Accurate Surgical Technique Research Articles

Results of cystadenolymphoma treatment of superficial parotid gland.

Introduction Warthin's tumor is a non-malignant tumor that occurs in major salivary glands. Diagnostics include an interview and physical examination as well as additional tests - ultrasonography, magnetic resonance tomography, fine-needle aspiration biopsy. Surgical tumor resection remains the method of treatment, the scope of which includes techniques from extracapsular tumor resection to a full range of parotidectomy. Material and methods A retrospective analysis was conducted for available medical records of 53 patients treated surgically at the Department of Otolaryngology and Laryngological Oncology at the Collegium Medicum of the Nicolaus Copernicus University in Toruń in 2009-2016. Each patient underwent an interview, physical examination and a routine ultrasound examination. Results of treatment of 57 tumors were analyzed. Results The study showed that in the case of extracapsular tumor excision in 57 patients in the treatment of Warthin's tumors of the lower pole of the parotid lobe, there were no complications in the form of: permanent paralysis or facial nerve palsy, mucocele, symptoms of Frey's syndrome or cosmetic facial defect. Ultrasound examination in 8 (14%) patients revealed changes requiring further diagnostics or periodic ultrasound monitoring. Conclusions 1. Extracapsular tumor excision appears to be an accurate surgical technique in Warthin's tumor of the lower pole of the parotid gland's superficial lobe. 2. After removal of a cancerous lesion of the parotid gland, every patient requires periodic laryngological monitoring.

Oncologic Resection and Reconstruction of the Chest Wall: A 19-Year Experience in a Single Center.

The aim of this study was to analyze chest wall reconstruction following oncologic resection performed by a single surgeon over a 19-year period. A retrospective review was performed for 135 patients who underwent oncologic chest wall resection from 1997 to 2015. Average patient age was 57.8 years. Indications for resection were advanced breast cancer (n = 44), soft-tissue sarcoma (n = 38), bone sarcoma or chondrosarcoma (n = 28), desmoid tumor (n = 11), metastasis from other cancers (n = 7), and other primary tumors (n = 7). There were 72 full-thickness and 63 partial-thickness resections (34 soft-tissue resections only and 29 skeletal bone resections only). Resection margins were wide (n = 29), marginal (n = 82), and intralesional (n = 24). Reconstruction was warranted in 118 cases: chest wall stabilization and flap coverage in 57, chest wall stabilization only in 36, and soft-tissue flap coverage only in 25 cases. In total, 82 flaps were performed (17 free flaps and 65 pedicled/local flaps). There were no perioperative mortalities or flap losses. Complications occurred in 29 operations (Clavien-Dindo classifications grade II, n = 12; grade IIIa, n = 4; grade IIIb, n = 10; and grade IVa, n = 3) and 19 reoperations were necessary. Median follow-up was 49 months. Survival was calculated by the Kaplan-Meier method. One-, 2-, and 5-year survival rates were 84, 82, and 70 percent, respectively. With careful patient selection, appropriate perioperative and postoperative care, and accurate surgical technique, even extensive chest wall resections and reconstructions are safe. Therapeutic, IV.

Onychopapillomas: a 68-case series to determine best surgical procedure and histologic sectioning.

Onychopapilloma (OP) is a benign longitudinal nail bed tumour usually presenting as longitudinal erythronychia. Evidence-based recommendations for proper histologic sectioning and definitive surgical management are not available. The aim of this study was threefold. The first was to review the clinical and histopathological features of all OP diagnosed in our department. The second was to identify the most accurate histological technique. The third aim was to determine the most effective surgical procedures by examining recurrence rates and complications over the long term. This retrospective analysis collected all patients with OP in the dermatology department of Saint-Pierre - Brugmann University Hospital (Brussels, Belgium) between January 2007 and March 2017. Clinical findings and type of surgery performed were recorded from medical files and iconographic documents. All slides were reviewed by a dermatopathologist with expertise in nail disease. Longitudinal follow-up was performed. A total of 68 patients were included (42 women, 26 men) with a median age of 46 years. Two children were 9 and 11. The histological interpretation was more difficult for the transverse sections than for the longitudinal ones (29.4% vs. 2.2%). The pathological diagnosis of OP was typical in 30.6%, suggestive in 51.6%, slightly suggestive in 12.9% and not contributive in 4.8%. 50 patients had a mean follow-up of 50 months. 38% recovered completely and 20% recurred. 42% had mild to moderate sequelae. We report herein the first two paediatric cases. Classical longitudinal excision with careful removal of the lesion from the inferior face of the nail plate seems to be the most accurate surgical technique. In the pathology laboratory, longitudinal sections should be recommended. In our series, a recurrence rate of 20% was observed. This was more frequent when a tangential longitudinal excision was performed.

