scholarly journals Evaluation of per-operative cough stress test during transobturator mid-urethral sling surgery

2017 ◽  
Vol 89 (3) ◽  
pp. 222 ◽  
Author(s):  
Abdulmuttalip Simsek ◽  
Sinan Levent Kirecci ◽  
Goksel Bayar ◽  
Kaya Horasanli ◽  
Faruk Ozgor ◽  
...  
Keyword(s):  
Stress Test ◽  
Test Group ◽  
Operation Time ◽  
Transobturator Tape ◽  
Patient Characteristics ◽  
Complication Rates ◽  
Time Duration ◽  
Voiding Difficulty ◽  
Cough Test ◽  
Cough Stress Test

Purpose: Currently, it is unclear how the mesh tension should be adjusted on the transobturator tape surgery (TOT) for improving continence. The aim of this study was to evaluate the effects of per-operative cough stress test on TOT. Materials and methods: Between March 2007 and December 2011, 206 women with SUI were enrolled in this study. Patients were randomly categorized to treatment with TOT (96) or TOT with cough stress test (110). The IIQ-7 and the UDI-6 were used to identify satisfaction level. At the end of 1st year, two groups were compared patient characteristics, operation time, duration of hospital stay, cure and complication rates. Results: The cure rate was 84.37% 81/96) versus 83.63% (92/110) in TOT and TOT with cough test groups, respectively. Postoperatively ten patient (10/110, 9.09%) suffered voiding difficulties (> 250 ml residual urine) in TOT with cough stress test group. Five patients were discharged with transurethral catheter, whereas, in traditional TOT group, two patients (2/96, 2.1%) had transient postoperative voiding difficulty and two patients were treated with repeated catheterization for 1 week (p < 0.05). Postoperative groin pain was present in 7/96 (8%) versus 24/110 (22%) in TOT and TOT with cough test groups, respectively (p < 0.05). TOT with cough stress test group had an higher rate of complications like, retention of urine, necessitating to cut the tape, mesh erosion and pain in groin or leg. No patient had resistant voiding difficulty or prolonged urinary retention (> 1 week) in traditional TOT group. Conclusions: We believe that per-operative cough stress test leads to overtreatment of stress urinary incontinence when the complication rates were considered.

scholarly journals Surgical Outcomes of LigaSure Hemorrhoidectomy in the Elderly Population: A retrospective cohort study

2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Chuang-Wei Chen ◽  
Tzung-Ju Lu ◽  
Koung-Hung Hsiao
Keyword(s):  
Cohort Study ◽  
Postoperative Complications ◽  
Surgical Outcomes ◽  
Multivariate Logistic Regression Analysis ◽  
Operation Time ◽  
Admission Rate ◽  
Complication Rates ◽  
Time Duration ◽  
Significant Difference ◽  
Prone Jackknife Position

Abstract Background This study aims to assess the association between age and outcomes in patients undergoing hemorrhoidectomy. Methods This is a population-based cohort study. A retrospectively collected database with consecutive patients whose symptomatic prolapsed hemorrhoids managed by the LigaSure hemorrhoidectomy between Jan. 2015 and May 2017 was reviewed. Among 1238 patients, 1075 were under 65 years old (group 1), and 163 were 65 years old or older (group 2). Both groups were compared regarding baseline characteristics and surgical outcomes. Results All patients tolerated the whole course of the operation in the prone jackknife position without anesthetic-associated complications. There was no significant difference between these two groups regarding sex, hemorrhoids grade, operation time, duration of hospital stays, postoperative pain score, analgesic consumption, total postoperative complications, re-admission rate, reoperation rate and follow-up times. The multivariate logistic regression analysis that may contribute to postoperative complications revealed no significant difference for all complications between both groups. Conclusion The LigaSure hemorrhoidectomy for elderly patients is safe and effective without significant difference in short-term operative outcomes and all complication rates, compared with younger patients.

scholarly journals Versatility and clinical effectiveness of a synthetic sealing hemostatic patch as alternative to parenchyma suturing in laparoscopic partial nephrectomy

2021 ◽  
Author(s):  
Eva Erne ◽  
Stephan Kruck ◽  
Tilman Todenhoefer ◽  
Stefan Aufderklamm ◽  
Bastian Amend ◽  
...  
Keyword(s):  
Partial Nephrectomy ◽  
Surgical Margin ◽  
Operation Time ◽  
Clinical Effectiveness ◽  
Patient Characteristics ◽  
Suture Technique ◽  
Laparoscopic Partial Nephrectomy ◽  
Complication Rates ◽  
Oxidized Cellulose ◽  
Hepatic Surgery

