scholarly journals The Health Impact of Surgical Techniques and Assistive Methods Used in Cesarean Deliveries: A Systemic Review

2020 ◽  
Vol 17 (18) ◽  
pp. 6894
Author(s):  
Li-Hsuan Wang ◽  
Kok-Min Seow ◽  
Li-Ru Chen ◽  
Kuo-Hu Chen
Keyword(s):  
Blood Loss ◽  
Cesarean Delivery ◽  
Operative Time ◽  
Surgical Techniques ◽  
Systemic Review ◽  
Fetal Head ◽  
Advantages And Disadvantages ◽  
Cesarean Deliveries ◽  
Fundal Pressure

Cesarean delivery is one of the most frequently performed surgeries in women throughout the world. However, the most optimal technique to minimize maternal and fetal morbidities is still being debated due to various clinical situations and surgeons’ preferences. The contentious topics are the use of vacuum devices other than traditional fundal pressure to assist in the delivery of the fetal head and the techniques of uterine repair used during cesarean deliveries. There are two well-described techniques for suturing the uterus: The uterus can be repaired either temporarily exteriorized (out of abdominal cavity) or in situ (within the peritoneal cavity). Numerous studies have attempted to compare these two techniques in different aspects, including operative time, blood loss, and maternal and fetal outcomes. This review provides an overview of the assistive method of vacuum devices compared with fundal pressure, and the two surgical techniques for uterine repair following cesarean delivery. This descriptive literature review was performed to address important issues for clinical practitioners. It aims to compare the advantages and disadvantages of the assistive methods and surgical techniques used in cesarean deliveries. All of the articles were retrieved from the databases Medline and PubMed using the search terms cesarean delivery, vacuum, and exteriorization. The searching results revealed that after exclusion, there were 9 and 13 eligible articles for vacuum assisted cesarean delivery and uterine exteriorization, respectively. Although several studies have concluded vacuum assistance for fetal extraction as a simple, effective, and beneficial method during fetal head delivery during cesarean delivery, further research is still required to clarify the safety of vacuum assistance. In general, compared to the use of in situ uterine repairs during cesarean delivery, uterine exteriorization for repairs may have benefits of less blood loss and shorter operative time. However, it may also carry a higher risk of intraoperative complications such as nausea and vomiting, uterine atony, and a longer time to the return of bowel function. Clinicians should consider these factors during shared decision-making with their pregnant patients to determine the most suitable techniques for cesarean deliveries.

scholarly journals The extra 1.5 cm makes the differences: reduced incidence of vaginal intraepithelial neoplasia after modified hysterectomy for CIN3/adenocarcinoma in situ (AIS) patients

2021 ◽  
Author(s):  
Lei Li ◽  
Xiaoyan Song ◽  
Xiaojie Feng ◽  
Xiaofeng Li ◽  
Zhenzhong Zhang ◽  
...  
Keyword(s):  
Blood Loss ◽  
Hospital Stay ◽  
Operative Time ◽  
Disease Free Survival ◽  
Intraepithelial Neoplasia ◽  
Postoperative Recurrence ◽  
Adenocarcinoma In Situ ◽  
Stay Time

Abstract Objectives To assess whether modified hysterectomy can improve locoregional control compared to the standard extrafascial hysterectomy for cervical high grade intraepithelial neoplasia 3 (CIN3)/adenocarcinoma in situ (AIS) patients. Methods A total of 135 CIN3/AIS patients from May 2014 to March 2018 were enrolled and randomized to different hysterectomy group and finally 128 patients were eligible for analysis, in which 60 patients received standard extrafascial hysterectomy and 68 patients received modified hysterectomy by removing extra 1.5cm of vagina. Intra-operative variables including operative time, estimated amount of blood loss, urinary catheter time, hospital stay time and postoperative complications, most importantly the postoperative recurrence and disease free survival (DFS) were compared and analyzed. Results Age, BMI and histology grade were comparable between these two groups. No significant differences were found at median surgical times, blood loss and postoperative hospital stay neither laparoscopicly nor abdominally, and neither was found about the incidences of fistulas, or other surgical complications. No incidences of prolonged urinary retention were found in both groups. With a median follow-up of 47.3 months (range 11–64 months), the modified hysterectomy group and had a significantly improved in DFS rate compared to the standard extrafascial hysterectomy group (P = 0.026). No disease related death occurred in the follow-up time. Conclusion With similar intra-operative variables operative time, modified hysterectomy appeared to provide the most reliable specimens and significantly reduced the postoperative vaginal recurrence rate for CIN3/AIS patients who choose remove their uterus when compared with standard extrafascial hysterectomy.

