Resection of Anterior Skull Base Tumors: Comparison of Combined Traditional and Endoscopic Techniques

2005 ◽  
Vol 19 (5) ◽  
pp. 521-528 ◽  
Author(s):  
Pete S. Batra ◽  
Martin J. Citardi ◽  
Sarah Worley ◽  
Joung Lee ◽  
Donald C. Lanza
Keyword(s):  
Blood Loss ◽  
Hospital Stay ◽  
Skull Base ◽  
Operative Time ◽  
Demographic Data ◽  
Mortality Rates ◽  
Anterior Skull Base ◽  
Open Approach ◽  
Estimated Blood Loss ◽  
Significant Difference

Background Traditional craniofacial resection (tCFR) has been used successfully for resection of anterior skull base (ASB) tumors. Minimally invasive endoscopic resection (MIER) also has been used recently; this strategy facilitates superior visualization, avoids facial incisions, and preserves local structures. The goal of this study was to compare the outcome for these two approaches. Methods Retrospective chart analysis was conducted to identify patients undergoing resection of ASB tumors between January 1995 and January 2003. Demographic data, tumor characteristics, and the surgical approach used were determined. The mean operative time, estimated blood loss, hospital stay, and complications were analyzed. Recurrence and mortality rates were calculated. Results Nine patients were managed with the MIER approach, and 16 patients were treated with the traditional open approach. No significant difference was observed between groups on operative time, estimated blood loss, or hospital stay. Major complications were encountered in 2/9 (22%) and 7/16 (44%) patients in the MIER and tCFR groups, respectively. Recurrence was observed in 3/9 (33%) and 5/14 (36%) of the patients in the MIER and tCFR groups, respectively. Mortality rates in the MIER and tCFR groups were 0/9 (0%) and 4/15 (27%), respectively. Conclusion In this preliminary study, MIER of ASB neoplasia did not differ significantly from tCFR in operative time, estimated blood loss, hospital stay, or complication rate. Survival and recurrence rates were similar also. This early experience suggests that MIER is a viable alternative for the surgical management of ASB lesions in appropriately selected patients.

scholarly journals Transverse Versus Longitudinal Uterine Incision in Abdominal Myomectomy: A Randomized Controlled trial

QJM ◽  
2020 ◽  
Vol 113 (Supplement_1) ◽  
Author(s):  
A Elguindy ◽  
H Hemeda ◽  
M Esmat ◽  
M Nawara ◽  
A M F Metwally
Keyword(s):  
Blood Loss ◽  
Operative Time ◽  
Controlled Trial ◽  
Demographic Data ◽  
Operative Blood Loss ◽  
Postoperative Fever ◽  
Abdominal Myomectomy ◽  
Randomized Controlled ◽  
Uterine Incision ◽  
Significant Difference

Abstract Objective The Aim of the study is to compare between transverse and longitudinal uterine incision in abdominal myomectomy regarding intraoperative blood loss Design: A randomized Controlled interventional study. Setting Ain Shams Maternity teaching hospital. Patients and methods 52 patients undergoing abdominal myomectomy for single myoma were involved The patients were randomized into two groups that showed no significant difference in demographic data, characters of myoma or indication of surgery Results Our results proved that there was no significant difference between both incisions regarding intra-operative blood loss, need for blood transfusion, post-operative Hgb drop, operative time or incidence of postoperative fever. Conclusion Transverse uterine incision for myomectomy does not cause more blood loss than longitudinal incision. There is no difference between both incisions in operative time or postoperative complications Trial identifier: NCT03009812, MY-789

The Self-Retaining Barbed Suture for Parenchymal Repair in Laparoscopic Partial Nephrectomy: A Systematic Review and Meta-Analysis

2019 ◽  
Vol 26 (6) ◽  
pp. 744-752
Author(s):  
Hailun Zhan ◽  
Chunping Huang ◽  
Tengcheng Li ◽  
Fei Yang ◽  
Jiarong Cai ◽  
...  
Keyword(s):  
Renal Function ◽  
Blood Loss ◽  
Hospital Stay ◽  
Partial Nephrectomy ◽  
Operative Time ◽  
Meta Analysis ◽  
Length Of Hospital Stay ◽  
The Self ◽  
Barbed Suture ◽  
Estimated Blood Loss

