scholarly journals Laparoscopic transperitoneal adrenalectomy: The gold standard treatment.

2019 ◽  
Vol 26 (09) ◽  
pp. 1440-1444
Author(s):  
Mohammad Zarin ◽  
Maham Qazi ◽  
Sayed Asad Maroof ◽  
Junaid Zeb ◽  
Muhammad Ishfaq Ahmad ◽  
...  
Keyword(s):  
Intraoperative Complications ◽  
Adrenal Tumors ◽  
Cross Sectional ◽  
Intraoperative Complication ◽  
Intraoperative Bleeding ◽  
Bleeding Vessel ◽  
Operative Complications ◽  
The Right ◽  
Operative Recovery ◽  
Laparoscopic Transperitoneal

Objectives: The aim of our study was to evaluate safety and outcomes of laparoscopic transperitoneal adrenalectomy in the treatment of adrenal tumors in terms of peri operative complications. Moreover we have also focused on frequency of tumors presented with adrenal masses. Study Design: Cross sectional study. Setting: Khyber Teaching Hospital, Peshawar Pakistan. Period: 20th October 2014 to 30th January 2018. Material and Methods: Total of 43 patients were included in study after informed consent to participate in the study. Data was collected by predesigned questionnaire and analyzed by SPSS 20. Results: A total of 43 Laparoscopic transperitoneal adrenalectomies were performed, predominantly for pheochromocytomas (19 cases). Out of all cases operated 24 laparoscopic transperitoneal adrenalectomies were performed on the right side and 19 on the left side. According to the tumor localization, the mean operative time was 90± 9.5 minutes. Intraoperative complications occurred in five cases 11.6%. The common intraoperative complication was intraoperative bleeding (9.3%). The intraoperative complication rate on the right side was 9.3% due to intra-operative hemorrhage and the corresponding rate on left was 2.3% due to inra-operative diaphragh tear. In one case (2.3%) we could not control intraoperative hemorrhage laparoscopically and it got converted to open surgery for control of bleeding, whereas rest of the three cases with intraoperative bleeding were controlled by identifying the bleeding vessel and clipping it. Post-operative complications occurred in 7 patients (16.27%). Conclusion: Laparoscopic transperitoneal Adrenalectomy is safe, feasible procedure with decrease morbidity and early post operative recovery and discharge from hospital with no mortality.

scholarly journals Laparoscopic transperitoneal adrenalectomy in the large adrenal tumor from single center experience

BMC Surgery ◽  
2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Thanasit Prakobpon ◽  
Apirak Santi-ngamkun ◽  
Manint Usawachintachit ◽  
Supoj Ratchanon ◽  
Dutsadee Sowanthip ◽  
...  
Keyword(s):  
Tumor Size ◽  
Adrenal Tumor ◽  
Intraoperative Complications ◽  
Perioperative Outcomes ◽  
Adrenal Tumors ◽  
Transfusion Rate ◽  
Intraoperative Complication ◽  
Estimated Blood Loss ◽  
Group 2 ◽  
Laparoscopic Transperitoneal

Abstract Background The role of laparoscopic adrenalectomy (LA) in a large adrenal tumor is controversial due to the risk of malignancy and technical difficulty. In this study, we compared the perioperative outcomes and complications of LA on large (≥ 6 cm) and (< 6 cm) adrenal tumors. Methods We retrospectively reviewed all clinical data of patients who underwent unilateral transperitoneal LA in our institution between April 2000 and June 2019. Patients were classified by tumor size into 2 groups. Patients in group 1 had tumor size < 6 cm (n = 408) and patient in group 2 had tumor size ≥ 6 cm (n = 48). Demographic data, perioperative outcomes, complications, and pathologic reports were compared between groups. Results Patients in group 2 were significant older (p = 0.04), thinner (p = 0.001) and had lower incident of hypertension (p = 0.001), with a significantly higher median operative time (75 vs 120 min), estimated blood loss (20 vs 100 ml), transfusion rate (0 vs 20.8%), conversion rate (0.25 vs 14.6%) and length of postoperative stays ( 4 vs 5.5 days) than in group 2 (all p < 0.001). Group 2 patients also had significantly higher frequency of intraoperative complication (4.7 vs 31.3%; adjust Odds Ratio [OR] = 9.67 (95% CI 4.22–22.17), p-value < 0.001) and postoperative complication (5.4 vs 31.3%; adjust OR = 5.67 (95% CI 2.48–12.97), p-value < 0.001). Only eight (1.8%) major complications occurred in this study. The most common pathology in group 2 patient was pheochromocytoma and metastasis. Conclusions Laparoscopic transperitoneal adrenalectomy in large adrenal tumor ≥ 6 cm is feasible but associated with significantly worse intraoperative complications, postoperative complications, and recovery. However, most of the complications were minor and could be managed conservatively. Careful patient selection with the expert surgeon in adrenal surgery is the key factor for successful laparoscopic surgery in a large adrenal tumor. Trial registration: This study was retrospectively registered in the Thai Clinical Trials Registry on 02/03/2020. The registration number was TCTR20200312004.

