scholarly journals Decoding the learning curve of non-descent vaginal hysterectomy in the era of laparoscopy- experience at a Zonal Hospital

2021 ◽  
Vol 10 (5) ◽  
pp. 2015
Author(s):  
Shikha Sharma ◽  
Jafar Husain ◽  
Anshul Jain ◽  
Sruthi Bhaskaran ◽  
Raj Singh ◽  
...  
Keyword(s):  
Learning Curve ◽  
Vaginal Hysterectomy ◽  
Limited Resource ◽  
Laparoscopic Hysterectomy ◽  
Military Hospital ◽  
Vaginal Route ◽  
Program Objective ◽  
Group 2 ◽  
Set Up ◽  
Group 1

Background: Despite of the increasing popularity of laparoscopic hysterectomy, vaginal route still stays pertinent. Non descent vaginal hysterectomy (NDVH) involves d steep learning curve and hence, should be a fundamental part of every Gynaecology residency program. Objective of the study was to assess the learning curve of NDVH surgery skill at a Military Zonal Hospital by a single Specialist over a period of two years.Methods: Retrospective study conducted at Military Hospital, Agra between June 2015 to June 2017 on 30 patients who underwent NDVH for benign gynaecological conditions.Results: The average blood loss was noted to reduce from a mean of 285ml (±108.94) in the first 20 cases (Group 1) to 227ml (±110.89) in the next 10 cases (Group 2) despite of the average uterine size increasing from 8.5 (±1.43) weeks in Group 1 to 10.2 (±2.39) weeks in Group 2. The average time taken in minutes was also seen to reduce from 89.75 (±12.62) in Group 1 to 70.5 (±16.50) in Group 2 indicating an improvement of surgical skills. The average 24 hr post-operative haemoglobin fall of 0.8gm% was similar between the two groups.Conclusions: Acquiring NDVH skills is a slow but rewarding process. NDVH involves no incisions, no elaborate set-up, avoids complications of general anaesthesia and pneumo-peritoneum and displays similar results as of laparoscopy. In limited resource countries vaginal route may be the only available minimally invasive option for hysterectomy. Hence, it’s pertinent that Gynecologists are trained in the same. 

scholarly journals The Learning Curve of Total Laparoscopic Hysterectomy in a Rural Hospital

2019 ◽  
pp. 1
Author(s):  
İsmail Biyik ◽  
Mustafa Albayrak ◽  
Fatih Keskin ◽  
Ayse Nur Usturali Mut
Keyword(s):  
Online Education ◽  
Learning Curve ◽  
Operation Time ◽  
Laparoscopic Hysterectomy ◽  
Total Laparoscopic Hysterectomy ◽  
Certification Programs ◽  
Transfusion Requirements ◽  
Before And After ◽  
Group 2 ◽  
Group 1

<p><strong>OBJECTIVES:</strong> Online education and certification programs which help most gynecologic surgeons to advance, improve and prove their skills. However, the benefits of such distant programs in terms of complication rate and operation time has not been evaluated so far. The aim of this study was to report the improvement of a single surgeon’s learning curve in total laparoscopic hysterectomy who had no previous mentorship/fellowship education, working in a rural district hospital before and after the completion of a distant on-line education and certification program - Gynaecological Endoscopic Surgical Education and Assessment.<br /><strong></strong></p><p><strong>STUDY DESIGN:</strong> Medical records of patients who underwent total laparoscopic hysterectomy between May 2015 and December 2018 were retrospectively reviewed and grouped based on the certification date of the surgeon, Group 1 before and Group 2 after certification. Groups were compared for variables that impact the learning curve (operation time, complications and conversion to laparotomy)<br /><strong></strong></p><p><strong>RESULTS:</strong> Of the 57 women eligible for evaluation 30 had total laparoscopic hysterectomy in Group 1 and 27 had total laparoscopic hysterectomy in Group 2. BMI, number of vaginal/cesarean births, previous abdominal/pelvic surgeries, operation indications, uterine weight, adnexectomy, and adhesiolysis rates, transfusion requirements, and the decrease in hemoglobin before and after operation were similar between the groups (p&gt;0.05). Operation time was significantly shorter in Group 2 (83 min vs.116 min, p&lt;0.0001). <br /><strong></strong></p><p><strong>CONCLUSION:</strong> Thirty total laparoscopic hysterectomy operations seem enough to reach a plateau in the learning curve for gynecologists working in rural areas with limited facilities who cannot afford lengthily and expensive fellowship/mentorship programs, after completing distant online certification programs.</p>

scholarly journals Does transition from standard to Retzius-sparing technique in robot-assisted radical prostatectomy affect the functional and oncological outcomes?

