Surgical and Postoperative Evaluations of Rectal Adenomas Ecised With a Novel Proctoscope.

Abstract Purpose Many transanal endoscopic surgeries require a high level of technical expertise and surgeon experience. Considering the economic feasibility of material acquisition and the technical feasibility of training and experience with complex methods, a simpler technique with available resources is relevant for the excision of rectal adenomas. This study presents the surgical and postoperative results achieved with a novel proctoscope using the transanal endoscopic technique to excise rectal adenomas. The results are compared to the results obtained with other currently employed transanal techniques. Methods We retrospectively investigated the medical records of patients who underwent transanal endoscopic operations from April 2000 to June 2018 at two tertiary referral centers for colorectal cancer. Results This study included 99 patients. The mean age was 65.3 ± 13.3 years. The average size of the adenomas was 4.6 ± 2.3 cm, and their average distance to the anal border was 5.6 ± 3.3 cm. The average operative time was 65.3 ± 41.7 min. In 48.5% of the operations, the specimen was fragmented, and in 59.6% of the cases, the microscopic margins were free. The rates of postoperative complications and relapse were 5% and 19%, respectively. The mean follow-up was 80 ± 61.5 months. Conclusions The described proctoscope proved to be a viable technique with results similar to other techniques, with the advantage that it allowed greater accessibility for surgeons. Therefore, its use could be implemented and become widespread in surgical practice.

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LAPAROSCOPIC TRANS-ABDOMINAL PRE-PERITONEAL (TAPP) REPAIR FOR TREATMENT INGUINAL HERNIA DISEASE

Journal of Medicine and Pharmacy ◽

10.34071/jmp.2018.4.11 ◽

2018 ◽

Vol 8 (4) ◽

pp. 76-80

Author(s):

Thao Nguyen Minh ◽

Vu Pham Anh ◽

Tri Nguyen Huu ◽

Phu Nguyen Doan Van ◽

Phuc Nguyen Thanh ◽

...

Keyword(s):

Inguinal Hernia ◽

Operative Time ◽

Bilateral Hernia ◽

Repair Method ◽

Tapp Repair ◽

Post Operation ◽

Average Operative Time ◽

The Mean

Background: Inguinal hernia is one of the commonest surgical diseases and there are many different techniques applied. The laparoscopic trans-abdominal pre-peritoneal (TAPP) repair allows a better view of the inguinal anatomy, evaluation of opposite side and resolve combined peritoneal diseases as well. Patient and method: The study included 60 cases with inguinal hernia that have been treated by laparoscopic transabdominal pre-peritoneal (TAPP) repair. Method: Description, prospective follow-up. Result: The mean age was 58±18.2. 96.7% were males. The average operative time was 45.6±15.1 minutes for one side hernia, 73±25.2 minutes for bilateral hernia. 02 cases have been post-operation inguinal seroma complication (3.3%), 02 cases with hydrocele (3.3%), 01 case with abdominal seroma (1.7%). 04 cases (6.7%) opposite inguinal hernia were detected and 05 cases (8.3%) with combined diseases were resolved. Duration of post-operative stay was 3.9±1.1 days. Conclusion: TAPP is a safe and feasible procedure, allows evaluation of opposite side and resolve combined peritoneal diseases.

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Revisiting One-Stage Urethroplasties for Distal Urethral Strictures

Journal of Clinical Medicine ◽

10.3390/jcm10245905 ◽

2021 ◽

Vol 10 (24) ◽

pp. 5905

Author(s):

Matthias D. Hofer ◽

Lauren Folgosa Cooley ◽

Ayman Elmasri ◽

Francisco E. Martins

Keyword(s):