scholarly journals Feasibility and Safety of Laparoscopic Transperitoneal Adrenalectomy in Large Adrenal Tumor From 20 Years Single-center Experiences- A Retrospective Cohort Study

2020 ◽  
Author(s):  
Thanasit Prakobpon ◽  
Apirak Santi-ngamkun ◽  
Manint Usawachintachit ◽  
Supoj Ratchanon ◽  
Dutsadee Sowanthip ◽  
...  
Keyword(s):  
Tumor Size ◽  
Adrenal Tumor ◽  
Intraoperative Complications ◽  
Perioperative Outcomes ◽  
P Value ◽  
Transfusion Rate ◽  
Intraoperative Complication ◽  
Estimated Blood Loss ◽  
Group 2 ◽  
Laparoscopic Transperitoneal

Abstract Background: The role of laparoscopic adrenalectomy (LA) in a large adrenal tumor is controversial due to the risk of malignancy and technical difficulty. In this study, we compared the perioperative outcomes and complications of LA on large (≥ 6 cm) and (< 6 cm) adrenal tumors.Methods: We retrospectively reviewed all clinical data of patients who underwent unilateral LA in our institution between April 2000 and June 2019. Patients were classified by tumor size into 2 groups. Patients in group 1 had tumor size < 6 cm (n=408) and patient in group 2 had tumor size ≥ 6 cm (n=48). Demographic data, perioperative outcomes, complications, and pathologic reports were compared between groups.Results: Patients in group 2 were significant older (p=0.04), thinner (p=0.001) and had lower incident of hypertension (p=0.001), with a significantly higher median operative time (75 vs 120 min), estimated blood loss (20 vs 100 ml), transfusion rate (0 vs 20.8%), conversion rate (0.25 vs 14.6%) and length of stays (6 vs 9 days) than in group 2 (all p<0.001). Group 2 patients also had significantly higher frequency of intraoperative complication (4.7 vs 31.3%; adjust Odds Ratio [OR] =7.73 (95% CI 3.35-17.84), p-value < 0.001) and postoperative complication (5.4 vs 31.3%; adjust OR=6.06, 95% CI 2.84-13.73, p-value < 0.001). Only eight (1.8%) major complications occurred in this study. The most common pathology in group 2 patient was pheochromocytoma and metastasis. Conclusions: Laparoscopic transperitoneal adrenalectomy in large adrenal tumor ≥ 6 cm is feasible but associated with significantly worse intraoperative complications, postoperative complications and recovery. However, most of the complications were minor and could be managed conservatively. Careful patient selection with the expertise surgeon in adrenal surgery are the key factors for successful laparoscopic surgery in a large adrenal tumor. Trial registration: This study was retrospectively registered in the Thai Clinical Trials Registry on 02/03/2020. The registration number was TCTR20200312004.

scholarly journals Relationship between the Recurrent Laryngeal Nerve and the Inferior Thyroid Artery in the Togolese Subject: Surgical Anatomy Study from 227 Thyroidectomies