Objectives. The warm ischemia time (WIT) is key to successful laparoscopic partial nephrectomy (LPN). The aim of this study was to perform a meta-analysis comparing the self-retaining barbed suture (SRBS) with a non-SRBS for parenchymal repair during LPN. Methods. A systematic search of PubMed, Scopus, and the Cochrane Library was performed up to March 2018. Inclusion criteria for this study were randomized controlled trials (RCTs) and observational comparative studies assessing the SRBS and non-SRBS for parenchymal repair during LPN. Outcomes of interest included WIT, complications, overall operative time, estimated blood loss, length of hospital stay, and change of renal function. Results. One RCT and 7 retrospective studies were identified, which included a total of 461 cases. Compared with the non-SRBS, use of the SRBS for parenchymal repair during LPN was associated with shorter WIT ( P < .00001), shorter overall operative time ( P < .00001), lower estimated blood loss ( P = .02), and better renal function preservation ( P = .001). There was no significant difference between the SRBS and non-SRBS with regard to complications ( P = .08) and length of hospital stay ( P = .25). Conclusions. The SRBS for parenchymal repair during LPN can significantly shorten the WIT and overall operative time, decrease blood loss, and preserve renal function.

scholarly journals Robot-Assisted Laparoscopic Radical Prostatectomy in the Morbidly Obese Patient

2011 ◽  
Vol 2011 ◽  
pp. 1-5 ◽  
Author(s):  
Jennifer Yates ◽  
Ravi Munver ◽  
Ihor Sawczuk
Keyword(s):  
Blood Loss ◽  
Hospital Stay ◽  
Operative Time ◽  
The United States ◽  
Morbidly Obese ◽  
Health Issues ◽  
Morbidly Obese Patient ◽  
Estimated Blood Loss ◽  
Clavien Grade ◽  
Grade Ii

Introduction. Obesity and prostate cancer are among the more common health issues affecting men in the United States.Methods. We retrospectively reviewed morbidly obese (BMI ≥ 40 kg/m2) patients undergoing RALP between 2004–2009 at our institution. Parameters including operative time, estimated blood loss, hospital stay, pathology, and complication rate were examined.Results. A total of 15 patients were included, with a mean BMI of 43 kg/m2. Mean preoperative PSA was 5.78 ng/dL, and Gleason score was 6.6. Mean operative time was 163 minutes, and mean estimated blood loss was 210 mL. The mean hospital stay was 1.3 days. Positive margins were noted in 2 (13%) patients, each with pT3 disease. There were no blood transfusions, open conversions, or Clavien Grade II or higher complications.Conclusions. In our experience, RALP is feasible in morbidly obese patients. We noted several challenges in this patient population which were overcome with modification of technique and experience.

Safety and Efficacy of Laparoscopic Liver Resection for Colorectal Liver Metastasis With Obesity

2020 ◽  
pp. 000313482095244
Author(s):  
Yoshihiro Inoue ◽  
Masatsugu Ishii ◽  
Kensuke Fujii ◽  
Kentaro Nihei ◽  
Yusuke Suzuki ◽  
...  
Keyword(s):  
Liver Resection ◽  
Blood Loss ◽  
Laparoscopic Liver Resection ◽  
Operative Time ◽  
Surgical Site Infections ◽  
Obese Patients ◽  
Visceral Fat Area ◽  
Safety And Efficacy ◽  
Estimated Blood Loss ◽  
Significant Difference

