Experience with Minimally Invasive Ponto Surgery and Linear Incision Approach for Pediatric and Adult Bone Anchored Hearing Implants

2019 ◽  
Vol 129 (4) ◽  
pp. 380-387 ◽  
Author(s):  
Aren Bezdjian ◽  
Rachel Ann Smith ◽  
Nathalie Gabra ◽  
Luhe Yang ◽  
Marco Bianchi ◽  
...  
Keyword(s):  
Minimally Invasive ◽  
Intraoperative Complications ◽  
Patient Characteristics ◽  
Perioperative Outcomes ◽  
Surgical Approaches ◽  
Implant Stability ◽  
Eligibility Criteria ◽  
Included Patient ◽  
Common Etiology ◽  
Surgical Duration

Purpose: To compare intra- and postoperative outcomes between the standard linear incision with tissue preservation and the Minimally Invasive Ponto Surgery (MIPS). Study Design: A non-randomized retrospective cohort series. Methods: Medical files were reviewed of adult and pediatric bone anchored hearing implant recipients. Extracted outcomes included patient characteristics, implant survival, operative time, anesthesia use, intra and postoperative complications, soft tissue tolerability assessed by the Holger’s classification, and implant stability assessed by the Resonance Frequency Analysis (RFA). Outcomes were compared between two surgeries. Results: A total of 59 implants were placed (21 MIPS; 38 linear). Conductive hearing loss was the most common etiology for implantation. Surgery was conducted under local anesthesia in 67% of MIPS patients and 16% of linear patients. No intraoperative complications were reported for both surgical approaches and no implants were lost. Patients undergoing implantation via the MIPS approach displayed less skin reaction postoperatively, however this was not significant ( P = .2848). The most common Holgers score for both groups was grade 1. The median and mean surgical duration for the MIPS group was statistically lower than the linear group ( P = .0001). Implant stability measured by the RFA implant stability quotient was greater in the MIPS cohort. Conclusion: The MIPS approach seems either similar or superior to the linear approach in all perioperative outcomes evaluated. Outcomes such as surgical duration, anesthesia choice and implant stability measurements support implantation through the MIPS approach for patients meeting eligibility criteria.

scholarly journals Routine intraoperative jejunostomy placement and minimally invasive oesophagectomy: an unnecessary step?†

2019 ◽  
Vol 56 (4) ◽  
pp. 746-753 ◽  
Author(s):  
Tiuri E Kroese ◽  
Leonidas Tapias ◽  
Jacqueline K Olive ◽  
Lena E Trager ◽  
Christopher R Morse
Keyword(s):  
Weight Loss ◽  
Minimally Invasive ◽  
Relative Weight ◽  
Patient Characteristics ◽  
Perioperative Outcomes ◽  
P Value ◽  
Oral Nutrition ◽  
Significant Difference ◽  
Minimally Invasive Oesophagectomy ◽  
The Impact

Abstract OBJECTIVES: Adequate nutrition is challenging after oesophagectomy. A jejunostomy is commonly placed during oesophagectomy for nutritional support. However, some patients develop jejunostomy-related complications and the benefit over oral nutrition alone is unclear. This study aims to assess jejunostomy-related complications and the impact of intraoperative jejunostomy placement on weight loss and perioperative outcomes in patients with oesophageal cancer treated with minimally invasive Ivor Lewis oesophagectomy (MIE). METHODS: From a prospectively maintained database, patients were identified who underwent MIE with gastric reconstruction. Between 2007 and 2016, a jejunostomy was routinely placed during MIE. After 2016, a jejunostomy was not utilized. Postoperative feeding was performed according to a standardized protocol and similar for both groups. The primary outcomes were jejunostomy-related complications, relative weight loss at 3 and 6 months postoperative and perioperative outcomes, including anastomotic leak, pneumonia and length of stay, respectively. RESULTS: A total of 188 patients were included, of whom 135 patients (72%) received a jejunostomy. Ten patients (7.4%) developed jejunostomy-related complications, of whom 30% developed more than 1 complication. There was no significant difference in weight loss between groups at 3 months (P = 0.73) and 6 months postoperatively (P = 0.68) and in perioperative outcomes (P-value >0.999, P = 0.591 and P = 0.513, respectively). CONCLUSIONS: The use of a routine intraoperative jejunostomy appears to be an unnecessary step in patients undergoing MIE. Intraoperative jejunostomy placement is associated with complications without improving weight loss or perioperative outcomes. Its use should be tailored to individual patient characteristics. Early oral nutrition allows patients to maintain an adequate nutritional status.

