Average Surgical Time Research Articles

Experience in Providing Ambulatory Surgery From an Expeditionary Fast Transport Mobile and Rapidly Deployable Expeditionary Medical Unit During Continuing Promise 2018.

This article describes the surgical component of the Continuing Promise 2018 (CP-18) medical training and military cooperation mission. We report on the surgical experience and lessons learned from performing peacetime ambulatory surgeries in a tent-based facility constructed on partner nation territory. This CP mission was unique in utilizing a land-based expeditionary surgical facility. Institutional Review Board approval was obtained to collect prospective deidentified patient data and aggregate information on all surgical cases performed. Specific aims of this study included describing surgical patient characteristics and evaluating conservatively selected cases performed in this environment. Body mass index (BMI) was used as a crude screening tool for perioperative risk to assist patient selection. Our secondary aim was to report lessons learned from preparation, logistics, and host nation exchanges. The team coordinated medical credentialing and documentation of all medical supplies with each host nation. Advance teams collaborated with local physicians in country to arrange training exchanges and identify surgical candidates. The mission was conducted from February to April 2018. Only two of five planned partner nation visits were completed. The surgical facility supported 78 procedures over 14 surgical days, averaging over six cases performed per core surgical day. Patients were predominantly female, with a mean age of 25.4 and a mean BMI of 31.1. The average surgical time was 37.5 minutes, the average anesthesia time was 70 minutes, and the average recovery time was 47.6 minutes. No significant complications or adverse events were noted. CP-18 was the first CP mission to perform elective ambulatory surgery on foreign soil using a tent-based facility in a noncombat, nondisaster environment instead of a hospital or amphibious ship. This mission demonstrated that such a facility may be employed to safely perform low-risk ambulatory surgeries on carefully selected patients. The Expeditionary Medical Unit, coupled with the fast transport vessel enabled rapid expeditionary surgical facility setup with significant military and disaster relief applications. Expansion of surgical indications should be performed carefully and deliberately to avoid complications and damage to international relationships.

Comparative study of minimally invasive endoscopic tympanoplasty with microscopic tympanoplasty

Background: Chronic suppurative otitis media (CSOM) is a disease of a low-socioeconomic group with high prevalence in India. Tympanoplasty is a common procedure done for CSOM. Hopkins endoscopes are now more popular for various ear surgeries due to better optics, portability, and cost-effectiveness. The objective was to compare the surgical outcome of minimally invasive endoscopic tympanoplasty and microscopic tympanoplasty. Materials and Methods: A prospective follow-up comparative study was performed on 60 patients who underwent tympanoplasty from January 2021 to December 2021. The subjects were divided equally and randomly into two groups (endoscopic group and microscopic group). Demographic data, perforation size of the tympanic membrane, pure-tone audiometry results preoperatively, and at the 8th week postoperatively, type of anesthesia used, average surgical time, postoperative morbidity, and graft uptake rate in both the groups were compared. Results: Graft uptake was 93% in the endoscopic group and 96% in the microscopic group. Postoperative morbidity was more in the microscopic group as compared to the endoscopic group. Average surgical time was less in the endoscopic group as compared to the microscopic group. Endoscopic tympanoplasty was done under local anesthesia and is economically more acceptable to the patient as compared to the microscopic group. The mean air–bone gap gain was 16.44 dB in the endoscopic group and 16.07 dB in the microscopic group. Conclusion: With minimally invasive endoscopic procedure, it is possible to get a similar graft uptake rate and hearing gain as compared with conventional microscopic procedure with the advantage of having less postoperative morbidity and lesser consumption of medical resources. Thereby making it a more cost-effective technique and can be easily performed in remote places.

Prospective study to assess functional outcome in proximal humerus fracture treated using philos

Introduction: Proximal humerus fractures are 2nd most common fractures of upper limb and 3rd overall. Proximal humerus fractures which were stable and minimally displaced were treated conservatively, unstable fractures (3 part, 4 part) were treated with ORIF with Plate osteosynthesis. ORIF with PO allows early mobilization with stable fracture construct. Stability is contributed by the fixed angle construct of the prosthesis. This is a prospective study aimed at knowing the functional outcome in proximal humerus fractures treated with PHILOS plating system.Methods: Prospective study done at tertiary center from June 2020 to November 2021.Over a period of 1.5 yrs. All patients were operated by the same surgeon with standard surgical procedure. Total number of patients were 30. They were graded at 3 months and 6 months and 1year using constant murley scoring and VAS scoring.Results: There were 24males and 6 female’s average age being 40.53yrs, right side being most commonly affected side. Average surgical time was 77.8 min (63 to 92min) average surgical time being 77.8min average blood loss being 257ml, average constant murley score was at 3 mo. was 22.5 at 6mo 56.05 at 1yr 73.3 score at 1 year has increased significantly from 3mo to 1yr (p

