Feasibility of Using the Epidural Space Detecting Device (EPI-DetectionTM) for Interlaminar Cervical Epidural Injection

Cervical epidural injection (CEI), which is widely used for the treatment of cervical radiculopathy, sometimes has been associated with post-operative complications. Recently, EPI-DetectionTM, which detects the negative pressure of the epidural space and notifies the proceduralist by flashing a light and producing a beeping sound, was introduced. We assumed that the newly developed device could be as safe and efficient as the conventional loss of resistance (LOR) method. Therefore, we aimed to evaluate the effectiveness of the EPI-DetectionTM and compare it to that of the conventional LOR method. We randomly assigned 57 patients to the LOR and EPI-Detection groups (29 and 28 patients, respectively). Subjects were treated with interlaminar CEI (ILCEI) using one of two methods. The measured parameters, i.e., operation time and radiation dose were lower in the EPI-DetectionTM group (4.6 ± 1.2 min vs. 6.9 ± 2.1 min; and 223.2 ± 206.7 mGy·cm2 vs. 380.3 ± 340.9 mGy·cm2, respectively; all p < 0.05) than in the LOR group. There were no complications noted in either group. Both the EPI-DetectionTM and LOR methods were safe and effective in detecting the epidural space, but the former was superior to the latter in terms of operation time and radiation exposure. The EPI-DetectionTM may help perform ILCEI safely.

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

Urologia Journal ◽

10.1177/03915603211001677 ◽

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.

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False Loss of Resistance in Cervical Epidural Injection: The Loss of Resistance Technique Compared with the Epidrum Guidance in Locating Epidural Space

January 2018 - Pain Physician ◽

10.36076/ppj/2019.19.131 ◽

2016 ◽

Vol 3;19 (3;3) ◽

pp. 131-138

Author(s):

Dr. Woo Seog Sim

Keyword(s):

Epidural Space ◽

Medical Center ◽

Academic Medical Center ◽

False Negative ◽

Epidural Injection ◽

Epidural Block ◽

Epidural Injections ◽

Academic Medical ◽

Combined Use ◽

Loss Of Resistance

Background: Epidural block failures can occur due to a misleading loss of resistance (LOR) signal. Objective: This study was designed to evaluate the false LOR rate and to determine whether the Epidrum, which is an LOR device for identifying the epidural space, improves the ability to find the epidural space during cervical epidural injection compared the LOR technique. Study Design: A randomized, single-blind trial. Setting: Single academic medical center. Methods: A total of 150 patients undergoing cervical interlaminar epidural injections at C7-T1 were randomized to receive either the LOR technique with a syringe (group C) or the Epidrum guidance (group E). Fluoroscopic images were used to confirm the accuracy of the needle placement within the epidural space. The rate of misleading epidural signals and adverse effects were recorded and analyzed. Results: The false LOR rate was 74.7% for group C, 62.7% for group E, and 68.7% overall. The incidence of false LOR was not significantly different between the 2 groups. Also, the success rate and the rate of true epidural signals were similar between the 2 groups. Limitations: The Epidrum cannot be used to confirm whether the needle has entered the vascular space without fluoroscopy. Conclusions: In this study, we did not find any difference in accuracy between the Epidrum and the LOR technique with a syringe for detecting the cervical epidural space. The overall higher false LOR rate suggests that the combined use of fluoroscopy and LOR technique with a syringe or the Epidrum is necessary to increase the rate of finding the true cervical epidural space. Clinical Trials registration: KCT0001333 Key words: Cervical epidural injection, epidural space, Epidrum, false positive, false negative, loss of resistance

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COMPARISON OF OUTCOMES BETWEEN EARLY AND DELAYED LAPAROSCOPIC CHOLECYSTECTOMY IN ACUTE CALCULOUS CHOLECYSTITIS

Pakistan Armed Forces Medical Journal ◽

10.51253/pafmj.v71i3.2777 ◽

2021 ◽

Vol 71 (3) ◽

pp. 796-800

Author(s):

Muhammad Ismail ◽

Nasir Mehmood Wattoo ◽

Muhammad Qasim Butt ◽

Fareeha Naz

Keyword(s):

