scholarly journals The Importance of Culture Change Associated With Novel Surgical Approaches and Innovation: Does Perioperative Care Transcend Technical Considerations for Pulmonary Lobectomy?

2021 ◽  
Vol 8 ◽  
Author(s):  
Kathrin Freystaetter ◽  
Benjamin R. Waterhouse ◽  
Nicholas Chilvers ◽  
Jason Trevis ◽  
Jonathan Ferguson ◽  
...  
Keyword(s):  
Perioperative Care ◽  
Culture Change ◽  
Thoracoscopic Surgery ◽  
Surgical Approaches ◽  
Pulmonary Lobectomy ◽  
Substantial Impact ◽  
Significant Difference ◽  
Operative Complications ◽  
Technical Considerations ◽  
Post Operative Complications

Robotic thoracic surgery for pulmonary lobectomy was introduced at our unit in 2015, along with enhanced perioperative patient care pathways. We evaluated the effect of this practice change on short-term outcomes. Data on all adult patients who underwent a lobectomy in our unit between 2015 and 2019 were obtained retrospectively from our surgical database. Patients fell into three groups: conventional open surgery via thoracotomy, video-assisted thoracoscopic surgery (VATS), and robot-assisted thoracoscopic surgery (RATS). Survival was defined as survival to discharge. Our cohort included 722 patients. Three hundred and ninety-two patients (54.3%) underwent an open operation, 259 patients (35.9%) underwent VATS surgery, and 71 patients (9.8%) underwent a robotic procedure. Comparing these surgical approaches, there was no statistically significant difference in the overall incidence of post-operative complications (p = 0.15) as well as the incidence of wound infections, arrhythmias, prolonged air leaks, respiratory failure, or ICU readmissions. Additionally, there was no statistically significant difference in survival to discharge (p = 0.66). However, patients who had a VATS procedure were less likely to develop a post-operative chest infection (p = 0.01). Evaluating our practice over time, we found a decrease in the overall incidence of post-operative complications (p = 0.01) with an improvement in survival to discharge (p = 0.02). In our experience, VATS lobectomy was associated with a lower incidence of post-operative chest infections. However, the limitations of our study must be considered; factors such as patient selection that may have had a substantial impact. The culture change associated with adoption of a VATS and robotic surgical programme appears to have corresponded with an improved survival to discharge for all lobectomy patients, irrespective of surgical approach. Perioperative care may therefore have a more significant impact on outcomes than technical considerations.

Laparoscopic versus open partial nephrectomy for the management of highly complex renal tumors with PADUA score ⩾10: A single center analysis.

2021 ◽  
pp. 039156032110016
Author(s):  
Francesco Chiancone ◽  
Marco Fabiano ◽  
Clemente Meccariello ◽  
Maurizio Fedelini ◽  
Francesco Persico ◽  
...  
Keyword(s):  
Partial Nephrectomy ◽  
Operation Time ◽  
Renal Tumors ◽  
Open Partial Nephrectomy ◽  
Estimated Blood Loss ◽  
Significant Difference ◽  
Operative Complications ◽  
Group A ◽  
Group B ◽  
Post Operative Complications

Introduction: The aim of this study was to compare laparoscopic and open partial nephrectomy (PN) for renal tumors of high surgical complexity (PADUA score ⩾10). Methods: We retrospectively evaluated 93 consecutive patients who underwent PN at our department from January 2015 to September 2019. 21 patients underwent open partial nephrectomy (OPN) (Group A) and 72 underwent laparoscopic partial nephrectomy (LPN) (Group B). All OPNs were performed with a retroperitoneal approach, while all LPNs were performed with a transperitoneal approach by a single surgical team. Post-operative complications were classified according to the Clavien-Dindo system. Results: The two groups showed no difference in terms of patients’ demographics as well as tumor characteristics in all variables. Group A was found to be similar to group B in terms of operation time ( p = 0.781), conversion to radical nephrectomy ( p = 0.3485), and positive surgical margins ( p = 0.338) while estimated blood loss ( p = 0.0205), intra-operative ( p = 0.0104), and post-operative ( p = 0.0081) transfusion rates, drainage time ( p = 0.0012), pain score at post-operative day 1 (<0.0001) were significantly lower in Group B. The rate of enucleation and enucleoresection/polar resection was similar ( p = 0.1821) among the groups. Logistic regression analysis indicated that preoperative factors were not independently associated with the surgical approach. There was a statistically significant difference in complication rate (<0.0001) between the two groups even if no significant difference in terms of grade ⩾3 post-operative complications ( p = 0.3382) was detected. Discussion: LPN represents a feasible and safe approach for high complex renal tumors if performed in highly experienced laparoscopic centers. This procedure offers good intraoperative outcomes and a low rate of post-operative complications.

