scholarly journals Myomectomy by vaginal route

2004 ◽  
Vol 132 (1-2) ◽  
pp. 18-21 ◽  
Author(s):  
Zagorka Milovanovic ◽  
Dusan Stanojevic
Keyword(s):  
Operating Time ◽  
Surgical Techniques ◽  
Posterior Wall ◽  
Postoperative Recovery ◽  
Surgical Instruments ◽  
Prospective Clinical Study ◽  
Vaginal Route ◽  
Operative Blood Loss ◽  
Operative Trauma ◽  
Vaginal Myomectomy

In recent years, the development of new surgical techniques in uterus myoma treatment have reduced operative trauma significantly. Our objective was to present operative technique-vaginal myomectomy, making a prospective clinical study where we have evaluated the operative and postoperative period after intentive diagnosis. The result of our study shows the feasibility of myomectomy by entering the peritoneum through the posterior vaginal fornix, using traditional and cheap surgical instruments and thus avoiding the trauma of laparatomy, minimal operative blood loss, reduced operating time and postoperative recovery. In our opinion, vaginal myomectomy could be useful for the treatment of selected cases with fundal or posterior wall uterine myomas.

Postoperative care

2021 ◽  
pp. 235-242
Author(s):  
Usman Latif ◽  
Tyler Concannon ◽  
Andrew Frazier
Keyword(s):  
Postoperative Care ◽  
Wound Care ◽  
Recovery Period ◽  
Operating Time ◽  
Surgical Techniques ◽  
Bone Allograft ◽  
Normal Activity ◽  
Postoperative Recovery ◽  
Short Period

This chapter discusses postoperative recommendations, including ambulation, wound care, antibiotic guidelines, and follow-up interval, for patients who have undergone open surgical SIJ fusion versus minimally invasive (MIS) SIJ fusion. Postoperative care varies widely based on the surgical approach. In particular, patients undergoing MIS are less likely to be admitted, ambulate sooner, have a shorter period of less stringent restrictions, and have faster wound healing with fewer complications. These benefits are due to a variety of factors including shorter incision length, less tissue disruption, decreased operating time, and less blood loss. This benefit is most pronounced with approaches that do not involve the use of hardware. Patients undergoing open surgery typically progress through a 4- to 5-month phased plan of progressive physical therapy. In contrast, patients undergoing MIS, particularly percutaneous SIJ fusion with bone allograft, are able to ambulate immediately and have a short period of mild restrictions followed by return to normal activity. The advent of new surgical techniques and less invasive solutions for SIJ fusion is leading the way to an easier postoperative recovery period for patients.

scholarly journals Myomectomy by vaginal route

2006 ◽  
Vol 53 (1) ◽  
pp. 83-86
Author(s):  
M. Zamurovic ◽  
D. Stanojevic ◽  
P. Srbinovic ◽  
M. Cerovic ◽  
M. Stanojevic
Keyword(s):  
Cost Benefit ◽  
Posterior Wall ◽  
Postoperative Recovery ◽  
Control Group ◽  
Intraoperative Blood Loss ◽  
Vaginal Route ◽  
Postoperative Course ◽  
Abdominal Myomectomy ◽  
Health Authorities ◽  
Type Of Surgery

Myomectomy by vaginal route is the least invasive of all methods for myoma removal. Compared to classical, abdominal myomectomy, it has numerous advantages, especially in cases of fundal and posterior wall myomas, but still it is relatively rarely performed. This study provides an analysis of operative and postoperative course of patients subjected to myomectomy by vaginal route in the period from 01/01/2003 to 01/11/2005 as well as the corresponding control group of patients which had undergone classical, abdominal myomectomy. The study points out to significance and advantages of application of surgical technique for removal of myoma through the posterior wall of the vagina as opposed to classical, abdominal myomectomy. Transvaginal myomectomy eliminates trauma of laparotomy, intraoperative blood loss is reduced, postoperative complications are down to minimum, postoperative recovery is shorter, and so is the number of days spent in hospital. Thus, by performing this type of surgery, a positive cost-benefit effect is obtained not only for the patient but for health authorities as well.

scholarly journals Pelviscopic Compared to Laparotomic and Vaginal Intrafascial Hysterectomy

1997 ◽  
Vol 3 (4) ◽  
pp. 231-239
Author(s):  
L. Mettler ◽  
N. Lutzewitsch
Keyword(s):  
Vaginal Hysterectomy ◽  
Operating Time ◽  
Surgical Techniques ◽  
Abdominal Hysterectomy ◽  
Supracervical Hysterectomy ◽  
Laparoscopic Assisted Vaginal Hysterectomy ◽  
Indications For Operation ◽  
Laparoscopic Assisted ◽  
Benign Disorders ◽  
The University