2019 ◽  
Vol 27 (1) ◽  
Author(s):  
Bathokedeou Amana ◽  
Winga Foma ◽  
Essobozou Pegbessou ◽  
Tchin Darré ◽  
Essohanam Boko ◽  
...  
Keyword(s):  
Recurrent Laryngeal Nerve ◽  
Intraoperative Complications ◽  
Cross Sectional Study ◽  
Surgical Anatomy ◽  
Laryngeal Nerve ◽  
Inferior Thyroid Artery ◽  
University Hospital ◽  
Cross Sectional ◽  
Recurrent Laryngeal Nerves ◽  
The Right

Introduction Identification of the recurrent laryngeal nerve during thyroid surgeries is recommended to preserve its functionl integrity. This study aims to determine the relationship between the recurrent laryngeal nerves and the inferior thyroid arteries during thyroidectomies, as well as any particularities and intraoperative complications. Materials and Methods Observational cross-sectional study of all culturally Togolese patients who underwent thyroidectomy with nerve dissection in the ENT department of Sylvanus Olympio University Hospital from 1 January 2013 to 30 June 2017, i.e. a period of 4 years 6 months. Results The sex ratio was 0.14 i.e., 7 women for 1 man and the average age of 41.82 years. Tissue nodules and multinodular goiters were the most operated lesions in 40.97% and 33.04%, respectively, with a plunging character in 17 cases. We had 306 cases of nerve dissection but the recurrent laryngeal nerve could not be found in 1 case on the right. It was globally retro-arterial (under the trunk and under the branches of the inferior thyroid artery) in 75.08% of cases with prevalence of the truncal, pre arterial situation in 16.07% and inter-arterial in 3.28% cases. The nerve was non-recurrent (type II pathway) in 1 case on the right. There was no recurrence injury. Parathyroid devascularization (5 cases) was autotransplanted. The surgeon's experience did not have a significant impact on the occurrence of intraoperative complications (p = 0.24). Conclusion This observational cross-sectional anatomical-surgical study supports the existing data on the relationships between the recurrent laryngeal nerve and the inferior thyroid artery by confirming their variability. Nevertheless, it was marked by the predominance of the retro arterial truncal situation of the nerve unlike the literature that most often reports a situation of the nerve under the arterial branches.

Carotid endarterectomy in patients with foetal-type posterior circle of Willis: Is there an indication for local anaesthesia?

VASA ◽  
2011 ◽  
Vol 40 (5) ◽  
pp. 404-407
Author(s):  
Maras ◽  
Tzormpatzoglou ◽  
Papas ◽  
Papanas ◽  
Kotsikoris ◽  
...  
Keyword(s):  
Carotid Endarterectomy ◽  
Local Anaesthesia ◽  
Anatomical Variation ◽  
Anatomical Variations ◽  
Circle Of Willis ◽  
Variable Degree ◽  
Operative Complications ◽  
The Right ◽  
Ica Stenosis ◽  
Symptomatic Stenosis

Foetal-type posterior circle of Willis is a common anatomical variation with a variable degree of vessel asymmetry. In patients with this abnormality, carotid endarterectomy (CEA) may create cerebral hypo-perfusion intraoperatively, and this may be underestimated under general anaesthesia. There is currently no evidence that anatomical variations in the circle of Willis represent an independent risk factor for stroke. Moreover, there is a paucity of data on treating patients with such anatomical variations and co-existing ICA stenosis. We present a case of CEA under local anaesthesia (LA) in a 52-year-old female patient with symptomatic stenosis of the right ICA and coexistent foetal-type posterior circle of Willis. There were no post-operative complications and she was discharged free from symptoms. She was seen again 3 months later and was free from complications. This case higlights that LA should be strongly considered to enable better intra-operative neurological monitoring in the event of foetal-type posterior circle of Willis.

