operator experience
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2022 ◽  
Vol 12 (1) ◽  
Author(s):  
Pei-Rong Gao ◽  
Chi-Hui Wang ◽  
Yu-Jr Lin ◽  
Yu-Huei Huang ◽  
Ya-Ching Chang ◽  
...  

AbstractThe automated blister epidermal micrograft (ABEM) is a newly introduced surgical transplantation for refractory vitiligo. Comparative analysis of other surgical methods is lacking. We conducted a retrospective study to compare the efficacy, safety, and experience of ABEM with conventional suction blister epidermal graft (SBEG). A total of 118 anatomically based vitiligo lesions from 75 patients were included. The primary outcome was the degree of repigmentation; the patient and operator experience were evaluated. SBEG had a significantly greater incidence of repigmentation (p < 0.001), as measured by the Physician Global Assessment, as well as improvements in the Vitiligo Area Scoring Index, particularly on the face/neck area (p < 0.001). ABEM, on the contrary, had reduced donor harvest time, a better patient operative experience, and more significant Dermatology Life Quality Index improvements. In a subgroup of 38 lesions from ten patients who received both SBEG and ABEM concomitantly, there was no difference in the degree of repigmentation in the same recipient area. Overall, the degree of repigmentation for SBEG is higher than ABEM, especially in the mobilized region, and the cost is less expensive. On the contrary, ABEM requires less procedure learning curve and can supply a greater transplanting zone with shorter donor site recovery. Understanding the benefits and drawbacks of two blister grafting procedures is essential for optimal surgical outcomes for vitiligo grafting.


Neurospine ◽  
2021 ◽  
Vol 18 (4) ◽  
pp. 806-815
Author(s):  
Huizhi Guo ◽  
Huasheng Huang ◽  
Yang Shao ◽  
Qiuli Qin ◽  
De Liang ◽  
...  

Objective: Pulmonary cement embolism (PCE) is an underestimated but potentially fatal complication after cement augmentation. Although the treatment and follow-up of PCE have been reported in the literature, the risk factors for PCE are so far less investigated. This study aims to identify the preoperative and intraoperative risk factors for the development of PCE.Methods: A total of 1,373 patients treated with the polymethylmethacrylate (PMMA) augmentation technique were retrospectively included. Patients with PCE were divided into vertebral augmentation group and screw augmentation group. Possible risk factors were collected as follows: age, sex, bone mineral density, body mass index, diagnosis, comorbidity, surgical procedure, type of screw, augmented level, number of augmented vertebrae, fracture severity, presence of intravertebral cleft, cement volume, marked leakage in the paravertebral venous plexus, and periods of surgery. Binary logistic regression analyses were used to analyze independent risk factors for PCE.Results: PCE was identified in 32 patients, with an incidence rate of 2.33% (32 of 1,373). For patients who had undergone vertebral augmentation, marked leakage in the paravertebral venous plexus (odds ratio [OR], 0.012; 95% confidence interval [CI], 0.001–0.103; p = 0.000) and previous surgery (OR, 0.161; 95% CI, 0.042–0.610; p = 0.007) were independent risk factors for PCE. Regarding patients who had undergone screw augmentation, the marked leakage in the paravertebral venous plexus (OR, 0.042; 95% CI, 0.005–0.373; p = 0.004) was the main risk factor.Conclusion: Marked leakage in the paravertebral venous plexus and previous surgery were significant risk factors related to PCE. Paravertebral leakage and operator experience should be concerned when performing PMMA augmentation.


2021 ◽  
Vol 10 (24) ◽  
pp. 5917
Author(s):  
Paolo Pesce ◽  
Francesco Bagnasco ◽  
Nicolò Pancini ◽  
Marco Colombo ◽  
Luigi Canullo ◽  
...  

(1) Background: Intraoral scanners (IOS) are widely used in prosthodontics. However, a good trueness is mandatory to achieve optimal clinical results. The aim of the present in vitro study was to compare two IOS considering the operator’s experience and different implant clinical scenarios. (2) Methods: Two IOS (IT—Itero, Align Technology; and OS—Opera MC, Opera System, Monaco) were compared simulating three different clinical scenarios: single implant, two implants, and full-arch rehabilitation. Ten scans were taken for each configuration by two different operators (one expert, one inexperienced); influence of operator experience and the type of scanner used was investigated. (3) Results: Trueness of the scans differed between the experienced and non-experienced operator and this difference was statistically significant in all the three scenarios (p = 0.000–0.001, 0.037). A significant difference was present between the scanners (p = 0.000), in the two-implant and full-arch scenarios (p = 0.00). (4) Conclusions: Experience of the operator significantly affect trueness of IT and OP scanners. A statistically significant difference was present among IOS in the two-implant and full-arch scenarios.