Suprapatellar versus Infrapatellar Approach for Intramedullary Nailing in Tibial Shaft Fractures: A Prospective Interventional Study

Introduction: Tibial diaphyseal fractures are the most prevalent type of tibia fracture. A well known surgical method for treating tibial shaft fractures was the traditional infrapatellar approach for tibia Intramedullary Nailing (IMN). However, due to increased valgus and procurvatum deformities, IMN insertion through the infrapatellar route poses problems. Recently, suprapatellar nailing in the semi-extended position has been promoted as a safe and effective surgical treatment. Aim: To compare the clinical and functional outcomes of tibial shaft fractures treated with IMN utilising the Suprapattelar (SP) and Infrapatellar Methods (IP). Materials and Methods: A prospective interventional study was conducted on 40 patients, in the Department of Orthopaedics, in Government Medical College, Patiala ,Punjab, India from November 2019 to May 2021. The patients were divided into two groups on the basis of tibial shaft fractures treated with IMN utilising the S.P and those treated with I.P techniques during a two year period (20 in each group) with six months followup. Group A patients were treated with IMN in tibia through suprapatellar technique and group B Patients were treated with IMN in tibia via infrapatellar approach. The outcomes of IMN in tibial shaft fractures via SP and IP approach were compared in terms of fluoroscopy time, average surgical time, anterior knee pain using Visual Analogue Scale (VAS) score, average blood loss, fracture union time and functional outcome (in terms of the lower extremity functional Score). For statistical analysis student t-test and chi-square test was used, p-value <0.05 was considered as significant. Results: There were significant differences between SP and IP IMN in terms of fluoroscopy duration (94.25 vs 129.40 seconds, p-value-0.001), anterior knee pain (VAS score) (19.65 vs 29.85, p-value-0.001), average blood loss (49.30 vs 62.45 mL, p- value 0.001), and functional result (75.45 vs 70.05, p-value=0.001). The fracture union time between the two groups was non significant (90.50 vs 90.30 days, p-value=0.876). Conclusion: In terms of fluoroscopy time, anterior knee pain, average blood loss, and knee ratings, the SP technique was superior to the IP strategy.

Conventional Surgery or Minimally Invasive Osteosynthesis for the Diaphyseal Fractures of the Tibia

Introduction. Tibial fractures are common injuries. Minimally invasive osteosynthesis, with conventional percutaneous plate, has been described as a technique that seeks to preserve soft tissue viability as much as possible. Method. A prospective, longitudinal, coasi-experimental study is carried out on surgical treatment of tibial fractures, using theoretical and empirical research methods. Results. The largest number of patients belong to the male sex (n=89), adults between 40 and 59 years old, with fractures of the middle third of the tibia, mainly short oblique line and with average times for the intervention in the conventional approach group is of 2.89 days, average surgical time of 73.8 minutes and 8.89 days of stay, with significant differences compared to the MIPO group where the average time for the intervention is 3.10 days, average surgical time of 38.2 minutes and 3.36 days of stay. The group treated with MIPO shows earlier consolidation (1.5 weeks) Conclusions. Minimally invasive osteosynthesis has advantages regarding the reduction of surgical times, complications and consolidation.

SURGICAL CHARACTERISTICS OF STAGE I-IIA NON-SMALL CELL LUNG CANCER

Objectives: To describe surgical characteristics of stage I-IIA non-small cell lungcancer.Subjects and methods: An uncontrolled intervention study on 83 patients diagnosedwith stage I - IIa non-small cell lung cancer who underwent thoracoscopy at MilitaryHospital 175 from January 2015 to December 2020.Results: The average surgical time in the study was 137.5 minutes and the blood losswas not much. Small incisions have an average length of 2.95cm, high aesthetics andlow postoperative pain (5.92 days). The patient had a tumor that pulled the visceralpleura 62/83 (74.7%); 21/83 (25.3%) patients with tumors located in parenchyma;6/83 (7.2%) patients had lung adhesions to the chest wall. There were 2 (2.4%) patientswith bleeding complications that required conversion to open surgery; After surgery,there were 7 complications including 1 (1.2%) pneumonia; 1 (1.2%) empyema causedby green pus bacilli; 5 (6.0%) cases of gas leak lasting more than 7 days.Conclusion: Tumor characteristics in surgery include features of tugging visceralpleura, tumor located in parenchyma, lung sticking to chest wall. Commoncomplications include bleeding. Complications after surgery include pneumonia,empyema caused by green pus bacilli, prolonged gas.