scholarly journals Robotic Stereotactic Assistance (ROSA) for Pediatric Epilepsy: A Single-Center Experience of 23 Consecutive Cases

Children ◽  
2020 ◽  
Vol 7 (8) ◽  
pp. 94
Author(s):  
Jonathon H. Nelson ◽  
Samantha L. Brackett ◽  
Chima O. Oluigbo ◽  
Srijaya K. Reddy
Keyword(s):  
Minimally Invasive ◽  
Pediatric Patients ◽  
Case Series ◽  
Intractable Epilepsy ◽  
Electrode Placement ◽  
Perioperative Outcomes ◽  
Surgical Approaches ◽  
Single Center ◽  
Invasive Approach ◽  
Ablative Surgery

Robotic assisted neurosurgery has become increasingly utilized for its high degree of precision and minimally invasive approach. Robotic stereotactic assistance (ROSA®) for neurosurgery has been infrequently reported in the pediatric population. The goal of this case series was to describe the clinical experience, anesthetic and operative management, and treatment outcomes for pediatric patients with intractable epilepsy undergoing ROSA® neurosurgery at a single-center institution. Patients who underwent implantation of stereoelectroencephalography (SEEG) leads for intractable epilepsy with ROSA® were retrospectively evaluated between August 2016 and June 2018. Demographics, perioperative management details, complications, and preliminary seizure outcomes after resective or ablative surgery were reviewed. Nineteen children who underwent 23 ROSA® procedures for SEEG implantation were included in the study. Mean operative time was 148 min. Eleven patients had subsequent resective or ablative surgery, and ROSA® was used to assist with laser probe insertion in five patients for seizure foci ablation. In total, 148 SEEG electrodes were placed without any perioperative complications. ROSA® is minimally invasive, provides superior accuracy for electrode placement, and requires less time than traditional surgical approaches for brain mapping. This emerging technology may improve the perioperative outcomes for pediatric patients with intractable epilepsy since large craniotomies are avoided; however, long-term follow-up studies are needed.

Perioperative Outcomes of Radical Trachelectomy in Early-Stage Cervical Cancer: Vaginal Versus Laparoscopic Approaches

2015 ◽  
Vol 25 (6) ◽  
pp. 1051-1057 ◽  
Author(s):  
Aera Yoon ◽  
Chel Hun Choi ◽  
Yoo-Young Lee ◽  
Tae-Joong Kim ◽  
Jeong-Won Lee ◽  
...  
Keyword(s):  
Blood Loss ◽  
Tumor Size ◽  
Early Stage ◽  
Medical Center ◽  
Intraoperative Complications ◽  
Outcome Data ◽  
Perioperative Outcomes ◽  
Surgical Approaches ◽  
Radical Trachelectomy ◽  
Gynecology And Obstetrics