2021 ◽  
Vol 93 (4) ◽  
pp. 399-403
Author(s):  
Hakan Anıl ◽  
Kaan Karamık ◽  
Ali Yıldız ◽  
Murat Savaş
Keyword(s):  
Radical Prostatectomy ◽  
Learning Curve ◽  
Surgical Margin ◽  
Nerve Sparing ◽  
Robot Assisted ◽  
Continence Status ◽  
Oncological Results ◽  
Group 2 ◽  
Group 1

Objective: To appraise the outcomes on the Retzius-sparing robot-assisted radical prostatectomy (Rs-RARP) learning curve of a surgeon with previous experience of anterior (standard) RARP. Materials and methods: The first 50 cases during the Rs-RARP learning curve (group 1) and 50 cases after the second 100 cases with the standard approach (group 2) were comprised in the study. Patients who used zero or one safety pads were considered continent. Erectile function recuperation was characterized as the competence to achieve penetrative intercourse without receiving any medication. All patients were reevaluated at two weeks, first, third, sixth, and 12th months after surgery using IIEF-5, PSA level, and continence status. Results: Immediate continence rates following catheter removal were 32/50 (64%) in Rs-RARP group and 26/50 (52%) in S-RARP group (p = 0.224). The continence recovery rate was 48/50 (96%) in Rs-RARP group and 46/50 (92%) in the S-RARP group at 12 months follow-up (p = 0.400). Total nerve-sparing surgery was enforced in 36/50 (72%) patients for group 1 and 35/50 (70%) patients for group 2. Potency recovery was 27/43 (62.8%) in Rs-RARP and 30/44 (68.2%) for S-RARP at 12 months follow up (p = 0.597). Surgical margin positivity was detected in 6/50 (12%) cases in the Rs-RARP group and in 4/50 (8%) cases in the S-RARP (p = 0.444). Conclusions: Functional and oncological results are not negatively affected in the first 50 cases for a surgeon who is experienced in S-RARP before transition to the Rs-RARP method.

scholarly journals Defining The Learning Curve of Single-Port Inflatable Mediastinoscopy With Simultaneous Laparoscopic-Assisted Surgery For Radical Esophagectomy

2021 ◽  
Author(s):  
Jinpeng Shi ◽  
Xiaojian Li ◽  
Tianchi Wu ◽  
Xiangwen Wu ◽  
Xiaojin Wang ◽  
...  
Keyword(s):  
Learning Curve ◽  
Single Port ◽  
Thoracoscopic Surgery ◽  
Surgical Team ◽  
Radical Esophagectomy ◽  
Extensive Experience ◽  
Estimated Blood Loss ◽  
Group 2 ◽  
Laparoscopic Assisted ◽  
Group 1

Abstract Background Single-port inflatable mediastinoscopy with simultaneous laparoscopic-assisted surgery for radical esophagectomy is a promising surgical method with high technical requirements and needs team cooperation. Therefore, it is necessary to define a learning curve to guide personnel training and improve the safety of these surgical techniques.Method This study prospectively analyzed the data of 79 consecutive patients, who underwent the surgery in the Fifth Affiliated Hospital of Sun Yat-sen University from October 2016 to May 2018. All of these patients were treated by the same surgical team with extensive experience in thoracotomy, laparotomy, thoracoscopic surgery and laparoscopic surgery. The learning curve was analyzed by cumulative summation (CUSUM) analysis, with the assessment of operative time, estimated blood loss, and postoperative complications.Result By analyzing these data, The scatter diagram of every measure showing a declining situation. The learning curve decreased beginning at 25th operation. All patients were chronologically divided into two groups, the group 1(the first 25 patients) and the group 2 (the last 54 patients). The median estimated blood loss of group 2 was lower than group 1(200 vs 100ml, p<0.05). No other clinic or pathologic characteristics were observed as significantly different.Conclusion For a surgical team with extensive experience in thoracotomy, laparotomy, thoracoscopic surgery and laparoscopic surgery, 25 cases are needed before becoming proficient in this surgery.

scholarly journals A randomized controlled trial comparing short-term versus long-term catheterization after vaginal prolapse surgery