Laparoscopic Cholecystectomy ◽

Hospital Stay ◽

Operation Time ◽

Acute Calculous Cholecystitis ◽

Delayed Laparoscopic Cholecystectomy ◽

Operative Complications ◽

Group A ◽

Group B ◽

Calculous Cholecystitis ◽

Post Operative Complications

Objective: To compare early versus delayed laparoscopic cholecystectomy in acute calculous cholecystitis in terms of mean operative time, hospital stay, conversion rate to open surgery and post-operative complications. Study Design: Quasi experimental study. Place and Duration of Study: Army Liver Transplant Unit, Department of Surgery, Pak-Emirates Military Hospital Rawalpindi, from Jul to Dec 2018. Methodology: A total of 170 patients (85 in each group) diagnosed as a case of acute calculous cholecystitis who met the sample selection criteria were included. Group A patients underwent early laparoscopic cholecystectomy within 72 hours of admission while group B patients underwent conservative management followed by delayed laparoscopic cholecystectomy after 6 weeks. All patients were followed for operative time, hospital stay, per-operative difficulties encountered and post-operative complications. Results: Group A had a mean operation time of 43.9 ± 11.1 minutes, while group B had a mean operation time of 45.8 ± 10.1 minutes (p=0.83). The mean duration of hospitalization was 2.8 ± 1.1 days in group A and 5.3 ± 0.8 days in group B (p<0.001). Complications were measured at a frequency of 14.1% in group A and 5.9% in group B (p=0.07). Conclusion: Early laparoscopic cholecystectomy is better than delayed laparoscopic cholecystectomy in acute calculous cholecystitis in terms of hospital stay and per-operative difficulties faced. The post-operative complications between the two groups are comparable.

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Low-temperature radiofrequency coblation reduces treatment interval and post-operative pain of laryngotracheal recurrent respiratory papillomatosis

Bioscience Reports ◽

10.1042/bsr20192005 ◽

2020 ◽

Vol 40 (5) ◽

Author(s):

Fang Hao ◽

Liyan Yue ◽

Xiaoyan Yin ◽

Xiaotong Wang ◽

Chunguang Shan

Keyword(s):

Low Temperature ◽

Blood Loss ◽

Co2 Laser ◽

Operation Time ◽

Recurrent Respiratory Papillomatosis ◽

High Recurrence Rate ◽

Time Interval ◽

Pain Scores ◽

Operative Complications ◽

Post Operative Complications

Abstract Laryngeal papillomatosis is a benign disease in the larynx but with the potential to develop into significant complications as a result of its high recurrence rate. CO2 laser and radiofrequency controlled ablation (coblation) have been used to treat recurrent respiratory papillomatosis, but detailed comparisons of their respective treatment outcomes are not fully investigated. This retrospective study examines the procedure time, time interval between interventions, blood loss during operation, post-operative complications and pain scores among patients who received either CO2 laser or radiofrequency coblation interventions for laryngotracheal recurrent respiratory papillomatosis. Compared with CO2 laser intervention, radiofrequency coblation significantly reduced operation time, time interval between interventions, blood loss during operation and number of times bipolar electrocoagulation needed in each procedure. Post-operatively, pain scores after radiofrequency coblation were significantly lower than those after CO2 laser intervention. Incidence rates of post-operative complications, in terms of palate pharyngeal mucosa damage, bleeding and subcutaneous emphysema, were also significantly reduced after radiofrequency coblation. Low-temperature radiofrequency coblation is a superior intervention compared with CO2 laser against laryngotracheal recurrent respiratory papillomatosis.

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Bilateral, simultaneous cochlear implantation in children: surgical considerations

The Journal of Laryngology & Otology ◽

10.1017/s0022215109004824 ◽

2009 ◽

Vol 123 (8) ◽

pp. 837-839 ◽

Cited By ~ 10

Author(s):

L Migirov ◽

J Kronenberg

Keyword(s):

Cost Effectiveness ◽

Cochlear Implantation ◽

Clinical Care ◽

Operation Time ◽

Study Cohort ◽

General Anaesthetic ◽

Safe Procedure ◽

Operative Complications ◽

Post Operative Complications

AbstractProblem:The advantages of bilateral, simultaneous cochlear implantation include: the possibility to pre-empt cochlear calcification following meningitis; reduction of the intervention to only one procedure, general anaesthetic and course of clinical care (with obvious benefits for the patient); and greater cost-effectiveness. The disadvantages of such a procedure include: doubling the risk of associated complications; placing the patient on the implanted side during contralateral implantation; the possibility of vestibular alteration simultaneously in both ears; the need for precise planning of symmetrical incisions and implant sites; and longer surgery time.Methods:The study cohort included 10 children who underwent bilateral, simultaneous cochlear implantation using the suprameatal approach.Results:The overall operation time, inclusive of anaesthesia, was approximately three hours in all cases. None of the children had any intra- or post-operative complications.Conclusions:From a surgical perspective, bilateral, simultaneous cochlear implantation is a safe procedure. The use of a non-mastoidectomy approach is recommended.

