Difference In Procedure Time Research Articles

Ardışık pediatrik radyoterapi seanslarında sevofluran insüflasyonu ve intravenöz ketamin kullanımının başarısızlık oranı açısından karşılaştırılması: çapraz bir çalışma

Aim: Childhood cancers are often treated with radiotherapy. During radiation therapy, sedation is often required for immobilization, especially for young children and patients with mental disabilities. Our study aimed to compare the efficacy of sevoflurane insufflation and intravenous ketamine for sedation during pediatric radiotherapy.
 Materials and methods: This prospective, randomized, cross-over study was conducted between August and December 2020 on pediatric patients (1 month to 18 years) requiring sedation or general anesthesia for radiotherapy. 352 repeated sessions were conducted in the study involving 18 patients who participated. Two groups were categorized by session: ketamine (Group K) or sevoflurane (Group S).
 Results: The study included the evaluation of 352 sessions for 18 patients Although there was no significant difference in procedure times between Group S and Group K during the sessions (p>0.05), Group K showed a significantly longer discharge time, higher failure rate, and higher score sedation scale in comparison to Group S (p

Active narcotic use and post–peroral endoscopic myotomy outcomes in esophageal motility disorders

Background and AimsPeroral Endoscopic Myotomy (POEM) is a minimally invasive technique used to treat esophageal motility disorders. Opioid use has been demonstrated to adversely affect esophageal dysmotility and is associated with an increased prevalence of esophageal motility disorders. Our aim was to investigate the effect of narcotic use on success rates in patients undergoing POEM. MethodsThis was a single center retrospective study of patients undergoing POEM between February 2017 and September 2021. Primary outcomes were post-POEM Eckardt Score (ES), Distensibility Index (DI), and length of procedure. Secondary outcomes included technical success, myotomy length, length of stay, adverse events, reintervention rates, post-procedure GERD. ResultsDuring the study period, 90 patients underwent POEM for treatment of esophageal dysmotility disorders. Age, sex, race, indications for POEM, and BMI were not significant between those with or without narcotic use. There were no differences in procedure time, pre-procedure ES, or length of stay. Post-procedure ES were higher in the active narcotic user group compared to the no prior history group (2.73 vs. 1.2, p = .004). Distensibility indices (DI) measured with EndoFLIP were not different in narcotic users compared with opioid naïve subjects. ConclusionActive narcotic use negatively impacts symptom improvement following POEM for treatment of esophageal motility disorders.

Feasibility and safety of cavotricuspid isthmus ablation using exclusive intracardiac echocardiography guidance: a proof-of-concept, observational trial.

Catheter ablation is the preferred treatment for typical atrial flutter (AFl), but it can be challenging due to anatomical abnormalities. The use of 3D electroanatomical mapping systems (EAMS) has reduced fluoroscopy exposure during AFl ablation. Intracardiac echocardiography (ICE) has also shown benefits in reducing radiation exposure during AFl ablation. However, there is a lack of evidence on the feasibility of ICE-guided, zero-fluoroscopy AFl ablation without the use of EAMS. In this prospective study, we enrolled 80 patients with CTI-dependent AFl. The first 40 patients underwent standard fluoroscopy + ICE-guided ablation (Standard ICE group), while the other 40 patients underwent zero-fluoroscopy ablation using only ICE (Zero ICE group). Procedure outcomes, including acute success, procedure time, fluoroscopy time, radiation dose, and complications, were compared between the groups. The acute success rate was 100% in both groups. Out of the 40 cases, the zero-fluoroscopy strategy was successfully implemented in 39 cases (97.5%) in the Zero ICE group. There were no significant differences in procedure time [55.5 (46.5; 66.8) min vs. 51.5 (44.0; 65.5), p = 0.50] and puncture to first ablation time [18 (13.5; 23) min vs. 19 (15; 23.5) min, p = 0.50] between the groups. The Zero ICE group had significantly lower fluoroscopy time [57 (36.3; 90) sec vs. 0 (0; 0) sec, p < 0.001] and dose [3.17 (2.27; 5.63) mGy vs. 0 (0; 0) mGy, p < 0.001] compared to the Standard ICE group. Total ablation time was longer in the Standard ICE group [597 (447; 908) sec vs. 430 (260; 750), p = 0.02], but total ablation energy [22,458 (14,836; 31,116) Ws vs. 17,043 (10,533; 29,302) Ws, p = 0.10] did not differ significantly. First-pass bidirectional conduction block of the CTI and acute reconnection rates were similar between the groups. No complications or recurrences were observed during the follow-up period. Our study suggests that zero-fluoroscopy CTI ablation guided solely by ICE for AFl is feasible and safe. Further investigation is warranted for broader validation.

