scholarly journals Comparison of endoscopic underlay and microscopic underlay tympanoplasty: a prospective research at a tertiary care centre in Gujarat

2017 ◽  
Vol 3 (4) ◽  
pp. 874
Author(s):  
Mohit Sinha ◽  
Narendra Hirani ◽  
Ajeet Kumar Khilnani
Keyword(s):  
Patient Satisfaction ◽  
Learning Curve ◽  
Tertiary Care ◽  
Chronic Otitis Media ◽  
Simple Random Sampling ◽  
Endoscopic Technique ◽  
Tertiary Care Centre ◽  
Post Surgery ◽  
Duration Of Surgery ◽  
Endoscopic Group

<p class="abstract"><strong>Background:</strong> Tympanoplasty is an ever evolving surgery with myriad of approaches and tools. Use of endoscope is relatively new and there are few studies evaluating the use of endoscope via microscope because of a big learning curve in using one hand endoscopic technique despite it being minimally invasive.</p><p class="abstract"><strong>Methods:</strong> This is a prospective study conducted from June 2016 to May 2017 with a sample size of 44 patients. The study included patients of Chronic Otitis Media (COM) of mucosal inactive type without any co-morbidities in which only Type-1 tympanoplasty was done. The patients were divided into endoscopic or microscopic group using simple random sampling and after taking written and informed consent. The patient’s details regarding audiometric, oto-endoscopic and nasal endoscopic evaluation were recorded. Intra operative findings, duration of surgery and post-operative pain scoring were recorded. The patients were followed up for 3 months and subjected to post-operative audiometry and patient satisfaction questionnaire. The groups were evaluated for graft take up and closure of air bone gap, post-operative complications and patient satisfaction. The results were analysed using descriptive statistics (mean and percentage) and CHISQ test.</p><p class="abstract"><strong>Results:</strong> Graft was taken up in 21 patients (95%) in microscopic as opposed to 20 in endoscopic group (90%). Mean VAS scoring for pain was 2.5 in microscopic group on first post-operative day and 1.5 for the endoscopic group. The mean improvement in air bone gap post-surgery was 23.68 dB (SD=4.94) for microscopic group and 16.13 dB (SD=6.49) for endoscopic group.</p><p><strong>Conclusions:</strong> Endoscopic tympanoplasty as a technique has a long learning curve. The results indicate that endoscopic technique is as efficacious as and less invasive than microscope surgery for doing tympanoplasty. </p>

Mastoid cavity obliteration using bone pâté versus bioactive glass granules in the management of chronic otitis media (squamous disease): a prospective comparative study

2021 ◽  
pp. 1-9
Author(s):  
A K Mishra ◽  
A Mallick ◽  
J R Galagali ◽  
A Gupta ◽  
A Sethi ◽  
...  
Keyword(s):  
Bioactive Glass ◽  
Tertiary Care ◽  
Chronic Otitis Media ◽  
Mastoid Cavity ◽  
Tertiary Care Centre ◽  
Mastoid Obliteration ◽  
Glasgow Benefit Inventory ◽  
Significant Difference ◽  
Duration Of Surgery ◽  
The Mean

Abstract Objective To compare the efficacy of bone pâté versus bioactive glass in mastoid obliteration. Method This randomised parallel groups study was conducted at a tertiary care centre between September 2017 and August 2019. Sixty-eight patients, 33 males and 35 females, aged 12–56 years, randomly underwent single-stage canal wall down mastoidectomy with mastoid obliteration using either bone pâté (n = 35) or bioactive glass (n = 33), and were evaluated 12 months after the operation. Results A dry epithelised cavity (Merchant's grade 0 or 1) was achieved in 65 patients (95.59 per cent). Three patients (4.41 per cent) showed recidivism. The mean air–bone gap decreased to 16.80 ± 4.23 dB from 35.10 ± 5.21 dB pre-operatively. The mean Glasgow Benefit Inventory score was 30.02 ± 8.23. There was no significant difference between the two groups in these outcomes. However, the duration of surgery was shorter in the bioactive glass group (156.87 ± 7.83 vs 162.28 ± 8.74 minutes; p = 0.01). Conclusion The efficacy of both materials was comparable.

scholarly journals Endoscopic vs. microscopic transsphenoidal pituitary surgery: a single centre study

2020 ◽  
Vol 10 (1) ◽  
Author(s):  
Morten Winkler Møller ◽  
Marianne Skovsager Andersen ◽  
Dorte Glintborg ◽  
Christian Bonde Pedersen ◽  
Bo Halle ◽  
...  
Keyword(s):  
Visual Impairment ◽  
Tumour Size ◽  
Pituitary Surgery ◽  
Endoscopic Technique ◽  
Electronic Patient Records ◽  
Beneficial Effects ◽  
Duration Of Surgery ◽  
Single Centre Study ◽  
Transsphenoidal Pituitary Surgery ◽  
Endoscopic Group

