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 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 Adrenal Incidentalomas: Should We Operate on Small Tumors in the Era of Laparoscopy?

2014 ◽  
Vol 2014 ◽  
pp. 1-5 ◽  
Author(s):  
Michał Pędziwiatr ◽  
Michał Natkaniec ◽  
Mikhail Kisialeuski ◽  
Piotr Major ◽  
Maciej Matłok ◽  
...  
Keyword(s):  
Surgical Treatment ◽  
Operation Time ◽  
Adrenal Tumors ◽  
Estimated Blood Loss ◽  
Important Argument ◽  
Risk Of Malignancy ◽  
Potentially Malignant ◽  
Group 2 ◽  
Histopathological Results ◽  
Group 1

Tumor size smaller than 4 cm as an indication for surgical treatment of incidentaloma is still a subject of discussion. Our aim was the estimation of the incidence of malignancy and analysis of treatment outcomes in patients with incidentaloma smaller than 4 cm in comparison to bigger lesions. 132 patients who underwent laparoscopic adrenalectomy for nonsecreting tumors were divided into two groups: group 1 (55 pts., size < = 40 mm) and group 2 (77 pts., size > 40 mm). Operation parameters and histopathological results were analyzed. No differences in group characteristics, mean operation time, and estimated blood loss were noted. Complications in groups 1 and 2 occurred in 3.6% and 5.2% of patients, respectively (P=0.67). Malignancy in groups 1 and 2 was present in 1 and 6 patients, respectively (P=0.13). Potentially malignant lesions were identified in 4 patients in group 1 and 4 patients in group 2 (P=0.39). The results do not allow for straightforward recommendations for surgical treatment of smaller adrenal tumors. The safety of laparoscopy and minimal, but impossible to omit, risk of malignancy support decisions for surgery. On the other hand, the risk of malignancy in smaller adrenal tumors is lower than surgical complications, which provides an important argument against surgery.

Role of Frameless Stereotaxy in the Surgical Treatment of Cerebral Arteriovenous Malformations: Technique and Outcomes in a Controlled Study of 44 Consecutive Patients

Neurosurgery ◽  
2002 ◽  
Vol 51 (5) ◽  
pp. 1108-1118 ◽  
Author(s):  
Stephen M. Russell ◽  
Henry H. Woo ◽  
Seth S. Joseffer ◽  
Jafar J. Jafar
Keyword(s):  
Blood Loss ◽  
Arteriovenous Malformations ◽  
Operative Time ◽  
Controlled Study ◽  
Frameless Stereotaxy ◽  
Complication Rates ◽  
Cerebral Arteriovenous Malformations ◽  
Estimated Blood Loss ◽  
Group 2 ◽  
Group 1

Abstract OBJECTIVE To describe a frameless stereotactic technique used to resect cerebral arteriovenous malformations (AVMs) and to determine whether frameless stereotaxy during AVM resection could decrease operative times, minimize intraoperative blood losses, reduce postoperative complications, and improve surgical outcomes. METHODS Data for 44 consecutive patients with surgically resected cerebral AVMs were retrospectively reviewed. The first 22 patients underwent resection without stereotaxy (Group 1), whereas the next 22 patients underwent resection with the assistance of a frameless stereotaxy system (Group 2). RESULTS The patient characteristics, AVM morphological features, and percentages of preoperatively embolized cases were statistically similar for the two treatment groups. The mean operative time for Group 1 was 497 minutes, compared with 290 minutes for Group 2 (P = 0.0005). The estimated blood loss for Group 1 was 657 ml, compared with 311 ml for Group 2 (P = 0.0008). Complication rates, residual AVM incidences, and clinical outcomes were similar for the two groups. CONCLUSION Frameless stereotaxy allows surgeons to 1) plan the optimal trajectory to an AVM, 2) minimize the skin incision and craniotomy sizes, and 3) confirm the AVM margins and identify deep vascular components during resection. These benefits of stereotaxy were most apparent for small, deep AVMs that were not visible on the surface of the brain. Frameless stereotaxy reduces the operative time and blood loss during AVM resection.

scholarly journals Effect of single-port inflatable mediastinoscopy simultaneous laparoscopic-assisted radical esophagectomy on respiration and circulation