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

Journal of Orthopaedic Surgery and Research ◽

10.1186/s13018-021-02211-0 ◽

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.

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Effectiveness of Tirobot-assisted Vertebroplasty in Treating Thoracolumbar Osteoporotic Compression Fracture

10.21203/rs.3.rs-118249/v1 ◽

2020 ◽

Author(s):

Boyao Wang ◽

Jiang Cao ◽

Jie Chang ◽

Guoyong Yin ◽

Weihua Cai ◽

...

Keyword(s):

Radiation Exposure ◽

Traditional Approach ◽

Compression Fracture ◽

Cement Leakage ◽

Control Group ◽

Osteoporotic Compression Fracture ◽

Reduce Radiation Exposure ◽

Operative Duration ◽

Operative Complications ◽

Post Operative Complications

Abstract Background: Percutaneous kyphoplasty is the main method for the treatment of thoracolumbar osteoporotic compression fractures. However, much radiation exposure during the operation could harm the health of the surgeon and the patient. In addition, the accuracy of its 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: A total of 60 patients with thoracolumbar osteoporotic compression fracture who underwent unilateral vertebroplasty at our hospital between June 2019 and June 2020 were included in this retrospective cohort study. All of them were between 60 and 90 years old and free of systemic diseases. All the patients 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), pre-operative and pre-discharge indexes (VAS scores, JOA scores, and Cobb’s angles) were compared.Results: The fluoroscopic frequency(P<0.001), post-operative complications(P=0.035) in Tirobot group was significantly lower than those in control group. The operative duration and LOS in Tirobot group were shorter than those in 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 significant differences after surgery in each group (P<0.001), but not between groups (PVAS=0.175, PCobb’s=0.585, PJOA =0.448).Conclusion: As a safe and effective strategy, Tirobot-assisted vertebroplasty can reduce radiation exposure and be clinically replicated.

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The Role of Portable Incisional Negative Pressure Wound Therapy (piNPWT) in Reducing Local Complications of Post-bariatric Brachioplasty: A Case-Control Study

Aesthetic Plastic Surgery ◽

10.1007/s00266-020-02122-1 ◽

2021 ◽

Author(s):

Federico Facchin ◽

Andrea Pagani ◽

Paolo Marchica ◽

Laura Pandis ◽

Carlotta Scarpa ◽

...

Keyword(s):

Wound Healing ◽

Negative Pressure ◽

Negative Pressure Wound Therapy ◽

Body Contouring ◽

Full Description ◽

Wound Therapy ◽

Level Of Evidence ◽

Operative Complications ◽

Post Operative Complications

Abstract Background Due to the great impact of bariatric surgery on the overweight epidemic, the number of post-bariatric body-contouring procedures is constantly increasing worldwide. The portable incisional negative pressure wound therapy (piNPWT) is a promising medical device for accelerating wounds closure and controlling post-operative complication, which have been shown promising results in post-bariatric population. We aimed to evaluate the role of piNPWT in optimizing wound healing and controlling post-operative complications after a post-bariatric brachioplasty. Patients and Methods 26 post-bariatric female patients who underwent a brachioplasty followed by either a piNPWT (14 cases) or a standard wound treatment (12 controls) were analyzed. The number of post-operative dressing changes, the rate of local post-operative complications (re-operation, hematoma and serosa development, dehiscence and necrosis), the time to dry as well as the scar quality and hospitalization length were evaluated. Results None of the patients prematurely stopped treatment with piNPWT due to intolerance. The piNPWT patient group showed a significant lower healing time as well as a significant reduction of the number of post-operative dressing changes and hospital stay. Despite the scarring process was excellent from the functional point of view in the long term, we noticed a higher rate of hyperchromic scarring at 90 days after surgery. Conclusion The piNPWT is a cost-effective and user-friendly medical tool that increase and promote wound healing. We suggest the use of this device in post-bariatric patients who undergo a brachioplasty, especially if there is the need to minimize the number of post-operative dressing changes. Level of Evidence IV This journal requires that authors assign a level of evidence to each article. For a full description of these evidence-based Medicine ratings, please refer to Table of Contents or the online Instructions to Authors www.springer.com/00266.

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