Average Intraoperative Blood Loss Research Articles

Combined anteroposterior approaches in lateral position treatment of lumbosacral tuberculous in single-stage

BackgroundThe local anatomy of the lumbosacral region of spine is complicated, with special biomechanical characteristics. For surgical management of tuberculous spondylitis reported in the literature, the methods would be two-stage anterior and posterior approaches or one-stage anterior and posterior approach with patient’s intraoperative position being changed. These types of surgery approaches would result in long operative duration and more intraoperative blood loss, and most important there is no coordination between anterior and posterior procedures.MethodsThe purpose of this study was to introduce a new procedure called in the lateral position single -stage combined anteriorposterior approaches for treatment of lumbosacral tuberculous spondylitis and to evaluate its preliminary surgical outcomes. Fifteen patients with lumbosacral tuberculous spondylitis who underwent single-stage anterior and posterior radical focal debridement and reconstruction in lateral position in our hospital from April 2005 to June 2012 were included in the study. There were 6 males and 9 females with the average age of 46.8 years. The tuberculous lesions involved the following regions: L3-4 in 5cases, L4-5 in 5 cases, L5-S1 in 2 cases, L4 in one case, and L5 in 2 cases. The assessment of surgical outcomes was conducted with clinical symptoms and radiological findings,including operative time, blood loss. deformity angle, Frankel grade and Kirkaldy-Willis evaluation.ResultsOperation posture: The right lateral position was used for 11 patients and the left lateral position was used for the remaining 4 patients. The average duration of operation for the 15 patients was 270 min. The average intraoperative blood loss was 1720 ml. The mean follow-up period was 4.2 years. There was no recurrence. The postoperative radiological findings showed that the interbody bone grafts were fixed without any dislodgment. There was significant difference between preoperative and postoperative lumbosacral lordotic angles. Kirkaldy-Willis classification rating for the 13 cases with satisfactory results.ConclusionSingle-stage combined anterior and posterior surgical management of lumbosacral tuberculous spondylitis with patient in lateral position can achieve radical focal debridement, anterior and posterior procedure coordination and spinal reconstruction.

A new method for posterior pelvic reconstruction with autologous tissue in robot-assisted radical prostatectomy

BACKGROUND: Despite the improvement of surgical techniques and a significant improvement in the functional results of surgical interventions for prostate cancer urinary incontinence after radical prostatectomy remains the most important factor that negatively affects the quality of life of patients.
 AIM: Evaluation of the effectiveness and safety of a new technique for posterior reconstruction using autologous tissue an endopelvic fascia flap in robot-assisted radical prostatectomy.
 MATERIALS AND METHODS: 28 patients with localized prostate cancer who underwent modified robot-assisted radical prostatectomy at one medical center were included in the study. During the operation after removal of the prostate a posterior reconstruction of the small pelvis was performed by excising a flap of the endopelvic fascia on one side, placing it behind the bladder neck and urethrocystoanastomosis, followed by fixing this flap to a similar structure on the opposite side in the form of a loop, strengthening the anastomosis from behind. The main intraoperative parameters, oncological and functional results were evaluated.
 RESULTS: Analysis of the results of the study confirmed the high efficiency of the proposed surgical technique. The average operation duration was 145 min (120170 min), average console time was 68 min (55102 min), the average duration of the posterior reconstruction stage was 6 min (3.58.5 min). Average intraoperative blood loss was 55 ml (25175 ml). The urethral catheter was removed on the 7th day after the operation in all patients. During surgery there were no conversions and any complications of IIIV groups according to the Clavien Dindo classification. Immediate urinary continence was noted in 23 (82.1%) patients (82,1%), early urinary continence was noted in 26 (92.8%) patients.
 CONCLUSIONS: The results of the study showed that the use of a new technique for posterior reconstruction in robot-assisted radical prostatectomy using endopelvic fascia flaps is effective and safe, showing good early functional results, in particular, immediate urinary continence without compromising oncological outcomes.

