Surgical approaches in juxtarenal and pararenal aortic aneurysms repair

2021 ◽  
pp. 021849232199738
Author(s):  
Eduard R Charchyan ◽  
Anna B Stepanenko ◽  
Andrey P Gens ◽  
Nail A Galeev ◽  
Yuri V Belov
Keyword(s):  
Operative Time ◽  
Surgical Intervention ◽  
Pain Syndrome ◽  
Reliable Data ◽  
Aortic Aneurysms ◽  
Retroperitoneal Approach ◽  
Surgical Approaches ◽  
Midline Laparotomy ◽  
Advantages And Disadvantages ◽  
Case Basis

Background In this study, surgical tactic features and juxtarenal and pararenal treatment immediate results were analyzed depending on the use of various surgical approaches. Methods Between 2015 and 2019, a total of 89 patients received surgical treatment, of which 52(58%) had juxtarenal aneurysms and 37 (42%) – pararenal aneurysms. During repairs, three types of surgical approaches were used: midline laparotomy, extended retroperitoneal approach and thoraco-phreno-retroperitoneal approach. The patients were divided into three groups accordingly. Results At the immediate postoperative period, mortality rate equaled 2 (2.2%). The reasons were pulmonary embolism and sepsis. Statistically reliable data were obtained, confirming the advantages of midline laparotomic approach over the lateral retroperitoneal ones, which consisted in a shorter operative time, less pronounced pain syndrome, lesser blood loss, fewer postoperative days. The disadvantages were that enteroparesis occurred more often when the midline laparotomy was used in comparison to extended retroperitoneal or thoraco-phrenoretroperitoneal approaches. Conclusion Thus, open repairs of juxtarenal and pararenal aortic aneurysms have some specific technical and strategical features which are associated with intraoperative renal ischemia. During open surgical intervention, it is important to first consider the possibility of repair with midline laparotomy. However, lateral retroperitoneal approaches can also be used on a case-by-case basis noting their advantages and disadvantages.

scholarly journals The choice of surgical treatment of inguinal hernia (literature review)

2019 ◽  
Vol 12 (4) ◽  
pp. 274-281 ◽  
Author(s):  
Yury Viktorovich Ivanov ◽  
Aleksandr Sergeevich Avdeev ◽  
Dmitry Nikolaevich Panchenkov ◽  
Alexander Vyacheslavovich Smirnov ◽  
Dmitry Vasilevich Porkhunov ◽  
...  
Keyword(s):  
Pain Syndrome ◽  
Long Term Results ◽  
Surgical Approaches ◽  
Inguinal Hernioplasty ◽  
Advantages And Disadvantages ◽  
Surgical Access ◽  
Surgical Methods ◽  
Total Extraperitoneal ◽  
Single Standard ◽  
Mesh Implant

Inguinal hernioplasty is one of the most common surgical procedures, but the long-term results of operations leave much to be desired: there are recurrences of hernias, chronic pain syndrome, violation of testicular function in men. A modern review of the literature on the most common surgical methods of treatment of inguinal hernias is presented. Separately, describes the methods of hernioplasty with using local tissue (autodermaplasty) and with the use of mesh implants (allohernioplasty). Material allohernioplasty set out on the basis of their surgical approaches are used: traditional (open) and laparoscopic. Special attention is paid to the necessary properties of the mesh implant, the choice of the method of its fixation. The advantages and disadvantages of the most common methods of hernioplasty are listed. Currently, there is no single standard for inguinal hernioplasty. The choice of the method is based on the experience of the surgeon, technical capabilities and desires of the patient. The most commonly used methods for autoplasty are Desarda and Shouldies, and among allogernioplasty - Liechtenstein technique (traditional surgical access) and laparoscopic methods (transabdominal preperitoneal hernioplasty, total extraperitoneal hernioplasty).

