Comparison of Percutaneous versus Open Surgical techniques for placement of Peritoneal Dialysis Catheters

JMS SKIMS ◽  
2019 ◽  
Vol 22 (2) ◽  
Author(s):  
Imtiyaz Ahmad Wani ◽  
Rayees Yousuf Sheikh ◽  
Muzafar Masood Wani ◽  
Arif Hamid ◽  
Gh Mohammad Bhat ◽  
...  
Keyword(s):  
Peritoneal Dialysis ◽  
Surgical Technique ◽  
Hospital Stay ◽  
Surgical Techniques ◽  
Invasive Technique ◽  
Surgical Morbidity ◽  
Non Invasive ◽  
Laparoscopic Techniques ◽  
Access Technique ◽  
Mini Laparotomy

Background: Nephrologists have used percutaneous placements of peritoneal dialysis catheters (PDCs) with or without fluoroscopic guidance. PDCs are also placed using mini-laparotomy and laparoscopic techniques by surgeons. Percutaneous PDC placement by nephrologists is a simple, non-invasive technique with minimum intraoperative morbidity. We compared operative and immediate complications of PDCs using percutaneous versus open surgical mode of insertion. Methods: Data of all patients entering into CAPD programme in our center between July 2011 to July 2015 was collected. A total of 377 PDCs had been inserted over 48 months in 358 patients. Of 377 catheters inserted, 224 had been inserted by percutaneous method and 153 by surgical technique. Results: Wound hematoma developed in 3.5% of percutaneously placed catheters vs 2.6% of catheters placed by surgical technique, p-0.061. Haemorrhagic effluent was seen in 4.46% of percutaneously placed catheters vs 3.92% of surgically placed catheters, p-0.068. Bowel injury occurred in 1.33% of percutaneously placed catheters vs 0.65% of surgically placed catheters, p-0159. Dialysate leak occurred in 2.6% of catheters placed percutaneously vs 6.5% of catheters placed by surgical technique, p-0.068. Percutaneous PDC allowed a significantly shorter hospital stay, smaller wound size and less break-in period Conclusions: Percutaneously placed CAPD catheters by nephrologists ensues significantly less hospital stay, small sized incision, lesser break-in period and less post-surgical morbidity as compared with surgically placed catheters. Percutaneous PDC placement is minimally invasive, safe, less time consuming and dependable peritoneal access technique.

The Evolution of Surgical Technique for Total Gastrectomy over a 12-Year Period: A Single Institution's Experience

2012 ◽  
Vol 78 (10) ◽  
pp. 1054-1058 ◽  
Author(s):  
Amanda K. Arrington ◽  
Rebecca Nelson ◽  
Steven L. Chen ◽  
Joshua D. Ellenhorn ◽  
Julio Garcia-Aguilar ◽  
...  
Keyword(s):  
Surgical Technique ◽  
Lymph Nodes ◽  
Total Gastrectomy ◽  
Surgical Techniques ◽  
Laparoscopic Total Gastrectomy ◽  
Estimated Blood Loss ◽  
Institutional Experience ◽  
Open Total Gastrectomy ◽  
Laparoscopic Techniques ◽  
Average Tumor Size

Despite the wide acceptance of laparoscopic surgical techniques, its use for gastric cancer has been limited. Laparoscopic total gastrectomy poses many technical challenges when compared with open gastrectomy. Our objective was to evaluate our institutional experience and surgical technique for total gastrectomy. Through a review of patients undergoing total gastrectomy (1999 to 2011), 50 patients were identified. During the first decade, 25 per cent of total gastrectomies were performed laparoscopically compared with 77 per cent since 2009. Compared with open cases, laparoscopic cases yielded a significantly higher number of examined lymph nodes (29 vs 19), lower estimated blood loss (200 vs 450 mL), and shorter length of stay (8 vs 14 days). Median operative time, average tumor size, and number of positive lymph nodes were not different. Morbidity rates were much lower in the laparoscopic series; and 30-day mortality rates were similar in both groups. Laparoscopic total gastrectomy and D2 lymphadenectomy are comparable in safety and have improved efficacy than our open total gastrectomy experience. After initiation of a laparoscopic total gastrectomy program in 2009, the majority of cases in our institution are now performed by laparoscopic techniques.