Laparoscopic Colon Resection

Background: Laparoscopic surgery has a well-documented role in colon resection with improved postoperative outcomes even in low-volume centers. Recently, we have integrated minimally invasive laparoscopic resection, followed by the enhanced recovery after surgery (ERAS) protocol, to improve postoperative outcomes in our hospital. Objectives: To review our experience of laparoscopic colonic resection with the ERAS protocol and compare our outcomes with those in the literature. Design: Observational retrospective. Setting: Governmental tertiary hospital. Materials (Patients) and Methods: Data of patients over 18 years of age who had undergone laparoscopic colonic resection between January 2016 and December 2021 were retrospectively obtained from medical records. Patients with trauma-related injuries were excluded. The variables collected included patient demographics, disease information, operative and postoperative data, and histopathological reports. Data were compared with similar published studies and landmark trials. Sample Size: 92 patients. Main Outcome Measures: Rates of conversion to open procedure, number of lymph nodes harvested, hospital length of stay, percentage of positive margins, 30-day morbidity, and 30-day mortality. Results: During the study period, 92 patients (59% men) underwent laparoscopic colon resections, of which eight (8.6%) required an open procedure. The average operative time was 233 minutes, and the average intraoperative blood loss was 78 mL. Intraoperative complications occurred in four cases with no postoperative sequelae. The median length of hospital stay was 5 days. Malignant specimens revealed 100% disease-free margins with an average of 22 lymph nodes harvested. The postoperative 30-day morbidity, mortality, and histopathological results were comparable with landmark trials. Conclusion: As a new technique in a low-volume center, laparoscopic colon resection was challenging. Despite the presence of an experienced laparoscopic surgeon, extensive training was required to safely complete the procedure within a reasonable operative time with a successful outcome. Furthermore, the implementation of the ERAS protocol was difficult; however, the team mastered it after the first few cases. This study showed that both efficacy and safety can be achieved in laparoscopic colon resections in low-volume centers. Moreover, the ERAS protocols can be implemented; however, their implementation will require additional training, which may lead to better outcomes. Limitations: The lack of general surgery wards in a busy tertiary trauma center meant that patients with variable wound contamination would share the same unit. Conflict of Interest Statement: None. Number of similar cases published: N/A.

A comparison of use microdebrider with conventional endoscopic surgery for nasal polyps

Background: Nasal polyps are chronic and benign inflammatory lesions that arise from the mucous membrane of the nasal cavity and paranasal sinuses. And it represents a challenge in treatment due to its uncertain causes and recurrent relapse. Because of that the surgical treatment is considered as the best choice for the removal of nasal polyps. And, it contains endoscopic sinus surgery using either conventional instruments or the microdebrider which is an automatic device used to remove the obstructing tissue. And, it represents a modern technology in the treatment of nasal polyps. Objectives: Studying and comparing the microdebrider assisted endoscopic surgery and conventional methods using sinus endoscopes in the surgical management of nasal polyps, and evaluating the advantages of the microdebrider. Methods: The study was a comparative prospective study conducted at the department of ENT, tishreen university hospital, lattakia, Syria done between 2020 to 2021. 76 patients (46 male and 30 females) were enrolled in the study and divided into two groups depending on the used surgical method. Group1: conventional endoscopic sinus surgery method, Group2: microdebrider assisted endoscopic surgery. Then, comparing the results during and after 3 months of the surgery. Results: There were a significant difference between study groups in the mean time required for surgery (shorter in group2 with p-value <0.01) and the average intraoperative blood loss (less in group2 with p-value<0.01). Endoscopic sinus surgery with the microdebrider noted a low rate of postoperative synechiae formation after three monthes and there is no significant difference between the two groups in recurrence of nasal polyps after three monthes. Conclusion: Using the microdebrider in the surgical treatment of nasal polyposis is an effective and safe method because it has the advantage of saving time, decreasing blood loss during surgery, and reducing the rate of postoperative synechiae formation. but there is no significant difference in recurrence between the microdebrider and conventional methods.

Transvertebral space and under the pedicle osteotomy for thoracolumbar kyphosis caused by old osteoporotic vertebral compression fracture

To investigate the effectiveness of transvertebral space and under the pedicle osteotomy for thoracolumbar kyphosis caused by old osteoporotic vertebral compression fracture (OVCF). The clinical data of 11 patients with thoracolumbar kyphosis caused by old OVCF treated by transvertebral space and under the pedicle osteotomy between January 2016 and December 2020 were retrospectively analyzed. There were 2 males and 9 females, with an average age of 61.3 years (range, 50-77 years) and with a median disease duration of 8 years (range, 6 months to 50 years). Fracture reasons: 9 cases had a clear history of trauma, and 2 cases had no obvious incentive. A total of 11 vertebrae was involved in fracture, including T 12 in 3, L 1 in 7, L 2 in 1. The operation time, intraoperative blood loss, postoperative drainage volume, and complications were recorded. Full-length X-ray films of spine and local X-ray films of the operation area were examined before operation, at 7 days after operation, and at last follow-up. The Cobb angle of thoracolumbar kyphosis was measured, and the correction rate was calculated. The visual analogue scale (VAS) score and Oswestry disability index (ODI) were recorded to assess patients' pain and functional improvement before operation, at 1 month after operation, and at last follow-up. All operations were successfully completed. The average operation time was 188.6 minutes (range, 140-215 minutes); the average intraoperative blood loss was 268.2 mL (range, 100-500 mL); the average postoperative drainage volume was 615.5 mL (range, 160-1 500 mL). One patient developed bilateral thigh rebound pain after operation, which relieved after symptomatic treatment of nutritional nerve and acesodyne. All patients were followed up 14.7 months on average (range, 6-56 months). At last follow-up, osseous fusion was observed in all patients, and no fracture, loose, or displacement of internal fixator was observed on imaging. At 7 days after operation and at last follow-up, the Cobb angle of thoracolumbar kyphosis significantly improved when compared with preoperative one ( P<0.05), and there was no significant difference between at 7 days after operation and at last follow-up ( P>0.05); the correction rates of Cobb angle at 7 days after operation and at last follow-up were 68.0%±9.8% and 60.3%±11.9%, respectively. At 1 month after operation and at last follow-up, the VAS score and ODI significantly improved when compared with preoperative ones, and further improved at last follow-up when compared with those at 1 month after operation, all showing significant differences ( P<0.05). Transvertebral space and under the pedicle osteotomy is an effective way to treat thoracolumbar kyphosis caused by old OVCF with less trauma, shorter operation time, and less intraoperative blood loss. Patients can obtain good orthopedic results and quality of life.

