Difference In Estimated Blood Loss Research Articles

Predictors of Blood Transfusion in Patients Undergoing Cytoreductive Surgeries for Ovarian Malignancy.

The aims of this study were to describe the baseline estimated blood loss (EBL) in surgery and transfusion rate in patients undergoing cytoreductive surgeries for ovarian malignancy, and identify perioperative variables associated with blood loss and transfusion. A retrospective cohort study at a single institution was performed that included patients with known or suspected ovarian malignancy undergoing cytoreductive surgery between 2016 and 2021. t tests, χ2 tests, and multiple logistic regression analyses were used. Among 44 patients meeting inclusion criteria, 61% received perioperative blood transfusion. There were significant differences in EBL and preoperative hemoglobin levels between patients who did and did not receive transfusion (EBL 442.6 vs 236.8 mL, P = 0.0008; preoperative hemoglobin 10.2 vs 11.2 g/dL, P = 0.049). After adjusting for preoperative hemoglobin, the risk of transfusion increased for each additional 200 mL of EBL (odds ratio [OR] 3.8, 95% confidence interval [CI] 1.5-9.5). Stratified by race, the association between EBL and transfusion risk remained statistically significant only for non-Latinx White patients (OR 6.1, 95% CI 1.7-21.9), who made up 77% of the study population, but not for patients of other races and ethnicities (OR 1.0, 95% CI 0.16-6.42). Perioperative blood transfusion is common in patients undergoing cytoreductive surgery. In this study, EBL and preoperative hemoglobin levels were significantly associated with transfusion receipt. Clinicians should optimize hemoglobin levels and intraoperative blood conservation strategies to reduce the need for transfusion. The results also highlight the importance of considering racial and ethnic differences when developing strategies to reduce transfusion risk.

Exploring the Utility of remimazolam in cesarean sections under general anesthesia: A preliminary retrospective analysis and Implications for future study

BackgroundRemimazolam has recently been introduced as a maintenance agent for general anesthesia. However, the effect of remimazolam on peripartum prognosis has not been reported. Therefore, this study aimed to compare the effects of remimazolam and propofol for uterotonic drugs following cesarean section. MethodsThe electronic medical records of 51 adult women who underwent elective cesarean sections by single obstetrician under general anesthesia were collected. Participants were categorized into two groups: the propofol group and the remimazolam group. General anesthesia was maintained by continuous infusion of propofol or remimazolam after delivery. The number of uterotonic drugs administered during the cesarean section, the estimated blood loss (EBL), and length of hospital stay (LOS) after delivery were assessed. ResultsOf the 51 patients included in the study, 35 were in the propofol group and 16 in the remimazolam group. In the remimazolam group, five patients (31.3%, 5/16) received more uterotonics than the standard regimen. Conversely, in the propofol group, 19 patients (54.3%, 19/35) were injected with more uterotonics than the standard regimen. Logistic regression analysis showed that abnormal positioning of the placenta (P = 0.079) and not using remimazolam (P = 0.100) were the most relevant factors associated with the increased use of uterotonics. There was no significant difference in EBL between the two groups. The use of remimazolam was clinically relevant with a shorter LOS (P = 0.059). ConclusionsThe use of remimazolam as a maintenance agent did not result in significantly higher use of intrapartum uterotonics compared to the use of propofol. These results cannot exclude all adverse effects of remimazolam during cesarean delivery. Further randomized controlled trials must be conducted to obtain high-quality evidence.

The Consecutive 200 Cases of Endoscopic-Combined Intrarenal Surgery: Comparison between Standard and Miniature Surgeries.

