Role of minimally invasive percutaneous fixation in thoracolumbar fractures: a prospective study

Abstract Background Each year, there are approximately 5 million new vertebral fractures worldwide. Being a mobile flexible segment that is prone to severe stresses and loads, thoracolumbar fractures are considered one of the most controversial and challenging fracture types to manage. Objective The aim of this study is to explore the technique and to evaluate feasibility, safety, and outcome of percutaneous transpedicular fixation in the management of thoracolumbar fractures. Methods This study was carried out in the period between May 2016 and June 2017, where 20 consecutive patients with thoracolumbar fractures, based on TLICS scoring and neurological status, underwent a posterior percutaneous transpedicular fixation. The mean age was 33.85 years, range 20–49 years. Patients were followed up for 12 months. Patients had their clinical outcomes reviewed and evaluated in terms of cosmesis by visual analog scale (VAS) and in terms of Cobb angle correction. Results The length of the procedure varied from 120 to 180 min with mean time of 154.50 min. There was no significant blood loss in all cases. The volume of blood loss ranged from 150 to 200 cc with mean loss of 174.25 cc. No major intraoperative complications happened in our study cases. Six cases had only one laterally malpositioned screw each. All cases returned to their previous activity without limitations (E5). Those who were completely pain free (F5) were 15 patients. Only five patients were suffering from moderate pain (F4). The Prolo scale was either 9 or 10 with mean of 9.60. Conclusion By comparing our results with other studies, we found more or less equivalence in terms of neurological recovery, functional outcome, fusion rate, and maintenance of correction gain. However, the cosmesis scores for patients in the study were great.

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Rate and reasons for elective ventilation in patients undergoing intracranial tumour surgery

Journal of Neuroanaesthesiology and Critical Care ◽

10.4103/2348-0548.130396 ◽

2014 ◽

Vol 01 (02) ◽

pp. 125-130 ◽

Cited By ~ 2

Author(s):

Charu Mahajan ◽

Girija Rath ◽

Manish Sharma ◽

Surya Dube ◽

Vanitha Rajagopalan ◽

...

Keyword(s):

Risk Factors ◽

Blood Loss ◽

Intraoperative Complications ◽

Air Embolism ◽

Perioperative Period ◽

Neurological Status ◽

Haemodynamic Instability ◽

Intracranial Tumour ◽

Venous Air Embolism ◽

The Mean

Abstract Background: Mechanical ventilation (MV) after neurosurgery is often decided by the preoperative neurological status of the patient. However, there is paucity of information regarding factors responsible for continuation of MV in these patients. This study was carried out to identify the indications and risk factors for elective ventilation after intracranial tumour surgery. Materials and Methods: A prospective observational study was carried out on consecutive adult patients who underwent elective craniotomy for tumour excision, and postoperatively required MV. Data on anaesthesia technique, duration of anaesthesia and surgery, blood loss and transfusion and volume of fluids infused were noted. Intraoperative complications like tight brain, massive blood loss, brainstem handling, cranial nerve handling, haemodynamic instability, cardiac arrhythmias, venous air embolism, electrolyte abnormality and hypothermia were also recorded. Statistical analysis was done using Strata 9.0 software. Categorical data was analysed using Chi-square test or Fisher's exact test and continuous data by Student's t-test. Results: A total of 709 patients enrolled for the study over a period of one year out of which 347 patients (48.9%) required continuation of MV during the postoperative period. The mean duration of MV was 29.7 ± 39.7 hrs. The most common causes for postoperative MV were ‘not responding to commands’ (43.2%), and neurosurgeon's advice (41.8%). The mean ICU and hospital stays were 92.2 ± 134.0 hrs and 13.8 ± 16.5 days, respectively. 47.6% of patients who required postoperative MV on neurosurgeon's advice developed complications whereas it was 33.2% for those ventilated other reasons (P < 0.05). Glasgow outcome scale (GOS) at discharge was poor in 12.4%. On multivariate analysis, intraoperative blood transfusion, tracheostomy and duration of ventilation more than 48 hrs were the independent risk factors associated with poor outcome. Conclusions: Although the neurosurgeon's advice for elective ventilation should not be ignored, but prolonged and avoidable MV may exacerbate the postoperative morbidities apart from increasing the cost of treatment. Hence, a complete understanding of intraoperative events, cerebral physiology and various factors influencing it during the perioperative period may not be overemphasised.