567 Compression of the lower uterine segment (colus) – new technique for reducing the bleeding during c-section in women with placenta previa

Objectiveto evaluate efficiency of a new approach for bleeding prevention and cessation during C-section in pregnant women with placenta previa. Study design: 61 pregnant women with diagnosed by ultrasound examination placenta previa were recommended planned operative delivery. All of them were randomized and divided into 2 groups. Study group (n=30) had elective C-section at 36-36+6 gestation weeks using our modified method of surgical hemostasis (COLUS): after placenta's we perfomed compressive suture on the lower uterine segment, uterine vessels' ligation and placed catheter inside the uterine cavity. All patients received prevention of neonatal RDS. Pregnant women in control group (n=31) had planned caesarean section at 38-39 weeks. Hemostasis of the area of the placenta location was reached by using electrocoagulation of the lower uterine segment vessels and additional suturing of bleeding areas, wherever necessary. Intraoperative blood loss and neonatal outcomes in both groups were evaluated, analyzed and compared respectively. Newborns’ condition was assessed using Apgar score at the 1st and 5th minute after delivery. Results: Bleeding control was achieved in all patients (100%). Average intraoperative blood loss in control group was 1277 ± 119 mL vs. 698±139 mL - in study group. Apgar score at 1'-5' min ranged between 7 and 9 in both groups. Weight and length of newborns were 2679±33g and 47±1cm for study group vs. 3151±78g and 48±1cm for control group, that matches the normal values for that gestational ages. No major complications occurred in both groups. Conclusions: tactic developed by us allows to prevent massive obstetric hemorrhage in most cases of placenta previa during cesarean section and lead to reduction of intraoperative blood loss by 45%.

Clinical Application Study of Minimally Invasive Double-Reverse Traction in Complex Tibial Plateau Fractures.

The aim of this study was to evaluate the clinical application of double-reverse traction for minimally invasive reduction of complex tibial plateau fractures. A retrospective analysis was performed to identify all patients admitted to the Department of Orthopedics, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, from March 2017 to December 2019 with Schatzker type VI tibial plateau fractures. 12 patients were identified (7 men and 5 women) with an average age of 46.15 ± 13 (39-58) years old. All patients were treated with double-reverse traction and closed reduction. After the fracture was reduced, the bone plate was fixed by percutaneous minimally invasive implantation. Outcomes assessed in this study include operation time and intraoperative blood loss. Imaging was performed during the postoperative follow-up, and functional recovery was evaluated at the final follow-up according to the Hospital for Special Surgery (HSS) score and the International Knee Joint Literature Committee (IKDC) functional score. Patients were followed up for 12.54 ± 1.5 (8-15) months. The average operation time was 63.63 ± 21 (35-120) minutes, and the average intraoperative blood loss was 105.45 ± 21 (60-200) mL. The Rasmussen imaging score was either excellent or good in all cases. The knee joint HSS score was 86.15 ± 6 (79-90) points, and the IKDC score was 80.01 ± 11 (75-90) points. No complications, such as wound infection, incision disunion, loosening of internal fixation, and internal fixation failure, occurred. In the treatment of Schatzker VI type complex tibial plateau fracture, the dual-reverse traction minimally invasive technique has the advantages of safety and effectiveness, less soft tissue injury, and allowing early joint movement, which is worthy of clinical promotion.

