Ultrasonic cutting and coagulation device versus conventional diathermy dissection in thyroid surgery: prospective randomized trial

Background: The objective of this study was to compare the operative time and postoperative outcomes in thyroid surgeries using the ultrasonic cutting and coagulation device with conventional diathermy dissection. Methods: This study was a prospective, interventional, cohort study. The patients were randomized in two groups by lottery system. The patients operated with ultrasonic device were labeled as Group A: UCCD and by conventional diathermy as Group B: CDD. The operative time, postoperative drain volume, pain score on VAS and complications were assessed and compared in between the two techniques of surgery. Results: Total of 18 males and 58 females underwent thyroid surgery with age ranging from 17 to 75 years. The operative time in UCCD group was less than CDD group (93.29 min vs. 106.59 min; p=0.06). The cumulative mean amount of drain was found to be less in UCCD group, this difference was statistically significant (77.86 ml vs. 138.05 ml; p=0.00018). The drain was removed earlier in UCCD group, this comparison was also statistically significant (2.49 days in UCCD group vs. 3.02 days in CDD group; p=0.000009). The mean pain score was found to be statistically significant on all the postoperative days in UCCD group. Conclusions: The patients experienced less pain and complication while using UCCD as technique for surgery. Hence, ultrasonic device using both cutting and coagulating mode at the same time is efficient in hemostasis and lesser post-operative pain, and found to be advantageous.

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A comparative study of adenoidectomy by microdebrider vs conventional method

International Journal of Otorhinolaryngology and Head and Neck Surgery ◽

10.18203/issn.2454-5929.ijohns20181876 ◽

2018 ◽

Vol 4 (3) ◽

pp. 808

Author(s):

M. Muniraju ◽

Mohammed Saifulla

Keyword(s):

Pain Score ◽

Recovery Time ◽

Operative Time ◽

Recovery Period ◽

Collateral Damage ◽

Adenoid Tissue ◽

Post Operative Pain ◽

Group A ◽

The Mean ◽

Group B

Background: Adenoidectomy is a commonly performed ENT surgery. This present article aims to evaluate endoscopic powered adenoidectomy as an alternative for conventional curettage method.Methods: Sixty consecutive cases requiring adenoidectomy were randomized into two groups of thirty each. Group A underwent endoscopic assisted micro-debrider adenoidectomy and Group B underwent conventional adenoidectomy using the curettage method in study period from November 2015 to May 2017. Results: The average time taken in Group A was 34.10 minutes and in Group B was 22.83 minutes (p<0.001). The average blood loss in Group A was 29.57 ml as compared to 16.67 ml in Group B (p<0.001). The resection was invariably complete in Group A whereas five (16.7%) cases had more than 50% residual adenoid tissue in Group B. Four cases in group B had collateral damage whereas in Group A, there were no added injuries. Post operative pain was studied only in cases undergoing adenoidectomy alone. Group A (n=8) demonstrated a pain score of 3.50 – 3.09 whereas Group B (n=11) demonstrated a pain score of 2.75-2.55. In group A, the mean recovery period was 2.80 days and 8.23 days in Group B (p<0.001).Conclusions: Endoscopic powered adenoidectomy was found to be a safe and effective tool for adenoidectomy. The study parameters where endoscopic powered adenoidectomy fared better were completeness of resection, accurate resection under vision, lesser collateral damage and faster recovery time. On the other hand, conventional adenoidectomy scored in matter of lesser operative time and intra-operative bleeding.

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Comparative study between conventional adenoidectomy and adenoidectomy using micro-debrider

The Egyptian Journal of Otolaryngology ◽

10.1186/s43163-021-00102-z ◽

2021 ◽

Vol 37 (1) ◽

Author(s):

Essam A. Abo Elmagd ◽

Mahmoud S. Khalifa ◽

Beshoy K. Abeskharoon ◽

Abdelrahman A. El Tahan

Keyword(s):