AbstractEndoscopic pituitary surgery has shown promising results. This study reports the experiences of experienced microscopic pituitary surgeons changing to the endoscopic technique, and the beneficial effects on the postoperative outcomes. 45 transsphenoidal endoscopic-assisted surgeries performed in 2016–2017 were compared with 195 microscope-assisted surgeries performed in 2007–2017 for pituitary adenoma. Tumour size, hormonal status and vision were assessed preoperatively and 3–5 months postoperatively. Cases were identified through electronic patient records. GTR was achieved in 39% of the endoscopic operations vs. 22% of microscopic operations, p = 0.018. Mean duration of surgery was 86 min (77–95) with the endoscopic technique vs. 106 min (101–111) with the microscopic technique, p < 0.001. New hypothalamus–pituitary–adrenal axis deficiencies were observed after 3% of endoscopic vs. 34% microscopic operations, p = 0.001, and overall fewer postoperative pituitary deficiencies were observed in the endoscope-assisted group. Complications within 30 days of surgery occurred in 17% of endoscopic operations vs. 27% of microscopic operations (p > 0.05). Normalization of visual impairment occurred in 37% of the cases with preoperative visual impairment in the endoscopic group vs. 35% of those in the microscopic group (p > 0.05). The endoscopic technique performed better as a surgical procedure for pituitary adenomas. We found no statistically significant differences in complication rate or visual improvement between the two techniques.

scholarly journals Primary cemented bipolar hemiarthroplasty by transtrochanteric approach in unstable intertrochanteric fractures

2021 ◽  
Author(s):  
Thomas Angelo Skariah ◽  
Koshy George ◽  
Deny Mathew ◽  
James C. George ◽  
Samuel Chittaranjan
Keyword(s):  
Elderly Patients ◽  
Successful Treatment ◽  
Tertiary Care ◽  
Postoperative Outcome ◽  
Early Mobilization ◽  
Bipolar Hemiarthroplasty ◽  
Intertrochanteric Fractures ◽  
Tertiary Care Centre ◽  
Duration Of Surgery ◽  
One Year

<p><strong>Background:</strong> The successful treatment of unstable intertrochanteric fractures of the femur in elderly patients is a challenge. Due to complications associated with internal fixation, primary hemiarthroplasty is increasingly becoming an alternative treatment to achieve early mobilisation. A transtrochanteric approach could potentially decrease the complications associated with primary hemiarthroplasty. Aim of the study is to document the postoperative outcome and complications associated with this treatment.</p><p><strong>Methods:</strong> In this retrospective study, all elderly patients with unstable trochanteric fractures, treated by primary hemiarthroplasty through a transtrochanteric approach, in a tertiary care centre, from September 2017 to December 2019, were enrolled. Their data from hospital records were analysed and results compared to literature.</p><p><strong>Results:</strong> 48 patients underwent the procedure. Average age was 85 years. One year mortality was 31.25%. Average duration of surgery is 85 min. 58.3% were ambulant at one year. One case of dislocation secondary to surgical site infection was present.</p><p><strong>Conclusions:</strong> Primary hemiarthroplasty as a primary treatment in this group of patients enables early mobilization and prevents complications associated with prolonged immobilization. Transtrochanteric approach reduces the duration of surgery. Achieving early ambulation is the key to successful treatment.</p>

scholarly journals Comparison of open and robotic-assisted prostatectomy: The University of British Columbia experience

2014 ◽  
Vol 8 (3-4) ◽  
pp. 92 ◽  
Author(s):  
Louis-Olivier Gagnon ◽  
Larry Goldenberg ◽  
Kenny Lynch ◽  
Antonio Hurtado ◽  
Martin Gleave
Keyword(s):  
Urinary Incontinence ◽  
Length Of Stay ◽  
Learning Curve ◽  
Tertiary Care ◽  
Surgical Margin ◽  
Hospital Length Of Stay ◽  
Positive Surgical Margin ◽  
Robotic Assisted ◽  
Post Surgery ◽  
The Impact

