scholarly journals Evaluation of the complications in laparoscopic retroperitoneal radical nephrectomy; An experience of high volume centre

2017 ◽  
Vol 89 (4) ◽  
pp. 266 ◽  
Author(s):  
Ali Serdar Gozen ◽  
Vitalie Gherman ◽  
Yigit Akin ◽  
Mustafa Suat Bolat ◽  
Muhammad Elmussareh ◽  
...  
Keyword(s):  
Learning Curve ◽  
Complication Rate ◽  
Radical Nephrectomy ◽  
High Volume ◽  
Safe Procedure ◽  
Number Of Patients ◽  
Lower Complication ◽  
Lower Complication Rate ◽  
Group A ◽  
Group B

Objectives: To provide a standardised report of complications after retroperitoneal laparoscopic radical nephrectomy (rLRN) in a high-volume centre using Clavien-Dindo classification. Materials and methods: We analysed records maintained in a prospective database of 330 consecutive patients that underwent rLRN between March 1995 and September 2016. All complications were graded according to the modified Clavien-Dindo classification. Three generations of surgeons were defined and the learning curve in rLRN was evaluated by comparing the first 100 cases (Group A) performed by firstgeneration surgeons with the last 100 cases (Group B) by thirdgeneration surgeons. Results: The mean age of our cohort was 66 ± 11.9 years. The overall complication rate was 19.7%. The majority of complications (12.7%) were Clavien 1 (5.1%) and Clavien 2 (7.6%) and did not require any interventions; blood transfusion was the most frequently encountered intervention (4.8%). Half of which were because of major intraoperative bleeding. Mortality rate was 0.9%. We found a trend towards lower complication rate in group B (19%) compared to group A (23%); this was mainly because of the reduction in the incidence of Clavien 1 and 2 complications. The pathological stage varied significantly in the two groups while the rate of negative surgical margins was comparable. Conclusions: rLRN is a safe procedure with an acceptable rate of complications. The learning curve was shorter for the thirdgeneration surgeons (group B); although these surgeons operated on a significantly higher number of patients with more advanced diseases. The Clavien-Dindo classification is suitable for assessing rLRN complications. Adopting this standardised system can help in the evaluation and comparison of surgical quality of LRN series.

Totally laparoscopic pancreaticoduodenectomy: Learning curve.

2012 ◽  
Vol 30 (15_suppl) ◽  
pp. e14717-e14717
Author(s):  
Igor Khatkov ◽  
Viktor Tsvirkun ◽  
Roman Izrailov ◽  
Pavel Tiutiunnik
Keyword(s):  
Blood Loss ◽  
Learning Curve ◽  
Postoperative Morbidity ◽  
Operative Time ◽  
Postoperative Mortality ◽  
Safe Procedure ◽  
Laparoscopic Pancreaticoduodenectomy ◽  
Group A ◽  
Group B ◽  
Totally Laparoscopic

e14717 Background: Laparoscopic pancreaticoduodenectomy (LPDE) has become increasingly popular in the world and now is considered to be a technically feasible and safe procedure for patients with tumors of the head of the pancreas and the periampullare area. At the same time, according to the literature data, a lot of surgeons stop performing totally laparoscopic pancreaticoduodenectomy (TLPDE) after 5 – 15 procedures because of the difficulties of learning curve. Aim of thew study: to evaluate the learning curve of totally laparoscopic pancreaticoduodenectomy. Methods: The data of 43 patients who were planed for LPDE during 5 year were analyzed. All the procedures were performed by one surgical team. 35 patients underwent totally laparoscopic pancreaticoduodenectomy (TLPDE). For 8 patients the procedures were palliative or converted. Patients were divided in three groups. Group A, B and C – 12;12;11 patients respectively. Operative time, intraoperative blood loss and the level of postoperative morbidity were examined. Results: Among the 43 patients, 35 patients underwent TLPDE. The conversion rate was in the group A - 33% (4 patients), group B – 33%(4 patients) and group C – no conversions. Mean operative time of TLPDE for the group A was - 542min; group B – 542min and group C less than 360min, minimally - 280). Mean blood loss was for group A - 683ml, group B – 612ml and group C 250ml. Total level of all kinds of postoperative morbidity was: group A - 66,5%, group B – 65,5% and group C – 36,0%. Postoperative mortality was: group A - 8,3%(one of the patients died from insufficiency of the pancreatojejenostomy, another – because of acute heart failure without any surgical complications); group B – 0% and group C - 0%. Conclusions: The results of TLPDE become significantly better after 25 procedures. The most difficult and potentially dangerous for intra and postoperative complications were: dissection along superior mesenteric and portal vein and suturing of pancreaticojejuno anastomosis. Performing TLPDE by the same team, including nurses, is a very important factor for quick learning curve and safety.

