scholarly journals Hysterectomy and Adnexal Procedures by Vaginal Natural Orifice Transluminal Endoscopic Surgery (VNH): Initial Findings From a Korean Surgeon

2021 ◽  
Vol 7 ◽  
Author(s):  
Myeong-Seon Kim ◽  
Joseph J. Noh ◽  
Tae-Joong Kim
Keyword(s):  
Learning Curve ◽  
Pain Score ◽  
Endoscopic Surgery ◽  
Operation Time ◽  
Natural Orifice ◽  
Wound Retractor ◽  
Total Operation Time ◽  
Tertiary Center ◽  
Surgical Data ◽  
Installation Time

Objective: To evaluate feasibility and safety of hysterectomy and adnexal procedures by vaginal natural orifice transluminal endoscopic surgery (vNOTES).Study Design: This is a prospective observational study at a tertiary center and teaching University hospital. We enrolled prospectively 34 patients with benign diseases sequentially.Results: We measured baseline characteristics, surgical data, and pain score (VAS) after surgery. We surveyed before/after surgery. The time of port installation and each stage of surgery was measured. The learning curve was assessed through the graph according to the number of operations using linear and logarithmic regression curve estimation. The complications of surgery were investigated. The median age of the patients was 47.5 years (38–73). Median BMI was 22.4 (18.2–30.0). 20 cases of leiomyoma, four cases of adenomyosis, three cases of uterine prolapse, four cases of endometrial hyperplasia, and three cases of CIN were diagnosed. The median uterine weight was 180.0 g. The median port-installation time was 15.0 min (range, 4–35 min) and median total operation time was 85.5 min (range 43.0–132.0). Complications occurred in three patients. Two cases of bladder injury happened during vesicovaginal space dissection before the installation of the Wound Retractor (WR). One patient underwent transumbilical single-port surgery because of late-onset postoperative bleeding on the 13th postoperative day. The mean postoperative VAS scores were 3.36 immediately after surgery and 3.06, 2.79, and 2.45 at 6, 12, and 24 h after surgery, respectively. In continuous variable analysis, we detected a correlation between port-installation time and postoperative VAS ≥4 (pain score as need for medication). Based on a learning curve, port-installation time and total operation time appeared to reach the proficiency level by the 10th case.Conclusions: Although there were three complications, vNOTES offers advantages to patients and surgeons. More surgical techniques will be developed in vNOTES.

OVUM PICK UP (LOPU) IN SANTA INES SHEEP: LEARNING CURVE AND TECHNICAL DETAILS Aspiração folicular ovariana em ovelhas da raça Santa Inês: curva do aprendizado e detalhes técnicos

2013 ◽  
Vol 11 (3) ◽  
pp. 235 ◽  
Author(s):  
Pedro Paulo Maia Teixeira ◽  
Luciana Cristina Padilha ◽  
Alanna Do Socorro Lima da Silva ◽  
Felipe Farias Pereira da Câmara Barros ◽  
Leandro Nassar Coutinho ◽  
...  
Keyword(s):  
Learning Curve ◽  
Estrous Cycle ◽  
Laparoscopic Approach ◽  
Operation Time ◽  
Surgical Time ◽  
Short Learning Curve ◽  
Laparoscopic Procedures ◽  
Total Operation Time ◽  
Technical Details ◽  
Santa Inês

The aim of the current study was to assess the efficacy, the learning curve and associated technical difficulties oflaparoscopic ovum pick-up (LOPU) in sheep. Ten ovum pick-up sessions were performed in six Santa Ines sheep during a cycle of 7-day intervals, totaling 60 laparoscopic procedures. The sheep were managed for synchronizationof the estrous cycle. The laparoscopic approach was carried out using three ports. The number of follicles viewed, aspirated follicles and oocytes recovered were 13.32 ± 2.8, 11.37 ± 2.8 and 6.36 ± 2.0, respectively. Total operation time was used to assess the learning curve among 10 laparoscopic sessions. Mean surgical time was relatively short (26.75 ± 9.6 minutes). Surgical time decreased from the first session on (P < 0.05). LOPU was demonstrated to be a procedure with little intercurrence and with a short learning curve. Others studies regarding this technique should be performed to minimize possible complications and enabling its use in the field

scholarly journals The Learning Curve of Computer-Assisted Free Flap Jaw Reconstruction Surgery Using 3D-Printed Patient-Specific Plates: A Cumulative Sum Analysis