Introduction: We assessed outcomes and costs of open prostatectomy (OP) versus robotic-assisted prostatectomy (RAP) at a single tertiary care university hospital.Methods: We retrospectively analyzed 200 consecutive OP by 1 experienced open surgeon (MG) and 200 consecutive RAP by an experienced open surgeon (SLG), after allowing for a short learning curve of 70 cases.Results: The 2 groups had similar demographics, including mean age (64.7 vs. 64.2) and mean body mass index (27.2 vs. 27.2). The OP group had a higher proportion of higher risk cancers compared to the RAP group (32.5% vs. 8.5%). Mean skin-to-skin operative room time was less for the OP (114.2 vs. 234.1 minutes). Transfusion rates were similar at 1.5% with OP compared to 3.5% with RAP. The mean length of stay was 1.78 days for OP compared to 1.76 days for RAP, for the last 100 patients in each group. The OP group had more high-grade disease in the prostatectomy specimen, with Gleason ≥8 in 23.5% compared to 3.5% in the RAP group. Positive surgical margin rates were comparable at 31% for OP and 24.6% for RAP, and remained similar after stratification for pT2 and pT3 disease. The grade I and II perioperative complication rate (Clavien-Dindo classification) was lower in the OP group (8.5% vs. 20%). Postoperative stress urinary incontinence rates (4.8% for OP and 4.6% for RAP) and biochemical-free status (91.8% for OP and 96% for RAP) did not differ at 12 months post-surgery. The additional cost of RAP was calculated as $5629 per case. The main limitations of this study are its retrospective nature and lack of validated questionnaires for evaluation of postoperative functional outcomes.Conclusion: While hospital length of stay, transfusion rates, positive surgical margin rates and postoperative urinary incontinence were similar, OP had a shorter operative time and a lower cost compared to the very early experience of RAP. Future parallel prospective analysis will address the impact of the learning curve on these outcomes.

scholarly journals Comparison of Clinical Outcomes using a Piezosurgery Device Vs. A Conventional Osteotome for Lateral Osteotomy in Rhinoplasty

2017 ◽  
Vol 96 (8) ◽  
pp. 318-326 ◽  
Author(s):  
Bulent Koc ◽  
Eltaf Ayca Ozbal Koc ◽  
Selim Erbek
Keyword(s):  
Patient Satisfaction ◽  
Learning Curve ◽  
Clinical Outcomes ◽  
Time Interval ◽  
Open Technique ◽  
Critical Step ◽  
Lateral Osteotomy ◽  
Perioperative Bleeding ◽  
Duration Of Surgery

Our aim for this study was to evaluate and compare the clinical outcomes in patients who underwent lateral osteotomy with a Piezosurgery device or a conventional osteotome in open-technique rhinoplasty. This cohort trial involved 65 patients (36 women and 29 men; average age: 23.6 ± 5.71 yr) who underwent surgery between May 2015 and January 2016. Piezo-surgery was used for lateral osteotomy in 32 patients, whereas 33 patients underwent conventional external osteotomy. These 2 groups were compared for duration of surgery, perioperative bleeding, postoperative edema, ecchymosis, pain, and patient satisfaction on the first and seventh postoperative days. The Piezosurgery group revealed significantly more favorable outcomes in terms of edema, ecchymosis, and hemorrhage on the first day postoperatively (p < 0.001 for all). Similarly, edema (p = 0.005) and ecchymosis (p < 0.001) on the seventh postoperative day also were better in the Piezosurgery group. Hemorrhage was similar in both groups on the seventh postoperative day (p = 0.67). The Piezosurgery group not only experienced less pain on the first postoperative day (p < 0.001), but these patients also were more satisfied with their results on both the first and seventh postoperative days. Results of the present study imply that Piezosurgery may be a promising, safe, and effective method for lateral osteotomy, a critical step in rhinoplasty. The time interval necessary for the learning curve is counteracted by the comfort and satisfaction of both patients and surgeons.

scholarly journals A Comparative Study between Endoscopic and Microscopic Tympanoplasty

2019 ◽  
Vol 21 (3) ◽  
pp. 195-198
Author(s):  
Anup Dhungana ◽  
R. R. Joshi ◽  
A. S. Rijal ◽  
K. K. Shrestha ◽  
S. Maharjan
Keyword(s):  
Uptake Rate ◽  
Chronic Otitis Media ◽  
Endoscopic Technique ◽  
Random Allocation ◽  
Microscopic Technique ◽  
Significant Difference ◽  
The Mean ◽  
Bone Gain ◽  
Audiometric Test ◽  
Endoscopic Group

