scholarly journals The Number of Myomas Is the Most Important Risk Factor for Blood Loss and Total Operation Time in Robotic Myomectomy: Analysis of 242 Cases

2021 ◽  
Vol 10 (13) ◽  
pp. 2930
Author(s):  
Sa Ra Lee ◽  
Ju Hee Kim ◽  
Sehee Kim ◽  
Sung Hoon Kim ◽  
Hee Dong Chae
Keyword(s):  
Blood Loss ◽  
Cesarean Section ◽  
Abdominal Surgery ◽  
Operation Time ◽  
Postoperative Fever ◽  
Factors Affecting ◽  
Maximal Diameter ◽  
Estimated Blood Loss ◽  
History Of ◽  
Robotic Myomectomy

To identify factors affecting blood loss and operation time (OT) during robotic myomectomy (RM), we reviewed a total of 448 patients who underwent RM at Seoul Asan Hospital between 1 January 2019, and 28 February 2021, at Seoul Asan Hospital. To avoid variations in surgical proficiency, only 242 patients managed by two surgeons who each performed >80 RM procedures during the study period were included in this study. All cases of RM were performed with a reduced port technique. We obtained the following data from each patient’s medical chart: age, gravidity, parity, body mass index, and history of previous abdominal surgery including cesarean section. We also collected information on the maximal diameter and type of myomas, number and weight of removed myomas, concomitant surgery, total OT from skin incision to closure, estimated blood loss (EBL), and blood transfusion. Data on preoperative use of gonadotropin-releasing hormone agonists (GnRHas) and perioperative use of hemostatic agents (tranexamic acid or vasopressin) were also collected. Data on the length of hospital stay, postoperative fever within 48 h, and any complications related to RM were also obtained. The primary endpoint in this study was the identification of factors affecting EBL and the secondary endpoint was the identification of factors affecting the total OT during multiport RM. Univariate and multivariate analyses were used to identify the factors affecting EBL and OT during multiport RM. The medians of the maximal diameter and weight of the removed myomas were 9.00 (interquartile range [IQR], 7.00 to 10.00) cm and 249.75 (IQR, 142.88 to 401.00) g, respectively. The median number of myomas was two (IQR, one to four), ranging from 1 to 34. Of the cases, 155 had low EBL and 87 had high EBL. Most myomas were of the intramural type (n = 179). The odds of EBL > 320 mL increased by 251% (odds ratio [OR], 2.51; 95% confidence interval [CI], 1.16–5.42) for five to nine myomas and by 647% (OR, 6.47; 95% CI, 1.87–22.33) for ≥10 myomas. The odds of subserosal-type myomas decreased by 67% compared with intramural-type myomas (OR, 0.33; 95% CI, 0.14–0.80). History of abdominal surgery other than cesarean section was positively correlated with EBL. The weight of the removed myomas and a history of previous cesarean section were not correlated with the EBL. Conclusion: The number of myomas (5–9 and ≥10), maximal myoma diameter, and history of abdominal surgery other than cesarean section affect the EBL in RM.

scholarly journals Study on the method of enucleation of anterior uterine fibroids by transverse incision of the lower uterine segment during cesarean section

2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Yan Dai ◽  
Li Xia ◽  
Jinxiao Lin ◽  
Rongli Xu ◽  
Wenqiang You
Keyword(s):  
Cesarean Section ◽  
Operation Time ◽  
Anterior Wall ◽  
Control Group ◽  
Study Group ◽  
Transverse Incision ◽  
Postoperative Fever ◽  
Postoperative Changes ◽  
Perioperative Bleeding ◽  
Surgical Data