Abstract Background Improvements in laparoscopic partial nephrectomy (LPN) in order to minimize perioperative warm ischemia time (WIT), complications, and consequently patient outcome are desirable. Veriset™ is a ready-to-use hemostatic patch of absorbable oxidized cellulose and hydrogel components that has earlier been implemented in vascular and hepatic surgery. We report our experience using this device in LPN. Methods Patients with a solitary malignant renal mass suspicious for renal cancer underwent LPN with either the use of Veriset™ hemostatic patch (n = 40) or conventional suture technique (n = 40). Patient characteristics, operation time and WIT, postoperative course and complications were recorded retrospectively. Tumor complexity was calculated according to the R.E.N.A.L. score. Outcome was determined according to the “trifecta” criteria (negative surgical margin, WIT < 25 min, no complications within 30 days). Results No significant differences with regard to clinical parameters and median R.E.N.A.L. score (6) were observed between both groups. Operation time (mean 127.1 min vs. 162. 8 min; p = 0.001) and WIT were both lower in the Veriset™ group (14.6 min vs. 20.6 min; p = 0.01). No differences in surgical margins (p = 0.602) and overall complication rates at 30 (p = 0.599) and 90 days (p = 0.611) postoperatively were noticed. The surgical outcome according to “trifecta” was achieved in 65% of patients using Veriset™ and in 57.5% of patients by suture closure, respectively. Conclusion The hemostatic Veriset™ patch can successfully be implemented in LPN. Handling and application appear favorable, thereby reducing operation time and WIT. The present results suggest that the device may represent an alternative to parenchyma suturing in LPN.

scholarly journals Learning curve of trainees performing laparoscopic appendectomy- a register-based study

2021 ◽  
Author(s):  
Nathalie Young ◽  
Lennart Boström ◽  
Gabriel Sandblom ◽  
Hans Järnbert Pettersson
Keyword(s):  
Learning Curve ◽  
Complication Rate ◽  
Moving Average ◽  
Operation Time ◽  
Patient Characteristics ◽  
First Year ◽  
Complication Rates ◽  
Surgical Trainees ◽  
Trainee Surgeon ◽  
Training Programmes

Abstract Background Appendectomy is one of the first procedures that surgical trainees are expected to manage alone. The purpose of this study was to analyse the learning curve of a cohort of surgical trainees and to explore the association between trainee surgeon volume and complication rate. Method The study was based on a cohort extracted from the local appendectomy register at Södersjukhuset (transl. South Hospital), Stockholm. The register includes patient characteristics, surgical method, operation time, and 30-day complications. First-year surgical trainees attending the hospital’s trainee programme were included and followed over five years of training. Trainees who had performed less than ten procedures during the period of the study were excluded. The learning curve was described using moving average of order ten for each trainee, studying the trend in operation time with increasing volume. The cumulative sum technique was used to chart changes in complication rates of the trainees. Results 586 procedures performed by 9 surgical trainees were included, of which 97.6% were performed laparoscopically. A plateau in operation time on the learning curve was reached at 60 procedures. For three of the trainees, the 30-day complication rate decreased after completing the learning curve, whereas for two others it increased. In a multivariate analysis, operation times differed more between the trainees than it did between procedures performed early or late in the programme. Shortest versus longest mean operation time (41 min versus 89 min). Conclusion At least 60 procedures are required to reach sufficient proficiency in appendectomy. This highlights the importance of meticulous selection of surgical trainees, structure of training programmes, feedback, and assessment.

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 An Indigenous Method of Securing Ventriculoperitoneal Shunt Tube in Peritoneal Cavity

2021 ◽  
Author(s):  
Samir Kumar Kalra ◽  
Krishna Shah ◽  
Sneyhil Tyagi ◽  
Suviraj John ◽  
Rajesh Acharya
Keyword(s):  
Ventriculoperitoneal Shunt ◽  
Operation Time ◽  
Complication Rates ◽  
Effective Technique ◽  
Common Procedure ◽  
Shunt System ◽  
Shunt Tube ◽  
Csf Diversion ◽  
Median Operation Time

Abstract Introduction Ventriculoperitoneal shunt (VPS) is the most common procedure used for cerebrospinal fluid (CSF) diversion in hydrocephalus. Over the years, many technical, procedural, and instrument-related advancements have taken place which have reduced the associated complication rates. Shunt block is a very common complication irrespective of the shunt system used. The abdominal end of the shunt tube gets blocked usually due to plugging of omentum onto the shunt catheter. We describe a technique of catheter fixation and placement under vision coupled with omentopexy done laparoscopically to prevent this complication. Materials and Methods This technique was used in 23 patients (11 female, 12 male; range 16–73 years) afflicted with hydrocephalus from June 2016 and December 2019 after obtaining an informed consent, and the outcomes were noted in terms of shunt patency, complications, if any, and the need for revision. Results The median operation time was 90 minutes (range 35–160 minutes). All shunt catheters were still functional after a mean follow-up of 16.5 months (range 1–34 months) and none required revision. Conclusion Laparoscopic placement of shunt tube along with omental folding is a safe and effective technique for salvaging the abdominal end of VPS and may be helpful in reducing shunt blockage.

