Open Surgery Cases Research Articles

Single center experience in selecting the laparoscopic Frey procedure for chronic pancreatitis

To share our experience regarding the laparoscopic Frey procedure for chronic pancreatitis (CP) and patient selection. All consecutive patients undergoing duodenum-preserving pancreatic head resection from July 2013 to July 2014 were reviewed and those undergoing the Frey procedure for CP were included in this study. Data on age, gender, body mass index (BMI), American Society of Anesthesiologists score, imaging findings, inflammatory index (white blood cells, interleukin (IL)-6, and C-reaction protein), visual analogue score score during hospitalization and outpatient visit, history of CP, operative time, estimated blood loss, and postoperative data (postoperative mortality and morbidity, postoperative length of hospital stay) were obtained for patients undergoing laparoscopic surgery. The open surgery cases in this study were analyzed for risk factors related to extensive bleeding, which was the major reason for conversion during the laparoscopic procedure. Age, gender, etiology, imaging findings, amylase level, complications due to pancreatitis, functional insufficiency, and history of CP were assessed in these patients. Nine laparoscopic and 37 open Frey procedures were analyzed. Of the 46 patients, 39 were male (85%) and seven were female (16%). The etiology of CP was alcohol in 32 patients (70%) and idiopathic in 14 patients (30%). Stones were found in 38 patients (83%). An inflammatory mass was found in five patients (11%). The time from diagnosis of CP to the Frey procedure was 39 ± 19 (9-85) mo. The BMI of patients in the laparoscopic group was 20.4 ± 1.7 (17.8-22.4) kg/m(2) and was 20.6 ± 2.9 (15.4-27.7) kg/m(2) in the open group. All patients required analgesic medication for abdominal pain. Frequent acute pancreatitis or severe abdominal pain due to acute exacerbation occurred in 20 patients (43%). Pre-operative complications due to pancreatitis were observed in 18 patients (39%). Pancreatic functional insufficiency was observed in 14 patients (30%). Two laparoscopic patients (2/9) were converted. In seven successful laparoscopic cases, the mean operative time was 323 ± 29 (290-370) min. Estimated intra-operative blood loss was 57 ± 14 (40-80) mL. One patient had a postoperative complication, and no mortality was observed. Postoperative hospital stay was 7 ± 2 (5-11) d. Multiple linear regression analysis of 37 open Frey procedures showed that an inflammatory mass (P < 0.001) and acute exacerbation (P < 0.001) were risk factors for intra-operative blood loss. The laparoscopic Frey procedure for CP is feasible but only suitable in carefully selected patients.

Robotic-assisted lateral lymph node dissection for lower rectal cancer: short-term outcomes in 50 consecutive patients.

The goal of this study was to evaluate the short-term outcomes of robotic-assisted lateral lymph node dissection for patients with advanced lower rectal cancer. Between 2012 and 2013, 50 consecutive patients underwent robotic-assisted lateral lymph node dissection for rectal cancer in Shizuoka Cancer Center Hospital. Perioperative outcomes including operative time, operative blood loss, length of stay, postoperative complications, and histopathological data were collected prospectively. Median patient age was 62years (range 36-74years). Operative procedures included low anterior resections (n=27), intersphincteric resections (n=16), and abdominoperineal resections (n=7). Bilateral lymph node dissection was performed in 44 patients. The median operative time was 476min (range 320-683min), and the median time required for lateral lymph node dissection was 165min (range 85-257min). The median blood loss was 27mL (range 5-690mL). There were no cases of open surgery or laparoscopic conversion. The median duration of postoperative hospital stay was 8days (range 6-13days). Clavien-Dindo classification Grade III-IV complications occurred in only one patient (2.0%). There were no cases of anastomotic leak. There was no perioperative mortality. The median number of harvested lateral lymph nodes was 19 (range 5-47). Robotic-assisted lateral lymph node dissection is a safe, feasible, and useful approach for patients with advanced lower rectal cancer.

