Advantages Of Less Blood Loss Research Articles

P123. Clinical outcome of anterior only approach for cervical fracture dislocations

BACKGROUND CONTEXT Treatment of choice in cervical fracture-dislocation is an area of contention between anterior cervical discectomy and fusion (ACDF) and/or posterior instrumentation and fusion. Anterior cervical discectomy and fusion permits the introduction of a large graft surface area placed under compression. Also, with this approach associated cervical disk herniation can be removed and fusion can be performed in a single approach. Posterior approach is indispensable in cases associated with laminar and facetal fractures. PURPOSE The aim of this article is to analyse the clinical outcome and complications in patients undergoing anterior cervical discectomy and fusion for cervical fracture dislocations. STUDY DESIGN/SETTING Retrospective case series. PATIENT SAMPLE A total of 41 patients (25 males and 16 females) average age 46.8 years who underwent anterior cervical discectomy/corpectomy and fusion (ACDF/ACCF) with bone graft/metallic cage indicated for traumatic fracture dislocation from January 2016 to July 2018 at AIIMS, Rishikesh were included in the study. OUTCOME MEASURES ASIA scoreODI scoreVAS scoremJOA scoreNurick grading. METHODS A total of 41 patients with radiology proven unilateral or bilateral fracture dislocation included in the study were managed with planned closed reduction under general anaesthesia followed by ACDF/ACCF procedure in the same setting. All patients were followed up monthly for first 3 months and then 6 monthly till their last follow up visit and were evaluated on basis of radiological, clinical and patient reported outcomes with average follow up of 18.3 months (min 4 month, max 39 months). RESULTS Out of 41 patients (35 ACDF, 6 ACCF) 30 had complete spinal cord injury while 11 had incomplete spinal cord injury (ASIA B,C AND D). At their final follow up all showed clinical improvements in pain assessed by Visual Analog Scale (VAS) (6.8 to 1.1). Other patient reported outcomes showed significant improvement: Oswestry Disability Index (ODI) score (56.7 to 23), Modified Japanese Orthopedics Association (mJOA) score (11.5 to 17.3), Nurick's grading (4.8 to 3.4). There was no severe intraoperative complications like spinal cord/nerve root/thoracic duct/esophagus/vertebral artery injury with average blood loss of 253.1 ml. One patient of ACDF needed secondary posterior fixation in view of instability. CONCLUSIONS Anterior approach to cervical spine in cervical fracture dislocation is an effective treatment of choice showing optimal recovery rate in terms of patient reported outcomes and structural stability with added advantages of less blood loss and less instrumentation. FDA DEVICE/DRUG STATUS This abstract does not discuss or include any applicable devices or drugs.

Comparison of Stand-Alone, Transpsoas Lateral Interbody Fusion at L3-4 and Cranial vs Transforaminal Interbody Fusion at L3-4 and L4-5 for the Treatment of Lumbar Adjacent Segment Disease

Retrospective cohort study. To compare outcomes and complications of stand-alone minimally invasive lateral interbody fusion (LIF) vs revision posterior surgery for the treatment of lumbar adjacent segment disease. Adults who underwent LIF or transforaminal lumbar interbody fusion (TLIF) for adjacent segment disease were compared. Exclusion criteria: >grade 1 spondylolisthesis, posterior approach after LIF, and L5/S1 surgery. Patient demographics, estimated blood loss, hospital length of stay, complications, reoperations, health-related quality of life measures, and radiographs were examined. Data were analyzed with the χ2, Wilcoxon signed rank, and Mann-Whitney U tests. A total of 17 LIF and 16 TLIF patients were included. Demographics were similar. Follow up was similar (LIF: 22.9 ± 11.8 months vs TLIF: 22.0 ± 4.6 months; P = .86). The LIF patients had significantly less blood loss (LIF: 36 ± 16 mL vs TLIF: 700 ± 767 mL; P < .001) and shorter length of stay (LIF: 2.6 ± 2.9 days vs TLIF: 3.3 ± 0.9 days; P = .001). There were no intraoperative complications. Revision rate was 4 of 17 in LIF and 3 of 16 in TLIF (P = .73). Baseline health-related quality of life and radiographic measurements were similar. In both groups, back and leg pain scores significantly improved, and in LIF, the Owestry Disability Index, and EuroQol-5D significantly improved. The LIF had a significant increase in intervertebral height (LIF: 4.8 ± 2.9 mm, P < .001, TLIF: 1.3 ± 3.4 mm, P = .37), which was significantly greater for LIF than TLIF (P = .002). Similarly, LIF had a significant increase in segmental lordosis (LIF: 5.6° ± 4.9°, P < .001, TLIF: 3.6° ± 8.6°, P = .16), which was not significantly different between groups. Patients with adjacent segment disease may receive significant benefit from stand-alone LIF or TLIF. The LIF offers advantages of less blood loss and a shorter hospital stay. 3.