Complications from tracheal resection for thyroid carcinoma

Thyroidectomy associated to en bloc tracheal resection with end-to-end anastomosis is the treatment of choice of thyroid tumor invading the tracheal wall and is associated with a good prognosis. However, the postoperative morbidity is not irrelevant. The present review aims to discuss the complications occurring after this aggressive surgical procedure. The search was performed using PubMed through an overarching for the following terms: "complication of tracheal resection [AND] invasive thyroid cancer". Postoperative complications rate after tracheal sleeve resection with end-to-end anastomosis for thyroid cancer invading tracheal wall range from 15% to 39%. Postoperative mortality is about 1.2%. The most common postoperative complications are: anastomotic dehiscence, airway stenosis, infections and bleeding. Tumor local recurrence can be considered a late on set complication. To conclude, in locally invasive thyroid cancer, en bloc resection of the thyroid with the tracheal segment interested by the tumor provides a good prognosis despite the non-negligible postoperative morbidity rate. Patients' selection and accurate surgical technique performing a tracheal tension-free anastomosis are mandatory to reduce postoperative morbidity and mortality.

A multicenter prospective study of patients undergoing open ventral hernia repair with intraperitoneal positioning using the monofilament polyester composite ventral patch: interim results of the PANACEA study.

PurposeThis study assessed the recurrence rate and other safety and efficacy parameters following ventral hernia repair with a polyester composite prosthesis (Parietex™ Composite Ventral Patch [PCO-VP]).Patients and methodsA single-arm, multicenter prospective study of 126 patients undergoing open ventral hernia repair with the PCO-VP was performed. Patient outcomes were assessed at discharge and at 10 days, 1, 6, 12, and 24 months postoperative.ResultsAll patients had hernioplasty for umbilical (n = 110, 87.3%) or epigastric hernia (n = 16, 12.7%). Mean hernia diameter was 1.8 ± 0.8 cm. Mean operative time was 36.2 ±15.6 minutes, with a mean mesh positioning time of 8.1 ± 3.4 minutes. Surgeons reported satisfaction with mesh ease of use in 95% of surgeries. The cumulative hernia recurrence rate at 1 year was 2.8% (3/106). Numeric Rating Scale (NRS) pain scores showed improvement from 2.1 ± 2.0 at preoperative baseline to 0.5 ± 0.7 at 1 month postoperative (P < 0.001), and this low pain level was maintained at 12 months postsurgery (P < 0.001). The mean global Carolina’s Comfort Scale® (CCS) score improved postoperatively from 3.8 ± 6.2 at 1 month to 1.6 ± 3.5 at 6 months (P < 0.001). One patient was unsatisfied with the procedure.ConclusionThis 1-year interim analysis using PCO-VP for primary umbilical and epigastric defects shows promising results in terms of mesh ease of use, postoperative pain, and patient satisfaction. Recurrence rate is low, but, as laparoscopic evaluation shows a need for patch repositioning in some cases, an accurate surgical technique remains of utmost importance.