The use of a single-piece bone flap for cranial reshaping in anterior craniosynostosis patients: clinical experience and a description of a novel technique

BackgroundCraniosynostosis is known as premature closure of one or more of the cranial sutures. Anterior craniosynostosis involves anterior plagiocephaly and trigonocephaly. One of the issues in anterior craniosynostosis skull reshaping is maintaining an aesthetically pleasing forehead curve. Therefore, in this article, we demonstrate our novel technique to use a single-piece bone flap for cranial reshaping of the anterior mold in patients diagnosed with anterior craniosynostosis. A retrospective record review of patients who underwent single piece bone flap cranial reshaping for correction of unicoronal synostosis (UCS) and metopic synostosis (MS) at an Academic Institute in Riyadh, Saudi Arabia, between 2018 and 2020, was conducted.ResultsSix non-syndromic consecutive patients were included. Three of the patients had MS. The mean age at surgery was 11.16 months (range, 6–19 months). The average OR time was 315 min (range, 263–368 min). The average intraoperative blood loss was 225 ml (range, 100–400 ml). All patients had achieved acceptable functional and aesthetic results.ConclusionOur novel technique is an innovative and efficient reconstructive technique to simultaneously address MS and UCS and minimize intraoperative bleeding and surgery time. However, more studies with more cases are required.

Role of combined brim and spring plates in the treatment of acetabular fractures involving quadrilateral plates: a retrospective study of early results

Background: Quadrilateral plate (QP) fractures constitute an intrapelvic component of acetabular fractures and are challenging for surgical fixation. Inability to reduce and buttress QP leads to poor functional outcome. The hypothesis was that use of combined brim and spring plates for fixation of fractures that involved QP would maintain reduction and improve functional outcomes of those patients. Methods: This was a retrospective case series study of 44 patients with acetabular fractures that involved QPs that were fixed by combined brim and spring plates between March 2015 and January 2020 in the orthopaedic surgery department in Suez Canal University Hospitals. All patients were operated by the same surgical team. A minimum of 12 mo of postoperative follow-up was planned for each. Statistical analysis was done using SPSS software (version 17 for Windows, Chicago, Illinois). Results: The mean patient age was about 40.4 yr. The associated dislocations were present in ten patients (22.7%). Anterior column and posterior hemitransverse fractures were in about 50% of patients. Average operative time was about 146 min. Average intraoperative blood loss was about 583 mL. No patients developed avascular necrosis of the femoral head, heterotopic ossification, or implant failure. Two patients had postoperative obturator nerve injury. Quadrilateral component reduction was anatomical in 28 hips (63.6%). At 1-year follow-up, final clinical scores were excellent in 15 hips (34.1%) and good in 18 hips (40.9%). Conclusions: Combined brim and spring plates can maintain anatomical reduction of QP fractures and give good clinical results with less operative time and fewer complications than other methods mentioned in the literature. Level of Evidence: Level IV.

Application of da Vinci robot and laparoscopy on repeat hepatocellular carcinoma.

Background:Repeat laparoscopic liver resection has been used safely and effectively on hepatocellular carcinoma (HCC). However, few studies have been performed on repeat HCC surgery by a da Vinci robot. This study aims to evaluate the outcomes of the patients with repeat HCC treated using a da Vinci robot or laparoscopic system at a single centre.Methods:All of the patients with repeat HCC treated using a da Vinci robotic or laparoscopic system between April 2017 and April 2020 were included in this retrospective study.Results:There were 24 patients with a mean age of 56 years who underwent da Vinci robotic or laparoscopic surgery for treatment of repeat HCC who were included in this study. The operations lasted 152 ± 25 min and 142 ± 34 min. The average intraoperative blood loss was 284 ± 89 ml and 251 ± 92 ml. The average hospitalisation stay lasted 9 ± 2 days and 9 ± 3 days. The rates at which surgeons switched to open surgery were 9% and 23%. No serious perioperative or post-operative complications were encountered.Conclusion:Da Vinci robots can provide a precise dissection of the tissue under a perfect view. It is a technically feasible procedure for less rates at which surgeons switched to open surgery on repeat HCC.

Manifestation of Urinary Tract Injury during Cervical Cancer Surgery Based on CT Urography Secretion Phase Images.

Methods We grouped the patients who had undergone cervical cancer surgery in a hospital in this article and compared the nanodrug carrier system under CT imaging with traditional laparoscopy. The postoperative physical parameters of surgical patients are collected from cervical cancer patients of different degrees, and the parameters and prognostic health of patients after different operations are compared. Results The results of the study show that the postoperative patient's body parameters of the nanodrug delivery system under the CT imaging technology used in this article are better than those of the traditional surgery group, and the average intraoperative blood loss is about 20% less than that of the traditional surgery. Postoperative complications occur. The situation is even lower, more than 30% lower than traditional surgery. Conclusion This shows that the operation of the nanodrug delivery system based on CT imaging technology has broken through some of the limitations of the development of laparoscopic technology and has played an important role in the surgical treatment of cervical cancer.

The Treatment of Subtrochanteric Fracture with Reversed Contralateral Distal Femoral Locking Compression Plate (DF-LCP) Using a Progressive and Intermittent Drilling Procedure in Three Osteopetrosis Patients.