scholarly journals Effect of wrist dorsiflexion on ultrasound-guided radial artery catheterisation using dynamic needle tip positioning technique in adult patients: a randomised controlled clinical trial

2021 ◽  
pp. emermed-2020-209504
Author(s):  
Qingyu Xiao ◽  
Dejiang Xu ◽  
Shaohui Zhuang
Keyword(s):  
Success Rate ◽  
Radial Artery ◽  
Adult Patients ◽  
Controlled Clinical Trial ◽  
Complication Rates ◽  
Success Rates ◽  
Time Duration ◽  
Positioning Technique ◽  
Randomised Controlled ◽  
Group D

BackgroundIt is generally recommended to keep the wrist joint mildly dorsiflexed during radial artery catheterisation. However, wrist dorsiflexion might decrease the success rate of radial artery catheterisation with dynamic needle tip positioning technique. Therefore, we assessed the success rates of two groups with or without wrist dorsiflexion by 5 cm wrist elevation in adult patients.MethodsThis randomised controlled clinical trial was performed between March and December 2018 in the First Affiliated Hospital of Shantou University Medical College, China. We recruited 120 adult patients undergoing major surgical procedures and randomly allocated them into two groups: dorsiflexion group (group D) and neutral group (group N). The primary outcome was first-attempt success rates of two groups. Secondary outcomes were overall success rates within 5 min; numbers of insertion and cannulation attempts; overall catheterisation time; duration of localisation, insertion and cannulation; and complication rates of catheterisation.ResultsFirst-attempt success rate was 88.3% in group D and 81.7% in group N (p=0.444). The overall success rate within 5 min was 93.3% in group D compared with 90.0% in group N (p=0.743). Numbers of insertion and cannulation attempts, overall catheterisation time, duration of localisation and insertion, and complication rates did not show a significant difference between the two groups. Cannulation time was longer in group N (35.68 s) than that in group D (26.19 s; p<0.05).ConclusionWrist dorsiflexion may not be a necessity for ultrasound-guided radial artery catheterisation using dynamic needle tip positioning technique in adult patients.Trial registration numberChiCTR1800015262.

scholarly journals A machine learning-based predictor for the identification of the recurrence of patients with gastric cancer after operation

2021 ◽  
Vol 11 (1) ◽  
Author(s):  
Chengmao Zhou ◽  
Junhong Hu ◽  
Ying Wang ◽  
Mu-Huo Ji ◽  
Jianhua Tong ◽  
...  
Keyword(s):  
Machine Learning ◽  
Gastric Cancer ◽  
Learning Algorithms ◽  
Test Group ◽  
Operation Time ◽  
Predictive Performance ◽  
Original Data ◽  
Postoperative Recurrence ◽  
Machine Learning Algorithms ◽  
Gastric Cancer Patients

AbstractTo explore the predictive performance of machine learning on the recurrence of patients with gastric cancer after the operation. The available data is divided into two parts. In particular, the first part is used as a training set (such as 80% of the original data), and the second part is used as a test set (the remaining 20% of the data). And we use fivefold cross-validation. The weight of recurrence factors shows the top four factors are BMI, Operation time, WGT and age in order. In training group:among the 5 machine learning models, the accuracy of gbm was 0.891, followed by gbm algorithm was 0.876; The AUC values of the five machine learning algorithms are from high to low as forest (0.962), gbm (0.922), GradientBoosting (0.898), DecisionTree (0.790) and Logistic (0.748). And the precision of the forest is the highest 0.957, followed by the GradientBoosting algorithm (0.878). At the same time, in the test group is as follows: the highest accuracy of Logistic was 0.801, followed by forest algorithm and gbm; the AUC values of the five algorithms are forest (0.795), GradientBoosting (0.774), DecisionTree (0.773), Logistic (0.771) and gbm (0.771), from high to low. Among the five machine learning algorithms, the highest precision rate of Logistic is 1.000, followed by the gbm (0.487). Machine learning can predict the recurrence of gastric cancer patients after an operation. Besides, the first four factors affecting postoperative recurrence of gastric cancer were BMI, Operation time, WGT and age.

Morbidity and mortality of pelvic exenteration for cervical cancer at a German referral center.

