Unilateral biportal endoscopic discectomy versus percutaneous endoscopic lumbar discectomy in the treatment of lumbar disc herniation: a retrospective study

Background Unilateral biportal endoscopic discectomy (UBE) is a rapidly growing surgical method that uses arthroscopic system for treatment of lumbar disc herniation (LDH), while percutaneous endoscopic lumbar discectomy (PELD) has been standardized as a representative minimally invasive spine surgical technique for LDH. The purpose of this study was to compare the clinical outcomes between UBE and PELD for treatment of patients with LDH. Methods The subjects consisted of 54 patients who underwent UBE (24 cases) and PELD (30 cases) who were followed up for at least 6 months. All patients had lumber disc herniation for 1 level. Outcomes of the patients were assessed with operation time, incision length, hospital stay, total blood loss (TBL), intraoperative blood loss (IBL), hidden blood loss (HBL), complications, total hospitalization costs, visual analogue scale (VAS) for back and leg pain, the Oswestry disability index (ODI) and modified MacNab criteria. Results The VAS scores and ODI decreased significantly in two groups after operation. Preoperative and 1 day, 1 month, 6 months after operation VAS and ODI scores were not significantly different between the two groups. Compared with PELD group, UBE group was associated with higher TBL, higher IBL, higher HBL, longer operation time, longer hospital stay, longer incision length, and more total hospitalization costs. However, a dural tear occurred in one patient of the UBE group. There was no significant difference in the rate of complications between the two groups. Conclusions Application of UBE for treatment of lumbar disc herniation yielded similar clinical outcomes to PELD, including pain control and patient satisfaction. However, UBE was associated with various disadvantages relative to PELD, including increased total, intraoperative and hidden blood loss, longer operation times, longer hospital stays, and more total hospitalization costs.

Comparison of Therapeutic Outcomes of Transabdominal Pararectus Approach and Modified Stoppa Approach in Treating Pelvic and Acetabular Fractures

Objective Pelvic and acetabular fractures are common orthopedic diseases, and this research was to investigate the therapeutic effects of pararectus and Stoppa approaches in treating complex pelvic acetabular fractures. Methods The clinical information of patients with pelvic and acetabular fractures treated surgically in Lu'an Hospital of Chinese medicine, China from January 2016 to April 2020 was analyzed. There were 30 cases each in the transabdominal pararectus approach and modified Stoppa approach groups. The operation time, incision length, blood loss, and postoperative complications of both groups were recorded according to the Merle d'Aubigné-Postel hip score. The recovery of hip function was evaluated 6 months after surgery, and the clinical and therapeutic efficacies of the two groups were compared. Results The patients were followed up for 6–7 months (average, 6.5 months). The average operation time, incision length, and blood loss in the pararectus and Stoppa approach groups were 180 ± 41.105 min, 8.667 ± 1.373 cm, 259.667 ± 382 mL and 202.667 ± 32.793 min, 11.600 ± 1.958 cm, and 353.667 ± 590 mL, respectively. The satisfactory rate of fracture reduction, excellent and good rate of hip function score, and incidence of complications were 28/30, 27/30, 1/30 and 25/30, 25/30, 3/30, respectively. There were significant differences in operation time, incision length, and blood loss between the two groups (p < 0.05). However, there was no significant difference in the excellent and good rate of hip function score, fracture reduction satisfaction, and complication rate between both groups (p > 0.05). Conclusions The pararectus approach can reveal the better anatomical structure of the pelvis and acetabulum, such as the corona mortis and quadrilateral plate, for conducive fracture reduction and fixation. It can also effectively shorten the length of the incision, reduce operative blood loss, and shorten the operation time. It is a better choice for the clinical treatment of complex pelvic and acetabular fractures.

Anatomic Study and Assembled Navigation Template-Assisted Implantation for Anterograde Transpubic Screws

