scholarly journals Increase in Cesarean Operative Time Following Institution of the 80-Hour Workweek

2015 ◽  
Vol 7 (3) ◽  
pp. 369-375 ◽  
Author(s):  
Michael P. Smrtka ◽  
Ravindu P. Gunatilake ◽  
Benjamin Harris ◽  
Miao Yu ◽  
Lan Lan ◽  
...  
Keyword(s):  
Cesarean Delivery ◽  
Operative Time ◽  
Resident Training ◽  
University Hospital ◽  
Skin Closure ◽  
Delivery Time ◽  
Total Operative Time ◽  
Duty Hours ◽  
Estimated Blood Loss ◽  
Time Required

ABSTRACT Background  In 2003, the Accreditation Council for Graduate Medical Education limited resident duty hours to 80 hours per week. More than a decade later, the effect of the limits on resident clinical competence is not fully understood. Objective  We sought to assess the effect of duty hour restrictions on resident performance of an uncomplicated cesarean delivery. Methods  We reviewed unlabored primary cesarean deliveries at Duke University Hospital after 34 weeks gestation, between 2003 and 2011. Descriptive statistics and linear regression were used to compare total operative time with incision to delivery time as a function of years since institution of the 80-hour workweek. Resident training level, subject body mass index, estimated blood loss, and skin closure method were controlled for in the regression model. Results  We identified 444 deliveries that met study criteria. The mean (SD) total operative time in 2003–2004 was 43.3 (14.3) minutes and 59.6 (10.7) minutes in 2010–2011 (P < .001). Multivariable regression demonstrated an increase in total operative time of 1.9 min/y (P < .001) but no change in incision to delivery time (P = .05). The magnitude of increased operative time was seen among junior residents (2.0 min/y, P < .001) compared to that of senior residents (1.2 min/y, P = .06). Conclusions  Since introduction of the 2003 duty hour limits, there has been an increase of nearly 20 minutes in the time required for a routine cesarean delivery. It is unclear if the findings are due to a change in residency duty hours or to another aspect of residency training.

scholarly journals Canada’s First Robotic Assisted Totally Intracorporeal Orthotopic Ileal Neobladder

2013 ◽  
Vol 7 (7-8) ◽  
pp. 537 ◽  
Author(s):  
Richard L. Haddad ◽  
Patrick Richard ◽  
Franck Bladou
Keyword(s):  
Operative Time ◽  
Technical Difficulty ◽  
Outcome Data ◽  
Ileal Neobladder ◽  
Total Operative Time ◽  
Robotic Assisted ◽  
Estimated Blood Loss ◽  
Timely Completion ◽  
Muscle Invasive

Despite robotic-assisted radical cysto-prostatectomy being performed in several centres, the urinary diversion is most often performed extra-corporeal. A robotic intra-corporeal ileal neobladder is technically demanding and long-term functional outcome data is lacking. We performed a robotic intra-corporeal ileal neobladder in a 73-year-old man for muscle invasive non-metastatic bladder cancer. The total operative time was 6 hours 8 minutes. The estimated blood loss was 900 mL. There were no complications and he was discharged on day 12. The principles of open neobladder surgery were maintained, however key modifications were used to reduce technical difficulty and enable timely completion. We found that robotic intracorporeal ileal neobladder can be safely performed with an experienced robotic unit.

A Procedure for Rapid Issue of Red Cells for Emergency Use

2005 ◽  
Vol 129 (4) ◽  
pp. 492-496
Author(s):  
Richard B. Weiskopf ◽  
Mary Webb ◽  
Deena Stangle ◽  
Gunter Klinbergs ◽  
Pearl Toy
Keyword(s):  
Red Blood Cells ◽  
Operating Room ◽  
Blood Cells ◽  
Blood Bank ◽  
Red Cells ◽  
University Hospital ◽  
Delivery Time ◽  
Delivery Times ◽  
The Times ◽  
Time Required