scholarly journals Non-invasive removal of self-locking entrapped nephrostomy tubes

2020 ◽  
Vol 92 (3) ◽  
Author(s):  
Fabio Campodonico ◽  
Umberto Geremia Rossi ◽  
Marco Ennas ◽  
Alessandro Valdata ◽  
Antonia Di Domenico ◽  
...  
Keyword(s):  
Surgical Technique ◽  
Invasive Technique ◽  
Nephrostomy Tube ◽  
Introducer Sheath ◽  
Non Invasive ◽  
Fluoroscopy Guidance ◽  
Exchange Technique

Introduction: The removal of an encrusted nephrostomy tube can be a challenging maneuver. Urological literature is very bare in detailing techniques for removal of entrapped percutaneous catheters. We present a simple, safe and non-invasive technique of nephrostomy removal using a vascular introducer sheath, useful to manage complicated situations such as nephrostomies blocked for severe encrustations or disabled in their self-locking system. Surgical technique: The nephrostomy tube is cut and the stump is passed with a suture needle. The suture is passed through the inner vascular introducer sheath tip, and the introducer is then removed. The introducer sheath is advanced over the nephrostomy until joining the pigtail segment, under fluoroscopy guidance. Thus the suture is pulled out with strenght to contrast the opposite stiffness of the encrusted coil, until the nephrostomy has safely come out. Comment: The sheath exchange technique is quick, involves less manipulation through the perirenal fascia and kidney, and is suitable for different conditions of entrapped nephrostomies.

Peritoneal dialysis in children: Review of surgical techniques

1992 ◽  
Vol 59 (1_suppl) ◽  
pp. 272-274
Author(s):  
N. Capozza ◽  
G. Mosiello ◽  
M. De Gennaro ◽  
E. Matarazzo ◽  
S. Rinaldi ◽  
...  
Keyword(s):  
Peritoneal Dialysis ◽  
Surgical Technique ◽  
Surgical Techniques ◽  
Average Weight ◽  
Peritoneal Dialysis Catheter ◽  
Peritoneal Dialysis Fluid ◽  
Stage Renal Disease ◽  
End Stage ◽  
Surgical Guidelines ◽  
Pediatric Icu

Peritoneal dialysis has become an effective and widely used technique for the treatment of patients with end-stage renal disease. Peritoneal dialysis has become more practical for use in pediatric patients since equipment and techniques have been adapted for smaller patients. In the present work we describe the surgical technique that we currently use at our institution for surgical placement of peritoneal dialysis catheter. From January 1985 to January 1992, 19 peritoneal catheters were placed in 17 children, at the Bambino Gesù Children's Hospital. At the time of catheter insertion the average weight of the children was 14.2 kg., and the average age was 4 y. 10m. Peritoneal dialysis catheters were always placed under sterile conditions, in an operating room or in a pediatric ICU, with surgical technique. Regarding our surgical technique we recommend: 1) to use Tenckhoff catheter, 2 cuffs pigtail (curled) type; 2) to perform a minilaparatomy with lateral surgical approach and a routine omentectomy; 3) to create a submuscular tunnel (rectus abdominis) to reduce the leakaqe of peritoneal dialysis fluid. Furthermore the various clinical problems encountered in our experience and some surgical guidelines for the prevention of complications are reviewed.

scholarly journals Maximal surgical resection and adjuvant surgical technique to prolong the survival of adult patients with thalamic glioblastoma

PLoS ONE ◽  
2021 ◽  
Vol 16 (2) ◽  
pp. e0244325
Author(s):  
Jaejoon Lim ◽  
YoungJoon Park ◽  
Ju Won Ahn ◽  
So Jung Hwang ◽  
Hyouksang Kwon ◽  
...  
Keyword(s):  
Overall Survival ◽  
Surgical Technique ◽  
Surgical Resection ◽  
Surgical Approach ◽  
Dna Methyltransferase ◽  
Surgical Techniques ◽  
Motor Evoked Potential ◽  
High Rate ◽  
Surgical Morbidity ◽  
Neurophysiologic Monitoring