2021 ◽  
Vol 16 (1) ◽  
Author(s):  
Haibo Ye ◽  
Xiaojin Wang ◽  
Xiaojian Li ◽  
Xiangfeng Gan ◽  
Hongcheng Zhong ◽  
...  
Keyword(s):  
Carbon Dioxide ◽  
Postoperative Complications ◽  
Partial Pressure ◽  
Single Port ◽  
Perioperative Complications ◽  
Venous Pressure ◽  
Oxygenation Index ◽  
Radical Esophagectomy ◽  
Pressure Peak ◽  
Laparoscopic Assisted

Abstract Background and purpose We previously developed a new surgical method, namely, single-port inflatable mediastinoscopy simultaneous laparoscopic-assisted radical esophagectomy. The purpose of this study was to evaluate the effect of carbon dioxide inflation on respiration and circulation using this approach. Methods From April 2018 to October 2020, 105 patients underwent this novel surgical approach. The changes in respiratory and circulatory functions were reported when the mediastinal pressure and pneumoperitoneum pressure were 10 and 12 mmHg, respectively. Data on blood loss, operative time, and postoperative complications were also collected. Results 104 patients completed the operation successfully, except for 1 patient who was converted to thoracotomy because of intraoperative injury. During the operation, respectively, the heart rate, mean arterial pressure, central venous pressure, peak airway pressure, end-expiratory partial pressure of carbon dioxide and partial pressure of carbon dioxide increased in an admissibility range. The pH and oxygenation index decreased 1 h after inflation, but these values were all within a safe and acceptable range and restored to the baseline level after CO2 elimination. Postoperative complications included anastomotic fistula (8.6%), pleural effusion that needed to be treated (8.6%), chylothorax (0.9%), pneumonia (7.6%), arrhythmia (3.8%) and postoperative hoarseness (18.2%). There were no cases of perioperative death. Conclusions When the inflation pressure in the mediastinum and abdomen was 10 mmHg and 12 mmHg, respectively, the inflation of carbon dioxide from single-port inflatable mediastinoscopy simultaneous laparoscopic-assisted radical esophagectomy did not cause serious changes in respiratory and circulatory function or increase perioperative complications.

scholarly journals How safe are elective craniotomies in elderly patients in neurosurgery today? A prospective cohort study of 1452 consecutive cases

2020 ◽  
pp. 1-9
Author(s):  
Ralph T. Schär ◽  
Shpend Tashi ◽  
Mattia Branca ◽  
Nicole Söll ◽  
Debora Cipriani ◽  
...  
Keyword(s):  
Cohort Study ◽  
Blood Loss ◽  
Elderly Patients ◽  
Age Groups ◽  
Head Ct ◽  
Estimated Blood Loss ◽  
Group 3 ◽  
Group 2 ◽  
The Impact ◽  
Group 1