Abstract Introduction A retrospective study was conducted to investigate the effectiveness and feasibility of fibroid enucleation in the anterior wall of the uterus by transverse uterine incision during cesarean section. Methods The medical history, surgical data, preoperative and postoperative changes in the blood system, and complications of 90 pregnant women who underwent myomectomy of the anterior uterine wall during cesarean section at the second Department of Maternal and Child Health Hospital of Fujian Province were analyzed retrospectively. Results No significant differences were noted in the leiomyoma number, pathological type, preoperative and postoperative hemoglobin level, perioperative bleeding incidence, blood transfusion frequency, postoperative fever incidence, and duration of lochia between the study and control groups. The proportion of large fibroids was slightly higher in the study group than in the control group (p < 0.05), and the operation time and average hospitalization time were slightly longer in the study group than in the control group (p < 0.05). The distribution of type III–V fibroids was slightly more in the study group than in the control group (p < 0.05), and the distribution of type VI fibroids in the study group was less than that in the control group (p < 0.05). Conclusion Fibroid enucleation is safe and effective in the anterior wall of the uterus through the lower uterine transverse incision in cesarean section. It has the potential to reduce the risk of pelvic and intrauterine adhesions in the future.

Regrowth of the adenoids after adenoidectomy down to the pharyngobasilar fascial surface

2015 ◽  
Vol 129 (7) ◽  
pp. 662-665 ◽  
Author(s):  
L Wei ◽  
M Wang ◽  
N Hua ◽  
K Tong ◽  
L Zhai ◽  
...  
Keyword(s):  
Surgical Technique ◽  
Blood Loss ◽  
Success Rate ◽  
Operation Time ◽  
Early Complications ◽  
Estimated Blood Loss ◽  
Endoscopic Guidance ◽  
Pharyngobasilar Fascia

AbstractObjectives:This study aimed to explore adenoid regrowth after transoral power-assisted adenoidectomy down to the pharyngobasilar fascial surface.Methods:Transoral adenoidectomy down to the pharyngobasilar fascia surface was performed on 39 patients under endoscopic guidance, using a power-assisted system. The operation time, amount of blood loss and iatrogenic injury, presence of complications, and success and regrowth rates were recorded to assess the feasibility, safety and effectiveness of our surgical technique.Results:In this adenoidectomy procedure, the pharyngobasilar fascia was left intact. The estimated blood loss was 5–50 ml (mean 15 ml), and the success rate was 97.3 per cent. Early complications occurred in 2.3 per cent of patients, while no long-term complications occurred in the cohort. No regrowth was found in the follow-up assessments, which were performed for 18–36 months after surgery.Conclusion:Adenoid regrowth was rare after adenoidectomy down to the pharyngobasilar fascial surface. The pharyngobasilar fascia can therefore be considered a surgical boundary for adenoidectomy.

Differences in Outcome Between Open vs Laparoscopic Insertion of Ventriculoperitoneal Shunts

2021 ◽  
pp. 000313482110505
Author(s):  
Aaron B. Lopacinski ◽  
Kevin M. Guy ◽  
Jessica R. Burgess ◽  
Jay N. Collins
Keyword(s):  
Abdominal Surgery ◽  
General Surgery ◽  
Operation Time ◽  
Laparoscopic Group ◽  
Prior History ◽  
Team Approach ◽  
Tertiary Referral Hospital ◽  
Shunt Insertion ◽  
Vp Shunt ◽  
History Of

Background Abdominal access during ventriculoperitoneal (VP) shunt insertion has historically been obtained by neurosurgeons via an open abdominal approach. With recent advances in laparoscopy, neurosurgeons frequently consult general surgery for aid during the procedure. The goal of this study is to identify if laparoscopic assistance improves the overall outcomes of the procedure. Methods This retrospective study included all patients who underwent open or laparoscopic VP shunt placement between September 2012 and August 2020 at our tertiary referral hospital. Patient demographics, comorbidities, prior history of abdominal surgery, open vs. laparoscopic insertion, operation time, and complications within 30 days were obtained. Results Neurosurgery placed 107 shunts using an open abdominal technique and general surgery placed 78 using laparoscopy. The average OR time in minutes was 75.5 minutes for the open cohort and 61.8 for the laparoscopic cohort ( p = 0.006). In patients without a history of abdominal surgery, the average OR time in minutes was 79.4 in the open cohort and 57.1 in the laparoscopic cohort ( p = 0.015). The postoperative shunt infection rate was 10.2% in the open group and 3.8% in the laparoscopic group ( p = 0.077). Discussion Laparoscopic placement of VP shunts is a reasonable alternative to open placement and results in shorter OR times. There is also a trend toward few infections in the laparoscopic placement. There appears to be an advantage with a team approach and laparoscopic placement of the peritoneal portion of the shunt.