The importance of maximal resection in the treatment of glioblastoma (GBM) has been reported in many studies, but maximal resection of thalamic GBM is rarely attempted due to high rate of morbidity and mortality. The purpose of this study was to investigate the role of surgical resection in adult thalamic glioblastoma (GBM) treatment and to identify the surgical technique of maximal safety resection. In case of suspected thalamic GBM, surgical resection is the treatment of choice in our hospital. Biopsy was considered when there was ventricle wall enhancement or multiple enhancement lesion in a distant location. Navigation magnetic resonance imaging, diffuse tensor tractography imaging, tailed bullets, and intraoperative computed tomography and neurophysiologic monitoring (transcranial motor evoked potential and direct subcortical stimulation) were used in all surgical resection cases. The surgical approach was selected on the basis of the location of the tumor epicenter and the adjacent corticospinal tract. Among the 42 patients, 19 and 23 patients underwent surgical resection and biopsy, respectively, according to treatment strategy criteria. As a result, the surgical resection group exhibited a good response with overall survival (OS) (median: 676 days, p < 0.001) and progression-free survival (PFS) (median: 328 days, p < 0.001) compared with each biopsy groups (doctor selecting biopsy group, median OS: 240 days and median PFS: 134 days; patient selecting biopsy group, median OS: 212 days and median PFS: 118 days). The surgical resection groups displayed a better prognosis compared to that of the biopsy groups for both the O6-methylguanine-DNA methyltransferase unmethylated (log-rank p = 0.0035) or methylated groups (log-rank p = 0.021). Surgical resection was significantly associated with better prognosis (hazard ratio: 0.214, p = 0.006). In case of thalamic GBM without ventricle wall-enhancing lesion or multiple lesions, maximal surgical resection above 80% showed good clinical outcomes with prolonged the overall survival compared to biopsy. It is helpful to use adjuvant surgical techniques of checking intraoperative changes and select the appropriate surgical approach for reducing the surgical morbidity.

scholarly journals Peritoneal Dialysis Catheter Placement by Open Surgical Technique: Nikdu Experience

2020 ◽  
Vol 18 (2) ◽  
pp. 62-67
Author(s):  
Md Waliul Islam ◽  
Kazi Shahnoor Alam ◽  
Md Mamunur Rashid ◽  
Mohammad Mizanur Rahman ◽  
Md Abul Hossain ◽  
...  
Keyword(s):  
Peritoneal Dialysis ◽  
Surgical Technique ◽  
Abdominal Cavity ◽  
Catheter Insertion ◽  
Invasive Technique ◽  
Peritoneal Dialysis Catheter ◽  
Dialysis Catheter ◽  
Exit Site Infection ◽  
Management Of Complications ◽  
Catheter Malfunction

Objective: To determine the outcome and complications of CAPD catheter implanted by open surgical technique for peritoneal dialysis. Methods: In this prospective study peritoneal dialysis catheter (PDC) for continuous ambulatory peritoneal dialysis was inserted into the abdominal cavity using an open surgical approach. We described our experience of open surgical minimal invasive technique of CAPD catheterization from July 2012 to June 2015. Total 40 catheters were inserted successfully. Patients were followed up for a variable period of 3-36 months. Results: In this study common indications of CAPD catheter insertion were CKD-5 due to diabetic nephropathy, chronic glomerulonephritis, and hypertensive nephrosclerosis. Common catheter related complications were peritonitis, hypokalaemia, exit site infection, catheter malfunction. Late peritonitis remains the major drawback of PD treatment, with the need of temporary or permanent changeover to the HD treatment in 10% of the patients. Conclusion: Enrichment of the physician’s interest and experience, along with a multidisciplinary approach to outline the optimal strategy of PD-catheter insertion and management of complications may improve technique and patients’ survival and decrease the morbidity. Bangladesh Journal of Urology, Vol. 18, No. 2, July 2015 p.62-67

scholarly journals Comparative Assessment of Original vs. Standard Surgery Techniques in Treatment for Purulent Pyelonephritis