Laparoscopic total gastrectomy for remnant gastric cancer: A single-institution experience.

The incidence of remnant gastric cancer is increasing because of past use of subtotal gastrectomy to treat peptic ulcer and increased survival rates after radical gastrectomy for gastric cancer. The feasibility and advantages of laparoscopic total gastrectomy (LTG) for remnant gastric cancer remain unclear. Therefore, we aimed to investigate the safety, feasibility, and clinical short-term outcomes of LTG for remnant gastric cancer. Patients who underwent completion total gastrectomy for remnant gastric cancer between April 2007 and October 2017 were divided into two groups: the open total gastrectomy (OTG) group and the LTG group. Clinicopathological data and short-term outcomes were analyzed. A total of 31 remnant gastrectomies (23 OTG, 8 LTG) were performed. Blood loss was significantly lower in the LTG group than in the OTG group (135.5 vs 568.3 mL, P = 0.013). However, there was no significant difference in the operation time, days to food intake, or length of hospital stay between the two groups. Additionally, there was no significant difference in the postoperative complications, number of retrieved lymph nodes, or pathological findings. Two LTG patients (25.0%) required conversion to open surgery. There was no mortality in either group. LTG for remnant gastric cancer can be a safe treatment option and may have an advantage of less blood loss than OTG.

Comparison of minimally invasive and open transforaminal lumbar interbody fusion in the treatment of single segmental lumbar spondylolisthesis: minimum two-year follow up

Compare the efficacy and safety of minimally invasive and open transforaminal lumbar interbody fusion (TLIF) in the treatment of single segmental lumbar spondylolisthesis. From 2010-01 to 2015-10, in total, 167 patients with single segmental spondylolisthesis treated by TLIF were included, 79 cases in minimally invasive TLIF (MI-TLIF) group and 88 cases in open TLIF group. The peri-operative parameters of operative time, estimated blood loss and length of postoperative hospital stay was recorded, as well as complications. Visual Analogue Scale (VAS) of low back pain and leg pain, and Oswestry Disability Index (ODI) were used to assess the pain and functional outcomes at pre-operatively, 3 months/1 year/2 years/5 years after operation. The radiographic parameters of posterior height of the intervertebral space and segmental lordosis were measured too. No significantly difference was found at baseline characteristic data of age, gender ratio, the percentage of degenerative and isthmic spondylolisthesis, the percentage of slip, and segmental distribution between MI-TLIF and open TLIF groups. MI-TLIF group had less estimated intra-operative blood loss (163.7±49.6 mL) than open TLIF group (243.3±70.2 mL, P<0.001) and had shorter post-operative hospital stay (5.8±1.4 days) than open TLIF group (7.3±2.9 days, P<0.001). Both MI-TLIF and open TLIF can significantly reduce the VAS of low back pain, VAS of leg pain, ODI, and improve the posterior height of the intervertebral space and segmental lordosis, but no significantly difference was found of them between two groups. Our study suggests that MI-TLIF is a safe and effective choice in the treatment of lower grade lumbar spondylolisthesis (grade II or less), and it has advantages of less blood loss, postoperative hospital stay when compared to open TLIF.

Comparison of effectiveness of cortical bone trajectory screw fixation and pedicle screw fixation in posterior lumbar interbody fusion

To compare the effectiveness of cortical bone trajectory screw (CBTS) and conventional pedicle screw for posterior lumbar interbody fusion (PLIF) in the treatment of single segment lumbar degenerative disease. Between May 2013 and May 2016, a total of 97 patients with single segment lumbar degenerative disease were treated with PLIF. Fifty-one patients were fixed with CBTS in PLIF (trajectory screw group) and 46 with pedicle screw (pedicle screw group). There was no significant difference in age, gender, body mass index, preoperative diagnosis, lesion segment, and preoperative visual analogue scale (VAS) score, Oswestry dysfunction index (ODI) between 2 groups ( P>0.05). The operation time, intraoperative blood loss, postoperative drainage, bed rest time, length of hospital stay, serum creatine kinase (CK) concentration, total amount of diclofenac sodium, perioperative complications, ODI, VAS score, and interbody fusion rate were recorded and compared between 2 groups. All patients were followed up 12 months. The patients in trajectory screw group had a significantly less operation time, intraoperative blood loss, postoperative drainage, and serum CK concentration when compared with the patients in pedicle screw group ( P<0.05). Thirty-five patients (68.6%) in trajectory screw group and 46 patients (100%) in pedicle screw group were given diclofenac sodium within 48 hours after operation, showing significant difference between 2 groups ( χ2=89.334, P=0.000). There was no significant difference in the incidence of perioperative complications between trajectory screw group and pedicle screw group (3.9% vs. 8.7%, P=0.418). There was no significant difference in the VAS score, ODI, and interbody fusion rate at 12 months after operation between 2 groups ( P>0.05). For the single segment degenerative lumbar disease, the use of CBTS or conventional pedicle screw for PLIF can obtain satisfactory clinical function and interbody fusion rate. But the former has the advantages of less blood loss, less intraoperative muscle damage, less perioperative pain, shorter length of hospital stay and bed rest time.