ObjectiveTo describe the application of reversed contralateral distal femoral locking compression plate (DF‐LCP) inserted through a progressive and intermittent drilling procedure in the treatment of osteopetrotic subtrochanteric fracture (OSF).MethodsThree patients (one male and two females with an average age of 45.33 ± 11.09 years) with OSF hospitalized between September 2015 and September 2020, were included in this present study. Lateral approach was applied in all patients who accepted open reduction and internal fixation (ORIF) with a reversed contralateral DF‐LCP inserted through a progressive and intermittent drilling procedure. The operation time and intraoperative blood loss were recorded to evaluate the efficiency of this surgical method. Physical examination and imaging examination of the fracture site were used to evaluate the fracture union status, the position and stability of the implant, and the alignment of the injured limb at 1, 3, 6, and 12 months after operation, then a subsequent visit was conducted at least once a year. Harris Hip Score (HHS) was used to evaluate the hip joint function at 6 and 12 months after operation.ResultsThe average operation time was 140 ± 21.60 min (110, 160, and 150 min); The average intraoperative blood loss was about 333.33 ± 23.57 ml (300, 350, and 350 ml). The average follow‐up time was 22.33 ± 7.41 months (29, 26, and 12 months). All patients achieved bone union with an average time of 6.67 ± 0.94 months (6, 8, and 6 months). At the time of 6 months after operation, case 1 and 3 were almost pain‐free and could walk with full weight bearing while case 2 could walk only with partial weight bearing using a crutch. The HHS scores of cases 1, 2, and 3 were 84/100, 74/100, and 92/100, respectively. At the follow‐up at 12 months after operation, the HHS score improved to 91/100, 81/100, and 96/100, respectively. The contralateral incomplete old subtrochanteric fracture was deteriorated in case 1 at 26 months after operation. After 3 months of limited weight bearing using a crutch, bone union was verified in radiograph imaging. Fresh contralateral subtrochanteric fracture occurred in case 2 at 26 months after operation, which was treated using a similar surgical approach, and its clinical outcome is under follow‐up. Moreover, no perioperative complications including operation‐related death, vascular/nerve injury, deep venous thrombosis, pulmonary embolism, and incision infection, and long‐term complications involving malunion, nonunion, implant failure, ankylosis, heterotopic ossification, osteonecrosis, and osteomyelitis were identified.ConclusionThe application of reversed contralateral DF‐LCP in OSF is practicable and reliable. Progressive and intermittent drilling is a safe and efficient method for implant insertion in this complicated situation.

Carinal resection and reconstruction with complete pulmonary parenchyma preservation: a single-institution analysis of 36 cases.

BackgroundCarinal resection, performed in only a few high-volume centers, remains one of the most complicated and technically demanding surgeries. Few studies have examined the outcomes of carinal resection and reconstruction with complete pulmonary parenchyma preservation.MethodsPatients who underwent isolated carinal resection and reconstruction at the Shanghai Chest Hospital between 2006 and 2020 were retrospectively reviewed. Clinicopathological, perioperative, and follow-up outcomes were analyzed.ResultsA total of 36 patients were included, including 19 men and 17 women. The average age was 50.7±14.8 years. Right posterolateral thoracotomy (n=33, 91.7%) and cross-field intubation during anastomosis (n=31, 86.1%) were selected for the majority of the carinal surgeries. The average intraoperative blood loss was 225.0 mL, and the mean operation duration was 196.1 minutes. Postoperative complications were observed in 14 patients (38.9%), including cicatricial stenosis (n=8, 22.2%), anastomotic fistula (n=3, 8.3%), air leak (n=1, 2.8%), cardiac arrhythmia (n=4, 11.1%), pneumonia (n=2, 5.6%), respiratory failure (n=1, 2.8%), and pulmonary embolism (n=1, 2.8%). There were 2 perioperative deaths (5.6%). Multivariate analysis revealed that being overweight was an independent favorable factor for postoperative complications [P=0.042, odds ratio (OR) =0.092, 95%, confidence interval (CI): 0.009–0.922]. Pathological diagnoses included squamous cell carcinoma (SCC) (n=12, 33.3%), adenoid cystic carcinoma (ACC) (n=15, 41.7%), mucoepidermoid carcinoma (MEC) (n=2, 5.6%), stricture (n=1, 2.8%), and other rare histological types. An R0 resection was achieved in 14 patients, while 21 patients (60.0%) had microscopically positive margins. Lymph node metastasis was confirmed in 6 patients (17.1%). Overall survival (OS) was 94.4% at 1 year and 79.4% at 5 years, with 107 months as the median survival time (95% CI: 64.0–150.0 months). All patients with negative margins remained alive during the follow-up period, while those who received R1 resections had much poorer survival rates due to tumor recurrence [P=0.042, hazard ratio (HR) =4.938, 95% CI: 1.062–22.950].ConclusionsIn selected patients, carinal resection and reconstruction with complete pulmonary parenchyma preservation was a feasible option to achieve an appreciable long-term survival at the risk of acceptable operative mortality and morbidity, particularly when complete resection with negative margins could be realized.