Background and Objectives: Percutaneous nephrolithotomy (PCNL) is still the gold-standard treatment for large and/or complex renal stones. Endoscopic combined intrarenal surgery (ECIRS) was developed with the goal of minimizing the number of access tracts of PCNL while simultaneously improving the one-step stone-free rate (SFR). The aim of this study was to share the experience of the consecutive 200 cases of ECIRS in one institute and analyze surgical outcomes of mini-ECIRS and standard ECIRS. Materials and Methods: We performed ECIRS for 200 adult patients between July 2017 and January 2020. An ECIRS was performed with the patient under general anesthesia in the intermediate-supine position. Surgeries were finished using a tubeless technique with a simple ureteral stent insertion. Results: There were significant differences in the mean maximal stone length (MSL), the variation coefficient of stone density (VCSD), the linear calculus density (LCD), the Seoul National University Renal Stone Complexity (S-ReSC), and the modified S-ReSC scores in stone characteristics, and estimated blood loss (EBL) and operation time in peri-operative outcomes between conventional and mini-ECIRS. After propensity-score matching, there was only a difference in EBL between the two groups. In logistic regression models, MSL [odds ratio (OR) 0.953; 95% confidence interval (CI) 0.926-0.979; p < 0.001], LCD (OR 4.702; 95% CI 1.613-18.655; p = 0.013) were significant factors for the success rate after ECIRS. Conclusions: In patients who underwent a mini-ECIRS, the stones were relatively smaller and less complex, and the operation time was shorter. However, if the size of stones was similar, there was no difference in the success rate, but EBL was lower in mini-ECIRS than in standard surgery.

Placental cord drainage vs delayed cord clamping at elective caesarean section: A randomised controlled trial.

Placental cord drainage (PCD) after vaginal birth accelerates placental delivery by 2.85 minutes, but reduces blood loss by only 77 mL. To determine if PCD at elective caesarean section accelerates placental delivery, compared to delayed cord clamping (DCC). This randomised controlled trial randomised 100 women undergoing elective caesarean sections to receive either PCD for 60 sec after birth, or DCC for 60 sec. The primary outcome was time from birth until placental delivery. Secondary outcomes included estimated blood loss (EBL), postoperative haemoglobin drop, rates of postpartum haemorrhage (PPH), manual removal of placenta and blood transfusion. There was no significant difference in timing of placental delivery (PCD 122 sec vs DCC 123.5 sec, P = 0.717). There were no significant differences in EBL (PCD 425 mL vs DCC 400 mL, P = 0.858), postoperative haemoglobin drop (PCD 12 g/L vs DCC 15 g/L, P = 0.297), PPH rate (PCD 45.8% vs DCC 44.4%, P = 0.893, relative risk (RR) 1.03, 95% confidence interval (CI) 0.66-1.62), manual removal rate (PCD 2.1% vs DCC 4.4%, P = 0.609, RR 0.47, 95% CI 0.04-4.99) or transfusion rate (PCD 4.2% vs DCC 0%, P = 0.495). PCD did not accelerate placental delivery at caesarean compared with DCC. Given that both PCD and DCC groups had faster placental deliveries than quoted in the literature at caesarean (200 sec), it could be postulated that DCC is mimicking the effect of PCD through passive transfusion to the neonate. This supports routine use of DCC at elective caesarean section.

1252 Body Mass Index (BMI) and Estimated Blood-Loss (EBL) in Patients Undergoing Robot Assisted Radical Prostatectomy (RARP)

Abstract Introduction Higher BMI is a factor which urologists associate with increased difficulty during RARP. (1) One previous review of 218 patients undergoing RARP found no significant differences in EBL in patients with a higher BMI. (2) The aim of this study was to examine the relationship between BMI and EBL in patients undergoing RARP. Method Between April 2019 and March 2022, 155 patients underwent RARP. Demographic and clinical variables were collated including EBL, pre-operative and post-operative haemoglobin checks, need for transfusion, length of stay (LOS) and BMI. Pearson’s correlation coefficient was calculated to examine the relationship between increasing BMI and blood loss. Results The mean age of patient was 62 years (range 45-79). The mean BMI was 27.98 (range 19.4-40). The mean blood loss was 281.2mls (range 50-1000). No patient required a blood transfusion. The mean LOS was 2.4 days (range 1-16). There was a positive correlation between higher BMI and higher blood loss (r = 0.1746, p = 0.0421). Conclusions This review found a statistically significant increase in EBL in patients with higher BMI undergoing RARP.

Robotic versus nonrobotic sacroiliac joint fusion.