Introduction Laparoscopic liver resection (LLR) in obese patients has been reported to be particularly challenging owing to technical difficulties and various comorbidities. Methods The safety and efficacy outcomes in 314 patients who underwent laparoscopic or open nonanatomical liver resection for colorectal liver metastases (CRLM) were analyzed retrospectively with respect to the patients’ body mass index (BMI) and visceral fat area (VFA). Results Two hundred and four patients underwent LLR, and 110 patients underwent open liver resection (OLR). The rate of conversion from LLR to OLR was 4.4%, with no significant difference between the BMI and VFA groups ( P = .647 and .136, respectively). In addition, there were no significant differences in terms of operative time and estimated blood loss in LLR ( P = .226 and .368; .772 and .489, respectively). The incidence of Clavien-Dindo grade IIIa or higher complications was not significantly different between the BMI and VFA groups of LLR ( P = .877 and .726, respectively). In obese patients, the operative time and estimated blood loss were significantly shorter and lower, respectively, in LLR than in OLR ( P = .003 and < .001; < .001 and < .001, respectively). There was a significant difference in the incidence of postoperative complications, organ/space surgical site infections, and postoperative bile leakage between the LLR and OLR groups ( P = .017, < .001, and < .001, respectively). Conclusion LLR for obese patients with CRLM can be performed safely using various surgical devices with no major difference in outcomes compared to those in nonobese patients. Moreover, LLR has better safety outcomes than OLR in obese patients.

Robotic and Laparoscopic Approaches for Adrenal Surgery in Obese Patients

2020 ◽  
pp. 000313482095149
Author(s):  
Hosam Shalaby ◽  
Mohamed Abdelgawad ◽  
Mahmoud Omar, MD ◽  
Ghassan Zora, MD ◽  
Saad Alawwad ◽  
...  
Keyword(s):  
Blood Loss ◽  
Hospital Stay ◽  
Operative Time ◽  
Laparoscopic Approach ◽  
Obese Patients ◽  
Adrenal Surgery ◽  
Robotic Approach ◽  
Robot Assisted ◽  
Operative Outcomes ◽  
Estimated Blood Loss

Objective Minimally invasive adrenalectomy is a challenging procedure in obese patients. Few recent studies have advocated against robot-assisted adrenalectomy, particularly in obese patients. This study aims to compare operative outcomes between the robotic and laparoscopic adrenalectomy, particularly in obese patients. Materials and Methods A retrospective analysis was performed on all consecutive patients undergoing adrenalectomy for benign disease by a single surgeon using either a laparoscopic or robotic approach. Adrenal surgeries for adrenal cancer were excluded. Demographics, operative time, length of hospital stays, estimated blood loss (EBL), and intraoperative and postoperative complications were evaluated. Patients were divided into 2 groups; obese and nonobese. A sub-analysis was performed comparing robotic and laparoscopic approaches in obese and nonobese patients. Results Out of 120, 55 (45.83%) were obese (body mass index ≥ 30 kg/m2). 14 (25.45%) of the obese patients underwent a laparoscopic approach, and 41 (74.55%) underwent a robotic approach. Operative times were longer in the obese vs. nonobese groups (173.30 ± 72.90 minutes and 148.20 ± 61.68 minutes, P = .04) and were associated with less EBL (53.77 ± 82.48 vs. 101.30 ± 122, P = .01). The robotic approach required a longer operative time when compared to the laparoscopic approach (187 ± 72.42 minutes vs. 126.60 ± 54.55 minutes, P = .0102) in the obese but was associated with less blood loss (29.02 ± 51.05 mL vs. 138.30 ± 112.20 mL, P < .01) and shorter hospital stay (1.73 ± 1.23 days vs. 3.17 ± 1.27 days, P < .001). Conclusion Robot-assisted adrenal surgery is safe in obese patients and appears to be longer; however, it provides improvements in postoperative outcomes, including EBL and shorter hospital stay.

A Comparison of Two Methods of Hemostasis in Thyroidectomy

2009 ◽  
Vol 75 (11) ◽  
pp. 1073-1076 ◽  
Author(s):  
Michael M. Mcnally ◽  
Steven C. Agle ◽  
R. Fredrick Williams ◽  
Walter E. Pofahl
Keyword(s):  
Blood Loss ◽  
Thyroid Surgery ◽  
Operative Time ◽  
Recurrent Laryngeal Nerve Palsy ◽  
Chi Square ◽  
Ultrasonic Dissection ◽  
Gland Weight ◽  
Vessel Sealing ◽  
Estimated Blood Loss ◽  
Significant Difference