Objective: Research the anatomical parameters of the anterograde transpubic screw corridor and evaluate the safety of anterograde transpubic screw placement assisted by the assembled navigation template.Methods: A total of 50 normal subjects, including 25 males and 25 females, underwent pelvic CT scanning in our hospital from January 2020 to September 2020. A 3D model of the ilium was established. The ilium was divided into zone Ⅰ, Ⅱ and Ⅲ according to Nakatani classification. The anterograde transpubic screw channel completely passes through zone Ⅰ and Ⅱ to form corridor A. The anterograde screw channel completely passes through zone Ⅰ, Ⅱ and Ⅲ to form corridor B. The diameter and length of the inner circle, the distance from the center of the inner circle to the posterior superior and to the inferior iliac spine of corridor A and corridor B were measured, respectively. A total of 9 patients underwent anterograde transpubic screw and transverse sacroiliac screw placement assisted by the assembled navigation template in our hospital, including 5 males and 4 females, were retrospectively analyzed. Operative time, blood loss, incision length and fluoroscopy times were recorded. Grading score and Matta score were evaluated after surgery.Results: In 50 normal subjects, the diameter of corridor A was 11.16±2.13 mm, and that of corridor B was 8.54±1.52mm, and the difference between the two corridors was statistically significant (P=0.000). The length of corridor A was 86.39±9.35 mm, and that of corridor B was 117.05±5.91 mm, with significant difference between the two corridors (P=0.000). The surface distance from the screw entry point to the posterior superior iliac spine in corridor A was 109.31± 11.06mm, and that in corridor B was 127.86± 8.23mm, the difference between the two corridors was statistically significant (P=0.000). The surface distance from the screw entry point to the posterior inferior iliac spine in corridor A was 91.16±10.34 mm, and that in corridor B was 106.92±7.91 mm. The difference between the two corridors was statistically significant (P=0.000). Nine patients successfully completed surgery, and a total of 18 sacroiliac transverse screws and 11 anterograde transpubic screws were inserted with the assistance of assembled navigation templates. The mean operation time of the 9 patients was 108.75±25.71 min, the blood loss was 141.11±50.21 ml, the incision length was 14±4.62 cm, and the intraoperative fluoroscopy was 17.89±4.01 times. Matta scores were excellent in 5 patients and good in 4 patients. One of the anterograde transpubic screw was in Grade 1, and 10 were in Grade 0. One S1 screw was in Grade 1, and 8 S1 screws were in Grade 0. Nine S2 screws were in Grade 0.Conclusions: Majority of the patients can accommodate anterograde transpubic screw s with diameter of 6.5 mm. Anterograde transpubic screw placement assisted by an assembled navigation template is clinically feasible, and with low cortical breaches.

Wound closure after total knee replacement: Comparison between staples and sutures

Background and Objective: Total Knee Arthroplasty is a commonly performed procedure for arthritic knees. Preventing complications is of utmost importance for good functional outcomes and preventing morbidity. Wound closure after the procedure is as important as the replacement aspect of surgery.The objective of this study was to provide subjective and objective evidence of better closure technique and material; we conducted the study so that the outcome of TKA can be further improved. Methods: We conducted a randomized trial at The Indus Hospital, Karachi, from December 2018 to June 2020. All patients from age 40 to 70 years who underwent total knee arthroplasty were included in the study. The wound of one knee was closed with Polypropylene (Prolene) sutures, and the other with staples. The wound was assessed independently by two assessors using Hollander’s score; lower score means a worse outcome. All data was entered and analyzed using STATA version 16. Results: Thirty patients who underwent bilateral total knee replacement were included in the analysis, among which 71.8% were female. The average age of participants was 57.3 (± 7.5) years. The mean incision length on the right knee was 17.6 ± 1.1 cm, while on the left the incision length was 18.3 ± 1.2 cm. Overall, the mean Hollander score was significantly different among participants in the sutures and staples group in both the right (p-value=0.001) and left knees (p-value=0.001). The score was significantly higher in knees closed with sutures as compared to staples. Also, the mean Hollander score is significantly higher in females than males in both the right knee (B=0.56, p-value=0.049) and the left knee (B=0.38, p-value=0.044). Conclusion: The study has shown that Hollander’s score was significantly higher in knees closed with sutures as compared to the patients in whom staples were used for wound closure. doi: https://doi.org/10.12669/pjms.38.ICON-2022.5782 How to cite this:Khan MA, Memon MW, Chinoy A, Javed S, Barkat R, Jiwani A. Wound closure after total knee replacement: Comparison between staples and sutures. Pak J Med Sci. 2022;38(2):340-344. doi: https://doi.org/10.12669/pjms.38.ICON-2022.5782 This is an Open Access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/3.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

Freehand Minimally Invasive Pedicle Screw Fixation and Minimally Invasive Decompression for a Thoracic or Lumbar Vertebral Metastatic Tumor From Hepatocellular Carcinoma