Robot-assisted pedicle screw placement in spinal fusion has been well studied. However, few studies have evaluated robot-assisted sacroiliac joint (SIJ) fusion. The aim of this study was to compare surgical characteristics, accuracy, and complications between robot-assisted and fluoroscopically guided SIJ fusion. A retrospective review of 110 patients with 121 SIJ fusions done at a single academic institution was conducted from 2014 to 2023. Inclusion criteria included adult age and a robot- or fluoroscopically guided approach to SIJ fusion. Patients were excluded if the SIJ fusion was part of a longer fusion construct, not minimally invasive, and/or had missing data. Demographics, approach type (robotic vs fluoroscopic), operative time, estimated blood loss (EBL), number of screws, intraoperative complications, 30-day complications, number of intraoperative fluoroscopic images (as a surrogate for radiation exposure), implant placement accuracy, and pain status at the first follow-up were recorded. Primary endpoints were SIJ screw placement accuracy and complications. Secondary endpoints were operative time, radiation exposure, and pain status at the first follow-up. Ninety patients were included who underwent a total of 101 SIJ fusions, of which 78 were robotic and 23 were fluoroscopic. The mean age of the cohort at the time of surgery was 55.9 ± 13.8 years; 46 patients were females (51.1%). No difference was found in screw placement accuracy between robotic and fluoroscopic fusion (1.3% vs 8.7%, p = 0.06). Chi-square analysis of robotic versus fluoroscopic fusion found no difference in the presence of 30-day complications (p = 0.62). Mann-Whitney U-test analysis found that robotic fusion had a significantly longer operative time than fluoroscopic fusion (72.0 vs 61.0 minutes, p = 0.01); however, robot-assisted fusions involved significantly lower radiation exposure (26.7 vs 187.4 fluoroscopic images, p < 0.001). No difference in EBL was noted (p = 0.17). No intraoperative complications were present in this cohort. Subgroup analysis comparing the 23 most recent robotic cases against the 23 fluoroscopic cases found that robotic fusion still was associated with significantly longer operative times than fluoroscopic fusion (74.0 ± 26.4 vs 61.0 ± 14.9 minutes, respectively; p = 0.047). SIJ screw placement accuracy did not significantly differ between robot-assisted and fluoroscopic SIJ fusion. Complications overall were low and similar between the two groups. The operative time was longer with robotic assistance, but there was markedly less radiation exposure to the surgeon and staff.

The Optimal Time between Embolization and Surgery for Hypervascular Spinal Metastatic Tumors : A Systematic Review and Meta-Analysis.

Preoperative transarterial embolization (TAE) of tumor feeders in hypervascular spine metastasis is known to reduce intraoperative estimated blood loss (EBL) during surgery. The effect of TAE varies for several reasons, and one controllable factor is the timing between embolization and surgery. However, the adequate timing remains unclear. This study aimed to evaluate the timing and other factors that reduce EBL in spinal metastasis surgery through a meta-analysis. A comprehensive database search was performed to identify direct comparative studies of EBL stratified by the timing of surgery after TAE for spinal metastasis. EBL was analyzed according to the timing of surgery and other factors. Subgroup analyses were also performed. The difference in EBL was calculated as the mean difference (MD) and 95% confidence interval (CI). Among seven studies, 196 and 194 patients underwent early and late surgery after TAE, respectively. The early surgery was defined as within 1-2 days after TAE, while the late surgery group received surgery later. Overall, the MD in EBL was not different according to the timing of surgery (MD, 86.3 mL; 95% CI, -95.5 to 268.1 mL; p=0.35). A subgroup analysis of the complete embolization group demonstrated that patients who underwent early surgery within 24 hours after TAE had significantly less bleeding (MD, 233.3 mL; 95% CI, 76.0 to 390.5 mL; p=0.004). In cases of partial embolization, EBL was not significantly different regardless of the time interval. Complete embolization followed by early spinal surgery within 24 hours may reduce intraoperative bleeding for the patients with hypervascular spinal metastasis.

Higher risk of intraoperative bleeding in right-sided renal tumors compared to left-sided tumors in robot-assisted partial nephrectomy.