A comprehensive analysis of the management of renal cell carcinoma in 18 Chinese hospitals from 2008 to 2012

Objective To analyze the demographic and clinical data of patients with renal cell carcinoma (RCC) in 18 hospitals throughout China between 2008 and 2012,and to assess the change of concept in RCC management.Methods Demographic and clinical data of RCC patients managed in urology department of 18 hospitals in China was collected and analyzed,including age,gender,type of surgical procedure,surgical pathology,length of hospital-stay,cost of treatment,and geographical distribution.Results A total of 9 725 RCC cases were managed throughout the 5 years in 18 hospitals,among which 6 853 cases had full records,including 4 529 males and 2 324 females,with a male to female ratio of 1.95 ∶ 1.00.Age of presentation ranged from 1 to 99 years,with an average of 56.0 years.The number of the patients in East China and North China were 3 422 and 2 153.Clear cell RCC was the predominant type of pathology,with a total of 3 517 cases (51.32％).Among all the 6 853 patients,there were 2495 cases of laparoscopic surgery (36.41％),3 891 cases of open surgery (56.78％),and 467 others (6.81％).1 935 patients (30.30％) received nephron-sparing surgery,while 4 451 patients (69.70％) had radical nephrectomy.The total length of hospital-stay was (16.8 ± 7.8) d,with the cost of (22 059 ± 9 722) RMB.Conclusions Clear cell RCC is the predominant pathological subtype of RCC.Surgery as always has been the main choice of treatment,with the proportion of laparoscopic surgery and nephron-sparing surgery gradually increasing. Key words: Carcinoma, renal cell; Multi-center; Pathology, clinical; Diagnosis ; Treatment

The clinical diagnosis and treatment of blood-blister-like cerebral aneurysms in supra-clinoid segment of internal carotid artery

To study the clinical characteristics, surgical principles and treatment options of blood-blister-like cerebral aneurysms in supra-clinoid segment of internal carotid artery. Twelve blood-blister-like aneurysms were retrospectively studied including 4 open-surgery cases and 8 endovascular-treated cases from November 2008 to December 2012. Patients comprised 8 female and 4 male patients, whose mean age was 46.6 (range 38-56) years. Eleven patients presented with severe headache as the primary symptom, and 1 patient was found with aneurysm incidentally. Preoperative Hunt-Hess graded 0 in 1 patient, graded I in 5 patients, graded II in 4 patients, and graded III in 2 patients. By DSA examinations, 4 blood-blister-like aneurysms located in anterior wall and 8 in medial-anterior wall of supra-clinoid segment of internal carotid artery. Open surgical treatment included direct clipping, trapping, or wrapping and interventional treatment included stent-assisted coiling or simple stent placement. Intra-operative electroencephalogram and somatosensory evoked potentials monitoring was regularly used. Microvascular Doppler ultrasonography and indocyanine green videoangiography were used to assess blood flow in parent and branch vessels. The patients were followed up at 6 months by CT angiography (CTA) examination in outpatient clinic. For 4 open surgeries, 2 aneurysms were directly clipped, 1 was trapped and 1 was wrapped. The patient underwent trapping paralyzed postoperatively. For endovascular treatment, 6 patients were coiled assisted with stents and 2 patients were treated with simple stent placement. All the patients were followed with a mean follow-up time of 16 months (range, 6-61 months). At 6 months follow-up, 3 out of 4 surgical treated patients had good outcome and 1 was moderately severe disabled by modified Rankin scale; 1 patient underwent wrapping recurred and was transferred to endovascular treatment. Of the 6 patients treated with stent-assisted coiling, 4 patients were recurrent and coil replacements were performed. Two patients with simple stent placement had no recurrences. Blood-blister-like aneurysm is a special type of complex cerebral aneurysm. Comprehensive understanding of blood-blister-like aneurysm is the key to successful treatment.Open surgery is difficult procedure with high risk and complications while stent-assisted coiling has a high recurrent rate. To date, neither is the safe and effective treatment option.