Skills transfer from the DaVinci® system to the Hugo™ RAS system

PurposeRecently, the robotic surgical system, Hugo™ was approved for clinical use. The transfer of skills is important for understanding the implementation of surgical innovation. We explored the transfer of skills from the DaVinci® to the Hugo™ by studying the learning curve and short-term patient outcomes during radical prostatectomy (RARP).MethodsWe examined the transfer of skills from one surgeon performing RARP from the first case with the Hugo™ system in April 2022. The surgeon had previously performed > 1000 RARPs using DaVinci®. Perioperative and clinical outcomes were collected for procedures on both Hugo™ and DaVinci®. Patient follow-up time was 3 months.ResultsNineteen Hugo™ cases and 11 DaVinci® cases were recorded. No clinically relevant difference in procedure time was found when transferring to Hugo™. Patients operated using Hugo™ had more contacts postoperatively compared to the DaVinci®, all Clavien–Dindo (CD) grade 1 (53% vs 18%). Three patients from the Hugo™ group were re-admitted within 30 days with catheter malfunction (CD grade 1), infection without a focus (CD grade 2), and ileus due to a hernia in the port hole (CD grade 3b). The 3-month follow-up showed similar results in prostate-specific antigen levels (PSA) and erectile dysfunction between the two robotic systems, but a higher incidence of incontinence was found for the Hugo™.ConclusionWe observed that the skills of an experienced robotic surgeon are transferable from DaVinci® to Hugo™ when performing RARP. No obvious benefits were found for using Hugo™ compared to DaVinci® for RARP although this needs confirmatory studies.

Comparison of robotic-assisted laparoscopic radical prostatectomy: SP versus XI, a single surgeon experience.

Currently, there is a paucity of data regarding Single Port (SP) robotic-assisted laparoscopic prostatectomy (RALP). Our objective was to compare our single-institution single-surgeon SP RALP experience to our XI RALP experience with regard to patient selection, perioperative data, and outcomes. Patients who underwent prostatectomy at our institution between August 2019 and April 2021 were selected for analysis. All patients had biopsy confirmed prostate cancer. All surgeries were performed by one urologist at our institution to limit inter-surgeon variability. Demographic and clinical information were extracted from the medical record in standardized fashion. All documented classifications were graded using the Clavien-Dindo classification system. Patients with previous prostate cancer therapies were excluded. Categorical variables were compared using Chi-square or Fisher's exact test where appropriate. Continuous variables were compared using t tests or Wilcoxon rank sum tests where appropriate. Complete records were available for 208 patients. Of the total patient population 127 (61.1%) underwent SP prostatectomy compared to 81 (38.9%) underwent XI prostatectomy. There was no significant difference between the two cohorts in terms of mean age (65 vs. 66 years; p = 0.60), BMI (29.2 vs. 30.1; p = 0.22), preop ASA score ≥ 3 (68.5% vs. 64.2%; p = 0.52), or preop PSA (7.1 vs. 7.4, p = 0.94). There no difference in procedure time for SP prostatectomy (170 vs. 168 min, p = 0.035), estimated blood loss (100 vs. 100 mL; p = 0.14), or average length of stay (1 vs. 1 days; p = 0.22). There was a significant difference in Gleason grade group between the two cohorts with patients undergoing XI RALRP more likely to have higher stage disease (p = 0.025) and a trend towards higher D'Amico risk scores in the XI group (p = 0.053). There was no difference in rate of positive surgical margins (29.9% vs. 29.6%; p = 0.96). There was no difference in the distribution of complications between the two groups (p = 0.99) with 89% of patients having no complication. There was no difference in the number of lymph nodes removed by modality (p = 0.94). To date, this study represents one of the largest cohorts of patients who underwent SP RALP. Importantly, it is among the first studies comparing perioperative variables between the SP and XI platforms. As surgeons become more facile with the SP system there appear to minimal differences in patient factors, perioperative results, or outcomes between the platforms. These findings provide evidence that surgeons who are competent on the XI platform can confidently perform SP RALPs through a single incision without compromising outcomes.