Encountering the Accessory Polar Renal Artery during Laparoscopic Para-Aortic Lymphadenectomy

A 60-year-old Korean woman underwent laparoscopic bilateral salpingo-oophorectomy and was confirmed to have high-grade serous carcinoma of both ovaries with a huge omental cake, extensive agglutinated intra-abdominal metastatic masses, extensive serosa invasion of the intestines, and mesenterial deposits. She underwent 3 cycles of neoadjuvant chemotherapy followed by laparoscopic interval debulking surgery, including hysterectomy, pelvic and para-aortic lymphadenectomy, appendectomy, partial peritonectomy, and omentectomy. We encountered the right accessory polar renal artery (APRA) during the surgery and carefully preserved the right APRA from the abdominal aorta to the right kidney (Fig. 1). Postoperative computed tomography angiography showed an intact right APRA and normal-appearing kidney (Fig. 2). The patient had adjuvant chemotherapy and is alive without disease recurrence. Because APRA is a functional end artery, it is important to preserve it during surgery to prevent ischemic damage and renal failure [1]. It is very important for the gynecologic-oncologist to have knowledge of the retroperitoneal vascular anatomy, experience in laparoscopic surgery, and an accurate surgical technique to avoid vascular injury during laparoscopic para-aortic lymphadenectomy.

Functional outcome of high tibial osteotomy among patients with osteoarthritis

Introduction: Osteoarthritis of knee is more common among all types of arthritic conditions. High tibial osteotomy is an accepted surgical technique for treatment of medial compartment arthrosis of knee in younger patients. Selection of the appropriate patients, extensive pre-operative planning and accurate surgical technique are essential for successful outcome. The methods of high tibial osteotomy include open wedge osteotomy and closed wedge osteotomy, the later procedure being more popular. Aims and Objectives: To assess the functional outcome among patients undergoing high tibial osteotomy. Methodology: A hospital based prospective interventional study was done on 30 patients of osteoarthritis with varus deformity. For all the 30 patients after a proper preoperative assessment the surgical intervention in the form of high tibial osteotomy was done and the outcome was evaluated using knee society scoring system. Results: Among the study population 73.3% of the patients had grade III type of osteoarthritis and only 26.6% had grade IV type of osteoarthritis based on Kellgren and Lawrence type of classification. The mean knee score and the mean functional score of the patients before surgery were 54.6 and 53.9 respectively and post operatively at the end of 12 months the knee score and functional score was 83.1 and 82 respectively. A statistically significant improvement was seen in both the knee society score and the functional score. Conclusion: The main improvements seen in this study was the increase in the knee score and functional score after high tibial osteotomy for the patients of osteoarthritis with varus deformity. Appropriate patient selection, proper osteotomy types and precise surgical techniques are essential for the success of high tibial osteotomy.

Comparison of soft-tissue changes after the surgical repair of unilateral cleft lip side to noncleft lip side: An anthropometric study

Aim: The aim of this article was to compare the tissue contraction after the surgical repair of unilateral cleft lip side to noncleft lip side. Materials and Methods: Forty patients with unilateral cleft lip only were used as subjects. They were divided into two groups based on gender (20 males and 20 females). Measurements of soft-tissue landmarks of cleft side and noncleft side were compared after surgical repair of the lip to check for soft-tissue contractions. A vernier caliper was used to measure the linear measurements, and all the measurements were measured directly on the patients' lips. Results: When gender comparison was done, it was found to be significant only for oral commissure to the peak of Cupid's bow for both cleft and noncleft sides (P < 0.05). When comparison between the two sides (left and right) was done, a significant difference was observed only for subalar to peak of Cupid's bow measurement which was found to be significantly larger at noncleft as compared to cleft side in overall assessment (P = 0.005) and in females (P = 0.046); however, this difference was not statistically significant when evaluated for males alone (P = 0.060). Conclusion: Marked soft-tissue contraction was seen after surgical repair of the unilateral cleft lip, more was seen in females. This indicates that adequate planning and accurate surgical techniques and measurements should be taken while approximating the two lip flaps both in vertical and in horizontal direction before planning the surgery to get the best esthetic result for the patients.