Oncological outcomes of renal pelvic and ureteral cancer patients registered in 2005: The first large population report from the Cancer Registration Committee of the Japanese Urological Association

To describe the clinical and pathological characteristics and the outcomes of renal pelvic and ureteral cancer patients diagnosed in 2005 in Japan. In 2011, data were collected from renal pelvic and ureteral cancer patients diagnosed in 2005. A total of 1509 registered patients from 348 institutions were analyzed. Epidemiology and survival were analyzed based on each cancer location and on cancer multiplicity. The 5-year overall survival of the 1509 patients was estimated at 0.64. Open surgery was carried out in 409 renal pelvic cancer cases (66.9%) and 315 ureteral cancer cases (63.0%). The retroperitoneal approach was common, and lymph node dissection was carried out in approximately one-third of open surgery cases and one-fifth of laparoscopic cases. Approximately 60% of the operated unilateral renal pelvic or ureteral cancer was diagnosed as invasive, and just 14.6% was diagnosed as stage pTa. Distribution of the estimated worst tumor grade was significantly different for renal pelvic cancer and ureteral cancer. This article presents the first large population report of survival data in Japanese renal pelvic and ureteral cancer patients. In comparison with the Japanese bladder cancer database report in 1999-2001 from the Cancer Registration Committee of the Japanese Urological Association, the pathological characteristics of renal pelvic and ureteral cancer were diagnosed as aggressive.

Results of revision after failed surgical treatment for traumatic anterior shoulder instability

Introduction and objectivesPersistent or recurrent glenohumeral instability after a previous operative stabilization can be a complex problem.Our aim is to establish the incidence of recurrence and its revision surgery, and to analyze the functional results of the revision instability surgery, as well as to determine surgical protocols to perform it. Materials and methodsA retrospective analysis was conducted on 16 patients with recurrent instability out of 164 patients operated on between 1999 and 2011. The mean follow-up was 57 months and the mean age was 29 years. To evaluate functional outcome we employed Constant, Rowe, UCLA scores and the visual analog scale. ResultsOf the 12 patients who failed the initial arthroscopic surgery, 6 patients underwent an arthroscopic antero-inferior labrum repair technique, 4 using open labrum repair techniques, and 2 coracoid transfer. The two cases of open surgery with recurrences underwent surgery for coracoid transfer. Results of the Constant score were excellent or good in 64% of patients. ConclusionsSurgical revision of instability is a complex surgery essentially for two reasons: the difficulty in recognizing the problem, and the technical demand (greater variety and the increasingly complex techniques).

Cirugía de revisión de la inestabilidad anterior de hombro

Introduction and objectivesPersistent or recurrent glenohumeral instability after a previous operative stabilization can be a complex problem.Our aim is to establish the incidence of recurrence and its revision surgery, and to analyse the functional results of the revision instability surgery, as well as to determine surgical protocols to perform it. Materials and methodsA retrospective analysis was conducted on 16 patients with recurrent instability out of 164 patients operated on between 1999 and 2011. The mean follow-up was 57 months and the mean age was 29 years. To evaluate functional outcome we employed Constant, Rowe, UCLA scores and the visual analogue scale. ResultsOf the 12 patients who failed the initial arthroscopic surgery, 6 patients underwent an arthroscopic antero-inferior labrum repair technique, 4 using open labrum repair techniques, and 2 coracoid transfer. The two cases of open surgery with recurrences underwent surgery for coracoid transfer. Results of the Constant score were excellent or good in 64% of patients. ConclusionsSurgical revision of instability is a complex surgery essentially for two reasons: the difficulty in recognising the problem, and the technical demand (greater variety and the increasingly complex techniques).