Abstract Context.—A College of American Pathologists Q-Probe revealed that the median turnaround times for emergency requests for red blood cells from the operating room were 30 minutes to release of cells from the blood bank and 34 minutes to delivery to the operating room. These times may not be adequate to permit the red cells to provide sufficiently rapid delivery of oxygen in massively bleeding patients. Objective.—To improve the time from emergency request for red cells to delivery to the operating room. Design.—A new emergency issue program was implemented for only the operating rooms; emergency issue to all other hospital locations remained unchanged. Six units of group O Rh-negative red blood cells (RBCs) are maintained in the blood bank in a separate basket with transfusion forms containing the unit numbers and expiration dates and a bag with one blood tubing segment from each unit. The times to issue and to delivery to the operating room suite were compared with time to issue of 2 group O Rh-negative RBCs for other hospital locations using the older system during the same time period and with the time to issue of 2 units to all other hospital locations during the preceding 2 years. Setting.—A university hospital. Main Outcome Measures.—Time between emergency request for red cells and delivery to the operating room. Results.—The time between blood bank notification and arrival in the operating room of the 6 units of RBCs was significantly shorter than the time required to just issue (not including delivery time) 2 units of RBCs to other hospital locations. With the new procedure, 82% of units issued reached the operating room within 2 minutes of request, 91% arrived within 3 minutes, and 100% arrived within 4 minutes. These percentages are significantly higher than those for only issue of blood (without delivery) using the older issuing procedure for all hospital locations during the previous 2 years (37%, 49%, and 66%, respectively; P = .007, .009, and .02, respectively) and for other locations during the same 7-month period (29%, 46%, and 73%, respectively; P = .004, .01, and .09, respectively). Time (mean [95% confidence interval]) from blood bank notification to delivery of RBCs to the operating room suite (2.1 [1.6–2.6] minutes, of which approximately 50–60 seconds is attributable to delivery time) was less than issue times (not including delivery times) using the older issuing procedure for other hospital locations during the same period (4.1 [3.1–5.0] minutes; P = .007). Conclusions.—An emergency issue procedure can be used to issue several units of RBCs within 1 minute and have them delivered to the operating room within 2 minutes while maintaining sufficient controls and providing required information to satisfy patient and blood bank requirements.

The Impact of Body Mass Index on Perioperative Outcomes of Robotic Adrenalectomy: An Update

2019 ◽  
Vol 26 (6) ◽  
pp. 687-691 ◽  
Author(s):  
Orhan Agcaoglu ◽  
Melis Akbas ◽  
Murat Ozdemir ◽  
Ozer Makay
Keyword(s):  
Body Mass Index ◽  
Robotic Surgery ◽  
Blood Loss ◽  
Operative Time ◽  
Length Of Hospital Stay ◽  
Perioperative Outcomes ◽  
Total Operative Time ◽  
Estimated Blood Loss ◽  
Robotic Adrenalectomy ◽  
The Impact

Background. Robotic surgery has gained increasing popularity over the past 2 decades. However, factors including patient comorbidities and tumor characteristics are still crucial factors for outcomes of surgery. In this study, we evaluated the impact of body mass index (BMI) on perioperative outcomes in patients who underwent robotic adrenal surgery. Methods. Between May 2012 and November 2017, 66 consecutive patients who underwent robotic adrenalectomy were included in this study. Patients were divided into 2 groups based on their BMI: nonobese (<30 kg/m2) and obese (≥30 kg/m2). Additionally, patient demographics, tumor size, total operative time, docking time, console time, estimated blood loss, conversion to open, complications, additional analgesia requirement, length of hospital stay, and rough costs were evaluated. Results. Of the 66 patients, a total of 26 patients were obese (30%). Between study groups, the median BMI was calculated as 26 (18-29) and 33 (30-57). The groups were similar in terms of age, gender, American Society of Anesthesiologists scores, and previous history of abdominal surgery. Likewise, there were no significant differences between groups regarding total operative time ( P = .085), docking time ( P = .196), console time ( P = .211), estimated blood loss ( P = .180), complications ( P = .991), length of hospital stay ( P = .598), and rough costs ( P = .468). Five cases were converted to open surgery. Nonobese cases required additional analgesia ( P = .007). We had no unexpected hospitalizations in either group. Conclusion. Guidelines express the advantages of robotic surgery in obese patients. No statistically significant differences were detected between the 2 groups except for the additional analgesia required in nonobese patients.