1970 ◽  
Vol 2 (1) ◽  
pp. 29-34 ◽  
Author(s):  
Nupur Thakur ◽  
Geeta Gurung ◽  
Ashma Rana
Keyword(s):  
Urinary Tract Infection ◽  
Urinary Tract ◽  
Tract Infection ◽  
Urinary Retention ◽  
Vaginal Hysterectomy ◽  
Residual Volume ◽  
Short Term ◽  
Group 2 ◽  
Group 1

Aim: To determine whether short term bladder catheterisation for 24 hrs after vaginal hysterectomy for prolapse would be more advantageous to routinely practiced 3 days catheterisation. Method: Randomized comparative study was done as thesis topic in Gynaecological Ward of TU Teaching Hospital, Maharajgunj, Kathmandu from 30th October 2004 to 2nd November 2005. A total of 100 women were included in this study. Prior to surgery at OT table, and before giving prophylactic antibiotics urine samples were collected from metal catheter for routine analysis. They were randomized into two groups. In groups 1 (n=50) transurethral catheter was removed after 24 hrs of surgery. In group 2 (n=50) catheter was removed on 3rd post operative day. Urine culture was taken before removal of the catheter. Residual volume of urine after the first voiding was measured by transabdominal ultrasound. Recatheterisation for three more days was considered whenever residual volume exceeded 200ml. Result: Recatheterisation was not needed in either groups for residual volume >200ml. Regarding recatheterisation 4 needed them after 2-3 hrs of first voiding. Among these 4 women, cause of urinary retention was accountable for pelvic haematoma leading to pelvic abscess in one case, which belonged to group 1 where as urinary tract infection was responsible for urinary retention in group 2. There were no explainable causes in two cases. But urinary tract infection was seen in two cases in group 1 and 11 cases in group 2 (P value 0.017). Conclusion: This study has shown that short term catheterisation is more beneficial in terms of lower incidence of urinary tract infection (2 Vs 11) and related febrile morbidity as compared to long term catheterisation. Key words: Uterovaginal prolapse, pelvic floor repair with vaginal hysterectomy, catheterisation.   doi:10.3126/njog.v2i1.1473 N. J. Obstet. Gynaecol Vol. 2, No. 1, p. 29 - 34 May -June 2007

Impact of Introducing 2 Simple Technique Modifications on the Descemet Membrane Endothelial Keratoplasty Learning Curve

2016 ◽  
Vol 27 (1) ◽  
pp. 16-20 ◽  
Author(s):  
Francisco Arnalich-Montiel ◽  
Ane Pérez-Sarriegui ◽  
Alfonso Casado
Keyword(s):  
Learning Curve ◽  
Graft Failure ◽  
Endothelial Keratoplasty ◽  
Descemet Membrane Endothelial Keratoplasty ◽  
Descemet Membrane ◽  
Primary Graft Failure ◽  
Air Tamponade ◽  
Group 2 ◽  
The Impact ◽  
Group 1

Purpose To analyze the impact of performing premarking of the Descemet roll and using SF6 20% on a surgeon's Descemet membrane endothelial keratoplasty (DMEK) learning process. Methods A total of 30 consecutive eyes with endothelial dysfunction undergoing DMEK during the learning curve of a surgeon were retrospectively analyzed. Prior to the study, the surgeon had already performed 10 DMEKs. The first 15 consecutive patients were included in group 1 (no premarking and air tamponade) and the other 15 consecutive patients were included in group 2 (premarking and SF6 tamponade). Main outcome parameters were best-corrected visual acuity (BCVA), endothelial cell density (ECD) loss at 6 months, and intraoperative and postoperative complications. Results Among the 2 groups, BCVA and ECD loss at 6 months were similar. However, there was a statistically significant reduction in primary graft failure (40% vs 0%) and need of rebubbling due to complete or partial graft detachment (40% vs 6%) when comparing group 1 versus group 2. In group 1, half of the patients needing rebubbling had primary graft failure. Conclusions Based on our personal experience, premarking the graft to assess orientation and using a SF6 gas tamponade dramatically reduces the risk of primary graft failure and the need for rebubbling even during the first stages of the learning curve. These findings should encourage surgeons to safely change from Descemet stripping automated endothelial keratoplasty to DMEK.

scholarly journals Comparative Evaluation of Two Different Doses of Pre-Emptive Oral Pregabalin on Duration of Spinal Anesthesia and Postoperative Pain

2021 ◽  
Author(s):  
Neha Amey Panse ◽  
Kavita Udaykumar Adate ◽  
Sachin Harishchandra Panchal
Keyword(s):  
Postoperative Pain ◽  
Total Dose ◽  
Spinal Anesthesia ◽  
Postoperative Analgesia ◽  
Vaginal Hysterectomy ◽  
Rescue Analgesia ◽  
Sensory Blockade ◽  
Group 2 ◽  
Different Doses ◽  
Group 1