Usefulness of an enhanced recovery after surgery protocol for perioperative management following open repair of an abdominal aortic aneurysm

To achieve early recovery and early discharge from the hospital by applying an enhanced recovery after surgery (ERAS) protocol, which is mainly used with colonic surgery, for the perioperative management of open AAA surgery. One hundred twenty-seven open AAA surgery cases successfully carried out between 2003 and 2011 were included in this study. The ERAS protocol was used for the cases from April 2008 onward, and we performed a comparison of the conventionally treated cases with ERAS cases regarding the start of postoperative oral consumption, the postoperative hospital stay, and hospitalization medical costs. The time to restarting oral consumption and the postoperative hospital stay were significantly shorter for the ERAS group (n = 52) compared to the conventionally managed group (n = 75); with values of 59 ± 15 and 93 ± 25 h (p = 0.021), 9 ± 3 and 16 ± 5 days (p = 0.001), respectively. The medical costs for the ERAS group were 92 % of the costs of the conventionally managed group. Use of the ERAS protocol for the perioperative management of open AAA surgery shortened the time before recommencing oral consumption, the postoperative hospital stay, and reduced the medical costs compared to the conventional approach.

Two-year Outcome of High-risk Benign Prostate Hyperplasia Patients Treated With Transurethral Prostate Resection by Plasmakinetic or Conventional Procedure

To perform a systematic comparison of transurethral plasmakinetic resection of the prostate (PKRP) to conventional transurethral resection of the prostate for treating benign prostate hyperplasia (BPH) in aged high-risk patients. Three hundred twenty-nine symptomatic patients diagnosed with BPH underwent endourological treatment by transurethral resection of the prostate (n = 136) or PKRP (n = 193). Preoperative and postoperative assessments were conducted for the International Prostate Symptom Scores, quality of life (QoL), postvoid residual urine (PVRU) volumes, maximal urine flow rates (Q(max.)), and prostate-specific antigen. Perioperative data were collected for operative time, weight of resected tissue, blood loss, cases of open surgery, duration of bladder irrigation, and duration of catheter use. Patients were re-evaluated at postoperative months 3, 6, 12, 18, and 24. Postoperative complications were recorded. In the perioperative period, no significant differences were found between the 2 surgery groups for weight of resected tissue or cases of open surgery. However, PKRP was associated with significantly shorter operative time, duration of bladder irrigation, and duration of catheter use, as well as less blood loss. At the 2-year follow-up, both procedures were found to have significantly improved International Prostate Symptom Scores, QoL, Q(max.), PVRU, and prostate-specific antigen. In addition, each procedure was associated with some postoperative complications, some of which were significantly reduced in one over the other, such as secondary hemorrhage in PKRP. The currently available endourological treatments, transurethral resection of the prostate, and PKRP, are safe and effective therapies for treating aged high-risk patients with benign prostatic hyperplasia (BPH), although PKRP is superior in many aspects, including perioperative outcomes.

Laparoscopic colorectal resection for cancer: effects of conversion on long-term oncologic outcomes

The effects of conversion to open surgery during laparoscopic resection for colorectal cancer on long-term oncologic outcomes still are unclear. All 450 laparoscopic colorectal resections for cancer performed at a single center between 1994 and 2008 and included in a prospectively maintained database were considered. Patients who required conversion to open surgery (CONV) were matched 1:2 with laparoscopically completed cases (LAP) and 1:5 with open surgery cases (OPEN) for age, American Society of Anesthesiologists (ASA) score, year of surgery, tumor location, and tumor stage. Fisher's exact, chi-square, and Wilcoxon tests were used as appropriate. Kaplan-Meier curves were compared to analyze survival. In this study, 31 CONV cases were independently compared with 62 LAP and 155 OPEN cases. Compared with the LAP and OPEN patients, the CONV patients were characterized by a numerically higher rate of preoperative comorbidity (61.3% vs LAP, 51.6; P = 0.4 and OPEN, 48.4%; P = 0.2), male gender (77.4% vs LAP, 59.7%; P = 0.09 and OPEN, 58.1%; P = 0.05), and a significantly higher mean body mass index (29.6 vs LAP, 26.8; P = 0.012 and OPEN, 28.8; P = 0.3). The pathologic tumor stage, location, and chemotherapy and radiotherapy rates were comparable among the groups. After a median follow-up period of 4.1, 4.2, and 4.6 years, the 5-year disease-free survival rate was significantly lower for the CONV patients (40.2%) than for the LAP (70.7%, P = 0.01) or the OPEN (63.3%, P = 0.04) patients. However, the 5-year cancer-specific survival rates were similar among the CONV (94.4%), LAP (86.1%, P = 0.36), and OPEN (84.9%, P = 0.14) patients. Conversion to open surgery does not affect oncologic outcomes, although CONV patients have increased comorbidity rates affecting long-term mortality.