ObjectiveThis study aimed to compare the laparoscopic-assisted radical vaginal trachelectomy (LARVT) and laparoscopic radical trachelectomy (LRT) surgical approaches and provide outcome data on patients who have undergone radical trachelectomy.MethodsWe identified patients who had undergone LARVT or LRT at Samsung Medical Center between January 2005 and March 2013.ResultsA total of 38 patients were identified, and 21 patients had undergone LARVT, whereas 17 patients had undergone LRT. The median age was 32 years for both groups. Most of the patients had a squamous cell carcinoma (68.4%) and International Federation of Gynecology and Obstetrics stage IB1 disease (76.3%). Twenty (52.6%) of 38 patients had tumor size greater than 2 cm. There were no significant differences between groups in the baseline characteristics except for the tumor size. Patients undergoing LRT had significantly larger tumor size than patients undergoing LARVT (median tumor size, 2.7 cm [range, 1.2–3.7] vs 2.1 cm [range, 0.4–3.0],P= 0.032). Perioperative outcomes were similar between groups except for the decline of hemoglobin after surgery. The median decline of hemoglobin indicating blood loss was significantly smaller in the LRT group than in the LARVT group (1.8 g/dL [range, 0.5–3.5] vs 2.6 g/dL [range, 0.7–6.2],P= 0.017). Intraoperative complications occurred in 2 patients (9.5%, 2/21) in LARVT group. Although 52.6% of tumors were larger than 2 cm, recurrence occurred only in 3 (7.9%) patients who underwent LARVT.ConclusionsThe study shows the feasibility of LRT, with the advantage of reduced blood loss. The LRT could be an alternative option for patients with large tumors. Further researches are needed to investigate the long-term outcomes.

Perioperative and Long-term Outcomes of Laparoscopic, Open Abdominal, and Vaginal Surgery for Endometrial Cancer in Patients Aged 80 Years or Older

2014 ◽  
Vol 24 (5) ◽  
pp. 894-900 ◽  
Author(s):  
Giorgio Bogani ◽  
Antonella Cromi ◽  
Stefano Uccella ◽  
Maurizio Serati ◽  
Jvan Casarin ◽  
...  
Keyword(s):  
Endometrial Cancer ◽  
Postoperative Complications ◽  
Intraoperative Complications ◽  
Vaginal Surgery ◽  
Perioperative Outcomes ◽  
Surgical Approaches ◽  
Rank Test ◽  
Term Survival ◽  
Log Rank Test

ObjectiveThis study was undertaken to evaluate the safety, feasibility, and the long-term effectiveness of laparoscopy in endometrial cancer patients aged 80 years or older.MethodsData of consecutive patients aged 80 years and older undergoing laparoscopic, open abdominal, and vaginal approaches were compared. Postoperative complications were graded per the Accordion Severity Classification. Survival outcomes within the first 5 years were analyzed using the Kaplan-Meier method.ResultsAmong 726 patients, 63 (9%) were aged 80 years and older. Laparoscopic, open abdominal, and vaginal surgery were performed in 22 (35%), 25 (40%), and 16 (25%) cases, respectively. All laparoscopic procedures were completed laparoscopically, whereas a conversion from vaginal to open procedure occurred (0% vs 6%; P = 0.42). Patients undergoing laparoscopy experienced similar operative time (P > 0.05), lower blood loss (P < 0.05), and shorter hospital stay (P < 0.05) than patients undergoing open and vaginal surgery. No intraoperative complications were recorded. Laparoscopy is related to a lower rate of postoperative complications (P = 0.09) and Accordion grade greater than or equal to 2 complications (P = 0.05) in comparison to open abdominal and vaginal surgery. The route of surgical approaches did not influence the 5-year disease-free (P = 0.97, log-rank test) and overall (P = 0.94, log-rank test) survivals.ConclusionsLaparoscopy seems to represent a safe and effective treatment of endometrial cancer in women aged 80 years or older. Our data suggest that in elderly women, laparoscopic surgery improves perioperative outcomes compared with open and vaginal approaches without compromising long-term survival.

Cost comparison of laparoscopic partial nephrectomy and robot-assisted laparoscopic partial nephrectomy.