scholarly journals LDLT Portal Vein Thrombosis: Technical Advances

QJM ◽  
2020 ◽  
Vol 113 (Supplement_1) ◽  
Author(s):  
M B Ahmed ◽  
M A Rady ◽  
M A Abd-errazik ◽  
A R M A Azzam
Keyword(s):  
Liver Transplantation ◽  
Blood Loss ◽  
Portal Vein ◽  
Portal Vein Thrombosis ◽  
Operative Time ◽  
Surgical Techniques ◽  
Vein Thrombosis ◽  
Operative Complications ◽  
End Stage ◽  
Post Operative Complications

Abstract Background portal vein thrombosis (PVT) is a common complication of end-stage liver disease with an incidence of 0.6–16% in patients with well-compensated disease (1–3), increasing up to 35% in cirrhotic patients with hepatocellular carcinoma. Aim of the Work the aim of the study is to compare between thrombectomy of PVT using vascular clamps “eversion” & manual technique “modified eversion” during liver transplantation regarding operative time, degree of blood loss, portal vein rethrombosis, and post-operative complications. Patients and Methods This is a retrospective cohort study to compare between thrombectomy of PVT using vascular clamps “eversion” & manual technique “modified eversion” during liver transplantation regarding operative time, degree of blood loss, portal vein rethrombosis & post-operative complications. The study was conducted as retrospective study of 33 adult patients who underwent LDLT at Ain Shams Specialized Hospital, Ain Shams University, Cairo, Egypt, between January 2016 and July 2018. Results the mean child score was 9.55 and the median hospital stay was 12 days. Based on review manager statics program, the PVT recurrence was non-significant (P = 0.295, Test value: 1.096). However, the blood loss was significant (p < 0.029, test value: -2.186) and the surgical time was significant (p = 0.013, test value: 2.633). Conclusion portal vein thrombosis (PVT) represents a significant technical challenge in liver transplantation and for many years was considered a relative contraindication. While advances in surgical techniques, axial imaging, and alternative inflow reconstruction options have made liver transplantation possible in transplant candidates with PVT.

scholarly journals Endoscopic thoracic discectomy

2000 ◽  
Vol 9 (4) ◽  
pp. 1-8 ◽  
Author(s):  
J. Patrick Johnson ◽  
Aaron G. Filler ◽  
Duncan Q. McBride
Keyword(s):  
Blood Loss ◽  
Chest Tube ◽  
Operative Time ◽  
Surgical Techniques ◽  
Invasive Procedure ◽  
Hospital Length ◽  
Hospital Length Of Stay ◽  
Steep Learning Curve ◽  
Thoracic Discectomy

Object Thoracoscopic discectomy is a minimally invasive procedure simulating a thoracotomy and is an alternative to the costotransversectomy and transpedicular approaches. In recent studies authors have concluded that thoracoscopic discectomy is the preferred procedure; however, relative historical comparisons were difficult to interpret. The authors conducted a prospective nonrandomized study in which they compared data on 36 patients undergoing thoracoscopic discectomy with eight patients undergoing thoracotomy between 1995 and 1999. Methods Patients affected with one- or two-level lesions underwent a thoracoscopic discectomy, and patients with three-level lesions or more underwent thoracotomy and discectomy. Data were collected on operative time, blood loss, chest tube duration, narcotic agent use, and hospital length of stay (LOS). Longer-term follow-up study of pain-related symptoms and neurological function was conducted. Patients who underwent thoracoscopic discectomy had shorter operative times, less blood loss, a shorter period of chest tube drainage dependence, less narcotic usage, and a shorter LOS. These findings were statistically significant (p < 0.05) for narcotic usage and shorter LOS. Pain related to radiculopathy was improved by means of 75%, and no patients exprienced worsened pain. In patients with myelopathy there was an improvement of two Frankel grades in the thoracoscopic group and one Frankel grade in the thoracotomy discectomy group, but patients in the thoracotomy group were significantly worse preoperatively. One myelopathic patient from each group suffered a worsened outcome postoperatively, although this was not attributed to the method of surgery. The incidence of complications (minor and major) was 31% in the thoracoscopic group and greater than 100% (that is, more than one complication per patient) in the thoracotomy/discectomy group. Conclusions One advantage to thoracoscopic discectomy is its reduced incidence of morbidity compared with thoractomy, but its steep learning curve and unfamiliar surgical techniques make this procedure less practical for surgeons not performing it frequently. The more familiar costotransversectomy, transpedicular, and thoracotomy procedures remain viable alternatives for surgeons more experienced in these procedures.

