Totally laparoscopic pancreaticoduodenectomy: Learning curve.

e14717 Background: Laparoscopic pancreaticoduodenectomy (LPDE) has become increasingly popular in the world and now is considered to be a technically feasible and safe procedure for patients with tumors of the head of the pancreas and the periampullare area. At the same time, according to the literature data, a lot of surgeons stop performing totally laparoscopic pancreaticoduodenectomy (TLPDE) after 5 – 15 procedures because of the difficulties of learning curve. Aim of thew study: to evaluate the learning curve of totally laparoscopic pancreaticoduodenectomy. Methods: The data of 43 patients who were planed for LPDE during 5 year were analyzed. All the procedures were performed by one surgical team. 35 patients underwent totally laparoscopic pancreaticoduodenectomy (TLPDE). For 8 patients the procedures were palliative or converted. Patients were divided in three groups. Group A, B and C – 12;12;11 patients respectively. Operative time, intraoperative blood loss and the level of postoperative morbidity were examined. Results: Among the 43 patients, 35 patients underwent TLPDE. The conversion rate was in the group A - 33% (4 patients), group B – 33%(4 patients) and group C – no conversions. Mean operative time of TLPDE for the group A was - 542min; group B – 542min and group C less than 360min, minimally - 280). Mean blood loss was for group A - 683ml, group B – 612ml and group C 250ml. Total level of all kinds of postoperative morbidity was: group A - 66,5%, group B – 65,5% and group C – 36,0%. Postoperative mortality was: group A - 8,3%(one of the patients died from insufficiency of the pancreatojejenostomy, another – because of acute heart failure without any surgical complications); group B – 0% and group C - 0%. Conclusions: The results of TLPDE become significantly better after 25 procedures. The most difficult and potentially dangerous for intra and postoperative complications were: dissection along superior mesenteric and portal vein and suturing of pancreaticojejuno anastomosis. Performing TLPDE by the same team, including nurses, is a very important factor for quick learning curve and safety.

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Laparoscopic Radical Prostatectomy: The Learning Curve of a Low Volume Surgeon

The Scientific World JOURNAL ◽

10.1155/2013/974276 ◽

2013 ◽

Vol 2013 ◽

pp. 1-5 ◽

Cited By ~ 4

Author(s):

Anuar I. Mitre ◽

Mario F. Chammas ◽

José Eugênio A. Rocha ◽

Ricardo Jordão Duarte ◽

Gustavo Xavier Ebaid ◽

...

Keyword(s):

Radical Prostatectomy ◽

Blood Loss ◽

Learning Curve ◽

Operative Time ◽

Surgical Margin ◽

Positive Surgical Margin ◽

Estimated Blood Loss ◽

Group A ◽

Low Volume ◽

Group B

Objective. Analyze the learning curve for laparoscopic radical prostatectomy in a low volume program.Materials and Methods. A single surgeon operated on 165 patients. Patients were consecutively divided in 3 groups of 55 patients (groups A, B, and C). An enhancement of estimated blood loss, surgery length, and presence of a positive surgical margin were all considered as a function of surgeon’s experience.Results. Operative time was 267 minutes for group A, 230 minutes for group B, and 159 minutes for group C, and the operative time decreased over time, but a significant difference was present only between groups A and C (). Mean estimated blood loss was 328 mL, 254 mL, and 206 mL (). A conversion to open surgery was necessary in 4 patients in group A. Positive surgical margin rates were 29.1%, 21.8%, and 5.5% (). Eight patients in group A, 4 patients in group B, and one in group C had biochemical recurrence.Conclusion. Significantly less intraoperative complications were evident after the first 51 cases. All other parameters (blood loss, operative time, and positive surgical margins) significantly decreased and stabilized after 110 cases. Those outcomes were somehow similar to previous published series by high-volume centers.

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TONSILLECTOMY IN PAEDIATRIC POPULATION

The Professional Medical Journal ◽

10.29309/tpmj/2016.23.04.1540 ◽

2016 ◽

Vol 23 (04) ◽

pp. 499-503

Author(s):

Raheel Ahmad ◽

Farhan Salam ◽

Abdul Saeed Khan ◽

Faisal Bashir ◽

Atif Rafique

Keyword(s):