Pain Score ◽

Operative Time ◽

Recovery Period ◽

Study Groups ◽

Average Amount ◽

Left Behind ◽

Adenoid Tissue ◽

Group A ◽

The Mean ◽

Group B

Abstract Background Adenoidectomy is a common ENT procedure. This article aims to evaluate micro-debrider-assisted adenoidectomy as a substitute for the conventional curettage method. Results The study aimed to compare between two study groups: micro-debrider-assisted adenoidectomy (group A) and conventional adenoidectomy (group B). The average time needed in group A was 34.1 min while it was 22.83 min in group B (p<0.001). The average amount of blood lost in group A was 29.57 ml and 16.67 ml in group B (p<0.001). The resection was nearly complete in group A, while in group B, five (16.66%) cases had more than 50% of the adenoid tissue left behind. Four cases in group B had damage to collaterals while in group A no major injuries were noted. Postoperative pain has only been studied in cases where adenoidectomy solely was done. Candidates in group A (n=8) reported a pain score of 3.5-3.09 whereas candidates in group B (n=11) reported a pain score of 2.75-2.55. The mean recovery time was 2.8 days in group A and 8.23 days in group B (p<0.001). Conclusions Endoscopic adenoidectomy using micro-debrider is both an effective and safe adenoidectomy tool. The strengths of this technique include resection completeness, precise resection under vision, minor damage to collaterals, and a more rapid recovery period. Conventional adenoidectomy, however, scored better regarding lesser operative time and bleeding intraoperatively.

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Comparison of Harmonic Scalpel versus conventional hemostasis in Thyroid surgery in terms of per-operative and postoperative outcome.

The Professional Medical Journal ◽

10.29309/tpmj/2019.27.01.3278 ◽

2020 ◽

Vol 27 (01) ◽

pp. 68-73

Author(s):

Mumtaz Ali ◽

Mudassar Murtaza ◽

Mohammad Aleem-ud-Din ◽

Mohammad Burhan Ud Din ◽

Assam Sarwar ◽

...

Keyword(s):

Postoperative Pain ◽

Thyroid Surgery ◽

Operative Time ◽

Harmonic Scalpel ◽

Laryngeal Nerve ◽

P Value ◽

Drainage Volume ◽

Group A ◽

The Mean ◽

Group B

Harmonic scalpel is popular for use in a variety of surgical procedures including thyroid surgery. Proposed advantages of the harmonic scalpel include less lateral thermal tissue damage with no electrical energy transferred to the patient, no neuromuscular stimulation, less smoke formation as compared with electrocautery. Objectives: Our aim was to compare outcomes following thyroid surgery in terms of operative time, postoperative pain, drainage volume, recurrent laryngeal nerve and parathyroid gland injury with the use of the Harmonic Scalpel compared to conventional methods of hemostasis. Study Design: Randomized control trial. Setting: Surgical Department Lahore General Hospital. Period: Twelve Months June 2016 to June 2017. Material & Methods: 60 patients, 30 in each group. Patients were randomized in each group by balloting method. Operative time, postoperative pain and drainage volume was assessed during hospital stay. Recurrent laryngeal nerve and parathyroid gland injury was assessed during hospital stay and follow-up. Results: There was no significant difference in development of hoarseness of voice in both groups, p-value > 0.05. The mean operative time for group A was 69.47 ± 15.44 minutes and for group B it was 54.93 ± 11.56 minutes, p-value <0.05. The overall blood loss in group-A and group-B was 118.73 ± 50.72 ml and 44.60±10.70 ml, p-value<0.05. The mean post-op pain observed at 2nd day for group B was 2.93 ±3.57 and for group A it was 3.57±0.77, p-value < 0.05. Conclusion: Use of Harmonic Scalpel has better results in thyroid surgery in terms of less operative time, less postoperative pain, less drainage volume, while no RLN & parathyroid injury detected in either group.

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Safety and feasibility of three port procedure in laparoscopic cholecystectomy

International Surgery Journal ◽

10.18203/2349-2902.isj20192063 ◽

2019 ◽

Vol 6 (6) ◽

pp. 1975

Author(s):

Vipin Gupta ◽

Shailendra Pal Singh ◽

Somendra Pal Singh ◽

Anil Kumar Keshari ◽

Anil Kumar Erry ◽

...