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The Emerging Role of Robotic Single-site Approach for Myomectomy: A Systematic Review of the Literature

Surgical Innovation ◽

10.1177/1553350620988227 ◽

2021 ◽

pp. 155335062098822

Author(s):

Eirini Giovannopoulou ◽

Anastasia Prodromidou ◽

Nikolaos Blontzos ◽

Christos Iavazzo

Keyword(s):

Blood Loss ◽

Minimally Invasive ◽

Complication Rate ◽

Operative Time ◽

Intraoperative Complications ◽

Single Site ◽

Minimally Invasive Technique ◽

Invasive Technique ◽

Robotic Myomectomy ◽

The Mean

Objective. To review the existing studies on single-site robotic myomectomy and test the safety and feasibility of this innovative minimally invasive technique. Data Sources. PubMed, Scopus, Google Scholar (from their inception to October 2019), as well as Clinicaltrials.gov databases up to April 2020. Methods of Study Selection. Clinical trials (prospective or retrospective) that reported the outcomes of single-site robotic myomectomy, with a sample of at least 20 patients were considered eligible for the review. Results. The present review was performed in accordance with the guidelines for Systematic Reviews and Meta-Analyses (PRISMA). Four (4) studies met the inclusion criteria, and a total of 267 patients were included with a mean age from 37.1 to 39.1 years and BMI from 21.6 to 29.4 kg/m2. The mean operative time ranged from 131.4 to 154.2 min, the mean docking time from 5.1 to 5.45 min, and the mean blood loss from 57.9 to 182.62 ml. No intraoperative complications were observed, and a conversion rate of 3.8% was reported by a sole study. The overall postoperative complication rate was estimated at 2.2%, and the mean hospital stay ranged from 0.57 to 4.7 days. No significant differences were detected when single-site robotic myomectomy was compared to the multiport technique concerning operative time, blood loss, and total complication rate. Conclusion. Our findings support the safety of single-site robotic myomectomy and its equivalency with the multiport technique on the most studied outcomes. Further studies are needed to conclude on the optimal minimally invasive technique for myomectomy.

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Functional Outcomes of Nerve Root Sparing Posterior Corpectomy in Lumbar Vertebral Burst Fractures

Global Spine Journal ◽

10.1177/2192568220984128 ◽

2021 ◽

pp. 219256822098412

Author(s):

Abhinandan Reddy Mallepally ◽

Nandan Marathe ◽

Abhinav Kumar Shrivastava ◽

Vikas Tandon ◽

Harvinder Singh Chhabra

Keyword(s):

Blood Loss ◽

Burst Fracture ◽

Operating Time ◽

Deformity Correction ◽

Neurological Status ◽

Height Loss ◽

Vas Score ◽

Post Surgery ◽

Burst Fractures ◽

The Difference

Study Design: Retrospective observational. Objectives: This study aimed to document the safety and efficacy of lumbar corpectomy with reconstruction of anterior column through posterior-only approach in complete burst fractures. Methods: In this retrospective study, we analyzed complete lumbar burst fractures treated with corpectomy through posterior only approach between 2014 and 2018. Clinical and intraoperative data including pre and post-operative neurology as per the ISNCSCI grade, VAS score, operative time, blood loss and radiological parameters, including pre and post-surgery kyphosis, height loss and canal compromise was assessed. Results: A total of 45 patients, with a mean age of 38.89 and a TLICS score 5 or more were analyzed. Preoperative VAS was 7-10. Mean operating time was 219.56 ± 30.15 minutes. Mean blood loss was 1280 ± 224.21 ml. 23 patients underwent short segment fixation and 22 underwent long segment fixation. There was no deterioration in post-operative neurological status in any patient. At follow-up, the VAS score was in the range of 1-3. The difference in preoperative kyphosis and immediate post-operative deformity correction, preoperative loss of height in vertebra and immediate post-operative correction in height were significant (p < 0.05). Conclusion: The posterior-only approach is safe, efficient, and provides rigid posterior stabilization, 360° neural decompression, and anterior reconstruction without the need for the anterior approach and its possible approach-related morbidity. We achieved good results with an all posterior approach in 45 patients of lumbar burst fracture (LBF) which is the largest series of this nature.