Modified median hepatic fissure approach for resection of liver tumours located in the angle between the root of the middle and right hepatic veins

BackgroundLiver tumours between the root angle of the middle and right hepatic veins are a special type of liver segment VIII tumour. In this study, we designed a modified median hepatic fissure approach to remove these tumours. The safety and effectiveness of the approach were evaluated.Materials and methods From April 2015 to November 2019, 11 patients with liver tumours between the angle of the middle and right hepatic veins underwent this modified median hepatic fissure approach. We retrospectively analysed data from the perioperative periods of these 11 patients, including general condition, operation time, intraoperative bleeding, and postoperative complications. Disease-free survival and overall survival were assessed.ResultsOf the 11 patients, 9 patients had primary hepatocellular carcinoma and 2 had colorectal liver metastases. The average intraoperative blood loss was 285 mL (150–450 mL). Two patients developed postoperative bile leakage, but there were no significant serious complications, such as intraabdominal bleeding and liver failure, in any of the patients. The liver function returned to the normal range on the 5th day after surgery. Of the 11 patients, 5 have survived for more than 3 years (45.5%), and 4 have been disease-free for more than 3 years (36.3%).ConclusionsFor liver tumours between the root angle of the middle and right hepatic veins, the modified median hepatic fissure approach is a safe and feasible method.

Outcome of Surgical Management of Hemophilic Pseudotumor: Review of 10 Cases from Single-Center.

ObjectiveTo evaluate the operative methods and clinical results of surgical treatment in a case series of 10 patients with hemophilic pseudotumors.MethodsTen patients with hemophilic pseudotumors who received surgical resection treatment in our hospital from October 2017 to June 2020 were retrospectively reviewed. All patients were hemophilia A (factor VIII deficiency).The age range was 20–51 years. Preoperative imaging examination revealed the size of irregular mass from 8.2 cm× 3.3 cm× 2.3 cm to 22.3 cm× 15.5 cm× 17.0 cm. With the supplementary of recombinant coagulation factor VIII, five cases received complete resection; one received resection and skin grafting; one received cytoreduction surgery as the pseudotumor closing to iliac vessel and nerve; three cases received complete resection and construction as bone destruction. The perioperative variables were recorded and all the patients were followed in the outpatient clinic. Clinical and radiological assessments were conducted.ResultsIn these patients, the average intraoperative blood loss volume was 783.1 mL (range, 240–2100 mL). Six patients received blood transfusion during perioperative period. The average duration of surgery was 140.7 min (range, 110–240 min). All wounds healed smoothly and there was no infection or chronic sinus formation. The average length of hospital stay was 16.3 days (range, 12–25 days). There is no iatrogenic vascular nerve injury in our series. Complete follow‐up was performed in all patients. Mean follow‐up duration was 14.2 months (range, 6–26 months). One patient with pseudotumor in the thigh had a recurrence 1 year after operation, then secondary operation was performed. In three cases who received complete resection and construction, patient 8 obtained bone graft and late fixation. X‐ray examination showed bone formation in the lesion at the 2‐year follow‐ups after operation. Patient 9 underwent knee replacement, his left knee showed flexion deformity in preoparation. At the last follow‐up, range of motion was improved from 0° to 40° compared with preoperative status. Patient 10 had pseudotumor in the distal femur, received long bone graft and intramedullary nail fixation.ConclusionsSurgical resection for hemophilic pseudotumors is an effective and safe method. The choice of surgical procedure must be individualized according to the localization and progress of pseudotumor.

Single-stage debridement via autogenous iliac bone graft through the OLIF corridor and lateral fixation in treating spontaneous single-level lumbar pyogenic spondylodiscitis

