Intraoperative MRI in trans-sphenoidal surgery using frameless stereotaxis

Background: Intraoperative magnetic resonance imaging (iMRI) has been used for pituitary surgery for approximately 20 years. The introduction of frameless stereotaxis allows efficient navigation for both the ENT and neurosurgeon. This allows flexibility in placement of the patients head to facilitate resection, efficient use of theater time and improves the safety profile of the operation. This is the first study to describe and investigate the use of frameless stereotaxis in conjunction with iMRI. Methods: Consecutive patients who underwent iMRI guided trans-sphenoidal debulking using frameless stereotaxis over a 3-year period, from January 2016 to June 2019, were included in this case series and reviewed retrospectively. The use of AxiEM (Medtronic, USA) tracker facilitated frameless stereotaxis in conjunction with iMRI for trans-sphenoidal debulking of sellar lesions based on the “twin-operating” model. Results: The cohort of 47 patients had a mean age of 55 years with a slight female predilection. The average lesion size measured 20 mm (3–46 mm) in maximal diameter with objective evidence of visual deterioration being the most common indication to consider surgery. The use of iMRI identified two patients with suboptimal decompression facilitating further resection in the same anesthetic and one hemorrhagic complication requiring evacuation and hemostasis to reduce postoperative morbidity. Conclusion: This study describes the procedural nuances in the use of frameless stereotaxis for iMRI in transsphenoidal surgery to further reduce morbidity and improve outcomes, as well as improving theater utilization and reducing cost.

Otology practice during COVID-19 era: a review of current practice

Background The novel coronavirus started as an outbreak in Wuhan, China, in December 2019.The outbreak was declared a pandemic by the WHO on 12 March 2020. The virus is called SARS-CoV-2, and the virus-induced disease is called COVID-19. The infection spreads via droplets or direct contact with contaminated surfaces. Airborne transmission occurs during aerosol-generating procedures on patients. Many otologic procedures are considered AGPs and therefore require precautions to protect staff and patients and minimize transmission of the disease. Main body Outpatient otology activity has seen changes, including virtual clinics and limitation of face-to-face consultations, to ensure safety. Powered instrumentation should be avoided during surgical procedures unless necessary or replaced with other tools, and if performed, enhanced personal protective equipment (PPE) must be used. Ear, nose, and throat (ENT) examination is recommended for any patient with full PPE in place except for consultations done without examination. Systemic steroid administration for treating conditions such as Bell’s palsy and sudden sensorineural hearing loss should be discussed with both the patient and infectious diseases specialist to weigh risks against benefits. Triaging of patients and prioritization is unavoidable during the pandemic and even after due to the limitations of clinic and theater time. All emergency/urgent cases are considered potentially COVID-19 positive. For the semi-urgent and all elective cases, COVID-19 testing 48 h prior to surgery, strict quarantine awaiting test results, and repeat testing on day of surgery if rapid tests are available are the precautions suggested. Different measures should be in place to minimize staff potential exposure intraoperatively. Conclusions Otology practice has been affected by the COVID-19 pandemic. Various measures are in place to ensure the delivery of safe and effective service for patients and health care workers.

Dnipropetrovsk Ukrainian academic youth theater in the contemporary sociocultural context

The purpose of this article is concentrated by researcher into revealing of the particularity for modern theater on the example Dnipropetrovsk Ukrainian academic youth theater. The author studies performances for young people that the theater has in its repertoire. The dialogue between the theater and the audience has its own scientific interest for the author. The author uses the most effective methods of scientific research. The author has a need to understand the peculiarities of the style of acting and directing. It is also necessary to understand the general style of the theater. This position is significant, because there is a specificity in the interpretation of theatrical performance. Scientific novelty. This article has its own peculiarity. The author aims to determine for the first time the main provisions of the activities of the Ukrainian academic theater for youth from the Dnieper. To achieve this goal, the author of the article makes an analysis in which there is a specific meaning of the theater's activities, the subject of this research. Theater is analyzed as an artistic value. The author assesses the state of the collective as a theater historian. The activity of the theater is analyzed in the context of the functioning of modern theater culture. This is what makes it possible to understand the features of the historical phenomenon. It combines the present with the past. It aims to understand the perspective of contemporary theater time in the future. Methods. The performances of this theater have the characteristics of a synthetic genre. These performances have the ability to explain the nature of the interaction between theater and music. Therefore, research methods are based on the synthesis of various areas of scientific activity. In which there are various scientific disciplines. Specifically: the structural system of the history of the theater, the use of analytical methods in the analysis of drama, direction, skill of actors, singing, orchestra work, scenography. The author explores their analogies and connections, what unites them and what is opposition. Conclusions. The performances of the Ukrainian academic theater for young people from Dnipro are of different genres. The principles of the dialogue between the theater system and the audience, which exists in mutual exchange, are revealed in these performances. The author notes the real mutual cooperation between the theater and the audience. At the same time, there is an addition of one dramatic tradition to another. You can also observe how professional directors worked with the texts of the plays. The fact of how the structure and style of the performance is changing is significant. The academic professional artistic transformation of vocational performances in modern society is essential relevant.