Safe thyroid surgery requires meticulous hemostasis. The objective of the current study is to compare the effectiveness and safety of ultrasonic dissection (UD) and electronic vessel sealing (EVS) in patients undergoing thyroidectomy. A retrospective analysis of a prospectively maintained database was performed. Between January 1, 2007 and January 25, 2008, hemostasis was achieved using EVS (LigaSure Precise, Valleylab, Boulder, CO). Since January 25, 2008, hemostasis has been achieved using UD (Harmonic Focus, Ethicon Endo-Surgery, Cincinnati, OH). Operative time, estimated blood loss, gland weight, and postoperative complications were compared. Differences were analyzed using unpaired t test and Chi square with significance assigned P < 0.05. Seventy-four patients underwent total thyroidectomy (EVS n = 59, UD n = 15). Operative time (EVS 115.0 ± 38.3 min, UD 88.0 ± 14.0 min, P = 0.012) was significantly decreased in the UD group compared with the EVS group. There were no significant differences in mean age (EVS 50.4 ± 13.9 years, UD 49.1 ± 15.6 years), gender distribution (EVS 78% female, UD 87% female), estimated blood loss (EVS 49.4 ± 44.7 mL, UD 47.0 ± 70.4 mL), and gland weight (EVS 67.4 ± 66.4 gm, UD 41.3 ± 26.6 gm). Analysis of complications, including hematoma, hypocalcemia, and recurrent laryngeal nerve palsy showed no significant difference. Based on the current analysis, ultrasonic dissection is a safe method of hemostasis for thyroid surgery. Its use decreases operative time when compared with electronic vessel sealing.

Complicated Appendicitis–Is the Laparoscopic Approach Appropriate? A Comparative Study with the Open Approach: Outcome in a Community Hospital Setting

2007 ◽  
Vol 73 (8) ◽  
pp. 737-742 ◽  
Author(s):  
Naveen Pokala ◽  
S. Sadhasivam ◽  
R.P. Kiran ◽  
V. Parithivel
Keyword(s):  
Blood Loss ◽  
Operative Time ◽  
Laparoscopic Approach ◽  
Complicated Appendicitis ◽  
Complication Rates ◽  
Intraabdominal Abscess ◽  
Estimated Blood Loss ◽  
Significant Difference ◽  
American Society ◽  
American Society Of Anesthesiologists

Good outcome has been reported with the laparoscopic approach in uncomplicated appendicitis, but a higher incidence of postoperative intraabdominal abscesses has been reported after laparoscopic appendectomy in complicated appendicitis. This retrospective comparative study compares outcome after laparoscopic (LA) and open appendectomy (OA) in complicated appendicitis. All patients who had LA or OA for complicated appendicitis between January 2003 and February 2006 were included in the study. Data collection included demographics, operative time, estimated blood loss, length of stay (LOS), complications, readmission, and reoperative rates. The primary end points for analysis were postoperative intraabdominal abscess and complication rates and secondary end points were LOS and operative time. All data were analyzed on an intent-to-treat basis. Of 104 patients, 43 patients underwent LA and 61 had OA. The mean age (24.8 ± 16.5 versus 31.3 ± 18.9, P = 0.08) in the LA group was lower than the OA group because there was a significantly higher proportion of pediatric patients (34.8% versus 14.8%, P = 0.02) who had LA. There was no significant difference in gender (female/male, 14/29 versus 27/34, P = 0.3) or American Society of Anesthesiologists class distribution (American Society of Anesthesiologists 1/2/3/4/, 35/7/1/0 versus 45/12/3/1, P = 0.68) between the two groups. The operative time (100.5 ± 36.2 versus 81.5 ± 29.5 minutes, P = 0.03) was significantly longer and the estimated blood loss (21 mL versus 33 mL, P = 0.01) was lower in LA when compared with OA, but there was no significant difference in the number of patients with preoperative peritonitis versus abscesses (7/36 versus 13/48, P = 0.6) in both groups. There was no difference in the median LOS (6 [interquartile range 5–9] versus 6 [interquartile range 4–8], P = 0.7) in the two groups. The conversion rate in LA was 18.6% (n = 8). There was also no significant difference in the complication (17/43 [39.5%] versus 21/61 [34.4%], P = 0.54), reoperative (3/43 [7%] versus 0/61 [0%], P = 0.07), and 30-day readmission (5/41 [11.6%] versus 3/61 [4.9%], P = 0.23) rates between the two groups. The rate of postoperative intraabdominal abscesses was significantly higher in the LA group when compared with the OA group (6/43 [14%] versus 0/61 [0%], P = 0.04) and the wound infection (1/43 [2.3%] versus 5/61 [8.2%], P = 0.4) and pulmonary complication (0/43 [0%] versus 3/61 [4.9%], P = 0.26) rate was higher in the OA group. There was no mortality in the LA group, but there was one mortality in the OA group resulting from postoperative myocardial infarction. Laparoscopic appendectomy can be performed in patients with complicated appendicitis with a comparative operative time, LOS, and complication rates but results in a significantly higher intraabdominal abscess rate and lower wound infection rate when compared with OA.

