scholarly journals Establishing pneumoperitoneum: Verres or Hasson? The debate continues

2011 ◽  
Vol 93 (1) ◽  
pp. 22-24 ◽  
Author(s):  
N Dunne ◽  
MI Booth ◽  
TCB Dehn
Keyword(s):  
Laparoscopic Surgery ◽  
Bowel Perforation ◽  
Complication Rates ◽  
Previous Surgery ◽  
Significant Difference ◽  
Verres Needle ◽  
A Prospective Study ◽  
Based Medicine ◽  
Open Port ◽  
Upper Gastrointestinal

INTRODUCTION The technique of establishing pneumoperitoneum for laparoscopic surgery remains contentious, with various different techniques available and each having its own advocates. The Verres needle approach has attracted much criticism and is seen to entail more risk, but is this view justified in the era of evidence-based medicine? PATIENTS AND METHODS Over a 6-year period, a prospective study was undertaken of 3126 patients who underwent laparoscopic surgery performed by two upper gastrointestinal surgeons. One surgeon preferred the Verres needle and the other an open technique. A database was created of all cases and complication rates of the different techniques ascertained. RESULTS Peri-umbilical Verres needle was used in 1887 cases (60.4%) with two complications encountered, both of which were colonic injuries, with an incidence of 0.1%. Open port insertion was used in 1200 cases (38.4%) with one complication, a small bowel perforation, to give an incidence of 0.08%. The Verres needle was used in alternative positions in 22 cases (0.75%) and, when used in the left upper quadrant (19 cases), there was one complication, a left hepatic lobe puncture, with an incidence of 5.26%. Our overall incidence of intra-abdominal injury was 0.13%, all in patients who had undergone previous abdominal surgery, and in the subgroup of patients with previous surgery the rate was 0.78%. There was no mortality. CONCLUSIONS Practice varies as to the method chosen to induce pneumoperitoneum, but our results show there is no significant difference between the technique chosen and incidence of complications, and this is supported in the literature.

A Prospective Study Comparing Cancer Detection Rates of Transperineal Prostate Biopsies Performed by Junior Urologists Versus a Senior Consultant in a Real World-setting

2020 ◽  
Author(s):  
Jiaao Song ◽  
Bi-ming He ◽  
Hu-sheng Li ◽  
Zhen-kai Shi ◽  
Guan-yu Ren ◽  
...  
Keyword(s):  
Specific Antigen ◽  
Daily Practice ◽  
Secondary Outcome ◽  
Complication Rates ◽  
Detection Rates ◽  
Prostate Biopsies ◽  
Significant Difference ◽  
Procedural Time ◽  
Practice Method ◽  
A Prospective Study

Abstract Background: Prostate biopsy (PB) is a typical daily practice method for the diagnosis of prostate cancer (PCa). This study was to compare the PCa detection rate and peri- and post-operative complications of PB among three residents and a consultant.Methods: A total of 343 patients who underwent PB between August 2018 with July 2019 were involved in this study. Residents were systematically trained two weeks by the consultant for performing systemic biopsy (SB) and targeted biopsy (TB). And then, three residents and the consultant performed PB independently every quarter due to routine rotation in daily practice. The peri- and post-operative data was prospectively collected. The primary outcome and secondary outcome were to compare the PCa-detection rates and complications between residents and consultant, respectively. Results: There was no significant difference between the residents and consultant in terms of overall PCa-detection rates of SB, TB or further stratified by prostate specific antigen value, prostate imaging reporting and data system (PI-RADS) scores. We found the consultant had more TB cores compared with residents (175 cores versus 86 to 114 cores, P=0.043) and shorter procedural time versus residents (mean 16 min versus 19.7 to 20.1 min, P <0.001). The complication rate for consultant was 6.7%, and 5% to 8.2% for residents, respectively (P = 0.875).Conclusions: The residents could get a similar PCa detection and complication rates compared with the consultant after a two-week training. However, the residents still need more cases to shorten the time of biopsy procedure.

scholarly journals Comparison of clinical outcomes following CuT-380A insertion in postplacental period with interval insertion