2011 ◽  
Vol 29 (7_suppl) ◽  
pp. 402-402
Author(s):  
R. L. O'Malley ◽  
T. Kowalik ◽  
M. H. Hayn ◽  
T. B. Collins ◽  
H. L. Kim ◽  
...  
Keyword(s):  
Minimally Invasive ◽  
Operating Room ◽  
Partial Nephrectomy ◽  
Laparoscopic Partial Nephrectomy ◽  
Cost Comparison ◽  
Oncologic Outcomes ◽  
Perioperative Outcomes ◽  
Surgical Approaches ◽  
Robot Assisted ◽  
Renal Masses

402 Background: Although nephron-sparing surgery is the standard of care for the treatment of small renal masses, partial nephrectomy (PN) remains under-utilized. A potential reason for the discrepancy is the desire for minimally invasive surgical approaches but limitation of the advanced laparoscopic techniques needed to perform PN. Robot-assisted surgery has eased the transition to minimally invasive prostate surgery and may also do so for PN, although some believe costs may be prohibitive. The purpose of this investigation was to quantify the cost of robot-assisted PN (RAPN) compared to laparoscopic PN (LPN). Methods: An institutional renal tumor database was used to identify consecutive patients with normal renal function who underwent RAPN for a localized renal mass by a single surgeon who had performed < 25 previously. The 35 RAPN patients were compared to the last 35 similar patients who underwent LPN by a surgeon who had performed > 150 previous LPNs. Surgical outcomes were compared. Because room time, length of stay and Cxs were similar, cost was compared based only on the total operating room charges (ORC). Total ORC included surgeon and anesthesia fees, as well as labor and supply costs. The depreciation of the robot was included in the ORC as a higher per unit time charge than for LPN. Data on charges were available for the first 29 RAPN patients which were then compared to the last 29 LPN patients. Results: Dates of operation ranged from October 2008 to July 2009 for LPN and January 2010 to August 2010 for RAPN. Patient and tumor characteristics were similar between groups, except tumor size, which was larger in the RAPN group (3.6 ± 1.8 cm vs. 2.7 ± 0.9 cm, p = 0.007). Cxs, surgical and oncologic outcomes were similar. Mean ORC (IQR) for the LPN group was $28,606 (4,796) and for the RAPN group was $30,874 (20,389) representing a difference of $2,269. If you subtract an additional $858 for the average yearly inflation rate (3%), the difference is $1,411. Conclusions: RAPN is a safe option with perioperative outcomes similar to those of LPN performed by an experienced surgeon. A cost difference of $2,269 per procedure as estimated using ORC may decrease as the experience of the operating room staff and surgeon increase. No significant financial relationships to disclose.

Propensity Score Adjusted Comparison of Minimally Invasive versus Open Thymectomy in the Management of Early Stage Thymoma

2017 ◽  
Vol 66 (04) ◽  
pp. 352-358 ◽  
Author(s):  
Ayotunde Fadayomi ◽  
Carlos Iniguez ◽  
Ritam Chowdhury ◽  
Antonio Coppolino ◽  
Francine Jacobson ◽  
...  
Keyword(s):  
Minimally Invasive ◽  
Surgical Approach ◽  
Early Stage ◽  
Smoking Status ◽  
Positive Margin ◽  
Patient Characteristics ◽  
Surgical Approaches ◽  
Rank Test ◽  
Multicenter Studies ◽  
Prolonged Length

Background The benefits of minimally invasive versus open thymectomy for the management of thymoma are debatable. Further, patient factors contributing to the selection of operative technique are not well elucidated. We aim to identify the association between baseline patient characteristics with choice of surgical approach. Methods Medical records of early stage thymoma (stages I and II) patients undergoing thymectomy between 2005 and 2015 at a single center were identified. Baseline characteristics and surgical outcomes such as prolonged length of stay (LOS ≥ 4 days), 90-day postoperative morbidity, completeness of resection, and recurrence or mortality free rates were compared by surgical approach. Results Fifty-three patients underwent thymectomy (34 open [64.15%] vs. 19 minimally invasive [35.85%]). There were no statistical differences between the two surgical approaches in demographic variables, smoking status, lung function, comorbidity, tumor size, or staging. Open thymectomy had significantly prolonged LOS (≥4 days) compared with minimally invasive procedures (odds ratio: 11.65; p < 0.01). There were no significant differences in postoperative composite morbidity (p = 0.56), positive margin (p = 0.40), tumor within 0.1 cm of resection margin (p = 0.38), and survival probability estimates (log rank test; p = 0.48) between the two groups. Conclusion Baseline patient characteristics were not associated with surgical approach selected for thymectomy. Minimally invasive thymectomy patients had shorter LOS but no significant differences in 90-day composite morbidity and recurrence or mortality. Larger multicenter studies are needed to evaluate factors contributing to patient selection for each approach, which may include surgeon preference.

