pathologies. A systematic search of electronic databases and bibliographic reference lists were conducted, and a combination of free text and controlled vocabulary search adapted to thesaurus headings, search operators and limits in electronic databases were applied. Intraoperative and post-operative complications, wound infection, haematoma, conversion to open procedure, return to theatre, volume of blood loss, procedure time and length of hospital stay were the evaluated outcome parameters. We identified 8 comparative studies reporting a total of 560 patients comparing outcomes of robotic ( n = 202) and laparoscopic ( n = 258) splenectomies. The robotic approach was associated with significantly lower volume of blood loss (MD: −82.53 mls, 95% CI −161.91 to −3.16, P = .04) than the laparoscopic approach. There was no significant difference in intraoperative complications (OR: 0.68, 95% CI .21-2.01, P = .51), post-operative complications (OR: .91, 95% CI .40-2.06, P = .82), wound infection (RD: -.01, 95% CI -.04-.03, P = .78), haematoma (OR: 0.40, 95% CI .04-4.03, P = .44), conversion to open (OR: 0.63; 95% CI, .24-1.70, P = .36), return to theatre (RD: −.04, 95% CI -.09-.02, P = .16), procedure time (MD: 3.63; 95% CI -16.99-24.25, P = .73) and length of hospital stay (MD: −.21; 95% CI -1.17 - .75, P = .67) between 2 groups. In conclusion, robotic and laparoscopic splenectomies seem to have comparable perioperative outcomes with similar rate of conversion to an open procedure, procedure time and length of hospital stay. The former may potentially reduce the volume of intraoperative blood loss. Future higher level research is required to evaluate the cost-effectiveness and clinical outcomes

Transoral versus Transcervical Drainage of Pharyngeal Abscesses in Children: Post-Operative Complications

2021 ◽  
pp. 000348942199016
Author(s):  
Christopher A. Maroun ◽  
Habib G. Zalzal ◽  
Ayman A. Mustafa ◽  
Michele Carr
Keyword(s):  
Hospital Stay ◽  
Length Of Hospital Stay ◽  
Perioperative Outcomes ◽  
Improvement Program ◽  
Surgical Quality ◽  
Ventilator Support ◽  
Significant Difference ◽  
Operative Complications ◽  
Baseline Characteristics ◽  
Post Operative Complications

Introduction: The objective of this study was to compare complications and other perioperative outcomes between intraoral and transcervical drainage of both retropharyngeal and parapharyngeal abscesses. Materials and Methods: This was a retrospective study that analyzed data from the 2012 to 2016 National Surgical Quality Improvement Program (NSQIP)-Pediatric public use files. Baseline characteristics and perioperative outcomes including postoperative complications and length of hospital stay (LOS) were compared between intraoral and transcervical drainage groups. Multivariable logistic regression was performed to inspect predictors of having an extended LOS, defined as LOS greater than 3 days. Results: A total of 1174 patients were included. Mean age was 5.1 ± 3.8 years in the intraoral group (N = 1063) and 4.2 ± 4.3 years in the transcervical group (N = 111, P < .001). There was no significant difference in the rate of post-operative complications between groups (5.7% intraoral vs 8.1% transcervical, P = .316). LOS was significantly longer in the transcervical group (>3 days in 36.2% of intraoral vs 49.5% of transcervical, P = .006). Patients in the transcervical group had 1.59 times the odds of extended LOS, after adjusting for age, pre-operative ventilator support, asthma, structural pulmonary disease, hematologic disorders, and all post-operative complications ( P = .024). Conclusion: There does not appear to be a significant difference in the rate of post-operative complications after intraoral versus transcervical drainage for pharyngeal abscesses in children. However, transcervical drainage was associated with an extended hospital stay. Further prospective studies will be needed to determine the reasons for this.

Abdominal sacrohysteropexy UV prolapse and preservation of reproduction.