Surgical Technique ◽

Operative Time ◽

Scar Tissue ◽

Urethral Reconstruction ◽

One Stage ◽

Urethral Strictures ◽

Average Operative Time ◽

The Mean ◽

Flap Repairs

Background: Reconstructive approaches for distal urethral strictures range from simple meatotomy to utilizing grafts or flaps depending on the etiology, length and location. We describe a contemporary cohort of distal urethral strictures and report a surgical technique termed distal one-stage urethroplasty developed to address the majority of distal urethral strictures encountered. Methods: Thirty-four patients were included. The mean age was 56.7 years (range 15.7–84.9 years), the mean stricture length was 1.1 cm (0.5–1.5) and the mean follow-up was 42.5 months (28–61.3). Results: The vast majority of distal strictures (27/34 (79.4%)) were treated with our hybrid one-stage approach combining a distal urethral reconstruction with excision of the scar tissue without the need to use grafts or flaps. The average stricture length was 0.68 cm and average operative time was 24.43 min. Post-operative spraying was reported in a minority of patients (4/27 (14.8%)). The length of stricture and surgery were significantly longer in those 7/34 (20.6%) patients in whom grafts or flaps were used (2.88 cm and 154.8 min, respectively, p < 0.001 for both when compared to the hybrid one-stage approach). We noted 6/34 (17.6%) recurrences of distal urethral strictures, all of which were treated successfully with graft and flap repairs. Conclusions: The vast majority of distal urethral strictures are amenable to a distal one-stage urethroplasty, avoiding the use of grafts and/or flaps while achieving reasonable outcomes. This limited approach, at least initially, is associated with shorter operative time and time of catheter placement and avoids morbidity associated with graft or flap harvesting. Spraying of urine is seldomly encountered and comparable to other approaches addressing distal urethral strictures.

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Laparoscopic Orchiopexy for the Nonpalpable Testis : 3 Years Experience

TAJ Journal of Teachers Association ◽

10.3329/taj.v24i2.37506 ◽

2018 ◽

Vol 24 (2) ◽

pp. 70-75

Author(s):

M Nowshad Ali ◽

M Rokeya Khatun ◽

SMA Shahid ◽

M Ahmed ◽

Chinmoy Kanti Das

Keyword(s):

Survival Rate ◽

Operative Time ◽

Average Operative Time ◽

The Mean ◽

Low Incidence ◽

Nonpalpable Testis ◽

The Right ◽

Laparoscopic Orchiopexy ◽

Abdominal Testis

We evaluated the safety and efficacy of laparoscopic orchiopexy to manage a nonpalpable intra-abdominal testis and studied the outcomes. We report our 3 years experience.Patients and methods Laparoscopic Orchiopexy was performed on 28 children (32 testicular units) for non-palpable intra-abdominal testis between 2010 and 2012. We retrospectively reviewed the medical records. The mean age was 3.4 years (range, 2.5 -11 years). Of the 28 patients, 18 (64.28 %) were on the right, 6 (21.44%) were on the left and 4 (14.28%) of bilateral. The mean follow-up period was 14.8 months (range, 3-36 months). Testicular viability and orchiopexed positioning were evaluated within 1 month and beyond 3 months.Results Thirty one testes were descended successfully by laparoscopy. The average operative time was 41.5 ± 3.8 min. Primary laparoscopic orchiopexy done in 26 testes.Three of unilateral and 2 of bilateral testicular units underwent one -stage Fowler-Stephens Orchiopexy. One patient needs laparoscopic orchiectomy. At follow-up (mean 14.8 months), one testis atrophied and need orchiectomy. Testicular survival rate was 96.77% (30/31) and all of the testes maintained an adequate size. Twenty six (86.66%) are in an acceptable scrotal position and 4 testes (13.33%) are mid to high in the scrotum without atrophy. There was no recurrent inguinal hernia.Conclusions Laparoscopic orchiopexy is successful for a nonpalpable intra-abdominal testis with a high testicular survival rate. The low incidence of complications and high success rate underscore the feasibility of this procedure. It is our procedure of choice for the treatment of nonpalpable testis.TAJ 2011; 24(2): 70-75

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Outcomes of distal femoral arthroplasty after periprosthetic fractures: minimum 2-year follow-up

Acta Orthopaedica Belgica ◽

10.52628/87.1.14 ◽

2021 ◽

Vol 87 (1) ◽

pp. 111-116

Author(s):

Y Warschawski ◽

S Garceau ◽

M Bonyun ◽

O Dahduli ◽

J Wolfstadt ◽

...