2021 ◽  
Author(s):  
Wouter J. Bom ◽  
Frank Joosten ◽  
Marcel van Borren ◽  
E.p. Bom ◽  
R.r.j.p. van Eekeren ◽  
...  

Objective: Radiofrequency ablation (RFA) is increasingly considered the prime option for treating symptomatic, benign, non-functioning thyroid nodules (NFTN). However, little is known about the degree of operator experience required to achieve optimal results. This study describes the RFA learning curve of a single-centre team. Methods: Retrospective cohort study of the first 103 patients receiving RFA treatment for a single, symptomatic, and benign NFTN, with a follow-up of at least one year. Primary outcome measure was technique efficacy, defined as the percentage of patients with a 6-month nodal volume reduction ratio (VRR) > 50% after single-session RFA. Optimal treatment efficacy was defined as a 6-month VRR > 50% achieved in at least 75% of patients. Secondary outcomes were complications of RFA and indications of secondary interventions. Results: Median nodal volume at baseline was 12.0 ml (range 2.0–58.0 ml). A 6-month VRR > 50% was achieved in 45% of the first 20 patients, 75% of the next 20, and 79% of the following 63 patients. Complications included minor bleeding (N = 4), transient hyperthyroidism (N = 4), and transient loss of voice (N = 1). Poor volume reduction or nodular regrowth led to diagnostic lobectomy in 11 patients and a second RFA in five. Lobectomy revealed a follicular carcinoma (T2N0M0) in two patients. In one patient, nodule regrowth was caused by an intranodular solitary B-cell lymphoma. Conclusion: About 40 procedures are required to achieve a 6-month VRR > 50% in the majority of patients. Appropriate follow-up with re-evaluation is recommended for all patients with a VRR < 50% and in those with regrowth to exclude underlying malignancy.


2021 ◽  
pp. 1-13

OBJECTIVE The long-term safety and efficacy of intrasaccular flow disruption (IFD) for the treatment of brain aneurysms remain unclear. With accumulating experience and increasing use of IFD devices, recent studies have provided additional data regarding their outcomes. This review summarizes the long-term outcomes of IFD-treated brain aneurysms. METHODS A systematic literature review was performed on May 23, 2021, in PubMed, Web of Science, and Ovid MEDLINE for aneurysm treatment outcomes with IFD devices. Procedural details, including use of adjunctive devices and complications, were collected. The quality of studies was assessed using the Downs and Black checklist. Angiographic outcomes were classified as complete occlusion, residual neck, and residual aneurysm. Other outcomes included need for retreatment, permanent neurological deficit, and mortality. Pooled analyses were performed. RESULTS The final analysis comprised 1217 patients with 1249 aneurysms from 22 studies. The mean aneurysm diameter and neck width were 6.9 and 4.5 mm, respectively, and 27.6% of aneurysms were ruptured. The complete occlusion rates at 12 months and final follow-up (pooled mean duration 15.7 months) were 50.1% and 58.2%, respectively. Adjunctive devices were used in 6.4% of cases. The rates of hemorrhage, symptomatic infarction, permanent neurological deficit, and mortality were 1.2%, 2.8%, 1.0%, and 2.6%, respectively. CONCLUSIONS IFD is a very safe treatment for appropriately selected brain aneurysms with low complication and neurological deterioration rates. However, complete occlusion is achieved in only half of IFD-treated aneurysms at 1 year with a modest increase beyond this time point. As the majority of the studies were single arm, the pooled data are subject to selection and reporting biases. Future device developments, increased operator experience, and direct comparisons with alternative endovascular strategies and surgical clipping may clarify the role of IFD in aneurysm management.


2021 ◽  
pp. 1-9
Author(s):  
Ayoub Dakson ◽  
Michelle Kameda-Smith ◽  
Michael D. Staudt ◽  
Pascal Lavergne ◽  
Serge Makarenko ◽  
...  