Retrospective evaluation of radiological and clinical outcomes after surgical treatment of proximal femur fractures utilizing TFNA

IntroductionThe aim of this study was to evaluate the clinical and radiological outcomes of patients treated with the TFN-Advanced™ Proximal Femoral Nailing system (TFNA¸ DePuy Synthes, West Chester, PA) including intra- and postoperative complications.Materials and methodsAll patients with an acute proximal femur fracture consequently treated with a TFNA between September 2014 and December 2018 were evaluated. Clinical and radiological data were assessed for intra- and postoperative complications, including treatment failure. In addition, intra- and postoperative X-rays were used to determine the position of the implant, and any migration, via tip-apex-distance (TAD) and the caput-collum-diaphyseal angle (CCD). The accuracy of the fracture reduction was rated by both observers according to Baumgartners criteria.Results275 consecutive patients (mean age 77.5 ± 14.1; 70.2% female) were included. The predominant OTA/AO fracture classification was 31A2 (140 cases, 50.7%). The average surgical time was 69 min (± 39.8). The reduction quality was good in 253 cases (92.0%) and acceptable in 22 cases (8.0%). In 18 cases, a pre-defined primary outcome parameter (6.5%) was recorded after a mean of 8.2 ± 8.0 months. During the observational period, 19 patients (6.9%) required a total of 23 additional surgeries. Implant removal was not considered a failure in the absence of pain. Significant group differences were observed with younger age (p = 0.001), lower Charlson Comorbidity Index (CCI)-score (p = 0.041) and lower rate of osteoporosis (p = 0.015) in the failure group. There were no cases of cut-out or cut-through among the patients who underwent augmentation as part of osteosynthesis.ConclusionsProximal femur fractures treated with the TFNA show low complication rates and high levels of radiological healing. Implant-related complications might be more common in patients with younger age, a lower CCI-score and lower frequency of osteoporosis. Usage of cement augmentation could potentially be beneficial to reduce postoperative cut-through and cut-out.

Learning Curve in Robotic-Assisted Total Knee Arthroplasty: A Systematic Review of the Literature

Several innovations have been introduced in recent years to improve total knee arthroplasty (TKA). Robotic-assisted surgery is gaining popularity for more precise implant placement while minimizing soft tissue injury. The main concerns are increased cost, operative time, and a significant learning curve. This systematic review aims to analyze the surgical time learning curve, implant placement accuracy, and complications related to robotic-assisted TKA (raTKA). A systematic literature review was performed according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. The research was conducted up to September 2022 in four databases (PubMed/MEDLINE, Embase, Scopus, and the Cochrane Database of Systematic Reviews), with the following key terms: “robotic-assisted”, “total knee arthroplasty”, “robotic”, “TKA”, “learning”, and “TKR”. The methodology quality of the studies was assessed using the Methodological Index for Non-Randomized Studies (MINORS) criteria. This systematic review was registered on the International Prospective Register of Systematic Reviews (PROSPERO), ID: CRD42022354797, in August 2022. Fifteen clinical studies that analyzed the raTKA learning curve of 29 surgeons and 2300 raTKAs were included in the systematic review. Fourteen surgeons reported the presence of an inflection point during the learning curve. Few studies have reported the learning curve of raTKA regarding lower limb alignment, component position, and intraoperative and postoperative complications. The main finding of this systematic review is that the procedure number required to reach the learning plateau is about 14.9 cases. Furthermore, an average decrease in surgical time of 23.9 min was described between the initial and proficiency phases; the average surgical time in the two phases was 98.8 min and 74.4 min, respectively. No learning curve was observed for implant placement and lower limb alignment because the implants were correctly placed from the first raTKAs. No significant complication rates were reported during the raTKA learning curve.