Management of stable intertrochanteric fractures with minimally invasive dynamic hip screw

&lt;p class="abstract"&gt;&lt;strong&gt;Background:&lt;/strong&gt; Trochanteric fracture is the commonest fracture which accounts to 90 % of the fractures in patients over 50 years. The aim of the treatment is to prevent malunion and early mobilization with ambulation which is accomplished by dynamic hip screw and sliding plate. Minimal invasive technique has advantages of less blood loss, minimal soft tissue dissection, early mobilization and shorter hospital stay&lt;span lang="EN-IN"&gt;.&lt;/span&gt;The study was done to evaluate the amount of intraoperative blood loss, reduction of postoperative haemoglobin, requirement of postoperative analgesics and duration of postoperative hospital stay in the patients with stable intertrochanteric fracture treated with minimal invasive dynamic hip screw (MIDHS).&lt;/p&gt;&lt;p class="abstract"&gt;&lt;strong&gt;Methods:&lt;/strong&gt; Twenty five patients with stable intertrochanteric fractures were treated with minimal invasive Dynamic hip screw fixation. Average intra operative blood loss, reduction of postoperative haemoglobin, requirement of post-operative analgesics and total duration of postoperative hospital stay were evaluated. All the patients were followed up periodically at 6 weeks, 3 months, 6 months, 1 year. All the patients were evaluated radiologically in the follow up period. The functional assessment was done with Harris hip score.&lt;strong&gt;&lt;/strong&gt;&lt;/p&gt;&lt;p class="abstract"&gt;&lt;strong&gt;Results:&lt;/strong&gt; Mean intraoperative blood loss was found to be 75 ml. The mean duration of surgery was found to be 44.3 minutes. All the patients were mobilized 24 hours of surgery with non-weight bearing walking with walker support. The average time for union was found to be 4 months. No complications like postoperative infection, malunion, coxa vara, limb length discrepancy were seen. The final functional Harris hip score was found to be excellent in 14, good in 4, fair in 2&lt;span lang="EN-IN"&gt;. &lt;/span&gt;&lt;/p&gt;&lt;p class="abstract"&gt;&lt;strong&gt;Conclusions:&lt;/strong&gt; MIDHS is a safe technique having advantages of less blood loss, minimal soft tissue dissection and shorter hospital stay, early rehabilitation in treating stable intertrochanteric fractures compared to conventional DHS&lt;span lang="EN-IN"&gt;.&lt;/span&gt;&lt;/p&gt;

A comparative study between conventional and minimally invasive dynamic hip screw fixation in management of intertrochanteric femoral fractures

Introduction: The intertrochanteric fractures of femur are commonly fixed using dynamic hip screw using a conventional open Dynamic Hip Screw (CDHS). This is associated with a long incision, blood loss, considerable soft tissue trauma and pain. All these problems can be avoided using minimally invasive Dynamic Hip Screw (MIDHS), which has a theoretical advantage of less blood loss, soft tissue trauma, and early rehabilitation. Thus, we conducted a prospective comparative study of the two techniques. Materials and Methods: This is a prospective comparative study conducted over a period of 2 years at Department of Orthopedics GMC Bhopal. Fifty patients in the age group of 50-80 years who presented with intertrochanteric femur fracture and fulfilled inclusion criteria were divided into two groups of 25 each for fixation by CDHS or MIDHS. Patients in both the groups were matched. The data analysis was performed using SPSS package. Results: The patients in minimally invasive group had shorter operative time (45 min vs. 75 min). The average postoperative blood loss in drain in conventional group was 150 ml whereas no drain was used in minimally invasive group. Postoperatively need for analgesic was significantly lower in minimally invasive group (P < 0.05). Duration of hospital stay was significantly less with minimally invasive technique. The duration of bony union was similar in both techniques. Conclusion: Our study concludes that the minimally invasive technique of fixation of Intertrochanteric femur fractures is superior in terms of less operating time and less duration of hospital stay.

Explore the characteristics of bladder function of the patients with pelvic organ malignancy

Explore the characteristics of bladder function of the patients with pelvic organ malignancy

Laparoendoscopic single site surgery versus conventional laparoscopy for transperitoneal pyeloplasty: A systematic review and meta-analysis.