2021 ◽  
Vol 39 (15_suppl) ◽  
pp. e17505-e17505
Author(s):  
Jelena Boekhoff ◽  
Luisa terGlane ◽  
Uwe Wagner ◽  
Axel Hegele
Keyword(s):  
Cervical Cancer ◽  
Overall Survival ◽  
Pelvic Exenteration ◽  
Survival Rates ◽  
Operation Time ◽  
Previous Treatment ◽  
University Hospital ◽  
Treatment Modalities ◽  
Complication Rates ◽  
Recurrent Cervical Cancer

e17505 Background: The purpose of this study was to evaluate data regarding the outcome of pelvic exenteration (PE) when performed for advanced or recurring cervical cancer. Methods: A total of 24 patients underwent PE for cervical cancer at the University Hospital Marburg between 2011 and 2016. Their data were retrospectively assessed and statistically analyzed. Survival was evaluated using the Kaplan-Meyer method. Results: Mean age was 52.2 years (29.7 to 72.6 years), mean BMI was 23.4 kg/m2. Most common indication was squamous cell carcinoma, whereas 3 patients underwent PE for adenocarcinoma. The majority of the tumors (62.5%) were stage pT4. Negative margins could be achieved in 70.8%. Lymph nodes could be assessed in 55% and were tumor-afflicted in 20.8%. 45.8% were treated for recurrent cancer; median recurrence free time between previous treatment and PE was 16 months. Up-front PE was performed in 20.8%. Another 79.2% received treatment prior to PE: 20.8% received all 3 treatment modalities whereas 37.5% had two treatments before (29.2% underwent chemo- and radiotherapy, 8.3% had surgery and radiotherapy) and 20.8% underwent one type of treatment. Anterior PE (APE) and total PE (TPE) were performed in 62.5% and 37.5%, respectively. Median operation time was 324min. Blood products were administered perioperatively in 75%; 37.5% needed 2 or more. Median hospital stay was 25 days. Major complications (Clavien Dindo≥3) were observed in 41.7% and 16.7% had no complications. Overall Survival (OS) was 29.2%; median overall survival was 19.1 months. 2- and 3-year survival rates for curative PE were 50% and 35% respectively. 4 patients underwent PE with palliative intent. Overall survival correlated significantly with R1- (p = 0.012), N1- (p = 0.047) and M1-status p < 0.01), TPE (p = 0.034) and surgical time > 6 h (p = 0.003). Conclusions: In cases of advanced or recurrent cervical cancer gynecologists struggle to find suitable therapeutic options, especially since most patients have already received radio- and/or chemotherapy. PE is a valid option for selected patients that may represent a cure with tolerable complication rates.

scholarly journals Do we have a limit for retrograde intrarenal surgery for solitary kidney stone?

2021 ◽  
Vol 93 (3) ◽  
pp. 318-322
Author(s):  
Bulent Kati ◽  
Eyyup Sabri Pelit ◽  
Mehmet Demir ◽  
Ismail Yagmur ◽  
Adem Tuncekin ◽  
...  
Keyword(s):  
Kidney Stone ◽  
Surgical Complication ◽  
Operation Time ◽  
Patient Characteristics ◽  
Solitary Kidney ◽  
Retrograde Intrarenal Surgery ◽  
Stone Size ◽  
Operation Duration ◽  
The Mean ◽  
Duration Of Operation

Objective: The management of urolithiasis in patients with a solitary kidney is challenging for urologists. This study aimed to evaluate the safety of retrograde intrarenal surgery (RIRS) in the treatment of stones in patients with solitary kidney and to reply to the question if there is any limit for this surgery. Methods: Between January 2016 and December 2019, we enrolled 52 patients who had a solitary kidney and underwent RIRS. We collected data on preoperative patient characteristics, stone dimensions, and postoperative outcomes. Stone size, duration of operation, duration of fluoroscopy, type of anesthesia, and degree of surgical complication were evaluated retrospectively. Surgeries performed in less and more than 60 minutes and with and without complications were compared. Results: A total of 52 patients with a kidney stone and a solitary kidney were evaluated. The mean stone size was 14 ± 0.4 cm and surgical success rate was 87.3%. In our study, 13 patients (24.5%) had grade 1 minor complications, and none required a blood transfusion. The mean operation time was 51.9 ± 17.3 minutes. The postoperative creatinine value increased in 6 patients. The duration of operation in the group with complications was significantly higher than that in the group without complications. In patients who underwent an operation lasting ≥ 60 minutes, stone size, fluoroscopy time, and complication rate were significantly higher than in patients who underwent an operation lasting ≤ 60 minutes. Conclusion: Our opinion is to be careful in patients with a solitary kidney with a big stone and we recommend assigning these procedure to experienced hands for not exceeding 60 minutes in one session.

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