scholarly journals Ensuring the effectiveness and safety of peripheral blockades

2021 ◽  
Vol 6 (6-1) ◽  
pp. 105-112
Author(s):  
I. G. Oleshchenko ◽  
D. V. Zabolotsky ◽  
V. A. Koriachkin ◽  
V. V. Pogorelchuk
Keyword(s):  
Surgical Intervention ◽  
Muscle Relaxation ◽  
Complex Structure ◽  
Pain Syndrome ◽  
Perioperative Period ◽  
Anatomical Structures ◽  
Advantages And Disadvantages ◽  
Pterygopalatine Ganglion ◽  
Therapy Of Pain ◽  
Transmission Stage

Adequate analgesia determines the success of the performed surgical intervention. In modern surgery, most of postoperative complications are directly related to ineffective therapy of pain syndrome in the perioperative period. The main principle of modern analgesia is its multicomponence, when analgesia, neurovegetative blockade and relaxation are achieved and potentiated by different drugs and methods. The blockade of nociceptive impulses with a local anesthetic at the transmission stage provides effective, targeted analgesia, hyporefl exia and muscle relaxation, prevents the sensitization of neuroaxial structures, hyperalgesia and the development of postoperative chronic pain syndrome. At the same time, providing analgesia with drugs of central action leads to the ineffectiveness of therapy in 80 % of cases, which has serious consequences.The aim. According to the literature review, to evaluate the effectiveness and safety of peripheral blockades on the example of performing a blockade of the pterygopalatine ganglion.Conclusion. The pterygopalatine blockade has broad indications for use in ophthalmology, which is explained by the complex structure of the pterygopalatine ganglion and the possibility of simultaneous infl uence on sympathetic, parasympathetic and nociceptive innervation. All the presented methods of pterygopalatine blockade performance have their advantages and disadvantages. Ultrasound navigation eliminates technical difficulties and the possibility of damage of the pterygopalatine fossa anatomical structures, ensuring the effectiveness and safety of the pterygopalatine blockade.

Transoral versus Extraoral Reduction of Mandible Fractures: A Comparison of Complication Rates and other Factors

2003 ◽  
Vol 128 (2) ◽  
pp. 215-219 ◽  
Author(s):  
Vincent S. Toma ◽  
Robert H. Mathog ◽  
Roger S. Toma ◽  
Robert J. Meleca
Keyword(s):  
Open Reduction ◽  
Operative Time ◽  
Surgical Approaches ◽  
Mandibular Fractures ◽  
Complication Rates ◽  
Body Angle ◽  
Advantages And Disadvantages ◽  
Surgeon Experience ◽  
Mandibular Body ◽  
Mandible Fractures

OBJECTIVE: This retrospective study evaluates results and complications of the transoral and extraoral approaches for open reduction and internal fixation of mandibular body, angle, and ramus fractures. Our aim was to describe advantages and disadvantages of the techniques and to develop criteria for choosing between surgical approaches. STUDY DESIGN AND SETTING: A retrospective chart review was performed on patients with mandible fractures occurring between August 1999 and October 2001 at a level I trauma center. Only mandibular body, angle, and ramus fractures requiring open reduction were selected for this study. Cases were evaluated for cause, age, gender, dentition, site and extent of fractures, surgical approach, postoperative complications, operative time, and postoperative occlusion. RESULTS: Of the 227 patients with mandibular fractures, 78 had body, angle, or ramus fractures requiring open reduction. Of these, 36 were treated extraorally, and 42 were treated transorally. Criteria for selecting one procedure over another often involved training and surgeon experience and those factors normally considered important in defining the difficulty of treatment and prognosis of the patient. Seven of the 42 patients were converted from a transoral to an extraoral approach because of inadequate exposure. Similar complication rates occurred for the transoral and extraoral approaches, but because of the time required for converting from the transoral to extraoral approach, the average operative time was found to be increased in patients undergoing the transoral approach. CONCLUSION AND SIGNIFICANCE: Decisions regarding treatment approaches for open reduction of mandible fractures often relate to surgeon experience and training, modified by factors that can affect uncomplicated healing such as fracture locations and displacement, comminution of the fracture, infection, dentition, and atrophic changes of the mandible. In some cases, the choice is affected by availability of equipment and experience of operating room personnel. More difficult cases involving an edentulous, atrophic mandible or comminution should be considered for extraoral exposure.