scholarly journals Anterior approach in situ resection for total laparoscopic pancreaticoduodenectomy

BMC Surgery ◽  
2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Yunqiang Cai ◽  
He Cai ◽  
Bing Peng
Keyword(s):  
Blood Loss ◽  
Hospital Stay ◽  
Anterior Approach ◽  
Operative Time ◽  
Oral Intake ◽  
Laparoscopic Pancreaticoduodenectomy ◽  
Periampullary Tumors ◽  
Estimated Blood Loss ◽  
Male Patients

Abstract Background Laparoscopic pancreaticoduodenectomy (LPD) is gaining popularity in last decade. However, it is still technical challenging to perform LPD for patients with large periampullary tumors. Methods From January 2019 to January 2020, 13 cases of LPD were performed via anterior approach. Data were collected prospectively in terms of demographic characteristics (age, gender, body mass index, pathological diagnosis and tumor size), intra-operative variables (operative time, estimated blood loss, transfusion), and post-operative variables (time for oral intake, post-operative hospital stay, and complications). Results There were five male patients and eight female patients included in this study. The median age of these patients was 52.7 ± 14.5 years. The median size of tumors was 7.2 ± 2.9 cm. One patient converted to open surgery because of uncontrollable hemorrhage. The median operative time was 356 ± 47 min. The median estimated blood loss was 325 ± 216 ml. The mean post-operative hospital stay was 12.4 ± 1.9 days. One patient suffered from grade B pancreatic fistula. One patient suffered from delayed gastric emptying which was cured by conservative therapy. 90-day mortality was zero. Conclusions Laparoscopic pancreaticoduodenectomy via anterior approach is safe and feasible for patients with large periampullary tumors. Its oncological benefit requires further investigation.

scholarly journals Laparoscopic vs open gastrectomy- An updated metaanalysis of randomised control trials for short term outcomes

2020 ◽  
Author(s):  
Bhavin Vasavada ◽  
Hardik Patel
Keyword(s):  
Gastric Cancer ◽  
Blood Loss ◽  
Operative Time ◽  
Laparoscopic Group ◽  
Open Gastrectomy ◽  
Systemic Review ◽  
Wound Complications ◽  
Short Term ◽  
Significant Difference ◽  
Randomised Control Trials

AbstractIntroductionAim of this metaanalysis was to compare short term outcomes of laparoscopic and open gastrectomy for gastric cancer.Material and methodsEMBASE, MEDLINE, PubMed and the Cochrane Database were searched for randomised control trials comparing outcomes in patients undergoing laparoscopic gastrectomies with those patients undergoing open gastrectomies. The primary outcome was 30 day morbidity and mortality. Secondary outcomes studied included length of stay, blood loss, d2gastrectomies, lymphnode retrieval, operative time, distal gastrectomy, wound complications and intraabdominal complications Systemic review and Metaanalysis were done according to MOOSE and PRISMA guidelines.ResultsMorbidity was significantly low in laparoscopic group(P=0.004).There was no significant difference between mortality between the two groups. (P=0.989). There less wound complications in laparoscpic group, no difference intra-abdominal complications in both the groups. Operative time was significantly higher in laparoscopic group. (P< 0.001) wmd 56.904. Hospital stay was similar in laparoscopic group. (P=0.305) wmd –0.533 days. Blood loss was significantly lesser in laparoscopic group.(p <0.001). Laparoscopic group patients had less number of lymph node retrieval compared to laparoscopic group.(p< 0.001). Laparoscopic group also contained similar advanced staged gastric cancer than open gastrectomies.ConclusionsLaparoscopic gastrectomies were associated with better short term outcomes.

