scholarly journals Bone cutter versus plastibell device in neonatal circumcision: A randomized trial

2020 ◽  
Vol 9 ◽  
pp. 24
Author(s):  
Ademola Olusegun Talabi ◽  
Gabriel Unimke Udie ◽  
Oludayo Adedapo Sowande ◽  
Owolabi Oni ◽  
Olusanya Adejuyigbe
Keyword(s):  
Blood Loss ◽  
Randomized Trial ◽  
Complication Rate ◽  
Operative Time ◽  
Urban Setting ◽  
Complication Rates ◽  
Estimated Blood Loss ◽  
Tertiary Teaching ◽  
Neonatal Circumcision ◽  
Perception Score

Background: Several techniques and devices have been described for circumcision each with its own pros and cons. The objective of this study was to compare the outcome of neonatal circumcision between bone-cutter and plastibell devices at our institution. Methods: This is a randomized trial (unregistered) conducted at the Pediatric Surgical Unit of a tertiary teaching hospital situated in a semi-urban setting, between January 2019 and December 2019. The uncircumcised neonates underwent circumcision by either bone-cutter or plastibell device. Demographic characteristics, operative time, estimated blood loss, and postoperative complications were compared. A p-value of <0.05 was considered significant. Results: The age ranged between 7 days and 30 days with a mean of 15.9±5.5 days. The mean age and weight of both groups were well matched (p >0.05). The operative time in the bone cutter technique was 4.2±0.9 minutes compared to 5.8±1.2 minutes in the plastibell device method (p <0.001). Blood loss was lesser with bone cutter (0.27 ±0.32mls versus 0.51 ±0.44mls in the plastibell device, p <0.001). The complication rates were comparable in both study groups (p =1.000). The overall complication rate was 5.8%. The penile perception score and the Hollander wound evaluation score for bone-cutter were 15.7±0.8 and 5.7±0.84 while in the plastibell device were 15.4±1.1 and 5.4±1.1, respectively (p >0.05). Conclusion: Operative time and blood loss were less with bone cutter compared to plastibell device. However, the complication rate, penile perception score, and Hollander wound evaluation scores were similar.

Role of Frameless Stereotaxy in the Surgical Treatment of Cerebral Arteriovenous Malformations: Technique and Outcomes in a Controlled Study of 44 Consecutive Patients

Neurosurgery ◽  
2002 ◽  
Vol 51 (5) ◽  
pp. 1108-1118 ◽  
Author(s):  
Stephen M. Russell ◽  
Henry H. Woo ◽  
Seth S. Joseffer ◽  
Jafar J. Jafar
Keyword(s):  
Blood Loss ◽  
Arteriovenous Malformations ◽  
Operative Time ◽  
Controlled Study ◽  
Frameless Stereotaxy ◽  
Complication Rates ◽  
Cerebral Arteriovenous Malformations ◽  
Estimated Blood Loss ◽  
Group 2 ◽  
Group 1

Abstract OBJECTIVE To describe a frameless stereotactic technique used to resect cerebral arteriovenous malformations (AVMs) and to determine whether frameless stereotaxy during AVM resection could decrease operative times, minimize intraoperative blood losses, reduce postoperative complications, and improve surgical outcomes. METHODS Data for 44 consecutive patients with surgically resected cerebral AVMs were retrospectively reviewed. The first 22 patients underwent resection without stereotaxy (Group 1), whereas the next 22 patients underwent resection with the assistance of a frameless stereotaxy system (Group 2). RESULTS The patient characteristics, AVM morphological features, and percentages of preoperatively embolized cases were statistically similar for the two treatment groups. The mean operative time for Group 1 was 497 minutes, compared with 290 minutes for Group 2 (P = 0.0005). The estimated blood loss for Group 1 was 657 ml, compared with 311 ml for Group 2 (P = 0.0008). Complication rates, residual AVM incidences, and clinical outcomes were similar for the two groups. CONCLUSION Frameless stereotaxy allows surgeons to 1) plan the optimal trajectory to an AVM, 2) minimize the skin incision and craniotomy sizes, and 3) confirm the AVM margins and identify deep vascular components during resection. These benefits of stereotaxy were most apparent for small, deep AVMs that were not visible on the surface of the brain. Frameless stereotaxy reduces the operative time and blood loss during AVM resection.