2021 ◽  
Vol 28 (05) ◽  
pp. 652-655
Author(s):  
Robina Ali ◽  
Riffat Ehsan ◽  
Ghazala Niaz ◽  
Fatima Abid
Keyword(s):  
Hospital Stay ◽  
Length Of Hospital Stay ◽  
Uterovaginal Prolapse ◽  
Prolapse Recurrence ◽  
Gynecology And Obstetrics ◽  
Duration Of Surgery ◽  
Operative Complications ◽  
Operative Recovery ◽  
Post Operative Complications

Objectives: The purpose of this study was to assess the safety of sacrohystcopxy by determining intraoperative and post-operative complications and its effectiveness by pelvic organ prolapse recurrence on follow up. Study Design: Prospective study. Setting: Department of Gynecology and Obstetrics Unit-II DHQ Hospital PMC, Faisalabad. Period: Jan-2014 to Jan-2017. Material & Methods: Patients with uterovaginal prolapse, admitted through OPD were selected for abdominal sacrohysteropexy. Variables of study including duration of surgery, any intra-operative and post operative complications, need of intra operative blood transfusion, post operative hospital stay; recurrence of POP, number of pregnancies in 06 moths follow up were recorded. Results: During this study period, 319 patients were admitted with uterovaginal prolapse. 32 (10.03%) cases were selected for abdominal sacrohysteropexy. In these 32 patients, 03 (9.37%) were <30years of age, 21(65.62%) were between 30-35 years and 8 (25%) were between 35-40 years of age. About 2(6.25%) were unmarried, while 30(93.7%) were married. In these married women 14(43.75%) were multiparas, another 14(43.75%) were para 1 or 2, while 4(12.5%) were para 3 or more. Duration of surgery was 40-45 minutes in 31(96.87%) patients. In 28(87.5%) cases per operative blood loss was <150ml while in 4(12.5%) it was estimated to be >150ml but less than 300ml. Post operatively only 1(3.12%) case developed wound sepsis and it was the only one (3.12%) who was discharged on 7th post operative day, while rest 31(96.87%) were discharged on 3rd post operative day. No recurrence was noticed in 06 moths follow up, while 2(6.25%) patients became pregnant. Conclusion: Abdominal sacrohysteropexy is a safe and an effective treatment in terms of overall anatomical and functional outcome, complications, post operative recovery, length of hospital stay and sexual functioning, in women who desire uterine and hence fertility preservation.

scholarly journals Non-descent vaginal hysterectomy for large uterus-safety and feasibility

2018 ◽  
Vol 7 (9) ◽  
pp. 3563
Author(s):  
Rameshkumar R. ◽  
Sahana N. Naik ◽  
Dhanalakshmi .
Keyword(s):  
Blood Loss ◽  
Hospital Stay ◽  
Vaginal Hysterectomy ◽  
Cost Effective ◽  
Cost Effective Method ◽  
Duration Of Surgery ◽  
Operative Complications ◽  
Large Uterus ◽  
Duration Of Operation ◽  
Post Operative Complications

Background: Non Descent Vaginal Hysterectomy (NDVH) is removal of uterus through vagina in non-prolapsed uterus. The objective of the present study was to assess safety and feasibility of NDVH in patients with large uterus (>12 weeks size uterus).Methods: Retrospective study was conducted in Department of Obstetrics and Gynecology of Shree Dharmasthala Manjunatheshwara (SDM) College of Medical Sciences and Hospital, Dharwad, India from May2014 to May 2017. Effort was made to perform hysterectomies vaginally in women with benign conditions with large uterine size. Information regarding age, parity, uterine size, blood loss, duration of operation, number of fibroids, other surgical difficulties encountered, intra–operative and post-operative complications were recorded.Results: Total of 65 cases was selected for NDVH with large uterine size. All successfully underwent NDVH. 25 patients had uterus of 10-12 weeks size, 17 had uterine size of 12-14 weeks size. Mean duration of surgery was 90 min. Mean blood loss was 300ml. Post-operative complications were minimal. All patients had early mobility with faster resumption to daily activities. Mean hospital stay was 4-5 days.Conclusions: Non descent vaginal hysterectomy is safe, cost effective method of hysterectomy in women with large uterus requiring hysterectomy for benign conditions with less complications, shorter hospital stay and less morbidity.

scholarly journals A Comparative evaluation of Non-descent vaginal hysterectomy versus total Abdominal hysterectomy: A hospital based case control study