scholarly journals Comparison of Short Term Results of Type IIB2 Middle Third Clavicular Fractures Treated with Figure of Eight Bandage and Locked Plate Fixation

2014 ◽  
Vol 2 (11_suppl3) ◽  
pp. 2325967114S0026
Author(s):  
Melih Malkoc ◽  
Ozgur Korkmaz ◽  
Erhan Bayram ◽  
Ali Seker ◽  
Murat Yılmaz ◽  
...  
Keyword(s):  
Constant Score ◽  
Plate Fixation ◽  
Locked Plate ◽  
Significant Difference ◽  
Lower Complication ◽  
Lower Complication Rate ◽  
Group A ◽  
Student’S T ◽  
Group B

Objectives: Most acute displaced midshaft clavicular fractures conventionally have been treated nonoperatively with the expectation of a high probability of fracture union, good functional outcomes, and a high level of patient satisfaction . However, the outcome of nonoperative treatment is not as favorable as once thought and there has been a growing trend to treat these fractures surgically We aimed to evaluate and compare the short term results of conservative treatment and locked plate fixation in the treatment of type IIB2 clavicula fractures according to Robinson classification in this study. Methods: Thirty eight patients with type IIB2 clavicula fractures according to Robinson classification were retrospectively reviewed. 20 patients who were treated conservatively were enrolled as group A and 18 patients who were operated with locked plate and screws were enrolled as group B. All patients were evaluated with Constant and Oxford scores in their last follow up control. For the patients that were treated conservatively (Group A) figure of eight bandage were applied for six week. Patients (Group B) were operated under general anesthesia in the beach chair position. A straight incision was made over the fracture line. Butterfly or free fragments in comminuted fractures were fixed to the main fragment with a lag screw in 3 patients before fracture reduction and plate fixation. Fracture reduction was performed with taking care of minimal periosteal stripping. After reduction of the main fragments, titanium alloy, locked anatomic compression plate were applied on the superior surface of the clavicle. A minimum of six cortexes were fixed with 3.5 mm locked cortical screws on the medial and lateral sides of the fracture. We did not need any Auto- or allografts during the surgery. Statistical analysis was performed between the scores of two groups. Conservative and surgical treated groups Oxford scores and Constant scores had normal distribution. For this reason Student's t test, and Non-parametric version of Student’s t test Mann Whitney U test were performed. 95% confidence interval and p <0.05 was considered significant as statistically. Results: Mean follow up period is 18 months (12-24 months). At the last follow-up, mean Constant score is 79.5 (98-43) and mean Oxford score was 46.35(49-44) for group A. In group B mean Constant score is 89.3(100-77) and mean Oxford score is 46,6(48-44) at the last follow-up. There were no patients who require any revision surgery in group B. Bone healing was detected in all fractures radiologically in both groups. There was no statistically significant difference between Oxford scores of the two groups (p=0,570). There was statistically significant difference between Constant scores of the two groups whereas results of Group B were better than group A (p=0,013) Surgical treatment with locked plate fixation in type IIB2 clavicle fractures according to Robinson Classification, can be the first treatment choice with better cosmetics, lower complication rate, and better outcomes. Conclusion: Surgical treatment with locked plate fixation in type IIB2 clavicle fractures according to Robinson Classification, can be the first treatment choice with better cosmetics, lower complication rate, and better outcomes.