Keyword(s):

Laparoscopic Cholecystectomy ◽

Operative Time ◽

Open Cholecystectomy ◽

Standard Technique ◽

Post Operative Pain ◽

Conversion To Open Cholecystectomy ◽

Operative Complications ◽

Group A ◽

The Mean ◽

Group B

Background: Laparoscopic cholecystectomy is widely accepted gold standard technique for management of cholelithiasis and has undergone many refinements including decrease in size and number of ports. Many researchers have claimed that three-port laparoscopic cholecystectomy is safe and feasible method for management of cholelithiasis but still it is not performed widely by the surgeons. Objective of our study was to assess the safety and feasibility of three-port laparoscopic cholecystectomy by comparing the various defined parameters with the standard four-port laparoscopic cholecystectomy.Methods: The study included 100 patients and was divided equally in 2 groups. Patients in Group A underwent laparoscopic cholecystectomy by three-port technique and in Group B were operated by four-port technique. Patients in both the groups were compared in terms of operative time, intra-operative complications, post-operative pain, post-operative complications and cosmesis outcome.Results: The mean operative time was similar in both groups. Intra-op and post-op complications were also similar. 3 patients in Group A needed fourth port and 1 patient in both group required conversion to open cholecystectomy. Mean pain score and requirement of parentral analgesia was found to be lower in Group A. Duration of hospital was similar in both the groups. Patients in group A had slightly better cosmetic outcome.Conclusions: Three-port laparoscopic cholecystectomy is a minimally invasive, safe and feasible technique and is not difficult to master than other advanced techniques. In experienced hands, laparoscopy cholecystectomy can be initially started with three-ports and can be converted to four-port if rarely necessary.

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Modified Percutaneous Achilles Tendon Lengthening by Triple Hemisection for Achilles Tendon Contracture

BioMed Research International ◽

10.1155/2019/1491796 ◽

2019 ◽

Vol 2019 ◽

pp. 1-8 ◽

Cited By ~ 1

Author(s):

Yangjing Lin ◽

Jin Cao ◽

Changgui Zhang ◽

Liu Yang ◽

Xiaojun Duan

Keyword(s):

Achilles Tendon ◽

Recurrence Rate ◽

Operative Time ◽

Achilles Tendon Rupture ◽

Tendon Lengthening ◽

Group A ◽

Achilles Tendon Lengthening ◽

The Mean ◽

Group B

Background. Both percutaneous Achilles tendon lengthening by triple hemisection and the traditional open Z-lengthening are effective methods for Achilles tendon contracture. This study aims to evaluate the efficacy and safety of this new therapeutic method, which is based on the percutaneous sliding technique with three hemi-cuts in the tendon, as compared with the traditional open Z-lengthening. Methods. Retrospective analysis of the Achilles tendon contracture cases in our hospital between January 2010 and September 2016 was conducted. Twenty-five cases received percutaneous Achilles tendon lengthening (group A), and 30 patients who underwent open Z-lengthening during the same period were in the control group (group B). Operative time and hospital stay were statistically analyzed. Incision complication, equinus recurrence rate and Achilles tendon rupture morbidity were recorded. The function was assessed by American Orthopaedic Foot & Ankle Society (AOFAS) score. All cases in group A received Magnetic Resonance Imaging (MRI) of ankle preoperatively and in the follow-ups. Results. The mean follow-up period was 42.04 months in group A and 61.7 months in group B. The entire operative time and the mean hospitalization days were lower in group A than in group B. No incision and infection complication occurred in group A. The infection rate in group B was 3.3%. Equinus recurrence rate was 4% in group A and the equinus recurrence rate in group B was 21.4%. In group A, the mean AOFAS score increased from 64 ± 10.16 points preoperatively to 96.08 ± 3.17 at final follow-up, while the score in group B increased from 63.48 ± 6.2 points to 85.4 ± 10.3. MRI showed continuity of the Achilles tendon and homogeneous signal in group A. Conclusion. Modified surgery can significantly reduce the risk of Achilles tendon rupture, provide better balance in soft tissue strength between ankle dorsiflexion and ankle plantarflexion, helping to avoid recurrence of the deformity.