Keyword(s):

Operative Time ◽

Knee Dislocation ◽

Consecutive Series ◽

Success Rates ◽

Short Term ◽

Average Operative Time ◽

Total Knee ◽

The Mean ◽

Periprosthetic Infections

Purpose : distal femoral periprosthetic fracture (DFPPF) is a serious complication following total knee arthroplasty (TKA). Recently, treatment of DFPPF with distal femoral arthroplasty (DFA) has gained popularity because of its posited benefits for both patients and the medical system. Short-term follow-up trials investigating DFA have demonstrated acceptable results with regards to function, pain relief and lower postoperative complications than ORIF in elderly patients. The purpose of the current study was to evaluate a consecutive series of DFPPF treated with DFA, with a minimum 2- year follow-up. Methods : We performed a retrospective study asses- sing the outcomes of distal femoral arthroplasty (DFA) for patients diagnosed with DFPPF. Results : Twenty patients were identified. The mean age of patients was 76.3 (SD, 9.41), the average time from the fracture to revision surgery was 6.7 days (SD, 11.35), The average operative time was 93.5 minutes (SD,16.6). The average follow-up time was 50.15 months (SD, 20.87). During this time, two patients (10%) had complications. One patient experienced a knee dislocation and the second patient had recurrent periprosthetic infections. At final follow up, the mean knee society score was 86.25 (SD, 9.44), the mean Forgotten joint score was 62.16(SD, 23.45) and 93.7 percent of patients were ambulatory. Conclusion : DFA following DFPPF is associated with high success rates and provides patients with the opportunity for return of function in a safe and reliable manner.

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V-Loc urethro-intestinal anastomosis during robotic cystectomy with orthotopic urinary diversion

Canadian Urological Association Journal ◽

10.5489/cuaj.508 ◽

2013 ◽

Vol 7 (11-12) ◽

pp. 663 ◽

Cited By ~ 9

Author(s):

Khanh N. Pham ◽

Bryan S Sack ◽

R. Corey O'Connor ◽

Michael L Guralnick ◽

Peter Langenstroer ◽

...

Keyword(s):

Urinary Diversion ◽

Operative Time ◽

Intestinal Anastomosis ◽

Barbed Suture ◽

Orthotopic Neobladder ◽

Robotic Cystectomy ◽

Orthotopic Urinary Diversion ◽

Average Operative Time ◽

The Mean

Introduction: Robotic-assisted radical cystectomy (RARC) is an emerging minimally invasive alternative for the treatment of invasive bladder cancer. The V-loc (Covidien, Mansfield, MA) suture is a unidirectional barbed suture that provides even distribution of tension. We determined the rate of urinary leak at the urethro-intestinal anastomosis following orthotopic neobladder construction performed with V-loc suture.Methods: We retrospectively reviewed charts on all patients that underwent RARC with orthotopic neobladder urinary diversion performed with a V-loc suture from February 2010 to February 2012. The urethro-intestinal anastomosis was evaluated for urinary leak by cystogram at 3 to 4 weeks, postoperatively.Results: In total, 11 patients were available for analysis. The mean patient age was 57.2 years (range: 47-71). The average clinical follow-up was 8 months (range: 4-15). On surgical pathology, 8 (73%) patients had pT2 or less disease, 3 (27%) had pT3/T4 disease, and 1 (9%) had N+ disease. The mean intraoperative blood loss was 315 mL (range: 150-600) and the average operative time was 496 minutes (range: 485-519). No patient (0%) demonstrated a urinary leak at the urethro-intestinal anastomosis on postoperative cystogram. Eight patients (73%) were continent by 4 months, postoperatively.Conclusions: Orthotopic neobladder urethro-intestinal anastomosis can be performed effectively and safely with V-loc suture with an acceptably low urinary leak rate.