Standard Deviation ◽

Blood Loss ◽

Operative Time ◽

Controlled Trial ◽

Operation Time ◽

Group A ◽

Group B ◽

Cold Steel Dissection ◽

Cold Dissection ◽

Dissection Method

Objectives: To compare mean operative time and Intra operative blood lossbetween bipolar electro dissection and cold dissection tonsillectomy in paediatric population.Study Design: Randomized controlled trial. Place and Duration: Department of ENT and Headand Neck Surgery, Continental Medical College, Hospital Lahore, from 1 January 2015 to 30September 2015. Materials and Methods: This study included 164 patients of age group 4 to12 years of either gender undergoing tonsillectomy. The patients were divided into two equalgroups designated as A and B each having 82 patients using simple random sampling. Patientsin group A were operated for tonsillectomy by bipolar electrocautry while group B underwenttonsillectomy by cold steel dissection method. All patients in both groups were assessed foroperating time and intra-operative blood loss. Results: Out of 82 cases of Bipolar DissectionGroup 49(60%) patients were male and 33(40%) patients were female. Whereas in 82 casesof Cold Dissection Group 51(62%) patients were male and 31(38%) patients were female.Mean age of patients was 7.2(SD ± 1.97) years. Mean operation time was 15 minutes withstandard deviation ± 1.21 in group A as compared to group B where mean operation time was20 minutes with standard deviation ± 1.87. Mean blood loss was 7 ml with standard deviation± 2.53 in patients of group A as compared to Patients in group B who mean blood loss of 30ml with standard deviation ± 3.46. Group A had statistically significant lower operative time andblood loss than group B. Conclusion: Tonsillectomy with bipolar electro dissection method ismuch better than cold steel dissection method. It has an advantage of less blood loss duringsurgery. It significantly reduces intra operative time.

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Comparison of Clinical and Radiologic Outcome of Adolescent Idiopathic Scoliosis Treated with Hybrid Hook-Screw Instrumentation versus Universal Clamp System

Advances in Medicine ◽

10.1155/2016/7639727 ◽

2016 ◽

Vol 2016 ◽

pp. 1-5 ◽

Cited By ~ 2

Author(s):

Ebrahim Ghayem Hassankhani ◽

Farzad Omidi-Kashani ◽

Shahram Moradkhani ◽

Golnaz Ghayem Hassankhani ◽

Mohammad Taghi Shakeri

Keyword(s):

Adolescent Idiopathic Scoliosis ◽

Blood Loss ◽

Idiopathic Scoliosis ◽

Operative Time ◽

Intraoperative Blood Loss ◽

Curve Correction ◽

Universal Clamp ◽

Outcome Scores ◽

Group A ◽

Group B

Background. In surgical treatment of adolescent idiopathic scoliosis (AIS), hybrid universal clamp system has been used by some authors. We aimed to compare the clinical and radiologic outcome of hybrid universal clamp with hybrid thoracic hook lumbar screw. Methods. A prospective study was performed on 56 consecutive patients with AIS, who had alternatively undergone a posterior spinal fusion and instrumentation with hybrid thoracic hook lumbar screw system (28 patients: group A) and hybrid universal clamp system (28 patients: group B) between June 2006 and January 2014 at Imam Reza University Hospital and had been followed up for more than two years. The comparison was according to radiographic changes, operative time, intraoperative blood loss, complications, and Scoliosis Research Society (SRS-22) outcome scores. Results. The preoperative mean curve Cobb angle was 58°±7° (42°–74°) in group A and 60°±9° (46°–75°) in group B. The mean final coronal curve correction was 60.4% and 75.5% in groups A and B, respectively (P=0.001). Postoperative SRS outcome scores were also comparable. Conclusion. Universal clamp instrumentation had a significantly better curve correction and lower complication rate compared with hybrid thoracic hook lumbar screw. Both instrumentation methods had similar operative time, intraoperative blood loss, and postoperative SRS outcome scores.

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Evaluation of the complications in laparoscopic retroperitoneal radical nephrectomy; An experience of high volume centre

Archivio Italiano di Urologia e Andrologia ◽

10.4081/aiua.2017.4.266 ◽

2017 ◽

Vol 89 (4) ◽

pp. 266 ◽

Cited By ~ 1

Author(s):

Ali Serdar Gozen ◽

Vitalie Gherman ◽

Yigit Akin ◽

Mustafa Suat Bolat ◽

Muhammad Elmussareh ◽

...