2019 ◽  
Vol 17 (1) ◽  
pp. 20-22
Author(s):  
Durga BC ◽  
Aseem Sharma ◽  
Binod Mahaseth ◽  
Nirmala Sharma
Keyword(s):  
Blood Loss ◽  
Hospital Stay ◽  
Vaginal Hysterectomy ◽  
Operating Time ◽  
Total Abdominal Hysterectomy ◽  
Abdominal Hysterectomy ◽  
Benign Pathology ◽  
Operative Complications ◽  
Control Study ◽  
Post Operative Complications

Background: Hysterectomy is a common surgery performed by gynecologist worldwide. It can be done either by vaginal, abdominal or laparoscopic route. Non decent vaginal hysterectomy (NDVH) is less invasive, less time consuming and scar less surgery. The blood loss during surgery, intra-operative and post-operative complications are less in NDVH compare to TAH (total abdominal hysterectomy). Aim and objective: to compare the clinical outcome between NDVH and TAH. Method: A hospital based prospective study was done at Nepalgunj medical collage Kolhapur between March 2018–March 2019, 60 cases fulfilling selection criteria were selected, 30 cases underwent NDVH next 30 cases underwent TAH. Outcome is measured on the basis of operating time, blood loss during surgery, hospital stay and post-operative complications. Result: The most common indication for hysterectomy was fibroid uterus in both the groups (NDVH and TAH). The operating time, blood loss, hospital stay and post-operative complications were less in NDVH as compare to TAH. Conclusion: NDVH is a choice of surgery over TAH for freely mobile uterus with benign pathology and uterus size less than twelve weeks and without adenexal pathology.

scholarly journals Non-descent vaginal hysterectomy surgery associated with less complications and good prognosis

2022 ◽  
Vol 13 (1) ◽  
pp. 123-128
Author(s):  
Pranita Somani ◽  
Priyanka Singh ◽  
Mangala Shinde
Keyword(s):  
Blood Loss ◽  
Hospital Stay ◽  
Vaginal Hysterectomy ◽  
Vaginal Discharge ◽  
Operative Time ◽  
Intraoperative Complications ◽  
Vaginal Route ◽  
Background Removal ◽  
Operative Complications ◽  
Post Operative Complications

Background: Removal of the uterus through vagina when performed in a case without uterine descent or prolapse is known as “non-descent vaginal hysterectomy” or NDVH. Vaginal route is preferred as compared to laparoscopic and abdominal methods. The advantages of vaginal hysterectomy being fewer complications, less post-operative stay, cost effective, and useful in bulky uterus. Aims and Objectives: The aims of the study were as follows: (1) To study the intraoperative and post-operative complications encountered during NDVH and their management. (2) To assess the intraoperative blood loss, the operative time, and post-operative hospital stay. (3) To study and check the feasibility of vaginal route as the primary route for all hysterectomies in the absence of uterine prolapse. Materials and Methods: A total of 50 patients were included in the study. Detailed history was taken including obstetric history and menstrual history and clinical examination was performed. After taking written, informed consent and doing proper pre-operative preparation, the patient was posted for NDVH. Post-operative complications were noted. Patients were asked to come for follow-up after 15 days. Results: In 92% of cases operated, no intraoperative complications were found suggesting low morbidity associated with the procedure. Hemorrhage requiring blood transfusion was found in 4% of cases. Average operative time was 61.2 ± 27.89 min, average blood loss was 170 ± 81.44 ml, and average hospital stay was 5.94 ± 4.95 days. On histopathological examination, 40% were having leiomyoma and dysfunctional uterine bleeding was seen in 22% of cases. Pain was the most common complication seen in 30% of cases while vaginal discharge was seen in just 4% of cases. About 80% of patients were discharged on post-operative day 5. Conclusion: In 92% of NDVH cases, no intraoperative complications were found suggesting low morbidity associated with the procedure. The post-operative hospital stay was restricted to 5 days in 80% of cases which indicates early discharge of the patient. Post-operative complications such as vaginal discharge and fever were seen only in 4% of cases. NDVH should, therefore, be considered as the primary route for all hysterectomies unless contraindicated in the absence of prolapse.

scholarly journals Clinical Presentation and Surgical Outcome in Patients Presented with Peritonitis

2021 ◽  
pp. 185-190
Author(s):  
Shahnawaz Abro ◽  
Sajjad Hussian Qureshi ◽  
Faiza Hameed ◽  
Aftab Ahmed ◽  
Sohail Yousif
Keyword(s):  
Hospital Stay ◽  
Wound Infection ◽  
Peritoneal Cavity ◽  
Surgical Outcome ◽  
Clinical Presentation ◽  
Abdominal Cavity ◽  
Care Hospital ◽  
Case Series Study ◽  
Operative Complications ◽  
Post Operative Complications