scholarly journals Comparative study of modified Stoppa approach and ilioinguinal approach for pelviacetabular fractures

2020 ◽  
Vol 6 (5) ◽  
pp. 1070
Author(s):  
Ansari Muqtadeer Abdul Aziz ◽  
Venktesh D. Sonkawade ◽  
Shivkumar Santpure
Keyword(s):  
Blood Loss ◽  
Operative Time ◽  
Direct Access ◽  
Meralgia Paresthetica ◽  
Ilioinguinal Approach ◽  
Advantages And Disadvantages ◽  
Quadrilateral Plate ◽  
Stoppa Approach ◽  
Group A ◽  
Group B

<p class="abstract"><strong>Background:</strong> The present study was done to study advantages and disadvantages of modified Stoppa approach (MSA) and ilioinguinal approach (IIA) for surgery of pelviacetabular fractures involving anterior column, anterior wall, quadrilateral plate with protrusion and complex fractures, pelvic ring fractures with pubic diastasis or sacroiliac joint disruptions which needs to be stabilized anteriorly.</p><p class="abstract"><strong>Methods:</strong> Study was conducted in Department of Orthopaedics, Government Medical College and Hospital, Aurangabad on patients with pelviacetabular fractures during June 2018 to March 2020. In our study of 25 patients, they were divided into group A containing 13 patients operated using MSA and group B containing 12 patients operated using IIA. Follow up period was 12-18 months (mean=15) and 12-16 months (mean=14) for group A and B, respectively. Patients assessed using modified Merle d’Aubigné score and Matta’s score.<strong></strong></p><p class="abstract"><strong>Results:</strong> Mean modified Merle d’Aubigné score was 16 and 14 for group A and B, respectively (p value=0.89). Mean blood loss and operative time were less in MSA. Superficial infection was found in one patient each of group A and B whereas one patient developed deep infection in group B. One patient each of both group had hip pain suggestive of early arthrosis. In group B, two patients developed meralgia paresthetica. One patient developed external iliac artery thrombosis and inguinal hernia in group B. one patient from group A developed incisional hernia.</p><p class="abstract"><strong>Conclusions:</strong> MSA was better and simpler than IIA with due adequate training and practice to achieve direct access for pelviacetabular fracture reduction and also it requires less operative time, less blood loss and better postoperative outcome.</p><p> </p>

scholarly journals The Impact of Obesity on Operative Time and Blood Loss during Cesarean Delivery

2019 ◽  
Vol 1 (1) ◽  
Author(s):  
Roeckner JT ◽  
Sanchez-Ramos L ◽  
Kaunitz A
Keyword(s):  
Body Mass Index ◽  
Blood Loss ◽  
Cesarean Delivery ◽  
Body Mass ◽  
Operative Time ◽  
Maternal Body Mass Index ◽  
Maternal Body ◽  
Apgar Scores ◽  
The Impact

Objective: To test the hypothesis that increased maternal body mass index (BMI) is associated with longer operative and anesthesia times, increasing blood loss, and lower APGAR scores.

Surgical outcome for thoracic disc surgery in the postlaminectomy era

2000 ◽  
Vol 9 (4) ◽  
pp. 1-5 ◽  
Author(s):  
Thomas C. Chen
Keyword(s):  
Patient Satisfaction ◽  
Blood Loss ◽  
Surgical Outcome ◽  
Operative Time ◽  
Surgical Techniques ◽  
Axial Loading ◽  
Length Of Hospital Stay ◽  
Disc Surgery ◽  
Thoracic Discectomy ◽  
Thoracic Disc

In this article the author reviews outcomes of thoracic disc surgery reported in the literature. Care was taken to include only series in which none or a few patients underwent laminectomy for the treatment of thoracic disc lesions. The author found that thoracic discectomy may be performed in an efficacious and safe manner via the transthoracic, lateral extracavitary, transpedicular, or endoscopic approach. In the vast majority of patients, preoperative symptoms of pain (radiculopathy or axial loading pain) and myelopathy were improved after surgery. Measurements of operative time, blood loss, length of hospital stay, and patient satisfaction were often inadequately reported. Complications (systemic and neurological) were well documented and were not common. A plea is made for uniformity in documenting outcome in future series so that today's procedures for thoracic discectomy may be more accurately compared with future cases regardless of the inevitable advances in surgical techniques for removal of thoracic discs.