scholarly journals How I do it—the posterior question mark incision for decompressive hemicraniectomy

2021 ◽  
Vol 163 (5) ◽  
pp. 1447-1450
Author(s):  
Michael Veldeman ◽  
Mathias Geiger ◽  
Hans Clusmann
Keyword(s):  
Complication Rate ◽  
Question Mark ◽  
Decompressive Hemicraniectomy ◽  
Skull Reconstruction ◽  
Number Of Patients ◽  
Lower Complication ◽  
Lower Complication Rate

Abstract Background Decompressive hemicraniectomy (DHC) is a lifesaving procedure which every neurosurgeon should master early on. As indications for the procedure are growing, the number of patients eventually requiring skull reconstruction via cranioplasty also increases. The posterior question mark incision is a straightforward alternative to the classic trauma-flap and can easily be adopted. Some particularities exist one should consider beforehand and are discussed here in detail. Methods Surgical steps, aids, and pitfalls are comprehensively discussed to prepare surgeons who wish to gain experience with this type of incision. Conclusion Due to the lower complication rate after cranioplasty, the posterior question mark incision has superseded the traditional pre-auricular starting anterior question mark incisions, in our department for the performance of decompressive hemicraniectomies.

PREDICTABILITY OF RENAL NEPHROMETRY SCORING IN DETERMINING TYPE OF SURGICAL APPROACH IN THE TREATMENT OF LOCALIZED RENAL TUMOURS : A SINGLE TERTIARY CENTER EXPERIENCE.

2021 ◽  
pp. 36-38
Author(s):  
Jitendra Kumar Barad ◽  
Raghuveer Pedamallu ◽  
Rahul Devraj ◽  
Ram Reddy. Ch
Keyword(s):  
Partial Nephrectomy ◽  
Renal Cell ◽  
Radical Nephrectomy ◽  
Individual Component ◽  
Scoring Systems ◽  
Nephrometry Score ◽  
Renal Tumours ◽  
Group A ◽  
Group B ◽  
Component Scores

Background: Partial nephrectomy became more preferred option in the treatment of localized small renal tumours due to recent advances in imaging modalities and surgical techniques. Renal scoring systems are known to compliment urologist in aiding surgical decision process on extent of surgery in small localized renal tumours. There are few scoring systems described in the literature with their own limitations. Methods: This is a retrospective study of patients with localized renal cell tumours who underwent nephrectomy at Nizam Institute of Medical Sciences (NIMS), Hyderabad fromJanuary 2017 to January 2019. Patients with advanced renal cell cancer disease at presentation were excluded. Total RENAL nephrometry Score (RNS), its individual component scores and complexity category were calculated based on CT report. The study cases were categorized into Group A (Partial Nephrectomy) and as Group B (Radical Nephrectomy). Mean and standard deviation value of the RENAL nephrometry scores and its component scores were calculated for each group. Statistical signicance was calculated using unpaired T-test, using SPSS statistics 21.0 software. Results: The mean age for all patients included in this study is 52.1 years. Out of 80 patients, 32 patients had partial nephrectomy (Group A) and 48 patients had radical nephrectomy (Group B). Based on RENAL nephrometry score complexity, Group A and Group B were further categorized into low, intermediate and high complexity score categories. The total RENAL score, individual component scores and RENAL score complexity were found to be signicantly different between the two group in addition to the tumor size. No statistical signicance was found between the two groups for age and type of tumour on histopathology (benign or malignant). Conclusion: We conclude that preoperative RENAL nephrometry scoring is a useful aid to surgeons to classify the renal tumour complexity before deciding on effective surgical strategy for better patient outcomes

Risk of Damaging Anatomical Structures During Minimally Invasive Hallux Valgus Correction (Bösch Technique): An Anatomical Study

