Minilaparotomy Cholecystectomy: A Forgotten Art in Laparoscopic Cholecystectomy Era (Our Experience from a Peripheral Hospital in North India)

Background: This study aimed to report the experience of performing minilaparotomy cholecystectomy in a peripheral hospital by a single surgeon. Methods: Data collected from 50 consecutive patients undergoing minilaparotomy cholecystectomy by a single surgeon over 18 months at a peripheral hospital were reviewed and studied. The recorded data encompassed demographics, operating time, incision size, conversion rate to open cholecystectomy, perioperative complications, and hospital stay duration. Results: Fifty consecutive patients, who underwent minilaparotomy cholecystectomy for symptomatic cholelithiasis, were studied, among whom 48 patients were females. The participants’ mean age was 45 years. The length of the surgical incision was 4.5 - 6 cm, and only three patients required conversion to open cholecystectomy. The average operating time was 60 minutes; and the average postoperative hospital stay was 2.14 days. Conclusions: Minilaparotomy cholecystectomy is comparable with laparoscopic cholecystectomy in terms of postoperative morbidity, and it is ideal for peripheral hospitals lacking laparoscopic facilities.

Assessment of the intensity of engine oil contamination during operation

The acceleration of internal combustion engines leads to an increase in thermal and mechanical loads on the most critical parts. To ensure the required resource indicators in conditions of increased loads, it is necessary to use high-quality lubricants, the requirements for the operational properties of which are also steadily increasing. In order to ensure the necessary physical and chemical characteristics of engine oils, additives are introduced into their composition, but during operation the quality of engine oil decreases, the reasons for this are both the destruction of additives, and the accumulation of dirt particles in the oil and the ingress of fuel and coolant into the oil. The conducted studies are devoted to determining the intensity of engine oil contamination under operating conditions in the Wärtsilä 6L20 engine lubrication system and the effectiveness of the dispersing additives contained in the oil. Samples of Petro Canada and TARO oils brands were used as prototypes at the beginning of the operational period, at the time of average operating time and at the time of oil change. The dispersing ability of the oil was determined by the method of assessing the oil stain. According to the results of the research, it is concluded that when the properties of the oil change as a result of contamination, their dispersing ability remains satisfactory. This result can serve as a justification for extending the service life of engine oil, provided that its properties are monitored during operation.

One-stage thoracoscopic resection of bilateral bronchiectasis

Objective To evaluate the results of one-stage thoracoscopic resection of bilateral bronchiectasis. Methods Between June 2009 and December 2020, there were 23 patients selected for one-stage thoracoscopic resection of bilateral bronchiectasis. Their average age was 58.5 (36–73). Female patients were more common, accounting for 17 (74%). Preoperatively, 17 (74%) patients mainly presented with hemoptysis and the other 6 (26%) patients with purulent sputum. Results In these 23 patients, a total of 121 segments were resected, with an average of 5.26 segments, ranging from 3 to 9 segments. Five of 17 patients with massive hemoptysis underwent ligation of bronchial arteries in addition to lung resections. The average operating time was 271 min, ranging from 145 to 500 min. The average blood loss was 108 ml, ranging from 20 to 600 ml. The average postoperative hospital stay was 8 days, ranging from 3 to 20 days. There was no surgical morbidity or surgical death. Hemoptysis and purulent sputum of all patients was almost controlled after surgery. Conclusion One-stage thoracoscopic resections of bilateral localized bronchiectasis could be well-tolerated and safe for these selected patients. The one-stage operation could shorten the course of treatment.