Pelvic Canal Narrowing Caused by Triple Pelvic Osteotomy in the Dog

1994 ◽  
Vol 07 (03) ◽  
pp. 110-113 ◽  
Author(s):  
D. L. Holmberg ◽  
M. B. Hurtig ◽  
H. R. Sukhiani
Keyword(s):  
Postoperative Complications ◽  
Pelvic Osteotomy ◽  
Cross Sectional Area ◽  
Sectional Area ◽  
Cross Sectional ◽  
Canal Width ◽  
Operative Complications ◽  
Post Operative Complications

SummaryDuring a triple pelvic osteotomy, rotation of the free acetabular segment causes the pubic remnant on the acetabulum to rotate into the pelvic canal. The resulting narrowing may cause complications by impingement on the organs within the pelvic canal. Triple pelvic osteotomies were performed on ten cadaver pelves with pubic remnants equal to 0, 25, and 50% of the hemi-pubic length and angles of acetabular rotation of 20, 30, and 40 degrees. All combinations of pubic remnant lengths and angles of acetabular rotation caused a significant reduction in pelvic canal-width and cross-sectional area, when compared to the inact pelvis. Zero, 25, and 50% pubic remnants result in 15, 35, and 50% reductions in pelvic canal width respectively. Overrotation of the acetabulum should be avoided and the pubic remnant on the acetabular segment should be minimized to reduce postoperative complications due to pelvic canal narrowing.When performing triple pelvic osteotomies, the length of the pubic remnant on the acetabular segment and the angle of acetabular rotation both significantly narrow the pelvic canal. To reduce post-operative complications, due to narrowing of the pelvic canal, overrotation of the acetabulum should be avoided and the length of the pubic remnant should be minimized.

Advantages and limitations of the endoscopic tympanoscopy a prospective study

2020 ◽  
Vol 1 (1) ◽  
pp. 012-017
Author(s):  
Najib Zouhair ◽  
Anass Chaouki ◽  
Amine M’khatri ◽  
Youssef Oukessou ◽  
Sami Rouadi ◽  
...  
Keyword(s):  
Middle Ear ◽  
Operating Time ◽  
Cross Sectional Study ◽  
Cross Sectional ◽  
Invasive Approach ◽  
Intraoperative Bleeding ◽  
Advantages And Disadvantages ◽  
Early Return ◽  
The Mean ◽  
Endoscopic Tympanoplasty

Tympanoplasty is one of the most performed procedures in ENT. The aggressiveness of its microscopic approach has led otologists to adopt the endoscopic approach as a less invasive alternative. The purpose of this work is to appreciate the advantages and disadvantages of this surgical technique. We conducted a prospective descriptive cross-sectional study on 20 interventions within the ENT department of August the 20th 1953 Hospital of Casablanca from April 2019 to June 2019. The average age of operated patients was 36.3 years. Perforations were unilateral in (71%) of the cases with a predominance of the anterior (29%) and subtotal (36%) locations. The tympanoplasties were performed by 3 different senior otologic surgeons, and were left in (57%). The mean operating time was (59.5 min) and the mean anesthesia duration was 75.1 min. Intraoperative vision allowed us to fully visualize the margins of all perforations (100%) and anatomical structures of the middle ear in almost all interventions. The first procedures carried out were filled with difficulties whose management of intraoperative bleeding was the main one in (42.8%) of the cases. (57%) procedures were described as easy. No complication was detected intraoperatively or immediately postoperatively. Endoscopic tympanoplasty has several advantages, including: Minimally invasive approach to the middle ear; panoramic perioperative vision; Gain of operating time; decrease in the duration of anesthesia; Valuable educational tool; postoperative comfort; Decrease in hospital stay and early return to daily activities; Better aesthetic rendering; cost and transportability. However, we also note a number of disadvantages of endoscopic tympanoplasty, particularly: performing the procedure with one hand; difficulty passing through the EAC; 2D vision that alters the perception of depth; management of intraoperative bleeding; fogging; learning curve.