Endovenous laser ablation versus conventional surgery (ligation and stripping) for primary great saphenous varicose vein: a systematic review and meta-analysis.

The great saphenous varicose vein was managed with high ligation and stripping conventionally, but with the development of minimally invasive surgical techniques like endovascular laser ablation (EVLA), they have become popular. This systematic review and meta-analysis of randomized controlled trials aim to compare the short-term and long-term outcomes of these two modalities on headings like procedural time, technical success, recovery time, recurrences, cost-effectiveness, and complications. The protocol followed in this study was registered prospectively in the Registry of Systematic Reviews/Meta-analyses. Electronic databases were searched with appropriate search terms for relevant studies, and after their screening, data was extracted. The odds ratio was used for dichotomous data, and the mean difference or standardized mean difference was used for continuous variables. This study identified 18 publications (10 randomized controlled trials) with a total of 1936 patients. There was no difference in procedural time, recovery time, recurrences at 1, 2, and 5 years, or clinical severity score. The surgery group had 4.35 times higher statistically significant odds of being technically successful at 2 years, while pooling data on bruising, hematoma, sensory disturbance, infection, and phlebitis showed that the EVLA group was less likely to develop postoperative complications. Technical failures were more common in the EVLA, whereas postoperative complications were more common in the surgery group. Both have comparable clinical effectiveness, and neither modality has clear superiority over the other. Parameters like cost-effectiveness must be assessed at the hospital level before choosing the right procedure for the patients.

Ankle fracture internal fixation performed by cadaveric simulation-trained versus standard-trained orthopaedic trainees: a preliminary, multicentre randomized controlled trial.

Ankle fracture fixation is commonly performed by junior trainees. Simulation training using cadavers may shorten the learning curve and result in a technically superior surgical performance. We undertook a preliminary, pragmatic, single-blinded, multicentre, randomized controlled trial of cadaveric simulation versus standard training. Primary outcome was fracture reduction on postoperative radiographs. Overall, 139 ankle fractures were fixed by 28 postgraduate year three to five trainee surgeons (mean age 29.4 years; 71% males) during ten months' follow-up. Under the intention-to-treat principle, a technically superior fixation was performed by the cadaveric-trained group compared to the standard-trained group, as measured on the first postoperative radiograph against predefined acceptability thresholds. The cadaveric-trained group used a lower intraoperative dose of radiation than the standard-trained group (mean difference 0.011 Gym2, 95% confidence interval 0.003 to 0.019; p = 0.009). There was no difference in procedure time. Trainees randomized to cadaveric training performed better ankle fracture fixations and irradiated patients less during surgery compared to standard-trained trainees. This effect, which was previously unknown, is likely to be a consequence of the intervention. Further study is required.

AQUACEL® Ag Advantage reduces the stress of postoperative packing removal after endoscopic sinus surgery

ObjectiveAfter Endoscopic Sinus Surgery (ESS), packing plays an important role in wound healing and hemostasis. However, the effect of the packing removal procedure on physician stress has not been evaluated. The purpose of this study was to evaluate physician stress during packing removal for patients treated with AQUACEL® Ag Advantage versus KALTOSTAT®. MethodsThis retrospective study included 15 patients who underwent packing with ESS for chronic rhinosinusitis performed at two centers; 9 were treated with AQUACEL® Ag Advantage and 6 were treated with KALTOSTAT®. Physician stress during packing removal was evaluated with the National Aeronautics and Space Administration-Task Load Index (NASA-TLX). The time required to remove the packing and the number of instruments used in the procedure were recorded. Postoperative bleeding (Boezaart bleeding score) and wound healing were graded. Patient symptoms on the day after surgery and pain during packing removal were assessed using a visual analog scale. ResultsComputed tomography scores, asthma complications, and blood eosinophil counts were significantly higher in the AQUACEL® Ag Advantage group. Patient symptoms on the day after surgery were not significantly different between the two groups. Physician stress during the task of packing removal was significantly lower in the AQUACEL® Ag Advantage group than in the KALTOSTAT® group (35.5 vs. 81.0, p=0.016) according to the NASA-TLX scores. The number of instruments used in the procedure was significantly lower in the AQUACEL® Ag Advantage group than in the KALTOSTAT® group (3.0 vs. 6.0, p=0.015). There were no significant differences in procedure time for packing removal, postoperative bleeding, wound healing, or patient pain at the time of packing removal between the groups. ConclusionPhysicians feel stressed about packing removal. In addition, AQUACEL® Ag Advantage is useful for packing after ESS, requiring fewer instruments for the procedure than KALTOSTAT® and reducing physician stress about the procedure. Level of evidenceLevel 3.