Complicated Appendicitis–Is the Laparoscopic Approach Appropriate? A Comparative Study with the Open Approach: Outcome in a Community Hospital Setting

2007 ◽  
Vol 73 (8) ◽  
pp. 737-742 ◽  
Author(s):  
Naveen Pokala ◽  
S. Sadhasivam ◽  
R.P. Kiran ◽  
V. Parithivel
Keyword(s):  
Blood Loss ◽  
Operative Time ◽  
Laparoscopic Approach ◽  
Complicated Appendicitis ◽  
Complication Rates ◽  
Intraabdominal Abscess ◽  
Estimated Blood Loss ◽  
Significant Difference ◽  
American Society ◽  
American Society Of Anesthesiologists

Good outcome has been reported with the laparoscopic approach in uncomplicated appendicitis, but a higher incidence of postoperative intraabdominal abscesses has been reported after laparoscopic appendectomy in complicated appendicitis. This retrospective comparative study compares outcome after laparoscopic (LA) and open appendectomy (OA) in complicated appendicitis. All patients who had LA or OA for complicated appendicitis between January 2003 and February 2006 were included in the study. Data collection included demographics, operative time, estimated blood loss, length of stay (LOS), complications, readmission, and reoperative rates. The primary end points for analysis were postoperative intraabdominal abscess and complication rates and secondary end points were LOS and operative time. All data were analyzed on an intent-to-treat basis. Of 104 patients, 43 patients underwent LA and 61 had OA. The mean age (24.8 ± 16.5 versus 31.3 ± 18.9, P = 0.08) in the LA group was lower than the OA group because there was a significantly higher proportion of pediatric patients (34.8% versus 14.8%, P = 0.02) who had LA. There was no significant difference in gender (female/male, 14/29 versus 27/34, P = 0.3) or American Society of Anesthesiologists class distribution (American Society of Anesthesiologists 1/2/3/4/, 35/7/1/0 versus 45/12/3/1, P = 0.68) between the two groups. The operative time (100.5 ± 36.2 versus 81.5 ± 29.5 minutes, P = 0.03) was significantly longer and the estimated blood loss (21 mL versus 33 mL, P = 0.01) was lower in LA when compared with OA, but there was no significant difference in the number of patients with preoperative peritonitis versus abscesses (7/36 versus 13/48, P = 0.6) in both groups. There was no difference in the median LOS (6 [interquartile range 5–9] versus 6 [interquartile range 4–8], P = 0.7) in the two groups. The conversion rate in LA was 18.6% (n = 8). There was also no significant difference in the complication (17/43 [39.5%] versus 21/61 [34.4%], P = 0.54), reoperative (3/43 [7%] versus 0/61 [0%], P = 0.07), and 30-day readmission (5/41 [11.6%] versus 3/61 [4.9%], P = 0.23) rates between the two groups. The rate of postoperative intraabdominal abscesses was significantly higher in the LA group when compared with the OA group (6/43 [14%] versus 0/61 [0%], P = 0.04) and the wound infection (1/43 [2.3%] versus 5/61 [8.2%], P = 0.4) and pulmonary complication (0/43 [0%] versus 3/61 [4.9%], P = 0.26) rate was higher in the OA group. There was no mortality in the LA group, but there was one mortality in the OA group resulting from postoperative myocardial infarction. Laparoscopic appendectomy can be performed in patients with complicated appendicitis with a comparative operative time, LOS, and complication rates but results in a significantly higher intraabdominal abscess rate and lower wound infection rate when compared with OA.

