Extra-peritoneal Laparoscopic Resection of Benign Prostate Adenoma >150 CC with preservation of posterior wall of prostatic urethra: Dundee Technique and early outcomes

2021 ◽  
pp. 003693302110681
Author(s):  
Hollie A Clements ◽  
Ghulam Nabi
Keyword(s):  
Intraoperative Complications ◽  
Case Series ◽  
Posterior Wall ◽  
Prostatic Urethra ◽  
Laparoscopic Technique ◽  
Management Options ◽  
Residual Symptoms ◽  
Peritoneal Space ◽  
Prostate Adenoma

Background There are limited options for men with large benign prostates (>150cc) and bladder outflow obstruction due to benign prostatic hyperplasia (BPH). Management options include surgery (open or minimal access) and endoscopic procedures. There is a paucity of literature on outcomes for prostates >150cc. Methods In this case series we describe a step-by-step, illustrated, modified extra-peritoneal technique of laparoscopic prostatectomy with preservation of the posterior prostatic urethra. This involves creation of extra-peritoneal space, transverse incision of prostate capsule, progressive adenoma dissection, resection, and closure of the capsule. Results Ten patients underwent this procedure between 2015 and 2019. The mean age was 72.4 years and mean prostate size was 215.5cc. Mean procedure duration was 200 min and there were no intraoperative complications. Most patients were discharged on postoperative day 1. Mean intraoperative blood loss was 120 ml with no patient requiring blood transfusion. At follow up (mean 37 months) no patients had residual symptoms of BPH. Conclusion We describe a novel extraperitoneal laparoscopic technique for benign prostates of >150cc with very good outcomes. The transferability of this technique to centres with laparoscopic expertise at minimal extra cost and future adaptability in the robotic setting are some of the advantages of this technique.

scholarly journals Intracranial hemorrhage from dural arteriovenous fistulas: clinical features and outcome

2013 ◽  
Vol 34 (5) ◽  
pp. E15 ◽  
Author(s):  
David J. Daniels ◽  
Ananth K. Vellimana ◽  
Gregory J. Zipfel ◽  
Giuseppe Lanzino
Keyword(s):  
Clinical Features ◽  
Intracranial Hemorrhage ◽  
Case Series ◽  
Venous Drainage ◽  
Sudden Onset ◽  
Residual Symptoms ◽  
Arteriovenous Fistulas ◽  
Common Location ◽  
Dural Arteriovenous Fistulas

Object In this paper the authors' goal was to review the clinical features and outcome of patients with intracranial dural arteriovenous fistulas (DAVFs) who presented with hemorrhage. Methods A retrospective study of 28 patients with DAVFs who presented with intracranial hemorrhage to 2 separate institutions was performed. The information reviewed included clinical presentation, location and size of hemorrhage, angiographic features, treatment, and clinical and radiologically documented outcomes. Clinical and radiological follow-up were available in 27 of 28 patients (mean follow-up 17 months). Results The vast majority of patients were male (86%), and the most common presenting symptom was sudden-onset headache. All DAVFs had cortical venous drainage, and about one-third were associated with a venous varix. The most common location was tentorial (75%). Treatment ranged from endovascular (71%), surgical (43%), Gamma Knife surgery (4%), or a combination of modalities. The majority of fistulas (75%) were completely obliterated, and most patients experienced excellent clinical outcome (71%, modified Rankin Scale score of 0 or 1). There were no complications in this series. Conclusions Case series, including the current one, suggest that the vast majority of patients who present with intracranial hemorrhage from a DAVF are male. The most common location for DAVFs presenting with hemorrhage is tentorial. Excellent outcomes are achieved with individualized treatment, which includes various therapeutic strategies alone or in combination. Despite the hemorrhagic presentation, almost two-thirds of patients experience a full recovery with no or minimal residual symptoms.