OBJECTIVEWith global aging, elective craniotomies are increasingly being performed in elderly patients. There is a paucity of prospective studies evaluating the impact of these procedures on the geriatric population. The goal of this study was to assess the safety of elective craniotomies for elderly patients in modern neurosurgery.METHODSFor this cohort study, adult patients, who underwent elective craniotomies between November 1, 2011, and October 31, 2018, were allocated to 3 age groups (group 1, < 65 years [n = 1008], group 2, ≥ 65 to < 75 [n = 315], and group 3, ≥ 75 [n = 129]). Primary outcome was the 30-day mortality after craniotomy. Secondary outcomes included rate of delayed extubation (> 1 hour), need for emergency head CT scan and reoperation within 48 hours after surgery, length of postoperative intensive or intermediate care unit stay, hospital length of stay (LOS), and rate of discharge to home. Adjustment for American Society of Anesthesiologists Physical Status (ASA PS) class, estimated blood loss, and duration of surgery were analyzed as a comparison using multiple logistic regression. For significant differences a post hoc analysis was performed.RESULTSIn total, 1452 patients (mean age 55.4 ± 14.7 years) were included. The overall mortality rate was 0.55% (n = 8), with no significant differences between groups (group 1: 0.5% [95% binominal CI 0.2%, 1.2%]; group 2: 0.3% [95% binominal CI 0.0%, 1.7%]; group 3: 1.6% [95% binominal CI 0.2%, 5.5%]). Deceased patients had a significantly higher ASA PS class (2.88 ± 0.35 vs 2.42 ± 0.62; difference 0.46 [95% CI 0.03, 0.89]; p = 0.036) and increased estimated blood loss (1444 ± 1973 ml vs 436 ± 545 ml [95% CI 618, 1398]; p <0.001). Significant differences were found in the rate of postoperative head CT scans (group 1: 6.65% [n = 67], group 2: 7.30% [n = 23], group 3: 15.50% [n = 20]; p = 0.006), LOS (group 1: median 5 days [IQR 4; 7 days], group 2: 5 days [IQR 4; 7 days], and group 3: 7 days [5; 9 days]; p = 0.001), and rate of discharge to home (group 1: 79.0% [n = 796], group 2: 72.0% [n = 227], and group 3: 44.2% [n = 57]; p < 0.001).CONCLUSIONSMortality following elective craniotomy was low in all age groups. Today, elective craniotomy for well-selected patients is safe, and for elderly patients, too. Elderly patients are more dependent on discharge to other hospitals and postacute care facilities after elective craniotomy.Clinical trial registration no.: NCT01987648 (clinicaltrials.gov).

scholarly journals 1439 A Change in The Use of Post-Operative Drains in Total Knee Arthroplasty (TKA)

2021 ◽  
Vol 108 (Supplement_6) ◽  
Author(s):  
P Erdman ◽  
R Ali ◽  
R Bhattacharya
Keyword(s):  
Blood Loss ◽  
Statistical Significance ◽  
Length Of Hospital Stay ◽  
Social Barriers ◽  
Estimated Blood Loss ◽  
Relevant Variables ◽  
Total Knee ◽  
Group 2 ◽  
Haematoma Formation ◽  
Group 1

Abstract Aim Closed suction drains (CSD) are routinely used to reduce the risk of haematoma formation and wound infections in TKA. Our study aims to determine if the use of drains has any impact on estimated blood loss, transfusion rates and length of stay in hospital. Method Elective TKA cases performed under a single consultant between February 2018-March 2020 were identified. Electronic medical records were reviewed, and data collected on relevant variables. Estimated blood loss was calculated using Ward’s formula. Mann-Whitney U test was applied to assess for statistical significance. Results A total of 86 elective TKA cases were included in the study. In 41 cases patients had a CSD insitu post-operatively (group 1), in the other 45 cases a drain was not used (group 2). Both groups had similar distributions of age, BMI, and sex. We found no statistically significant differences in mean change (+/-SD) in haemoglobin post-operatively between group 1 (21.3 (+/- 9.4)) and group 2 (19 (+/- 10)), (p = 0.34). Mean estimated blood loss was 915mls (+/-365) for group 1 and 871mls (+/-455) for group 2, (p = 0.45). Group 1 had a higher rate of transfusion (4.8% vs 2.2%); however, this was not statistically significant (p = 0.51). After accounting for unrelated medical complications or social barriers to discharge, the length of hospital stay was 4.7 (+/- 2.27) and 4.9 (+/- 3.14) for group 1 and 2 respectively, (p = 0.84). There were no reported cases of wound infection in both groups. Conclusions We found the use of drains in TKA confers no benefits in the outcomes evaluated.

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 Postoperative Pulmonary Complications in Complex Pediatric and Adult Spine Deformity: A Retrospective Review of Consecutive Patients Treated at a Single Site in West Africa

2020 ◽  
pp. 219256822094248
Author(s):  
Irene Wulff ◽  
Henry Ofori Duah ◽  
Henry Osei Tutu ◽  
Gerhard Ofori-Amankwah ◽  
Kwadwo Poku Yankey ◽  
...  
Keyword(s):  
West Africa ◽  
Cobb Angle ◽  
Retrospective Review ◽  
Pulmonary Complication ◽  
Pulmonary Complications ◽  
Spine Deformity ◽  
Consecutive Series ◽  
Estimated Blood Loss ◽  
Group 2 ◽  
Group 1