scholarly journals SURGERY OF THORACIC DISC HERNIATION: A SYSTEMATIC REVIEW OF ENGLISH-LANGUAGE LITERATURE

2019 ◽  
Vol 16 (1) ◽  
pp. 70-80 ◽  
Author(s):  
A. E. Simonovich
Keyword(s):  
Disc Herniation ◽  
English Language ◽  
Pain Syndrome ◽  
Surgical Approaches ◽  
Scientific Publications ◽  
Optimal Method ◽  
Good Opportunity ◽  
Advantages And Disadvantages ◽  
Reliable Assessment ◽  
Thoracic Disc

The presented review of scientific publications from the Medline (PubMed) and Scopus databases considers modern surgical approaches used to remove intervertebral hernias in the thoracic spine. The advantages and disadvantages of anterior and posterior approaches are analyzed. It has been revealed that the anterior approaches, providing a good opportunity to remove a hernia, are associated with the risk of serious complications, including pulmonary ones, and often lead to the formation of a post-thoracotomy pain syndrome. Mini-thoracotomy and percutaneous thoracoscopy, although less invasive, do not exclude the development of complications inherent in conventional thoracotomy. Modern posterior approaches are less traumatic and allow, with minimal contact with the spinal cord, to successfully remove not only soft tissue, but also ossified disc herniation. The choice of the optimal method of discectomy remains an unsolved problem and depends on practical skills, experience and preferences of the surgeon. For an objective and reliable assessment of the efficiency of surgical technologies and the determination of optimal indications for each of them, a prospective multicenter study is necessary.

scholarly journals Extracervical Approaches to Thyroid Surgery: Evolution and Review

2019 ◽  
Vol 2019 ◽  
pp. 1-14 ◽  
Author(s):  
B. M. Sephton
Keyword(s):  
Patient Satisfaction ◽  
Thyroid Surgery ◽  
Operative Time ◽  
Financial Burden ◽  
Endoscopic Thyroidectomy ◽  
Evidence Base ◽  
Surgical Approaches ◽  
Widespread Application ◽  
Advantages And Disadvantages ◽  
Future Direction

Over the last two decades, advances and adaptation of technology have led to a variety of endoscopic thyroidectomy procedures being performed. The drive for extracervical procedures has been predominantly influenced by the desire for improved cosmesis via avoidance of visible scars. Extracervical techniques have shown considerable evolution with approaches that have included transaxillary, breast, postauricular, and transoral routes. There has been a varied evidence base for each of these approaches with regard to technical feasibility, safety, patient satisfaction, and cost-effectiveness. In recent years, robotic-assisted thyroid surgery has gained increased popularity worldwide with the introduction of the da Vinci Robot. Reports of improved postoperative outcomes and patient satisfaction have been in contrast to the financial burden, longer operative time, and increased training required which, to date, have limited widespread application. The aim of this review is to describe the evolution of extracervical procedures including surgical approaches, outcomes, advantages, and disadvantages. Consideration is also given to the future direction of extracervical thyroid surgery with regard to the safety, feasibility, and application of robotic systems.

Estimating Risk of Pituitary Apoplexy after Resection of Giant Pituitary Adenomas

2021 ◽  
Author(s):  
John T. Butterfield ◽  
Takako Araki ◽  
Daniel Guillaume ◽  
Ramachandra Tummala ◽  
Emiro Caicedo-Granados ◽  
...  
Keyword(s):  
Pituitary Adenomas ◽  
Pituitary Apoplexy ◽  
Residual Tumor ◽  
Extent Of Resection ◽  
Morbidity And Mortality ◽  
Surgical Approaches ◽  
Subtotal Resection ◽  
Advantages And Disadvantages ◽  
Cranial Nerve Palsies ◽  
Giant Pituitary Adenomas