2021 ◽  
Vol 11 ◽  
Author(s):  
Wang-yong Zhu ◽  
Wing Shan Choi ◽  
May Chun Mei Wong ◽  
Jingya Jane Pu ◽  
Wei-fa Yang ◽  
...  
Keyword(s):  
Learning Curve ◽  
Hospital Stay ◽  
Bone Graft ◽  
Length Of Hospital Stay ◽  
Operation Time ◽  
Cumulative Sum ◽  
Jaw Reconstruction ◽  
Cumulative Sum Analysis ◽  
Total Operation Time ◽  
3D Printed

BackgroundComputer-assisted jaw reconstruction (CAJR) has benefits in reducing operation time and improving reconstruction accuracy, compared to conventional freehand jaw reconstruction. However, no information is available regarding learning curves in CAJR with the use of 3D-printed patient-specific surgical plates (PSSP). The purpose of this study was to assess surgical outcomes and learning curve for the first 58 consecutive CAJR using 3D-printed PSSP performed by a single surgical team in a single institution.MethodsIn a prospective study, consecutive patients who underwent free flap CAJR using 3D-printed PSSP were included. The determination of proficiency, based on the cumulative sum of surgical success (no major adjustment of 3D-printed PSSP, flap survival) passing the acceptable boundary line of cumulative sum analysis, was the primary outcome. To find out any potential factors influencing the learning curve, baseline characteristics of patients were compared before and after proficiency achievement. Secondary outcomes included inflexion points of the total operation time, blood loss, length of hospital stay, and bone graft deviation, measured by the cumulative sum analysis.ResultsFrom December 2016 to November 2020, 58 consecutive cases underwent surgery performed by a single surgical team. The overall surgical success rate was 94.8% (55/58). A three-stage learning curve of primary outcome was observed. The proficiency was achieved after 23 cases. The proportions of advanced tumor staging and concomitant surgery after obtaining proficiency were significantly higher than those before achieving proficiency (p = 0.046 and p &lt; 0.001, respectively). Mean values of operation time, intraoperative blood loss, length of hospital stay, and bone graft deviation were 532.5 ± 119.2 min, 1,006.8 ± 547.2 ml, 16.1 ± 6.3 days, and 0.9 ± 1.2 mm, respectively. Two trends of learning curve were observed in the CUSUM analyses of total operation time, length of hospital stay, and bone graft deviation, in which the first and second inflexion points occurred between 8 and 17 cases and between 43 and 46 cases, respectively.ConclusionOur results revealed a three-stage learning curve of CAJR with the use of PSSP, including initial learning, plateau, and overlearning. Based on CUSUM analysis, the surgical proficiency was achieved after 23 cases, and total operation time, length of hospital stay, and bone graft deviation stabilized after 8–17 cases.

Evaluation of the Learning Curve for Natural Orifice Transluminal Endoscopic Surgery: Bilateral Ovariectomy in Dogs

2011 ◽  
Vol 40 (2) ◽  
pp. 140-150 ◽  
Author(s):  
Lynetta Freeman ◽  
Emad Y. Rahmani ◽  
Richard C. F. Burgess ◽  
Mohammad Al-Haddad ◽  
Don J. Selzer ◽  
...  
Keyword(s):  
Learning Curve ◽  
Endoscopic Surgery ◽  
Natural Orifice ◽  
Bilateral Ovariectomy