To compare intraoperative blood loss in robot-assisted partial nephrectomy (RAPN) between the right and left sides. The data of patients who underwent RAPN at a single institution between 2013 and 2021 were retrospectively analyzed. Using propensity score matching, we compared estimated blood loss (EBL) between right- and left-sided tumors. This study included 1006 patients who underwent transperitoneal RAPN (N=726) and retroperitoneal RAPN (N=280). Through matching, 303 patients were selected for each group. The mean tumor size was 3.1 ± 1.4cm. The RENAL score was 4-6 in 270 (44.5%), 7-9 in 263 (43.3%), and 10-11 in 73 (12.0%) cases. The EBL on the right side was significantly higher than on the left side (102 vs 70 mL, P=.02). The most experienced surgeon showed significant differences in EBL (116 vs 73 mL, P=.024) and blood transfusion rate (2.5 vs 0%, P=0.025) between the right and left sides. In the retroperitoneal RAPN, 104 patients were selected in each group through matching. The EBL was significantly higher on the right side than on the left side (50 vs 24 mL, P=0.02). Operative time was longer on the right side than on the left side (120 vs 109 min, P=.05). Right-sided tumors had a significantly larger EBL than left-sided tumors in RAPN. The difference was evident in the most experienced surgeon who performed RAPN for larger and complicated cases. This information may help surgeons decide whether to clamp the renal artery and vein during tumor resection in large and complicated right-sided tumors.

A Study of 57 Patients with Prostate Cancer to Compare Outcomes of Estimated Blood Loss and Postoperative Pain Between Robot-Assisted Laparoscopic Radical Prostatectomy and Standard Laparoscopic Radical Prostatectomy.

BACKGROUND Robot-assisted radical prostatectomy (RARP) is becoming an increasingly common method for treatment of prostate cancer. This study aimed to compare outcomes of estimated blood loss and postoperative pain, determined by patient-controlled analgesia (PCA), between RARP and standard laparoscopic radical -prostatectomy (LRP). MATERIAL AND METHODS We enrolled 57 patients who had localized prostate cancer (28 patients in RARP, 29 patients in LRP). Primary outcomes were estimated blood loss (EBL) measured by gravimetric method for gauze and visual estimation for suction bottle, and PCA bolus count that the bolus doses were injected at the 1st, the 6th, the 24th, and the 48th hour after the operation. We recorded anesthesia and operation time, pneumoperitoneum duration, vital signs, fluid volume, and remifentanil use. Using the numeric rating scale (NRS), adverse effects were checked at the 1st, the 6th, the 24th, and the 48th hour and patient satisfaction was assessed at the 48th hour after the operation. RESULTS Anesthesia time, operation time, and gas insufflation time were longer (P=0.001, P=0.003, P=0.021), and patient-controlled analgesia (PCA) bolus counts at the 1st hour after the operation and volumes of administered crystalloid and remifentanil were higher in the RARP group than in the LRP group (P=0.013, P=0.011, P=0.031). There were no significant differences in EBL. CONCLUSIONS The RARP group required longer anesthetic time and more analgesics during the acute postoperative period compared to the LRP group. Regarding anesthesia, LRP is as good a surgical procedure as RARP until the operation time and the number of ports are reduced.

Accuracy of Visual Estimation of Blood Loss in Obstetrics Using Clinical Reconstructions: An Observational Simulation Cohort Study

(Int J Obstet Anesth. 2022;50:10359) Postpartum hemorrhage accounts for 27% of worldwide maternal deaths and is defined as blood loss ≥1000 mL or blood loss accompanied by hypovolemia after birth. Visually estimated blood loss (EBL) following delivery remains the most common method of measurement despite it being largely inaccurate. Previous studies reported that accurate and timely hemorrhage diagnosis occurred in a minority (31%) of cases. While delivery mode, distribution or location of blood loss, the patient’s cardiovascular status, or experience may impact accuracy, these have not been tested. This study investigated the relationship between these factors, EBL and actual blood loss (ABL) and contributing factors between differences in EBL and ABL.

Blood loss in laparoscopic distal pancreatectomy could be underestimated.

Previous studies have reported that laparoscopic distal pancreatectomy (LDP) has an advantage in reducing blood loss over open distal pancreatectomy (ODP). This study was performed to investigate whether blood loss is truly reduced in LDP. A total of 113 patients undergoing DP from 2014 to 2022 were classified into Open and LDP groups and compared by statistical analysis. Estimated blood loss (EBL) was calculated from the perioperative changes in the hematocrit, hemoglobin, or red blood cell volume, and actual blood loss (ABL) was taken from the operative record. ABL was significantly lower in the LDP than ODP group (50[5-1350] vs 335 [5-1950] ml, P < .01). However, there were no significant differences in EBL calculated from the hematocrit (406 [66-1990] vs 540 [23-1490] ml, P=.14), hemoglobin, or red blood cell volume. EBL showed more linear correlations with ABL in the ODP group (r=0.64-0.73) than in the LDP group (r=0.52-0.57). In the multivariate analysis for ABL, ODP (P=.02) and operative time (P < .01) were significant factors. In contrast, no significant factors were found for EBL. Intraoperative blood loss may be underestimated in LDP, and a new evaluation method needs to be established.