Radiographic Landmarks for Identifying the Anterolateral Ligament of the Knee

To identify the radiographic position of the origin and insertion of the anterolateral ligament (ALL) of the knee on a lateral radiograph. Twelve unpaired, fresh-frozen cadaveric knees were dissected to expose the ALL. Theorigin and insertion of the ALL on each cadaver were then tagged using 2-mm radiopaque beads. True lateral fluoroscopic views of the knee were then obtained, and the distance from known radiographic landmarks was recorded by 2 reviewers. The origin of the ALL was found at a distance that is 37.0 ± 9.2% of the total anterior-posterior length of the femoral condyle from the posterior edge as measured along Blumensaat's line. The insertion was located at a distance that is 56.1 ± 6.9% of the total length of the tibial plateau from the posterior edge. The origin of the ALL is 5mm posterior to a line from the posterior femoral cortex and 9mm distal to a line along Blumensaat's line. The insertion is 4mm anterior to the 50% mark of the anterior-posterior width of the tibia, 14mm distal to the articular surface. The origin and insertion of the ALL can be accurately identified using intraoperative fluoroscopy. Determining radiographic parameters for the ALL will assist in developing accurate surgical techniques for ALL reconstruction.

Planning of High Tibial Osteotomy

Introduction:High Tibial Osteotomy (HTO) is an establish technique for the treatment of varus malaligned knees. The aim of HTO is to reduce the load on the medial compartment by shifting the mechanical axis toward the lateral compartment. It is indisputable that appropriate patient selection, precise surgical planning, and correct operative techniques can provide favorable treatment outcomes of HTO.Method:Case Series. We reported four cases of HTO during clinical attachment in Gleneagles Hospital Kuala Lumpur Malaysia. Two cases are simple Open Wedge HTO, and two cases are Open Wedge HTO that performed simultaneously with posterolateral corner reconstruction. The assessment of lower limb alignment is based on an examination of clinical assessment and full standing radiographs, andplanned correction was achieved when the weight-bearing line passedthrough a target point located at 62% (Fujisawa point) ofthe tibial plateau width measured from themedial border of the tibial plateau.Result:We performed 90, 110, and 60 corrections to shift the weight bearing area to Fujisawa point. Post operative radiologic measurement shown all patients had a good alignment with 60, 50, and 60 valgus over correction, and with insignificant change of tibial slope. PLC instability was reconstruct with modified Larson’s technique by using semitendinous graft. In these cases, we used Tomifix plate (Sythes, Switzerland) as a bridging internal fixation with the principle of a locking compression plate (LCP), and ChronOS (Sythes, Switzerland) as a bone void filler.Conclusion:To achieve good results with HTO requires proper patient selection, good surgical planning, accurate surgical technique, and discipline rehabilitation. Reconstruction of the ligament abnormalities that affect the stability around the knee joint is necessary to achieve better results.

Transthoracic approach for lesions involving the anterior dorsal spine: A multidisciplinary approach with good outcomes.

Introduction:Anterior approach provides excellent visualization and access to the anterior thoracic spine. It may be used alone, in combination with a posterior midline approach or in a staged or sequential fashion.Aims:To analyse our institutional experience in transthoracic approaches and to determine the safety and benefit of this approach in our patient series.Materials and Methods:A total of 16 patients were operated for varying lesions of body of dorsal vertebra by the transthoracic approach. The study was for a period of 5 years from January 2011 to December 2015. Patients age ranged from 25 to 61 years with an average of 36.4 yrs. There were 7 males and 9 females. In our series 9 patients had Kochs spine, 4 patients were traumatic fracture spine and 3 had neoplastic lesion. Majority of patients had multiple symptoms with backache being present in all patients.Results:There was one post operative mortality which was unrelated to surgery. One patient had post operative delayed kyphosis. Remaining patients improved in their symptoms following surgery.Conclusion:With careful coordination by thoracic surgeons, neurospinal surgeons and anaesthetists, the anterior spine approach for dorsal spine is safe and effective. Adequate preoperative evaluation should stratify the risk and institute measures to reduce it. Accurate surgical planning and careful surgical technique are the key to yield a good outcome and to reduce the risk of complications.