Surgical Approaches to the Irradiated Breast

2020 ◽  
Author(s):  
Megan Fracol ◽  
Neil Fine
Keyword(s):  
Radiation Therapy ◽  
Breast Surgery ◽  
Surgical Approaches ◽  
Autologous Reconstruction ◽  
Breast Irradiation ◽  
Surgery Complications ◽  
Number Of Patients ◽  
Operative Complications ◽  
Salvage Mastectomy ◽  
Post Operative Complications

The use of radiation therapy for treatment of breast cancer has steadily increased since the 1990s. Plastic surgeons must be prepared to reconstruct patients with prior lumpectomy and radiation now needing salvage mastectomy, as well as the growing number of patients who will go on to need post mastectomy radiation therapy. Operating in the irradiated field presents unique challenges, including but not limited to intra-operative difficulties such as friable vessels when performing autologous-based reconstruction and higher rates of post-operative complications when performing implant-based reconstruction. Reconstructed outcomes are often inferior to the non-irradiated patient and as such the plastic surgeon should be prepared to perform further revision as necessary. This chapter will review indications for radiation therapy, both autologous- and implant-based approaches to reconstructing the irradiated breast and how to manage post-operative complications. This review contains 3 figures, 5 tables, and 75 references. Keywords: radiation, breast irradiation, breast reconstruction, radiation therapy, autologous reconstruction, implant-based reconstruction, revisionary breast surgery, complications

Thromboelastrography Reduces Blood Product Transfusion in Pediatric Cardiac Surgery

Blood ◽  
2012 ◽  
Vol 120 (21) ◽  
pp. 1176-1176
Author(s):  
Michael Ritchie ◽  
Cathy Woodward ◽  
Lauren Kane ◽  
Melissa Frei-Jones
Keyword(s):  
Cardiac Surgery ◽  
Congenital Heart ◽  
Blood Product ◽  
Pediatric Cardiac Surgery ◽  
Blood Product Transfusion ◽  
Red Cell ◽  
Time Period ◽  
Significant Difference ◽  
Operative Complications ◽  
Post Operative Complications

Abstract Abstract 1176 Thromboelastography (TEG) has emerged as an important tool to guide blood product transfusions in pediatric cardiac surgery requiring cardio-pulmonary bypass (CPB). Blood product transfusions are associated with risk including transfusion transmitted infections, transfusion reactions, and allo-immunization. Previous studies have reported fewer red cell and plasma transfusions but increased platelet transfusions with no difference in post-operative bleeding in pediatric CPB using TEG to determine transfusion needs. In this study, we evaluated the use of intra-operative TEG to reduce blood product transfusion in pediatric cardiac surgery with CPB. A retrospective case control study of 150 patients, age birth to 18 years, who required CPB during cardiac surgery, was performed from January 1, 2010 to May 31, 2012. Cases were chosen serially during the time period when TEG was utilized by anesthesia. Controls were chosen from the time period before TEG was available. Exclusion criteria were a personal or family history of bleeding or clotting disorder. Controls were matched 2:1 on age and Risk Adjustment for Congenital Heart Surgery score (RACHS). The type and amount of blood product transfusions were compared between cases and controls in addition to post-operative complications including bleeding, infection and thrombosis. This study included 50 cases and 100 controls. Average age and gender were not different between cases and controls (19 mo (0–213) vs 20 mo (0–255), p=0.86; 52% (26/50) males vs 62% (62/100), p=0.24). Ethnicity was similar between groups and primarily Hispanic (66% (33/50) vs 70% (70/100), p=0.71). The most common congenital heart defect was Tetralogy of Fallot (20% (10/50) vs 22% (22/100); p=0.84). The median RACHS score between groups was the same (3 (2–6) vs 3 (2–6), p=0.88). There was no significant difference in pre-surgical or post-surgical blood counts, coagulation testing or CPB pump time. The average number of TEGs performed per case was 2.6 (1–6). Cases received significantly fewer platelet and cryoprecipitate (cryo) units but similar red cell and plasma units to controls as shown in Figure 1. The difference persisted when transfusions were adjusted for weight. Cases received fewer platelets (13 (0–49) ml/kg vs 21 (0–119) ml/kg, p=0.015), and cryo (3 (0–36) ml/kg vs 6.3 (0–47) ml/kg, p=0.029) with the most significant difference seen in patients less than 10 kg (platelets 15 ml/kg vs 25 ml/kg, p=0.007; cryo 4 ml/kg vs 8 ml/kg, p=0.03). There was no difference in red cell volume (130 (0–332) ml/kg vs 133 (0–680) ml/kg, p=0.88), or plasma volume (109 (0–277) ml/kg vs 107 (0–553) ml/kg, p=0.9) at any weight between groups. There was no statistical difference in PICU length of stay (LOS), hospital LOS, mechanical ventilation, survival to discharge or frequency of post-operative bleeding or thrombosis. There was a 50% reduction in hospital cost of platelet transfusions ($29,750 vs $65,450) and cryo ($1,950 vs $4,700) for the 50 cases compared to controls. The cost of three TEGs per 50 cases was $3,450 ($23/TEG) for a total cost savings of $35,000. Intra-operative TEG reduced the amount of platelet and cryoprecipitate transfusions used during pediatric CPB without an increase in post-operative complications. The reduction in blood product administration by using TEG resulted in decreased cost. Disclosures: No relevant conflicts of interest to declare.