Anterior Thoracolumbar Corpectomies: Approach Morbidity With and Without an Access Surgeon

Neurosurgery ◽  
2011 ◽  
Vol 68 (5) ◽  
pp. 1220-1226 ◽  
Author(s):  
Seunggu J. Han ◽  
Darryl Lau ◽  
Daniel C. Lu ◽  
Pierre Theodore ◽  
Dean Chou
Keyword(s):  
Blood Loss ◽  
Complication Rate ◽  
Operative Time ◽  
Length Of Hospital Stay ◽  
Final Analysis ◽  
Senior Author ◽  
Neurological Function ◽  
Complication Rates ◽  
Significant Morbidity ◽  
Neurological Outcomes

Abstract BACKGROUND: Anterior approaches for thoracolumbar corpectomies can have significant morbidity. Spine surgeons have historically performed their own anterior approaches, but recently access surgeons are being used more frequently. OBJECTIVE: To evaluate the morbidity rates of approaches performed by an access surgeon and by an approach-trained spinal neurosurgeon. METHODS: From 2004 to 2008, 46 patients undergoing anterior thoracolumbar corpectomies (levels T2-L5) by the senior author (D.C.) were identified and subdivided into 2 groups based on whether an access surgeon was involved. Nine patients were excluded, leaving 37 patients in the final analysis. Blood loss, operative times, length of hospital stay, complications, and neurological outcomes were evaluated. RESULTS: Eighteen patients had anterior spinal access by an approach-trained spinal neurosurgeon, and 19 patients underwent the approach by an access surgeon. Surgeries performed by the spinal neurosurgeon alone were comparable to those performed by an access surgeon with respect to operative time, days spent in the hospital, blood loss, complication rates, and improvement in neurological function. CONCLUSION: There appears to be no increased morbidity of anterior approaches performed by an approach-trained spinal neurosurgeon compared with approaches performed by an access surgeon in terms of operative time, complication rate, and improvement in neurological function.

The impact of surgeon experience on perioperative complications and operative measures following thoracolumbar 3-column osteotomy for adult spinal deformity: overcoming the learning curve

2020 ◽  
Vol 32 (2) ◽  
pp. 207-220 ◽  
Author(s):  
Darryl Lau ◽  
Vedat Deviren ◽  
Christopher P. Ames
Keyword(s):  
Blood Loss ◽  
Operative Time ◽  
Surgical Complication ◽  
Perioperative Complications ◽  
Adult Spinal Deformity ◽  
Neurological Deficits ◽  
Complication Rates ◽  
Years Of Experience ◽  
Surgeon Experience ◽  
Operative Measures

OBJECTIVEPosterior-based thoracolumbar 3-column osteotomy (3CO) is a formidable surgical procedure. Surgeon experience and case volume are known factors that influence surgical complication rates, but these factors have not been studied well in cases of adult spinal deformity (ASD). This study examines how surgeon experience affects perioperative complications and operative measures following thoracolumbar 3CO in ASD.METHODSA retrospective study was performed of a consecutive cohort of thoracolumbar ASD patients who underwent 3CO performed by the senior authors from 2006 to 2018. Multivariate analysis was used to assess whether experience (years of experience and/or number of procedures) is associated with perioperative complications, operative duration, and blood loss.RESULTSA total of 362 patients underwent 66 vertebral column resections (VCRs) and 296 pedicle subtraction osteotomies (PSOs). The overall complication rate was 29.4%, and the surgical complication rate was 8.0%. The rate of postoperative neurological deficits was 6.2%. There was a trend toward lower overall complication rates with greater operative years of experience (from 44.4% to 28.0%) (p = 0.115). Years of operative experience was associated with a significantly lower rate of neurological deficits (p = 0.027); the incidence dropped from 22.2% to 4.0%. The mean operative time was 310.7 minutes overall. Both increased years of experience and higher case numbers were significantly associated with shorter operative times (p < 0.001 and p = 0.001, respectively). Only operative years of experience was independently associated with operative times (p < 0.001): 358.3 minutes from 2006 to 2008 to 275.5 minutes in 2018 (82.8 minutes shorter). Over time, there was less deviation and more consistency in operative times, despite the implementation of various interventions to promote fusion and prevent construct failure: utilization of multiple-rod constructs (standard, satellite, and nested rods), bone morphogenetic protein, vertebroplasty, and ligament augmentation. Of note, the use of tranexamic acid did not significantly lower blood loss.CONCLUSIONSSurgeon years of experience, rather than number of 3COs performed, was a significant factor in mitigating neurological complications and improving quality measures following thoracolumbar 3CO for ASD. The 3- to 5-year experience mark was when the senior surgeon overcame a learning curve and was able to minimize neurological complication rates. There was a continuous decrease in operative time as the surgeon’s experience increased; this was in concurrence with the implementation of additional preventative surgical interventions. Ongoing practice changes should be implemented and can be done safely, but it is imperative to self-assess the risks and benefits of those practice changes.