P131 REVEALING THE ERGONOMIC CRISIS OF AN UPPER GASTROINTESTINAL ROBOTIC SURGEON – STILL A LOT TO IMPROVE IN MINIMALLY INVASIVE SURGERY

2019 ◽  
Vol 32 (Supplement_2) ◽  
Author(s):  
H Fuchs ◽  
F Ahn ◽  
J Leers ◽  
W Schröder ◽  
C Höfler ◽  
...  
Keyword(s):  
Minimally Invasive ◽  
New Technology ◽  
Intraoperative Complications ◽  
Gastrointestinal Surgery ◽  
Robotic System ◽  
Perioperative Outcomes ◽  
Robotic Technology ◽  
Center Of Excellence ◽  
Touch Sensor ◽  
Upper Gastrointestinal

Abstract Introduction/Aim Minimally invasive technologies have improved outcomes after esophagectomy and the use of robotic technology in Europe is rapidly increasing. Even though robotic technology was primarily developed to improve perioperative outcomes, many robotic surgeons complain about ergonomics when using existing devices. Aim of this study is to evaluate the ergonomics of the newest robotic technology in a center of excellence for upper gastrointestinal surgery. Background and Methods Starting 02/2017 the latest available robotic system (davinci xi) was introduced at our academic center (certified center of excellence for surgery of the upper gastrointestinal tract, n>300 esophageal cases/year). Surgeons ergonomics were studied using a standardized video capture and touch sensor protocol (Fig 1 & 2). Data recorded were analyzed to study whether the new robotic system was used in an ergonomic fashion throughout robotic esophageal surgery. Results From 02/2017 – 05/2019, a total of 90 mainly upper gastrointestinal robotic cases including 45 Esophagectomies for cancer and 25 Heller Myotomies were performed. All cases were performed safely without operation-associated intraoperative complications. Even though experienced robotic console surgeons used the robotic device, the davinci xi arm rest was used in less than 25% of surgery time (Fig. 3), resulting in loss of efficacy when using the robotic range of motion. Video documentation using the new technology is provided to showcase the dilemma. Conclusion Robotic technology allows for safe minimally invasive upper gastrointestinal surgery. Further development in robotics should focus on improvement of surgeons ergonomics.

scholarly journals Completeness of the operating room to intensive care unit handover: a matter of time?

2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Fabian Dusse ◽  
Johanna Pütz ◽  
Andreas Böhmer ◽  
Mark Schieren ◽  
Robin Joppich ◽  
...  
Keyword(s):  
Intensive Care Unit ◽  
Intensive Care ◽  
Information Transfer ◽  
Time Pressure ◽  
Intraoperative Complications ◽  
Patient Characteristics ◽  
Information Loss ◽  
Ensure Patient Safety ◽  
Underlying Diseases

Abstract Background Handovers of post-anesthesia patients to the intensive care unit (ICU) are often unstructured and performed under time pressure. Hence, they bear a high risk of poor communication, loss of information and potential patient harm. The aim of this study was to investigate the completeness of information transfer and the quantity of information loss during post anesthesia handovers of critical care patients. Methods Using a self-developed checklist, including 55 peri-operative items, patient handovers from the operation room or post anesthesia care unit to the ICU staff were observed and documented in real time. Observations were analyzed for the amount of correct and completely transferred patient data in relation to the written documentation within the anesthesia record and the patient’s chart. Results During a ten-week study period, 97 handovers were included. The mean duration of a handover was 146 seconds, interruptions occurred in 34% of all cases. While some items were transferred frequently (basic patient characteristics [72%], surgical procedure [83%], intraoperative complications [93.8%]) others were commonly missed (underlying diseases [23%], long-term medication [6%]). The completeness of information transfer is associated with the handover’s duration [B coefficient (95% CI): 0.118 (0.084-0.152), p<0.001] and increases significantly in handovers exceeding a duration of 2 minutes (24% ± 11.7 vs. 40% ± 18.04, p<0.001). Conclusions Handover completeness is affected by time pressure, interruptions, and inappropriate surroundings, which increase the risk of information loss. To improve completeness and ensure patient safety, an adequate time span for handover, and the implementation of communication tools are required.