Comparative outcomes of physician-modified fenestrated/branched endovascular aortic aneurysm repair in the setting of prior failed endovascular aneurysm repair

ObjectiveEndovascular treatment of aortic aneurysms involving renal-mesenteric arteries, especially in the setting of prior failed endovascular aneurysm repair (EVAR) typically requires fenestrated/branched endovascular aneurysm repair (F/BEVAR) with a custom-made device (CMD). CMDs are limited to select centers, and physician-modified endografts are an alternative treatment platform. Currently, there is no data on the outcomes of physician-modified F/BEVAR (PM-F/BEVAR) in the setting of failed prior EVAR. The purpose of this study was to evaluate the use of PM-F/BEVAR in patients with prior failed EVAR. MethodsA prospective database of consecutive patients treated at a single center with PM-F/BEVAR between March 2021 and November 2022 was retrospectively reviewed. The cohort was stratified by presence of a failed EVAR (type Ia endoleak or aneurysm development proximal to a prior EVAR) prior to PM-F/BEVAR. Demographics, operative details, and postoperative complications were compared between the groups using univariate analysis. One-year survival and freedom from reintervention were compared using the Kaplan-Meier method. ResultsA total of 103 patients underwent PM-F/BEVAR during the study period; 27 (26%) were in the setting of prior EVAR. Patients with prior failed EVAR had similar age (75.2 ± 7.7 vs 71.5 ± 8.8 years; P = .058), male gender (n = 24 ; 89% vs n = 57 ; 75%; P = .130), and comorbid conditions except higher incidence of moderate-to-severe chronic obstructive pulmonary disease (n = 7 ; 26% vs n = 7 ; 9%; P = .047). Overall, aneurysm diameter was 65.5 ± 13.9 mm with aneurysms categorized as juxta-/pararenal in 43% and thoracoabdominal in 57%, with no differences between the groups. Twelve patients (14%) presented with symptomatic/ruptured aneurysms. The average number of target arteries incorporated per patient was 3.8. Four different aortic devices were modified with a greater proportion of Terumo TREO devices used in the failed EVAR group (P = .03). There was no difference in procedure time, radiation dose, or iodinated contrast use between groups. Overall technical success was 99%. Rates of 30-day mortality (n = 0 ; 0% vs n = 3 ; 4%; P = .565) and major adverse events (n = 6 ; 22% vs n = 16 ; 21%; P = 1.0) were similar between groups. For the overall cohort, rates of type 1 or 3 endoleak, branch vessel stenosis/occlusion, and reintervention were 2%, 1%, and 8%, respectively, with no difference between groups. One-year survival (failed EVAR 94% vs no EVAR 82%; P = .756) was similar between groups. ConclusionsPM-F/BEVAR is a safe and effective treatment for patients with aneurysms involving the renal-mesenteric arteries in the setting of prior failed EVAR where additional technical challenges may be present. Additional follow-up is warranted to demonstrate long-term efficacy, but early results are encouraging and similar to those using CMDs.

Impact of age on mechanical thrombectomy and clinical outcome in patients with acute ischemic stroke

Background and purposeMechanical thrombectomy is less effective in patients aged 80 years or older. Our goal was to better understand the impact of age in general on recanalization rates and clinical outcome. MethodsWe performed a retrospective analysis of our prospective database of adult patients with acute ischemic stroke due to large vessel occlusions, who had undergone mechanical thrombectomy between 2019 and mid-2021. The cohort was categorized into five age groups: 18 – 49, 50 – 59, 60 – 69, 70 – 79 and ≥ 80 years. Our primary outcome measure was clinical outcome at three months after mechanical thrombectomy, measured by the mRS score. Secondary outcomes were procedure times and rates of successful recanalization, defined by mTICI ≥ 2b. ResultsData of 264 patients were analyzed. There were no significant differences in procedure times (p = 0.46) or in rates of successful recanalization (p = 0.49) between age groups. There was a significant association of age and mRS score at three months (p < 0.0001): From youngest to oldest group, odds of functional independence (mRS ≤ 2) decreased (80.0% vs. 21.3%) and odds of death (mRS 6) increased (13.3% vs. 57.3%). Increasing age was significantly associated with lower rates of functional independence (OR 0.93; [95% CI 0.90 – 0.95]), higher rates of care dependency (OR 1.04; [95% CI 1.01 – 1.07]) and higher mortality rates (OR 1.06; [95% CI 1.04 – 1.09]). ConclusionHigher age had no significant impact on recanalization times or recanalization rates but was strongly associated with worse clinical outcome after mechanical thrombectomy.