Keyword(s):

Learning Curve ◽

Complication Rate ◽

Radical Nephrectomy ◽

High Volume ◽

Safe Procedure ◽

Number Of Patients ◽

Lower Complication ◽

Lower Complication Rate ◽

Group A ◽

Group B

Objectives: To provide a standardised report of complications after retroperitoneal laparoscopic radical nephrectomy (rLRN) in a high-volume centre using Clavien-Dindo classification. Materials and methods: We analysed records maintained in a prospective database of 330 consecutive patients that underwent rLRN between March 1995 and September 2016. All complications were graded according to the modified Clavien-Dindo classification. Three generations of surgeons were defined and the learning curve in rLRN was evaluated by comparing the first 100 cases (Group A) performed by firstgeneration surgeons with the last 100 cases (Group B) by thirdgeneration surgeons. Results: The mean age of our cohort was 66 ± 11.9 years. The overall complication rate was 19.7%. The majority of complications (12.7%) were Clavien 1 (5.1%) and Clavien 2 (7.6%) and did not require any interventions; blood transfusion was the most frequently encountered intervention (4.8%). Half of which were because of major intraoperative bleeding. Mortality rate was 0.9%. We found a trend towards lower complication rate in group B (19%) compared to group A (23%); this was mainly because of the reduction in the incidence of Clavien 1 and 2 complications. The pathological stage varied significantly in the two groups while the rate of negative surgical margins was comparable. Conclusions: rLRN is a safe procedure with an acceptable rate of complications. The learning curve was shorter for the thirdgeneration surgeons (group B); although these surgeons operated on a significantly higher number of patients with more advanced diseases. The Clavien-Dindo classification is suitable for assessing rLRN complications. Adopting this standardised system can help in the evaluation and comparison of surgical quality of LRN series.

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Comparative study of modified Stoppa approach and ilioinguinal approach for pelviacetabular fractures

International Journal of Research in Orthopaedics ◽

10.18203/issn.2455-4510.intjresorthop20203037 ◽

2020 ◽

Vol 6 (5) ◽

pp. 1070

Author(s):

Ansari Muqtadeer Abdul Aziz ◽

Venktesh D. Sonkawade ◽

Shivkumar Santpure

Keyword(s):

Blood Loss ◽

Operative Time ◽

Direct Access ◽

Meralgia Paresthetica ◽

Ilioinguinal Approach ◽

Advantages And Disadvantages ◽

Quadrilateral Plate ◽

Stoppa Approach ◽

Group A ◽

Group B

Background: The present study was done to study advantages and disadvantages of modified Stoppa approach (MSA) and ilioinguinal approach (IIA) for surgery of pelviacetabular fractures involving anterior column, anterior wall, quadrilateral plate with protrusion and complex fractures, pelvic ring fractures with pubic diastasis or sacroiliac joint disruptions which needs to be stabilized anteriorly.Methods: Study was conducted in Department of Orthopaedics, Government Medical College and Hospital, Aurangabad on patients with pelviacetabular fractures during June 2018 to March 2020. In our study of 25 patients, they were divided into group A containing 13 patients operated using MSA and group B containing 12 patients operated using IIA. Follow up period was 12-18 months (mean=15) and 12-16 months (mean=14) for group A and B, respectively. Patients assessed using modified Merle d’Aubigné score and Matta’s score.Results: Mean modified Merle d’Aubigné score was 16 and 14 for group A and B, respectively (p value=0.89). Mean blood loss and operative time were less in MSA. Superficial infection was found in one patient each of group A and B whereas one patient developed deep infection in group B. One patient each of both group had hip pain suggestive of early arthrosis. In group B, two patients developed meralgia paresthetica. One patient developed external iliac artery thrombosis and inguinal hernia in group B. one patient from group A developed incisional hernia.Conclusions: MSA was better and simpler than IIA with due adequate training and practice to achieve direct access for pelviacetabular fracture reduction and also it requires less operative time, less blood loss and better postoperative outcome.

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Laparoscopic versus open hysterectomies in obese patients

International Surgery Journal ◽

10.18203/2349-2902.isj20185014 ◽

2018 ◽

Vol 5 (12) ◽

pp. 3893

Author(s):

Soliman A. El Shakhs ◽

Moharam A. Mohamed ◽

Mahmoud A. Shahin ◽

Ahmed M. Eid

Keyword(s):

Blood Loss ◽

Surgical Procedure ◽

Operative Time ◽

Laparoscopic Hysterectomy ◽

Obese Patients ◽

Optimal Route ◽

Significant Difference ◽

Group A ◽

Prospective Comparative Study ◽

Group B

Background: Hysterectomy is one of the most frequently performed surgical procedure. Though there are three approaches in hysterectomy (open, vaginal and laparoscopic), still there are controversies regarding the optimal route for performing it.Methods: This prospective comparative study included 42 obese patients subjected for pan-hysterectomy as a treatment. The forty-two patients were allocated into two groups: group (A) subjected to laparoscopic pan-hysterectomy, group (B) subjected to open pan-hysterectomy.Results: There was significant difference between the two groups regarding mean operative time, blood loss, analgesic requirements and hospital stay, while no significant difference regarding intra-operative complications.Conclusions: Laparoscopic hysterectomy in obese patients has emerged as a viable, safe and better alternative to open hysterectomy amongst appropriately trained surgeons.