2017 ◽  
Vol 6 (9) ◽  
pp. 4111
Author(s):  
Divya Chauhan ◽  
Shalini Gainder
Keyword(s):  
Caesarean Section ◽  
Vaginal Delivery ◽  
Mode Of Delivery ◽  
Abnormal Uterine Bleeding ◽  
Complication Rates ◽  
Expulsion Rate ◽  
Interval Group ◽  
Obstetrics And Gynaecology ◽  
Significant Difference ◽  
A Prospective Study

Background: Postplacental intra-uterine device has many benefits like providing contraception immediately after childbirth, non-interference with lactation and high efficacy. However, concerns about its safety have led to decreased use of this method of contraception. Hence, this study aims to compare the complication rates following insertion of immediate postplacental IUCD (PPIUCD) with interval insertion.Methods: This is a prospective study conducted under the Department of Obstetrics and Gynaecology in PGIMER, Chandigarh. 196 women were included in the study. Women were divided in two groups, those who were inserted with immediate postplacental IUCD versus those who had IUCD insertion in interval period. The two groups were followed up for a period of 6 months and complications were recorded. The PPIUCD group was further subdivided into 2 subgroups based on mode of delivery, vaginal delivery and caesarean section. These PPIUCD subgroups were also compared.Results: There was no statistically significant difference in the incidence of pelvic pain, infection, abnormal uterine bleeding and expulsion between the PPIUCD and interval group. However, when the PPIUCD subgroups were compared, it was seen that no woman in caesarean section subgroup had expulsion of IUCD whereas 9.8% women had expulsion in the vaginal delivery PPIUCD subgroup.Conclusions: Postplacental and interval IUCD seem to be comparable for the incidence of various complications. However, intra-caesarean PPIUCD insertion seems to have a much lower expulsion rate as compared to vaginal delivery PPIUCD insertion.

scholarly journals Port site complications following laparoscopic surgeries: a prospective study

2018 ◽  
Vol 5 (2) ◽  
pp. 598
Author(s):  
Madan Mohan Mudgal ◽  
Pradeep Kumar Kothiya ◽  
Naveen Kushwah ◽  
Raghvendra Singh
Keyword(s):  
Laparoscopic Surgery ◽  
Hypertrophic Scar ◽  
Minimal Invasive Surgery ◽  
Minimal Invasive ◽  
Port Site ◽  
Age Group ◽  
Site Infection ◽  
Visceral Injury ◽  
Verres Needle ◽  
A Prospective Study

Background: Port site complications are bothersome complications which undermine the benefits of minimal invasive surgery, not only does it add to the morbidity of the patient but also spoil the reputation of the surgeon. Aims and objective of the study was to determine the morbidity associated with the port site complications in laparoscopic surgery and to identify risk factors for complications.Methods: Three hundred patients having age between 15-50 years admitted for elective laparoscopic procedure were studied. All the patients had preoperative workup and general anaesthesia was given with endotracheal intubation. The patients were observed for any port-site complication during operation and in the immediate and postoperative till three months.Results: Female preponderance (77.34%) was observed with maximum patients belonging to age group of 41-50 years (31.7%). Majority of the patients were in the BMI range of 18.5-25kg/m2 (53.33%). In 54.66% and45.33% patients Verres needle and Hasson’s (Open) method was used to create pneumoperitoneum. Cholecystectomy was the indication in 80% patients. Port site morbidity was observed in 8.67% patients. As an early port site complication, bleeding, surgical site infection, emphysema and visceral injury was observed in 6, 8, 4 and 1 patient respectively. As a late port site complication, 4 and 3 patients developed hernia and hypertrophic scar respectively.Conclusions: Port site complications are least in elective laparoscopic surgery.

scholarly journals A Prospective Study Comparing Cancer Detection Rates of Transperineal Prostate Biopsies Performed by Junior Urologists versus a Senior Consultant in a Real-World Setting

2021 ◽  
pp. 1-7
Author(s):  
Jia-ao Song ◽  
Bi-ming He ◽  
Hu-sheng Li ◽  
Xiao-wen Yu ◽  
Zhen-kai Shi ◽  
...  
Keyword(s):  
Specific Antigen ◽  
Daily Practice ◽  
Secondary Outcome ◽  
Complication Rates ◽  
Detection Rates ◽  
Prostate Biopsies ◽  
Significant Difference ◽  
Procedural Time ◽  
Practice Method ◽  
A Prospective Study