Bronchoscopy using a head-mounted mixed reality device—a phantom study and a first in-patient user experience

Background: Bronchoscopy for peripheral lung lesions may involve image sources such as computed tomography (CT), fluoroscopy, radial endobronchial ultrasound (R-EBUS), and virtual/electromagnetic navigation bronchoscopy. Our objective was to evaluate the feasibility of replacing these multiple monitors with a head-mounted display (HMD), always providing relevant image data in the line of sight of the bronchoscopist.Methods: A total of 17 pulmonologists wearing a HMD (Microsoft® HoloLens 2) performed bronchoscopy with electromagnetic navigation in a lung phantom. The bronchoscopists first conducted an endobronchial inspection and navigation to the target, followed by an endobronchial ultrasound bronchoscopy. The HMD experience was evaluated using a questionnaire. Finally, the HMD was used in bronchoscopy inspection and electromagnetic navigation of two patients presenting with hemoptysis.Results: In the phantom study, the perceived quality of video and ultrasound images was assessed using a visual analog scale, with 100% representing optimal image quality. The score for video quality was 58% (95% confidence interval [CI] 48%–68%) and for ultrasound image quality, the score was 43% (95% CI 30%–56%). Contrast, color rendering, and resolution were all considered suboptimal. Despite adjusting the brightness settings, video image rendering was considered too dark. Navigation to the target for biopsy sampling was accomplished by all participants, with no significant difference in procedure time between experienced and less experienced bronchoscopists. The overall system latency for the image stream was 0.33–0.35 s. Fifteen of the pulmonologists would consider using HoloLens for navigation in the periphery, and two would not consider using HoloLens in bronchoscopy at all. In the human study, bronchoscopy inspection was feasible for both patients.Conclusion: Bronchoscopy using an HMD was feasible in a lung phantom and in two patients. Video and ultrasound image quality was considered inferior to that of video monitors. HoloLens 2 was suboptimal for airway and mucosa inspection but may be adequate for virtual bronchoscopy navigation.

Cardiovascular Outcomes of Transulnar Versus Transradial Percutaneous Coronary Angiography and Intervention: A Regression Matched Meta-Analysis

Transradial access (TRA) and transulnar access (TUA) are in close vicinity, but TRA is the preferred intervention route. The cardiovascular outcomes and access site complications of TUA and TRA are understudied. Databases, including MEDLINE and Cochrane Central registry, were queried to find studies comparing safety outcomes of both procedures. The outcome of interest was in-hospital mortality and access site bleeding. Secondary outcomes were all-cause major adverse cardiovascular events, crossover rate, artery spasm, access site large hematoma, and access site complications between TUA and TRA. A random-effect model was used with regression to report unadjusted odds ratios (ORs) by limiting confounders and effect modifiers, using software STATA V.17. A total of 4,796 patients in 8 studies were included in our analysis (TUA=2,420 [50.4%] and TRA=2,376 [49.6%]). The average age was 61.3 and 60.1years and the patients predominantly male (69.2% vs 68.4%) for TUA and TRA, respectively. TUA had lower rates of local access site bleeding (OR 0.58, 95% confidence interval 0.34 to 0.97, I2=1.89%, p=0.04) but higher crossover rate (OR 1.80, 95% confidence interval 1.04 to 3.11, I2=75.37%, p=0.04) than did TRA. There was no difference in in-hospital mortality, all-cause major adverse cardiovascular events, arterial spasm, and large hematoma between both cohorts. Furthermore, there was no difference in procedural time, fluoroscopy time, and contrast volume used between TUA and TRA. TUA is a safer approach, associated with lower access site bleeding but higher crossover rates, than TRA. Further prospective studies are needed to evaluate the safety and long-term outcomes of both procedures.

Clinical usefulness of the hold-and-drag closure using the SB clip for large mucosal defects after colorectal endoscopic submucosal dissection.