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Comparison of microdebrider assisted adenoidectomy and adenoid curette adenoidectomy

International Journal of Otorhinolaryngology and Head and Neck Surgery ◽

10.18203/issn.2454-5929.ijohns20181669 ◽

2018 ◽

Vol 4 (3) ◽

pp. 819

Author(s):

Shaweta . ◽

Ramesh K. Azad ◽

R. S. Minhas ◽

Shobha Mohindroo

Keyword(s):

Blood Loss ◽

Operative Time ◽

Symptomatic Relief ◽

Complete Removal ◽

Operative Blood Loss ◽

Left Behind ◽

Adenoid Tissue ◽

Group A ◽

Residual Tissue ◽

Group B

Background: Adenoidectomy is the surgical procedure to remove the adenoids. It is conventionally performed using the curettage method. The aim is to compare between adenoid curette adenoidectomy and microdebrider assisted adenoidectomy.Methods: From April 2016 to March 2017, 50 patients (34 males and 16 females), requiring adenoidectomy were randomized into two groups each of twenty five. Group A underwent microdebrider assisted adenoidectomy. Group B underwent conventional adenoidectomy using the curettage method. The parameters studied were intra-operative time, blood loss, residual tissue, associated trauma, and post-operative symptomatic relief and complications. Results: Microdebrider assisted adenoidectomy was significantly better in terms of residual tissue left behind as compared to adenoid curette adenoidectomy (p<0.001), similar operative blood loss and operative time with no difference in complications.Conclusions: Microdebrider-assisted adenoidectomy is a safe and effective alternative to curettage method as it allows complete removal of adenoid tissue under direct vision.

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Assessment of Shoulder Function after Internal Fixation of Humeral Diaphyseal Fractures in Young Adults: A Prospective Comparative Study

Advances in Orthopedics ◽

10.1155/2021/9471009 ◽

2021 ◽

Vol 2021 ◽

pp. 1-6

Author(s):

Hossam Fathi Mahmoud ◽

Ahmed Hatem Farhan ◽

Fahmy Samir Fahmy

Keyword(s):

Young Adults ◽

Blood Loss ◽

Internal Fixation ◽

Operative Time ◽

Shoulder Function ◽

Humeral Shaft ◽

Humeral Shaft Fractures ◽

Shaft Fractures ◽

Group A ◽

Group B

Background. Humeral shaft fractures are commonly encountered in casualties. There are different methods of operative internal fixation with no consensus on the best technique. The objective of this study was to assess shoulder function and rate of complications among two different options of fixation, intramedullary nailing, and minimal invasive plate osteosynthesis (MIPO) in young adults. Methods. Forty-two patients with humeral shaft fractures were included in the study and divided into two equal groups: group A treated with antegrade intramedullary locked nails (IMN) and group B with MIPO. Fracture union was evaluated with serial X-rays, and shoulder function was assessed in both groups using the scale of the American Shoulder and Elbow Surgeons (ASES), University of California at Los Angeles Shoulder Scale (UCLA), and visual analog score (VAS). The mean differences between groups were recorded and considered significant if the P value was ˂0.05. Results. The results were reported prospectively with no significant differences in mean age, sex, side of injury, type of fracture, mechanism of injury, and the follow-up period between the groups studied. Group A had shorter operative time and minimal blood loss than group B. Regarding shoulder function scores (ASES, UCLA, and VAS), the results in the MIPO group were better than the IMN group with shorter time of union and fewer complications. Conclusion. Despite a shorter operative time and lower blood loss during locked intramedullary nail fixation in the management of humeral shaft fractures, MIPO enables more superior shoulder function with better fracture healing and lower morbidities.

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Expanded eggshell procedure combined with closing-opening technique (a modified vertebral column resection) for the treatment of thoracic and thoracolumbar angular kyphosis

Journal of Neurosurgery Spine ◽

10.3171/2014.11.spine14710 ◽

2015 ◽

Vol 23 (1) ◽

pp. 42-48 ◽

Cited By ~ 7

Author(s):

Xinyu Liu ◽

Suomao Yuan ◽

Yonghao Tian ◽

Lianlei Wang ◽

Yanping Zheng ◽

...