FIRSTLY EXPERIENCE OF TRANSANAL AND TRANSVAGINAL NOTES FOR COLORECTAL CANCER

2017 ◽  
pp. 78-82
Author(s):  
Nhu Hiep Pham
Keyword(s):  
Colorectal Cancer ◽  
Endoscopic Surgery ◽  
Abdominal Cavity ◽  
Colorectal Anastomosis ◽  
Colon Adenocarcinoma ◽  
Operation Time ◽  
Natural Orifice ◽  
Important Variation ◽  
Hybrid Notes ◽  
Post Radiation

Objective: Natural Orifice Transluminal Endoscopic Surgery (NOTES) is an important variation in minimally invasive surgery (MIS) nowaday. We would like to present the techniques and the results of the pure transanal and transvaginal laparoscopies (NOTES) in treatment of colorectal cancer. Material and method: Prospective study at Hue Central Hospital, Vietnam. Patients: From December 2013 to December 2015, 22 cololorectal cancers (17 rectum, 4 sigmoid tumors and 1 descending colon), adenocarcinoma, T≤ T3N1M0. Methods: The patients were placed in the lithotomy and Trendelenburg position, and the lone-star retractor was placed in anus (rectum cancer) or vagina (sigmoid cancer). Inflating of surgical cavity with CO2 and setting at 12 mmHg. Continuing dissection until go inside of the abdominal cavity (transanal technique), after that, the rectum was pushed into the abdominal cavity. The IMA, IMV were divided (TME included) in both techniques. After finishing dissection, specimens were pulled out through the anus or vagina to prepare anastomosis. The coloanal or colorectal anastomosis was performed by hand-sewn (6 cases) or by EEA staplers (16 cases). Results: 3 patients needed one more 5 mm umbilical port in RLQ, 1 patient needed two 5mm trocars (post radiation hemorrhagy, urethral perforation,…). 1 patient converted to open and 1 patient converted to HYBRID-NOTES procedure. The operation time was 258 ± 40 (190 - 300). All patients required minimal analgesia. Bowel movement returned on the first day in 16 patients (average: 2 days, maximum: 3 days). The hospital stay was 8 ± 2,6 (4 -14 days). Kirwan clasification (sphinter function) is very good (stage I: 16). Conclusions: Pure transanal and transvaginal laparoscopies in treatment of colorectal cancer are feasible and safe. It seems to be the first pure transvaginal laparoscopy (NOTES) for human in the world. However, a multicentric studies and long follow-up are necessary. Key words: Natural Orifice Transluminal Endoscopic Surgery (NOTES), colorectal cancer, Pure transanal

scholarly journals Microscopic extra-laminar sequestrectomy (MELS) for the treatment of hidden zone lumbar disc herniation: report of the surgical technique, patient selection, and clinical outcomes

BMC Surgery ◽  
2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Chunxiao Wang ◽  
Yao Zhang ◽  
Xiaojie Tang ◽  
Haifei Cao ◽  
Qinyong Song ◽  
...  
Keyword(s):  
Blood Loss ◽  
Learning Curve ◽  
Clinical Outcomes ◽  
Lumbar Disc Herniation ◽  
Disc Herniation ◽  
Lumbar Disc ◽  
Operation Time ◽  
Operation Duration ◽  
The Mean