We aimed to review studies comparing the outcomes of the laparoendoscopic single site (LESS) pyeloplasty with those of conventional laparoscopic pyeloplasty (CLP). A systematic review of the literature was performed according to the PRISMA (preferred reporting items for systematic reviews and meta-analysis) criteria. The methodological quality of the studies was rated according validated scales. The level of evidence (LE) was reported as described by the Oxford criteria. Preoperative demographic parameters and perioperative outcomes between the two surgical techniques were assessed. A meta-analysis of the included studies was performed. A total of 5 studies were elected for the analysis, including 164 cases, 70 (42.6%) of them being LESS and 94 (57.4%) being CLP. Four studies were observational retrospective comparative studies (LE: 3a-4); one was a prospective randomized controlled trial (LE: 2b). There was no significant difference in age, body mass index, gender, side and presence of the crossing vessel, between the groups. There was no significant difference regarding the operative time (weight mean difference [WMD]: −7.02; 95% confidence interval [CI]: −71.82–57.79; P = 0.83) and length of hospital stay (WMD: 0.04; 95% CI: −0.11–0.20; P = 0.58), whereas the estimated blood loss was statistically lower for LESS (WMD: −16.83; 95% CI: −31.79–−1.87; P = 0.03). The postoperative use of analgesic favored the LESS group but without reaching statistical significance (WMD: −7.52; 95% CI: −17.56–2.53; P = 0.14). In conclusion, LESS pyeloplasty offers comparable surgical and functional outcomes to CLP while providing the potential advantages of less blood loss and lower analgesic requirement. Thus, despite being more technically challenging, LESS pyeloplasty can be regarded as a minimally invasive approach for patients seeking fewer incisional scars.

Minimally Invasive Dynamic Hip Screw Fixation for the treatment of stable Intertrochanteric Fractures of femur

Background: Trochanteric fracture is the commonest fracture in elderly people. These fractures carry risks associated with prolonged immobility. Early fracture fixation allowing early mobilization of the patients is the aim of the treatment. Dynamic hip screw and plate remains the most common method for treating stable intertrochanteric fractures. Minimal invasive technique has advantages of less blood loss, minimal soft tissue dissection, early mobilization, lesser requirement of analgesics and shorter hospital stay.Objectives: The study was done to evaluate the amount of intraoperative blood loss, reduction of post operative haemoglobin, requirement of post-operative analgesics and days of postoperative hospital stay in the patients of stable intertrochanteric femur fracture treated with minimal invasive dynamic hip screw (MIDHS).Methods: Twenty-five cases of stable intertrochanteric fractures of femur were treated with minimal invasive Dynamichip screw technique. Average blood loss during surgery, reduction of postoperative haemoglobin, requirement of post-operative analgesics and total days of postoperative hospital stay were studied.Results: Mean intraoperative blood loss was 53 ml, mean reduction of postoperative haemoglobin was 0.9 gm/dl. Average wound size was of five cm. Postoperative analgesic requirement was twice a day in an average and for five days. Mean hospital stay after surgery was five days.Conclusion: Minimal invasive Dynamic hip screw is a safe technique having advantages of less blood loss, minimal soft tissue dissection, lesser requirement of post-operative analgesics and shorter hospital stay in treating stable intertrochanteric fractures.DOI: http://dx.doi.org/10.3126/jkmc.v2i4.11739 Journal of Kathmandu Medical CollegeVol. 2, No. 4, Issue 6, Oct.-Dec., 2013Page: 170-174

Minimally invasive deltoid-splitting approach for treatment of proximal humeral fractures: a case-control study

Objective To evaluate the clinical outcomes of minimally invasive percutaneous locking plate osteosynthesis (MIPPO) via deltoid-splitting approach in the treatment of proximal humeral fractures.Methods From June 2010 to December 2012,60 cases of proximal humeral fractures were treated in our hospital with locking plate osteosynthesis.Among them,27 cases were treated with minimally invasive percutaneous plate osteosynthesis (MIPPO) via the anterolateral dehoid-splitting approach (group DS),while 33 cases were treated with open reduction and internal fixation through a traditional deltopectoral approach (group DP).Operation time,blood loss,wound complications and hospital stay time were compared between these two groups.Postoperative shoulder functions were assessed using Constant scores.Results Patients were follow-up for 12 to 24 months (average,18.6 months).There was no difference in the operation time between the two groups (P ＞ 0.05).Blood loss was lower in the DS group than in the DP group (P ＜ 0.05).The DS group had a significantly shorter hospital stay than the DP group (P ＜ 0.05).The difference of the mean healing time between two groups was not significant.The mean Constant score after 3 months showed higher values for group DS versus group DP.However at 6 and 12 months follow-up the scores of two groups had no statistically significant difference.The rate of complications of the DS group was lower than that of the DP group (P ＜ 0.05).Conclusion Pereutaneous locking plate osteosynthesis via deltoid-splitting approach has the advantages of less blood loss,less vascular damage,lower risk of complications and rapid recovery.It is an effective treatment for proximal humeral fractures. Key words: Humeral fractures, proximal; Surgical procedures, minimally invasive; Case-control studies

