scholarly journals Surgical outcome of radioguided parathyroidectomy in primary hyperparathyroidism

2021 ◽  
Vol 8 (2) ◽  
pp. 681
Author(s):  
Dinesh Nalbo ◽  
Divya Dahiya ◽  
Ashwani Sood ◽  
Sanjay Kumar Bhadada ◽  
Arunanshu Behera ◽  
...  
Keyword(s):  
Primary Hyperparathyroidism ◽  
Operative Time ◽  
Frozen Section ◽  
Perioperative Complications ◽  
Tertiary Care ◽  
Short Operative Time ◽  
Adequate Treatment ◽  
Incision Length ◽  
Radioguided Parathyroidectomy ◽  
Focused Parathyroidectomy

Background: Focused parathyroidectomy is the adequate treatment for primary hyperparathyroidism for localised disease. Adequacy of resection is confirmed by the availability of intraoperative parathormone assay (iOPTH). In the absence of availability of iOPTH assay, the radio guided surgery is an option. The aim of this study was to evaluate the feasibility of radioguided parathyroidectomy in tertiary care centre in India and to compare the overall success rate, operative time, hospital stay and postoperative outcome between focused open and radioguided parathyroidectomy.Methods: This was a prospective study which included 30 primary hyperparathyroidism patients with a single gland disease localised on Tc99m Sesta MIBI scan. Patients were randomized into two equal groups, and they underwent focused open or radioguided parathyroidectomy. Patients were followed up for three months.Results: All patients achieved biochemical cure as evident by the normalization of serum calcium and parathormone levels after surgery. The mean incision length, and operative time in this study was significantly better for radioguided parathyroidectomy (p=0.0001, <0.0001 respectively). There was no perioperative complications like recurrent laryngeal nerve injury, gland rupture, or bleeding in either group. However, there seems to be higher grade of pain experience by the patients who underwent open focused parathyroidectomy (p<0.0001).Conclusions: Radioguided parathyroidectomy has excellent cure rate for PHPT with an added advantage of short operative time & incision length and less post-operative pain. Radioguided parathyroidectomy seems to be a good alternative in the absence of availability of iOPTH assay and frozen section.

scholarly journals Contemporary surgical treatment of primary hyperparathyroidism without intraoperative parathyroid hormone measurement

2015 ◽  
Vol 97 (8) ◽  
pp. 603-607 ◽  
Author(s):  
OA Mownah ◽  
G Pafitanis ◽  
WM Drake ◽  
JN Crinnion
Keyword(s):  
Parathyroid Hormone ◽  
Surgical Treatment ◽  
Primary Hyperparathyroidism ◽  
Frozen Section ◽  
Lateral Approach ◽  
Preoperative Imaging ◽  
Surgical Cure ◽  
Focused Parathyroidectomy ◽  
Intraoperative Parathyroid Hormone ◽  
Iopth Measurement

Introduction Primary hyperparathyroidism (pHPT) is usually the result of a single adenoma that can often be accurately located preoperatively and excised by a focused operation. Intraoperative parathyroid hormone (IOPTH) measurement is used occasionally to detect additional abnormal glands. However, it remains controversial as to whether IOPTH monitoring is necessary. This study presents the results of a large series of focused parathyroidectomy without IOPTH measurement. Methods Data from 2003 to 2014 were collected on 180 consecutive patients who underwent surgical treatment for pHPT by a single surgeon. Preoperative ultrasonography and sestamibi imaging was performed routinely, with computed tomography (CT) and/or selective venous sampling in selected cases. The preferred procedure for single gland disease was a focused lateral approach guided by on-table surgeon performed ultrasonography. Frozen section was used selectively and surgical cure was defined as normocalcaemia at the six-month follow-up appointment. Results Focused surgery was undertaken in 146 patients (81%) and 97% of these cases had concordant results with two imaging modalities. In all cases, an abnormal gland was discovered at the predetermined site. Of the 146 patients, 132 underwent a focused lateral approach (11 of which were converted to a collar incision), 10 required a collar incision and 4 underwent a mini-sternotomy. At 6 months following surgery, 142 patients were normocalcaemic (97% primary cure rate). Three of the four treatment failures had subsequent surgery and are now biochemically cured. There were no complications or cases of persistent hypocalcaemia. Conclusions This study provides further evidence that in the presence of concordant preoperative imaging, IOPTH measurement can be safely omitted when performing focused parathyroidectomy for most cases of pHPT.