Endoscopic cystoventriculostomy for treatment of paraxial arachnoid cysts

2009 ◽  
Vol 110 (4) ◽  
pp. 792-799 ◽  
Author(s):  
Joachim M. K. Oertel ◽  
Jörg Baldauf ◽  
Henry W. S. Schroeder ◽  
Michael R. Gaab
Keyword(s):  
Fourth Ventricle ◽  
Case Series ◽  
Arachnoid Cysts ◽  
Surgical Time ◽  
Cyst Size ◽  
Residual Symptoms ◽  
Surgical Case ◽  
Initial Procedure ◽  
The Mean

Object The optimal therapy of arachnoid cysts is controversial. In symptomatic extraventricular arachnoid cysts, fenestration into the basal cisterns is the gold standard. If this is not feasible, shunt placement is frequently performed although another endoscopic option is available. Methods Between March 1997 and June 2006, 12 endoscopic cystoventriculostomies were performed for the treatment of arachnoid cysts in 11 patients (4 male and 7 female patients, mean age 52 years [range 14–71 years]). All patients were prospectively followed up. Results In 11 cases, the arachnoid cysts were frontotemporoparietal and fenestration was performed into the lateral ventricle. In 1 case, the arachnoid cyst was located in the cerebellum and the cyst was fenestrated into the fourth ventricle. Neuronavigational guidance was used in all but 1 case. Endoscopic cystoventriculostomy was performed in all cases without complications. No stents were placed. The mean surgical time was 71 minutes (range 30–110 minutes). The mean follow-up period was 42.7 months (range 19–96 months) per surgical case and 48.8 months (range 19–127 months) per patient. Symptoms improved after 11 of the 12 procedures; 7 of the 11 patients became symptom-free and the others had only mild residual symptoms. The patient who did not experience clinical improvement suffered from depression and demonstrated a significant decrease of the cyst size on the postoperative MR imaging. After 11 of 12 procedures, a decrease in cyst size was observed. In 1 case, a subdural hematoma developed; it required surgical treatment 3 months after surgery. In another case, reclosure of the stoma required repeated endoscopic cystoventriculostomy more than 7 years after the initial procedure. Conclusions Overall, endoscopic cystoventriculostomy represents a useful treatment option for patients with paraxial arachnoid cysts in whom a standard cystocisternotomy is not feasible. Based on the results in this case series, stent placement appears not to be required. Despite the long mean follow-up of almost 4 years, however, a longer follow-up period seems to be required before definite conclusions can be drawn.

scholarly journals Tactile Electrosurgical Ablation: A Technique for the Treatment of Intractable Heavy and Prolonged Menstrual Bleeding

2015 ◽  
Vol 2015 ◽  
pp. 1-4
Author(s):  
Ali M. El Saman ◽  
Faten F. AbdelHafez ◽  
Kamal M. Zahran ◽  
Hazem Saad ◽  
Mohamed Khalaf ◽  
...  
Keyword(s):  
Operative Time ◽  
Intraoperative Complications ◽  
Case Series ◽  
Abnormal Uterine Bleeding ◽  
Uterine Bleeding ◽  
Menstrual Bleeding ◽  
Efficacy And Safety ◽  
Beneficial Effects

Objective. To study the efficacy and safety of tactile electrosurgical ablation (TEA) in stopping a persistent attack of abnormal uterine bleeding not responding to medical and hormonal therapy.Methods. This is a case series of 19 cases with intractable abnormal uterine bleeding, who underwent TEA at the Women’s Health Center of Assiut University. The outcomes measured were; patient’s acceptability, operative time, complications, menstrual outcomes, and reintervention.Results. None of the 19 counseled cases refused the TEA procedure which took 6–10 minutes without intraoperative complications. The procedure was successful in the immediate cessation of bleeding in 18 out of 19 cases. During the 24-month follow-up period, 9 cases developed amenorrhea, 5 had scanty menstrual bleeding, 3 were regularly menstruating, 1 case underwent repeat TEA ablation, and one underwent a hysterectomy.Conclusions. TEA represents a safe, inexpensive, and successful method for management of uterine bleeding emergencies with additional long-term beneficial effects. However, more studies with more cases and longer follow-up periods are warranted.

scholarly journals Accuracy and clinical safety of guided root end resection with a trephine: a case series

2019 ◽  
Vol 15 (1) ◽  
Author(s):  
Márk Antal ◽  
Eszter Nagy ◽  
Gábor Braunitzer ◽  
Márk Fráter ◽  
József Piffkó
Keyword(s):  
Exploratory Study ◽  
Surgical Intervention ◽  
Intraoperative Complications ◽  
Case Series ◽  
Angular Deviation ◽  
Clinical Safety ◽  
Characteristic Finding ◽  
The Mean ◽  
End Resection