Objective: To compare freehand minimally invasive pedicle screw fixation (freehand MIPS) combined with percutaneous vertebroplasty (PVP), minimally invasive decompression, and partial tumor resection with open surgery for treatment of thoracic or lumbar vertebral metastasis of hepatocellular carcinoma (HCC) with symptoms of neurologic compression, and evaluate its feasibility, efficacy, and safety.Methods: Forty-seven patients with 1-level HCC metastatic thoracolumbar tumor and neurologic symptoms were included between February 2015 and April 2017. Among them, 21 patients underwent freehand MIPS combined with PVP, minimally invasive decompression, and partial tumor resection (group 1), while 26 patients were treated with open surgery (group 2). Duration of operation, blood loss, times of fluoroscopy, incision length, and stay in hospital were compared between the two groups. Pre- and postoperative visual analog scale (VAS) pain score, Oswestry Disability Index (ODI), American Spinal Injury Association (ASIA) grade, ambulatory status, and urinary continence were also recorded. The Cobb angle and central and anterior vertebral body height were measured on lateral radiographs before surgery and during follow-ups.Results: Patients in group 1 showed significantly less blood loss (195.5 ± 169.1 ml vs. 873.1 ± 317.9 ml, P = 0.000), shorter incision length (3.4 ± 0.3 vs. 13.6 ± 1.8 cm, P = 0.000), shorter median stay in hospital (4–8/6 vs. 8–17/12 days, P = 0.000), more median times of fluoroscopy (5–11/6 vs. 4–7/5 times, P = 0.000), and longer duration of operation (204.8 ± 12.1 vs. 171.0 ± 12.0 min, P = 0.000) than group 2. Though VAS significantly decreased after surgery in both groups, VAS of group 1 was significantly lower than that of group 2 immediately after surgery and during follow-ups (P &lt; 0.05). Similar results were found in ODI. No differences in the neurological improvement and spinal stability were observed between the two groups.Conclusion: Freehand MIPS combined with PVP, minimally invasive decompression, and partial tumor resection is a safe, effective, and minimally invasive method for treating thoracolumbar metastatic tumors of HCC, with less blood loss, better pain relief, and shorter length of midline incision and stay in hospital.

Electrosurgical bipolar vessel sealing versus conventional clamping and suturing for total abdominal hysterectomy

Objectives: To compare the use of Electrosurgical bipolar vessel sealing LigaSure™ small jaw instrument (LSJI) with conventional suture ligation in total abdominal hysterectomy (TAH). Methods: In this retrospective study 80 patients who underwent hysterectomy in the Gynecology and Obstetrics Department of Gulhane Education and Research Hospital between April 2017 and August 2018 were included. Two different groups that underwent Electrosurgical bipolar vessel sealing LigaSure™ small jaw instrument (LSJI) and conventional suture ligation in hysterectomy operation were analyzed retrospectively. The parameters evaluated and compared between the two groups include operation time, intraoperative blood loss, duration of hospitalization and incision length. Results: Among the parameters we compared between the two groups, there was no statistically significant difference between the amount of intraoperative blood loss (p:0.68) and the incision length (p:0.65). Among the parameters we compared between the two groups, a statistically significant difference was observed between the operation time (p:0.016) and the duration of hospitalization (p:0.01). Conclusion: Our comparison of LSJI vs. conventional ligation in hysterectomy revealed a significant difference only in operative time, where surgeries involving conventional ligation were shorter. On the other hand, incision length was evaluated in our study which has not been addressed in previous studies. There is also a need for multi-center studies that include more patients and evaluate cost-effectiveness. doi: https://doi.org/10.12669/pjms.38.1.4197 How to cite this:Ulubay M, Kinci MF, Pay RE, Dede M. Electrosurgical bipolar vessel sealing versus conventional clamping and suturing for total abdominal hysterectomy. Pak J Med Sci. 2022;38(1):---------. doi: https://doi.org/10.12669/pjms.38.1.4197 This is an Open Access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/3.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

Endoscopic and Robotic Parotidectomy for the Treatment of Parotid Tumors: A Systematic Review and Meta-Analysis

