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2022 ◽  
Vol 8 ◽  
Author(s):  
Maik Sahm ◽  
Clara Danzer ◽  
Alexis Leonhard Grimm ◽  
Christian Herrmann ◽  
Rene Mantke

Background and AimsPublished studies repeatedly demonstrate an advantage of three-dimensional (3D) laparoscopic surgery over two-dimensional (2D) systems but with quite heterogeneous results. This raises the question whether clinics must replace 2D technologies to ensure effective training of future surgeons.MethodsWe recruited 45 students with no experience in laparoscopic surgery and comparable characteristics in terms of vision and frequency of video game usage. The students were randomly allocated to 3D (n = 23) or 2D (n = 22) groups and performed 10 runs of a laparoscopic “peg transfer” task in the Luebeck Toolbox. A repeated-measures ANOVA for operation times and a generalized linear mixed model for error rates were calculated. The main effects of laparoscopic condition and run, as well as the interaction term between the two, were examined.ResultsNo statistically significant differences in operation times and error rates were observed between 2D and 3D groups (p = 0.10 and p = 0.72, respectively). The learning curve showed a significant reduction in operation time and error rates (both p's < 0.001). No significant interactions between group and run were detected (operation time: p = 0.342, error rates: p = 0.83). With respect to both endpoints studied, the learning curves reached their plateau at the 7th run.ConclusionThe result of our study with laparoscopic novices revealed no significant difference between 2D and 3D technology with respect to performance time and the error rate in a simple standardized test. In the future, surgeons may thus still be trained in both techniques.


2022 ◽  
Vol 19 (1) ◽  
pp. 1-4
Author(s):  
Naresh Man Shrestha

Introduction: Urinary bladder stone occupies only 5% of all urinary tract stone. Various techniques have been used for the management of bladder stone. Open Cystolithotomy is the traditional treatment but a percutaneous approach has been also in practice. Aims: To confirm the best options between open cystolithotomy and percutaneous cystolithotripsy for the treatment of bladder stone. Methods: It is a prospective hospital based study from May 2019 to January 2021 in Nepalgunj Medical College. Total 42 patients with inclusion criteria were divided into two groups.  Group I was allocated to 21 patients who were treated with open cystolithotomy while Group II were allocated to 21 patients who were treated with percutaneous cystolithotripsy. Two groups were compared for stone free rate, mean hospital stay, mean postoperative scar, mean operation time and rate of post-operative complications. Results: The stone free rate in Group I was 100 % and in Group II was 90.47 %. Mean Operation time was in Group I and Group II were 40.09+ 2.48  minutes and 31.38+15.65 days,  respectively with p<0.05. Mean hospital stay was significantly low in Group II (3.71+1.87 days ) when compared to Group I (7.67+ 2.12 days) with p<0.001. Mean scar length of Group I (5.466+2.9 cm) with respect to Group II (1.04+0.09) was significantly long (p<0.01). Rate of complications were not significantly different between two groups (p>0.5). Conclusion: For management of urinary bladder stones sized up to 4 cm, both open cystolithotomy and percutaneous cystolithotripsy are effective, with a low incidence of complications. However, comparing the surgery time, hospital stay, length of scar between two procedures, percutaneous cystolithotripsy procedure is more beneficial for treatment of urinary bladder stone.