<b><i>Introduction:</i></b> Prostate biopsy (PB) is a typical daily practice method for the diagnosis of prostate cancer (PCa). This study aimed to compare the PCa detection rates and peri- and postoperative complications of PB among 3 residents and a consultant. <b><i>Patients and Methods:</i></b> A total of 343 patients who underwent PB between August 2018 and July 2019 were involved in this study. Residents were systematically trained for 2 weeks by a consultant for performing systematic biopsy (SB) and targeted biopsy (TB). And then, 3 residents and the consultant performed PB independently every quarter due to routine rotation in daily practice. The peri- and postoperative data were collected from a prospectively maintained database (www.pc-follow.cn). The primary outcome and secondary outcome were to compare the PCa detection rates and complications between the residents and consultant, respectively. <b><i>Results:</i></b> There was no significant difference between the residents and consultant in terms of overall PCa detection rates of SB and TB or further stratified by prostate-specific antigen value and prostate imaging reporting and data system (PI-RADS) scores. We found the consultant had more TB cores (175 cores vs. 86–114 cores, <i>p</i> = 0.043) and shorter procedural time (mean 16 min vs. 19.7–20.1 min, <i>p</i> &#x3c; 0.001) versus the residents. The complication rate for the consultant was 6.7% and 5%–8.2% for the residents, respectively (<i>p</i> = 0.875). <b><i>Conclusions:</i></b> The residents could get similar PCa detection and complication rates compared with that of the consultant after a 2-week training. However, the residents still need more cases to shorten the time of the biopsy procedure.

Comparison of Medical Therapy Alone to Medical Therapy with Surgical Treatment of Peritonsillar Abscess

2017 ◽  
Vol 158 (2) ◽  
pp. 280-286 ◽  
Author(s):  
Alex Battaglia ◽  
Raoul Burchette ◽  
Jacob Hussman ◽  
Matthew A. Silver ◽  
Peter Martin ◽  
...  
Keyword(s):  
Surgical Treatment ◽  
Medical Therapy ◽  
Treatment Success ◽  
Case Series ◽  
Peritonsillar Abscess ◽  
Complication Rates ◽  
Surgical Drainage ◽  
Opioid Use ◽  
Significant Difference ◽  
A Prospective Study

Objective This study was performed to determine whether the efficacy and safety of medical management of uncomplicated peritonsillar abscess (PTA) presenting in the emergency department is equivalent to medical plus surgical therapy. Study Design Case series with chart review. Setting Southern California Permanente Medical Group (SCPMG). Subjects and Methods Upon successful completion of a prospective study comparing medical treatment (MT) to surgical treatment (ST) of PTA in 2008, MT was adopted by 12 SCPMG centers while 7 centers continued standard surgical drainage. Clinical outcomes are now reviewed on a random sampling of 211 patients with PTA treated with MT and 96 patients treated with ST between 2008 and 2013 at the respective medical centers. Patients were treated with intravenous (IV) fluids, weight-appropriate IV ceftriaxone, clindamycin, and dexamethasone, and then discharged on clindamycin × 10 days (MT). Patients in the ST group received MT but also surgical drainage. Primary end points were complication rates and failure rates. Results MT and ST resulted in no significant difference in treatment success or complications. However, patients in the MT group obtained significantly less liquid opioid prescriptions (MT, 30.8 ± 5.65; ST, 77.75 ± 13.41; P < .0001), reported fewer sore days (MT, 4.48 ± 0.27; ST, 5.77 ± 0.49; P = .0004), and required less days off from work (MT, 3.4 ± 0.44; ST, 4.9 ± 0.82; P = .044). Conclusions Compared to ST, MT appears to be equally safe and efficacious, with less pain, opioid use, and days off work, especially if patients with PTA present without trismus. MT for PTAs reduces the possibility of surgical complications, as well as the cost and inconvenience associated with ST.