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Comparison of harmonic scalpel versus Milligan Morgan technique in haemorrhoidectomy patients

Journal of the Pakistan Medical Association ◽

10.47391/jpma.03-1303 ◽

2021 ◽

Author(s):

Muhammad Ahmad ◽

Syed Tatheer Abbas ◽

Amna Javaid ◽

Naveed Arshad ◽

Falak Shair

Keyword(s):

Wound Healing ◽

Operative Time ◽

Harmonic Scalpel ◽

Controlled Trial ◽

P Value ◽

Randomized Controlled ◽

Group A ◽

The Mean ◽

Complete Wound Healing ◽

Group B

Objectives: To assess the comparison of harmonic scalpel versus Milligan Morgan technique in patients undergoing haemorrhoidectomy. Methodology: This randomized controlled trial study was conducted at General Hospital, Lahore, from March 2019 to September 2019. Informed consent was obtained from eligible 60 patients. Patients were randomly divided into two equal groups. In group-A, haemorrhoidectomy was conducted according to the harmonic scalpel method. In group-B, open haemorrhoidectomy was performed by the Milligan Morgan procedure. Data was assembled through a designed questionnaire and investigated via SPSS version 25. Data were stratified for descriptive statistics, level of haemorrhoids and period of haemorrhoids. Post-stratification, independent sample t-test was used. Results: Mean age of both groups patients were 44.6±7.6 and 43.8±8.2 years, respectively. In group-A, mean operative time was 20.8±2.8 minutes, while 26.5±2.8 minutes in group-B, which was statistically significant with p-value of 0.001. In group-A, mean convalescence period was 9.7±2.9 days, while 13.4±3.7 days in group-B, which was statistically significant with p-value of 0.001. The mean convalescence period with harmonic scalpel method was 7.4 days (range 5–14, SD 3.6) versus 18.6 days (range 7–30, SD 5.4) with Milligan Morgan technique (P?0.001). This research observed that harmonic scalpel method required almost six weeks for complete wound healing, whereas in Milligan Morgan technique, complete wound healing was achieved after three months (P<0.05). Conclusion: Harmonic scalpel haemorrhoidectomy found an advantageous method when assessing the operative time and convalescence period. Hence, Harmonic scalpel haemorrhoidectomy can be adapted as a safe and effective alternative method for treating symptomatic haemorrhoids. Continuous...

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COMPARISON OF TRIGGER POINT PRESSURE RELEASE WITH ULTRASOUND THERAPY TO DECREASE RHOMBOIDS TRIGGER POINTS PAIN

Pakistan Journal of Rehabilitation ◽

10.36283/pjr.zu.5.2/002 ◽

2016 ◽

Vol 5 (2) ◽

pp. 32-36

Author(s):

Azam Mahmood ◽

Saad Saleem ◽

Muhammad Usman Khan

Keyword(s):

Pain Score ◽

Outcome Measures ◽

Trigger Point ◽

Sampling Technique ◽

P Value ◽

Ultrasound Therapy ◽

Pressure Release ◽

Group A ◽

The Mean ◽

Group B

OBJECTIVE To compare the effects of trigger point (TrP) pressure release with ultrasound therapy to reduce rhomboid pain due to TrP. STUDY DESIGN Experimental study STUDY SETTINGS Outpatient department of Ziauddin Hospital, Clifton campus, Karachi, Pakistan. SAMPLE SIZE 50 patients SAMPLING TECHNIQUE Simple random sampling. The patients were divided into two groups of 25. Group A were given TrP pressure release treatment with exercise and group B were given ultrasound (u/s) treatment with exercise. OUTCOME MEASURES The outcome measures were visual analog scale (VAS) for pain and functional rating index (FRI) for functional performance RESULTS In group A, mean pain score on VAS before the treatment were 5.88±1.130 and after treatment were 1.80±1.041 with a p-value of <0.006. Group B, mean pain score on VAS before treatment were 6.56±1.446, after treatment were 2.72±1.208, with a p-value of <0.006. The mean FRI in group A before treatment was 39.92 ± 2.691 and after treatment was 29.60 ± 5.454, with a p-value of 0.002. The mean FRI in Group B before treatment was 41.12 ± 2.505 and after treatment was 35.92 ± 4.183, with a p-value of 0.002.

