Comparison of lateral transperitoneal and retroperitoneal approaches for homolateral laparoscopic adrenalectomy

Background There is a lack of data regarding the appropriateness of transperitoneal and retroperitoneal approaches for homolateral laparoscopic adrenalectomy. The aim of this study is to compare lateral transperitoneal and retroperitoneal approach for left-sided and right-sided laparoscopic adrenalectomy respectively. Methods Between January 2014 and December 2019, 242 patients underwent left-sided and 252 patients underwent right-sided laparoscopic adrenalectomy. For left side, transperitoneal approach was used in 132 (103 with tumors < 5 cm and 29 with tumors ≥ 5 cm) and retroperitoneal approach in 110 (102 with tumors < 5 cm and 8 with tumors ≥ 5 cm). For right side, transperitoneal approach was used in 139 (121 with tumors < 5 cm and 18 with tumors ≥ 5 cm) and retroperitoneal approach in 113 (102 with tumors < 5 cm and 11 with tumors ≥ 5 cm). Patient characteristics and perioperative outcomes were recorded. For each side, both approaches were compared for tumors < 5 cm and ≥ 5 cm respectively. Results For left-sided tumors < 5 cm, transperitoneal approach demonstrated shorter operative time, less blood loss and longer time to oral intake. For left-sided tumors ≥ 5 cm, the peri-operative data of both approaches was comparable. For right-sided tumors < 5 cm, transperitoneal approach demonstrated shorter operative time and less blood loss. For right-sided tumors ≥ 5 cm, the peri-operative data was comparable. Conclusions Lateral transperitoneal and retroperitoneal approach are both effective for laparoscopic adrenalectomy. Lateral transperitoneal approach is faster with less blood loss for tumors < 5 cm.

Frailty in the over 65’s undergoing elective surgery (FIT-65) – a three-day study examining the prevalence of frailty in patients presenting for elective surgery

Background Frailty increases the risk of perioperative complications, length of stay, and the need for assisted-living after discharge. As the UK population ages the number of frail patients presenting for elective surgery in the UK is likely to grow. Despite the potential benefits of early diagnosis, frailty is not uniformly screened for in UK elective surgical patients and its prevalence remains unclear. The primary aim of this study was to assess the prevalence of frailty in patients aged over 65 years undergoing elective surgery. Methods We performed a prospective cross-sectional observational study in eight UK hospitals. Data were collected over three consecutive days with follow-up at 30 days. HRA approval was obtained (REC 20/SC/0121) and signed informed consent obtained. Participants were eligible for inclusion if they were 65 years or older and undergoing elective surgery. Pre-operative data were collected from hospital notes by anaesthetic trainees. A member of the research team blinded to the pre-operative dataset screened the participant for frailty pre-operatively using the Reported Edmonton Frail Scale (REFS). Post-operative data were collected from the notes on day of surgery and at 30 days. Participants were defined as “frail” if they scored 8 or more on the REFS. Results 228 participants were recruited during the study period of whom 218 proceeded to surgery. There were 103 females and 115 males. Median age was 75 years (interquartile range 70-80). Thirty-seven participants (17.0%) were identified as frail. Frail patients were older, had a higher ASA score, were more likely to have carers and were more likely to be anaemic and present with ECG abnormalities. There were no differences in gender, BMI, place of residence or smoking status for patients identified as frail versus non-frail. There was no difference in length-of-stay between frail and non-frail patients, although those identified as frail were less likely to be discharged to their own home. Conclusion We found the prevalence of frailty in a mixed population of elective surgical patients aged 65 or over to be 17.0%. Furthermore, we found the REFS to be a practical tool for pre-operative frailty screening. Frail patients presented for elective surgery with modifiable co-morbidities which could have been optimised pre-operatively. Early screening could highlight frail patients, allowing time for pre-operative planning and evidence-based optimisations of comorbidities. We therefore encourage the adoption of frailty assessment as a routine part of pre-operative assessment.