Lateral lumbar interbody fusion in revision surgery for restenosis after posterior decompression

2020 ◽  
Vol 49 (3) ◽  
pp. E11 ◽  
Author(s):  
Yoshifumi Kudo ◽  
Ichiro Okano ◽  
Tomoaki Toyone ◽  
Akira Matsuoka ◽  
Hiroshi Maruyama ◽  
...  
Keyword(s):  
Revision Surgery ◽  
Spinal Canal ◽  
Interbody Fusion ◽  
Decompression Surgery ◽  
Complication Rates ◽  
Lumbar Interbody Fusion ◽  
Posterior Decompression ◽  
Lateral Lumbar Interbody Fusion ◽  
Significant Difference ◽  
Dural Tears

OBJECTIVEThe purpose of this study was to compare the clinical results of revision interbody fusion surgery between lateral lumbar interbody fusion (LLIF) and posterior lumbar interbody fusion (PLIF) or transforaminal lumbar interbody fusion (TLIF) with propensity score (PS) adjustments and to investigate the efficacy of indirect decompression with LLIF in previously decompressed segments on the basis of radiological assessment.METHODSA retrospective study of patients who underwent revision surgery for recurrence of neurological symptoms after posterior decompression surgery was performed. Postoperative complications and operative factors were evaluated and compared between LLIF and PLIF/TLIF. Moreover, postoperative improvement in cross-sectional areas (CSAs) in the spinal canal and intervertebral foramen was evaluated in LLIF cases.RESULTSA total of 56 patients (21 and 35 cases of LLIF and PLIF/TLIF, respectively) were included. In the univariate analysis, the LLIF group had significantly more endplate injuries (p = 0.03) and neurological deficits (p = 0.042), whereas the PLIF/TLIF group demonstrated significantly more dural tears (p < 0.001), surgical site infections (SSIs) (p = 0.02), and estimated blood loss (EBL) (p < 0.001). After PS adjustments, the LLIF group still showed significantly more endplate injuries (p = 0.03), and the PLIF/TLIF group demonstrated significantly more dural tears (p < 0.001), EBL (p < 0.001), and operating time (p = 0.04). The PLIF/TLIF group showed a trend toward a higher incidence of SSI (p = 0.10). There was no statistically significant difference regarding improvement in the Japanese Orthopaedic Association scores between the 2 surgical procedures (p = 0.77). The CSAs in the spinal canal and foramen were both significantly improved (p < 0.001).CONCLUSIONSLLIF is a safe, effective, and less invasive procedure with acceptable complication rates for revision surgery for previously decompressed segments. Therefore, LLIF can be an alternative to PLIF/TLIF for restenosis after posterior decompression surgery.

scholarly journals Prognostic significance of peritoneal cytology in low-risk endometrial cancer: comparison of laparoscopic surgery and laparotomy

2021 ◽  
Author(s):  
Satoe Fujiwara ◽  
Ruri Nishie ◽  
Shoko Ueda ◽  
Syunsuke Miyamoto ◽  
Shinichi Terada ◽  
...  
Keyword(s):  
Endometrial Cancer ◽  
Laparoscopic Surgery ◽  
Retrospective Study ◽  
Prognostic Significance ◽  
Low Risk ◽  
Peritoneal Cytology ◽  
Chi Square ◽  
Significant Difference ◽  
Chi Square Test ◽  
Positive Peritoneal Cytology

Abstract Background There is uncertainty surrounding the prognostic value of peritoneal cytology in low-risk endometrial cancer, especially in laparoscopic surgery. The objective of this retrospective study is to determine the prognostic significance of positive peritoneal cytology among patients with low-risk endometrial cancer and to compare it between laparoscopic surgery and conventional laparotomy. Methods From August 2008 to December 2019, all cases of pathologically confirmed stage IA grade 1 or 2 endometrial cancer were reviewed at Osaka Medical College. Statistical analyses used the Chi-square test and the Kaplan–Meier log rank. Results A total of 478 patients were identified: 438 with negative peritoneal cytology (232 who underwent laparotomy and 206 who undertook laparoscopic surgery) and 40 with positive peritoneal cytology (20 who underwent laparotomy and 20 who received laparoscopic surgery). Survival was significantly worse among patients with positive peritoneal cytology compared to patients with negative peritoneal cytology. However, there was no significant difference among patients with negative or positive peritoneal cytology between laparoscopic surgery and laparotomy. Conclusion This retrospective study suggests that, while peritoneal cytology is an independent risk factor in patients with low-risk endometrial cancer, laparoscopic surgery does not influence the survival outcome when compared to laparotomy.

scholarly journals Intracameral Bevacizumab Versus Sub-Tenon’s Mitomycin C as Adjuncts to Trabeculectomy: 3-Year Results of a Prospective Randomized Study