Endoscopic clip closure of mucosal defects after colorectal endoscopic submucosal dissection (ESD) reduces the risk of postoperative adverse events, but achieving complete closure for large mucosal defects can be difficult. The aim of this study was to evaluate the effectiveness of the hold-and-drag closure using an SB clip compared with that of the conventional closure for mucosal defects after colorectal ESD. Eighty-four consecutive colorectal lesions resected by ESD at the Hiroshima Asa Citizens Hospital were registered and randomly allocated to two groups (Group A: SB clip, Group B: EZ clip), and then endoscopic closures were performed. We crossed-over to the SB clip in situations where the initial closure using an EZ clip was unsuccessful in achieving complete closure. Outcomes were compared and analyzed. Forty-two lesions were randomly assigned to groups A and B. The complete closure rate was significantly higher in group A, especially in resected specimens with a diameter of 30mm or more. Twelve lesions that failed complete closure in group B were changed to SB clips, and 95% of the whole of group B were successfully closed. There were no significant differences in procedural time, number of clips, and cost of clips between groups A and B. Compared with the conventional closure, the hold-and-drag closure using an SB clip is a more suitable method for complete closure, especially for large mucosal defects of 30mm or more. Furthermore, this is a simpler and more economical compared to a zipper closure using EZ clips.

An endoscopic approach to stapes surgery needs less external auditory canal wall removal than a microscopic approach

Background Although many advantages of endoscopic stapes surgery have been reported, there is little objective data on whether it provides better visualization than the microscopic approach. Objectives To evaluate and compare audiological results, external auditory canal wall removal area, and adverse event rates between endoscopic and microscopic stapes surgery. Material and methods Data from patients who received stapedotomy were collected. Pre and postoperative audiometry, procedure-related parameters, and adverse events were analyzed in conventional microscopic and endoscopic groups. Results There were no differences in procedure time or postoperative hearing between the endoscopic and microscopic surgery groups. The mean procedure times were 87.3 ± 18.9 min in the endoscopic group and 79.9 ± 23.5 min in the microscopic group. The mean postoperative air-bone gaps were 10.9 ± 8.3 dB in the endoscopic group and 10.5 ± 7.8 dB in the microscopic group. There were no differences in the rate of sensorineural hearing loss, postoperative pain, facial palsy, vertigo, or dysgeusia between the two groups. The bony removal area of the posterosuperior external auditory canal wall measured by two observers was significantly less in the endoscopic group than in the microscopic group. Conclusions Endoscopic stapedotomy needed less external auditory canal wall removal and showed similar audiological outcomes to microscopic stapedotomy.

A randomized comparison of retrograde left-sided versus anterograde right-sided ablation of the atrioventricular junction.

Catheter ablation of the atrioventricular node (AVN) is an effective treatment for patients with symptomatic atrial fibrillation. This study compares the success rate, procedure time, radiation time, and complication rates of retrograde left-sided (LSA) and anterograde right-sided (RSA) AVN ablation in a randomised controlled trial. Thirty-onepatients undergoing AVN ablation were randomized to either LSA (15 patients) or RSA (16 patients). Crossover occurred after six unsuccessful radiofrequency (RF) applications. The LSA cohort had a mean age of 77.00 ± 5.17 and the RSA cohort was 79.44 ± 6.08 (p = .0240). There were five crossovers from LSA to RSA and there was one crossover from RSA to LSA. There was no significant difference in ablation time between LSA and RSA (210.40 ± 179.77vs. 192.19 ± 130.29 seconds, p = .748). There was no significant difference in procedure time, fluoroscopy time, radiation dose, or number of RF applications between the two groups. There was 1 (6.67%) serious adverse event in the LSA group and 1 (6.25%) in the RSA group due to femoral hematomas requiring blood transfusion or intervention. There was no significant difference in patient-reported discomfort between LSA and RSA (16.43 ± 20.67 vs. 17.87 ± 28.08, p = .877). The study was stopped before full recruitment due to futility. Retrograde LSA of the AVN does not reduce RF applications, procedure time, or radiation exposure compared with conventional RSA and cannot be recommended as a first-line clinical approach.