2022 ◽  
Vol 8 (1) ◽  
pp. 253-260
Author(s):  
Manpreet Singh

Background: Fractures of the proximal femur, including fractures affecting the pertrochanteric region, have become a public health problem. Owing to aging of the population, we have to operate on even more elderly patients who sometimes present with significant co-morbidities. Although conventional implants have given good results in stable peritrochanteric fractures, proximal femur locking compression plate (PFLCP) which has been recently introduced is better suited for comminuted, unstable pertrochanteric fractures and osteoporotic bones. In PF-LCP, bone-implantconstruct so formed is mechanically stable and fixation failure due to screw loosening in osteoporotic bone can be reduced. Materials &Methods: This prospective study was conducted in our institute and was approved by local ethical committee. Twenty-five consecutive patients of either sex with age more than 60 years (range, 60-84) having pertrochanteric fractures were operated upon with PFLCP. A.O classification was followed in the study and Singh’s index for osteoporosis was calculated. Operating time, blood loss and any technical difficulty with the implant were recorded. Patients were followed clinically and radiologically for union at fracture site and implant-related complications for a period of 24 months. The Harris Hip Score was used to document hip functions at final follow-up. Observations: Amongst the 25 patients, the average operation time in our study was 66.60±10.57 minutes. The average radiological union was 3.40±0.63 months (13.6 weeks). Average time for full weight bearing was 13.12±1.90 weeks. There were two cases of wound infection, one case of coxa vara and one case of a proximal screw back-out. There was no case of plate lift or screw breakage. There was no case of non-union. Conclusion: The PFLCP can be a feasible alternative to the treatment of peritrochanteric fractures. Treatment with PFLCP can provide good-to-excellent healing in osteoporotic bones having comminuted and unstable peritrochanteric fractures, with a limited occurrence of complications.


2022 ◽  
Vol 17 (1) ◽  
Author(s):  
Hao-Wei Jiang ◽  
Cheng-Dong Chen ◽  
Bi-Shui Zhan ◽  
Yong-Li Wang ◽  
Pan Tang ◽  
...  

Abstract 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.


2022 ◽  
Vol 11 (2) ◽  
pp. 436
Author(s):  
Paulina Głuszyńska ◽  
Inna Diemieszczyk ◽  
Łukasz Szczerbiński ◽  
Adam Krętowski ◽  
Piotr Major ◽  
...  

Background: Although laparoscopic sleeve gastrectomy (LSG) is considered a safe bariatric procedure in the treatment of obesity, it still involves a risk of developing postoperative complications. Knowledge of risk factors for possible complications would allow appropriate preoperative planning, optimization of postoperative care, as well as early diagnosis and treatment. The aim of this study was to evaluate risk factors for complications after laparoscopic sleeve gastrectomy. Methods: A retrospective study of 610 patients who underwent LSG at a tertiary institution were included in the study through retrospective analysis of the medical data. Complications were categorized as early (<30 days) and late (≥30 days) and evaluated according to the Clavien–Dindo Classification. Results: Early complications were observed in 35 patients (5.74%) and late complications occurred in 10 patients (1.64%). Independent risk factors of early complications after laparoscopic sleeve gastrectomy included hypercholesterolemia (OR 3.73; p-value = 0.023) and smoking (OR = 274.66, p-value < 0.001). Other factors that may influence the postoperative course are length of hospital stay and operation time. Smoking, peptic ulcer diseases and co-existence of hiatal hernia were found to be an independent predictors of late complications. Conclusions: Smoking is associated with the higher risk of both, early and late complications, while hypercholesterolemia with only <30 days complications after laparoscopic sleeve gastrectomy.


2022 ◽  
Author(s):  
chen bingqian ◽  
zhengfei wang ◽  
zhi chen ◽  
xiaohong qu ◽  
xiaowen fang ◽  
...  