UPAYA PENINGKATAN KINERJA PERAWAT GAWAT DARURAT MELALUI BERBAGAI GAYA KEPEMIMPINAN DI RSUD DAERAH ISTIMEWA YOGYAKARTA

2017 ◽  
Vol 6 (3) ◽  
pp. 186-194
Author(s):  
Deby Zulkarnain Rahadian Syah ◽  
Muhamat Nofiyanto
Keyword(s):  
Emergency Room ◽  
Leadership Style ◽  
Quantitative Research ◽  
Secondary Data ◽  
Cross Sectional ◽  
Organizational Goals ◽  
Democratic Leadership ◽  
The Right ◽  
Research Type ◽  
Special Region

Background: Nurses in charge of the Emergency Room are required to have more ability than nurses serving patients in other units. Emergency Room is an initial service in a hospital. One's leadership style will greatly affect the effectiveness of a leader. The selection of the right leadership style can lead to the achievement of individual or organizational goals. Objective: To know the various leadership style used by the head of room in improving the performance of nurses of Emergency Room RSUD in in Special Region of Yogyakarta. Method: This research includes quantitative research type, using cross sectional approach. The population of this study was the head of the treatment room. Secondary data of nurse's performance is taken from nursing care which is written in medical record file of Emergency Room of RSUD in Special Region of Yogyakarta. Results: The performance of nurses at Emergency Room RSUD A in the good category was 100%. The performance of nurses at Emergency Room RSUD B in the enough category was 45%. The performance of nurses at Emergency Room C in good category was 80%. The performance of nurses at Emergency Room RSUD D in good category was 55%. The performance of nurses at RSUD E in the good category was 95%. The result of cross tabulation between leadership style and nurse performance of RSUD in the whole DIY with good performance is leader who use democratic leadership style equal to 35%. Conclusion: Most of the nurse's good performance in Emergency Room is followed by democratic leadership style of head of space.  Keyword: leadership style, head of space, performance of nurses

Penanganan Issu Terkait Keselamatan Pasien di Rumah Sakit

2020 ◽  
Author(s):  
Kristin Natal Riang Gea
Keyword(s):  
Patient Safety ◽  
Health Workers ◽  
Sampling Technique ◽  
Good Health ◽  
Bivariate Analysis ◽  
P Value ◽  
Patient Identification ◽  
Cross Sectional ◽  
The Right ◽  
The Relationship

AbstrakKeselamatan pasien merupakan dasar dari pelayanan kesehatan yang baik. Pengetahuan tenaga kesehatan dalam sasaran keselamatan pasien terdiri dari ketepatan identifikasi pasien, peningkatan komunikasi yang efektif, peningkatan keamanan obat yang perlu diwaspadai, kepastian tepat lokasi, prosedur, dan tepat pasien operasi, pengurangan risiko infeksi, pengurangan risiko pasien jatuh. Tujuan penelitian untuk mengetahui hubungan antara pengetahuan dengan penerapan keselamatan pasien pada petugas kesehatan di Puskesmas Kedaung Wetan Kota Tangerang. Metode Penelitian menggunakan deskriptif korelasi menggunakan pendekatan cross sectional. Populasi sebanyak 50 responden. Teknik pengambilan sampel menggunakan total sampling. Instrumen yang digunakan berupa lembar kuesioner. Teknik analisa diatas menggunakan analisa Univariat dan Bivariat. Hasil Penelitian ada Hubungan Pengetahuan dengan Penerapan Keselamatan Pasien pada Petugas Kesehatan, dengan hasil, p value sebesar 0,013 &lt; 0,05 maka dapat disimpulkan bahwa ada Hubungan Pengetahuan dengan Penerapa Keselamatan Pasien pada Petugas Kesehatan. Kesimpulan penelitian ada Hubungan Pengetahuan dengan Penerapan Keselamatan Pasien.. AbstrackPatient safety is the basis of good health services. Knowledge of health personnel in patient safety targets consists of accurate patient identification, increased effective communication, increased safety of the drug that needs to be watched, certainty in the right location, procedure, and precise patient surgery, reduction in risk of infection, reduction in risk of falling patients. The purpose of this study was to determine the relationship between knowledge and the application of patient safety to health workers in the Kedaung Wetan Health Center, Tangerang City. The research method uses descriptive correlation using cross sectional approach. The population is 50 respondents. The sampling technique uses total sampling. The instrument used was a questionnaire sheet. The analysis technique above uses Univariate and Bivariate analysis. The results of the study there is a Relationship of Knowledge with the Implementation of Patient Safety in Health Officers, with the result, p value of 0.013 &lt;0.05, it can be concluded that there is a Relationship between Knowledge and Patient Safety Implementation in Health Officers. The conclusion of the study is the Relationship between Knowledge and the Implementation of Patient Safety.Keywords Knowledge, Patient safety, Health workers