Objective: To determine the surgical outcome in patients with peritonitis at tertiary care Hospital. Materials and Methods: This descriptive case series study was conducted in general surgery department of Peoples Medical Collage Hospital, Nawabshah (SBA). Study duration was two year from August 2014 to July 2016. All the patients aged more than 12 years and of both genders were included. Surgical management was done in all of the study subjects. Abdominal cavity was produced with midline incisions using grid iron as per investigations and clinical evaluation; the quantity and quality of intra-abdominal exudates were measured. Intestinal contents and pus were removed from peritoneal cavity with suction as well as by manual mopping, and full lavage was carried out with 3-5 liters of normal saline to all parts of the abdominal cavity. All the demographic data including clinical presentation and surgical outcome in terms of post-operative complications, Hospital stay and mortality were recorded via study proforma. Results: A total of 100 cases of peritonitis 75% patients were male and 25% patients were female. The mean age of patients was 36.21+12.32 years. Acute generalized abdominal pain was in all  cases, followed by fever 91.0%, vomiting 66.0%, constipation 69.0% and 2.0% patients complained of passing blood per rectum. Generalized abdominal tenderness, including rebound tenderness 90%, abdominal rigidity 83%, dehydration 88%, abdominal distention 85%, absent gut sound 70%, shifting dullness was elicited in 64% of cases and jaundice in 1.0% of cases. According to post-operative complications 20.0% patients developed Septicemia and Fecal fistula, 40.0% had wound Infection only, 9.0% patients developed wound infection and septicemia, 4.0% patients developed septicemia without any wound infection. Most of the patients had prolonged Hospital stay and overall mortality rate was 16%. Conclusion: Surgical outcome of the peritonitis resulted poor in those cases who came late and there was huge contamination of peritoneal cavity when operated, these patients developed post-operative complications i.e. wound infection, septicemia, faecal fistula and there hospital stay was longer.

scholarly journals Clinical predictors and outcome of bowel resection in paediatric intussusception

2020 ◽  
Vol 20 (3) ◽  
pp. 1463-1470
Author(s):  
Akinlabi E Ajao ◽  
Taiwo A Lawal ◽  
Olakayode O Ogundoyin ◽  
Dare I Olulana
Keyword(s):  
Developing Countries ◽  
Abdominal Pain ◽  
Hospital Stay ◽  
Bowel Resection ◽  
Length Of Hospital Stay ◽  
Clinical Predictors ◽  
College Hospital ◽  
Duration Of Symptoms ◽  
Operative Complications ◽  
Post Operative Complications

Introduction: Surgery remains the mainstay in treating intussusception in developing countries, with a correspondingly high bowel resection rate despite a shift to non-operative reduction in high-income countries. Objective: To assess factors associated with bowel resection and the outcomes of resection in childhood intussusception. Methods: A review of children with intussusception between January 2006 and December 2015 at the University College Hospital, Ibadan, Nigeria. The patients were categorized based on the need for bowel resection and analysis done using the SPSS version 23. Results: 121 children were managed for intussusception during this period. 53 (43.8%) had bowel resection, 61 (50.4%) did not require resection and 7 (5.8%) were unknown. 40 (75.5%) of the resections were right hemi-colectomy. The presence of fever, abdominal pain, distension, rectal mass, age < 12 months, heart rate > 145/min and duration of symptoms > 2 days were associated with the need for bowel resection (p < 0.05). However, only age and abdominal pain independently predicted need for resection. Bowel resection was more associated with development of post-operative complications and prolonged hospital stay (p < 0.05). Conclusion: Infants presenting with abdominal pain and abdominal distension after two days of onset of symptoms were more likely to require bowel resection. Resection in intussusception significantly increased post-operative complications and length of hospital stay. Keywords: Paediatric intussusception; bowel resection; developing countries.

Microsurgical Resection of Foramen Magnum Meningioma: Multi-institutional Retrospective Case Series and Proposed Surgical Risk Scoring System.