Abstract Background Root-end resection is an endodontic surgical intervention that requires high precision so that all ramifications and lateral canals so as infected tissues are eliminated. An exploratory study was conducted to justify the clinical safety and accuracy of guided root-end resection with a trephine. Methods Fourteen root-end resections were performed in 11 patients. With the aid of computer tomography and rapid prototyping a stereolithographically fabricated, tooth-supported surgical template was used to guide trephinations. Surgery was performed using the printed surgical stent and a trephine was used not only for the osteotomy but for the root end resection as well. Results The root end was successfully and completely resected by the trephine in all cases. No intraoperative complications were observed in any of the cases, and the patients were free of symptoms indicating recurrence or complications at the 6-month follow-up. The median angular deviation of the trephination was 3.95° (95% CI: 2.1–5.9), comparable to the angular deviation of guided implant surgery. The mean apex removal error (ARE) was 0.19 mm (95% CI: 0.03–0.07). The mean osteotomy depth error (ODE) was 0.37 mm (95% CI: 0.15–1.35). Overpenetration was a characteristic finding, which indicates the necessity of a stop-trephine. Conclusions Within the limitations of this study, we conclude that our results support the use of guided trephination for root-end resection.

scholarly journals Cervical vertebroplasty for osteolytic metastases as a minimally invasive therapeutic option in oncological surgery: outcome in 14 cases

2017 ◽  
Vol 43 (2) ◽  
pp. E3 ◽  
Author(s):  
Martin Stangenberg ◽  
Lennart Viezens ◽  
Sven O. Eicker ◽  
Malte Mohme ◽  
Klaus C. Mende ◽  
...  
Keyword(s):  
Cervical Spine ◽  
Minimally Invasive ◽  
Neck Pain ◽  
Vertebral Body ◽  
Spinal Metastases ◽  
Case Series ◽  
Posterior Wall ◽  
Oncological Surgery ◽  
Osteolytic Metastases

OBJECTIVEThe treatment of cervical spinal metastases represents a controversial issue regarding the type, extent, and invasiveness of interventions. In the lumbar and thoracic spine, kypho- and vertebroplasties have been established as minimally invasive procedures for patients with metastases to the vertebral bodies and without neurological deficit. These procedures show good results with respect to pain reduction and low complication rates. However, limited data are available for kypho- and vertebroplasties for cervical spinal metastases. In an effort to add to existing data, the authors here present a case series of 14 patients who were treated for osteolytic metastases of the cervical spine using vertebroplasty alone or in addition to another surgical procedure involving the cervical spine in a palliative setting to reduce pain and restore stability.METHODSFourteen patients consisting of 8 males and 6 females, with a mean age of 64.7 years (range 44–85 years), were treated with vertebroplasty at the authors’ clinic between January 2015 and November 2016. In total, 25 vertebrae were treated with vertebroplasty: 10 C-2, 5 C-3, 2 C-4, 2 C-5, 3 C-6, and 3 C-7. Two patients had an additional posterior stabilization and 5 patients an additional anterior stabilization. In 13 cases, the surgical approach was a modified Smith-Robinson approach; in 1 case, the cement was injected into the corpus axis from posteriorly. Patients with osteolytic defects of the posterior wall of the vertebral body did not undergo surgery, nor did patients with neurological deficits. Preoperatively, on the 2nd day after surgery, and at the follow-up, neck pain was rated using the visual analog scale (VAS).RESULTSTwelve patients were examined at follow-up (mean 9 months). Neck pain was rated as a mean of 6.0 (range 3–8) preoperatively, 2.9 on Day 2 after surgery (range 0–5), and 0.5 at the follow-up (range 0–4), according to the VAS. The mean Neck Disability Index at follow-up was 3.6% (range 0%–18%).CONCLUSIONSAnterior vertebroplasty of the cervical spine via an anterolateral approach represents a safe and minimally invasive procedure with a low complication rate and appears suitable for reducing pain and restoring stability in cases of cervical spinal metastases. Vertebroplasties can be combined with other anterior and posterior operations of the cervical spine and, in the axis vertebra, can be performed transpedicularly from posteriorly. Thus, in cases in which the posterior wall of the vertebral body is intact, vertebroplasty represents a less invasive alternative to vertebral replacement in oncological surgery. Prospective randomized trials with a longer follow-up period and a larger patient cohort are needed to confirm the encouraging results of this case series.

scholarly journals Trans-urethral bladder suture in female patients: Not a tour de force but a quick and realistic answer to complex situations

2021 ◽  
pp. 039156032110011
Author(s):  
Fanourios Georgiades ◽  
Chryssanthos Kouriefs ◽  
Jonathan Makanjuola ◽  
Philippe Grange
Keyword(s):  
Operative Time ◽  
Intraoperative Complications ◽  
Laser Lithotripsy ◽  
Defect Closure ◽  
Management Options ◽  
Mattress Suture ◽  
Needle Holder ◽  
Effective Option ◽  
Average Operative Time