2021 ◽  
Vol 10 (10) ◽  
pp. 2054
Author(s):  
Gerasimos Kopsinis ◽  
Dimitrios Tsoukanas ◽  
Dimitra Kopsini ◽  
Theodoros Filippopoulos
Keyword(s):  
Mitomycin C ◽  
Primary Outcome ◽  
Randomized Study ◽  
Primary Outcome Measure ◽  
Complication Rates ◽  
Filtration Surgery ◽  
Significant Difference ◽  
Exfoliative Glaucoma

Conjunctival wound healing determines success after filtration surgery and the quest for better antifibrotic agents remains active. This study compares intracameral bevacizumab to sub-Tenon’s mitomycin C (MMC) in trabeculectomy. Primary open-angle or exfoliative glaucoma patients were randomized to either bevacizumab (n = 50 eyes) or MMC (n = 50 eyes). The primary outcome measure was complete success, defined as Intraocular Pressure (IOP) > 5 mmHg and ≤ 21 mmHg with a minimum 20% reduction from baseline without medications. Average IOP and glaucoma medications decreased significantly in both groups at all follow-up points compared to baseline (p < 0.001), without significant difference between groups at 3 years (IOP: bevacizumab group from 29 ± 9.4 to 15 ± 3.4 mmHg, MMC group from 28.3 ± 8.7 to 15.4 ± 3.8 mmHg, p = 0.60; Medications: bevacizumab group from 3.5 ± 0.9 to 0.5 ± 1, MMC group from 3.6 ± 0.7 to 0.6 ± 1.1, p = 0.70). Complete success, although similar between groups at 3 years (66% vs. 64%), was significantly higher for bevacizumab at months 6 and 12 (96% vs. 82%, p = 0.03; 88% vs. 72%, p = 0.04, respectively) with fewer patients requiring medications at months 6, 9 and 12 (4% vs. 18%, p = 0.03; 6% vs. 20%, p = 0.04; 8% vs. 24%, p = 0.03, respectively). Complication rates were similar between groups. In conclusion, intracameral bevacizumab appears to provide similar long-term efficacy and safety results as sub-Tenon’s MMC after trabeculectomy.

scholarly journals Is jumbo biopsy forceps comparable to cold snare for diminutive colorectal polyps? – a meta-analysis

2021 ◽  
Vol 09 (01) ◽  
pp. E9-E13
Author(s):  
Sachin Srinivasan ◽  
Peter D. Siersema ◽  
Madhav Desai
Keyword(s):  
Meta Analysis ◽  
Complete Removal ◽  
Colorectal Polyps ◽  
Comparable Efficacy ◽  
Incomplete Resection ◽  
Complication Rates ◽  
Biopsy Forceps ◽  
Significant Difference ◽  
Leave One Out ◽  
Endoscopic Assessment

Abstract Background and study aims Diminutive colorectal polyps are increasingly being detected and it is not clear whether jumbo biopsy forceps (JBF) has comparable efficacy to that of cold snare polypectomy (CSP) for management of these lesions. Methods An electronic literature search was performed for studies comparing resection rates of JBF and CSP for diminutive polyps (≤ 5 mm). The primary outcome was incomplete resection rate (IRR). Secondary outcomes included failure of tissue retrieval and complication rates (post-polypectomy bleeding, perforation etc.). Leave-one-out analysis was performed to examine the disproportionate role of any of the studies. Meta-analysis outcomes and heterogeneity (I2) were computed using Comprehensive meta-analysis software. Results A total of 4 studies (3 randomized controlled trials and 1 retrospective study) with 407 patients and 569 total polyps (mean size of 3.62 mm) was included for analysis. IRR of JBF was slightly higher than that of CSP (10.2 % vs 7.2 %) but this was not statistically significantly different (Pooled OR 1.76; 95 % CI 0.94–3.28; I2 = 0). Leave-one-out analysis showed no significant difference in the pooled OR comparison either. Two of the 4 studies reported 0 % failure of tissue retrieval for JBF and 1 % and 4.3 % for CSP. There were no complications for either group from the 2 studies that reported this outcome. The quality of the included studies was moderate to high. Conclusions This systematic review with only limited data shows that JBF and CSP are not statistically different in completely removing diminutive polyps, although careful endoscopic assessment is needed to ensure complete removal of all polyp tissue.

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