Between 1993 and 1994, 368 women underwent hysterectomies for benign disorders at the University of Kiel. Of these, 58.7% were performed either by pelviscopic or by laparotomy Classic Intrafascial Supracervical Hysterectomy (CISH). Of the remaining, 14.8% were performed by abdominal hysterectomy, 13.6% by Intrafascial Vaginal Hysterectomy (IVH), 12.2% by Vaginal Hysterectomy (VH), and only 0.05% by Laparoscopic Assisted Vaginal Hysterectomy (LAVH). Comparative data of these six surgical techniques concerning patients characteristics, indications for operation, histological features, blood loss, operating time, hospital stay, uterine weights and postoperatively used analgesics are described.

Haemostatic devices in parotid surgery: a systematic review

2021 ◽  
pp. 1-7
Author(s):  
L Allen ◽  
C MacKay ◽  
M H Rigby ◽  
J Trites ◽  
S M Taylor
Keyword(s):  
Systematic Review ◽  
Blood Loss ◽  
Facial Nerve ◽  
Hospital Stay ◽  
Outcome Measures ◽  
Meta Analysis ◽  
Operating Time ◽  
Length Of Hospital Stay ◽  
Operative Blood Loss ◽  
Parotid Surgery

Abstract Objective The Harmonic Scalpel and Ligasure (Covidien) devices are commonly used in head and neck surgery. Parotidectomy is a complex and intricate surgery that requires careful dissection of the facial nerve. This study aimed to compare surgical outcomes in parotidectomy using these haemostatic devices with traditional scalpel and cautery. Method A systematic review of the literature was performed with subsequent meta-analysis of seven studies that compared the use of haemostatic devices to traditional scalpel and cautery in parotidectomy. Outcome measures included: temporary facial paresis, operating time, intra-operative blood loss, post-operative drain output and length of hospital stay. Results A total of 7 studies representing 675 patients were identified: 372 patients were treated with haemostatic devices, and 303 patients were treated with scalpel and cautery. Statistically significant outcomes favouring the use of haemostatic devices included operating time, intra-operative blood loss and post-operative drain output. Outcome measures that did not favour either treatment included facial nerve paresis and length of hospital stay. Conclusion Overall, haemostatic devices were found to reduce operating time, intra-operative blood loss and post-operative drain output.

X-ray-translucent retractors in spine surgery

1986 ◽  
Vol 64 (3) ◽  
pp. 520-521 ◽  
Author(s):  
Peter Knöringer
Keyword(s):  
Spine Surgery ◽  
Vertebral Column ◽  
Operating Time ◽  
Surgical Instruments ◽  
X Rays ◽  
Content Type ◽  
X Ray ◽  
Image Intensification ◽  
Fine Print

✓ With surgery of the vertebral column under image intensification, surgical instruments and conventional metal retractors often obscure important x-ray landmarks. Surgery is more difficult, operating time is longer, and exposure to x-rays is increased. The author has developed x-ray-translucent retractors for ventral and dorsal operations. Although for reasons of strength these retractors have somewhat more bulk than equivalent metal retractors, they are sufficiently stable and are compatible with spacial requirements. They can be sterilized and reused.

Video-Assisted Thoracoscopic Division of Vascular Rings in Pediatric Patients

2005 ◽  
Vol 71 (4) ◽  
pp. 289-291 ◽  
Author(s):  
Curt S. Koontz ◽  
Amina Bhatia ◽  
Joe Forbess ◽  
Mark L. Wulkan
Keyword(s):  
Aortic Arch ◽  
Pediatric Patients ◽  
Vascular Ring ◽  
Operating Time ◽  
Surgical Techniques ◽  
Retrospective Chart Review ◽  
Ligamentum Arteriosum ◽  
Vascular Rings ◽  
Computed Tomographic ◽  
Video Assisted