Introduction: Trans-urethral bladder surgery has gained popularity in the fields of electro-resection and laser lithotripsy, with endoscopic suturing being overlooked. Bladder defect closure using a pure trans-urethral suturing technique can provide a quick and effective solution in situations where conventional management options are not feasible. Methods: Here we describe this innovative novel technique developed by our group that was used to treat two different cases with bladder perforation at two different institutions. We used a 5 mm laparoscopic port with gas insufflation and a laparoscopic needle holder trans-urethrally to achieve defect closure with a monofilament 2/0 monocryl mattress suture on a small 22 mm needle. Results: The defects were successfully closed without any intraoperative complications. Average operative time for the technique was 18 min with minimal blood loss. Bladder closure was sustained at a median follow-up of 2 years for one of these cases. Conclusions: We claim that transurethral bladder suturing is quick, safe in expert hands and provides an effective option where the clinical condition/situation of the patient warrants a minimally invasive surgery approach.

scholarly journals Early Outcomes and Complications Following Initiation of a Total Ankle Arthroplasty Program

2021 ◽  
Vol 6 (1) ◽  
pp. 247301142098578
Author(s):  
Gregory Lundeen ◽  
Kaitlin C. Neary ◽  
Cody Kaiser ◽  
Lyle Jackson
Keyword(s):  
Intraoperative Complications ◽  
Case Series ◽  
Total Ankle Arthroplasty ◽  
Radiographic Evaluation ◽  
Wound Complications ◽  
Consecutive Series ◽  
Complication Rates ◽  
Ankle Arthroplasty ◽  
Intermediate Outcomes

Background: Surgeons who lack experience with total ankle arthroplasty (TAA) may remain hesitant to introduce this procedure owing to previously published results of high complication rates during initial cases. The purpose of the present study was to report the development of a TAA program through intermediate outcomes and complications for an initial consecutive series of TAA patients of a single community-based foot and ankle fellowship–trained orthopedic surgeon with little TAA experience using a co-surgeon with similar training and TAA exposure. Methods: The initial 20 patients following third-generation TAA with a single surgeon were reviewed. Clinical outcomes were measured and radiographs were evaluated to determine postoperative implant and ankle position. Complications were also measured including intraoperative, early (<3 months), and intermediate postoperative complications. Results: With a minimum follow-up of 2 years and average follow-up of 51 months (range 24-70 months), the mean American Orthopaedic Ankle & Foot Society Ankle-Hindfoot score was 87.7 (59-100) and VAS was 1.0 (0-5.5). All patients were improved following TAA. Radiographic evaluation demonstrated no evidence of component malalignment or ankle joint incongruity. There were no intraoperative complications nor any wound complications. Three patients returned to the operating room for placement of medial malleolar screw placement, and 1 had asymptomatic tibial component subsidence. Conclusions: Orthopedic surgeons with a proper background and updated training may be able to perform TAA with good outcomes. A TAA program was developed to define minimum training criteria to perform this procedure in our community. Our complication rate is consistent with those reported in the literature for experienced TAA centers, which contrasts previous literature suggesting increased complication rates and worse outcomes when surgeons perform initial TAAs. Utilization of an orthopedic co-surgeon was felt to be instrumental in the success of the program. Level of Evidence: Level IV, retrospective case series.

scholarly journals Modified everting sutures combined with reattachment to the inferior tarsal plate for involutional lower eyelid entropion: A new technique

2020 ◽  
Vol 47 (4) ◽  
pp. 347-353
Author(s):  
Emine Malkoc Sen ◽  
Kubra Ozdemir Yalcinsoy
Keyword(s):  
Recurrence Rate ◽  
Intraoperative Complications ◽  
Case Series ◽  
Lower Eyelid ◽  
New Technique ◽  
Before And After ◽  
A New Technique ◽  
The Right ◽  
Horizontal Eyelid Laxity