scholarly journals COMPARISON OF NEPHROMETRIC SYSTEMS IN PARTIAL NEPHRECTOMY FOR RENAL CELL CARCINOMA

2017 ◽  
Vol 25 (1) ◽  
pp. 110-117
Author(s):  
T V. Shatylko ◽  
V M. Popkov ◽  
A Yu. Korolev ◽  
D A. Chausovsky
Keyword(s):  
Chronic Kidney Disease ◽  
Partial Nephrectomy ◽  
Operative Time ◽  
De Novo ◽  
Low Complexity ◽  
High Complexity ◽  
Total Operative Time ◽  
Ischemia Time ◽  
Time Required ◽  
Kidney Resection

Evaluation of efficacy of using nephrometry scores was performed on our own cohort of patients. Correlation between them and clinical variables was studied. All nephrometry scores - RENAL, PADUA and C-index - correlate significantly with ischemia time during partial nephrectomy, but not with total operative time. Kidney resection for intermediate and high complexity tumors caused chronic kidney disease (CKD) de novo or CKD upstaging more often than resection for low complexity tumors. Low complexity tumors on RENAL and PADUA were characterized by significantly lower renal parenchyma ischemia time required for resection. Complications of partial nephrectomy were observed only in groups with intermediate and high tumor complexity, while differences between intermediate and high complexity seemed practically insignificant. Nephrometry systems are useful in clinical practice, but require further improvement.

Building a Single-Site Robotic Cholecystectomy Program in a Public Teaching Hospital: Is It Safe for Patients and Feasible for Residents to Participate?

2018 ◽  
Vol 84 (2) ◽  
pp. 188-191
Author(s):  
Michael P. O'Leary ◽  
Reed I. Ayabe ◽  
Christine E. Dauphine ◽  
Danielle M. Hari ◽  
Junko J. Ozao-Choy
Keyword(s):  
Length Of Stay ◽  
Teaching Hospital ◽  
Operative Time ◽  
Resident Training ◽  
Single Site ◽  
Safe Procedure ◽  
Resident Participation ◽  
Total Operative Time ◽  
Time Length ◽  
Robotic Cholecystectomy

Single-site robotic cholecystectomy (SSRC) accounts for most of the robotic surgery cases performed by general surgeons at our institution since acquiring the da Vinci Si Surgical SystemTM (Intuitive Surgical, Inc., Sunnyvale, CA) in 2014. We sought to determine whether a SSRC program is safe to start in a public teaching hospital and to determine whether resident participation in this procedure is feasible. Data on age, gender, race, BMI, total operative time, length of stay, comorbidities, and conversion from laparoscopic to open surgery were examined for elective SSRC and laparoscopic cholecystectomies (LCs) performed by two faculty surgeons between February 2015 and August 2015. Thirty-eight patients underwent elective SSRC, whereas 27 patients underwent LC. Residents participated as operating surgeons for some portion of the case in 15 SSRC cases and in all LC cases. There were no significant differences in operative time, length of stay, or 30-day readmission rates, regardless of resident involvement. Patients in the SSRC group had a significantly lower BMI (25.8 vs 33.7, P = 0.008). This study suggests that resident participation does not increase complications or total operative time and that SSRC is a safe procedure to start in a public teaching hospital after proper faculty and resident training.

A Prospective, Comparative Study on Robotic Versus Open-Surgery Hysterectomy and Pelvic Lymphadenectomy for Endometrial Carcinoma

2015 ◽  
Vol 25 (2) ◽  
pp. 250-256 ◽  
Author(s):  
Saskia Eklind ◽  
Anna Lindfors ◽  
Per Sjöli ◽  
Pernilla Dahm-Kähler
Keyword(s):  
Lymph Nodes ◽  
Hospital Stay ◽  
Endometrial Carcinoma ◽  
Daily Living ◽  
Operative Time ◽  
Pelvic Lymphadenectomy ◽  
University Hospital ◽  
Robot Assisted ◽  
Laparoscopy Group ◽  
Estimated Blood Loss