BackgroundThe goal of this review was to introduce endoscopic/robotic parotidectomy (EP/RP) and compare EP/RP against conventional parotidectomy (CP) regarding the intraoperative and postoperative parameters in the treatment of parotid tumors.MethodsA systematic literature search of medical databases (PubMed, Embase, and Cochrane Central Register of Controlled Trials) was performed from inception to November 2020 to generate relevant studies.ResultsA total of 13 eligible studies (572 patients) were included for systematic review, and 7 out of 13 comparable studies for the quantitative synthesis of outcomes. Patients who underwent EP were characterized by less intraoperative bleeding volume, shorter incision length, and higher satisfaction postoperatively (WMD, 95% CI, -42.80; - 58.23 to -27.37; p &lt; 0.01; WMD, 95% CI, -5.64; -7.88 to -3.39; p &lt; 0.01; SMD, 95% CI, 1.88; 1.46 to 2.31; p &lt; 0.01, respectively). However, operative time and risk of facial palsy exhibited no significant differences (WMD, 95% CI, -11.17; -26.71 to 4.34; p = 0.16; OR, 95% CI,0.71; 0.39 to 1.32; p = 0.28, respectively).ConclusionsOur findings suggest that the current evidence does not adequately support EP is equally safe and effective as CP. In certain selected cases, endoscopic technology has its unique advantages. For patients with strong cosmetic needs, endoscopic or robotic techniques may be an alternative through adequate preoperative evaluations.Systematic Review RegistrationInternational Prospective Register of Systematic Reviews, identifier CRD42020210299.

Risk factors associated with postoperative complications after liver cancer resection surgery in western China

Objectives Postoperative complications increase the workload of nursing staff as well as the financial and mental distress suffered by patients. The objective of this study is to identify clinical factors associated with postoperative complications after liver cancer resection surgery. Methods Data from liver cancer resections occurring between January 1st, 2019 to December 31st, 2019 was collected from the Department of Liver Surgery in West China Hospital of Sichuan University. The Kruskal–Wallis test and logistic regression were used to perform single-factor analysis. Stepwise logistic regression was used for multivariate analysis. Models were established using R 4.0.2 software. Results Based on data collected from 593 cases, the single-factor analysis determined that there were statistically significant differences in BMI, incision type, incision length, duration, incision range, and bleeding between cases that experienced complications within 30 days after surgery and those did not. Stepwise logistic regression models based on Kruskal–Wallis test and single-factor logistic regression determined that BMI, incision length, and duration were the primary factors causing complications after liver resection. The adjust OR of overweight patients and patients with obesity (stage 1) compared to low weight patients were 0.12 (95% CI:0.02–0.72) with p = 0.043 and 0.18 (95% CI:0.03–1.00) with p = 0.04, respectively. An increase of 1 cm in incision length increased the relative risk by 13%, while an increase of 10 min in surgical duration increased the relative risk by 15%. Conclusions The risk of postoperative complications after liver resection can be significantly reduced by controlling factors such as bleeding, incision length, and duration of the surgery.

Comparison of Femoral Neck System Versus Dynamic Hip System Blade for the Treatment of Femoral Neck Fracture in Young Patients: A Retrospective Study

Background: Femoral neck fracture is a common fracture in orthopedic practice. This study aimed to compare the clinical outcomes between the femoral neck system and dynamic hip system blade for the treatment of femoral neck fracture in young patients.Methods: This retrospective study included 43 and 52 patients who underwent treatment for femoral neck fracture with the femoral neck system and dynamic hip system blade, respectively, between August 2019 and February 2020. Operative indexes, including operation duration, blood loss, incision length, postoperative complications (femoral neck shortening, non-union, screw pull-out, femoral head necrosis), and Harris scale scores (preoperative and postoperative) were recorded and analyzed. Results: Compared to that with the dynamic hip system blade, the femoral neck system showed significantly less operation duration (femoral neck system vs dynamic hip system blade: 47.09±9.19 vs 52.90±9.64, P=0.004), less blood loss (48.53±10.69 vs 65.31±17.91, P<0.001), and shorter incision length (4.04±0.43 vs 4.93±0.53, P<0.001), but more expensive hospitalization charge (51224.14±2289.81 vs 41468.73±2431.05, P<0.001). Femoral neck shortening was significantly lower with the femoral neck system than with the dynamic hip system blade (3.93±2.40, n=39 vs 5.22±2.89, n=44, P=0.031). No statistical differences were observed between the two groups in nonunion, screw pull-out, and femoral head necrosis. In addition, the latest follow-up Harris scale score was significantly higher with the femoral neck system than with the dynamic hip system blade (92.3±4.5 vs 89. 9±4.9, P=0.015).Conclusion: The femoral neck system results in less trauma, less femoral neck shortening, and better hip joint function than the dynamic hip system blade for the treatment of femoral neck fracture in young patients.