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A comparative study of two operative procedures in anterior hypospadias repair: limited urethral mobilization and tubularized incised plate urethroplasty.

The Professional Medical Journal ◽

10.29309/tpmj/2021.28.11.6506 ◽

2021 ◽

Vol 28 (11) ◽

pp. 1578-1584

Author(s):

Shafiq ur Rehman ◽

Fareena Ishtiaq ◽

Zarlish Fazal ◽

Muhammad Anwar ◽

Saad Fazal

Keyword(s):

Hospital Stay ◽

Functional Outcomes ◽

Operative Time ◽

Operation Time ◽

Cosmetic Appearance ◽

Tubularized Incised Plate ◽

Group A ◽

Tubularized Incised Plate Urethroplasty ◽

The Mean ◽

Group B

Objectives: This study is aimed to compare the results of limited urethral mobilization and tubularized incised plate urethroplasty in the management of anterior hypospadias, in terms of cosmetic and functional outcomes, complication rate, operative time, and hospital stay. Study Design: Prospective Randomized Controlled study. Settings: Department of Pediatric Surgery, DHQ Teaching Hospital Sahiwal. Period: January 2019 to December 2020. Material and Methods: A total of 89 patients with anterior hypospadias were included. Patients were divided randomly into two groups. In group A, limited urethral mobilization was performed and in group B, tubularized incised plate urethroplasty was carried out. A self-structured performa was used to collect the data of all patients. Both groups were compared in terms of the operation time, hospital stay, postoperative complications, cosmetic appearance, and functional outcomes. Results: Forty-five patients were included in group A, age ranged from 2.5 to 12 years (mean 4.83years). Forty-four patients were included in group B and their ages ranged from 3.5 to 11years (mean 4.76 years). The operation time was significantly less for group A than for group B. In group A, it ranged from 54 to 69 min with an average time of 60.51 min and in group B from 70 to 88 min, with an average of 79.34 min. The mean hospital stay period in group A was 7.37 days, ranged from 7 to 9 days, and in group B was 11.04 days, ranging from 10 to 13 days. The mean follow-up period in both groups was 7.45 months, ranging from 3 months to 12 months. Meatal stenosis was the most common complication in group A, which developed in 6.66% (n=3) patients. Urethrocutaneous fistula was the most common complication in group B, which developed in 6.81% (n=3) patients. Cosmetic appearance and functional outcome were good and comparable in both groups. Conclusion: Although both techniques, tubularized incised plate and limited urethral mobilization urethroplasty are acceptable modalities for the management of anterior hypospadias. But limited urethral mobilization urethroplasty seems to be a good option due to its simplicity, short hospital stay, significant shorter operative time, low fistula formation rate, and good cosmetic and functional outcomes.

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Clinical outcome of the off-pump coronary artery bypass surgery- a comparison between combined high thoracic epidural anaesthesia with GA and GA alone

Journal of the Bangladesh Society of Anaesthesiologists ◽

10.3329/jbsa.v22i2.18142 ◽

2014 ◽

Vol 22 (2) ◽

pp. 54-60

Author(s):

Saiful Islam Azad ◽

Abdul Khaleque Beg ◽

AYF Elahi Chowdhury ◽

IH Shahera Khatun

Keyword(s):