To study the low-pressure pneumoperitoneum laparoscopic cholecystectomy

Aim: The aim of this study to determine the low-pressure pneumoperitoneum laparoscopic cholecystectomy.Materials and methods: This research comprised a total of 80 patients who were hospitalised for elective laparoscopic cholecystectomy. patients undergoing open cholecystectomy after conversion. The research did not include patients with acute inflammation or any other choledocholithiasis or gallstone-related complications. Every patient was asked for written informed permission after being told about the research.Results: The most prevalent presenting symptom (85%) was pain in the right upper quadrant. All of the patients had cholelithiasis confirmed by ultrasonography but no symptoms of inflammation. The majority of the patients (80%) had numerous gallbladder stones. The gallbladder was normal in 40 instances (50%), distended in 24 cases (30%), and constricted in 16 cases (20%) intraoperatively, cholesterosis was present in 10 cases (12.5%), and biliary sludge was found in 16 cases (20%). There were no severe intraoperative complications. There was no conversion to normal pressure laparoscopic cholecystectomy or open cholecystectomy. The average surgical time was 35.85±5.85 minutes. The visual analogue scale pain ratings for postoperative shoulder tip pain were 4.5±0.33, 2.4±0.12, and 0.22±0.04, respectively, at 5, 10, and 24 hours. In 91.25% of the patients, oral feeds were begun on the first postoperative day. On the 0th postoperative day, 95% of the patients were ambulating. The average length of stay after surgery was 1.2±0.51 days. On average 6 months of follow-up, no serious problems were notedConclusion: Experienced surgeons may safely use low-pressure pneumoperitoneum to perform laparoscopic cholecystectomy with a lower risk of early postoperative problems, such as shoulder tip discomfort. Only the lengthier learning curve holds it back from being optimal for general usage; in certain circumstances, its reduced intraoperative impact on hemodynamics makes it a worthwhile alternative.

High-grade dysplastic spondylolisthesis: surgical technique and case series

PurposeThe aim of the present study is to evaluate the results of our all posterior-one stage surgical technique for the reduction and fusion of high-grade high-dysplastic spondylolisthesis.MethodsPatients over 11 years old with high-grade spondylolisthesis treated by reduction and circumferential fusion with a posterior-only approach were reviewed. Data about operative time, blood loss, length of stay, intra- and postoperative complications were collected. Meyerding grade (M), lumbar lordosis (LL), thoracic kyphosis (TK), pelvic incidence (PI), pelvic tilt (PT), lumbosacral angle (LSA), slip angle (SLIP), lumbar index (LI) and severity index were measured on preoperative and last follow-up. Sagittal vertical axis (SVA) was used to assess sagittal balance.ResultsOf the 14 included patients, L5-S1 arthrodesis was performed in 12 cases, and L4-S1 was performed in 2 cases. Average surgical time was 275 ± 65 min; average blood loss was 635 ± 375 mL. Average length of stay of was 3.9 ± 1.5 days. The SLIP angle improves from 33.8° ± 7.3° to 6.4° ± 2.5°, (p = 0.002); the lumbosacral angle improves from 68.8° ± 18.6° to 100.7° ± 13.2°, (p = 0.01); and the SVA decreased from 49.4 ± 22.1 mm to 34.4 ± 8.6 mm (p = 0.02). No significant changes were observed in PI, PT and SS. Thoracic kyphosis (TK) and lumbar lordosis (LL) did not change significantly. At last follow-up, no patient had surgical site infection or mechanical complications; no pseudoarthrosis was observed. No revision surgery was performed.ConclusionAlthough technically demanding, reduction and fusion with one stage all posterior approach prove to be a safe and effective.

Macrovascular Decompression with the Transposition Method Using Teflon Sling for Trigeminal Neuralgia Caused by the Vertebrobasilar Artery