Preoperative meningioma vascularity index is associated with significantly increased intraoperative blood loss and greater risk of subtotal resection.

Surgical recovery of meningiomas relies on a variety of factors, including tumor volume, vascularity, embolization status, and blood loss during excision. Although hypervascular meningiomas can potentially be amendable to embolization, methods for determining optimal vascularity for this procedure are currently lacking. Our group previously established the meningioma vascularity index (MVI) as a marker of tumor vascularity. In this study, we aim to build on our previous work and further examine the relationship between MVI and intraoperative estimated blood loss (EBL). A retrospective data extraction was conducted between August 2010 and October 2019 from patients undergoing craniotomy for meningioma. Of the 85 intracranial meningiomas included, 39 were embolized. Demographic data, extent of resection, embolization status, and EBL were among the extracted variables. Flow void volumes were measured on T2-weighted MRI images using a segmentation software with a voxel-based segmentation method. MVI was a predictor of EBL within the entire cohort, when controlling for tumor volume (R2 adjusted = 0.26; P = 0.027). A high MVI (> 2.01 cm3) was associated with higher likelihood of receiving subtotal resection (STR) (OR 4.07, 95% CI 1.17-14.15; P = 0.035). Although the mean MVI and tumor volume were higher in the embolized cohort (P = 0.009 and P = 0.005), there were no significant differences in EBL, or blood transfusion rates regardless of embolization status. MVI may be used as a non-invasive radiological marker to gauge meningioma vascularity, predict EBL, and guide the decision-making process when it comes to embolization and surgical planning.

Preoperative low-molecular weight heparin chemoprophylaxis in head and neck free flap reconstruction

BackgroundThe safety of presurgical thromboprophylaxis using low molecular weight heparin (LMWH) has not been well described in head and neck oncologic surgery with free tissue transfer (HNS-FTT). MethodsRetrospective chart review of HNS-FTT patients receiving versus not receiving presurgical subcutaneous enoxaparin (Px-LMWH) was performed. Outcomes included estimated blood loss (EBL), hematoma, flap compromise, DVT or pulmonary embolus (PE). Fisher's exact test and Wilcoxon Rank Sum test were performed to compare groups. Odds ratios and associated 95 % confidence intervals were provided as appropriate. Results43 of 128 patients (34 %) received Px-LMWH. There was no significant difference in EBL, hematoma, or flap complications between groups. Patients without Px-LMWH had higher rates of DVT and PE, although the difference did not reach statistical significance (p = 1.00, 0.095, respectively). ConclusionPresurgical Px-LMWH can be used in major head and neck reconstructive surgery without increased intraoperative blood loss or postoperative complications. Larger studies will need to be done to determine the impact of Px-LMWH on DVT and PE in this patient population. Level of evidence3.

Optimal Release Timing of Drain Clamping to Reduce Postoperative Bleeding after Total Knee Arthroplasty with Intraarticular Injection of Tranexamic Acid.

Background and Objectives: Intraarticular injection of tranexamic acid (IA-TXA) plus drain-clamping is a preferred method of reducing bleeding after total knee arthroplasty (TKA). However, no consensus has been reached regarding the timing of the clamping. The purpose of this study was to determine the optimum duration of drain-clamping after TKA with IA-TXA. Materials and Methods: We retrospectively reviewed 151 patients that underwent unilateral TKA with IA-TXA plus drain-clamping for 30 min, 2 h, or 3 h. The total drained volume was reviewed as the primary outcome, and hematocrit (Hct) reductions, estimated blood loss (EBL), transfusion rates, and wound complications were reviewed as secondary outcomes. Results: The mean total drained volume, Hct reduction, and EBL were significantly less in the 3 h group than in the 30 min group. Between the 2 h and 3 h groups, there was no statistical difference in the mean total drained volume, Hct reduction, or EBL. The proportion of patients who drained lesser than 300 mL was high in the 3 h group. No significant intergroup difference was observed for transfusion volume, transfusion rate, and wound related complications. Conclusions: In comparison of the IA-TXA plus drain-clamping after TKA, there was no difference in EBL between the 2 h group and the 3 h group, but the amount of drainage volume was small in the 3 h group.