ObjectivesThe aim of this study was to compare surgical outcome, patient recovery, and costs between robot-assisted laparoscopy and laparotomy in women undergoing hysterectomy, bilateral salpingo-oophorectomy (BSOE), and pelvic lymphadenectomy for endometrial carcinoma.MethodsWomen undergoing hysterectomy, BSOE, and pelvic lymphadenectomy for endometrial carcinoma, according to regional guidelines, were prospectively, concurrently, and consecutively included from September 2010 to December 2012. Surgical outcomes such as operative time, estimated blood loss (EBL), number of lymph nodes retrieved, and complications were analyzed together with hospital stay, days until normal active daily living was retrieved, patient satisfaction with the length of the hospital stay, and cost per patient. Robot-assisted laparoscopy was performed on all cases at the Sahlgrenska University Hospital, and laparotomy was performed on all cases at 3 regional hospitals.ResultsForty women underwent robot-assisted laparoscopy, and 48 underwent laparotomy. There were no differences in age, body mass index, histology, or retrieved lymph nodes. Operative time was significantly shorter in the robot-assisted laparoscopy group (P< 0.0001). The EBL was lower and hospital stay was shorter in the robot-assisted laparoscopy group (P< 0.0001). There was no statistical difference in complications between the groups, and both groups found hospital stay duration satisfactory. In the robot-assisted laparoscopy group, active daily living was normal within 5 days postoperatively, compared with 14 days in the laparotomy group (P< 0.0001). Calculated costs per treated patient did not differ statistically between the groups.ConclusionsCompared with laparotomy and robot-assisted laparoscopic hysterectomy, BSOE pelvic lymphadenectomy for endometrial carcinoma was associated with significantly shorter operative time, hospital stay, and lower EBL. Patients recovered more quickly after robot-assisted laparoscopy, with equal costs number of retrieved lymph nodes, compared with laparotomy.

scholarly journals Functional and early oncological results in 2D vs 3D laparoscopic prostatectomy

2018 ◽  
Vol 8 (3) ◽  
pp. 5-10
Author(s):  
Oleg A. Bogomolov ◽  
Mikhail I. Shkolnik ◽  
Andrej D. Belov ◽  
Svetlana A. Sidorova ◽  
Denis G. Prokhorov ◽  
...  
Keyword(s):  
Prostate Cancer ◽  
Postoperative Complications ◽  
Blood Loss ◽  
Operative Time ◽  
Clinical Stage ◽  
Functional Results ◽  
Localized Prostate Cancer ◽  
Total Operative Time ◽  
Laparoscopic Prostatectomy ◽  
Estimated Blood Loss

Aim. To evaluate functional and early oncologic results with 2D and 3D laparoscopic prostatectomy in patients with localized prostate cancer. Materials and methods. In 2016 to 2017, 124 laparoscopic radical prostatectomies were performed for localized prostate cancer, 71 using 2D-HD and 53 using 3D-HD laparoscopic systems (Karl Storz). Data on total operative time, time required for prostatectomy and for anastomosis, estimated blood loss, intraoperative and early postoperative complications (Clavien-Dindo grade), early functional results, surgical margins, upgrading of clinical stage, and frequency of biochemical recurrence were recorded. Results. The total operative was significantly higher in the 2D than in the 3D group (152 min [range 100–192 min] vs 126 min [90–154 min]), (p < 0.05). The shorter time in the 3D group was achieved by a decrease in the anastomosis time (38 ± 4 min vs 26 ± 4 min, p < 0.05). Significant blood loss was significantly greater in the 2D group (240 ± 80 ml vs 190 ± 70 ml, p < 0.05). The two groups did not differ significantly in terms of the incidence and severity of postoperative complications. Conclusion. Compared with traditional 2D devices, using stereoscopic 3D laparoscopic devices for prostatectomy reduces total operative time, particularly during the reconstructive stage, as well as the volume of intraoperative blood loss. Additional prospective, randomized trials and longer postoperative follow-up are needed to confirm these findings.