393 Opportunities to Improve the Pan-Surgical Intercollegiate Elogbook: A National, Cross-Specialty Scoping Survey

Aim The Pan-surgical Intercollegiate eLogbook represents the world’s largest repository of training and operative data. ASiT have recently published concerns from a nationwide survey demonstrating widespread inaccuracies in eLogbook operative case reporting. This study aimed to add to this work by identifying opportunities to improve the way eLogbook data is used and interpreted. Method An online, self-administered, voluntary questionnaire was created on Google Forms (Google Inc, Menlo Park, CA) to explore patterns of use of the eLogbook, and highlight areas for improvement. The survey was disseminated to surgical trainees across the UK and Ireland using specialty networks and deanery training forums. Results Fifty trainees across the country from all ten surgical specialties completed the questionnaire. 54% of respondents reported using the Mobile eLogbook Application to record procedural data and 62% reported doing this on the same day of the procedure. 52% reviewed their eLogbook data less frequently than monthly. Just 16% thought the current presentation of eLogbook data were ‘very useful’ or ‘useful’. 72% were happy to record more detailed procedural data. 88% were interested in anonymously comparing procedural data with peers, and four-fifths reported that hospital or regional level data would influence their application choices. 96% reported that access to trainer’s supervision data would influence planning of their daily clinical activity. Conclusions This survey has identified several solutions for improving engagement and utility of the Intercollegiate eLogbook. Trainees report a desire to access enhanced analysis of individual, local, regional and national operative data.

Visual Outcomes of the FemtoLASIK Technology Using Excimer Lasers with Frequency More 1000 Hz in Low to Moderate Myopia Correction

Purpose: to evaluate the clinical and functional results of the operation the FemtoLASIK by excimer lasers with frequency more 1000 Hz in patients with low to moderate myopia.Patients and methods. The 84 eyes of 84 patients with low to moderate myopia who had undergone FemtoLASIK procedure using with excimer lasers: Schwind Amaris 1050 Hz (Germany) and Microscan Visum 1100 Hz (Russia) were included in the study. The “Schwind Amaris 1050 Hz” and “Microscan Visum 1100 Hz” groups were comparable in terms of pre-operative data (age, sex, corneal curvature, central thickness of the cornea, sphere, cylinder, SE) (p > 0.05). All patients underwent complete ophthalmological examination before refractive laser surgery, and also patients were examined on the 1st day and 1 month after FemtoLASIK.Results. One month postoperatively, in the “Schwind Amaris 1050 Hz” group the UDVA 1.0 or better (20/20 or better by Snellen) was achieved in 100 %, in the “Microscan Visum 1100 Hz” group — in 100 % (p > 0.05). There wasn’t observed a loss of the CDVA lines in both groups. In the “Schwind Amaris 1050 Hz” group gain of one or more lines of the CDVA was 14 %, in the “Microscan Visum 1100 Hz” group — in 12.2 % (p > 0.05). In the “Schwind Amaris 1050 Hz” group the predictability of targeted refraction within ±0.5 D was in 90.7, within ± 1.0 D — in 100 %, in the “Microscan Visum 1100 Hz” group — in 90.2 % and 100 %, respectively (p > 0.05).Conclusions. The FemtoLASIK procedure using with different high-frequency excimer lasers is an effective, safe and predictable method for correcting low to moderate myopia.

Use of GlideScope in Patients Undergoing NIM Thyroidectomy

Objectives: Thyroidectomy and parathyroidectomy using the nerve integrity monitor (NIM) require proper placement of the endotracheal tube with electrodes aligned correctly within the larynx. The purpose of this study is to determine the percentage of patients who require positional adjustments of the endotracheal tube prior to beginning surgery and to understand the value of using the GlideScope to assure proper NIM tube placement within the larynx. Methods: This prospective study examines operative data from 297 patients who underwent NIM thyroidectomy and parathyroidectomy. After routine orotracheal intubation by an anesthesiologist and positioning of the patient for surgery, a GlideScope was used to check the position of the tube in 2 planes: depth of tube placement and rotation of the tube within the larynx assuring proper placement of the electromyogram electrodes within the glottis. Results: Tube adjustment was required for 66.5% of patients. In 48.1% of cases, tube retraction or advancement to a proper depth was needed. Tube rotation was required for 30.1% of patients, and 11.8% of patients required both adjustment of tube depth and tube rotation to properly align electrodes. Conclusions: After the anesthesiologist places the NIM endotracheal tube, and the patient is positioned for surgery, additional tube adjustment is often needed prior to the start of surgery. The GlideScope is readily available in the operating suite, its use adds little time to the procedure, and assures proper NIM tube placement. The use of the GlideScope is recommended.