2021 ◽  
Vol 11 (4) ◽  
pp. 288-292
Author(s):  
V. A. Ananev ◽  
V. N. Pavlov ◽  
A. M. Pushkarev
Keyword(s):  
Minimally Invasive ◽  
Surgical Techniques ◽  
Pain Syndrome ◽  
Cortical Layer ◽  
Minimally Invasive Technique ◽  
Invasive Technique ◽  
Intraarterial Infusion ◽  
Minimally Invasive Surgical ◽  
Destructive Processes ◽  
Laparoscopic Techniques

Background. Modern minimally invasive surgical techniques reduce traumatism of operative interventions and aggressive anaesthesia, which accordingly shortens the patient’s hospital stay and rehabilitation period.Aim. An improvement of surgical outcomes in patients with purulent pyelonephritis via introduction of laparoscopic techniques.Materials and methods. Th e study included 80 purulent pyelonephritis patients operated at the Territorial Clinical Hospital during 2006—2018. Th e patients were divided between two cohorts. Cohort 1 included 40 (50 %) patients operated with standard techniques (ST), cohort 2 — 40 (50 %) patients having surgery by an original minimally invasive technique (OT). Kidney decapsulation was found to outcome in parenchymal decompression and blood circulation restore in cortical layer. Intraarterial infusion of alprostadil prevents further spread of purulent-destructive processes in kidney.Results and discussion. In patients with the minimally invasive technique, postoperative period proceeded at no complications. On day 1, the patients reported reduced pain syndrome in the surgical area. Contrasted renal MSCT before and aft er surgery showed the recovery of renal blood flow and significant diminishing of destruction foci in short term. Nephrectomy was not performed as no-indication.Conclusion. The treatment outcomes in 40 patients having the new surgical technique demonstrate its efficacy and applicability in clinical practice.

Hand-assisted laparoscopic nephrectomy in morbidly obese patients

2020 ◽  
Vol 99 (6) ◽  
pp. 271-276
Keyword(s):  
Body Weight ◽  
Surgical Technique ◽  
Blood Loss ◽  
Hospital Stay ◽  
Kidney Cancer ◽  
The Body ◽  
Laparoscopic Nephrectomy ◽  
Morbidly Obese ◽  
Obese Patients ◽  
Morbid Obese

Introduction: Prevalence of obesity is 30 % in the Czech Republic and is expected to increase further in the future. This disease complicates surgical procedures but also the postoperative period. The aim of our paper is to present the surgical technique called hand-assisted laparoscopic nephrectomy (HALS), used in surgical management of kidney cancer in morbid obese patients with BMI >40 kg/m2. Methods: The basic cohort of seven patients with BMI >40 undergoing HALS nephrectomy was retrospectively evaluated. Demographic data were analyzed (age, gender, body weight, height, BMI and comorbidities). The perioperative course (surgery time, blood loss, ICU time, hospital stay and early complications), tumor characteristics (histology, TNM classification, tumor size, removed kidney size) and postoperative follow-up were evaluated. Results: The patient age was 38−67 years; the cohort included 2 females and 5 males, the body weight was 117−155 kg and the BMI was 40.3−501 kg/m2. Surgery time was 73−98 minutes, blood loss was 20−450 ml, and hospital stay was 5−7 days; incisional hernia occurred in one patient. Kidney cancer was confirmed in all cases, 48–110 mm in diameter, and the largest removed specimen size was 210×140×130 mm. One patient died just 9 months after the surgery because of metastatic disease; the tumor-free period in the other patients currently varies between 1 and 5 years. Conclusion: HALS nephrectomy seems to be a suitable and safe surgical technique in complicated patients like these morbid obese patients. HALS nephrectomy provides acceptable surgical and oncological results.

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