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Photorefractive keratectomy for correction of myopia: Our one-year experience

Vojnosanitetski pregled ◽

10.2298/vsp1210852r ◽

2012 ◽

Vol 69 (10) ◽

pp. 852-857

Author(s):

Mirko Resan ◽

Miroslav Vukosavljevic ◽

Milorad Milivojevic

Keyword(s):

Visual Acuity ◽

Postoperative Complications ◽

Intraoperative Complications ◽

Mean Value ◽

Ablation Depth ◽

Laser In Situ Keratomileusis ◽

Photorefractive Keratectomy ◽

Corneal Tissue ◽

Surgical Method ◽

A Prospective Study

Background/Aim. Photorefractive keratectomy (PRK), after laser in situ keratomileusis (LASIK), is commonly performed refractive surgical method worldwide. The aim of this study was to examine the effectiveness and safety of PRK in correction of various strengths of myopia and to assess how much corneal tissue is being removed with one diopter sphere (Dsph) correction by using different optical zones (OZ). Methods. A prospective study with a follow-up period of 6 months included 55 patients of which 100 myopic eyes were treated by PRK method (one eye was included in 10 patients). Myopic eyes with a preoperative best corrected visual acuity (BCVA) = 1.0 (20/20) were analysed. In order to assess the effectiveness of PRK operated myopic eyes were divided into four groups according to the dioptric power: 1)? -1.75 Dsph (n = 26); 2) from -2 to -3.75 Dsph (n = 44); 3) from -4 to -6.75 Dsph (n = 23), and 4) ? -7 Dsph (n = 7). Myopic eyes with preoperative BCVA ? 0.9 (amblyopic eyes) were excluded from the study, as well as eyes with astigmatism > -1.5 Dcyl. To assess the effectiveness of PRK we examined the percentage of eyes in the mentioned groups, which derived uncorrected visual acuity (UCVA) 6 months after the intervention to the following: a) UCVA = 1.0 (20/20) and b) UCVA ? 0.5 (20/40). To assess the safety of PRK we examined the frequency of intraoperative and postoperative complications. To estimate how much corneal tissue was removed with one Dsph correction by using different OZ, we used preoperative and postoperative (after 6 months) central pachymetry values expressed in ?m and volume of cornea (central 7 mm) expressed in mm?. In that sense, we used only the myopic eyes with clear preoperative spherical refraction. The total number of these eyes was 27, of which 16 eyes were treated using a 6.5 mm OZ and 11 eyes using a 7 mm OZ. Results. Refractive spherical equivalent (RSE) for all eyes was in the range from -0.75 to -8.75 Dsph, and preoperative mean value of RSE with standard deviation (mean RSE ? SD) was -3.32 ? 1.83 Dsph. Six months after PRK, 91% of eyes had UCVA = 20/20, and 99% of eyes had UCVA ? 20/40. In the first group (? -1.75 Dsph) preoperative mean RSE ? SD was -1.34 ? 0.32 Dsph, six months after PRK, 96% of eyes had UCVA = 20/20, and 100% of eyes had UCVA ? 20/40. In the second group (from -2 to -3.75 Dsph) preoperative mean RSE ? SD was - 2.95 ? 0.57 Dsph, six months after PRK, 89% of eyes had UCVA = 20/20, and 100% of eyes had UCVA ? 20/40. In the third group (from -4 to -6.75 Dsph) preoperative mean RSE ? SD was - 4.93 ? 0.70 Dsph, six months after PRK, 100% of eyes had UCVA = 20/20. In the fourth group (? - 7 Dsph) preoperative mean RSE ? SD was -7.71 ? 0.67 Dsph, six months after PRK, 57% of eyes had UCVA = 20/20, and 86% of eyes had UCVA ? 20/40. There were no intraoperative complications while postoperative complications occurred in 2 patients - in both cases in one eye (2%). In that cases, epithelial defects were detected. In the group of eyes that were treated by 6.5 mm OZ mean RSE ? SD was -2.45 ? 0.99 Dsph, the ablation depth per 1 Dsph was 17.54 ? 5.58 ?m and ablated volume of central 7 mm cornea by 1 Dsph was 0.43 ? 0.18 mm?. In the group of eyes that were treated by 7 mm OZ mean RSE ? SD was -3.32 ? 2.26 Dsph, the ablation depth per 1 Dsph was 23.73 ? 6.91 ?m and ablated volume of central 7 mm cornea by 1 Dsph was 0.61 ? 0.31 mm?. Conclusion. PRK is effective and safe refractive surgical method for correcting myopia up to -8 .75 Dsph. OZ size is the main factor determining the depth of the excimer laser ablation of the corneal tissue volume consumed by 1 Dsph. Higher OZ value determines higher consumption of cornea tissue.

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Robotically Assisted Hysterectomy versus Vaginal Hysterectomy for Benign Disease: A Prospective Study

Minimally Invasive Surgery ◽

10.1155/2013/429105 ◽

2013 ◽

Vol 2013 ◽

pp. 1-4 ◽

Cited By ~ 3

Author(s):

M. Carbonnel ◽

H. Abbou ◽

H. T. N’Guyen ◽

S. Roy ◽

G. Hamdi ◽

...