scholarly journals Guided Bone Regeneration with Concentrated Growth Factor Enriched Bone Graft Matrix (Sticky Bone) vs. Bone-Shell Technique in Horizontal Ridge Augmentation: A Retrospective Study

2021 ◽  
Vol 10 (17) ◽  
pp. 3953
Author(s):  
Horia Mihail Barbu ◽  
Stefania Andrada Iancu ◽  
Antonio Rapani ◽  
Claudio Stacchi
Keyword(s):  
Bone Regeneration ◽  
Graft Infection ◽  
Multivariate Logistic Regression Analysis ◽  
Guided Bone Regeneration ◽  
Control Group ◽  
Ridge Augmentation ◽  
Significant Difference ◽  
Operative Complications ◽  
Ridge Width ◽  
Post Operative Complications

Background: The purpose of this study was to compare clinical results of two different horizontal ridge augmentation techniques: guided bone regeneration with sticky bone (SB) and the bone-shell technique (BS). Methods: Records of patients who underwent horizontal ridge augmentation with SB (test) and BS (control) were screened for inclusion. Pre-operative and 6-month post-operative ridge widths were measured on cone beam computer tomography (CBCT) and compared. Post-operative complications and implant survival rate were recorded. Results: Eighty consecutive patients were included in the present study. Post-operative complications (flap dehiscence, and graft infection) occurred in ten patients, who dropped out from the study (12.5% complication rate). Stepwise multivariate logistic regression analysis showed a significant inverse correlation between the occurrence of post-operative complications and ridge width (p = 0.025). Seventy patients (35 test; 35 control) with a total of 127 implants were included in the final analysis. Mean ridge width gain was 3.7 ± 1.2 mm in the test and 3.7 ± 1.1 mm in the control group, with no significant difference between the two groups. No implant failure was recorded, with a mean follow-up of 42.7 ± 16.0 months after functional loading. Conclusions: SB and BS showed comparable clinical outcomes in horizontal ridge augmentation, resulting in sufficient crestal width increase to allow implant placement in an adequate bone envelope.

scholarly journals Primitive Isolated Hydatid Cyst of the Spleen: Total Splenectomy Versus Spleen Saving Surgical Modalities

2020 ◽  
Author(s):  
Atef Mejri ◽  
khaoula Arfaoui ◽  
Mohamed Firas Ayadi ◽  
Badreddine Aloui ◽  
Jasser Yaakoubi
Keyword(s):  
Hydatid Cyst ◽  
Hospital Stay ◽  
Surgical Techniques ◽  
Case Series ◽  
Surgical Approaches ◽  
Average Hospital ◽  
Spleen Preserving ◽  
Operative Complications ◽  
Total Splenectomy ◽  
Post Operative Complications