Outcome Analysis of the Transglabellar/Subcranial Approach for Lesions of the Anterior Cranial Fossa: A Comparison with the Classic Craniotomy Approach

1997 ◽  
Vol 116 (6) ◽  
pp. 642-646 ◽  
Author(s):  
Thomas M. Jung ◽  
Raj P. Terkonda ◽  
Stephen J. Haines ◽  
Scott Strome ◽  
Lawrence J. Marentette
Keyword(s):  
Intensive Care Unit ◽  
Intensive Care ◽  
Blood Loss ◽  
Skull Base ◽  
Frontal Lobe ◽  
Anterior Skull Base ◽  
Transfusion Rate ◽  
Estimated Blood Loss ◽  
Classic Approach ◽  
Skull Base Lesions

The classic approach to anterior skull base lesions uses bifrontal craniotomies together with lateral rhinotomies. This approach requires frontal lobe retraction and is associated with postoperative anosmia and the development of frontal lobe encephalomalacia. The transglabellar/subcranial approach permits removal of anterior skull base lesions without frontal lobe retraction and avoids facial scars. No studies to date, however, have directly compared the two approaches in terms of patient morbidity. The present retrospective study compares the two approaches when used for the removal of anterior skull base lesions in terms of estimated blood loss, number of transfusions, number of days in the hospital and intensive care unit, and postoperative complications. Twenty patients with anterior skull base lesions were examined. The classic approach was used on 10, and the transglabellar/subcranial route was used on 10. When compared with the classic approach, the transglabellar/subcranial approach resulted in a lower estimated blood loss and subsequent transfusion rate, fewer days in the hospital and intensive care unit, and lower numbers and less severe types of complications. Furthermore, visualization of the tumors before resection with the transglabellar/subcranial approach allowed preservation of olfaction in virtually all of these patients. Although this study represents a small sample population, the results are sufficiently impressive to favor the transglabellar/subcranial approach for the removal of a variety of anterior skull base lesions.

scholarly journals Posterior thoracic corpectomy with cage reconstruction for metastatic spinal tumors: comparing the mini-open approach to the open approach

2015 ◽  
Vol 23 (2) ◽  
pp. 217-227 ◽  
Author(s):  
Darryl Lau ◽  
Dean Chou
Keyword(s):  
Blood Loss ◽  
Hospital Stay ◽  
Complication Rate ◽  
Open Surgery ◽  
Operative Time ◽  
Spinal Metastases ◽  
Open Group ◽  
Open Approach ◽  
Mini Open