Laparoscopic Cholecystectomy in Cirrhotic Patients with Symptomatic Cholelithiasis

Gallstones are twice as common in cirrhotic patients as in the general population. Laparoscopic cholecystectomy (LC) was originally contraindicated in cirrhotic patients because of the associated portal hypertension and coagulopathy. But nowadays, it is not considered contraindicated. This study examined the safety of LC in Child\'s class A-B patients. All the cirrhotic patients with gallstones who underwent LC between September 2008-October 20011 have been included in the study. All the cirrhotic patients with Child-Pugh class A and B cirrhosis undergoing LC were included in the study. Demographic characteristics and other parameters including initial presentation, conversion rate, complication rate, mortality, and duration of hospital stay, timing operative were investigated. 21 patients with Child-Pugh A (76.1%) and Child Pugh B (23.8%), liver cirrhosis, (F/M 4/21) underwent LC. The mean age was approximately 61.1p14 years. Two patients (9.5%) developed postoperative wound infection, and mean hospital stay was 3.8 (2-12) days. Of the 21 cases, 2 (9.5%) were converted to open cholecystectomy. The mean operation time was 82.5p15 minutes. Intra-operative and postoperative complications occurred in 3 patients (14.2%) in the form of liver bed bleeding. LC is a safe and effective alternative for the treatment of symptomatic cholelithiasis in patients with well-compensated Childas Class A and Class B cirrhosis. The laparoscopic approach offers advantages of less blood loss, shorter operative time, and shorter length of hospitalization in patients with cirrhosis compared to open cholecystectomy.

Laparoscopy-Assisted Versus Open Total Gastrectomy for Gastric Cancer: A Meta-analysis

It remains controversial whether laparoscopy-assisted total gastrectomy (LATG) is a safe or better alternative to open total gastrectomy (OTG) for the treatment of gastric cancer. We aimed to evaluate the safety and efficacy of LATG by pooling comparative studies of LATG and OTG in a meta-analysis. Original articles comparing LATG and OTG for gastric cancer, published in the English language since 1990, were searched for in PubMed, Embase, Medline, and the Cochrane Library. The outcome variables analyzed were number of harvested lymph nodes, postoperative complications, postoperative mortality, 5-year survival, operative time, blood loss, time of analgesic use, first flatus day, and postoperative hospital stay. Eight studies were considered suitable for the meta-analysis, for a total of 1161 patients (409 LATG and 752 OTG). Compared with OTG, LATG showed a similar number of lymph nodes harvested, morbidity, and postoperative mortality. There was also no difference in 5-year overall and disease-specific survival between groups, according to two enrolled studies where such data were available. LATG required longer operative times than OTG but also resulted in significantly less blood loss, earlier return of bowel function, less time of analgesics use, and shorter postoperative hospital stay. This meta-analysis suggests that LATG in the treatment of gastric cancer is similar in safety and efficacy to OTG. LATG has the advantages of less blood loss and faster postoperative recovery, at the expense of a longer operative time.

Closed reduction at the supine position versus at the side-lying position in intramedullary nailing for femoral shaft fractures

Objective To compare the short-term outcomes of closed reduction at the supine versus side-lying position in the intramedullary nailing for femoral shaft fractures.Methods A retrospective review was conducted of 71 patients with femoral shaft fracture who had been treated with closed reduction at the supine or side-lying position before intramedullary femoral nailing from June 2007 to September 2010.They were divided into 2 groups according to their reduction position.In the supine group there were 26 men and 7 women,with an average of 39.2 ± 9.6 years,and 15 cases of type A,9 ones of type B and 9 ones of type C by the AO classification.In the side-lying group,there were 29 males and 9 females,with an average of 42.2 ± 10.1 years,and 14 cases of type A,10 ones of type B and 14 ones of type C.The 2 groups were compared in terms of operation time,intraoperative blood loss,intraoperative fluoroscopy time,cases who changed to open reduction,postoperative complications,hospital stay and fracture healing time.Results The 71 patients were followed for 12 to 36 months (average,20 months).Compared with the side-lying group,the supine group had significantly longer operation time (139.9 ±46.8 minutes versus 75.5 ± 18.1 minutes)and fluoroscopy time (191.4 ± 78.6 seconds versus 93.3 ± 27.1 seconds),and significantly more blood loss (176.5 ± 103.0 milliliters versus 132.5 ±42.7 milliliters) (P ＜ 0.05).There were no significant differences regarding hospital stay or fracture healing time between the 2 groups (P ＞ 0.05).Three cases changed into open reduction in the supine group and no case did in the side-lying group.No short-term complications happened after operation in the 2 groups.Conclusion In the intramedullary nailing of femoral shaft fractures,closed reduction at the side-lying position is a good alternative because it has advantages of less blood loss,shorter operation time and fluoroscopy time,fewer complications and unnecessary requirement of a traction table. Key words: Femoral fractures; Fracture fixation, intramedullar; Bone nails; Posture