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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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LigaSure Haemorrhoidectomy versus Conventional Diathermy for IV-Degree Haemorrhoids: Is It the Treatment of Choice? A Randomized, Clinical Trial

ISRN Gastroenterology ◽

10.5402/2011/467258 ◽

2011 ◽

Vol 2011 ◽

pp. 1-6 ◽

Cited By ~ 15

Author(s):

Maurizio Gentile ◽

Michele De Rosa ◽

Gabriele Carbone ◽

Vincenzo Pilone ◽

Francesca Mosella ◽

...

Keyword(s):

Clinical Trial ◽

Postoperative Pain ◽

Operative Time ◽

Randomized Study ◽

Late Complications ◽

The Third ◽

Effective Instrument ◽

The Mean ◽

Complications Rate

Introduction. Milligan-Morgan haemorrhoidectomy performed with LigaSure system (LS) seems to be mainly effective where a large tissue demolition is required. This randomized study is designed to compare LigaSure haemorrohidectomy with conventional diathermy (CD) for treatment of IV-degree haemorrhoids. Methods. 52 patients with IV-degree haemorrhoids were randomized to two groups (conventional diathermy versus LigaSure haemorrhoidectomy). They were evaluated on the basis of the following main outcomes: mean operative time, postoperative pain, day of discharge, early and late complications. The time of recovery of work was also assessed. All patients had a minimum follow-up of twelve months (range 12–24). All data were statistically evaluated. Results. 27 patients were treated by conventional diathermy, 25 by LigaSure. The mean operative time was significantly shorter in LS, such as postoperative pain, mainly lower on the third and fourth postoperative day: moreover pain disappeared earlier in LS than CD. The time off-work was shorter in LS, while there was no difference in hospital stay and overall complications rate. Conclusions. LigaSure is an effective instrument when a large tissue demolition is required. This study supports its use as treatment of choice for IV degree haemorrhoids, even if the procedure is more expansive than conventional operation.

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Laryngoceles: Concepts of Diagnosis and Management

Ear Nose & Throat Journal ◽

10.1177/014556131709600313 ◽

2017 ◽

Vol 96 (3) ◽

pp. 133-138 ◽

Cited By ~ 4

Author(s):

Mohammad Kamal Mobashir ◽

Waleed M. Basha ◽

Abd ElRaof Said Mohamed ◽

Mostafa Hassaan ◽

Ahmed M. Anany

Keyword(s):

Operative Time ◽

Benign Lesion ◽

Direct Visualization ◽

Neck Swelling ◽

Treatment Results ◽

Endoscopic Laser ◽

The Mean ◽

Laryngeal Saccule ◽

Single Approach

A laryngocele is an abnormal dilatation of the laryngeal saccule. It is a rare benign lesion of the larynx. Various modalities of treatment have been advocated for its management. We present our treatment results and outcomes of a series of cases of laryngoceles and discuss the concepts of their management. This study included patients with different laryngocele types. Patients with an internal laryngocele underwent endoscopic CO2 laser resection, while those with a combined laryngocele underwent resection via a V-shaped lateral thyrotomy approach. Seven patients had an internal laryngocele, and 4 patients had a combined laryngocele. Hoarseness and neck swelling were the most common symptoms. The mean follow-up period was 8.5 months. None of the patients needed a tracheostomy either preoperatively or postoperatively, or had recurrence of laryngocele. We advocate the lateral thyrotomy approach for combined laryngoceles as it provides safe, precise, and complete resection under direct visualization via a single approach, while we favor the endoscopic laser approach for the internal ones as it allows resection of the entire lesion with minimal laryngeal trauma, less operative time, and a shorter hospital stay.