Background This study evaluated the outcomes of a new modified Wies technique for patients with involutional lower eyelid entropion without horizontal eyelid laxity.Methods This case series retrospectively analyzed consecutive patients with entropion who underwent surgery between January 2014 and March 2019 by the same experienced surgeon. Horizontal eyelid laxity, lower eyelid retractor function, and orbicularis muscle overriding were recorded before and after surgery. The recurrence rate and complications were also evaluated. This technique consisted of modified everting sutures combined with reattachment of the lower eyelid retractors to the inferior tarsal plate.Results This new technique was performed on 28 eyes in 25 patients (mean age, 71.0±8.0 years; range, 56–87 years). Nine patients (36%) were women and 16 (64%) were men. Lower lid entropion was present in the right eye in 14 patients (56%), the left eye in eight patients (32%), and both eyes in three patients (12%). The mean follow-up period was 27.3±12.4 months (range, 6–60 months). No intraoperative complications were observed. All patients’ symptoms were alleviated. One patient (3.6%) had recurrence after 2 years (success rate, 96.4%). The remaining 27 eyes maintained a satisfactory and comfortable eyelid position. No patients had problems with scarring.Conclusions The approach described herein proved to be safe and feasible in eyes with involutional lower eyelid entropion without horizontal eyelid laxity. These advantages of this procedure include the lack of a conjunctival scar, punctal eversion, and lateral canthal angle deformation. A low recurrence rate and a long interval to recurrence were also observed.

Periocular intravascular papillary endothelial hyperplasia: A retrospective study

2021 ◽  
pp. 112067212110481
Author(s):  
Azza MY Maktabi ◽  
Abdullah I Almater ◽  
Hind M Alkatan
Keyword(s):  
Thrombus Formation ◽  
Case Series ◽  
Excisional Biopsy ◽  
Vascular Lesions ◽  
Intravascular Papillary Endothelial Hyperplasia ◽  
Retrospective Case ◽  
Management Options ◽  
Papillary Endothelial Hyperplasia ◽  
Age Range

Introduction: Intravascular papillary endothelial hyperplasia (IPEH) is a rare proliferation of endothelial cells with uncertain etiology related to thrombus formation. Diagnosis is usually confirmed histopathologically. This condition has been previously described in the periocular region but not in the conjunctiva. Methods: It is a retrospective case series in which we evaluated seven patients with histopathologically confirmed IPEH cases. Data regarding the demographics, clinical presentation, radiological description, histopathological features including any IHC staining, suspected underlying vascular etiology, management options, and follow up outcome were collected. Results: A total of seven cases of histologically confirmed IPEH were included. Five out of seven patients were male (71.4%). The age range was between 6 and 69 years with a median age of 36 years. Three cases involved the eyelid (42.8%) and another three were found in the conjunctiva (42.8%). Pre-existing underlying vascular lesions were observed in all patients, five malformations (mostly lymphatic-venous) and two conjunctival hemorrhagic lymphangiectasis. All cases were treated with excisional biopsy with no signs of recurrence within an average of 7 months follow up. Conclusions: Periocular IPEH is a rare tumor that is likely to coexist with underlying vascular lesions and thrombus formation. We are reporting its existence in the conjunctiva for the first time. Therefore, pathologists should be aware of the histopathological spectrum of this lesion.

scholarly journals Amniotic Membrane Graft in the Management of Complex Vaginal Mesh Erosion

2020 ◽  
Vol 9 (2) ◽  
pp. 356
Author(s):  
Hui-Hsuan Lau ◽  
Quan-Bin Jou ◽  
Wen-Chu Huang ◽  
Tsung-Hsien Su
Keyword(s):  
Amniotic Membrane ◽  
Intraoperative Complications ◽  
Mesh Erosion ◽  
Surgical Revision ◽  
Vaginal Mesh ◽  
Management Options ◽  
Mesh Surgery ◽  
Amniotic Graft ◽  
Vaginal Erosions

Vaginal mesh erosion is a devastating complication after pelvic floor mesh surgery and it can be treated conservatively or with surgical revision. However, the management options following a failed primary revision or complex vaginal erosions are very limited. The aim of this study is to describe a novel treatment using an amniotic membrane as an inlay graft for such patients. Eight patients who failed conservative or primary surgical revision were enrolled. The complex erosions included vaginal agglutination, multiple vaginal erosions, recurrent erosions, and mesh cutting through the urethra. We used an amniotic membrane as a graft to cover the vaginal defect after partial excision of the mesh erosion and we describe the technique in this study. There were no intraoperative complications and none of the patients reported any further symptoms at a mean of 27 months follow-up. Only one patient had recurrent erosion, however, the erosion size was narrower and was subsequently successfully repaired. No further vaginal mesh erosions were noted in the other patients who all had good functional recovery. The use of an amniotic graft can be an economic and alternative method in the management of complex vaginal mesh erosions.

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