Keyword(s):

Blood Loss ◽

Vertebral Column ◽

Operative Time ◽

Kyphotic Angle ◽

Vertebral Column Resection ◽

Average Blood Loss ◽

Group A ◽

Angular Kyphosis ◽

Group B

OBJECT The purpose of this study was to determine the efficacy of a modified vertebral column resection for the treatment of thoracolumbar angular kyphosis. METHODS A total of 13 patients (8 male, 5 female) with thoracolumbar kyphosis (kyphotic angle > 60°) were included in this study (Group A). There were 3 patients with failure of spinal formation (Type 1 deformity), 6 patients with old thoracic or lumbar compression fracture, and 4 patients with old spinal tuberculosis (including 1 case of T3–5 vertebral malunion). The average preoperative kyphotic angle was 67.3° (range 62°–75°). Each patient underwent an expanded eggshell procedure combined with the closing-opening technique for the treatment of thoracolumbar angular kyphosis. Sixteen patients who were previously treated with a closing-opening wedge osteotomy in the same spine classification group (kyphotic angle > 60°) were used as a control group (Group B). RESULTS In Group A, the average (± SD) operative time was 400 ± 60 minutes, and the average blood loss was 960 ± 120 ml. There were no surgery-related complications observed during or after the operations. The average local kyphotic angle was 20.3° (range 18°–24.5°), and the average correction rate was 68.7%. In Group B, the average operative time was 470 ± 90 minutes, and the average blood loss was 2600 ± 1600 ml (range 1200–8200 ml). There were segmental vessels and spinal canal venous plexus injury in 1 case, spinal cord injury in 1 case, dural tearing in 2 cases, pleural rupture in 2 cases, and hemothorax and pneumothorax in 1 case. Each patient had more than 2 years of follow-up. At the latest follow-up examination, the average regional kyphotic angle was 19.9° ± 9.1° (range 19°–34°), and there was no significant loss of correction (p > 0.05). There was greater blood loss and a higher complication rate in Group B than in Group A (p < 0.05). CONCLUSIONS An expanded eggshell procedure combined with the closing-opening technique for the treatment of thoracolumbar angular kyphosis resulted in significant reduction of the kyphotic angle, few complications, and good follow-up results. However, a larger series of patients and long-term follow-up results is still required to verify the effectiveness and safety of this method.

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Comparison of Early versus Interval Tonsillectomy in Cases of Peritonsillar Abscess

Life and Science ◽

10.37185/lns.1.1.13 ◽

2020 ◽

Vol 1 (1) ◽

pp. 5

Author(s):

Muhammad Ahmed Khan ◽

Attique Ahmed ◽

Muhammad Khan

Keyword(s):

Blood Loss ◽

Operative Time ◽

Operation Time ◽

Peritonsillar Abscess ◽

Military Hospital ◽

Secondary Hemorrhage ◽

Perioperative Blood Loss ◽

Group A ◽

The Mean ◽

Group B

Objective: To compare early versus interval tonsillectomy in cases of peritonsillar abscess.Study Design: Comparative study.Place and Duration of Study: The study was carried out at ENT Department of Combined Military Hospital, Mardan from January 2017 to January 2018.Materials and Methods: A total 50 patients were selected from ENT outpatient department. All the cases were randomly divided into two groups of 25 each. Group A underwent early tonsillectomy after initial incision and drainage, Group B underwent interval tonsillectomy after 6 weeks. Both the groups were compared in terms of perioperative blood loss, operation time, ease of dissection and postoperative complications including pain and hemorrhage. Tonsillectomy was done with bipolar cautery in all the cases.Results: The mean age was 30.22 + 8.25. Out of 50 patients, 42 (84%) were males and 8 (16%) were females. The mean operative time of surgery in group A (early tonsillectomy) was 45.04+5.78 minutes compared to 32.72+4.37 minutes for group B (interval tonsillectomy (p=0.00). Mean post-operative pain in group A was 3.68+2.12 compared to group B where mean score was 3.36+1.93 (p=0.579). There were 3 cases of mild perioperative blood loss, 19 cases of moderate and 3 of severe perioperative blood loss in group A. There were 18 cases of mild perioperative blood loss, 7 cases of moderate and no case of severe perioperative blood loss in group B (p=0.00). Dissection was found to be significantly easier in group B (interval tonsillectomy). There were 7 cases of post-op secondary hemorrhage in group A compared to 3 in group B (p=0.289). All these cases of secondary hemorrhage were managed conservatively.Conclusion: Interval tonsillectomy is a safer procedure as compared to early tonsillectomy in terms of perioperative blood loss, operative time, dissection with almost similar post-op pain and similar risk of post tonsillectomy hemorrhage. How to cite this: Khan MA, Ahmed A, Khan M. Comparison of Early versus Interval Tonsillectomy in Cases of Peritonsillar Abscess. Life and Science. 2020; 1(1): 24-28. doi: https://doi.org/10.37185/L&S.1.1.13

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