OBJECTIVE External ventricular drainage (EVD) catheters are associated with complications such as EVD catheter infection (ECI), intracranial hemorrhage (ICH), and suboptimal placement. The aim of this study was to investigate the rates of EVD catheter complications and their associated risk factor profiles in order to optimize the safety and accuracy of catheter insertion. METHODS A total of 348 patients with urgently placed EVD catheters were included as a part of a prospective multicenter observational cohort. Strict definitions were applied for each complication category. RESULTS The rates of misplacement, ECI/ventriculitis, and ICH were 38.6%, 12.2%, and 9.2%, respectively. Catheter misplacement was associated with midline shift (p = 0.002), operator experience (p = 0.031), and intracranial length (p < 0.001). Although mostly asymptomatic, ICH occurred more often in patients receiving prophylactic low-molecular-weight heparin (LMWH) (p = 0.002) and those who required catheter replacement (p = 0.026). Infectious complications (ECI/ventriculitis and suspected ECI) occurred more commonly in patients whose catheters were inserted at the bedside (p = 0.004) and those with smaller incisions (≤ 1 cm) (p < 0.001). ECI/ventriculitis was not associated with preinsertion antibiotic prophylaxis (p = 0.421), catheter replacement (p = 0.118), and catheter tunneling length (p = 0.782). CONCLUSIONS EVD-associated complications are common. These results suggest that the operating room setting can help reduce the risk of infection, but not the use of preoperative antibiotic prophylaxis. Although EVD-related ICH was associated with LMWH prophylaxis for deep vein thrombosis, there were no significant clinical manifestations in the majority of patients. Catheter misplacement was associated with operator level of training and midline shift. Information from this multicenter prospective cohort can be utilized to increase the safety profile of this common neurosurgical procedure.


2021 ◽  
Vol 14 (11) ◽  
pp. e245688
Author(s):  
Prashanth Reddy ◽  
Mudassar Kamran ◽  
Satya Narayana Patro

An elderly patient presented with acute-onset right-sided weakness and aphasia. A large penumbra was noted in the left middle cerebral artery (MCA) territory without any infarct core. The patient was noted to have a carotid–carotid bypass. This posed certain technical challenge in accessing the intracranial circulation across the carotid bypass; however, the guiding catheter with soft distal segment was successfully navigated coaxially over the aspiration catheter across the bypass and intracranial circulation was accessed for mechanical thrombectomy. Complete recanalisation and reperfusion were achieved with significant neurological recovery of the patient post-thrombectomy. The aim of this report is to emphasise on this rarely encountered situation in thrombectomy and its successful management. The procedure should not be delayed or deferred due to lack of operator experience.


Author(s):  
Ivo Bach ◽  
Pratit Patel ◽  
Taha Nisar ◽  
Amit Singla ◽  
Priyank Khandelwal

Introduction : The transradial approach (TRA) has recently been adopted by neurointerventionalists and is now widely used. Among some of the benefits of TRA are reduced access site complications, increased patient comfort, earlier ambulation, and decreased time for postprocedural monitoring. The Distal transradial access method (dTRA) involves accessing the radial artery via the anatomic snuffbox and is practiced due to the belief that it may mitigate some of the complications seen with conventional TRA including but not limited to hand positioning, patient comfort (especially in those with shoulder injuries), and radial artery occlusion. Methods : A retrospective chart review was done of all patients on whom dTRA was performed between October 2018 until March 2020. Procedures were performed by 1 neuroendovascular fellow under the supervision of 2 neuroendovascular attendings. Although the number of cases was counted serially, cases were excluded from analysis if there was occlusion of the radial artery, aberrant origin of the subclavian artery was present, or if there was an intervention other than just diagnostic angiography (including but not limited to stenting, coiling, mechanical thrombectomy, intra‐arterial verapamil for cerebral vasospasm). Procedures were performed under local anesthetic and conscious sedation. Patient demographics, procedural complications, procedural time, total fluoroscopy time, and total radiation were collected. Results : Fifty‐seven cases were included in the analysis. The age of the patients ranged from 16 to 78. Thirty‐one cases out of the included cases were outpatient same‐day procedures. The total length of stay in these cases was a total of 444 minutes or 7.4 hours and they were discharged 213 minutes or 3.55 hours following the procedure on average. The highest rate of improvement in total fluoroscopy per vessel, total radiation per vessel, and case time per vessel occurs in the first 50 cases. When the 57 cases were broken down into 3 groups of 19and analyzed with ANOVA there was a significant difference between groups (Fluoro per Vessel p = 0.0003, Total radiation per vessel p = 0.0001, Duration of case per vessel p = 0.05). No major complications or significant bleeding were noted post‐procedurally. Vasospasm was the most common complication occurring in 5 and occurred within the first 25 cases. Conversion to conventional radial occurred in 4 of 57 cases. Two cases were converted due to vasospasm and 2 due to the inability to successfully puncture. Conclusions : Distal radial access in the anatomical snuffbox has been shown to have some benefits over conventional radial access. For those willing to adopt this practice, we have shown that a single operator can expect the greatest improvement within the first 50 cases.


2021 ◽  
Author(s):  
Yixiang Jin ◽  
Daniel Alonso Paredes Soto ◽  
John Anthony Rossiter ◽  
Sandor M. Veres

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