2018 ◽  
Vol 39 (11) ◽  
pp. 1355-1359 ◽  
Author(s):  
Martin Kaipel ◽  
Lukas Reissig ◽  
Lukas Albrecht ◽  
Stefan Quadlbauer ◽  
Joachim Klikovics ◽  
...  
Keyword(s):  
Minimally Invasive ◽  
Hallux Valgus ◽  
Complication Rate ◽  
Metatarsal Osteotomy ◽  
Anatomical Structures ◽  
Intensive Training ◽  
Increased Risk ◽  
Significant Difference ◽  
Group A ◽  
Group B

Background: Percutaneous, transverse distal metatarsal osteotomy with K-wire fixation (the Bösch technique) is an established technique for hallux valgus correction. Nevertheless, the risk of damaging the anatomical structures during the operation is unknown. Methods: Forty fresh-frozen anatomical foot specimens with hallux valgus deformity underwent a percutaneous corrective procedure. Specimens of group A (n = 20) were operated by an experienced surgeon while specimens of group B (n = 20) were done by untrained residents. Results: The dorsal cutaneous nerve was injured in 1 of 20 cases in group A and 6 of 20 cases in group B ( P = .037). There was a significant difference in overall complication rate between specimens of group A and group B ( P = .043). Conclusions: The results show an increased risk of perioperative injury of the dorsal cutaneous branch of the deep peroneal nerve as well as a significant effect of the surgeon’s experience on the overall complication rate. Clinical Relevance: Results of this study are highly relevant for all surgeons who perform percutaneous, minimally invasive hallux valgus surgery to avoid damage to the peripheral nerves. In addition, the data suggest an intensive training for surgeons before minimally invasive hallux valgus surgery is performed without supervision.

scholarly journals Prophylactic corneal cross-linking in LASIK surgery: effects on visual outcome and recovery time

2020 ◽  
Vol 17 (1) ◽  
pp. 61-68
Author(s):  
Dominique Clare Oh ◽  
Yiong Huak Chan ◽  
Sao Bing Lee ◽  
Jovina Li Shuen See
Keyword(s):  
Visual Acuity ◽  
Side Effects ◽  
Recovery Time ◽  
Visual Outcome ◽  
Cross Linking ◽  
Safe Procedure ◽  
Distance Visual Acuity ◽  
Visual Outcomes ◽  
Group A ◽  
Group B

Introduction: Collagen cross-linking is a useful adjunct in preventing corneal ectasia after laser-assisted in situ keratomileusis (LASIK). This study aimed to evaluate whether prophylactic cross-linking in IntraLase LASIK affects optimum visual outcome and recovery time in the immediate post-surgery period and is associated with any side effects. Methods: This was a retrospective case study on the right eyes of 100 Chinese subjects aged 18 to 40 years who underwent IntraLase LASIK. Fifty subjects who underwentcross-linking after completing LASIK (Group A) were compared with 50 subjects who did not undergo LASIK (Group B). Cases were evaluated for pre- and post-operative spherical equivalent, uncorrected distance visual acuity (UDVA) and corrected distance visual acuity (CDVA), recovery time and presence of side effects. Results: At 1 week post-LASIK, mean (SD) UDVA of Group A subjects was poorer than Group B, at 1.05 (0.19) vs 1.17 (0.19) (p = 0.036); however, there was no significant difference in CDVA (p = 0.095). By 1 month post-LASIK, differences in both UDVA and CDVA were insignificant (p = 0.055, 0.106, respectively). Mean recovery time was 2.72 (95% confidence interval [CI] = 0.64-4.7) days longer in Group A (p = 0.010), although by 1 month post-LASIK, both groups were able to achieve CDVA equal to or better than that achieved pre-LASIK. Incidence of mild inflammation and dry eyes post-LASIK was similar in both groups (p = 1.00, 0.749, respectively); no other complications were observed. Conclusion: No differences in visual outcomes at and occurrence of side effects at 1 month post-LASIK were observed between subjects who underwent cross-linking prior to refractive surgery and those who did not. However, the group that underwent cross-linking had a slightly longer mean recovery time. Our study supports prophylactic cross-linking as a safe procedure that does not affect immediate visual outcomes among the Chinese population when used in adjunct with LASIK surgery.