Epidural Anaesthesia ◽

Off Pump ◽

Thoracic Epidural ◽

Thoracic Epidural Anaesthesia ◽

Arterial Blood ◽

Post Operative Pain ◽

Group A ◽

The Mean ◽

High Thoracic Epidural ◽

Group B

Background: The common challenges for the cardiac anaesthesiologist during off pump coronary artery surgery (OPCAB) include haemodynamic stability during the different stressful surgical events and multiple cardiac manipulations, providing adequate myocardial protection, and obtaining effective postoperative analgesia leading to early discharge from the intensive care unit. Objective: This study has been undertaken with a view to find out whether a combined high thoracic epidural anaesthesia (HTEA) with general anaesthesia (GA) is safe and more efficient in providing overall cardiovascular stability as well as improving the parameters leading to a better outcome in terms of a shorter and more predictable road maps to recovery. Methods: Sixty patients aged within 40-70 years, without having any coagulopathy disorder, any emergency surgery or left main disease scheduled for CABG on beating heart were enrolled in prospective, randomized observational comparative study. Patients were divided in two groups. In group A patients received GA alone and in group B patients received high thoracic epidural anaesthesia with GA. The parameters including heart rate, SPO2, CVP, arterial blood pressure, ECG, and ABG analysis were recorded before induction, during induction, intubation and during different events of the surgery. Post operative pain score, sedation score, ventilator hour, duration in the ICU stay, rescue analgesic need and post operative complications was assessed and recorded. Results: significant per-operative mean heart rate changes were observed all the events except at wound closure and during anastomosis with D1/D2 and the mean difference of mean arterial pressure at intubations, skin incision, sternotomy, pericardiotomy, during anastomosis of distal end of the graft with RCA, PDA, LCX and D1/D2 were observed statistically significant (p<0.05). No incidence of different arrhythmia occurred in group B, premature ventricular complex (PVC) was statistically significant (p<0.05) between two groups. No significant change was found in per-operative pH of arterial blood, PaCO2 and PaO2 changes at different times. Post operative pain score (VAS 0-100) in different time interval was found significant (p<0.05) change between two groups in all follow-up times. Status of rescue analgesics were observed statistically significant (p<0.05). The mean ventilator hours were 7.4±1.09 hours in group A and 5.3±0.81 hours in group B. The mean ICU stay was 72.9±9.2 hours in group A and 57.1±12.0 hours in group B. No post-operative complication was observed in both groups. The data were compiled and analyzed by using statistical software SPSS (ver. 12.0) and significance test performed by unpaired t test and Chi square test. P value <0.05 was considered as statistically significant. Conclusion: Both anaesthetic techniques are equally safe but better clinical outcome of the OPCAB surgery with the high thoracic epidural anaesthesia with GA. DOI: http://dx.doi.org/10.3329/jbsa.v22i2.18142 Journal of BSA, 2009; 22(2): 54-60

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Role of Pre-operative Intravenous Methylprednisolone for Post-operative Pain Control after IFF Surgery

10.53350/pjmhs2115123188 ◽

2021 ◽

Vol 15 (12) ◽

pp. 3188-3190

Author(s):

Umair Saleem ◽

Kamran Afzal ◽

Saqib Shoaib ◽

Fareed Azam Khan

Keyword(s):

Pain Score ◽

Visual Analogue Scale Pain ◽

Control Group ◽

Intertrochanteric Fractures ◽

Intravenous Methylprednisolone ◽

Femur Fractures ◽

Post Surgery ◽

Post Operative Pain ◽

Group A ◽

Group B

Background: Intertrochanteric region are common in older ages. 33% females and 15% males in their 90s suffer from hip fracture, most commonly intertrochanteric fractures (50%). The pain associated with the surgery of the intertrochanteric fractures is quite troublesome and reduces patient mobilization thus increasing morbidity. Aim: To compare preoperative intravenous methylprednisolone vs control in terms of mean VAS score in patients presenting with intertrochanteric femur fractures. Study design: Randomized control trial Place and duration of study: Orthopaedic Department & General Surgery Department POF Hospital Wah Cantt and Izzat Ali Shah Hospital Wah Cantt from 1st Jan 2020 till 31st Dec 2020 Methodology: Sixty patients were enrolled and divided in two groups. Thirty patients in methylprednisolone group and 30 patients in control Group were enrolled. Age 40-75 years old people of both genders with intertrochanteric femur fractures were included. Post-operative pain was recorded at resting position and 45° hip flexion position 24 hours post-surgery through VAS. Results: In group A, 18 patients were males and 12 were female. In group B 19 patients were male and 11 were female. Mean age in group A was 56.37±4.56 years and in group B, 55.89±4.13 years. Mean VAS pain score in the control group was 5.03±1.542 while the mean VAS pain score in the treatment group was 3.70±15.79 (P=0.002). Conclusion: Methylprednisolone preoperatively reduces postoperative pain at 24 hours after surgery in patients undergoing intertrochanteric fracture fixation. Keywords: Methylprednisolone, Preoperative, Visual Analogue Scale, Pain, Postoperative’

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