Volumetric x-ray coherent scatter imaging of cancer in resected breast tissue: a Monte Carlo study using virtual anthropomorphic phantoms

Breast cancer patients undergoing surgery often choose to have a breast conserving surgery (BCS) instead of mastectomy for removal of only the breast tumor. If post-surgical analysis such as histological assessment of the resected tumor reveals insufficient healthy tissue margins around the cancerous tumor, the patient must undergo another surgery to remove the missed tumor tissue. Such re-excisions are reported to occur in 20%–70% of BCS patients. A real-time surgical margin assessment technique that is fast and consistently accurate could greatly reduce the number of re-excisions performed in BCS. We describe here a tumor margin assessment method based on x-ray coherent scatter computed tomography (CSCT) imaging and demonstrate its utility in surgical margin assessment using Monte Carlo simulations. A CSCT system was simulated in Geant4 and used to simulate two virtual anthropomorphic CSCT scans of phantoms resembling surgically resected tissue. The resulting images were volume-rendered and found to distinguish cancerous tumors embedded in complex distributions of adipose and fibroglandular breast tissue (as is expected in the breast). The images exhibited sufficient spatial and spectral (i.e. momentum transfer) resolution to classify the tissue in any given voxel as healthy or cancerous. ROC analysis of the classification accuracy revealed an area under the curve of up to 0.97. These results indicate that coherent scatter imaging is promising as a possible fast and accurate surgical margin assessment technique.

Mandibular Reconstruction with Free Fibular Flap and Dental Implant after Ablative Oral Cancer Surgery Using 3D RP Model: A Case Report

Reconstruction of the mandible after ablative oral cancer surgery requires esthetic and functional rehabilitation. Restoring facial symmetry and dentition need accurate preoperative surgical planning and meticulous surgical technique. Free fibular flap is most useful tools to reconstruct mandible because of its adequate length and height, simultaneous harvest of soft and hard tissues and placing dental implants. In this case report, recurred squamous cell carcinoma in the right mandible had been resected and free fibular flap was utilized for mandible reconstruction using 3D rapid prototype. Simulation surgery before dental implant placement has been performed for esthetic and functional prosthodontics.

Cavernomas da fossa posterior do crânio – Relato de série de seis casos

ResumoOs cavernomas são lesões classificadas como malformações vasculares, juntamente com malformações arteriovenosas, desenvolvimento venoso anômalo e telangiectasias capilares. Podem ocorrer de forma esporádica ou familiar e acometer qualquer área do sistema nervoso central, sendo a região supratentorial sua localização mais frequente. Neste artigo, é descrita uma série de seis pacientes com cavernoma na fossa posterior. Cinco cavernomas localizavam-se no tronco encefálico e um no cerebelo. A faixa etária dos pacientes variou de 14 a 50 anos. A abordagem cirúrgica diferiu entre os casos. Quatro casos apresentaram piora no pós-operatório imediato, com melhora subsequente. O seguimento dos pacientes variou de quatro meses a sete anos. Não houve óbito na série. Os cavernomas da fossa posterior requerem abordagem individualizada e técnica cirúrgica acurada. Embora possa ocorrer piora momentânea no pós-operatório imediato, a melhora subsequente é a regra, sendo o óbito infrequente.

Comparison of Clinical and Radiological Parameters with Two Different Surgical Methods for Anterior Cruciate Ligament Reconstruction

Objectives:We investigated the effects anatomic or nonanatomic femoral tunnel positions and tunnel fixation methods obtained using two different surgery methods on tunnel widening and clinical results in anterior cruciate ligament (ACL) reconstructions.Methods:Patients with isolated anterior cruciate ligament rupture are included to study who don’t have intra-and extra-articular additional pathology of the knee, without previously a history of operations of both knees. 2 groups were created. Group 1 Aperfix implant were used which can be able to perform non anatomical femoral tunnel and intra tunnel fixation with transtibial technique. In Group 2 Endobutton CL implant were used which can make fixation from outside the cortex with anatomic femoral tunnel in use of anteromedial portal techniques. 27 patients (average age 29,33, range 18 to 55 years) in group 1 and 27 patients (average age 27,51, range 16 to 45 years) in group 2 totally 54 patients were performed surgery. All patients were assessed using the IKDC (International knee documentation committee), Tegner Activity Scala and Lysholm II Functional Scores. Muscle strength measurements in both groups compared to intact knee was measured with an isokinetic dynamometer Biodex System 3 Pro. The location of the femoral tunnel aperture and tunnel widening were imaged with 3D reconstructive computed tomography. All measurements were performed using the same software application by the same radiologist.Results:The two groups were similar with respect to age and sex distribution, operated side, the size of the tunnel created, and follow-up period (p>0.05). After surgery in both groups, the clinical scores showed significant improvement compared to preoperative (p=0,0001). However, postoperative clinical outcomes in the two groups did not show a difference significantly (p>0,005). Isokinetic muscle strength study showed significant differences between the two groups (p=0,0001). Location of femoral tunnel aperture on the medial wall of the lateral femoral condyle showed a significant differences in the two groups (p=0,0001). The expansion of proximal and distal femoral tunnel in two groups showed significant differences (p=0,0001). There was relationship between distal femoral tunnel widening and location of femoral tunnel aperture.Conclusion:Although there is no statistically significant difference between the two groups clinically, difference noticed in terms of isokinetic muscle strength may be due to differences in the degree of shift as a result of multiple loading depending on the biomechanical properties of materials. We thought that the difference seen in the widening of tunnel in the proximal or distal may be due to, the technique of graft fixation, the distance between the fixation point and the joint, and to the location of the femoral tunnel aperture on medial wall of lateral condyle from anatomical or non anatomical region. There is no golden standard in neither surgical technique nor material of fixation. Proper theoretical knowledge and extensive clinical experience are important in the light of an accurate surgical technique applied. We thought that information we have reached in our study should be supported by biomechanical studies