Keyword(s):

Blood Loss ◽

Prospective Study ◽

Hospital Stay ◽

Vaginal Hysterectomy ◽

Operative Time ◽

Group Versus ◽

Length Of Hospital Stay ◽

Benign Disease ◽

Post Surgery ◽

A Prospective Study

Objectives. A prospective study was carried out to compare vaginal hysterectomy (VH) and robotically assisted hysterectomy (RH) for benign gynecological disease.Materials and Methods. All patients who underwent hysterectomy from March 2010 to March 2012 for a benign disease were included. Patients’ demographics per and post surgery results were collected from medical files. A questionnaire was also conducted 2 months after surgery.Results. Sixty patients were included in the RH group and thirty four in the VH one. Operative time was significantly longer in the RH group ( versus min; ). Blood loss and length of hospital stay were significantly reduced: versus ml; , and versus days; , respectively. Less pain was reported at D1 and D2 by RH patients, and levels of analgesia were lower compared to those observed in the VH group. No differences were found regarding the rate of conversion to laparotomy, intra- or postoperative complications.Conclusion. Robotically assisted hysterectomy appears to reduce blood loss, postoperative pain, and length of hospital stay, but it is associated with longer operative time and higher cost. Specific indications for RH remain to be defined.

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Role of routine fluid replacement in children undergoing tonsillectomy

The Journal of Laryngology & Otology ◽

10.1017/s0022215100113933 ◽

1990 ◽

Vol 104 (10) ◽

pp. 801-802 ◽

Cited By ~ 4

Author(s):

P. S. Wilson ◽

D. G. Snow ◽

J. O'Connel ◽

D. W. Proops ◽

M. Barrow

Keyword(s):

Blood Loss ◽

Prospective Study ◽

Intravenous Infusion ◽

Intravenous Fluid ◽

Fluid Replacement ◽

Control Group ◽

A Prospective Study ◽

To Receive

AbstractIt has been suggested that children undergoing tonsillectomy would benefit from an intravenous infusion, to counteract the period of pre-operativefasting combined with the blood loss at operation.A prospective study of 50 children undergoing tonsillectomy was undertaken. The children were randomly allocated into two groups, one to receive an infusion and a control group.There were no significant differences between the two groups, although the children with an infusion had a longer mean post-operative stay.There would seem to be no role for routine intravenous fluid replacement in children undergoing uncomplicated tonsillectomy.

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Intraoperative blood loss during different stages of scoliosis surgery: A prospective study

Scoliosis ◽

10.1186/1748-7161-5-16 ◽

2010 ◽

Vol 5 (1) ◽

Cited By ~ 27

Author(s):

Hitesh N Modi ◽

Seung-Woo Suh ◽

Jae-Young Hong ◽

Sang-Heon Song ◽

Jae-Hyuk Yang

Keyword(s):

Blood Loss ◽

Prospective Study ◽

Scoliosis Surgery ◽

Intraoperative Blood Loss ◽

A Prospective Study

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Microendoscope-Assisted Versus Open Posterior Lumbar Interbody Fusion for Lumbar Degenerative Disease: A Multicenter Retrospective Cohort Study

Medicina ◽

10.3390/medicina57020150 ◽

2021 ◽

Vol 57 (2) ◽

pp. 150

Author(s):

Masayoshi Fukushima ◽

Nozomu Ohtomo ◽

Michita Noma ◽

Yudai Kumanomido ◽

Hiroyuki Nakarai ◽

...

Keyword(s):

Interbody Fusion ◽

Intraoperative Complications ◽

Operating Time ◽

Posterior Lumbar Interbody Fusion ◽

Fusion Rate ◽

Open Group ◽

Lumbar Interbody Fusion ◽

Lumbar Degenerative Disease ◽

Radiographic Findings ◽

One Year

Background and objectives: Minimally invasive surgery has become popular for posterior lumbar interbody fusion (PLIF). Microendoscope-assisted PLIF (ME-PLIF) utilizes a microendoscope within a tubular retractor for PLIF procedures; however, there are no published reports that compare Microendoscope-assisted to open PLIF. Here we compare the surgical and clinical outcomes of ME-PLIF with those of open PLIF. Materials and Methods: A total of 155 consecutive patients who underwent single-level PLIF were registered prospectively. Of the 149 patients with a complete set of preoperative data, 72 patients underwent ME-PLIF (ME-group), and 77 underwent open PLIF (open-group). Clinical and radiographic findings collected one year after surgery were compared. Results: Of the 149 patients, 57 patients in ME-group and 58 patients in the open-group were available. The ME-PLIF procedure required a significantly shorter operating time and involved less intraoperative blood loss. Three patients in both groups reported dural tears as intraoperative complications. Three patients in ME-group experienced postoperative complications, compared to two patients in the open-group. The fusion rate in ME-group at one year was lower than that in the open group (p = 0.06). The proportion of patients who were satisfied was significantly higher in the ME-group (p = 0.02). Conclusions: ME-PLIF was associated with equivalent post-surgical outcomes and significantly higher rates of patient satisfaction than the traditional open PLIF procedure. However, the fusion rate after ME-PLIF tended to be lower than that after the traditional open method.