scholarly journals Running suture hemostatic technique versus standard reconstruction of the surgical bed in Zero - Ischemia Time mini-flank Open Partial Nephrectomies. Retrospective, Match-Paired Case-Control Study

2019 ◽  
Vol 91 (2) ◽  
Author(s):  
Petar Kavaric ◽  
Aleksandar Magdelinic ◽  
Marko Vukovic
Keyword(s):  
Blood Loss ◽  
Tumor Size ◽  
Operative Time ◽  
Surgical Techniques ◽  
Control Group ◽  
Reconstruction Technique ◽  
Ischemia Time ◽  
Estimated Blood Loss ◽  
Significant Difference ◽  
Zero Ischemia

Objective: To estimate the efficacy of our technique of zero ischemia time partial nephrectomy (ZTPN) with hemostatic running suture and compare it to the standard technique, in terms of perioperative complications, operative time (OT) and estimated blood loss (EBL). Materials and methods: We retrospectively analysed 180 consecutive patients who underwent ZTPN using a supra 11th or supra 12th rib mini flank approach. First group numbered 90 patients treated with running suture hemostatic technique (RSHT), while the control group enrolled 90 patients in whom we performed standard reconstruction technique (SRT). According the propensity score, both groups were similar in terms of tumor size, age and PADUA score. Patients with solitary tumour limited to the kidney (T1-T2a) were included. Our technique included a running suture of surgical bed edges and closure of the renal cortex by the positioning of peri-renal fat within the cortical bed and fixation with interrupted sutures. Results: PADUA score and tumor size were comparable between groups (7.12 ± 1.33 vs 7.1 ± 2.11, p = 0.4 and 52.9 ± 14.8 vs 50.0 ± 13.2, p = 0.3). The mean operative time (OT) was significantly longer in first group (165.2 vs 95, p = 0.04), while median estimated blood loss (EBL) was significantly reduced (250 vs 460 ml, p = 0.02). Surgical resection margins were negative in 100% of cases and no patient developed a local or distant recurrence during follow up. There was significant difference in postoperative GFR value between groups (p < 0.05). Conclusions: Our technique could be safely performed in local, low volume facilities, thus reducing the need for expensive and more challenging minimal invasive surgical techniques..

scholarly journals Accuracy of Blood Loss Measurement during Cesarean Delivery

2017 ◽  
Vol 07 (02) ◽  
pp. e93-e100 ◽  
Author(s):  
Sahar Doctorvaladan ◽  
Andrea Jelks ◽  
Eric Hsieh ◽  
Robert Thurer ◽  
Mark Zakowski ◽  
...  
Keyword(s):  
Blood Loss ◽  
Cesarean Delivery ◽  
Gravimetric Method ◽  
Assay Method ◽  
Visual Estimation ◽  
Colorimetric Analysis ◽  
Gravimetric Measurement ◽  
Colorimetric System ◽  
Cesarean Deliveries ◽  
Bland Altman Method

Objective This study aims to compare the accuracy of visual, quantitative gravimetric, and colorimetric methods used to determine blood loss during cesarean delivery procedures employing a hemoglobin extraction assay as the reference standard. Study Design In 50 patients having cesarean deliveries blood loss determined by assays of hemoglobin content on surgical sponges and in suction canisters was compared with obstetricians' visual estimates, a quantitative gravimetric method, and the blood loss determined by a novel colorimetric system. Agreement between the reference assay and other measures was evaluated by the Bland–Altman method. Results Compared with the blood loss measured by the reference assay (470 ± 296 mL), the colorimetric system (572 ± 334 mL) was more accurate than either visual estimation (928 ± 261 mL) or gravimetric measurement (822 ± 489 mL). The correlation between the assay method and the colorimetric system was more predictive (standardized coefficient = 0.951, adjusted R2 = 0.902) than either visual estimation (standardized coefficient = 0.700, adjusted R2 = 00.479) or the gravimetric determination (standardized coefficient = 0.564, adjusted R2 = 0.304). Conclusion During cesarean delivery, measuring blood loss using colorimetric image analysis is superior to visual estimation and a gravimetric method. Implementation of colorimetric analysis may enhance the ability of management protocols to improve clinical outcomes.

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