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Retroperitoneal hand-assisted laparoscopic nephrectomy and partial nephrectomy

Surgical Techniques Development ◽

10.4081/std.2013.e3 ◽

2013 ◽

Vol 3 (1) ◽

pp. 3 ◽

Cited By ~ 1

Author(s):

Nosratollah Nezakatzgoo ◽

Janet Colli ◽

Matthew Mutter ◽

Sheg Aranmolate ◽

Robert Wake

Keyword(s):

Partial Nephrectomy ◽

Operative Time ◽

Harmonic Scalpel ◽

Oral Intake ◽

Pathological Examination ◽

Tumor Diameter ◽

Renal Masses ◽

Estimated Blood Loss ◽

Average Operative Time

The purpose of the present paper is to describe our technique and experience with retroperitoneal hand-assisted laparoscopic (HAL) nephrectomies as an alternative to the transperitoneal approach. Eight retroperitoneal HAL nephrectomies and one partial nephrectomy were performed. Several excisional techniques were employed incorporating the Harmonic scalpel or Ligasure device. Hemostatic agents were used to cover the renal defect. Surgical bolsters were sutured to the renal capsule with pleget reinforcements to aid in hemostasis. The average operative time was 210 min and estimated blood loss 110 mL. Mean change in hematocrit was 3 units and creatinine was 1 point. No patient required a transfusion. There were no major complications, with a mean follow-up of fourteen months. On average, patients resumed oral intake in 2 days, and were discharged in 3 days. Pathological examination revealed that two lesions were benign and seven malignant. Tumor diameter averaged 3 cm. There were no positive surgical margins. In conclusion, we have demonstrated the feasibility of retroperitoneal laparoscopic hand-assisted nephrectomy and partial nephrectomy surgery for solid renal masses.

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Incisional Hernia Risk after Hand-Assisted Laparoscopic Surgery

The American Surgeon ◽

10.1177/000313481207800821 ◽

2012 ◽

Vol 78 (8) ◽

pp. 864-869 ◽

Cited By ~ 8

Author(s):

William S. Cobb ◽

Alfredo M. Carbonell ◽

Garrett M. Snipes ◽

Brianna Knott ◽

Viet Le ◽

...

Keyword(s):

Laparoscopic Surgery ◽

Incisional Hernia ◽

Operative Time ◽

Group Versus ◽

True Incidence ◽

Hernia Formation ◽

The Mean ◽

Laparoscopic Techniques ◽

Mean Time

Hand-assisted laparoscopic surgery (HALS) bridges traditional open surgery and pure laparoscopy. The HALS technique provides the necessary site for organ retrieval, reduces operative time, and realizes the postoperative benefits of laparoscopic techniques. Although the reported rates of incisional hernia should be theoretically low, we sought to determine our incidence of hernia after HALS procedures. A retrospective review of all HALS procedures was performed from July 2006 to June 2011. All patients who developed postoperative incisional hernias at the hand port site were confirmed by imaging or examination findings. Patient factors were reviewed to determine any predictors of hernia formation. Over the 5 years, 405 patients undergoing HALS procedures were evaluated: colectomy (264), nephrectomy (107), splenectomy/pancreatectomy (18), and ostomy reversal (10). The overall incidence of incisional hernia was 10.6 per cent. There were three perioperative wound dehiscences. The mean body mass index was significantly higher in the hernia group versus the no hernia cohort (32.1 vs 29.2 kg/m2; P = 0.001). The hernia group also had a higher incidence of renal disease (18.6 vs 7.2%; P = 0.018). Mean time to hernia formation was 11.4 months (range, 1 to 57 months). Follow-up was greater than 12 months in 188 (46%) of patients, in which the rate of incisional hernia was 17 per cent. The rate of incisional hernia formation after hand-assisted laparoscopic procedures is higher than the reported literature. Because the mean time to hernia development is approximately 1 year, it is important to follow these patients to this end point to determine the true incidence of incisional hernia after hand-assisted laparoscopy.

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