Abstract Background Pituitary apoplexy after resection of giant pituitary adenomas is a rare but often cited morbidity associated with devastating outcomes. It presents as hemorrhage and/or infarction of residual tumor in the postoperative period. Because of its rarity, its incidence and consequences remain ill defined. Objective The aim of this study is to estimate the rate of postoperative pituitary apoplexy after resection of giant pituitary adenomas and assess the morbidity and mortality associated with apoplexy. Methods A systematic review of literature was performed to examine extent of resection in giant pituitary adenomas based on surgical approach, rate of postoperative apoplexy, morbidities, and mortality. Advantages and disadvantages of each approach were compared. Results Seventeen studies were included in quantitative analysis describing 1,031 cases of resection of giant pituitary adenomas. The overall rate of subtotal resection (<90%) for all surgical approaches combined was 35.6% (95% confidence interval: 28.0–43.1). Postoperative pituitary apoplexy developed in 5.65% (n = 19) of subtotal resections, often within 24 hours and with a mortality of 42.1% (n = 8). Resulting morbidities included visual deficits, altered consciousness, cranial nerve palsies, and convulsions. Conclusion Postoperative pituitary apoplexy is uncommon but is associated with high rates of morbidity and mortality in subtotal resection cases. These findings highlight the importance in achieving a maximal resection in a time sensitive fashion to mitigate the severe consequences of postoperative apoplexy.

scholarly journals Comparison of the effectiveness of sacrospinous ligament fixation and sacrocolpopexy: a meta-analysis

2021 ◽  
Author(s):  
Wenju Zhang ◽  
Willy Cecilia Cheon ◽  
Li Zhang ◽  
Xiaozhong Wang ◽  
Yuzhen Wei ◽  
...  
Keyword(s):  
Operative Time ◽  
Meta Analysis ◽  
Current Evidence ◽  
Cochrane Library ◽  
Surgical Approaches ◽  
Sacrospinous Ligament ◽  
Gastrointestinal Complications ◽  
Sacrospinous Ligament Fixation ◽  
Apical Support ◽  
Abdominal Sacrocolpopexy

Abstract Introduction and hypothesis Sacrocolpopexy and sacrospinous ligament fixation (SSLF) have been used for the restoration of apical support. Studies comparing sacrocolpopexy and SSLF have reported conflicting results. We aim to assess the current evidence regarding efficiency and the complications of sacrocolpopexy compared with SSLF. Methods We searched PubMed, Embase, and Cochrane Library and performed a systematic review meta-analysis to assess the two surgical approaches. Results 5Five randomized controlled trials, 8 retrospective studies, and 2 prospective studies including 4,120 cases were identified. Compared with abdominal sacrocolpopexy (ASC), SSLF was associated with a lower success rate (88.32% and 91.45%; OR 0.52; 95% CI 0.29–0.95; p = 0.03), higher recurrence (11.58% and 8.32%; OR 1.97; 95% CI 1.04–3.46; p = 0.04), and dyspareunia rate (14.36% and 4.67%; OR 3.10; 95% CI 1.28–7.50; p = 0.01). Patients in this group may benefit from shorter operative time (weighted mean difference −25.08 min; 95% CI −42.29 to −7.88; p = 0.004), lower hemorrhage rate (0.85% and 2.58%; OR 0.45; 95% CI 0.25–0.85; p = 0.009), wound infection rate (3.30% and 5.76%; OR 0.55; 95% CI 0.39–0.77; p = 0.0005), and fewer gastrointestinal complications (1.33% and 6.19%; OR 0.33; 95% CI 0.15–0.76; p = 0.009). Conclusion Both sacrocolpopexy and SSLF offer an efficient alternative to the restoration of apical support. When anatomical durability and sexual function is a priority, ASC may be the preferred option. When considering factors of mesh erosion, operative time, gastrointestinal complications, hemorrhage, and wound infections, SSLF may be the better option.

scholarly journals Available options for doing more with less: laboraory automation as one tool in the arsenal

1998 ◽  
Vol 20 (3) ◽  
pp. 87-89
Author(s):  
Stephen Scypinski ◽  
John Baiano ◽  
Theodore Sadlowski
Keyword(s):  
Laboratory Automation ◽  
Drug Discovery Process ◽  
Contract Research Organization ◽  
Advantages And Disadvantages ◽  
Line Extensions ◽  
Use Of Resources ◽  
Analytical Development ◽  
Effective Use ◽  
Case Basis