RELIABILITY OF WATER TREATMENT FACILITIES ACCORDING TO OPERATING DATA

The centralized water supply system from the water source to the consumer includes 3 main complexes: water intake, water treatment and supply and distribution. The reliability of water supply in the area depends on the reliability of each of these complexes, which, in turn, consist of a number of structures. The paper develops the developed principle of assessing the reliability of water treatment plants (WPP) by quantitative indicators of the quality of treated water. The assessment of the reliability of the current WPP was performed to reflect its work, which implements the "black box" model. That is, some process parameters have one value at the input and other values at the output. The disadvantage of this method is that it is impossible to assess the reliability if the process does not occur. In addition, it is impossible to assess the reliability of the BOC for another set of individual structures. And the advantage is the sufficient simplicity of calculating the reliability indicator. Data on the purification of the Dnieper water at the Kremenchug WPP in terms of turbidity and chromaticity are used. Graphs of average variable indicators of turbidity and chromaticity of Dnieper water at the entrance of the WPP and graphs of exceedances of maximum permissible concentrations of treated water are constructed. The main indicator of reliability for municipal water supply facilities is the coefficient of readiness of KD, and the basic indicators of reliability are the average operating time for failure T and the average recovery time of the TR. The possibility of calculating the coefficients KD downtime and KR readiness in case of exceeding the MPC treated water is shown. After analyzing the graphs of water quality indicators, it was determined that the greatest turbidity and chromaticity of the Dnieper water is observed in the autumn.

OUTCOME ANALYSIS OF PERCUTANEOUS NEPHROLITHOTOMY IN SUPINE POSITION

Supine PCNL (Percutaneous Nephrolithotomy) is an Alternative to traditional prone positioning. Benets of the supine position include easy access to the airway and Optimization of cardiopulmonary function in patients. This is a prospective study which analyzes the outcome of percutaneous nephrolithotomy in supine position. There were totally 50 patients included in the study. 27 were male and 23 female patients. Mean age was 43 years, ranging from 18 to 70 years. Right side stones seen in 60% of cases ( 30/50). Average stone size was 2.6cm ranging from 1.8 to 6cm. Average operating time were 63.5 minutes and uroscopy 18.9 minutes (5 to 35 minutes). Clearance rate in our study were pretty good with 90% (45 out of 50 cases). Five patients required secondary procedures and ve had complications in form of sepsis and bleeding requiring blood transfusion. There were no visceral injury or srtula. Thus Supine PCNL has several potential advantages with successful technical feasibility and can be used to treat all stone sizes especially very effective in high risk patients for anesthesia. There is no added risk in this technique, and the stone clearance and complication rates are comparable to standard prone PCNL

Relevance of a simulation model to microsurgery for military surgical residents

IntroductionMicrosurgical training is an asset for military orthopedic surgeons who frequently treat hand or nerve injuries in external operations. The objective of this study was to evaluate a microvascular surgery simulation model intended to prepare residents prior to their enrolment in conventional degree training.Materials and MethodsAn experimental study was conducted to evaluate technical progress and satisfaction of military surgical residents using a model based on Japanese noodles with four tests of increasing difficulty. Objective endpoints included: instrument handling, distribution and quality of stitches, duration of anastomoses and responses to the Structured Assesment of MicrosurgerySkill (SAMS) self-assessment questionnaire were also analyzed.ResultsNine residents from different specialties participated in the study. The quality of their anastomoses and their average satisfaction were significantly increased between the first and the last session: respectively 7.2 / 15 versus 10.7 / 15 (p < 0.05) and 37.5 / 70 versus 47.5 / 70 (p < 0.05). Conversely, the average operating time decreased significantly over the sessions (92 min versus 52 min, p < 0.001).ConclusionsThis simulation model seems to constitute a satisfactory initiation to microsurgery which could limit the use of the animal model. It could also be included in the continuing education of military surgeons who perform microsurgery only occasionally in external operations.