BackgroundThe aim of the present study was to investigate the efficacy and safety of mini-open oblique debridement and lumbar interbody fusion combined with lateral screw fixation for treating single-level pyogenic spondylodiscitis.MethodsTwelve patients with single-level lumbar pyogenic spondylodiscitis underwent OLIF combined with lateral screw fixation were analyzed. Patients underwent follow-up for 12 to 24 months. The clinical characteristics, etiological examinations, operative time, intraoperative blood loss, Oswestry Disability Index (ODI), visual analog scale score (VAS), postoperative complications, and the bony fusion rate were recorded.ResultsThe mean follow-up period of time was 14.8 months. The average operative time and intra-operative blood loss were 129.0 ± 19.76 min and 309.2 ± 92.96 mL, respectively. No severe intra-operative complications were observed during surgery, except in 1 case that develops abdominal pain and distension after surgery, 2 cases that develop left-sided transient thigh pain/numbness and 8 cases that complains of donor site (iliac crest) pain. All of these symptoms disappeared 8 weeks after surgery. Tissue sample cultures were obtained from all patients intraoperatively and four (33.3%) were positive, including 2 with Staphylococcus aureus, 1 with Staphylococcus epidermidis, and 1 with Escherichia coli. During an average of 22.5 ± 2.1 days (range, 14–29 days) after surgery, WBC, CPR, and ESR levels in all patients had returned to normal. All patients were pain free with no recurring infection. Solid bony fusions were observed in all cases within 6 months, including 10 with I grade fusion, 2 with II grade fusion according to the classification suggested by Burkus et al. No fixation failure was observed during follow up and solid bony fusions were observed in all 12 patients at finally follow-up. A significant postoperative increase was also observed in the mean segmental height and lordosis (P < 0.05), followed by a slight decrease of segmental height and lordosis at final follow-up. At the final follow up, the mean VAS (1.5 ± 0.6) and ODI (18.9 ± 7.6) were significantly lower than VAS (8.4 ± 2.7) and ODI (71.2 ± 16.5) before surgery (P < 0.01).ConclusionSingle-stage debridement with autogenous iliac bone graft through the OLIF corridor and lateral fixation was a feasible surgical approach in our consecutive 12 cases of pyogenic spondylitis.

Первичная артропластика как метод выбора при лечении чрезвертельных переломов у лиц пожилого и старческого возраста

Актуальность. Первичное эндопротезирование применяется как альтернатива внутреннему остеосинтезу при остеопоротических чрезвертельных переломах у пациентов пожилого и старческого возраста. Существуют контраверсийные взгляды хирургов на выбор показаний, хирургического доступа, технику реконструкции вертельной области, технику имплантации бедренного компонента эндопротеза и травматичность операции. Цель работы — обосновать собственный подход к первичной артропластике при чрезвертельных и межвертельных переломах у пациентов пожилого и старческого возраста с позиции оценки ближайших и среднего срока клинико-функциональных результатов. Материалы и методы. В период с 2015 по 2019 год первичная цементная артропластика выполнена у 44 пациентов. Возраст пациентов — от 72 до 89 лет (средний возраст — 77,34 ± 2,10 года). В соответствии с классификацией АО у 13 переломы относились к типу 31-А1, у 25 — 31-А2, у 6 — 31-А3. Перед имплантацией бедренного компонента выполняли реконструкцию вертельной области с восстановлением калькара по собственной методике. Результаты. Мы не наблюдали осложнений, связанных с реконструкцией вертельной области и имплантацией эндопротезов. Продолжительность хирургических вмешательств варьировала от 50 минут до 1 часа 20 минут. Средняя интраоперационная кровопотеря составила 280 ± 60 мл. Продолжительность лечения в отделении — от 6 до 11 дней (в среднем 8,3 ± 2,6 дня). Клинико-рентгенологические результаты изучены у 32 (72,72 %) пациентов в сроки от 4 до 14 месяцев. У всех восстановлена функция ходьбы с опорой на поврежденную ногу. При контрольной рентгенографии отмечены репаративные процессы в области реконструкции, удовлетворительная плотность кости вокруг цементной мантии и ножки эндопротеза. Согласно опросу, восстановленная функциональная активность соответствовала уровню до травмы. Выводы. Общая оценка анатомических и функциональных результатов подтверждает целесообразность применения первичной артропластики как альтернативного метода лечения остеопоротических вертельных переломов.

Retroperitoneoscopic debridement and internal fixation for the treatment of lumbar tuberculosis.

To describe the retroperitoneoscopic debridement technique and evaluate the clinical outcome of internal fixation for the treatment of lumbar tuberculosis.Twenty-eight patients were performed conventional laparoendoscopic technique (n = 17) or laparoendoscopic single-site technique (n = 11). Antituberculosis chemotherapy and thoracolumbosacral orthosis were given to all patients. The clinical outcomes were evaluated with preoperative and postoperative Visual Analog Scale, and radiographs with respect to sagittal angle and fusion status.Average time of the 28 procedures was 220.6 ± 50.9 min (180–365 min). The average intraoperative blood loss was 108.6 ± 95.3 mL (50–400 mL). All patients showed significant improvement of their Visual Analog Scale back pain score at follow-up and were classified as having a radiographic fusion in this study. The mean sagittal angle was 11.2 ± 3.6° before operation, significantly improved to 3.7 ± 2.4° after operation. There were no recurrent infections during the follow-up period. Complications included loosening of anterior fixation and temporary deficit of the sympathetic nerve.Retroperitoneal laparoscopic approach with CO2 insufflation technique is a challenging but safe and effective procedure for lumbar spine tuberculosis. Retroperitoneal laparoendoscopic single-site can be used for anterior lumbar spine surgery, offer exposure for L1 through L5.