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Comparison of peribulbar anesthesia and topical anesthesia on outcome of phacoemulsification

International Journal of Research in Medical Sciences ◽

10.18203/2320-6012.ijrms20172456 ◽

2017 ◽

Vol 5 (6) ◽

pp. 2608 ◽

Cited By ~ 2

Author(s):

Rishi Mehta ◽

Sharda Punjabi ◽

Nutan Bedi ◽

Chandra Kant Nagar

Keyword(s):

Intraoperative Complications ◽

Visual Outcome ◽

Topical Anesthesia ◽

Satisfaction Score ◽

The Other ◽

Patients Satisfaction ◽

Peribulbar Anesthesia ◽

Group 2 ◽

A Prospective Study ◽

Group 1

Background: Due to advancement in phacoemulsification techniques, there has been growing shift from peribulbar anesthesia (PA) to topical anesthesia (TA). But dilemma exists regarding the supremacy of one over the other as both types have certain advantages and disadvantages.Methods: A prospective study was conducted. Patients were divided into two groups. Group-1 underwent PA while group-2 underwent TA. Satisfaction score of patients and surgeons and incidence of complications were noted. The data was analyzed.Results: Lowest patients’ satisfaction score among group-1 vs. group-2 was 160 (87.9%) vs.82 (45.81%). Highest surgeons satisfaction score among group-1 and group-2 was 74(40.65%) vs. 2(1.1%). Intraoperative complications among the group-1 and group-2 were 35 (19.2%) vs. 86(48.0%).Conclusions: While TA provides initial painless phase of surgical procedure, PA results in lesser intraoperative complications resulting in better visual outcome.

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Blood loss predictive factors and transfusion practice during percutaneous nephrolithotomy of kidney stones: a prospective study

F1000Research ◽

10.12688/f1000research.8993.1 ◽

2016 ◽

Vol 5 ◽

pp. 1550 ◽

Cited By ~ 4

Author(s):

Firtantyo Adi Syahputra ◽

Ponco Birowo ◽

Nur Rasyid ◽

Faisal Abdi Matondang ◽

Endrika Noviandrini ◽

...

Keyword(s):

Blood Loss ◽

Prospective Study ◽

Percutaneous Nephrolithotomy ◽

Predictive Factors ◽

Transfusion Practice ◽

Influential Factor ◽

Full Blood Count ◽

Baseline Serum ◽

Stone Burden ◽

A Prospective Study

Objectives Bleeding is the most common complication of percutaneous nephrolithotomy (PCNL). Injudicious transfusion is frequently performed in current practice, even though it is not always needed. This study aimed to identify the predictive factors of blood loss in the PCNL procedure and evaluate the perioperative transfusion practice. Methods A prospective study of PCNL was randomly performed by two consultants of endo-urology at our institution. The inclusion criteria were adults with kidney pelvic stones >20 mm or stone in inferior calyx >10 mm or staghorn stone. Those with coagulopathy, under anti-coagulant treatment or open conversion were excluded. A full blood count was taken at baseline and during 12, 24, 36, 72-hours post-operatively. Factors such as stone burden, sex, body surface area, shifting of hematocrit level and amount of blood transfused were analyzed statistically using line regression to identify the predictive factors of total blood loss (TBL). Results Eighty-five patients were enrolled in this study. Mean TBL was 560.92 ± 428.43 mL for both endo-urology surgeons. Stone burden was the most influential factor for TBL (p=0.037). Our results revealed that TBL (mL) = -153.379 + 0.229 × stone burden (mm2) + 0.203 x baseline serum hematocrit (%); thus considerably predicted the need for blood transfusion. A total of 87.1% patients did not receive perioperative transfusion, 3.5% received intra-operative transfusion, 7.1% received post-operative transfusion, 23% had both intra and post-operative transfusion, resulting in a cross-matched transfusion ratio of 7.72. Mean perioperative blood transfused was 356.00 ± 145.88 mL.

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