Abstract BackgroundThis study aims to describe the clinical features of the isolated primitive splenic hydatid cyst, discuss and compare the different surgical approaches of this uncommon disease.MethodsThis is a descriptive retrospective study carried out over a period of 7 years extended from January 2013 until December 2019 reporting eight cases of isolated primitive splenic localization of hydatid disease. Data were collected from the register of the general surgery department of the Jendouba regional hospital. Files concerning another associated hydatid localization were excluded. Four patients underwent total splenectomy and four of them underwent different spleen preserving surgical techniques including resection of the protruding dome, partial splenectomy and pericystectomy.ResultsThe discovery of the pathology was incidental in 50% of cases, while pain in the left upper quadrant of the abdomen and renitent mass in the same quadrant revealed the pathology only in 25% and 12,5% respectively . None of patients who underwent total splenectomy had fever or sings of postoperative sepsis. Compared to those who had total splenectomy, patients who underwent spleen preserving surgery had a longer average hospital stay ( 9 vs 6,25 days) related to post-operative complications including abscess in the residual cavity after protruding dome resection in one patient and post-operative haemorrhage in one patient. ConclusionsThe current case series argues in favor of total splenectomy, preferably by laparoscopic route whenever the technical platform allows it, associated with some specific peri-operative therapeutic measures, as the safest way that helps to avoid post-operative complications of spleen saving surgical modalities. These complications are usually difficult to manage in poor countries with limited technical resources. Total splenectomy guarantees at least a decreased hospital stay, reduced healthcare costs, and the absence of recurrence in highly endemic underdeveloped countries.

scholarly journals Comparative study of uterine repair during caesarean section: exteriorization repair versus in-situ repair

2017 ◽  
Vol 6 (4) ◽  
pp. 1426
Author(s):  
Lakshmi Priya ◽  
Reddi Rani P. ◽  
Lopamudra B
Keyword(s):  
Caesarean Section ◽  
Cesarean Section ◽  
Comparative Study ◽  
P Value ◽  
Surgical Methods ◽  
Significant Difference ◽  
Operative Complications ◽  
In Situ Repair ◽  
Post Operative Complications

Background: Cesarean section is one of the most common major obstetrical operation performed worldwide and the rates of cesarean section are increasing. It is associated with both intra-operative and post-operative complications. Many variations in surgical methods have been devised to decrease the adverse effects and morbidity. One such method is technique of uterine repair after delivery of the fetus and placenta by exteriorizing the uterus or in-situ repair.Methods: A prospective comparative study was conducted in the department of Obstetrics and Gynecology at MGMCRI Pondicherry over 18 months from March 2015 to August 2016. Two hundred women undergoing caesarean section were assigned to 2 groups. Group 1 (Exteriorization) 100 women and Group 2 (In-situ repair) 100 women. Intra-op and post-operative complications were assessed in both groups and compared.Results: There was no significant difference between the two groups with regard to age, parity, gestational age and type of cesarean section. There was no significant difference between two groups with regard to fall in Hb, operating time, mean drop in pulse rate and blood pressure, nausea, vomiting and intra-op pain. There was significant difference in blood loss during surgery in in-situ repair, P value was <0.001 highly significant and also statistically significant increase in transfusion rates in in-situ group with a p value of 0.038. Postoperative complications like febrile morbidity was significantly more in in-situ repair P=0.046. There was no significant difference in other variables like urinary tract infection, surgical site infection, endometritis and hospital stay.Conclusions: Both techniques are accepted methods of uterine repair. Technique of repair depends on surgeon’s choice and clinical situation. Exteriorization repair is a valid option with no significant increase in morbidity compared to In-situ repair especially in cases where exposure of lower uterine segment is difficult, there is extension of incision and difficulty in achieving hemostasis.

scholarly journals A comparative study of non-descent vaginal hysterectomy and total laparoscopic hysterectomy

2020 ◽  
Vol 9 (2) ◽  
pp. 777
Author(s):  
Vijay Kansara ◽  
Jaydeep Chaudhari ◽  
Ajesh Desai
Keyword(s):  
Comparative Study ◽  
Hospital Stay ◽  
Vaginal Hysterectomy ◽  
Pap Smear ◽  
Operative Time ◽  
Laparoscopic Hysterectomy ◽  
Total Laparoscopic Hysterectomy ◽  
Significant Difference ◽  
Operative Complications ◽  
Post Operative Complications

Background: Hysterectomy is the second most common operation performed by the gynecologists, next only to caesarean section. Objective of the study was to compare fall in blood haemoglobin level, duration of operation, intra- and post-op complications between non-descent vaginal hysterectomy and total laparoscopic hysterectomy and establish the better method for hysterectomy in non-descent uterus.Methods: A retrospective comparative study of 90 hysterectomies was done from a period of May 2018 - April 2019 at GMERS Medical College and Hospital Sola, with 45 cases in group of non-descent vaginal hysterectomy (NDVH) and 45 in group of total laparoscopic hysterectomy (TLH). Demographic characteristics, co-morbid conditions, indications for surgery, operative time, intra- operative blood loss, post-operative analgesia requirements, post-operative hospital stay and post-operative complications were compared between both groups. Those patients having malignancy as diagnosed by Pap smear or by D and C were excluded from the studyResults: The most common age in both groups was 41-50 years. Adenomyotic uterus was the most common indication for surgery in both groups. The mean operative time in NDVH group was 45 min while it was 80 min in TLH group. p<0.001 suggested significant difference when operative time were compared between both groups. Both groups were similar in post-operative analgesia requirement and post-operative hospital stay. Post-operative complications were similar in both groups.Conclusions: In which way to approach the uterus shall depend upon skill of the surgeon, size and pathological nature of uterus, technology available in the hospital and preference of patient as well as surgeon.