Are operating room distractions, interruptions, and disruptions associated with performance and patient safety? A systematic review and meta-analysis

2021 ◽  
Author(s):  
Ryan D McMullan ◽  
Rachel Urwin ◽  
Peter Gates ◽  
Neroli Sunderland ◽  
Johanna I Westbrook
Keyword(s):  
Patient Safety ◽  
Operating Room ◽  
Random Effects ◽  
Team Performance ◽  
Operative Time ◽  
Meta Analysis ◽  
Individual Performance ◽  
Negative Effects ◽  
Total Operative Time ◽  
Operative Duration

Abstract Background The operating room (OR) is a complex environment in which distractions, interruptions, and disruptions (DIDs) are frequent. Our aim was to synthesise research on the relationships between DIDs and (a) operative duration, (b) team performance, (c) individual performance, and (d) patient safety outcomes; in order to better understand how interventions can be designed to mitigate the negative effects of DIDs. Methods Electronic databases (MEDLINE, Embase, CINAHL, PsycINFO) and reference lists were systematically searched. Included studies were required to report quantitative outcomes of the association between DIDs and team performance, individual performance, and patient safety. Two reviewers independently screened articles for inclusion, assessed study quality, and extracted data. A random effects meta-analysis was performed on a subset of studies reporting total operative time and DIDs. Results Twenty-seven studies were identified. The majority were prospective observational studies (n=15), of moderate quality (n=15). DIDs were often defined, measured, and interpreted differently in studies. DIDs were significantly associated with: extended operative duration (n=8), impaired team performance (n=6), self-reported errors by colleagues (n=1), surgical errors (n=1), increased risk and incidence of surgical site infection (n=4), and fewer patient safety checks (n=1). A random effects meta-analysis showed that the proportion of total operative time due to DIDs was 22.0% (95% CI 15.7-29.9). Conclusion DIDs in surgery are associated with a range of negative outcomes. However, significant knowledge gaps exist about the mechanisms that underlie these relationships, as well as the potential clinical and non-clinical benefits that DIDs may deliver. Available evidence indicates that interventions to reduce the negative effects of DIDs are warranted, but current evidence is not sufficient to make recommendations about potentially useful interventions.

scholarly journals Radical prostatectomy outcomes in renal transplant recipients: a retrospective case series of Thai patients

BMC Urology ◽  
2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Kun Sirisopana ◽  
Pocharapong Jenjitranant ◽  
Premsant Sangkum ◽  
Kittinut Kijvikai ◽  
Suthep Pacharatakul ◽  
...  
Keyword(s):  
Prostate Cancer ◽  
Radical Prostatectomy ◽  
Renal Transplant ◽  
Operative Time ◽  
Case Series ◽  
Urinary Continence ◽  
Renal Transplant Recipients ◽  
Transplant Recipients ◽  
Estimated Blood Loss ◽  
The Mean

Abstract Background The incidence of prostate cancer in renal transplant recipients (RTR) is similar to the general population. Radical prostatectomy (RP) is the standard of care in the management of clinically localized cancer, but is considered complicated due to the presence of adhesions, and the location of transplanted ureter/kidney. To date, a few case series or studies on RP in RTR have been published, especially in Asian patients. This study aimed to evaluate the efficacy and safety and report the experience with RP on RTR. Methods We retrospectively reviewed data of 1270 patients who underwent RP from January 2008 to March 2020, of which 5 patients were RTR. All available baseline characteristics, perioperative and postoperative data (operative time, estimated blood loss (EBL), complications, length of hospital stay, complication), pathological stage, Gleason score, surgical margin status, and pre/postoperative creatinine were reviewed. Results Of the 5 RTR who underwent RPs (1 open radical prostatectomy (ORP), 1 laparoscopic radical prostatectomy (LRP), 2 robotic-assisted laparoscopic radical prostatectomies (RALRP), and 1 Retzius-sparing RALRP (RS-RALRP)) prostatectomy, the mean age (± SD) was 70 (± 5.62) years. In LRP and RALRP cases, the standard ports were moved slightly medially to prevent graft injury. The mean operative time ranged from 190 to 365 min. The longest operative time and highest EBL (630 ml) was the ORP case due to severe adhesion in Retzius space. For LRP and RALRP cases, the operative times seemed comparable and had EBL of ≤ 300 ml. All RPs were successful without any major intra-operative complication. There was no significant change in graft function. The restorations of urinary continence were within 1 month in RS-RALRP, approximately 6 months in RALRP, and about 1 year in ORP and LRP. Three patients with positive surgical margins had prostate-specific antigen (PSA) persistence at the first follow-up and 1 had later PSA recurrence. Two patients with negative margins were free from biochemical recurrence at 47 and 3 months after their RP. Conclusions Our series suggested that all RP techniques are safe and feasible mode of treatment for localized prostate cancer in RTR.

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