scholarly journals INTRAVENOUS REGIONAL ANESTHESIA (BIERS BLOCK);

2012 ◽  
Vol 19 (05) ◽  
pp. 710-714
Author(s):  
Muhammad ASGHER ◽  
ASIM GHAURI ◽  
MUHAMMAD ABDULLAH ◽  
Tariq Abassi
Keyword(s):  
Regional Anaesthesia ◽  
Military Hospital ◽  
P Value ◽  
Complete Evaluation ◽  
Intravenous Regional Anesthesia ◽  
Number Of Patients ◽  
Group A ◽  
The Mean ◽  
Group B ◽  
Intravenous Regional Anaesthesia

Objective: To compare the analgesic effects of combination of 0.5% Lidocaine plus Ketorolac in intravenous regionalanaesthesia technique with those of Lidocaine (0.5%) alone to prevent post operative pain after intravenous regional anaesthesia (Biersblock). Study design: Randomized Control Trial. Place and duration of study: The study was carried out at Department of Anaesthesiology,Intensive Care and pain management, Combined Military hospital, Rawalpindi from July 2008 to February 2009. Patients and Methods: Thestudy was conducted after complete evaluation of risk / benefit ratio to the patients. On the basis of random number method the patients weredivided into two equal groups (group A and group B). The number of patients in each group was 75. Group A was assigned Lidocaine in a dose of200mg 40ml of 0.5% solution and group B was assigned injection Ketorolac 30mg added to Lidocaine in a dose of 200mg 40ml of 0.5% solution.The patients were kept in post anaesthesia care unit for two hours and pain intensity was measured by visual analogue scale(VAS) on 15,30minutes,1hour, 1.5 and at 2 hours after the cuff deflation. The analgesic efficacy recorded on the basis of visual analog scale of two groups, wascompared using student’s t - test. p value of less than 0.05 was considered statistically significant. Results: In group A 33 males and 42 femaleswere enrolled for the study while in group B there were 38 males and 37 females. The mean age of the patients in group A was 34.31 ± 6.03years while in group B was 32.99 ± 6.08 years. Patients were also classified according to ASA classification in which 87 patients were classifiedas ASA – I and 63 patients as ASA – II. Group B which received Ketorolac in addition to Lidocaine for Bier’s block had low visual analogue scoresas compared to group A which received only Lidocaine for Bier’s block. P values obtained after the comparison of the mean VAS of two groupsat 15 minutes, 30 minutes, 1 hour, 1.5 hours and 2 hours were all less than 0.05 (0.002 for 15 minutes, 0.004 for 30 minutes, 0.001 for 1 hour,0.004 for 1.5 hours and 0.001 for 2 hours). Conclusions: Ketorolac improves the postoperative analgesia markedly when used with Lidocainein intravenous regional anaesthesia.

Energy-Based Devices Affect the Aesthetic Outcome of Cervical Thyroidectomy and Parathyroidectomy. A Retrospective Study

2021 ◽  
Vol 39 ◽  
Author(s):  
Antonella Pino ◽  
◽  
Lorenzo Gasco ◽  
Daqi Zhang ◽  
Paolo Carcoforo ◽  
...  
Keyword(s):  
Body Dysmorphic Disorder ◽  
The Body ◽  
University Hospital ◽  
Aesthetic Outcome ◽  
Aesthetic Result ◽  
Scar Assessment ◽  
Number Of Patients ◽  
Group A ◽  
Group B ◽  
The Impact