Complete separation of the vertebrobasilar artery (VBA) from the trigeminal nerve by microvascular decompression is technically challenging. This paper evaluates the transposition method using Teflon sling for trigeminal neuralgia (TN) caused by the VBA. Retrospective review of 32 patients including 2 patients with tic convulsif. Mobilization of the VBA in the anteromedial-caudal direction and repositioning of the VBA using Teflon sling and fibrin glue were performed. Pre- and postoperative pain were evaluated with the Barrow Neurological Institute (BNI) pain intensity score. Duration of surgery and postoperative neurologic complications were reviewed. Preoperative BNI score ranged from III to V. Postoperative BNI score I was observed in 30 patients, II in 1 patient, and V in 1 patient as recurrence. Abducens nerve palsy was observed in 9 patients but was transient in 8. Permanent hearing loss was observed in 6 patients. Transient mild lower cranial nerve palsy was recorded in 2 patients with tic convulsif. Average surgical time was 290 minutes. Our method for trigeminal neuralgia caused by VBA was very effective, but the complication rate of cranial nerve disorders was also high. A high rate of complications implied the technical difficulty of extensive vascular mobilization requiring long duration of surgery. Macrovascular decompression surgery is more descriptive of this surgery instead of microvascular decompression surgery.

224. Comparing 5-year outcomes between matched open and minimally invasive transforaminal lumbar interbody fusion in the treatment of single level lumbar degenerative disease

224. Comparing 5-year outcomes between matched open and minimally invasive transforaminal lumbar interbody fusion in the treatment of single level lumbar degenerative disease

Comparison Between Minimally Invasive Anterolateral and Conventional Posterior Hip Approaches for Hemiarthroplasty in Hip Fractures

Purpose: To compare the results between minimally invasive anterolateral and conventional posterior hip approaches for hemiarthroplasty in hip fractures. Methods: The elderly patients who had undergone hip hemiarthroplasty for hip fractures in Maharaj Nakhon Si Thammarat Hospital, were randomly divided into two groups: minimally invasive anterolateral and posterior approach groups Data were collected from March 2020 to November 2021, which included the duration of the surgery, length of the surgical wound, intraoperative bleeding volume, postoperative days of walking with a walker, morphine dosage for pain relief, and postoperative complications. Results: No significant difference (P-value > 0.05) was found between the baseline data of patients in both the groups, which included sex, age, body mass index, underlying musculoskeletal disease, and drug usage. The minimally invasive anterolateral approach group used an average surgical time of 53.48 ± 8.22 min, while the conventional posterior approach group required 65 ± 20.41 min; the length of the surgical wound was 7.78 ± 0.87 and 13.78 ± 1.37 cm, respectively; the volume of intraoperative bleeding was 82.17 ± 48.94 and 195.65 + 163.24 ml, respectively; the postoperative days of walking with a walker were 3.09 ± 0.92 and 6.59 ± 2.52 days, respectively; and the postoperative analgesic doses of morphine were 6.59 ± 2.80 and 11.09 ± 3.89 mg, respectively. The blood transfusion was required in 4 patients in the minimally invasive anterolateral approach group, while it was required in 14 patients in the conventional posterior approach group. Statistically significant (P-value < 0.05). Postoperative complications included, prosthetic hip joint dislocation in a patient in each group and sciatic nerve neurapraxia in a patient in the conventional posterior approach group. Conclusions: Hip hemiarthroplasty with the minimally invasive anterolateral approach in elderly patients with hip fractures was found to be superior to the conventional posterior approach.

Laparoscopic subtotal reconstituting cholecystectomy in type II & III Mirizzi syndrome: Case series of 5 patients.

BackgroundMirizzi syndrome Type II & III treatment is a true surgical challenge. The purpose was to determine whether the laparoscopic subtotal reconstituting cholecystectomy can be a safe and effective approach in our institution to treat Mirizzi Syndrome type II and III.Case presentationWe report a case series of 5 patients with Mirizzi syndrome type II and III who underwent laparoscopic subtotal reconstituting cholecystectomy.DiscussionWe found only one patient had presurgical diagnosis, average surgical time of 218 min, average surgical bleeding of 230 ml and the mean hospital stay of 3.4 days; one patient presented low volume and auto limited biliary leak; no cases presented biliary injury, major complications, or reintervention.ConclusionsLaparoscopic subtotal reconstituting cholecystectomy is a security and effective technique to treat type II and III Mirizzi syndrome in our context.

Laparoendoscopic surgery for the treatment of gastrointestinal stromal tumors: A case series.