A prospective study of transurethral resection of prostate and transurethral enucleation of prostate for benign prostatic hyperplasia according to different weights of prostate

Objective To compare the clinical effect of transurethral plasma kinetic enucleation of prostate (TPKEP) and transurethral resection of prostat (TURP) for benign prostatic hyperplasia (BPH) according to different weights of prostate.Methods 245 cases of BPH were divided into two groups randomly.122 cases underwent TURP and 123 cases underwent TPKEP.All cases were divided into three subgroups:67 cases in ＜40 g group,96 cases in 40-70 g group and 82 cases in ＞70 g group,according to different weights of prostate.Perioperative parameters and short-term outcomes between two groups were compared.Results In the ＜40 g subgroup there was no significant difference between two groups in perioperative factors and short-term outcomes (P＞0.05).In the 40-70 g subgroup,tissue resected by TPKEP was significantly more than that by TURP (30.2± 13.1 g versus 30.2± 13.1 g,P＜0.05).The intraoperative blood loss was less in TPKEP group than that in TURP group (70.1±10.4 ml versus 81.3±11.3 ml,P＜0.05).The decline of prostate specific antigen (PSA) was more dramatically in TPKEP group than that in TURP group after 3 months (2.6±0.3 μg/L versus 2.1±0.6 pg/L,P＜0.05).In the ＞70 g subgroup,the decline of PSA level was (3.4±0.3) μg/L after 3 months in TPKEP group,more than (2.3±0.7) μg/L in TURP group (P＜0.05).The increase of Qmax after 3 months in TPKEP group was (18.6±3.5) ml/s,more than (16.6±3.4) ml/s in TURP group (P＜0.05).There was no significant difference between the two groups in international prostate symptoms score and residual urine volume (P＞0.05).The transfusion rate for TPKEP (3 ca-ses) were lower than that for TURP (12 cases) (P＜0.05),but the incidence of false incontinence for TPKEP (17 cases) were higher than that for TURP (6 cases) (P＜0.05).Conclusions Compared with TURP,TPKEP resect the entire prostate with the advantages of less blood loss and more effective for a large prostate.TPKEP had no advantage for small prostate,and the medical results are equivalencies in prostate with medium size. Key words: Transurethral plasma kinetic enucleation of prostate; Transurethral resection of prostate; Prostatic hyperplasia; Prospective studies

Bipolar Microdebrider may Reduce Intraoperative Blood Loss and Operating Time during Nasal Polyp Surgery

Bleeding during endoscopic sinus surgery (ESS) can interrupt the flow of the procedure and increase the risk of complications. Advances in microdebrider design now allow for bleeding to be controlled by bipolar energy during the suctioning and shaving of polyps. We conducted a retrospective study to examine the effects of this technology on blood loss and operating times during ESS for chronic rhinosinusitis with nasal polyps (CRS+P). Our patient population was made up of 80 patients who had undergone ESS for CRS+P by the same surgeon from January 2007 through May 2008. All surgeries were performed with either the PK diego bipolar microdebrider (Gyrus ACMI, ENT Division; Bartlett, Tenn.) or a standard microdebrider. There were 40 patients in each group. The PK group was made up of 23 males and 17 females, aged 14 to 66 years (mean: 43.1), and the control group included 21 males and 19 females, aged 17 to 71 years (mean: 43.1); there were no statistically significant differences between the two groups in terms of sex and age. In addition to demographic data, the charts were reviewed for comorbidities and operative variables; the latter included blood loss, operating room (OR) time, and complications. The preoperative treatment and anesthesia protocols were similar for all patients, and all patients demonstrated a similar disease burden on imaging (mean Harvard CT stage: 3.12 for the PK group and 3.15 for the controls; p > 0.05). We found that during ESS, the PK group experienced significantly less intraoperative blood loss than did the controls (means: 86.0 and 123.0 ml, respectively; p = 0.015). In addition, the PK device was associated with significantly shorter OR times (means: 88.9 and 101.4 min, respectively; p = 0.026). There were no complications in either group. We conclude that using a microdebrider with bipolar capabilities during ESS may offer the advantages of less blood loss and shorter operating times in patients with nasal polyps.