Introduction: Thyroid and parathyroid diseases are very common. Most of these cases are in women and may be amenable to surgery. The patient’s perception that these are not life-threatening diseases leads them to expect an excellent aesthetic result, since the surgical incision area is clearly visible. Objective: To evaluate different scarring outcomes using three different energy-based devices (Harmonic Focus®, Johnson & Johnson, New Brunswick, NJ; Thunderbeat Open Fine Jaw®, Olympus Medical, Tokyo, Japan; LigaSure Small Jaw®, Medtronic, Dublin, Ireland) and to determine the impact of post-thyroidectomy/parathyroidectomy scars on the patient’s quality of life. Methods: One hundred female patients who underwent thyroidectomy or parathyroidectomy between September 2017 and September 2019 at the Endocrine and Minimally Invasive Surgery Department of Messina University Hospital were recruited. A retrospective analysis assessed the thickness of the cervical scar via ultrasound imaging, and the patient’s degree of satisfaction through the Patient and Observer Scar Assessment Scale (POSAS) and the Body Dysmorphic Disorder Questionnaire (BDDQ). Results: The patients were divided into three groups according to the energy-device used: group A (LigaSure SJ (n=38), group B (Harmonic F, n=32) and group C (Thunderbeat OFJ, n=30). The three groups were homogeneous with respect to number of patients, age and surgical procedures. The best aesthetic result, which correlated with the lowest scar thickness, was observed in group A; these patients were more satisfied than those in the other two groups. Moreover, correlations between scar thickness and quantitative variables (such as age or BMI) were not found in any of the groups. Conclusions: Based on the data collected and our experience, the LigaSure Small Jaw® (Medtronic) seems to offer the best aesthetic outcome in patients who undergo transverse cervicotomy for thyroid and parathyroid diseases. However, further prospective studies involving a greater number of cases are needed.

scholarly journals A comparative study between dexmedetomidine and dexamethasone as an intrathecal adjuvant for prevention of perioperative shivering in cesarean section

2020 ◽  
Vol 12 (1) ◽  
Author(s):  
Mohamed Abdul Mohsen Abdul Naiem Ismaiel ◽  
Omar Mohamed Taha El Safty ◽  
Ashraf El Sayed El-Agamy ◽  
Omar Mohamed Zafer Mohamed ◽  
Mohamed Mourad Mohsen Mohamed Ali
Keyword(s):  
Cesarean Section ◽  
Statistical Difference ◽  
Sensory Block ◽  
List Type ◽  
Hyperbaric Bupivacaine ◽  
Analgesic Requirement ◽  
Number Of Patients ◽  
Duration Of Surgery ◽  
Group A ◽  
Group B

Abstract Background One of the most common problems in parturients receiving regional anesthesia during cesarean section is shivering. It usually interferes with the readings of the oxygen plethysmography (SpO2) and electrocardiogram (ECG). It expands the needs for oxygen and increases creation of carbon dioxide about four folds. The aim of this work is to compare the efficacy of dexamethasone and dexmedetomidine in prevention of perioperative shivering when added to hyperbaric bupivacaine intrathecally in cesarean sections (CS) and their effect on the intraoperative hemodynamics, intensity of the block, sedation, and postoperative analgesic requirement. Results Study included 60 obstetric patients who fulfilled all the inclusion criteria and were randomized into 2 equal groups, each consisting of 30 patients, namely group A (dexmedetomidine group) and B (dexamethasone group). Group A patients received 5 μg dexmedetomidine with 12.5 mg hyperbaric bupivacaine 0.5% intrathecally. Group B patients received 8 mg dexamethasone then 12.5 mg hyperbaric bupivacaine 0.5% intrathecally. The comparison included assessment of intra- and postoperative hemodynamics, duration of surgery, assessment of sensory and motor block, assessment for shivering and sedation, and assessment of adverse events. This study showed that there were a small number of patients complaining of shivering (five patients in group A and seven patients in group B) with no statistical difference between both groups in the incidence and intensity of shivering. Time to two segment regression (minutes) was longer in group B compared to group A, and also, time to first analgesic rescue was longer in group B compared to group A. For sedation intensity, there was statistical difference between both groups as all patients in group A were sedated compared to six patients only in group B. There was no statistical difference between both groups as regards incidence of adverse effects. Conclusion We concluded that both drugs can be added safely to bupivacaine, and both dexmedetomidine and dexamethasone decreased the incidence and the intensity of shivering. Dexamethasone was found to prolong the duration of sensory block and delay opioid requirements post-operatively, while dexmedetomidine is more effective in sedating the patients intra- and postoperatively.

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