Impact of an Ultrasonically Activated Device in Robot-Assisted Distal Gastrectomy

2017 ◽  
Vol 12 (6) ◽  
pp. 453-458
Author(s):  
Makoto Hikage ◽  
Masanori Tokunaga ◽  
Rie Makuuchi ◽  
Yutaka Tanizawa ◽  
Etsuro Bando ◽  
...  
Keyword(s):  
Gastric Cancer ◽  
Blood Loss ◽  
Surgical Outcomes ◽  
Distal Gastrectomy ◽  
Operation Time ◽  
Patient Characteristics ◽  
Clinicopathological Characteristics ◽  
Robot Assisted ◽  
Estimated Blood Loss ◽  
Device Use

Objective Robot-assisted gastrectomy is increasingly used for the treatment of gastric cancer, although it remains a time-consuming procedure. An ultrasonically activated device might be useful to shorten operation times. This study therefore assessed the effect of ultrasonically activated device use on procedural times and on other early surgical outcomes. Methods Consecutive patients (N = 42) who underwent robot-assisted distal gastrectomy for gastric cancer were included. Clinicopathological characteristics and early surgical outcomes were compared between robotic-assisted gastrectomy procedures using an ultrasonically activated device (U group, n = 21) and those without it (NU group, n = 21). Results There were no significant differences in patient characteristics between the groups; however, the median operation time was significantly less in the U group than in the NU group (291 vs 351 minutes, P = 0.006). In detail, the median duration of console time until dividing the duodenum was less in the U group (70 vs 102 minutes, P < 0.001). Estimated blood loss, incidence of postoperative morbidity, and duration of postoperative hospital stay were not different between the groups. Conclusions An ultrasonically activated device reduced the operation time of robot-assisted gastrectomy without increasing blood loss and morbidity.

Radiofrequency bipolar coagulation for radical hysterectomy: Technique, feasibility and complications

2003 ◽  
Vol 13 (2) ◽  
pp. 187-191
Author(s):  
A. Ercoli ◽  
A. Fagotti ◽  
M. Malzoni ◽  
G. Ferrandina ◽  
T. Susini ◽  
...  
Keyword(s):  
Blood Loss ◽  
Radical Hysterectomy ◽  
Operative Time ◽  
Bipolar Coagulation ◽  
Maximal Diameter ◽  
Estimated Blood Loss ◽  
Safe Technique ◽  
Radiofrequency Coagulation ◽  
Vessel Dissection

This study describes the surgical technique and intra- and postoperative complications associated with the use of a radiofrequency bipolar coagulator in a series of 18 Piver type III-IV radical hysterectomies performed in cervical cancer patients. Preliminary vessel-by-vessel dissection of the lateral parametria was possible in 17 out of 18 (94%) cases, and a direct application of a radiofrequency bipolar coagulation instrument was performed to coagulate the posterior and anterior parametrial tissues in all cases. We were able to easily coagulate isolated vessels up to 5 mm of maximal diameter. In no case were clamps or hemoclips necessary to complete hemostasis. We did not observe any parametrial vessel damage or heat-related injury of the surrounding normal tissue. The median size of the parametria removed was 44 mm (range 31–58) and nodes were detected in 15 cases (83%). Median operative time and estimated blood loss for the whole procedure including systematic pelvic and aortic lymphadenectomy was 250 min (range 200–410) and 550 ml (range 400–2500), respectively. Median follow-up time was 9 months (range 5–13). No complications specifically related to the use of radiofrequency coagulation were found. In conclusion the radio-frequency coagulation with this instrument appears to be a safe technique that is particularly useful in reducing blood loss and operative time without affecting radicality in patients undergoing radical hysterectomy.