Iliosacral Bone Tumor Resection Using Cannulated Screw-Guided Gigli Saw - A Novel Technique

BackgroundAdequate margins are technically difficult to achieve for malignant tumors involving the sacroiliac joint due to limited accessibility and viewing window. In order to address the technical difficulties faced in iliosacral tumor resection, we proposed a technique for precise osteotomy, which involved the use of canulated screws and Gigli saw (CSGS) that facilitated directional control, anteroposterior linkage of resection points and adequate surgical margins. The purpose of the current study was to evaluate whether CSGS technique facilitated sagittal osteotomy at sacral side, and were adequate surgical margins achieved? Also functional and oncological outcomes was determined along with the noteworthy complications.MethodsFrom April 2018 to November 2019, we retrospectively reviewed 15 patients who underwent resections for primary tumors of pelvis or sacrum necessitating iliosacral joint removal using the proposed CSGS technique. Chondrosarcoma was the most common diagnosis. The osteotomy site within sacrum was at ipsilateral ventral sacral foramina in 8 cases, midline of sacrum in 5 cases, and contralateral ventral sacral foramina and sacral ala with 1 case each. The average intraoperative blood loss was 3640 mL (range, 1200 and 6000 mL) with a mean operation duration of 7.4 hours (range, 5 to 12 hours). The mean follow-up was 23.0 months (range, 18 and 39 months) for alive patients.ResultsSurgical margins were wide in 12 patients (80%), wide-contaminated in 1 patient (6.7%), and marginal in 2 patients (13.3%). R0 resection was achieved in 12 (80%) patients and R1 resection in 3 patients. There were three local recurrences (20%) occurred at a mean time of 11 months postoperatively. No local recurrence was observed at sacral osteotomy. The overall one-year and three-year survival rate was 86.7% and 72.7% respectively.Complications occurred in three patients.ConclusionsThe current study demonstrated that CSGS technique for tumor resection within the sacrum and pelvis was feasible and can achieve ideal resection accuracies. The use of CSGS was associated with high likelihood of negative margin resections in the current series. Intraoperative use of CSGS appeared to be technically straightforward and allowed achievement of planned surgical margins. It is worthwhile to consider the use of CSGS technique in resection of pelvic tumors with sacral invasion and iliosacral tumors, however further follow-up at mid to long-term is warranted to observe local recurrence rate.

Camrelizumab combined with albumin paclitaxel and cisplatin as neoadjuvant therapy for locally advanced esophageal squamous cell carcinoma (ESCC).

e16021 Background: The pathologic complete response (pCR) rate is improved by neoadjuvant therapy in locally advanced ESCC, but occurs less than 10% of patients(pts) with neoadjuvant chemotherapy agents. Immunotherapy has become a new promising treatment. Camrelizumab (anti-PD-1) is standard of care as second-line therapy for advanced ESCC in China. Therefore, we intended to evaluate the efficacy and safety of Camrelizumab combined with albumin paclitaxel and cisplatin as neoadjuvant therapy for pts with locally advanced ESCC. Methods: We retrospectively analysed locally advanced ESCC pts with clinical stage Ⅱ-ⅣA. Eligible pts were aged 18–75 years with no prior any therapy. Pts received 2-4 cycles neoadjuvant therapy which including Camrelizumab (200mg IV q3w), albumin paclitaxel (260 mg/m2 IV q3w) and cisplatin (75 mg/m2 IV q3w). Surgery was performed 4-6 weeks after neoadjuvant therapy. The primary endpoint was pCR, the secondary endpoints were major pathologic response (MPR), R0 resection rate, objective response rate (ORR), disease-free survival (DFS) and safety. Results: From Jul 27 2019 to Sep 26 2020,16 pts were enrolled and available evaluated. 8 pts (50%) had clinical complete response (cCR), and the ORR was 87.5% (14/16). All pts underwent surgery and surgical treatment was not delayed. The pCR was 43.8% (7/16), MPR was 75% (12/16). Notably, R0 resection rate was 100% (16/16). None of 16 pts progressed, the DFS was not yet achieved. The average intraoperative blood loss was 131ml (100-200ml) and the average hospitalization time after operation was 14 days (11-21 days). No patient developed anastomotic leak and other surgical treatment-related toxicity. The grade 1-2 treatment-related AEs were reactive cutaneous capillary endothelial proliferation (RCCEP) (n = 3,18.8%), weakness (n = 2, 12.5%), Myelosuppression (n = 1, 6.2%) and hypothyroidism (n = 1, 6.2%). No serious AEs resulted in termination of treatment, and treatment-related death was not observed. Conclusions: The addition of camrelizumab to albumin paclitaxel and carboplatin was demonstrated encouraging clinical efficacy and acceptable safety as neoadjuvant therapy, and might be a favorable option for pts with locally advanced ESCC. Further registered clinical trials are expected.