scholarly journals A comparison of the Thunderbeat and standard electrocautery devices in head and neck surgery: a prospective randomized controlled trial

2021 ◽  
Author(s):  
N. C. Kuipers ◽  
B. J. de Kleijn ◽  
J. Wedman ◽  
B. F. A. M. van der Laan ◽  
B. E. C. Plaat ◽  
...  
Keyword(s):  
Randomized Controlled Trial ◽  
Blood Loss ◽  
Head And Neck ◽  
Complication Rate ◽  
Operative Time ◽  
Controlled Trial ◽  
Neck Surgery ◽  
Head And Neck Surgery ◽  
Randomized Controlled ◽  
Standard Instrumentation

Abstract Purpose New energy-based sutureless vessel ligation devices, such as the Thunderbeat (Olympus Medical Systems Corp., Tokyo, Japan), could reduce operative time and limit blood loss in head and neck surgery; however, efficacy and safety in major head and neck surgery have not been investigated in a prospective, randomized study. Methods This prospective, double-arm, randomized controlled trial consisted of two parts: total laryngectomy (TL) and neck dissection (ND). Thirty patients planned for TL were randomized in two groups. For the ND part, forty-two operative sides were likewise randomized. In both parts, Thunderbeat was used in addition to the standard instrumentation in the intervention groups, while only standard instrumentation was used in the control groups. Primary outcome values were blood loss, operative time and complication rate. Results For the TL part there was no difference in mean blood loss (p = 0.062), operative time (p = 0.512) and complications (p = 0.662) between both hemostatic techniques. For the neck dissection part, there was a reduction in blood loss (mean 210 mL versus 431 mL, p = 0.046) and in operative time (median 101 (IQR 85–130) minutes versus 150 (IQR 130–199) minutes, p = 0.014) when Thunderbeat was used. There was no difference in complication rate between both hemostatic systems (p = 0.261). Conclusion The Thunderbeat hemostatic device significantly reduces operative blood loss and operative time for neck dissections, without increase in complications. In TL, blood loss using Thunderbeat was comparable with the standard technique, but the operative time tended to be shorter. Trial registration UMCG Research Register, Reg. no. 201700041, date of registration: 18/1/2017

The Emerging Role of Robotic Single-site Approach for Myomectomy: A Systematic Review of the Literature

2021 ◽  
pp. 155335062098822
Author(s):  
Eirini Giovannopoulou ◽  
Anastasia Prodromidou ◽  
Nikolaos Blontzos ◽  
Christos Iavazzo
Keyword(s):  
Blood Loss ◽  
Minimally Invasive ◽  
Complication Rate ◽  
Operative Time ◽  
Intraoperative Complications ◽  
Single Site ◽  
Minimally Invasive Technique ◽  
Invasive Technique ◽  
Robotic Myomectomy ◽  
The Mean

Objective. To review the existing studies on single-site robotic myomectomy and test the safety and feasibility of this innovative minimally invasive technique. Data Sources. PubMed, Scopus, Google Scholar (from their inception to October 2019), as well as Clinicaltrials.gov databases up to April 2020. Methods of Study Selection. Clinical trials (prospective or retrospective) that reported the outcomes of single-site robotic myomectomy, with a sample of at least 20 patients were considered eligible for the review. Results. The present review was performed in accordance with the guidelines for Systematic Reviews and Meta-Analyses (PRISMA). Four (4) studies met the inclusion criteria, and a total of 267 patients were included with a mean age from 37.1 to 39.1 years and BMI from 21.6 to 29.4 kg/m2. The mean operative time ranged from 131.4 to 154.2 min, the mean docking time from 5.1 to 5.45 min, and the mean blood loss from 57.9 to 182.62 ml. No intraoperative complications were observed, and a conversion rate of 3.8% was reported by a sole study. The overall postoperative complication rate was estimated at 2.2%, and the mean hospital stay ranged from 0.57 to 4.7 days. No significant differences were detected when single-site robotic myomectomy was compared to the multiport technique concerning operative time, blood loss, and total complication rate. Conclusion. Our findings support the safety of single-site robotic myomectomy and its equivalency with the multiport technique on the most studied outcomes. Further studies are needed to conclude on the optimal minimally invasive technique for myomectomy.