Vascular rings are usually repaired via left thoracotomy. We report our series of pediatric patients with vascular rings that were repaired thoracoscopically. From February 2002 to September 2004, 13 patients underwent video-assisted thoracoscopic surgical techniques (VATS) division of their vascular ring. Chest magnetic resonance arterography (MRA) and/or computed tomographic arteriography (CTA) were used to evaluate the vascular ring in most patients. Patients were chosen for VATS repair based on surgeon's choice and type of vascular ring. Data are expressed as mean ± SD. The Children's Healthcare of Atlanta Institutional Review Board approved this retrospective chart review. Age and weight was 1.5 ± 1.8 years (range: 4 months–17 years) and 16.0 ± 12.5 kg (range: 6.0–22.1 kg), respectively (n = 13). Associated diseases included congenital heart disease (n = 2). Symptoms included respiratory complaints (n = 6), dysphagia (n = 2), dysphagia and shortness of breath (n = 1), pneumonia (n = 2), tracheal deviation (n = 1), and one patient was asymptomatic. Vascular ring types included double aortic arch (n = 4) and right aortic arch with an aberrant left subclavian artery and a left ligamentum arteriosum (n = 9). Operating time was 70 ± 20 minutes (range: 46–122 minutes). One patient had to be opened because of a large arch. Length of stay was 1.9 ± 0.9 days (range: 1–3 days). There were no complications, and all patients improved clinically at follow-up. Thoracoscopic repair of certain types of vascular rings seems to be safe and effective in children. More patients, however, need to be studied.

Training Skills in Minimally Invasive, Robotic and Open Surgery: Brain Activation as an Opportunity for Learning

2020 ◽  
Vol 61 (1) ◽  
pp. 34-50
Author(s):  
Gloria Pelizzo ◽  
Lucilla Cardinali ◽  
Lilla Bonanno ◽  
Silvia Marino ◽  
Carlo Cavaliere ◽  
...  
Keyword(s):  
Surgical Training ◽  
Open Surgery ◽  
Surgical Techniques ◽  
Learning Curves ◽  
Surgical Instruments ◽  
Open Group ◽  
Control Group ◽  
Steady Increase ◽  
Motor Training ◽  
Starting Point

Introduction: The advantages of the robotic approach in surgery are undisputed. However, during surgical training, how this technique influences the learning curve has not been described. We provide a tentative model for analyzing the learning curves associated with observation and active participation in learning different surgical techniques, using functional imaging. Methods: Forty medical students were enrolled and assigned to 4 groups who underwent training in robotic (ROB), laparoscopic (LAP), or open (OPEN) surgery, and a control group that performed motor training without surgical instruments. Surgical/motor training included six 1-h sessions completed over 6 days of the same week. All subjects underwent functional magnetic resonance imaging (fMRI) scanning sessions, before and after surgical training during. Results: Twenty-three participants completed the study. The 3 surgical groups exhibited different learning curves during training. The main effects of the day of training (p < 0.01) and the group (p < 0.01) as well as a significant interaction of day of training group (p < 0.01) were observed. The performance increased in the first 4 days, reaching a peak at day 4, when all groups were considered together. The OPEN group showed the best performance compared to all other groups (p < 0.04). The OPEN group showed a rapid improvement in performance, which peaked at day 4 and decreased on the last day. Similarly, the LAP group showed a steady increase in the number of exercises they completed, which continued for the entire training period and reached a peak on the last day. However, the participants training in ROB surgery, after a performance initially indistinguishable from that of the LAP group, had a dip in their performance, quickly followed by an improvement and reaching a plateau on day 4. fMRI analysis documented the different involvement of the cortical and subcortical areas based on the type of training. Surgical training modified the activation of some brain regions during both observation and the execution of tasks. Conclusions: Differences in the learning curves of the 3 surgical groups were noted. Functional brain activity represents an interesting starting point to guide training programs.

scholarly journals Total hip arthroplasty performed by direct anterior approach – Does experience influence the learning curve?

SICOT-J ◽  
2020 ◽  
Vol 6 ◽  
pp. 15 ◽  
Author(s):  
Constant Foissey ◽  
Mathieu Fauvernier ◽  
Cam Fary ◽  
Elvire Servien ◽  
Sébastien Lustig ◽  
...  
Keyword(s):  
Total Hip Arthroplasty ◽  
Learning Curve ◽  
Hip Arthroplasty ◽  
Anterior Approach ◽  
Operating Time ◽  
Surgical Techniques ◽  
Direct Anterior Approach ◽  
Clinical Results ◽  
Total Hip ◽  
Significant Difference

Introduction: Proficiency in the direct anterior approach (DAA) as with many surgical techniques is considered to be challenging. Added to this is the controversy of the benefits of DAA compared to other total hip arthroplasty (THA) approaches. Our study aims to assess the influence of experience on learning curve and clinical results when transitioning from THA via posterior approach in a lateral position to DAA in a supine position. Methods: A consecutive retrospective series of 525 total hip arthroplasty of one senior and six junior surgeons was retrospectively analysed from May 2013 to December 2017. Clinical results were analysed and compared between the two groups and represented as a learning curve. Mean follow up was 36.2 months ± 11.8. Results: This study found a significant difference in complications between the senior and junior surgeons for operating time, infection rate, and lateral femoral cutaneous nerve (LFCN) neuropraxia. A trainee’s learning curve was an average of 10 DAA procedures before matching the senior surgeon. Of note, the early complications correlated with intraoperative fractures increased with experience in both groups. Operating time for the senior equalised after 70 cases. Dislocation rate and limb length discrepancy were excellent and did not show a learning curve between the two groups. Conclusion: DAA is a safe approach to implant a THA. There is a learning curve and initial supervision is recommended for both seniors and trainees. Level of evidence: Retrospective, consecutive case series; level IV.