Background: Pregabalin provides good postoperative analgesia in nociceptive stimuli. Various studies show that preemptive oral pregabalin reduces acute postoperative pain. We conducted a study to evaluate the efficacy of two different doses of pregabalin and its effect on onset and duration of spinal anesthesia and postoperative pain. Methods: In prospective, double-blind and randomized study, 60 patients posted for vaginal hysterectomy under spinal anesthesia were randomly allocated to two groups recieving cap. Pregabalin 75 mg (group 1) and cap pregabalin 150 mg (group 2) orally, 90 min prior to surgery. Onset and duration of motor and sensory blockade were observed. Postoperative pain was assessed by VAS for 24 hrs. Injection paracetamol 1 gm. was given intravenously as rescue analgesic. Time of first rescue analgesic and total dose of rescue analgesics was noted. Results: Group 2 patients had better postoperative analgesia in terms of prolonged sensory and motor blockade which correlated well with the time of first request for rescue analgesia (504±123.2 min) as compared to group 1 patients (304.9±37.6 min). Also the total dose of rescue analgesic (paracetamol) was significantly less with 150mg pregabalin (p = 0.0001). Conclusion: Pregabalin 150 mg prolongs the duration of spinal anesthesia and has better analgesic profile without significant side effects. Thus we conclude that 150 mg pregabalin given preemptively optimizes spinal anesthesia well in patients for vaginal hysterectomy.

scholarly journals VIVAX MALARIA;

2017 ◽  
Vol 24 (06) ◽  
pp. 859-864
Author(s):  
Sikandar Hayat Khan ◽  
Muhammad Farooq
Keyword(s):  
Matched Control ◽  
Hematological Parameters ◽  
Negative Group ◽  
Positive Group ◽  
Group 3 ◽  
Group 2 ◽  
Set Up ◽  
Post Hoc ◽  
Age And Sex ◽  
Group 1

Background: The primary health care physician is usually perplexed withregards to selection of initial therapy for patients presenting with fever. Some degrees ofhematological changes do exist in most patients with malaria. How often these changes doexist with malaria in our set up? And whether these changes are due to associated fever oractually resulting because of malaria. Objective: 1-To measure the frequency of abnormalhematological changes in malaria patients in our set up. 2-To compare the hematologicalparameters among subjects with laboratory proven malaria, fever but no malaria diagnosisand healthy controls. Design: Cross-sectional analysis. Place and duration of study: Thisstudy was carried out from May 2010 to Dec- 2010 at department of medicine PNS SHIFA, anddepartments of pathology PNS SHIFA and RAHAT, Karachi. Subjects and methods: Subjectswith history of fever and a clinical suspicion of malaria were recruited from primary physician’sOPD along with healthy age and sex-matched control. First, the frequencies of various abnormalfindings in hematological parameters were measured in subjects diagnosed to have malaria.Later, group-1: [Malaria (Laboratory positive) (n=74)], Group-2: [Fever (Laboratory negative)(n=104)] and group-3: [Age and sex matched controls (n=54)] were evaluated by one wayANOVA followed by post-hoc comparisons for significant differences among groups. Bloodcomplete picture were measured by automated hematology analyzer (Specifications: CELTAC- alpha, MEK-6410 K). Malaria parasite presence was confirmed by both slide examinationtechnique and immune-chromatographic (ICT) testing. Main outcome measures-Hemoglobin,white blood cells (WBC), platelets, PDW, % neutrophil. Results- 21.62 % cases from malariahad anemia, while the occurrence of leucopenia was 62.16%. This leukpenia was associatedwith relative neutrophil excess (63.51%). Thrombocytopenia was the most consistent findingamong our studied subjects (97.30%). The difference between the three groups were significantfor platelets [Group-1, Malaria (Laboratory positive) group= 86.42 (95%CI: 78.43-94.41)][Group 2, Fever (Laboratory negative) group = 192.47 (95%CI: 177.69-207.25)] and (Group-3,Age and sex matched control group=278.89 (95%CI: 254.16-303.62)] {p<0.001}, and WBC[Group-1, Malaria (Laboratory positive) group= 5.55 (95%CI: 5.08-6.01)] [Group 2, Fever(Laboratory negative) group = 6.68 (95%CI: 6.14-7.20)] and (Group-3, Age and sex matchedcontrol group=8.78 (95%CI: 8.01-9.55)] {p<0.001}. The results for % neutrophil and PDW werealso significant, but post-hoc comparison did not show significant differences between groupsthus differentiating a case of malaria from non-malaria fever or control. Conclusion: Malariadue to Plasmodium vivax is associated with thrombocytopenia and leucopenia in our set up.Moreover, the associated hematological parameters including % neutrophil and PDW may helpin augmenting a clinical diagnosis of malaria.