One of the ways to increase the durability of the sectional pump balancing ring

The article presents the results of scientific research aimed at struggling the adhesive wear of parts of sectional pumps balancing ring, where the drainage units pumping equipment of the Russian Federation underground kimberlite mines was used as an object of research. It has been theoretically proven and experimentally confirmed that if there is data on the total operating time of a sectional pump in transient modes per day, using the constructed regression model, it is possible to calculate with high accuracy the average operating time of its balancing ring unit to failure. The constructed regression model is applicable only to sectional pumps of drainage units of underground kimberlite mines in the Russian Federation. It is possible to increase the durability of the balancing ring by reducing the acceleration and deceleration time of the sectional pump; for safe operation, it should be at least 10 s. Pilot tests carried out indicate the effectiveness of the proposed method for prompt identification of the critical axial displacement of the sectional pump rotor through the vibration of the discharge tube. The introduction of this method will reduce the cost of repair work to restore the performance of parts of the hydraulic foot to a minimum.

833 Hyper Acute Dialysis Access Pathway (HADAP) – Undertaking Creation of Arteriovenous Fistulae in The Renal Ward

Introduction The impetus to apply the “lean method” to creation of arteriovenous fistulae came with the pandemic restricting access to theatres. Here we present HADAP implemented in a dedicated procedure room in the Renal ward. Method Between April and September 2020, 44 patients underwent ward-based arteriovenous fistula operations with no more than 3 people in the room – surgeon, runner and patient. The parameters assessed were duration of operation, complications, patency, patient and surgeon feedback and financial implications. Results The service was predominantly registrar-led who created 91% of the fistulae. 95% operations were completed successfully with a 2-week primary patency of 73% and no surgical site infections. 40% of the procedures were radiocephalic fistulae. 14% procedures required surgical assistance by the runner. The average operating time reduced from 90 minutes for the first 10 cases to 50 minutes for the last 9. A structured questionnaire showed positive feedback from both patients and surgeons (4-5 out of 5). This service has cleared potentially 9 main theatre lists for more complex procedures. Conclusions Our study demonstrates the successful implementation of a novel operating environment allowing expedited care for renal failure patients. It has enhanced our ability to deliver a dialysis access program despite the challenges of COVID.

Antimicrobial photodynamic therapy in voice rehabilitation of patients after laryngectomy

The article is devoted to the problem of voice rehabilitation of patients after laryngectomy. Modern possibilities of repairing laryngeal vocal function, methods for extending the lifetime of voice prostheses are considered. The author’s method of prevention of infection of vocal prostheses using the antimicrobial photodynamic therapy (PDT) with chlorin-type photosensitizer Radagel is presented. Performing antimicrobial PDT of vocal prostheses increased the average operating time to 11.9 months compared to the control group (6.8 months), where a monthly dose of 150 mg of fluconazole was used for prevention. The method developed by the authors makes it possible to significantly extend the lifetime of vocal prostheses, is devoid of adverse events, is well tolerated by patients.

Prevention of vault prolapse in cases of procedentia using combined vaginal and laparoscopic approach for vault suspension: Agrawal’s technique

Background: The objective of the current study was to assess the need of vault suspension after completion of hysterectomy in all cases of procedentia to prevent vault prolapse and to reduce the operating time for sacrocolpopexy using combined vaginal and laparoscopic approach by two surgeons.Methods: A total of 25 women undergoing surgery for procedentia were included. After completion of hysterectomy the need for vault suspension was assessed intraoperatively. In all cases polypropelene mesh was fixed vaginally to the uterosacral and cardinal ligaments. Vaginal vault was closed vaginally. Laparoscopic surgeon did laparoscopic sacrocolpopexy (LSC). Intraoperative and post-operative complications were then evaluated.Results: Our average operating time was 35 minutes for vaginal hysterectomy and 15 minutes for LSC. The shorter duration of surgery was because mesh was fixed vaginally and trackers were used to fix the mesh to sacral promontory. Intraoperative complications like bladder, ureteric, bowel injuries and hemorrhage were nil in our series. Postoperative stay in hospital was uneventful and all cases were discharged on second postoperative day. Conversion rate to laparotomy was nil. All cases have completed follow up for 5 years with 100% subjective and objective improvement.Conclusions: Restoration of vagina to its normal anatomic position remains the most important fact to prevent vault prolapse. Our technique is very easy, less time taking with negligible complication rates.