2180 ERASER LASER ENUCLEATION OF THE PROSTATE (ELEP) VERSUS BIPOLAR TURP

You have accessJournal of UrologyBenign Prostatic Hyperplasia: Surgical Therapy and New Technology III1 Apr 20122180 ERASER LASER ENUCLEATION OF THE PROSTATE (ELEP) VERSUS BIPOLAR TURP Lukas Lusuardi, Tobias Schätz, Stephan Hruby, Manuela Sieberer, Reinhold Zimmermann, and Günter Janetschek Lukas LusuardiLukas Lusuardi Salzburg, Austria More articles by this author , Tobias SchätzTobias Schätz Salzburg, Austria More articles by this author , Stephan HrubyStephan Hruby Salzburg, Austria More articles by this author , Manuela SiebererManuela Sieberer Salzburg, Austria More articles by this author , Reinhold ZimmermannReinhold Zimmermann Salzburg, Austria More articles by this author , and Günter JanetschekGünter Janetschek Salzburg, Austria More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2012.02.2353AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail INTRODUCTION AND OBJECTIVES Goal of the present study was to ascertain safety and efficacy of a 1,318-nm diode laser for transurethral enucleation of the prostate comparing it to the “gold standard” bipolar transurethral resection of the prostate (TURP). The Eraser laser has been successfully used to resect lung metastasis. It has been recognized to cut and coagulate vascular rich tissue safely and effectively. We describe a prospective randomized trial of Eraser enucleation (ELEP) of the prostate versus TURP. METHODS A total of 100 patients with lower urinary tract symptoms suggestive of bladder outlet obstruction and a mean prostate size of 61.3 ml on transrectal ultrasound were randomized to ELEP or bipolar TURP. Patients were assessed preoperatively and at 1 and 6 months postoperatively. RESULTS ELEP was equivalent to bipolar TURP in terms of improvement in IPSS, maximal flow rates and quality of life. ELEP was significantly superior to bipolar TURP for measured blood loss (114.54 ± 95.02 vs 389.80 ± 138.60ml, p<0.05), catheter time (31.70 ± 7.79 vs 63.74 ± 13.72 hours, p<0.05) and hospital time (43.15 ± 14.56 vs 89.10 ± 10.73 hours, p<0.05). Using the validated Clavien-Dindo system there were 3 grade Id complications and 1 grade II complication. CONCLUSIONS ELEP and bipolar TURP were equally safe and effective for relieving bladder outflow obstruction and lower urinary tract symptoms. ELEP has the advantage of less blood loss, shorter catheter time and hospital stay. Table 1. Perioperative data Mean ELEP+/− SD Mean TURP+/− SD p Value Operative time (min) 68.00 +/− 10.22 59.41 +/− 4.4 <0.05 Enucleation/resection time (min) 45.60 +/− 6.45 59.42 +/− 4.4 <0.05 Morcellation (min) 20.90 +/− 6.51 Resected wt (gm) 32.10 +/− 9.34 32.16 +/− 8.74 0.989 Retrieval rate (gm/min) 0.44 +/− 0.07 0.43 +/− 0.08 0.674 Hemoglobin postop.(gm/dl) 14.69 +/− 0.97 13.122 +/− 0.75 <0.05 Blood loss (ml) 114.54 +/− 95.02 389.80 +/− 138.60 <0.05 HB loss (gm/dl) 0.24 +/− 0.16 0.61 +/− 0.71 <0.05 Blood loss/resected tissue (ml/gm) 6.05 +/− 3.86 10.90 +/− 3.37 <0.05 Bleeding velocity (ml/min) 2.89 +/− 1.41 5.39 +/− 0.76 <0.05 Catheter time (hours) 31.70 +/− 7.79 63.74 +/− 13.72 <0.05 Hospital time (hours) 43.15 +/− 14.56 89.10 +/− 10.73 <0.05 Intraoperative irrigation volume (l) 21.17 +/− 2.84 14.07 +/− 1.60 <0.05 © 2012 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 187Issue 4SApril 2012Page: e879 Advertisement Copyright & Permissions© 2012 by American Urological Association Education and Research, Inc.MetricsAuthor Information Lukas Lusuardi Salzburg, Austria More articles by this author Tobias Schätz Salzburg, Austria More articles by this author Stephan Hruby Salzburg, Austria More articles by this author Manuela Sieberer Salzburg, Austria More articles by this author Reinhold Zimmermann Salzburg, Austria More articles by this author Günter Janetschek Salzburg, Austria More articles by this author Expand All Advertisement Advertisement PDF downloadLoading ...