Bangla Technique of Laparoscopic Cholecystectomy: a Novel, Safe and Cost-effective modification of American and French Techniques (Preprint)

BACKGROUND Laparoscopic cholecystectomy (LC) can be performed by following either of the two approaches proposed by the American and the French school. The two approaches have comparable operative times, but use different arrangements for the patient’s and operators’ positions, and sites for port insertions. OBJECTIVE The aim of the present paper is to describe an alternative to the American and the French approaches, referred to as the Bangla technique, which uses a standard four port approach but requires the presence of only one assistant along with the surgeon. It is hoped that the Bangla technique will improve surgery outcomes for gallbladder disease patients and encourage healthcare professionals in resource-poor settings to adopt minimally invasive/laparoscopic approaches to surgical problems. METHODS The sample consisted of a total of 280 gallbladder disease retrospective observational cases (of which 21 were children between 6 and 16 of age) who were treated with the Bangla technique at the South Point Hospital Chittagong, Bangladesh, between January 2018 and February 2020. RESULTS Surgery data showed that using the Bangla technique, the average operating time and average operation theater time were36.25 and 45.9 minutes, respectively. Of the patients, 86% left the hospital on the same day of operation, while the remaining left the following day. In 91.7% of the cases, there were no complications, while content leakage and bleeding occurred in 6.7% and 1.4% cases, respectively. CONCLUSIONS The proposed LC technique will benefit infection prevention and control by reducing the number of personnel in the operation theatre (one assistant and the surgeon) and, as such, reducing surgery-related expenses, which can be further decreased by using only one monitor. More so, the Bangla technique can be combined with the cystic artery sparing technique to reduce the risk of injury to the common bile duct and bleeding.

Bangla Technique of Laparoscopic Cholecystectomy: a Novel, Safe and Cost-effective modification of American and French Techniques

and KeywordsBackgroundLaparoscopic cholecystectomy (LC) can be performed by following either of the two approaches proposed by the American and the French school. The two approaches have comparable operative times, but use different arrangements for the patient’s and operators’ positions, and sites for port insertions.The aim of the present paper is to describe an alternative to the American and the French approaches, referred to as the Bangla technique, which uses a standard four port approach but requires the presence of only one assistant along with the surgeon. It is hoped that the Bangla technique will improve surgery outcomes for gallbladder disease patients and encourage healthcare professionals in resource-poor settings to adopt minimally invasive/laparoscopic approaches to surgical problems.MethodsThe sample consisted of a total of 280 gallbladder disease retrospective observational cases (of which 21 were children between 6 and 16 of age) who were treated with the Bangla technique at the South Point Hospital Chittagong, Bangladesh, between January 2018 and February 2020.ResultsSurgery data showed that using the Bangla technique, the average operating time and average operation theater time were36.25 and 45.9 minutes, respectively. Of the patients, 86% left the hospital on the same day of operation, while the remaining left the following day. In 91.7% of the cases, there were no complications, while content leakage and bleeding occurred in 6.7% and 1.4% cases, respectively.ConclusionThe proposed LC technique will benefit infection prevention and control by reducing the number of personnel in the operation theatre (one assistant and the surgeon) and, as such, reducing surgery-related expenses, which can be further decreased by using only one monitor. More so, the Bangla technique can be combined with the cystic artery sparing technique to reduce the risk of injury to the common bile duct and bleeding.Mini AbstractLaparoscopic cholecystectomy can be performed following the American or the French approach. The present paper proposes an alternative to the American and the French approaches referred to as the Bangla technique, which uses a standard four port approach but requires the presence of only one assistant along with the surgeon.

Percutaneous Hernia Repair in Children: Safe to introduce

Background and Aims: In 2014 we introduced percutaneous internal ring suture as an alternative to open surgery for the treatment of inguinal hernia. This study aims to evaluate the introduction of the procedure at our institution. Materials and Methods: In total, 100 consecutive patients operated with percutaneous internal ring suture were compared with 100 consecutive patients operated with open surgery. The patients were operated from August 2014 until November 2017. Patient demographics, clinical history, operative time, time in theater, and postoperative complications were extracted from charts. Results: The mean operative time for percutaneous internal ring suture was 26.54 min and for open surgery 39.94 min, P < 0.0001. The total mean operative theater time for percutaneous internal ring suture was 108.95 min and for open surgery 118.4 min, P = 0.0343.During follow-up, two percutaneous internal ring sutures were operated for recurrent hernia. In the open surgery-group, three patients were operated for recurrent hernia, three for secondary testicular retention, and three for metachronous contralateral hernia. Conclusion: Even when established as a new technique, the percutaneous internal ring suture procedure is safe and results in shorter operative time and shorter theater time compared to open surgery.