A study to compare tympanoplasty between endoscopic and microscopic approach was conducted at NMCTH. Patients diagnosed as chronic otitis media – mucosal type with age of 13 years and above were included in the study. Audiometric test was done before and 6 weeks after surgery. Seventy cases were included for the study with random allocation of cases each in endoscope group and microscopic group respectively. Graft uptake results were assessed after 6 weeks and postoperative hearing were evaluated and compared within and between the two groups. In endoscopic group and microscopic group, the graft uptake rate was 91.4% and 88.5% respectively with no significant difference (p = 0.71) in the graft uptake rate between the groups. The mean pre and post-operative air bone gap in endoscopic group and microscopic group were 34.59 dB±8.02, 21.97±8.60 dB and32.42±10.08 dB, 18.55±8.49 dB respectively. This showed a highly significant difference in both groups(p < 0.001), showing improvement in the hearing after surgery in both the groups. The mean air bone gain were 12.62 dB and 13.87 dB in endoscopic and microscopic group respectively, with no significant difference between the groups (p = 0.553). The graft uptake rate and hearing results with endoscopic technique is comparable to that of microscopic technique. However, the endoscopic technique requires shorter operative time than the microscopic technique. Therefore, we recommend the use of endoscope for tympanoplasty in hospital as well as in camps.

Concurrent surgeries in ENT: a cost-effective and safe approach in patients requiring multiple definitive procedures

2004 ◽  
Vol 118 (1) ◽  
pp. 31-33 ◽  
Author(s):  
Achamma Balraj ◽  
Mary Kurien ◽  
Anand Job
Keyword(s):  
Surgical Procedures ◽  
Tertiary Care ◽  
Case Series ◽  
Cost Effective ◽  
Definitive Treatment ◽  
Tertiary Care Centre ◽  
Retrospective Case ◽  
Average Hospital ◽  
Duration Of Surgery

Treatment of the predisposing factors that are identified in the nose and throat in several ENT diseases is mandatory prior to the definitive management of the latter. When surgical management is indicated it has been traditional to use staged procedures. This study was undertaken to assess the role of concurrent surgical procedures in ENT and evaluate their cost-effectiveness compared to similar staged procedures. This was a retrospective case series of 100 consecutive patients undergoing concurrent and similar staged ENT surgical procedures. On analysis, it was noted that the average duration of surgery, anaesthesia and hospital stay was significantly less in the concurrent procedures group than in the staged procedures (2.35/3.1.hours; 3.05/3.30.hours and 2.5/6.5 days, respectively). The average hospital bill for the concurrent procedures was also lower than for the staged procedures. Hence, in patients requiring multiple ENT surgical procedures for definitive treatment, concurrent procedures are more cost-effective than staged procedures and should be considered the treatment of choice in a tertiary care centre.

scholarly journals A COMPARISION OF INTRATHECAL HYPERBARIC BUPUVACAINE WITH BUPRENORPHINE AND HYPERBARIC BUPIVACAINE ALONE IN GYNAECOLOGICAL SURGERIES FOR POSTOPERATIVE ANALGESIA

2021 ◽  
Vol 9 (06) ◽  
pp. 773-777
Author(s):  
Archana Jadhav ◽  
◽  
Rashmi Bengali ◽  
Keyword(s):  
Blood Pressure ◽  
Respiratory Rate ◽  
Spinal Anaesthesia ◽  
Tertiary Care ◽  
Tertiary Care Centre ◽  
Hyperbaric Bupivacaine ◽  
Sensory Blockade ◽  
Duration Of Surgery ◽  
Group B ◽  
Effective Analgesia

This study was performed at a tertiary care centre after the approval of the Institutional Ethical Committee and obtaining written informed consent from all patients. Sixty ASA I and II, aged 18- 65yrs, bodyweight 45-70kgs scheduled for gynaecological surgeries under spinal anaesthesia were chosen for the study and were divided into two groups named Group B and Group BN each comprising 30 patients. Group B received 3ml of 0.5% hyperbaric bupivacaine with 0.5 ml normal saline and Group BN received 3ml of 0.5% hyperbaric bupivacaine with 0.5ml (150mcg) of buprenorphine. Vital parameters like pulse rate, blood pressure, respiratory rate, SpO2 were recorded at 0 (basal) 15, 30, 45, 90 and 180 minutes. Postoperatively heart rate, blood pressure, respiratory rate and SP02 were monitored at 3 ,6 ,12 and 24 hrs. The mean age, height, weight, duration of surgery were comparable. Time of onset of sensory blockade and motor blockade were noted. The time for rescue medication was 909.0±216.9 min in group BN with a range from 690 min to 1500 min and in group B it was 412.0±89.28 min with a range from 130 min to 195 min. Comparing both groups duration of effective analgesia was significantly higher in group BN with P<0.0001.thus, it can be concluded that addition of buprenorphine as an adjuvant in spinal anaesthesia excellently prolongs duration of analgesia in postoperative period with minimal side effects.

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