scholarly journals Effectiveness of Tirobot-assisted vertebroplasty in treating thoracolumbar osteoporotic compression fracture

2021 ◽  
Vol 16 (1) ◽  
Author(s):  
Boyao Wang ◽  
Jiang Cao ◽  
Jie Chang ◽  
Guoyong Yin ◽  
Weihua Cai ◽  
...  
Keyword(s):  
Radiation Exposure ◽  
Compression Fracture ◽  
Control Group ◽  
Osteoporotic Compression Fracture ◽  
Operative Duration ◽  
Vas Score ◽  
Significant Difference ◽  
Operative Complications ◽  
Cobb’S Angle ◽  
Post Operative Complications

Abstract Background Percutaneous kyphoplasty is the main method in the treatment of thoracolumbar osteoporotic compression fractures. However, much radiation exposure during the operation harms the health of surgeons and patients. In addition, the accuracy of this surgery still needs to be improved. This study aimed to assess the radiation exposure and clinical efficacy of Tirobot-assisted vertebroplasty in treating thoracolumbar osteoporotic compression fracture. Methods Included in this retrospective cohort study were 60 patients (60–90 years) who had undergone unilateral vertebroplasty for thoracolumbar osteoporotic compression fracture at our hospital between June 2019 and June 2020. All showed no systemic diseases and were assigned to Tirobot group (treated with Tirobot-assisted approach) and control group (treated with traditional approach). Fluoroscopic frequency, operative duration, length of stay (LOS), post-operative complications (cement leakage, infection, and thrombosis), and pre-operative and pre-discharge indexes (VAS score, JOA score, and Cobb’s angle) were compared. Results The fluoroscopic frequency (P < 0.001) and post-operative complications (P = 0.035) in Tirobot group were significantly lower than those in control group. The operative duration and LOS in the Tirobot group were shorter than those in the control group, but the differences were not statistically significant (P = 0.183). Pre-discharge VAS score and Cobb’s angle decreased, and JOA increased after surgeries in both groups. These three indexes showed a significant difference after surgery in each group (P < 0.001), but not between groups (PVAS = 0.175, PCobb’s = 0.585, PJOA = 0.448). Conclusion The Tirobot-assisted vertebroplasty can reduce surgery-related trauma, post-operative complications, and patients’ and operators’ exposure to radiation. As a safe and effective strategy, this surgery can realize the quick recovery from thoracolumbar osteoporotic compression fracture.

scholarly journals Post-operative complications and pain comparison between modified Bassini’s repair and Lichtestein’s hernioplasty in inguinal hernia repair

2021 ◽  
Vol 8 (2) ◽  
pp. 579
Author(s):  
Sunil Kumar ◽  
Sreenivasa .
Keyword(s):  
Chronic Pain ◽  
Inguinal Hernia ◽  
Hernia Repair ◽  
Randomized Study ◽  
Detailed Examination ◽  
Randomised Study ◽  
Significant Difference ◽  
Operative Complications ◽  
Mesh Hernioplasty ◽  
Post Operative Complications

Background: Bassini’s repair and the Lichtenstein’s tension free mesh hernioplasty are commonly used hernia repair techniques and yet there is no uniform opinion as to which is the best technique. This study was undertaken to compare the postoperative complications so as to determine the best suitable of the two procedures.Methods: A comparative randomized study was conducted on a total of 80 patients reporting to our hospital with inguinal hernia and were subjected to detailed examination, operated upon by either of technique and followed up. The post operative complications & pain were observed, analyzed and compared with other similar studies.Results: In this randomised study pain after 12 and 24 hours was significantly less in the Lichtenstein’s group when compared with Modified Bassini’s repair. However there was no significant difference at 36 hours. Chronic pain after 1, 3 & 6 months was also not significant.Conclusions: The Lichtenstein’s hernioplasty was comparatively better than Modified Bassini’s repair due to its simplicity, less dissection, lesser complications & lesser early pain and chronic pain in our study.

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