Abstract Objective: To investigate the method, technique and clinical efficacy of double-row anchor suture bridge technique in the treatment of inferior pole fractures of patella, and to compare it with traditional Kirschner wire tension band internal fixation. Methods: General information A total of 62 patients were enrolled in this study, including 35 males and 27 females, aged 31-80 years old, with an average of (53.2±4) years old. All the patients were divided into two groups by a random double-blind method: Group A (double-row anchor suture bridge technique group) and Group B (Kirschner wire tension band internal fixation group), with 32 cases and 30 cases in each group, respectively. The two techniques were performed by the same group of doctors to fix the fracture respectively, and the intraoperative bleeding, operation time, incidence of postoperative complications, knee function score, etc., were compared between the two techniques. Results: Group A (double-row anchor suture bridge technique group): operation time 56-80min, with an average of (60±10) min; intraoperative blood loss 30-56ml, with an average of (43±10) ml. All incisions healed in one stage and stitches were removed after 2 weeks. No complications such as incision infection, flap necrosis and nerve injury occurred. The average healing time of the fracture was 12 weeks. At the last follow-up, the Bostman score was (28.5±3.3), and the excellent rate was 93.7%. Group B (Kirschner wire tension band internal fixation group): operation time 54-76min, with an average of (56±10) min; intraoperative blood loss 31-50ml, with an average of (43±80) ml. One patient developed delayed incision healing postoperatively. Four patients experienced Kirschner wire withdrawal, one of which was accompanied by infection. Two patients were found to have mild separation of distal fracture fragments, despite the fracture being fine. The average healing time of the fracture was 13 weeks. At the last follow-up, the Bostman score was (23.5±3.3), and the excellent rate was 86.7%. Conclusion: Double-row anchor suture bridge technique is applied to inferior pole fractures of patella by virtue of its various effects, such as the complete preservation of the inferior pole fragments during the operation, satisfactory fracture reduction, firm fixation, and meeting patients’ requirements for early postoperative ambulation. This technology is superior to traditional Kirschner wire tension band internal fixation owing to its advantages of no need to take out the internal fixation, firm fixation, no need to worry about Kirschner wire withdrawal and fewer complications, and its clinical efficacy satisfaction rate is also better than traditional surgical methods. In short, double-row anchor suture bridge technique is an ideal surgical procedure for the treatment of the inferior pole fracture of patella with safety, reliability and high satisfaction.


2022 ◽  
pp. 159101992110686
Author(s):  
Tomotaka Ohshima ◽  
Megumi Koiwai ◽  
Naoki Matsuo ◽  
Shigeru Miyachi

The COVID-19 pandemic has demanded a change in learning modalities, which led us to develop a remote personal training system for clinicians performing neuroendovascular procedures. A portable vascular model designed for practicing catheter navigation guidance, thrombus retrieval, and intracranial aneurysm coil embolisation was established. We created an environment that enabled interactive dialogue and communication across long distances using the Internet. The instructor conducted approximately 2 h of hands-on training with two to four trainees at a time. Despite the restrictions enforced by the Government of Japan due to the COVID-19 pandemic, 17 online hands-on training were successfully conducted throughout Japan over 1 year for a total of 48 trainees. The developed remote training programme, to avoid the aggregation of a large number of trainees at a developed time, proved to be at par with the conventional learning system. The training was well-received since the operation time was longer and the question and answer sessions were more fulfilling compared to the conventional format in which a group of trainees had got a brief opportunity to receive actual hands-on experience.


2022 ◽  
Author(s):  
Xuefeng Zhou ◽  
Sichao Gu ◽  
Li Li ◽  
Lei Xu ◽  
Xujin Wang ◽  
...  

Abstract Femoral neck system (FNS) , as a novel minimally invasive internal fixation device, has been gradually applied in the treatment of femoral neck fracture.However, there are few related clinical studies on FNS at present, especially there is no clinical report on FNS in treating GardenIII and IV femoral neck fractures. The aim of the present study was to compare the short-term clinical efficacy of FNS and multiple cannulated compression screws (MCCS) in the treatment of Garden III and IV femoral neck fractures. The data of 78 patients with femoral neck fracture who were admitted to three teaching hospitals affiliated to Anhui Medical University and received internal fixation with FNS and MCCS from June 2019 to December 2020 were collected for a retrospective study. There were 39 patients in both the FNS and MCCS groups. The basic data, perioperative data were recorded and compared between the two groups of patients. The results of the study are encouraging. The operation time was shorter in FNS group than that in MCCS group (p<0.001). The post-operative partial and complete weight-bearing time was earlier in FNS group than that in MCCS group (p<0.001). The Harris hip score in FNS group was higher than that in MCCS group (p<0.001). The incidence rate of lateral thigh irritation in FNS group and MCCS group was 0 (0/39) and 33.3% (13/39), respectively (χ2=15.600, p<0.001). The length of femoral neck shortening was significantly shorter in FNS group than that in MCCS group (t=-5.093, p<0.001). In conclusion, The application of FNS for Garden III and IV femoral neck fractures can shorten the operation time, reduce the frequency of intraoperative fluoroscopy, and facilitate the recovery of hip joint function, so it provides a novel choice for the treatment of Garden III and IV femoral neck fractures in young people.