Gastrointestinal stromal tumors (GISTs) are the most common mesenchymal neoplasms of the gastrointestinal tract. The standard management for localized GIST is the complete surgical resection. For this procedure, laparoendoscopic cooperative surgery (LECS) has been proposed as a safe and effective alternative. We want to show our experience with LECS technique for the management of GIST and a literature review. A retrospective, cross-sectional study was carried out, which included patients with a diagnosis of localized GIST treated with LECS technique between January 2011 and December 2018. During the period of the study, 21 patients were managed by LECS technique, with a male-female rate 3:1. Average surgical time was 98.5 min, 100% negative borders in all patients. Intraoperative bleeding was 30.7 cc and all patients had orally tolerance in the first 24 h. None of them required ICU management, no mortality was reported. The LECS technique has demonstrated to be a viable, safe, and effective technique for the management of gastric GIST's, showing superiority in organ function preservation and in the range of oncological margins. Prospective studies are necessary to obtain knowledge about the outcome of patients managed through LECS technique.

MODIFIED ERICH ARCH BAR- A CROSSOVER BETWEEN IMF SCREWS AND CONVENTIONAL ERICH BAR, AN OBSERVATIONAL STUDY

Introduction: Maxillomandibular xation has been done using Erich arch bar for decades but it has its own disadvantages like gingival trauma, poor oral hygiene, wire prick injuries, time consuming. To overcome this modied Erich arch bar has been discovered but lack of literature on the use of modied Erich arch bar makes it questionable. Therefore, the present observational study focuses on application modied arch bar for maxillomandibular xation. This observational study was conducted on 50 patients that required MMF and receivedMaterials and Methods: intermaxillary xation (IMF) with modied Erich arch bars. The parameters recorded were average surgical time required, wire prick injuries, IMF stability, occlusal stability, screw loosening, oral hygiene status, and vitality response of the teeth. The variables were statistically analyzed and displayed in means of percentage and numbers. The wire prick injury wasResults: found to be only 4 episodes, intraoperative time in average was around 8minutes. Debris indices were found to be mild in all the cases(average=0.65). No vitality response of tooth was around 5 in numbers. The modied Erich arch bar couldconclusion: be a best alternative for conventional Erich bar but clinical trials are required to know about the efciency of modied Erich arc bar over conventional Erich bar.

Feasibility and perioperative safety of transoral robotic surgery with da Vinci Xi platform

Objective: To explore the feasibility and perioperative safety of transoral robotic surgery with da Vinci Xi platform for pharyngolaryngeal tumors. Methods: A retrospective analysis was performed on 55 consecutive cases with resection of pharyngolaryngeal tumors by transoral robotic surgery with da Vinci Xi platform from July 27, 2020 to October 31, 2021 in the Department of Head and Neck Surgery, Fudan University Eye, Ear, Nose and Throat Hospital, including 44 males and 11 females, aged 25-79 years. There were 41 cases of oropharyngeal tumors, 9 cases of parapharyngeal space tumors, 2 cases of laryngeal tumors, 2 cases of hypopharyngeal tumors and 1 case of retropharyngeal space tumor. Operative time, intraoperative blood loss, postoperative hospital stay, perioperative tracheotomy, nasal feeding, hemorrhage and other complications were analyzed. Results: Of the 55 patients, 54 received resection of pharyngolaryngeal tumors by da Vinci robot through oral approach, and only 1 case of pyriform sinus carcinoma underwent a conversion to open surgery due to poor exposure of lower margin. The average surgical time for the patients with transoral robotic surgeries was 64.4 min, the average blood loss was 24.8 ml, the average postoperative hospital stay was 6.9 d, and the average oral feeding time was 11.1 d. Seventeen patients (30.9%) underwent preventive tracheotomy during surgery. Among 38 cases of laryngeal cancer, 28 underwent simultaneously neck dissection. No serious complications occurred in all patients during and after operation. The follow-up time was 1-15 months. Aside from 1 patient had a relapse 10 months after surgery, other patients had no recurrence or metastasis. Conclusion: Transoral robotic surgery with da Vinci Xi is safe, effective and minimally invasive for resection of pharyngolaryngeal tumors under reasonable indications.

Comparison of suture anchor penetration rate between navigation-assisted and traditional shoulder arthroscopic capsulolabral repair.