Functional and MRI outcomes of Superior Capsule Reconstruction with Acellular Dermal Matrix

Objectives: Superior capsular reconstruction (SCR) is an emerging treatment option for irreparable massive rotator cuff tears (MRCT). The initial description utilized fascia lata autograft, but acellular dermal matrix (ADM) has become the graft of choice in the United States. Several reports have demonstrated excellent short-term functional improvement and patient satisfaction, but there is limited data correlating imaging studies of graft integrity to functional outcome. The purpose of this study was to determine if functional outcome after SCR is dependent on dermal allograft integrity on post-operative MRI. Methods: Inclusion criteria were patients who underwent an SCR by one of 5 fellowship-trained surgeons at a single institution for the indication of pain attributable to irreparable MRCT that failed non-operative treatment. Exclusion criteria included arthritis, prior infection, revision SCR, and less than 6 months follow-up. Pre- operative data including age, gender, prior surgery, Hamada grade, and Goutallier stage were recorded. Intra-operative data including surgical findings and concomitant procedures were recorded. Pre- and post-operative acromiohumeral distance (AHD), American Shoulder and Elbow Surgeons (ASES), Oxford, visual analogue scale (VAS) and post-operative SANE score were recorded. In 90% of cases, a 3 mm ADM was used and in 10% of cases, a 6 mm ADM was used (doubled over 3 mm graft). All grafts were fixed by a double-row, trans-osseous equivalent technique on the tuberosity and with a mean of 3 anchors on the glenoid. Patients were routinely offered to undergo an MRI postoperatively regardless of symptoms. Results: 53 patients met our inclusion criteria. Mean age was 60.1+7.9 years (range 34 to 77). 68% were male; 34% had at least one prior procedure; 58% had a concomitant procedure; 57% were Hamada 1, 38% Hamada 2, and 5% Hamada 3. Pre-op Goutallier stage was 3.7% grade 0, 17% grade 1, 40% grade 2; 26% grade 3; 13% grade 4. The mean clinical follow-up was 15+7.8 months (range 6-42 months). 81% of patients underwent an MRI post-operatively. The mean time for MRI was 14+7 months (range 6 -40). MRI revealed that 38% had a completely intact graft, 33% had a tear from the glenoid, 12% had a mid-substance tear, 14% tear from the tuberosity, and 2% had complete graft absence. There was a significant improvement in ASES (37.7 to 79.5, P<0.0001), Oxford (26.3 to 44, P<0.0001), and VAS (7 vs 2.3, P<0.0001). There was no difference between pre-op and post-op AHD (7.3 mm vs 6.9mm, P=0.57). There was no association between pre-operative AHD (P=0.9), Goutallier stage (P=0.43), Hamada grade (P=0.49) with post-operative ASES scores. There was a significant correlation between graft integrity with final outcome. There was no difference in post-operative ASES score when the graft was completely intact or torn from the glenoid (P=0.39), but graft tear from the tuberosity resulted in a significantly lower ASES score (P=0.013). Conclusions: In patients who undergo SCR for MRCT, there is significant improvement in ASES, Oxford, and VAS. This improvement is seen in patients who have an intact graft, as well as those where the graft is torn from the glenoid, but not those torn from the tuberosity. This supports the concept of the graft functioning as a ”biologic tuberoplasy” preventing bone-to-bone contact between the tuberosity and acromion. Preoperative AHD, Goutallier, Hamada, gender, or age did not have an association with post-operative ASES scores.