The effect of tranexamic acid in open reduction and internal fixation of pelvic and acetabular fracture: A systematic review and meta-analysis.

Background:Pelvic bone fractures may cause extensive bleeding; however, the efficacy of tranexamic acid (TXA) usage in pelvic fracture surgery remains unclear. In this systematic review and meta-analysis, we aimed to evaluate the efficacy of TXA in open reduction and internal fixation surgery for pelvic and acetabular fracture.Methods:MEDLINE, Embase, and Cochrane Library databases were systematically searched for studies published before April 22, 2020, that investigated the effect of TXA in the treatment of pelvic and acetabular fracture with open reduction and internal fixation. A pooled analysis was used to identify the differences between a TXA usage group and a control group in terms of estimated blood loss (EBL), transfusion rates, and postoperative complications.Results:We included 6 studies involving 764 patients, comprising 293 patients who received TXA (TXA group) and 471 patients who did not (control group). The pooled analysis showed no differences in EBL between the groups (mean difference –64.67, 95% confidence interval [CI] –185.27 to –55.93, P = .29). The study period transfusion rate showed no significant difference between the groups (odds ratio [OR] 0.77, 95% CI 0.19–3.14, P = .71, I2 = 82%), nor in venous thromboembolism incidence (OR 1.53, 95% CI 0.44–5.25, P = .50, I2 = 0%) or postoperative infection rates (OR 1.15, 95% CI 0.13–9.98, P = .90, I2 = 48%).Conclusions:Despite several studies having recommended TXA administration in orthopedic surgery, our study did not find TXA usage to be more effective than not using TXA in pelvic and acetabular fracture surgery, especially in terms of EBL reduction, transfusion rates, and the risk of postoperative complications.

Does Abnormal Preoperative Coagulation Status Lead to More Perioperative Blood Loss in Spinal Deformity Correction Surgery?

This study aims to analyze the potential association between the preoperative coagulation status and perioperative blood loss in spinal deformity correction surgery. The preoperative coagulation status and estimated blood loss (EBL) during operation, postoperative wound drainage, and allogeneic transfusion during and after operation were recorded and analyzed. Among the 164 patients, 26 had a longer prothrombin time (PT), 13 had a lower fibrinogen level, 55 had a longer activated partial thromboplastin time (APTT), and 2 had a longer thrombin time (TT), and the platelet count (PLT) was all normal or higher than the normal level. The mean EBL per surgical level was 77.8 ml (range, 22–267 ml), and the mean drainage per surgical level was 52.7 ml (range, 7–168 ml). Fifty-five patients and 12 patients underwent allogeneic transfusion during and after the operation, respectively. The differences in EBL per surgical level, mean drainage per surgical level, the occurrences of allogeneic transfusion during and after operation between the patients with a longer PT, lower fibrinogen level, longer APTT or longer TT, and the normal controls were not significant (all P’s > 0.05). The Spearman correlation analysis showed that there was no correlation between PT, fibrinogen, APTT, TT or PLT with EBL per surgical level, mean drainage per surgical level, or allogeneic transfusion during and after the operation (all P’s > 0.05). The abnormal preoperative coagulation status but not hemophilia does not lead to more perioperative blood loss or a higher rate of perioperative allogeneic transfusion in spinal deformity correction surgery.

Randomized, controlled trial of two tranexamic acid dosing protocols in adult spinal deformity surgery.