Curved periacetabular osteotomy via a novel intermuscular approach between the sartorius and iliac muscles

2018 ◽  
Vol 28 (6) ◽  
pp. 642-648 ◽  
Author(s):  
Toru Nishiwaki ◽  
Akihito Oya ◽  
Shinsuke Fukuda ◽  
Satoshi Nakamura ◽  
Masaya Nakamura ◽  
...  
Keyword(s):  
Operative Time ◽  
Perioperative Complications ◽  
Periacetabular Osteotomy ◽  
Weight Bearing ◽  
Harris Hip Score ◽  
Walking Ability ◽  
Early Weight Bearing ◽  
Incision Length ◽  
Curved Periacetabular Osteotomy ◽  
The Mean

Introduction: Herein, we describe and evaluate a curved periacetabular osteotomy (CPO) via an intermuscular approach (IM-CPO) between the sartorius and iliac muscles. Methods: Between January 2009 and January 2016, IM-CPO was performed in 17 joints (16 patients), and a traditional CPO was performed in 17 joints. The length of incision at wound closure, operative time, intraoperative blood loss, serum creatinine kinase (CK) level the day after surgery, correctional angle, walking ability assessed using the gait items of the Harris Hip Score (at 3 and 6 months after surgery), and perioperative complications were evaluated. Group differences were assessed using t-tests. Results: The IM-CPO and CPO groups did not differ in the mean operative time (130 minutes and 124 minutes, respectively), mean serum CK the day after surgery (349 IU/L and 425 IU/L, respectively), or mean correctional angle (24.9° and 24.6°, respectively). The mean incision length was significantly shorter in the IM-CPO group (8.3 cm) compared to that in the CPO group (9.5 cm). The mean walking ability was significantly higher in the IM-CPO group (24.2 points) compared to that in the CPO group (20.9 points) at 3 months after surgery, but not at 6 months after surgery (26.4 points and 24.9 points, respectively). No serious complications were observed in either group. Conclusion: In addition to demonstrating a similarly satisfactory correctional angle, IM-CPO is anticipated to enable early weight-bearing and recovery of walking ability. Thus, IM-CPO is considered a superior surgical technique.

scholarly journals Through-and-Through Dissection of the Soft Palate for Pharyngeal Flap Inset: A “Good-Fast-Cheap” Technique for Any Etiology of Velopharyngeal Incompetence

2021 ◽  
pp. 105566562110217
Author(s):  
Michael Carr ◽  
Michaela Skarlicki ◽  
Sheryl Palm ◽  
Marija Bucevska ◽  
Jeffrey Bone ◽  
...  
Keyword(s):  
Soft Palate ◽  
Operative Time ◽  
Care Center ◽  
Tertiary Care ◽  
Deletion Syndrome ◽  
Complication Rates ◽  
Short Operative Time ◽  
Velopharyngeal Incompetence ◽  
Obstructive Sleep ◽  
Pharyngeal Flap

Objective: To determine the efficacy and resource utilization of through-and-through dissection of the soft palate for pharyngeal flap inset for velopharyngeal incompetence (VPI) of any indication. Design: Retrospective review. Setting: Tertiary care center. Patients: Thirty patients were included. Inclusion criteria were diagnosis of severe VPI based on perceptual speech assessment, confirmed by nasoendoscopy or videofluoroscopy; VPI managed surgically with modified pharyngeal flap with through-and-through dissection of the soft palate; and minimum 6 months follow-up. Patients with 22q11.2 deletion syndrome were excluded. Intervention: Modified pharyngeal flap with through-and-through dissection of the soft palate. Main Outcome Measure(s): Velopharyngeal competence and speech assessed using the Speech-Language Pathologist 3 scale. Results: The median preoperative speech score was 11 of 13 (range, 7 to 13), which improved significantly to a median postoperative score of 1 of 13 (range 0-7; P < .001). Velopharyngeal competence was restored in 25 (83%) patients, borderline competence in 3 (10%), and VPI persisted in 2 (7%) patients. Complications included 1 palatal fistula that required elective revision and 1 mild obstructive sleep apnea that did not require flap takedown. Median skin-to-skin operative time was 73.5 minutes, and median length of stay (LOS) was 50.3 hours. Conclusions: This technique allows direct visualization of flap placement and largely restores velopharyngeal competence irrespective of VPI etiology, with low complication rates. Short operative time and LOS extend the value proposition, making this technique not only efficacious but also a resource-efficient option for surgical management of severe VPI.