STANDARD OPEN MICRODISCECTOMY VERSUS MINIMAL ACCESS TROCAR MICRODISCECTOMY

Neurosurgery ◽  
2008 ◽  
Vol 62 (1) ◽  
pp. 174-182 ◽  
Author(s):  
Yu-Mi Ryang ◽  
Markus F. Oertel ◽  
Lothar Mayfrank ◽  
Joachim M. Gilsbach ◽  
Veit Rohde
Keyword(s):  
Blood Loss ◽  
Visual Analog Scale ◽  
Oswestry Disability Index ◽  
Operative Time ◽  
Short Form ◽  
Lumbar Disc ◽  
Complication Rates ◽  
Minimal Access ◽  
Analog Scale ◽  
Short Form 36

Abstract OBJECTIVE Minimal access surgery as a less invasive alternative to standard macro- and microsurgical approaches is becoming increasingly popular in the management of traumatic and degenerative spine diseases. However, data is lacking if minimal access spine surgery is indeed beneficial. This prospective randomized study was conducted to compare efficiency, safety, and outcome of standard open microsurgical discectomy (SOMD) for lumbar disc herniation with microsurgical discectomy using an 11.5 mm trocar system for minimal access to the spine. METHODS Sixty patients were randomized to two groups of 30 patients each. Group 1 was treated by SOMD, and Group 2 was treated by minimal access microsurgical discectomy (MAMD). Perioperative parameters and pre- and postoperative clinical findings including sensory or motor deficits and pain according to the visual analog scale, Oswestry Disability Index scores, and Short Form-36 results were assessed. All patients were followed for at least 6 months postoperatively (mean, 16 mo). RESULTS Preoperatively, no statistically significant intergroup differences could be detected proving the comparability of both groups. Postoperatively, significant improvement of neurological symptoms and pain as measured by the visual analog scale, Oswestry Disability Index, and Short Form-36 scores could be achieved in both groups. In regard to operative time, intraoperative blood loss, and complication rate, slightly better results were observed in the MAMD group. CONCLUSION SOMD and MAMD allow achievement of significant improvement of pain and neurological deficits in patients with lumbar disc herniations. Differences in operative time, blood loss, and complication rates were statistically not significant in MAMD compared with SOMD, indicating that, at least in lumbar disc surgery, minimal access trocar techniques are a viable alternative to standard spinal approaches.

Complications and Outcomes of Chimeric Free Flaps: A Systematic Review

2019 ◽  
Vol 161 (4) ◽  
pp. 568-575 ◽  
Author(s):  
Abhinav R. Ettyreddy ◽  
Collin L. Chen ◽  
Joseph Zenga ◽  
Laura E. Simon ◽  
Patrik Pipkorn
Keyword(s):  
Head And Neck ◽  
Complication Rate ◽  
Operative Time ◽  
Donor Site ◽  
Locally Advanced ◽  
Major Complication ◽  
Free Flaps ◽  
Controlled Vocabulary ◽  
Cochrane Central Register ◽  
Complication Rates

ObjectiveAblations of locally advanced or recurrent head and neck cancer commonly result in large composite orofacial defects. Chimeric flaps represent a unique surgical option for these defects, as they provide diverse tissue types from a single donor site. The purpose of the study was to consolidate the literature on chimeric flaps with regard to postoperative complication rates to help inform surgical decision making.Data SourcesThe librarian created search strategies with a combination of keywords and controlled vocabulary in Ovid Medline (1946), Embase (1947), Scopus (1823), Cochrane Database of Systematic Reviews, Cochrane Central Register of Controlled Trials, and Clinicaltrails.gov (1997).Review MethodsCandidate articles were independently reviewed by 2 authors familiar with the subject material, and inclusion/exclusion criteria were uniformly applied for article selection. Articles were considered eligible if they included patients who received a single chimeric flap for reconstruction of head and neck defects and if they provided data on complication rates.ResultsA total of 521 chimeric flaps were included in the study. The major complication rate was 22.6%, while the minor complication rate was 14.0%. There were 7 flap deaths noted in the series. Median operative time and harvest time were 15.0 and 2.5 hours, respectively.ConclusionChimeric flaps represent a viable option for reconstruction of complex head and neck defects and have complication rates similar to those of double free flaps and single free flaps with locoregional flap while only modestly increasing total operative time.