OBJECT Spinal metastases most commonly affect the vertebral bodies of the spinal column, and spinal cord compression is an indication for surgery. Commonly, an open posterior approach is employed to perform a transpedicular costotransversectomy or lateral extracavitary corpectomy. Because of the short life expectancies in patients with metastatic spinal disease, decreasing the morbidity of surgical treatment and recovery time is critical. One potential approach to decreasing morbidity is utilizing minimally invasive surgery (MIS). Although significant advances have been made in MIS of the spine, data supporting the utility of MIS are still emerging. This study compared outcomes of patients who underwent mini-open versus traditional open transpedicular corpectomy for spinal metastases in the thoracic spine. METHODS A consecutive cohort from 2006 to 2013 of 49 adult patients who underwent thoracic transpedicular corpectomies for spinal metastases was retrospectively identified. Patients were categorized into one of 2 groups: open surgery and mini-open surgery. Mini-open transpedicular corpectomy was performed with a midline facial incision over only the corpectomy level of interest and percutaneous instrumentation above and below that level. The open procedure consisted of a traditional posterior transpedicular corpectomy. Chi-square test, 2-tailed t-test, and ANOVA models were employed to compare perioperative and follow-up outcomes between the 2 groups. RESULTS In the analysis, there were 21 patients who had mini-open surgery and 28 patients who had open surgery. The mean age was 57.9 years, and 59.2% were male. The tumor types encountered were lung (18.3%), renal/bladder (16.3%), breast (14.3%), hematological (14.3%), gastrointestinal tract (10.2%), prostate (8.2%), melanoma (4.1%), and other/unknown (14.3%). There were no significant intergroup differences in demographics, comorbidities, neurological status (American Spinal Injury Association [ASIA] grade), number of corpectomies performed, and number of levels instrumented. The open group had a mean operative time of 413.6 minutes, and the mini-open group had a mean operative time of 452.4 minutes (p = 0.329). Compared with the open group, the mini-open group had significantly less blood loss (917.7 ml vs 1697.3 ml, p = 0.019) and a significantly shorter hospital stay (7.4 days vs 11.4 days, p = 0.001). There was a trend toward a lower perioperative complication rate in the mini-open group (9.5%) compared with the open group (21.4%), but this was not statistically significant (p = 0.265). At follow-up, there were no significant differences in ASIA grade (p = 0.342), complication rate after the 30-day postoperative period (p = 0.999), or need for surgical revision (p = 0.803). The open approach had a higher overall infection rate of 17.9% compared with that in the mini-open approach of 9.5%, but this was not statistically significant (p = 0.409). CONCLUSIONS The mini-open transpedicular corpectomy is associated with less blood loss and shorter hospital stay compared with open transpedicular corpectomy. The mini-open corpectomy also trended toward lower infection and complication rates, but these did not reach statistical significance.

scholarly journals Introduction of gasless laparoscopic surgery as a minimally invasive procedure for endometrial cancer and its usefulness from the viewpoint of the learning curve

2021 ◽  
Vol 19 (1) ◽  
Author(s):  
Hiroe Ito ◽  
Tetsuya Moritake ◽  
Fumitoshi Terauchi ◽  
Keiichi Isaka
Keyword(s):  
Endometrial Cancer ◽  
Laparoscopic Surgery ◽  
Blood Loss ◽  
Learning Curve ◽  
Hospital Stay ◽  
Open Surgery ◽  
Operative Time ◽  
Perioperative Complications ◽  
Survival Rates ◽  
Significant Difference

Abstract Background We investigated the usefulness of gasless laparoscopic surgery (GLS) using a subcutaneous abdominal wall lifting method for endometrial cancer. Methods We studied 105 patients with early endometrial cancer who underwent GLS (55) or open surgery (50). A uterine manipulator was used in all GLS cases. We compared operative time, blood loss, number of lymph nodes removed, hospital stay, perioperative complications, cases converted to laparotomy, and recurrence and survival rates. We also studied the learning curve and proficiency of GLS. Results The GLS group had significantly longer operative time (265 vs. 191 min), reduced blood loss (184 vs. 425 mL), shorter hospital stay (9.9 vs. 17.6 days), and fewer postoperative complications (1.8 vs. 12.0%) than the open group. No case was converted to laparotomy. Disease-free and overall survival rates at 4 years postoperatively (GLS vs. open groups) were 98.0 versus 97.8 and 100 versus 95.7%, respectively, and there was no significant difference between the groups. Regarding the learning curve for GLS, two different phases were observed in approximately 10 cases. Operator 2, who was not accustomed to laparoscopic surgery, showed a significant reduction in operative time in the later phase 2. Conclusions GLS for endometrial cancer results in less bleeding, shorter hospital stay, and fewer complications than open surgery. Recurrence and survival rates were not significantly different from those of open surgery. This technique may be introduced in a short time for operators who are skilled at open surgery but not used to laparoscopic surgery.

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