The impact of surgeon experience on perioperative complications and operative measures following thoracolumbar 3-column osteotomy for adult spinal deformity: overcoming the learning curve

2020 ◽  
Vol 32 (2) ◽  
pp. 207-220 ◽  
Author(s):  
Darryl Lau ◽  
Vedat Deviren ◽  
Christopher P. Ames
Keyword(s):  
Blood Loss ◽  
Operative Time ◽  
Surgical Complication ◽  
Perioperative Complications ◽  
Adult Spinal Deformity ◽  
Neurological Deficits ◽  
Complication Rates ◽  
Years Of Experience ◽  
Surgeon Experience ◽  
Operative Measures

OBJECTIVEPosterior-based thoracolumbar 3-column osteotomy (3CO) is a formidable surgical procedure. Surgeon experience and case volume are known factors that influence surgical complication rates, but these factors have not been studied well in cases of adult spinal deformity (ASD). This study examines how surgeon experience affects perioperative complications and operative measures following thoracolumbar 3CO in ASD.METHODSA retrospective study was performed of a consecutive cohort of thoracolumbar ASD patients who underwent 3CO performed by the senior authors from 2006 to 2018. Multivariate analysis was used to assess whether experience (years of experience and/or number of procedures) is associated with perioperative complications, operative duration, and blood loss.RESULTSA total of 362 patients underwent 66 vertebral column resections (VCRs) and 296 pedicle subtraction osteotomies (PSOs). The overall complication rate was 29.4%, and the surgical complication rate was 8.0%. The rate of postoperative neurological deficits was 6.2%. There was a trend toward lower overall complication rates with greater operative years of experience (from 44.4% to 28.0%) (p = 0.115). Years of operative experience was associated with a significantly lower rate of neurological deficits (p = 0.027); the incidence dropped from 22.2% to 4.0%. The mean operative time was 310.7 minutes overall. Both increased years of experience and higher case numbers were significantly associated with shorter operative times (p < 0.001 and p = 0.001, respectively). Only operative years of experience was independently associated with operative times (p < 0.001): 358.3 minutes from 2006 to 2008 to 275.5 minutes in 2018 (82.8 minutes shorter). Over time, there was less deviation and more consistency in operative times, despite the implementation of various interventions to promote fusion and prevent construct failure: utilization of multiple-rod constructs (standard, satellite, and nested rods), bone morphogenetic protein, vertebroplasty, and ligament augmentation. Of note, the use of tranexamic acid did not significantly lower blood loss.CONCLUSIONSSurgeon years of experience, rather than number of 3COs performed, was a significant factor in mitigating neurological complications and improving quality measures following thoracolumbar 3CO for ASD. The 3- to 5-year experience mark was when the senior surgeon overcame a learning curve and was able to minimize neurological complication rates. There was a continuous decrease in operative time as the surgeon’s experience increased; this was in concurrence with the implementation of additional preventative surgical interventions. Ongoing practice changes should be implemented and can be done safely, but it is imperative to self-assess the risks and benefits of those practice changes.

scholarly journals Incidence of valvular regurgitation and leaflet perforation by using automated titanium fasteners (CORKNOT®) in heart valve repair or replacement: less usual than reported

2021 ◽  
Vol 16 (1) ◽  
Author(s):  
Faizus Sazzad ◽  
Ong Zhi Xian ◽  
Ashlynn Ler ◽  
Chang Guohao ◽  
Kang Giap Swee ◽  
...  
Keyword(s):  
Heart Valve ◽  
Operative Time ◽  
Tertiary Care ◽  
Paravalvular Leak ◽  
Valvular Regurgitation ◽  
Care Hospital ◽  
Valve Repair ◽  
Replacement Surgery ◽  
Triple Valve

Abstract Background CORKNOT® facilitates a reduction in cardiopulmonary bypass (CPB) time, aortic cross clamp (ACC) time and operative time, but reported to be associated with other complications. We aim to quantify the incidence of valvular complications related to CORKNOT® and determine the feasibility of its use between different valvular surgeries. Methods Patients who underwent heart valve repair or replacement surgery via the use of automated titanium suture fasteners (CORKNOT®) in a tertiary care hospital were included in the study. This single-centre retrospective study was conducted on 132 patients between January 2016 and June 2018. Results In our study, the overall mean operative time was 320.0 ± 97.0 min, mean CPB time was 171.4 ± 76.0 min and the calculated mean ACC time was 105.9 ± 54.0 min. Fifty-eight patients (43.9%) underwent minimally invasive valve replacement or repair surgery and 66 patients (50.0%) underwent concomitant procedures. A total of 157 valves were operated on, with 112 (84.8%) single valve surgeries, 15 (11.4%) double valve surgeries and 5 (3.8%) triple valve surgeries. After reviewed by the cardiologist blinded towards the study, we report trivial and/or mild paravalvular leak (PVL) in immediate post-operative echocardiography was found in 1 (1.01%) patients. There were no reported cases of valvular thrombosis, leaflet perforation, device dislodgement or embolization, moderate and/or severe PVL during hospitalization and follow-up echocardiography within 1 year. Single mitral valve and aortic surgeries had comparable incidences of post surgical complications. Conclusion We conclude the feasibility of CORKNOT® utilisation in mitral and aortic valve surgeries. Additionally, incidence of CORKNOT® related complications in heart valve repair or replacement surgery is less usual in our setting than previously reported. These results motivate the use of CORKNOT® as a valid alternative with complete commitment.