scholarly journals Tranexamic acid in prevention of postpartum hemorrhage in elective cesarean section

2019 ◽  
Vol 8 (2) ◽  
pp. 372
Author(s):  
Pravin Shah ◽  
Ajay Agrawal ◽  
Shailaja Chhetri ◽  
Pappu Rijal ◽  
Nisha K. Bhatta
Keyword(s):  
Blood Loss ◽  
Cesarean Section ◽  
Tranexamic Acid ◽  
Postpartum Hemorrhage ◽  
Elective Cesarean Section ◽  
Controlled Study ◽  
Control Group ◽  
Estimated Blood Loss ◽  
Elective Cesarean ◽  
The Mean

Background: Postpartum hemorrhage is a common and occasionally life-threatening complication of labor. Cesarean section is associated with more blood loss in compared to vaginal delivery. Despite, there is a trend for increasing cesarean section rates in both developed and developing countries thereby increasing the risk of morbidity and mortality, especially among anemic women. The objective of this study was to evaluate the effect of preoperative administration of intravenous Tranexamic acid on blood loss during and after elective cesarean section.Methods: This was a prospective, randomized controlled study with 160 eligible pregnant women of 37 or more period of gestation. They were all planned for elective cesarean section and were randomized into two groups either to receive 10ml (1gm) of Tranexamic acid intravenously or 10ml of normal saline. Blood loss was measured during and for 24 hours after operation.Results: The mean estimated blood loss was significantly lower in women treated with Tranexamic acid compared with women in the placebo group (392.13 ml±10.06 vs 498.69 ml±15.87, respectively; p<0.001). The mean difference in pre-operative and post-operative hemoglobin levels was statistically significant in the Tranexamic acid group than in the control group (0.31±0.18 vs 0.79±0.23, respectively; p<0.001).Conclusions: Pre-operative use of Tranexamic acid is associated with reduced blood loss during and after elective cesarean section. In a developing country like ours where postpartum hemorrhage is a major threat to the life of the mothers, it seems to be a promising option.

Sublingual Misoprostol vs Intravenous Tranexamic Acid in reducing Blood Loss during Cesarean Section: A Prospective Randomized Study

2017 ◽  
Vol 9 (1) ◽  
pp. 9-13 ◽  
Author(s):  
Deepak Bose ◽  
Rasheeda Beegum
Keyword(s):  
Risk Factors ◽  
Blood Loss ◽  
Cesarean Section ◽  
Tranexamic Acid ◽  
Randomized Study ◽  
Operation Time ◽  
Prospective Randomized Study ◽  
Cord Clamping ◽  
Group I ◽  
Sublingual Misoprostol

ABSTRACT Introduction The increasing incidence of cesarean sections in India has caused a rise in the incidence of postpartum hemorrhage (PPH). There has been expanding interest in the role of misoprostol and tranexamic acid (TXA) in preventing and managing PPH during lower (uterine) segment cesarean section (LSCS). However, the lack of a published study comparing the efficacies of these drugs prompted us to conduct this study. Aims and objectives To compare the efficacies of sublingual misoprostol (600 μg) and intravenous TXA injection (500 mg) in reducing blood loss during LSCS by assessing intraoperative blood loss, perioperative hemoglobin (Hb) fall, and need for additional uterotonic agents. Materials and methods A total of 163 pregnant patients undergoing emergency/elective LSCS during the study period from 2013 to 2014 were randomly assigned to two groups — group I (82) received sublingual misoprostol 600 μg and group II (81) intravenous TXA 500 mg at cord clamping. Visual estimation of blood loss was done and 48 hours postoperative Hb and packed cell volume were measured to compare with preoperative values. Need for added uterotonics, blood transfusion, and adverse effects of drugs was assessed. The two groups were again subgrouped based on presence or absence of risk factors for PPH. Results The TXA significantly reduced blood loss compared with misoprostol (416 vs 505 mL) in patients without high-risk factors for PPH. Misoprostol caused significantly higher minor side effects while TXA reduced operation time. Conclusion The TXA can be routinely used after cord clamping along with oxytocin in patients undergoing elective/emergency LSCS to reduce perioperative blood loss, especially in those without risk factors for PPH. How to cite this article Bose D, Beegum R. Sublingual Misoprostol vs Intravenous Tranexamic Acid in reducing Blood Loss during Cesarean Section: A Prospective Randomized Study. J South Asian Feder Obst Gynae 2017;9(1):9-13.