scholarly journals Glucose Level Estimation in Diabetes Mellitus By Saliva: A Bloodless Revolution

2015 ◽  
Vol 53 (3) ◽  
pp. 248-252 ◽  
Author(s):  
Vidya Kadashetti ◽  
Rajendra Baad ◽  
Neelima Malik ◽  
K.M. Shivakumar ◽  
Nupura Vibhute ◽  
...  
Keyword(s):  
Diabetes Mellitus ◽  
Glucose Level ◽  
Plasma Glucose ◽  
Diabetic Patients ◽  
Healthy Population ◽  
Glucose Levels ◽  
Whole Saliva ◽  
Group 2 ◽  
Set Up ◽  
Group 1

Abstract Background. Diabetes mellitus is a massive, growing, silent epidemic that has the potential to cripple health services in all parts of the world. Currently, a diagnosis of diabetes is achieved by evaluating plasma glucose levels. Saliva offers some distinctive advantages. Whole saliva can be collected non-invasively and by individuals with limited training. The present study was aimed to estimate and correlate the plasma and salivary glucose levels in diabetic and non diabetic subjects, with special reference to age. Method. The study population consisted of three groups: Group 1 consisted of diabetics with BGL>200mg/dl and Group 2 consisted of diabetics with BGL 130-200mg/dl based on their random plasma glucose levels. Group 3 consisted of healthy population as controls with BGL <130 mg/dl. 2 ml of peripheral blood was collected for the estimation of random plasma glucose levels and unstimulated saliva was collected for the estimation of salivary glucose Results. The salivary glucose levels were significantly higher in group 1 and group 2 diabetics when compared with controls. The salivary glucose levels show a significant correlation with plasma glucose levels between study populations, suggesting that salivary glucose levels can be used as a monitoring tool for predicting glucose level in diabetic patients. Conclusion. The present study found that estimation of salivary glucose levels can be used as a noninvasive, painless technique for the measurement of diabetic status of a patient in a dental set up.

scholarly journals Experience with opportunistic salpingectomy during vaginal hysterectomy for uterine prolapsus

2019 ◽  
Vol 1 (1) ◽  
pp. 1-4
Author(s):  
Emrah Töz ◽  
Aykut Özcan
Keyword(s):  
Clinical Practice ◽  
Vaginal Hysterectomy ◽  
Gynecologic Oncology ◽  
Operating Time ◽  
Intraoperative Complication ◽  
Estimated Blood Loss ◽  
Practice Recommendation ◽  
Group 2 ◽  
Opportunistic Salpingectomy ◽  
Group 1

Objective: The aim of this study was to evaluate the trend in uptake of salpingectomy at the time of vaginal hysterectomy after the Clinical Practice Statement of Society for Gynecologic Oncology and to assess the risk of operative/postoperative complications associated with salpingectomy during vaginal hysterectomy. Material and Methods: Patients who underwent vaginal hysterectomy or vaginal hysterectomy with salpingectomy for uterine prolapsus between January 2010 and January 2018 were analysed. We divided the patients into two groups to see the change in the rate of opportunistic salpingectomy after a systemwide practice recommendation was issued. Group 1 consist of patients who were operated between 2010-2014, before recommendation of the Society of Gynecologic Oncology that favour salpingectomy and Group 2 consist of patients operated after that. Results: From January 2010 to January 2018, a total of 1224 vaginal hysterectomies were performed. A total of 808 patients under 60 years old were included in the study. There was no difference in operating time, the median estimated blood loss, intraoperative complication and postoperative complication by the performance of salpingectomy (P>0.05). When we examine the changes in the rate of salpingectomy year by year, from 2014, the salpingectomy rates increased, being 4 % in 2013, 7 % in 2015, and 8 % in 2017 onward. Conclusion: We report an increase in the rate of salpingectomy during vaginal hysterectomies from 3 % to 7.2 % after the recommendation of the Society of Gynecologic Oncology that favour salpingectomy but this increase is not as great as the increase during laparoscopic or abdominal hysterectomies.

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