Thermography Detects Subclinical Inflammation in Chronic Tophaceous Gout

<h3>ABSTRACT</h3> <h3>Study Design:</h3> Retrospective cohort study. <h3>Objective:</h3> To compare outcomes and complications of stand-alone minimally invasive lateral interbody fusion (LIF) vs revision posterior surgery for the treatment of lumbar adjacent segment disease. <h3>Methods:</h3> Adults who underwent LIF or transforaminal lumbar interbody fusion (TLIF) for adjacent segment disease were compared. Exclusion criteria: &gt;grade 1 spondylolisthesis, posterior approach after LIF, and L5/S1 surgery. Patient demographics, estimated blood loss, hospital length of stay, complications, reoperations, health-related quality of life measures, and radiographs were examined. Data were analyzed with the χ², Wilcoxon signed rank, and Mann-Whitney <i>U</i> tests. <h3>Results:</h3> A total of 17 LIF and 16 TLIF patients were included. Demographics were similar. Follow up was similar (LIF: 22.9 ± 11.8 months vs TLIF: 22.0 ± 4.6 months; <i>P</i> = .86). The LIF patients had significantly less blood loss (LIF: 36 ± 16 mL vs TLIF: 700 ± 767 mL; <i>P</i> &lt; .001) and shorter length of stay (LIF: 2.6 ± 2.9 days vs TLIF: 3.3 ± 0.9 days; <i>P</i> = .001). There were no intraoperative complications. Revision rate was 4 of 17 in LIF and 3 of 16 in TLIF (<i>P</i> = .73). Baseline health-related quality of life and radiographic measurements were similar. In both groups, back and leg pain scores significantly improved, and in LIF, the Owestry Disability Index, and EuroQol-5D significantly improved. The LIF had a significant increase in intervertebral height (LIF: 4.8 ± 2.9 mm, <i>P</i> &lt; .001, TLIF: 1.3 ± 3.4 mm, <i>P</i> = .37), which was significantly greater for LIF than TLIF (<i>P</i> = .002). Similarly, LIF had a significant increase in segmental lordosis (LIF: 5.6° ± 4.9°, <i>P</i> &lt; .001, TLIF: 3.6° ± 8.6°, <i>P</i> = .16), which was not significantly different between groups. <h3>Conclusions:</h3> Patients with adjacent segment disease may receive significant benefit from stand-alone LIF or TLIF. The LIF offers advantages of less blood loss and a shorter hospital stay. <h3>Level of Evidence:</h3> 3

Safety and Efficacy of Eraser Laser Enucleation of the Prostate: Preliminary Report

We ascertained the safety and efficacy of the 1,318 nm diode Eraser laser (Rolle and Rolle, Salzburg, Austria) for transurethral enucleation of the prostate. This laser has been successfully used to resect lung metastasis. It cuts and coagulates vascular rich tissue safely and effectively. We describe a prospective, randomized trial of Eraser laser prostate enucleation vs bipolar transurethral prostate resection. A total of 60 patients with lower urinary tract symptoms suggesting bladder outlet obstruction and a mean prostate size of 59.5 ml on transrectal ultrasound were randomized to Eraser laser prostate enucleation or bipolar transurethral prostate resection. Patients were assessed preoperatively, and 1 and 6 months postoperatively. Eraser laser prostate enucleation was equivalent to bipolar transurethral prostate resection in improvement in International Prostate Symptom Score, maximal flow rate and quality of life. Laser enucleation was significantly superior to bipolar transurethral resection for measured blood loss (mean ± SD 116.83 ± 97.02 vs 409.83 ± 148.61 ml), catheter time (mean 32.80 ± 8.74 vs 65.73 ± 13.72 hours) and hospital time (mean 45.13 ± 14.77 vs 91.20 ± 11.76 hours, each p <0.05). Using the validated Clavien-Dindo system there were 3 grade Id and 1 grade II complications. Eraser laser prostate enucleation and bipolar transurethral prostate resection were equally safe and effective to relieve bladder outflow obstruction and lower urinary tract symptoms. This laser technique has the advantage of less blood loss, and shorter catheter time and hospital stay.

Minimally Invasive Approach versus Traditional Open Approach for One Level Posterior Lumbar Interbody Fusion

While over the last ten years minimally invasive posterior lumbar interbody fusion (PLIF) has been acknowledged to (i) reduce approach-related morbidity associated with quicker recovery, (ii) require a shorter hospital stay and (iii) deliver similar clinical outcomes when compared to a traditional approach, it is still not the current gold standard. In order to demonstrate the efficacy of the minimally invasive lumbar PLIF approach, a retrospective study was conducted comparing both approaches. A retrospective study was conducted with 40 patients treated for one level, degenerative lumbar instability. 20 patients received lumbar PLIF though a standard open approach, while another 20 underwent a minimally invasive approach using the "SpiRIT"-system. Spinal pathological features, stabilized segments, number of implanted pedicle screws, surgical time, radiation time, blood loss, complications, radiographic images and standardized patient questionnaires (VAS, ODI) were evaluated. The follow-up period was one year. One year after the performed surgery, we found no significant difference between the two groups with regard to clinical and radiographic outcome. However, in the minimally invasive group we noticed less blood loss, less postoperative pain, a shorter recovery time and a shorter hospital stay. Despite these benefits, the minimally invasive group also experienced a longer surgical and radiation time as compared to the "open" group. This study confirmed the results of previous studies which advocated the advantages of less blood loss, less postoperative pain, quicker recovery and shorter duration of hospitalization. However, in the long run, one year after surgery, both groups showed no significant difference with regards to clinical and radiographic outcome. Therefore long-term controlled studies are necessary to validate the role of the minimally invasive PLIF in degenerative lumbar instability.