scholarly journals Perioperative morbidity of different operative approaches in early cervical carcinoma: a systematic review and meta-analysis comparing minimally invasive versus open radical hysterectomy

2021 ◽  
Author(s):  
J. Kampers ◽  
E. Gerhardt ◽  
P. Sibbertsen ◽  
T. Flock ◽  
H. Hertel ◽  
...  
Keyword(s):  
Blood Loss ◽  
Minimally Invasive ◽  
Hospital Stay ◽  
Radical Hysterectomy ◽  
Postoperative Morbidity ◽  
Meta Analysis ◽  
Operation Time ◽  
Mean Difference ◽  
Inclusion Criteria ◽  
Estimated Blood Loss

Abstract Purpose Radical hysterectomy and pelvic lymphadenectomy is the standard treatment for early cervical cancer. Studies have shown superior oncological outcome for open versus minimal invasive surgery, but peri- and postoperative complication rates were shown vice versa. This meta-analysis evaluates the peri- and postoperative morbidities and complications of robotic and laparoscopic radical hysterectomy compared to open surgery. Methods Embase and Ovid-Medline databases were systematically searched in June 2020 for studies comparing robotic, laparoscopic and open radical hysterectomy. There was no limitation in publication year. Inclusion criteria were set analogue to the LACC trial. Subgroup analyses were performed regarding the operative technique, the study design and the date of publication for the endpoints intra- and postoperative morbidity, estimated blood loss, hospital stay and operation time. Results 27 studies fulfilled the inclusion criteria. Five prospective, randomized-control trials were included. Meta-analysis showed no significant difference between robotic radical hysterectomy (RH) and laparoscopic hysterectomy (LH) concerning intra- and perioperative complications. Operation time was longer in both RH (mean difference 44.79 min [95% CI 38.16; 51.42]), and LH (mean difference 20.96 min; [95% CI − 1.30; 43.22]) than in open hysterectomy (AH) but did not lead to a rise of intra- and postoperative complications. Intraoperative morbidity was lower in LH than in AH (RR 0.90 [0.80; 1.02]) as well as in RH compared to AH (0.54 [0.33; 0.88]). Intraoperative morbidity showed no difference between LH and RH (RR 1.29 [0.23; 7.29]). Postoperative morbidity was not different in any approach. Estimated blood loss was lower in both LH (mean difference − 114.34 [− 122.97; − 105.71]) and RH (mean difference − 287.14 [− 392.99; − 181.28]) compared to AH, respectively. Duration of hospital stay was shorter for LH (mean difference − 3.06 [− 3.28; − 2.83]) and RH (mean difference − 3.77 [− 5.10; − 2.44]) compared to AH. Conclusion Minimally invasive radical hysterectomy appears to be associated with reduced intraoperative morbidity and blood loss and improved reconvalescence after surgery. Besides oncological and surgical factors these results should be considered when counseling patients for radical hysterectomy and underscore the need for new randomized trials.

scholarly journals Factors Leading to Cesarean Section Delivery at Tarakan Hospital, North Kalimantan