Tranexamic acid (TXA) is an anti-fibrinolytic effective in reducing blood loss in orthopedic surgery. The appropriate dosing protocol for adult spinal deformity (ASD) surgery is not known. The purpose of this study was to evaluate two TXA protocols [low dose (L): 10mg/kg bolus, 1mg/kg/hr infusion; high dose (H): 50mg/kg, 5mg/kg/hr] in complex ASD surgery. Inclusion criteria were ASD reconstructions with minimum 10 fusion levels or planned 3-column osteotomy (3CO). Standard demographic and surgical data were collected. Intraoperative estimated blood loss (EBL) was calculated by suction canisters minus irrigation plus estimated blood lost in sponges, estimated to the nearest 50mL. Serious adverse events (SAE) were defined a priori as: venothromboembolic event (VTE), cardiac arrhythmia, myocardial infarction, renal dysfunction, and seizure. All SAE were recorded. Simple t tests compared EBL between groups. Mean EBL by total blood volume (TBV), transfusion volume, complications related to TXA were secondary outcomes. Sixty-two patients were enrolled and 52 patients completed the study; 25 were randomized to H and 27 to L. Demographic and surgical variables were not different between the two groups. EBL was not different between groups (H: 1596 ± 933cc, L: 2046 ± 1105cc, p = 0.12, 95% CI: -1022 to 122cc). EBL as a percentage of TBV was lower for the high-dose group (H: 29.5 ± 14.8%, L: 42.5 ± 26.2%, p = 0.03). Intraoperative transfusion volume (H: 961 ± 505cc, L: 1105 ± 808cc, p = 0.5) and post-operative transfusion volume (H: 513 ± 305cc, L: 524 ± 245cc, p = 0.9) were not different. SAE related to TXA were not different (p = 0.7) and occurred in 2 (8%) H and 3 (11%) L. There was one seizure (H), 2 VTE, and 2 arrhythmias. No differences in EBL, transfusion volume, nor SAE were observed between H and L dose TXA protocols. High dose was associated with decreased TBV loss (13%). Further prospective study, with pharmacologic analysis, is required to determine appropriate TXA dosage in ASD surgeries. Therapeutic Level II. The study was registered at Clinicaltrials.gov (NCT02053363) February 3, 2014.

A Novel Technique Using Ultrasonic Shears Versus Traditional Methods in Labiaplasty: A Retrospective Case-Control Study

<h3>Study Objective</h3> To compare the clinical outcomes of bilateral labia minora hypertrophy reduction using ultrasonic shears versus traditional methods. <h3>Design</h3> In this retrospective study, we evaluate the surgical outcomes of 11 women who underwent bilateral labia minora hypertrophy reduction using ultrasonic shears to 14 women who underwent the same procedure using various traditional methods between January 1, 2015, and February 29, 2020, in a single center. <h3>Setting</h3> Outpatient surgery at a single center. <h3>Patients or Participants</h3> Out of 25 patients, 11 underwent labiaplasty procedures using ultrasonic shears and 14 women who underwent the same procedure using various traditional methods. <h3>Interventions</h3> N/A. <h3>Measurements and Main Results</h3> The primary outcomes evaluated are total operative time, estimated blood loss (EBL), and post-operative pain. Secondary outcomes include post-operative complications and total admission time. The statistical analyses used were exact Wilconxon Rank and Fisher's exact test. The mean reduction operative time for the ultrasonic shears technique when compared with traditional methods was 43.25 minutes (22.82 minutes versus 66.07 minutes, p=.0002). A statistically significant but non-clinically significant difference in EBL was noted. No statistically significant differences existed with post-operative pain score, total admission time, or post-operative complications. <h3>Conclusion</h3> Ultrasonic shears significantly reduce the time needed for reduction of bilateral labia minora hypertrophy and therefore should be considered by surgeons as a useful tool in increasing the efficiency of this procedure.

Effects of Tranexamic Acid Administration at Time of Myomectomy with a Particular Focus on Fibroid Characteristics