Abstract Background The area which located at the medial pedicle, posterior vertebral body and ventral hemilamina is defined as the hidden zone. Surgical management of hidden zone lumbar disc herniation (HZLDH) is technically challenging due to its difficult surgical exposure. The conventional interlaminar approach harbors the potential risk of post-surgical instability, while other approaches consist of complicated procedures with a steep learning curve and prolonged operation time. Objective To introduce microscopic extra-laminar sequestrectomy (MELS) technique for treatment of hidden zone lumbar disc herniation and present clinical outcomes. Methods Between Jan 2016 to Jan 2018, twenty one patients (13 males) with HZLDH were enrolled in this study. All patients underwent MELS (19 patients underwent sequestrectomy only, 2 patients underwent an additional inferior discectomy). The nerve root and fragment were visually exposed using MELS. The operation duration, blood loss, intra- and postoperative complications, and recurrences were recorded. The Visual Analog Scale (VAS), Oswestry Disability Index (ODI), and the modified MacNab criteria were used to evaluate clinical outcomes. Postoperative stability was evaluated both radiologically and clinically. Results The mean follow-up period was 20.95 ± 2.09 (18–24) months. The mean operation time was 32.43 ± 7.19 min and the mean blood loss was 25.52 ± 5.37 ml. All patients showed complete neurological symptom relief after surgery. The VAS and ODI score were significantly improved at the final follow-up compared to those before operation (7.88 ± 0.70 vs 0.10 ± 0.30, 59.24 ± 10.83 vs 11.29 ± 3.59, respectively, p < 0.05). Seventeen patients (81%) obtained an “excellent” outcome and the remaining four (19%) patients obtained a “good” outcome based the MacNab criteria. One patient suffered reherniation at the same level one year after the initial surgery and underwent a transforaminal endoscopic discectomy. No major complications and postoperative instability were observed. Conclusions Our observation suggest that MELS is safe and effective in the management of HZLDH. Due to its relative simplicity, it comprises a flat surgical learning curve and shorter operation duration, and overall results in reduced disturbance to lumbar stability.

scholarly journals A learning curve in using organ retractor for single-incision laparoscopic right colectomy

2021 ◽  
Vol 11 (1) ◽  
Author(s):  
Toshio Shiraishi ◽  
Tetsuro Tominaga ◽  
Takashi Nonaka ◽  
Kiyoaki Hamada ◽  
Masato Araki ◽  
...  
Keyword(s):  
Colon Cancer ◽  
Laparoscopic Surgery ◽  
Blood Loss ◽  
Learning Curve ◽  
Single Incision ◽  
Operation Time ◽  
Perioperative Outcomes ◽  
Single Incision Laparoscopic Surgery ◽  
Right Colon ◽  
Right Colon Cancer

AbstractSingle-incision laparoscopic surgery (SILS) has the potential to improve perioperative outcomes, including less postoperative pain, shorter operation time, less blood loss, and shorter hospital stay. However, SILS is technically difficult and needs a longer learning curve. Between April 2016 and September 2019, a total of 198 patients with clinical stage I/II right colon cancer underwent curative resection. In the case of the SILS approach, an organ retractor was usually used to overcome SILS-specific restrictions. The patients were divided into two groups by surgical approach: the SILS with organ retractor group (SILS-O, n = 33) and the conventional laparoscopic surgery group (LAC, n = 165). Clinical T status was significantly higher in the LAC group (p = 0.016). Operation time was shorter and blood loss was lower in the SILS-O group compared to the LAC group (117 vs. 197 min, p = 0.027; 10 vs. 25 mL, p = 0.024, respectively). In the SILS-O group, surgical outcomes including operation time, blood loss, number of retrieved lymph nodes, and postoperative complications were not significantly different between those performed by experts and by non-experts. Longer operation time (p = 0.041) was significantly associated with complications on univariate and multivariate analyses (odds ratio 2.514, 95%CI 1.047–6.035, p = 0.039). SILS-O was safe and feasible for right colon cancer. There is a potential to shorten the learning curve of SILS using an organ retractor.

scholarly journals Role of robotic natural orifice specimen extraction surgery in colorectal neoplasms

2021 ◽  
Vol 11 (1) ◽  
Author(s):  
Hongliang Yao ◽  
Tiegang Li ◽  
Weidong Chen ◽  
Sanlin Lei ◽  
Kuijie Liu ◽  
...  
Keyword(s):  
Colorectal Neoplasms ◽  
Average Distance ◽  
Neoadjuvant Chemoradiotherapy ◽  
Operation Time ◽  
Patient Characteristics ◽  
Safe Procedure ◽  
Natural Orifice ◽  
Specimen Extraction ◽  
Natural Orifice Specimen Extraction