A gap between Law and Practice: A Community’s Perception of Unmarried Women’s Abortion Options in Nepal

2014 ◽  
Vol 12 (2) ◽  
pp. 24-30
Author(s):  
Simone Christensen Hald ◽  
Ditte Aagaard Sondergaard
Keyword(s):  
Cross Sectional Survey ◽  
Cross Sectional ◽  
Safe Abortion ◽  
Community Attitudes ◽  
Abortion Law ◽  
Premarital Sexual Activity ◽  
Premarital Sexual ◽  
The Right ◽  
Changing Attitudes ◽  
Depth Interviews

Background In 2002, the Nepalese abortion law went from being highly restrictive to fully liberal. This study aimed to explore a local community’s perception of the situation for unmarried Nepalese women wanting to practice their legal right to abortion.Methods The study comprised a cross-sectional survey and in-depth interviews with men and women above the age of 16 years living in the Makwanpur District, Nepal. The final data included 55 questionnaires and 16 interviews. The questionnaire data was univariate analysed, while a condensation of meaning analysis was carried out on the interviews.Results The overall awareness of abortion being legal was high, although the extent of knowledge of the specific legal grounds varied. Unmarried women were believed to have access to abortion services, although they risked stigmatisation due to their marital status. The community attitude towards these women having abortions was very negative, hence it differed from the legal acceptance of all women having the right to abortion. This was explained by societal norms on premarital sexual activity. Generally, the participants felt that changing attitudes would be difficult but possible over time.Conclusion A considerable gap exists between the legal acceptance of abortion and community attitudes when it comes to unmarried women as this group encounters barriers when wanting to practice their right. Therefore, these barriers need to be addressed to allow unmarried Nepalese women access to safe abortion services without the risk of being stigmatised.One possible alternative is educational initiatives such as disseminating information vigorously through mass media to create awareness.DOI: http://dx.doi.org/10.3126/hprospect.v12i2.9869 Health Prospect Vol.12(2) 2013: 24-30

STUDY OF RADIATION CHARACTERISTICS THE RENAL FUNCTION IN PATIENTS WITH TYPE 2 DIABETES

2014 ◽  
pp. 73-77
Author(s):  
Van Chuong Nguyen ◽  
Thi Kim Anh Nguyen
Keyword(s):  
Type 2 Diabetes ◽  
Renal Function ◽  
Glomerular Filtration Rate ◽  
Glomerular Filtration ◽  
Filtration Rate ◽  
Disease Duration ◽  
Left Kidney ◽  
Cross Sectional ◽  
The Right

Background: A Research glomerular filtration rate (GFR) of 61 patients with type 2 diabetes mellitus with renal scanning 99mTc-DTPA glomerular filtration rate at the hospital 175. Objective: (1) To study characteristics of imaging of renal function. (2) Understanding the relationship between GFR with blood sugar, HbA1c, blood pressure and albuminuria in patients with type 2 diabetes. Methods: Descriptive, prospective, cross-sectional study. Clinical examination, Clinical tests and 99mTc-DTPA GFR gamma - camera renography for patients. Result: GFR of the study group was 75,4 ± 22,3 ml/phut/1,73m2, the left kidney was 35,0 ± 13,0 is lower than the right kidney and 39,8 ± 11,9; p <0,01. There is no correlation between GFR with blood glucose and HbA1c, the risk of reduced GFR in hypertensive group associated is OR = 6,5 with p<0,01; albuminuria (+) is OR = 4,2 with p <0,01; and disease duration > 10 years is OR = 3,5 with p <0.01. Conclusion: GFR of the left kidneys is lower than the right kidney; correlation decreased GFR associated with hypertension, albuminuria and disease duration. Keywords: GFR, diabetes, albuminuria

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