Comparison of the application of retroperitoneal laparoscopy and open surgery in ureteropelvic junction obstruction

Objective To review and analyze the application of retroperitoneal laparoscopy and open surgery in ureteropelvic junction obstruction, sum up clinical expeirence, and improve the skills of retropeirtoneal laparoscopic surgery. Methods Retroperitoneal laparoscopic surgery was carired out in 22 csaes of ureteropelvic junction obstruction(retroperitoneal laparoscopy group). Open surgery was carried out in 21 cases(Open surgery group). The two groups were compared in operation time, blood loss postoperative discharge time and postoperative hospital stay respectively. Results Ureteropelvic junction obstruction group was significantly less than open surgery group in intraoperative bleeding time,postoperative bleeding time and average length of stay. Operation time in ureteropelvic junction obstruction group was slightly longer than that in open surgery group [(32.0 ± 10.0) ml vs (70.0 ± 11.9) ml, (31.0 ±5.7)h vs(52.0 ±6.9)h,(7.0 ± 1.6) d vs(14.0 ± 1.4) d, (113.0 ±7.6) min vs(72.0 ± 6.8) min] (t = 7.06,8. 14,11.37,11.36, all P ＜ 0.05). Conclusions Retroperitoneal laparoscopic technology was in the treatment of ureteropelvic junction obstruction for its direct way, had non interference and pollution to laparoscopic internal organs,less damage,less pain, rapid recovery and short hospitla stay. With on going training and constantly updating technical skills and equipments, retroperitoneal laparoscopic technology will shotren the operation time, and will substitute open surgery. Key words: Ureteral obstruction; Laparoscopy; Retroperitoneal space

Treatment experience of 36 cases of simple renal cysts

Objective To summarize the treatment of simple renal cysts experience,the advantages and disadvantages of the two surgical options. Methods Retrospective analysis of 15 cases of renal cysts after general anesthesia in patients with laparoscopic cyst decompression in the clinical data and 21 cases of renal cysts underwent open surgery in patients with clinical data,comparative analysis of advantages and disadvantages of both types of surgery were conducted. Results In this study,14 patients with laparoscopic surgery were successful,1 patient converted to open surgery,laparoscopic surgery in patients with blood loss,postoperative complications and time of staying hospital after operation postoperative hospital stay were significantly less than group of open surgery. Conclusion The laparoscopic renal cyst decortication was a safe and effective treatment for simple renal cysts,compared to traditional open surgery in patients with trauma,less bleeding postoperative pain,rapid recovery,shorter hospital staying and so on. Key words: Kidney diseases,Cystic; Laparoscopy; Decompression,surgical

Are Costs of Robot-Assisted Surgery Warranted for Gynecological Procedures?

The exponential use of robotic surgery is not the result of evidence-based benefits but mainly driven by the manufacturers, patients and enthusiastic surgeons. The present review of the literature shows that robot-assisted surgery is consistently more expensive than video-laparoscopy and in many cases open surgery. The average additional variable cost for gynecological procedures was about 1600 USD, rising to more than 3000 USD when the amortized cost of the robot itself was included. Generally most robotic and laparoscopic procedures have less short-term morbidity, blood loss, intensive care unit, and hospital stay than open surgery. Up to now no major consistent differences have been found between robot-assisted and classic video-assisted procedures for these factors. No comparative data are available on long-term morbidity and oncologic outcome after open, robotic, and laparoscopic gynecologic surgery. It seems that currently only for very complex surgical procedures, such as cardiac surgery, the costs of robotics can be competitive to open surgical procedures. In order to stay viable, robotic programs will need to pay for themselves on a per case basis and the costs of robotic surgery will have to be reduced.