scholarly journals Prognostic Factors for the Outcome of Salivary Gland Holmium: YAG Laser Intraductal Lithotripsy

2021 ◽  
pp. 014556132110100
Author(s):  
Shuo-Jen Wang ◽  
Lung-Che Chen ◽  
Yi-Chih Lin ◽  
Yen-Chun Chen ◽  
Luong Huu Dang ◽  
...  
Keyword(s):  
Logistic Regression ◽  
Salivary Gland ◽  
Success Rate ◽  
Operative Time ◽  
Tertiary Care ◽  
Operation Time ◽  
Laser Lithotripsy ◽  
Successful Outcome ◽  
Care Hospital ◽  
Yag Laser

Objectives: Holmium: YAG laser has gained its popularity throughout the years and is used to treat sialolithiasis, which helps to overcome the limitations of traditional sialendoscopic lithotripsy for larger-sized salivary stones. However, little information is available regarding factors predicting the success rate of Holmium: YAG laser intraductal lithotripsy. The purpose of this study is to investigate the factors affecting the success rates of Holmium: YAG laser lithotripsy for salivary stones treatment in a tertiary care hospital. Methods: A retrospective study conducted in patients receiving sialolithiasis surgery under sialendoscopy from May 2013 to March 2015 at Mackay Memorial Hospital, Taiwan. Data on various factors, including patients’ age, gender, glands, size of largest stone, multiple stones (≥2 stones), location of the stone (distal duct, middle duct, proximal duct, and hilum), and operative time. The success of the surgery defined as patients without any complaints such as swelling or tenderness. Logistic regression and Fisher exact tests were employed to examine these factors on the success rate. Results: Fifty-four patients who received sialendoscopy surgery with a mean age of 35.74 years old recruited. Logistic regression identified the operation time exceeding 210 minutes showed 23.497 folds higher odd ratio of having a result of operation failure ( P < .05). Conclusion: The prolonged operation time is the sole independent factor affecting the successful outcome for salivary gland intraductal laser lithotripsy. We recommend operative time be no more than 210 minutes to increase the success rate in salivary gland Holmium: YAG laser intraductal lithotripsy.

scholarly journals A Comparative Analysis of Outcomes of Conventional Cold Dissection Versus Laser Tonsillectomy in Pediatric Cases in a Tertiary Care Hospital in Haryana

2021 ◽  
Author(s):  
Amit Kumar ◽  
Surender Kumar ◽  
Anand Krishnan ◽  
Manish Verma ◽  
Uma Garg ◽  
...  
Keyword(s):  
Operative Time ◽  
Tertiary Care Hospital ◽  
Tertiary Care ◽  
Paediatric Population ◽  
Care Hospital ◽  
Secondary Complications ◽  
Post Operative Pain ◽  
Secondary Bleeding ◽  
Paediatric Age ◽  
Cold Dissection

AbstractTonsillectomy is one of the commonest ENT procedures done in paediatric population, the technique of which has evolved over years to decrease the morbidity associated with the surgery. This prospective randomized comparative study is done to evaluate the efficacy of two different techniques of this surgery, conventional cold dissection and laser tonsillectomy based on operative time, blood loss, post-operative pain and occurrence of secondary complications. The study was done in 68 patients of paediatric age group, 34 in each group underwent cold dissection and laser tonsillectomy. Operative time and bleeding were significantly low for laser group. Pain score was comparable in early post-operatives days, but was high towards the end of first week. Our study reported only one incidence of complication in the form of a secondary bleeding.

scholarly journals Stapled haemorrhoidopexy: is it time to move on?

2015 ◽  
Vol 97 (7) ◽  
pp. 490-493 ◽  
Author(s):  
EH Aly
Keyword(s):  
Operative Time ◽  
Wound Care ◽  
Dentate Line ◽  
Safe Procedure ◽  
Stapled Haemorrhoidopexy ◽  
Short Operative Time ◽  
Stapled Haemorrhoidectomy ◽  
Life Threatening ◽  
Number Of Publications ◽  
Randomised Controlled

Stapled haemorrhoidectomy was proposed as an ‘ideal’ solution for symptomatic haemorrhoids, with minimal postoperative pain, no perianal wound requiring postoperative wound care and a relatively short operative time. Some randomised controlled trials and reviews confirmed these findings, claiming that stapled haemorrhoidopexy is the most effective and safe procedure for haemorrhoids. However, there are increasing number of publications highlighting that the technique is associated with serious and life threatening complications. Maybe it is now the time to accept that stapled haemorrhoidopexy has done its role in directing our attention to the fact that modern surgical treatment of haemorrhoids should avoid excision of anorectal skin but should instead aim at treatment intervention above the dentate line.

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