Treatment of elbow instability: state of the art

2020 ◽  
pp. jisakos-2019-000316
Author(s):  
Alessandro Marinelli ◽  
Benjamin R Graves ◽  
Gregory Ian Bain ◽  
Luigi Pederzini
Keyword(s):  
Soft Tissue ◽  
State Of The Art ◽  
Current Knowledge ◽  
Imaging Techniques ◽  
Surgical Techniques ◽  
Surgical Instruments ◽  
Future Research ◽  
Elbow Instability ◽  
Soft Tissue Healing ◽  
Tissue Healing

The elbow is a congruent joint with a high degree of inherent stability, provided by osseous and soft-tissue constraints; however, when substantial lesions of these stabilising structures happen, instability of the elbow occurs. Significant improvements in surgical elbow instability diagnosis and treatment have been recently introduced both for acute and chronic cases. Specific stress tests, recently introduced in the clinical practice, and different imaging techniques, both static and dynamic, allow assessment of the elbow stabilisers and detection of the instability direction and mechanism even in subtle forms. Many surgical techniques have been standardised and surgical instruments and devices, specifically dedicated to elbow instability treatment, have been developed. Specific rehabilitation protocols have been designed to protect the healing of the elbow stabilisers while minimising elbow stiffness. However, despite the progress, surgical treatments can be challenging even for expert surgeons and the rate of persistent instability, post-traumatic arthritis, stiffness and pain can be still high especially in most demanding cases. The biology of the soft-tissue healing remains one of the most important aspects for future investigation. If future research will help to understand, correct or modulate the biological response of soft-tissue healing, our confidence in elbow instability management and the reproducibility of our treatment will tremendously improve. In this paper, the state of the art of the current knowledge of elbow instability is presented, specifically focusing on modern surgical techniques used to solve instability, with repair or reconstruction of the damaged elbow stabilisers.

scholarly journals Living-donor nephrectomy at Singapore General Hospital: Evolution of surgical techniques over the last two decades

2020 ◽  
Vol 29 (4) ◽  
pp. 239-244
Author(s):  
Edwin Jonathan Aslim ◽  
Yun Le Linn ◽  
Xinyan Yang ◽  
Glenn Yang Han Ng ◽  
Chui Wan Lee ◽  
...  
Keyword(s):  
Living Donor ◽  
Operating Time ◽  
Surgical Techniques ◽  
Donor Nephrectomy ◽  
Surgical Morbidity ◽  
Living Donor Nephrectomy ◽  
Warm Ischaemia ◽  
Singapore General Hospital ◽  
The Mean ◽  
Time Periods

Background: Laparoscopic living-donor nephrectomy is the current epitome of living kidney donation surgery. We review our experience in living-donor nephrectomies over the last 19 years, transitioning from open surgery to hand-assisted laparoscopy to full laparoscopic techniques. Methods: We retrospectively identified all living-donor nephrectomies performed at our institution from 1976 to 2018. The donors were categorised according to surgical techniques: open (ODN), hand-assisted laparoscopy (HALDN) and full laparoscopy (LDN). We reviewed changes in donor demographics over the years. Surgical outcomes between groups were compared from 2000 to 2018. We also compared the outcomes of LDN between different time periods to evaluate our learning curve. Results: A total of 214 living-donor nephrectomies were performed between 2000 and 2018. The majority were left sided (93%) and had single renal artery anatomy (90%). There were 22 ODN, 20 HALDN and 163 LDN cases. The mean operating time was 84±43, 151±32 and 179±37 minutes for ODN, HALDN and LDN, respectively ( p<0.001). There were no statistically significant differences in mean warm ischaemia times ( p=0.921) and length of hospital stay ( p=0.114) between groups. The overall 30-day surgical morbidity rate was 9.3%, with a major complications rate of 0.9%. The mean warm ischaemia time for LDN was significantly different ( p<0.001) between time periods: 281±260, 184±94 and 140±42 seconds for the periods between 2005–2009, 2010–2014 and 2015–2018, respectively. Conclusion: This study confirms the safety of living-donor nephrectomies performed at our institution, a centre with a modest volume of kidney transplants.

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