2021 ◽  
Vol 6 (1) ◽  
pp. 77-83
Author(s):  
Rahmi Padlilah ◽  
◽  
Ika Yulianti ◽  
Ririn Ariyanti ◽  
◽  
...  
Keyword(s):  
Logistic Regression ◽  
Regression Analysis ◽  
Cesarean Section ◽  
Logistic Regression Analysis ◽  
Multiple Logistic Regression Analysis ◽  
Mortality And Morbidity ◽  
Factors Affecting ◽  
Cesarean Section Delivery ◽  
History Of ◽  
Medical Indications

Background: The increase in cesarean section delivery requires attention. Mortality and morbidity rates for mother and fetus increase in line with the increase in cesarean section delivery. This study aimed to analyze the factors affecting the delivery of cesarean section. Subjects and Method: This was an analytical observational study with a case-control design. The study was conducted at Tarakan Hospital, North Kalimantan, from 2018 to 2020. There were 200 study subjects as the sample of this study that was selected by purposive sampling. The dependent variable was cesarean section delivery. The independent variables were parity, age, history of the disease, medical indications, and ANC history. This study used medical records to collect the data with multiple logistic regression analysis. Results: Cesarean section delivery increased with multiparous (OR= 1.26; 95% CI= 1.67 to 7.45; p= 0.001), age <20 and ≥ 35 years (OR= 1.51; 95% CI= 2.12 to 9.66; p <0.001), high-risk pregnancies such as diabetes mellitus, anemia, hypertension and preeclampsia (OR = 1.50; 95% CI = 2.12 to 9.52; p <0.001), medical indications (OR= 1.37; 95% CI = 1.82 to 8.57; p = 0.001) and complete ANC history (OR = 0.26; 95% CI = 0.13 to 0.56; p = 0.001). Conclusion: Caesarean section delivery increases with multiparous, age <20 and ≥35 years, had a history of the disease, medical indications, and a complete ANC history. Keywords: cesarean section, influencing factors, logistic regression analysis Correspondence: Rahmi Padlilah. University of Borneo Tarakan. Jl. Amal Lama No.1 Tarakan, North Kalimantan. Email: [email protected]. Mobile: +628- 11538073.

scholarly journals Treatment of irreducible atlantoaxial dislocation using one-stage retropharyngeal release and posterior reduction

2019 ◽  
Vol 27 (3) ◽  
pp. 230949901987046 ◽  
Author(s):  
Xianfeng Ren ◽  
Feng Gao ◽  
Siyuan Li ◽  
Jiankun Yang ◽  
Yongming Xi
Keyword(s):  
Blood Loss ◽  
Operative Time ◽  
Japanese Orthopaedic Association ◽  
Operation Time ◽  
Atlantoaxial Dislocation ◽  
Efficacy And Safety ◽  
Estimated Blood Loss ◽  
Irreducible Atlantoaxial Dislocation ◽  
The Mean

Introduction: Irreducible atlantoaxial dislocation (IAAD) has been challenging for spine surgeons. Various methods have been used to treat IAAD, but no consensus has been reached. This study aimed to retrospectively analyze the efficacy of anterior submandibular retropharyngeal release and posterior reduction and fixation for IAAD. Methods: From March 2007 to May 2015, 13 patients diagnosed with IAAD underwent anterior submandibular retropharyngeal release and sequential posterior reduction and fixation. The operation time, blood loss, postoperative complications, and Japanese Orthopaedic Association (JOA) scores were retrospectively recorded. Results: The surgeries were accomplished successfully. The mean operative time was about 3.8 h. The mean estimated blood loss was about 130 mL. The patients experienced postoperative pharyngeal pain. Only one patient had a vague voice and increased oral discharge postoperatively. At the final follow-up, JOA scores had significantly increased ( p < 0.05), and all the patients had solid bony fusion. Conclusion: The present study reinforces the efficacy and safety of anterior submandibular retropharyngeal release and posterior reduction and fixation for IAAD. It can achieve satisfactory clinical outcomes and is safe for experienced spine surgeons.

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