Comparison of effect between retroperitoneal laparoscopic living donor nephrectomy and open surgery

Objective To study the advantage of retroperitoneal laparoscopic living donor nephrectomy through comparative study on postoperative care between retroperitoneal laparoscopic living donor nephrectomy and open surgery. Methods During the period from August 2007 to December 2009, living donor nephrectomy were divided into 25 cases of retroperitoneal laparoscopic surgery and 20 cases of open surgery. The nursing characteristics were compared. Results The operation and recovery of all patients are successful. The drainage tube indwelling days, urinary catheter indwelling days, postoperative bed time, days of absolute diet and hospitalization in retroperitoneal laparoscopic surgery group were significantly shorter than those in open surgery group(P <0. 01). Conclusions Retroperitoneal laparoscopic living donor nephrectomy has the advantages of minimally invasive, rapid recovery and fewer hospital days, Worth being popularized in clinical otolaryngology application Key words: Retroperitoneal laparoscopic liviny donor nephrectomy; Open surgery; Nursing

The analysis of intracranial aneurysms undergoing surgical treatment

To study the surgical principles and treatment options of intracranial aneurysms. One hundred and thirty nine patients with intracranial aneurysms were retrospectively studied, including 80 open-surgery cases and 59 endovascular-treated cases from January to December in 2009. Open surgical methods included clipping, trapping or wrapping and interventional methods included simple coiling or stent-assisted coiling. Intra-operative electroencephalogram and somatosensory evoked potentials monitoring were regularly used. Microvascular doppler ultrasonography and indocyanine green videoangiography were used to assess blood flow in parent and branch vessels. Seventy-three aneurysms were directly clipped, 6 were trapped and 1 was wrapped. Thirty-three aneurysms were coiled and 26 were coiled assisted with stents. At discharge, 71 of the 80(88.8%) surgical treated patients had Glasgow Outcome Scale score of 4 or 5 points, 3 points in 6 patients (7.5%), 2 points in 1 patient (1.2%), and 1 point in 2 patients (2.5%). Fifty-four out of 59 cases underwent endovascular treatment scored 4 or 5 points (91.5%) and 3 points in 5 patients (8.5%). Surgical clipping and endovascular coiling are two major treatment choices for intracranial aneurysms. The treatment option should be individualized based on the patients' specific conditions, which could have a safe, effective and durable outcome.

Preliminary results of anatomic lung resection using energy-based tissue and vessel coagulative fusion technology

Mechanical stapling devices have been established as the mainstay of therapy in the selective isolation and division of bronchial and vascular structures during anatomic lung resection. Few data are available regarding the application of energy-based tissue fusion technology during anatomic lung resection. In the present study, we evaluated the use of energy-based instruments for the division of the pulmonary arterial and venous branches during anatomic lung resection. Anatomic lung resection (segmentectomy or lobectomy) was performed using energy-based coagulative fusion technology. A low-profile jaw can be used to facilitate dissection in both open and video-assisted thoracic surgery cases, applying a seal 6 mm wide by 22 mm in length. Two energy applications were applied to the arterial and venous branches before vessel division. The bipolar tissue fusion system was used in 211 patients between 2008 and 2010 (104 lobectomies and 107 anatomic segmentectomies). Initially, we used a device with a smaller, curved jaw (n=12), producing a 3.3- to 4.7-cm seal. No arterial dehiscences and 2 partial venous dehiscences that were recognized and controlled intraoperatively occurred. For the remaining cases, we used a new device with a larger jaw that applied a seal 6 mm wide by 22 mm in length. No arterial or venous dehiscences (vessel size range, 0.4-1.2 cm) occurred. The bipolar tissue fusion system provided safe and reliable control of pulmonary arterial and venous branches during anatomic lung resection. The use of energy-based tissue fusion technology represents a reasonable alternative to mechanical stapling devices during anatomic lung resection.