2022 ◽  
Vol 2022 ◽  
pp. 1-5
Author(s):  
Ke Niu ◽  
Qingzhi Zhai ◽  
Wensheng Fan ◽  
Li’an Li ◽  
Wen Yang ◽  
...  

Objective. The aim is to investigate the efficiency and outcome of robotic-assisted sacrocolpopexy (RASC) in a cohort of patients with pelvic organ prolapse (POP) in our Gynecology Department. Methods. We performed a retrospective study of female patients who underwent RASC in Chinese PLA General Hospital from January 2013 to December 2020. Their clinical features included age, degree of prolapse, menopause time, body mass index, pregnancy, delivery, operation time, and bleeding volume. All patients were followed up for more than 6 months. POP-Q was recorded to evaluate the position of prolapsed organs. PFDI-20, PFIQ-7, and PGI-I were used to evaluate the life quality after surgery. Results. Twenty-four patients with POP received RASC in our center. The intraoperative bleeding was 86.9 ± 98.3 ml (20–300 ml). The operation time was 143.5 ± 47.3 min (60–240 minutes). The hospitalization time was 10.4 ± 2.1 days (8–16 days). And the follow-up time was 40.8 ± 22.0 months (6–72 months). In the POP-Q follow-up, postoperative Aa, Ba, Ap, Bp, and C were significantly improved than those before surgery ( P < 0.05 ). The objective and subjective cure rate was 100%. PGI-I score was very good in 9 (9/24), very good in 10 (10/24), and good in 3 (3/24). Postoperative PFDI-20 and PFIQ-7 were 2.78 ± 3.82 and 1.57 ± 3.86, which decreased dramatically after surgery ( P < 0.05 ). Mesh exposure occurred in 4 cases (16.7%) at 2–12 months. The exposed diameters were less than 1 cm in 3 cases (2 A/T3/S1) and 1-2 cm in 1 case (3 B/T3/S1). These mesh exposures healed after conservative observation or mesh excision. Conclusion. RASC for POP has the advantage of less bleeding and hospitalization time. It is a minimally invasive option for pelvic organ prolapse.


2022 ◽  
Vol 2022 ◽  
pp. 1-7
Author(s):  
Zhao Zhang ◽  
Li Li ◽  
Bo Liu ◽  
Fengen Wang ◽  
Wenli Wang ◽  
...  

The aim of this study is to clarify the influence of laparoscopic total extraperitoneal umbilical hernia repair on incision infection, complication rate, and recurrence rate in patients with an umbilical hernia (UH). Sixty-seven UH patients referred to our hospital from June 2017 to June 2019 were selected as the research participants. Thirty-six patients in the research group (RG) were treated with laparoscopic total extraperitoneal umbilical hernia repair, and the other 31 cases in the control group (CG) were treated with traditional umbilical hernia repair. The two cohorts of patients were compared with respect to the curative effect after treatment; intraoperative blood loss, operation time, postoperative pain time, ambulation time, and hospital stay; incidence of complications; pain severity (VAS) before and after operation; sleep quality (PSQI) before and after operation; patient satisfaction after treatment; and recurrence half a year after discharge. The RG presented a higher effective treatment rate ( P  < 0.05), less intraoperative blood loss, operation time, postoperative pain time, ambulation time, and hospital stay, as well as lower incidence of complications than the CG ( P  < 0.05). VAS and PSQI scores differed insignificantly between the two cohorts of patients before treatment ( P  > 0.05) but reduced after treatment, with lower VAS and PSQI scores in the RG than in the CG ( P  < 0.05). The number of people who were highly satisfied, as investigated by the satisfaction survey, was higher in the RG than in the CG, while the recurrence rate of prognosis was lower than that in the CG ( P  < 0.05). Laparoscopic total extraperitoneal umbilical hernia repair is effective for UH patients and can validly reduce the incidence of complications and recurrence rate, which has huge clinical application value.


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