Projects that require analytical support can evolve from a number of different situations, for example new molecular entities from drug discovery; process changes; packaging changes; site changes; line extensions; and inlicensed projects and compounds. Laboratory automation has been shown to provide a viable and practical solution to assisting in analytical development. However, it is not always the most logical answer. A truly flexible and responsive analytical unit will make a decision on a case-by-case basis, when faced with a new project, whether it is best to: automate some or all aspects/testing involved; contract out to a reputable and approved contract research organization (CRO); hire temporary help; use available in-house resources; use a combination of the options shown above (for example to evaluate the complexity of the new project versus what the in-house resources are currently working on). The paper discusses the advantages and disadvantages of the various options with respect to providing analytical support and suggests optionsfor the most effective use of resources. The role of automation as one of the important tools in the arsenal of these options is highlighted.

Advantages and disadvantages of main surgical approaches for robot-assisted radical prostatectomy

2020 ◽  
Vol 10 (4) ◽  
pp. 347-354
Author(s):  
Dmitriy M. Il’in ◽  
Vladimir A. Makeev
Keyword(s):  
Radical Prostatectomy ◽  
Abdominal Cavity ◽  
Prostate Gland ◽  
Clinical Situation ◽  
Surgical Approaches ◽  
Robot Assisted ◽  
Scientific Databases ◽  
Advantages And Disadvantages ◽  
Robotic Assisted Surgery ◽  
History Of

The introduction of robotic-assisted surgery into clinical practice has opened up new possibilities for the surgical treatment of urological patients. Robot-assisted radical prostatectomy (RARP) is one of the most commonly performed robot-assisted surgery. The review is devoted to the main surgical approaches for RARP. An analysis of publications on this topic was carried out using the search engines of the scientific databases PubMed, Medscape, Google Scholar, eLibrary when writing the article The article presents an overview of the advantages and disadvantages of the existing four access options for RARP: anterior, perineal, lateral and posterior, as well as oncological and functional outcomes of operations. It has been shown that a surgeon with different approaches can choose the most suitable one for a given clinical situation, focusing on the stage of the disease, the patients age, anatomical features of the prostate gland, the state of the patients erectile function, and the history of operations on the abdominal cavity and pelvic organs.

COLLOID CYSTS OF THE THIRD VENTRICLE: A REVIEW OF SIXTEEN CASES

2021 ◽  
pp. 62-64
Author(s):  
Y Srinivas Rao ◽  
Hemal Chheda ◽  
Ch Surendra ◽  
M V Vijayasekhar ◽  
K Satya Varaprasad
Keyword(s):  
Benign Lesion ◽  
Third Ventricle ◽  
Clinical Manifestations ◽  
Colloid Cyst ◽  
Surgical Approaches ◽  
Imaging Features ◽  
Complete Excision ◽  
Advantages And Disadvantages ◽  
The Third ◽  
Colloid Cysts

BACKGROUND : Colloid cysts are one of the rare brain tumours and are mostly located in the anterosuperior portion of the third ventricle, between the fornix and surround of Foramen of Monroe. OBJECTIVES: Ÿ 1.To review the demographic information & analyse clinical manifestations of patients presenting with colloid cyst of third ventricle. Ÿ 2.To analyze the advantages and disadvantages of various surgical approaches Ÿ 3.To assess the surgical outcome in colloid cyst patients operated by any method. MATERIALS AND METHODS: A retrospective study was performed on 16 patients who presented with a colloid cyst and underwent surgery at the Department of Neurosurgery, King George Hospital, Andhra Medical College between 2013-2018. They were evaluated based on clinical ndings and imaging features, surgical approaches used for resection and their outcomes. RESULTS: Sixteen cases of colloid cyst of the third ventricle were operated upon between 2013-2018. There were seven male and nine female patients with their ages varying between 9 and 62 years old. Nine patients were operated on by using a transcortical trans-ventricular approach, four using the anterior trans-callosal approach and, three patients by using an endoscopic approach. In all patients, complete excision of the lesions was achieved. CONCLUSION: Colloid cysts, though benign, present surgical challenges because of its deep midline location. Complete excision of the colloid cyst carries an excellent prognosis. Surgery is a safe and effective treatment option for this benign lesion.

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