A new interventional technique for percutaneous treatment of drainage-resistant liver abscess

The objective of this case report is to describe a device that can be used as a minimally invasive alternative for the treatment of drainage-resistant liver abscess. The device uses pulse lavage to fragment and evacuate the semi-solid contents of a liver abscess. The treatment of liver abscesses consists of percutaneous drainage, antibiotics and treatment of the underlying cause. This approach can be ineffective if the contents of the abscess cavity are not liquid, and in those cases open surgery is often needed. Here, we describe for the first time a new minimally invasive technique for treating persistent liver abscesses. A patient developed a liver abscess after a hepatico-jejunostomy performed as a palliative treatment for an unresectable pancreatic head carcinoma. Simple drainage by a percutaneously placed pig-tail catheter was insufficient because of inadequate removal of the contents of the abscess cavity. After dilatation of the drain tract the persistent semi-solid necrotic contents were fragmented by a pulsed lavage device, after which the abscess healed uneventfully. The application of pulsed lavage for debridement of drainage-resistant liver abscesses proved to be an effective and minimally invasive alternative to open surgery.

The Impact of Laparoscopy on the Volume of Open Cases in General Surgery Training

The purpose of this study was to evaluate the impact of laparoscopy on the volume of open cases in general surgery residency training over the past 10 years. The Accreditation Council for Graduate Medical Education (ACGME) database (1999-2008), which records all cases (by Current Procedural Terminology code) performed by graduating general surgery trainees, was retrospectively analyzed. ACGME database (1999-2008). Trends were compared regarding the average number of the most common laparoscopic and open procedures (colectomy, hernia, and appendectomy) performed by graduating general surgery trainees during the reporting period. Across all procedures, an increase was noted in laparoscopic approaches with a reciprocal decrease in open cases. The number of open appendectomies decreased by 29% (30.7 to 21.7), whereas the number of laparoscopic appendectomies increased by 278% (8.5 to 32.1). Similarly, open inguinal hernia cases decreased by 12.5% (51.9 to 45.4) and open colectomy cases decreased by 10.4% (48 to 43). Conversely, laparoscopic hernia repair and laparoscopic colectomy increased by 87.5% (7.6 to 15.8) and 550% (2 to 13), respectively. In addition to the limitations placed on residency training by other factors (including work hour restrictions), changing practice patterns within the field of general surgery have a significant impact on the exposure of residents to open surgery cases. This trend might have far-reaching implications with regard to the overall competency of graduating residents and raises concerns for the future direction of surgical education.

Value and Pitfalls of Neurophysiological Monitoring in Thoracic and Thoracoabdominal Aortic Replacement and Endovascular Repair

The aim of our study was to analyze the neurophysiological monitoring method with regard to its potential problems during thoracic and thoracoabdominal aortic open or endovascular repair. Furthermore, preventive strategies to the main pitfalls with this method were developed. Between 11/2000 and 05/2007 in 97 cases open surgery or endovascular stentgraft-implantation was performed on the thoracic or thoracoabdominal aorta. Intraoperatively, neurophysiologic motor- and somatosensory-evoked potentials were monitored. Our cases were divided into four groups: event-free patients with normal potentials (A, 63 cases), with correlation of modified evoked potentials and neurological outcome (B, 14 cases), false-positive or false-negative results (C, 4 cases), and medication interaction or technical issues (D, 16 cases). We observed a sensitivity of 93 % and a specificity of 96 % for the neurophysiological monitoring. Monitoring spinal cord function during surgical and endovascular interventions on the thoracic and thoracoabdominal aorta is necessary. It can be made more effective by precisely analyzing the interference factors of the neurophysiological monitoring method itself. Successful strategies of immediate troubleshooting could be identified.

Clinical Study in the Relationship Among the Nasal, Urine Cultures and Surgical Site Infection of the Open Surgery Cases in the Field of Urology

Clinical Study in the Relationship Among the Nasal, Urine Cultures and Surgical Site Infection of the Open Surgery Cases in the Field of Urology