Impact of Severe Neutropenia and Other Risk Factors on Early Removal of Implanted Central Venous Catheter (ICVC) in Children With Hematologic Malignancies

In neutropenic children with hematologic malignancies, the optimal timing of implanted central venous catheter (ICVC) insertion is unclear. The policy in our Institution has been to place ICVC at the time of diagnosis of disease regardless of the absolute neutrophil count. The impact of this strategy on the incidence of ICVC removal within 30 days of placement was evaluated in a series of patients. Other possible risk factors for ICVC early removal were also examined. Records of all children with hematologic malignancies who underwent placement of ICVC during 2007 to 2010 were reviewed. The incidence of catheter-related complications and early removal was compared between subjects who were neutropenic at the time of ICVC placement and those who had a normal absolute neutrophil count. An ICVC was placed in 117 children, and only in 12 (10.2%) children it was removed within 30 days. However, the incidence of complications and removal was not influenced by the presence of neutropenia. Only an age below 2 years was demonstrated to be a risk factor for early complication and removal. The policy to place ICVC in neutropenic patients has been reasonably safe, in our hands. Meticulous preoperative evaluation, the accurate surgical technique and considerable care in their postoperative management are essential to prevent complications, especially in newborns and infants, who seem to be at greater risk of ICVC removal.

La stabilizzazione percutanea dello scafoide

Internal fixation reduces the problems associated with prolonged cast immobilization in minimum displaced scaphoid fractures and allows for early return to activity. Traditional open surgery is associated with a high amount of complications. The use of little diameter cannulated screws has made percutaneous fixation possible. The success of percutaneous treatment is dependent on an accurate assessment of the fracture, and very accurate surgical technique. We describe the percutaneous method of treating acute scaphoid waist fractures through a volar approach and touch on the outcome.

Factors affecting the osteolysis around the components after posterior-stabilized total knee replacement arthroplasty.

The purpose of the present study was to evaluate factors that affect the occurrence of osteolysis through clinical and radiological comparison between a patient group in which osteolysis occurred after total knee arthroplasty (TKA) and a patient group in which osteolysis did not occur after TKA. The present study was conducted with 486 knees that had been followed up for at least 2 years after undergoing a posterior-stabilized TKA. The subjects were divided into a group in which osteolysis occurred and a group in which osteolysis did not occur and retrospectively compared and analyzed. Knee Society Knee Score and Function Score, preoperative and postoperative range of motion (ROM), femoral and tibial implant positions, preoperative and postoperative femerotibial angles, posterior femoral condylar offset (PCO), level of joint line (JL), and posterior tibial slopes were measured and clinically and radiologically compared. Osteolysis occurred in 28 knee joints (5.7%). No significant difference was observed between the patient group without osteolysis, and the patient group with osteolysis was observed in preoperative and postoperative ROM, femoral and tibial implant positions, or preoperative and postoperative femerotibial angles. The means of preoperative and postoperative differences in PCO and level of JL were significantly larger in the patient group with osteolysis than in the patient group without osteolysis (p = 0.01, p = 0.007), and regression analyses showed that the means of preoperative and postoperative differences in these two variables were related with the occurrence of osteolysis (p = 0.021, p = 0.018). The present study shows that biomechanical changes occurring after TKA are related with the occurrence of osteolysis. For clinical relevance, surgeons should pay great attention to restore normal anatomical structure as much as possible with careful preoperative plans, accurate surgical techniques, and selection of appropriate implants. Retrospective comparative study, Level III.