<h3>Study Objective</h3> To compare the effect of tranexamic acid (TXA) administration on estimated blood loss (EBL) in patients undergoing myomectomy. <h3>Design</h3> Retrospective cohort study of women undergoing myomectomy between January 2015 and January 2020. <h3>Setting</h3> Academic-affiliated community hospital system. <h3>Patients or Participants</h3> All women (n=71). who underwent myomectomy with a Minimally Invasive Gynecologic Surgeon (MIGS) at a single institution between January 2015 and January 2020. <h3>Interventions</h3> In 2017, the MIGS department underwent a practice change and began routine administration of TXA to all myomectomy cases without an absolute contraindication. <h3>Measurements and Main Results</h3> Overall mean EBL was 236mL. There was no statistically significant difference in EBL between the TXA (184mL) and no TXA groups (266mL) (p=0.42). However, when stratified by fibroid characteristics, patients with total pathology fibroid weight >173g or a largest fibroid >73mm had a statistically significant decrease in EBL when they received TXA compared to those who did not (No TXA vs TXA, 405.4mL vs 205.6mL, p=0.006 and 408.3mL vs 229.2mL, p=0.01, respectively). No patients required a blood transfusion. Average operating time was 238 minutes and was also not statistically different between the two groups (p=0.95). There were no cases of anaphylaxis in either group. There was one case of thromboembolism which occurred in the non-TXA group. Rates of nausea/vomiting and headaches did not differ between the two groups (p=1.0 and p=0.41, respectively). <h3>Conclusion</h3> There was a statistically significant reduction in blood loss at the time of myomectomy in patients with a large fibroid burden treated with TXA. Furthermore, TXA is demonstrated as a safe hemostatic agent associated with extremely low rates of adverse events. TXA is a safe and effective hemostatic agent that may reduce intraoperative blood loss during myomectomy.

MP49-06 A HELPFUL TOOL IN THE RENAL SURGERY ARMAMENTARIUM: DORSAL LUMBOTOMY NEPHRECTOMY FOR TUMOR IN PATIENTS WITH END-STAGE RENAL DISEASE

You have accessJournal of UrologyKidney Cancer: Localized: Surgical Therapy IV (MP49)1 Sep 2021MP49-06 A HELPFUL TOOL IN THE RENAL SURGERY ARMAMENTARIUM: DORSAL LUMBOTOMY NEPHRECTOMY FOR TUMOR IN PATIENTS WITH END-STAGE RENAL DISEASE Ian Cooke, Samiha Sadruddin, Dattatraya Patil, Satyen Tripathi, Reza Nabavizadeh, Kenneth Ogan, and Viraj Master Ian CookeIan Cooke More articles by this author , Samiha SadruddinSamiha Sadruddin More articles by this author , Dattatraya PatilDattatraya Patil More articles by this author , Satyen TripathiSatyen Tripathi More articles by this author , Reza NabavizadehReza Nabavizadeh More articles by this author , Kenneth OganKenneth Ogan More articles by this author , and Viraj MasterViraj Master More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000002075.06AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: The dorsolumbar (DL) approach to the kidney was first described in 1870 but remains an infrequently utilized approach today, with little data comparing it to contemporary approaches. The purpose of our study was to compare operative outcomes between the DL and laparoscopic (LN) approaches for patients with end stage renal disease (ESRD) undergoing nephrectomy. DL operative technique is also described. METHODS: We performed a retrospective review of patients undergoing DL nephrectomy at our institution from 2008-2020. Cases were matched with controls who had undergone LN. Outcome parameters included operative time, estimated blood loss (EBL), length of stay (LOS), postoperative narcotic requirements, and complication rates. Statistical analysis performed with SPSS. RESULTS: 43 DL patients and 86 LN patients were assessed. DL had shorter total OR time (173min vs 198min; p=0.001) and surgery time (101min vs 135min; p<0.001) compared to LN. There was a trend towards decreased mean LOS among the DL group (2.65d vs 3.14d; p=0.069) as well as narcotic requirement measured in oral morphine equivalents (54.8mg/day vs 73.6mg/day, p=0.051). There were no differences in EBL, complication rates, or 30-day readmissions. Limitations include retrospective design and sample size. CONCLUSIONS: Our study is the first to perform a matched comparison of DL and LN approaches to nephrectomy in patients with ESRD. We found DL to be safe and effective compared to LN, with shorter operative times, a trend towards decreased LOS and post-operative narcotic requirements, and similar complication rates. DL should be considered as an approach for nephrectomy in appropriately selected patients in this population. Source of Funding: John Robinson Family Foundation, Christopher Churchill Foundation © 2021 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 206Issue Supplement 3September 2021Page: e876-e877 Advertisement Copyright & Permissions© 2021 by American Urological Association Education and Research, Inc.MetricsAuthor Information Ian Cooke More articles by this author Samiha Sadruddin More articles by this author Dattatraya Patil More articles by this author Satyen Tripathi More articles by this author Reza Nabavizadeh More articles by this author Kenneth Ogan More articles by this author Viraj Master More articles by this author Expand All Advertisement Loading ...