2021 ◽  
Author(s):  
Nida Fatima ◽  
John H. Shin ◽  
William T. Curry ◽  
Steven D. Chang ◽  
Antonio Meola
Keyword(s):  
Hospital Stay ◽  
Complication Rate ◽  
Length Of Hospital Stay ◽  
Foramen Magnum ◽  
Local Tumor Control ◽  
Tumor Control ◽  
Local Tumor ◽  
Operative Complications ◽  
Microsurgical Resection ◽  
Post Operative Complications

Abstract Purpose Foramen magnum meningiomas (FMMs) are a major surgical challenge, due to relevant surgical morbidity and mortality. The paper aims to review the clinical (symptomatic improvement, complication rate, length of hospital stay) and radiological outcome (completeness of resection) of microsurgical resection of FMMs, and to identify predictors of complications. Methods A multi-institutional retrospective review of prospectively maintained database of FMMs included 51 patients (74.5% females) with a median tumor volume of 8.18 cm3 (range, 1.77–57.9 cm3) and median follow-up of 36 months (range, 0.30–180.0 months). Tumors were resected though suboccipital approach (58.8%) or transcondylar approach (39.3%). Results Gross-total resection (GTR) was achieved in 80.4%, while local tumor control in 98% of cases. Clinical symptoms improved in 34 patients (66.7%) and worsened in 5 (9.8%). The median length of hospital stay was 5 days. Mortality was null. Postoperative complications developed in 15 patients (29.4%), with cerebrospinal fluid leak (7.8%) and lower cranial nerves deficits (7.8%) as the most frequent. Craniospinal location (p = 0.03), location anterior to the dentate ligament (DL) (p = 0.02), involvement of vertebral artery (VA) (p = 0.03) were significantly associated with complication rate. These three elements allow calculating the Foramen Magnum Meningioma Risk Score (FRMMRS), to estimate the risk of post-operative complications. Conclusion Microsurgical resection allows for high GTR rate and local tumor control rate, despite complications in one third of the patients. The FMMRS allows classifying FMMs and estimating the risk of post-operative complications.

scholarly journals Simple prostatectomy using the open and robotic approaches for lower urinary tract symptoms: A retrospective, case-control series

2021 ◽  
Vol 16 (1) ◽  
Author(s):  
Dor Golomb ◽  
Fernanda Gabrigna Berto ◽  
Jennifer Bjazevic ◽  
Jose A. Gomez ◽  
Joseph L.K. Chin ◽  
...  
Keyword(s):  
Blood Loss ◽  
Hospital Stay ◽  
Length Of Hospital Stay ◽  
Functional Results ◽  
Perioperative Outcomes ◽  
Minimal Risk ◽  
Complication Rates ◽  
Control Series ◽  
Estimated Blood Loss ◽  
Simple Prostatectomy

Introduction: We aimed to assess the outcome of our series of simple prostatectomy using the open simple prostatectomy (OSP) and robotic-assisted simple prostatectomy (RASP) approaches, at our institution. Methods: A retrospective chart review of men who underwent OSP and RASP at Western University, in London, ON. Preoperative, intraoperative, and postoperative data were collected and analyzed. Results: From 2012–2020, 29 men underwent a simple prostatectomy at our institution. Eight patients underwent an OSP and 21 patients underwent a RASP. The median age was 69 years. Preoperative median prostate volume was 153 cm3 (range 80–432 cm3). The surgical indications were failed medical treatment, urinary retention, hydronephrosis, cystolithiasis, and recurrent hematuria. The median operative time was 137.5 minutes in OSP and 185 minutes in the robotic approach (p=0.04). Median estimated blood loss was 2300 ml (range 600–4000 ml) and 100 ml (range 50–400 ml) in the open and robotic procedures, respectively (p=0.4). The mean length of hospital stay was shorter in the RASP group, one day vs. three days (z=4.152, p<0.005). Perioperative complication rates were significantly lower in the group undergoing RASP, with no complications recorded in this group (p=0.004). Both groups demonstrated excellent functional results, with most patients reporting complete urinary continence (p=0.8). Conclusions: We report very good perioperative outcomes, with a minimal risk profile and excellent functional results, leading to marked improvement in patients' symptoms at followup after both the OSP and RASP approaches. RASP was associated with a shorter length of hospital stay, decreased blood loss, and a lower complication rate.

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