AbstractNatural orifice specimen extraction surgery (NOSES) is especially suitable for colorectal surgery. Until now, most of the reports published were about laparoscopic NOSES, the reports about robotic NOSES are extremely rare. This study aims to explore the safety and feasibility of robotic NOSES for colorectal neoplasms. All patients underwent robotic NOSES from March 2016 to October 2019 in our hospital were enrolled for retrospective analysis. Clinicopathological data including patient characteristics, perioperative information and pathological information were collected and analyzed. According to the distance between tumor and anus or whether neoadjuvant chemoradiotherapy (nRCT) is performed, we grouped the cases and studied its influence on robotic NOSES. Also, we compared the previous reports on laparoscopic NOSES with our study and revealed advantages of robotic NOSES in terms of safety and feasibility. A total of 180 patients were enrolled. The average distance from the lower edge of the tumor to the anus was (8.64 ± 3.64) cm and maximum circumferential diameter (CDmax) of specimen was (3.5 ± 1.6) cm. In terms of safety, the average operation time, intraoperative blood loss, and postoperative hospital stay were (187.5 ± 78.3) min, (47.4 ± 34) mL, and (11.3 ± 7.5) days, respectively. In terms of feasibility, the average number of lymph node harvested was (14.8 ± 5). Robotic NOSES shows advantages in terms of safety and feasibility compared with laparoscopic NOSES. This procedure could not only be a safe procedure but also could achieve good oncological outcomes.

scholarly journals Open Versus Endoscopic Osteotomy of Posterosuperior Calcaneal Tuberosity for Haglund Syndrome: A Retrospective Cohort Study

2021 ◽  
Vol 9 (4) ◽  
pp. 232596712110010
Author(s):  
Yanbin Pi ◽  
Yuelin Hu ◽  
Qinwei Guo ◽  
Dong Jiang ◽  
Xin Xie ◽  
...  
Keyword(s):  
Cohort Study ◽  
Learning Curve ◽  
Endoscopic Surgery ◽  
Extent Of Resection ◽  
Endoscopic Procedure ◽  
Postoperative Outcomes ◽  
Open Procedure ◽  
Surgery Group ◽  
Duration Of Surgery

Background: Although endoscopic calcaneoplasty and retrocalcaneal debridement have been extensively applied to treat Haglund syndrome, evidence of the value of the endoscopic procedure remains to be fully established. Purpose/Hypothesis: The purpose of this study was to compare the postoperative outcomes and the amount of osteotomy between open and endoscopic surgery for the treatment of Haglund syndrome. It was hypothesized that endoscopic calcaneoplasty would lead to higher patient satisfaction and lower complication rates compared with open surgical techniques. Study Design: Cohort study; Level of evidence, 3. Methods: The following postoperative outcomes were compared between the open surgery group (n = 20) and the endoscopic surgery group (n = 27): visual analog scale for pain, American Orthopaedic Foot & Ankle Society ankle-hindfoot scale, Foot Function Index, Tegner score, Ankle Activity Score, and 36-Item Short Form Health Survey; postoperative complications; and duration of surgery. To determine the extent of resection, the authors compared the calcaneal height ratio, calcaneal resection ratio, calcaneal resection angle, pitch line, and Haglund deformity height between groups. The learning curve for endoscopic calcaneoplasty was also calculated. Results: There were no significant differences between the open and endoscopic groups on any outcome score. Two patients in the open group reported temporary paresthesia around the incisional site, indicating sural nerve injuries; no complication was reported in the endoscopy group. None of the parameters for extent of resection were statistically significant between the groups. The duration of surgery was 44.90 ± 10.52 and 65.39 ± 11.12 minutes in the open and endoscopy groups, respectively ( P = .001). Regarding the learning curve for endoscopic calcaneoplasty (6 surgeons; 27 follow-up patients; 9 patients lost to follow-up), the duration of surgery reached a steady point of 55.68 ± 4.19 minutes after the fourth operation. Conclusion: The results of this study indicated that the endoscopy procedure was as effective as the open procedure. The endoscopic procedure required significantly more time than the open procedure, and the duration of the endoscopic procedure was shortened only after the fourth operation, suggesting that it requires high technical skills and familiarity with the anatomic relationships.

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