Complications of medial unicompartmental knee arthroplasty.

BackgroundWe report intra- and postoperative complications of unicompartmental knee arthroplasty (UKA).MethodsThis study was conducted on 246 cases of UKA which were performed for degenerative osteoarthritis confined to the medial compartment, from May 2002 to May 2010, for which follow-up periods longer than one year were available. Complications were divided into intra- and postoperative complications. Pre- and postoperative clinical scores, the range of motion, and radiologic findings were analyzed.ResultsComplications developed in a total of 24 cases (9.8%, 24/246). Among them, 6 cases had intraoperative complications while 18 had postoperative complications. Among the 6 intraoperative complications, one fracture of the medial tibial condyle, two fractures of the intercondylar eminence, one rupture of the medial collateral ligament, one widening of the peg hole leading to femoral component malposition and late failure, and one total knee arthroplasty (TKA) conversion of a large bony defect of tibial avascular necrosis were observed. Among the 18 postoperative complications, four cases of aseptic loosening of the femoral component, one soft tissue impingement due to malalignment, nine cases of polyethylene bearing dislocation, one case of suprapatellar bursitis, one periprosthetic fracture, one TKA conversion due to medial component overhanging, and one TKA conversion due to pain of unexplained cause were observed.ConclusionsThe mid-term clinical outcomes of UKA were excellent in our study. However, the incidence of complications was very high (9.8%). To prevent intra- and postoperative complications, proper selection of the patients and accurate surgical techniques are required.

Laparoscopic cystectomy of endometrioma: Good surgical technique does not adversely affect ovarian reserve.

BACKGROUND:The damage to ovarian reserve inflicted by surgery for endometriosis represents a major concern in the balance between reproductive benefits and risks.AIM:To evaluate the ovarian reserve in sub fertile women after laparoscopic endometriotic cystectomy.SETTINGS AND DESIGN:Prospective study, done in Department of Obstetrics and Gynecology, tertiary care hospital between August 2010-2012.MATERIALS AND METHOD:Laparoscopic cystectomy performed by stripping technique for endometriotic cysts. Endometriosis was staged according to revised American Society of Reproductive Medicine classification (rASRM). Ovarian reserve assessed by comparing FSH and LH levels, measurement of residual ovarian volume, antral follicle counts and stromal blood flow on second day of menses pre and postoperatively. Cyst wall was evaluated histologically to note the presence of normal ovarian tissue in resected tissue.STATISTICAL ANALYSIS:SPSS for Windows version 16.0 (SPSS Inc., Chicago, IL) was used for statistical calculations. Wilcoxon signed test and Pearson Chi – Square test were applied. Significance level was P < 0.05.RESULTS:Incidence of minimal, mild, moderate, and severe endometriosis was 4.1%, 21.9%, 28.7%, 45.3% respectively. Ovarian reserve was assessed both by ultrasound and biochemical parameters on day 2 of menses; pre and post-operatively. Preoperative and post-operative values; FSH (7.24 ± 1.21, 7.23 ± 1.51 m IU/ml), LH levels (6.37 ± 1.8, 6.6 ± 2.3 m IU/ml), residual ovarian volume (8.5 cm3 ± 5.3, 7.4 cm3 ± 5.8), antral follicle count(3.3 ± 1.9, 4.1 ± 1.5) and stromal blood flow (6.8 cm/sec ± 4.57, 7.1 cm/sec ± 3.55) were statistically not significant. Loss of follicle was seen in 27.2% cyst walls on histopathological examination while 72.73% had no loss.CONCLUSION:Laparoscopic cystectomy when performed for endometriotic cysts with accurate surgical technique leads to no significant ovarian tissue removal.