Proper placement of suture anchors is an important step in Bankart repair as improper placement can lead to failure. Concern surrounding suture anchor placement inspired the use navigation systems in shoulder arthroscopy. We aimed to demonstrate the technological advantage of using the O-arm (Medtronic Navigation, Denver, CO, USA) image guidance system to provide real-time images during portal and anchor placements in shoulder arthroscopy. Consecutive patients (from July to October 2014) who were admitted for arthroscopic capsulolabral repair surgeries were included. Ten patients were randomly enrolled in the navigation group and 10 in the traditional group. The glenoid was divided into four zones, and the penetration rates in each zone were compared between the two groups. In zone III, the most inferior region of the glenoid, the penetration rate was 40.9% in the traditional group and 15.7% in the navigation group (P = 0.077), demonstrating a trend toward improved accuracy of anchor placement with the aid of the navigation system; however, this was not statistically significant. Average surgical time in the navigation and traditional groups was 177.6±40.2 and 117.7±17.6 mins, respectively. American Shoulder and Elbow Surgeons Shoulder Scores showed no difference before and 6 months after surgery. This pilot study showed a trend toward decreased penetration rate in O-arm-navigated capsulolabral repair surgeries and decreased risks of implant misplacement; however, possibly due to the small sample size, the difference was not statistically significant. Further large-scale studies are needed to confirm the possible benefit of the navigation system. Even with the use of navigation systems, there were still some penetrations in zone III of the glenoid. This penetration may be attributed to the micro-motion of the acromioclavicular joint. Although the navigation group showed a significant increase in surgical time, with improvements in instrument design, O-arm-navigated arthroscopy will gain popularity in clinical practice.

ИСПОЛЬЗОВАНИЕ 3D-ПЛАНИРОВАНИЯ И ХИРУРГИЧЕСКИХ ШАБЛОНОВ В СТОМАТОЛОГИЧЕСКОЙ ИМПЛАНТОЛОГИИ

Purpose: To evaluate the effectiveness of implant treatment using computer 3D modeling and surgical guides. Materials and Methods: The study included 148 patients, who underwent prosthodontics rehabilitation, using dental implants in 2015- 2021. 3D computer-aided modeling and surgical guides were used to plan the operation. To conduct a comparative analysis of the treatment results, two groups were formed: group A (included 72 patients, fully guided surgery), and group B (included 76 patients). Results: In Group A intraoperative or immediate postoperative complications were recorded: (errors in the position, inclination), anatomical risk structures were invaded, 3 years later producing a survival rate of 96.2%. In Group B, intraoperative complications were recorded: membrane perforation (4), errors in the position of the implants (16), inclination of the implants (18), fenestration (12), 3 years later producing a survival rate of 97.6%. Mean marginal bone loss (MBL) in patients of group A was significantly higher than in patients of group B (p < 0.05). In patients of Group A, the average surgical time from time of anesthesia to the placement of the healing abutment was 10.6±2.9 min per implant, in patients of group B, the average surgical time was 16.4±1.5 min per implant. Conclusion: The 3D modeling method and the controlled positioning of the implant allows surgical access with the minimal trauma, reducing treatment time and complications.

Influence of Socioeconomic Factors on Surgical Wait Times for Elective Surgeries in Benign Gynecology [A81

INTRODUCTION: In various disciplines, an association between patient outcomes and surgical wait times has been identified. This study provides the first investigation into whether practice setting influences wait times for elective surgeries in benign gynecology. METHODS: This retrospective study of patients at three Manhattan hospitals from October 2019 to February 2020 compared surgical wait times among patients seen in federally qualified health centers (FQHC) and private practice settings. Emergent surgeries, oncology cases, abortions, urogynecology procedures, and cases concurrently booked with another specialty were excluded. Surgical wait time was defined as the time (days) from the decision to operate to the day of procedure. A multivariable mixed model was used to model the log of surgical wait time by setting of care, adjusting for age, body mass index (BMI), race/ethnicity, insurance, need for medical clearance, and scheduled block time. RESULTS: A total of 540 patients were identified with a median age of 45.6 years (range 16-87 years). Average surgical wait time was 27 days (range 1-288 days). In multivariate analysis, longer surgical wait times were associated with the FQHC setting relative to private practice (70.9% longer, P=.006), and with needing medical clearance (36.8% longer, P=.02). Insurance type and race/ethnicity did not significantly impact surgical wait times in multivariate analysis. In univariate analysis, patients with public insurance had longer wait times compared with patients with commercial insurance (25% longer, P=.03). CONCLUSION: These results suggest that in benign gynecology, surgical wait times are significantly influenced by practice setting. Further research should investigate the reasons behind these preoperative delays with the goal of correcting inequities inherent in the medical system.