Study Design: Retrospective review of consecutive series. Objectives: This study sought to assess the incidence, risk factors, and outcomes of pulmonary complication following complex spine deformity surgery in a low-resourced setting in West Africa. Methods: Data of 276 complex spine deformity patients aged 3 to 25 years who were treated consecutively was retrospectively reviewed. Patients were categorized into 2 groups during data analysis based on pulmonary complication status: group 1: yes versus group 2: no. Comparative descriptive and inferential analysis were performed to compare the 2 groups. Results: The incidence of pulmonary complication was 17/276 (6.1%) in group 1. A total of 259 patients had no events (group 2). There were 8 males and 9 females in group 1 versus 100 males and 159 females in group 2. Body mass index was similar in both groups (17.2 vs 18.4 kg/m2, P = .15). Average values (group 1 vs group 2, respectively) were as follows: preoperative sagittal Cobb angle (90.6° vs 88.7°, P = .87.), coronal Cobb angle (95° vs 88.5°, P = .43), preoperative forced vital capacity (45.3% vs 62.0%, P = .02), preoperative FEV1 (forced expiratory volume in 1 second) (41.9% vs 63.1%, P < .001). Estimated blood loss, operating room time, and surgery levels were similar in both groups. Thoracoplasty and spinal osteotomies were performed at similar rates in both groups, except for Smith-Peterson osteotomy. Multivariate logistic regression showed that every unit increase in preoperative FEV1 (%) decreases the odds of pulmonary complication by 9% (OR = 0.91, 95% CI 0.84-0.98, P = .013). Conclusion: The observed 6.1% incidence of pulmonary complications is comparable to reported series. Preoperative FEV1 was an independent predictor of pulmonary complications. The observed case fatality rate following pulmonary complications (17%) highlights the complexity of cases in underserved regions and the need for thorough preoperative evaluation to identify high-risk patients.

scholarly journals Effect of different therapeutic strategies on the clinical outcome of asymptomatic intralobar pulmonary sequestration

2019 ◽  
Vol 29 (5) ◽  
pp. 706-713 ◽  
Author(s):  
Xiao-Kun Li ◽  
Jing Luo ◽  
Wen-Jie Wu ◽  
Zhuang-Zhuang Cong ◽  
Yang Xu ◽  
...  
Keyword(s):  
Clinical Outcome ◽  
Hospital Stay ◽  
Pulmonary Sequestration ◽  
Therapeutic Strategies ◽  
Postoperative Hospital Stay ◽  
Intralobar Sequestration ◽  
Estimated Blood Loss ◽  
Intralobar Pulmonary Sequestration ◽  
Group 2 ◽  
Group 1

Abstract OBJECTIVES Pulmonary sequestration is a rare congenital pulmonary malformation. The aim of this study was to explore the effect of different therapeutic strategies on the clinical outcome of asymptomatic intralobar pulmonary sequestration. METHODS We retrospectively reviewed the clinical data of 37 patients diagnosed with intralobar sequestration. All the patients were asymptomatic. Seventeen patients underwent video-assisted thoracoscopic surgery (VATS) once diagnosed and 20 patients chose to undergo observation. Of these 20 patients, 16 patients developed symptoms during the observation period and also underwent VATS; 4 patients never showed symptoms and did not have surgery. The 33 patients who had VATS were divided into 2 groups: group 1, patients who underwent VATS once diagnosed; group 2, patients who underwent VATS once symptoms appeared. Postoperative data and respiratory function data were compared between the 2 groups. RESULTS Twenty of the patients were men and 17 were women (mean age 37.05 ± 7.89 years). Results of a comparative analysis of the 2 groups indicated that patients in group 1 had better values for median estimated blood loss, median duration of chest tube insertion, postoperative hospital stay and postoperative hospital stay than those in group 2. Postoperative complications were reported in 1 patient in group 1 and in 3 patients in group 2. Meanwhile, the loss of lung function between group 1 and group 2 was statistically significant, which also suggested that patients benefited from surgery once diagnosed. CONCLUSIONS For asymptomatic intralobar sequestration, VATS could be effective and safe. The surgical intervention should be performed once the condition is diagnosed to avoid manifestations occurring and to preserve patients’ quality of life.

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