A team approach to anterior lumbar spine surgery in the military

Vascular ◽  
2013 ◽  
Vol 22 (4) ◽  
pp. 246-251 ◽  
Author(s):  
Anahita Dua ◽  
Jennifer Fox ◽  
Bhavin Patel ◽  
Eric Martin ◽  
Michael Rosner ◽  
...  
Keyword(s):  
Lumbar Spine ◽  
Blood Loss ◽  
Operative Time ◽  
Lumbar Spine Surgery ◽  
Team Approach ◽  
Disc Space ◽  
Estimated Blood Loss ◽  
All Cause Mortality ◽  
The Military ◽  
Median Operative Time

We report a five year military experience with anterior retroperitoneal spine exposure combining vascular and neurosurgical spine teams. From August 2005 through April 2010 (56 months), hospital records from a single institution were retrospectively reviewed. Complications, estimated blood loss, transfusions, operative time and length of stay were documented. Eighty-four patients with lumbar spondylosis underwent primary (63, 75%) or secondary exposure (21, 25%) of a single- (66, 79%) or multilevel disc space (18, 21%). Median operative time and estimated blood loss were 127 minutes (range, 30–331 minutes) and 350 mL (range, 0–2940 mL). The overall complication rate was 23.8%. Postoperative complications included six blood transfusions (7%), three patients with retrograde ejaculation (3.57%) or surgical site infection; two with a prolonged ileus (2.38%) or ventral hernia and one each with a bowel obstruction (1, 1.19%), deep venous thrombosis or lymphocele. All-cause mortality was 1%. In conclusion, a team approach can minimize complications while offering the technical benefits and durability of an anterior approach to the lumbar spine.

scholarly journals Tourniquet Use in Wide-Awake Carpal Tunnel Release

Hand ◽  
2018 ◽  
Vol 15 (1) ◽  
pp. 59-63 ◽  
Author(s):  
Sarah E. Sasor ◽  
Julia A. Cook ◽  
Stephen P. Duquette ◽  
Elizabeth A. Lucich ◽  
Adam C. Cohen ◽  
...  
Keyword(s):  
Blood Loss ◽  
Carpal Tunnel ◽  
Local Anesthetic ◽  
Operative Time ◽  
Carpal Tunnel Release ◽  
Estimated Blood Loss ◽  
Tunnel Syndrome ◽  
Clinically Significant ◽  
Without Tourniquet ◽  
Wide Awake

Background: Carpal tunnel syndrome is a common cause of upper extremity discomfort. Surgical release of the median nerve can be performed under general or local anesthetic, with or without a tourniquet. Wide-awake carpal tunnel release (CTR) (local anesthesia, no sedation) is gaining popularity. Tourniquet discomfort is a reported downside. This study reviews outcomes in wide-awake CTR and compares tourniquet versus no tourniquet use. Methods: Wide-awake, open CTRs performed from February 2013 to April 2016 were retrospectively reviewed. Patients were divided into 2 cohorts: with and without tourniquet. Demographics, comorbidities, tobacco use, operative time, estimated blood loss, complications and outcomes were compared. Results: A total of 304 CTRs were performed on 246 patients. The majority of patients were male (88.5%), and the mean age was 59.9 years. One hundred patients (32.9%) were diabetic, and 92 patients (30.2%) were taking antithrombotics. Seventy-five patients (24.7%) were smokers. A forearm tourniquet was used for 90 CTRs (29.6%). Mean operative time was 24.97 minutes with a tourniquet and 21.69 minutes without. Estimated blood loss was 3.16 mL with a tourniquet and 4.25 mL without. All other analyzed outcomes were not statistically significant. Conclusion: Operative time was statistically longer and estimated blood loss was statistically less with tourniquet use, but these findings are not clinically significant. This suggests that local anesthetic with epinephrine is a safe and effective alternative to tourniquet use in CTR. The overall rate of complications was low, and there were no major differences in postoperative outcomes between groups.

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