Robotic Pneumonectomy for Lung Cancer: Perioperative Outcomes and Factors Leading to Conversion to Thoracotomy

2021 ◽  
pp. 155698452097822
Author(s):  
Byron D. Patton ◽  
Daniel Zarif ◽  
Donna M. Bahroloomi ◽  
Iam C. Sarmiento ◽  
Paul C. Lee ◽  
...  
Keyword(s):  
Lung Cancer ◽  
Statistical Significance ◽  
Patient Characteristics ◽  
Perioperative Outcomes ◽  
Safe Procedure ◽  
Open Approach ◽  
Robotic Approach ◽  
Robotic Group ◽  
Robot Assisted ◽  
Estimated Blood Loss

Objective In the tide of robot-assisted minimally invasive surgery, few cases of robot-assisted pneumonectomy exist in the literature. This study evaluates the perioperative outcomes and risk factors for conversion to thoracotomy with an initial robotic approach to pneumonectomy for lung cancer. Methods This study is a single-center retrospective review of all pneumonectomies for lung cancer with an initial robotic approach between 2015 and 2019. Patients were divided into 2 groups: surgeries completed robotically and surgeries converted to thoracotomy. Patient demographics, preoperative clinical data, surgical pathology, and perioperative outcomes were compared for meaningful differences between the groups. Results Thirteen total patients underwent robotic pneumonectomy with 8 of them completed robotically and 5 converted to thoracotomy. There were no significant differences in patient characteristics between the groups. The Robotic group had a shorter operative time ( P < 0.01) and less estimated blood loss ( P = 0.02). There were more lymph nodes harvested in the Robotic group ( P = 0.08) but without statistical significance. There were 2 major complications in the Robotic group and none in the Conversion group. Neither tumor size nor stage were predictive of conversion to thoracotomy. Conversions decreased over time with a majority occurring in the first 2 years. There were no conversions for bleeding and no mortalities. Conclusions Robotic pneumonectomy for lung cancer is a safe procedure and a reasonable alternative to thoracotomy. With meticulous technique, major bleeding can be avoided and most procedures can be completed robotically. Larger studies are needed to elucidate any advantages of a robotic versus open approach.

scholarly journals The Investigation and Management of Adenomyosis in Women Who Wish to Improve or Preserve Fertility

2018 ◽  
Vol 2018 ◽  
pp. 1-12 ◽  
Author(s):  
Jin-Jiao Li ◽  
Jacqueline P. W. Chung ◽  
Sha Wang ◽  
Tin-Chiu Li ◽  
Hua Duan
Keyword(s):  
Surgical Treatment ◽  
Minimally Invasive ◽  
Treatment Options ◽  
Management Strategies ◽  
Definitive Treatment ◽  
Surgical Approaches ◽  
Child Bearing ◽  
Fertility Sparing

The management of adenomyosis remains a great challenge to practicing gynaecologists. Until recently, hysterectomy has been the only definitive treatment in women who have completed child bearing. A number of nonsurgical and minimally invasive, fertility-sparing surgical treatment options have recently been developed. This review focuses on three aspects of management, namely, (1) newly introduced nonsurgical treatments; (2) management strategies of reproductive failures associated with adenomyosis; and (3) surgical approaches to the management of cystic adenomyoma.

Sign in / Sign up

Export Citation Format

Share Document