Clinical significance of the DUS4ABL strategy for systematically guiding left atrial and ventricular electrophysiological procedures

Abstract Funding Acknowledgements Type of funding sources: None. Background The ultrasound evolved as an indispensable tool to guide electrophysiological (EP) procedures (i.e., gain femoral access, transseptal puncture or exclude pericardial effusion). However, there are no data regarding the course and safety features of ablation procedures in a systematic ultrasound-guided approach. Purpose The aim of this study was to investigate if the systematic use of ultrasound in the course of all ablation procedures with transseptal punction benefits the outcome especially reducing major complication rates and benefitting the process with a reduction of procedure time and fluoroscopy time and dose. This approach consisted of for elements: Firstly the transesophageal echocardiography ruling out left atrial thrombi in the EP laboratory, secondly the ultrasound guided femoral vein puncture, thirdly the transesophageal guided transseptal punction (TSP) and fourthly ruling out pericardial effusion peri and post procedural (TTE), summarized as the DUS4ABL strategy. Methods A cohort of 222 patients undergoing LA or LV electrophysiological ablation guided by the DUS4ABL strategy were compared to a historical cohort of 299 undergoing the same type of procedure using only TTE post procedural to rule out pericardial effusion and in some cases having ruled out left atrial thrombi via TEE in an independent examination up to 7 days prior to the electrophysiological procedure. In the standard group the femoral access was performed by palpation only, the transseptal punction was managed pressure and fluoroscopy guided. Comorbidities, medication and epidemiological data were recorded and analyzed such as major complications specifically: Pericardiac tamponade, strokes, pseudoaneurysms of the femoral vein and artery, atrio-esophageal fistula, phrenic lesions and death. Results All 521 patients (43% female) were included into the final analysis: 43.8% of patients presented with paroxysmal atrial fibrillation, 35.3% had persistent atrial fibrillation, 10.9% had atrial tachycardia and 10% arrhythmias arising from the left ventricle. Baseline characteristics of the patients did not differ significantly between both groups. Results show a significantly lower complication rate in the DUS4ABL group compared to the standard group with 0 major complications occurring in the DUS4ABL group and 11 complications in the standard group (p=.001). Complications included 4 pericardial tamponades and 7 pseudoaneurysms of the femoral artery, all of which were successfully managed. Other complications such as strokes, phrenic lesions and death did not occur in either of the groups. There was no significant difference in procedure time between the groups but a significant difference in fluoroscopy time and dose both of which were significantly lower in the DUS4ABL group (p=0.002 and p=0.013). Conclusion The DUS4ABL strategy significantly reduced the overall complication rate, and also resulted in positive effects for fluoroscopy time and dose.

Similarly high success and low complication rates of catheter ablation for idiopathic premature ventricular contractions from the left and right ventricular outflow tract

Abstract Funding Acknowledgements Type of funding sources: None. Introduction Catheter ablation is the first line treatment for idiopathic premature ventricular contractions (PVCs) from the right ventricular outflow tract (RVOT) but not from the left ventricular outflow tract (LVOT), due to presumed lower success and higher complication rates in the LVOT. In this observational single center study we analyzed success rates and complication rates in patients undergoing catheter ablation for idiopathic PVCs with an inferior axis. Methods Patients undergoing catheter ablation for idiopathic PVCs with an inferior axis at Hannover Heart Rhythm Center between 2012 and 2020 were included. Patients were excluded if no activation mapping could be performed because of low PVC activity. Ablation success was defined as complete suppression of the index PVC at the end of the procedure. Results 108 patients (53% male, age 53 ± 17 years) with predominantly symptomatic (94%) PVCs with one (72%), two (20%) or more (8%) morphologies and a PVC count of 22063 ± 14426 /24h were included. 47 PVCs (44%) were located in the RVOT (21 anterior RVOT and 26 septal RVOT) and 39 PVCs (36%) in the LVOT (11 lateral LVOT, 5 septal LVOT, 8 RCC, 2 ACC, 13 LCC). 14 PVCs (13%) had the origin close to the CS/LV summit and 8 PVCs (7%) in the parahisian region. Overall success rate was 82%. Success rates for RVOT and LVOT origin were 98% (46/47 cases) and 97% (38/39 cases) respectively. No significant differences in procedure time (145 ± 68 vs. 158 ± 72 min), ablation time (441 ± 328 vs. 462 ± 307 sec), fluoroscopy time (496 ± 521 vs. 519 ± 473 sec) or minor complications (5 vs. 8) were observed for outflow tract PVCs, and no major complications occurred in this group. However, 3 major complications and significantly lower success rates were observed for non-outflow tract PVCs (0/8 for parahisian origin, 4/14 (29%) for CS/LV summit origin). 2 patients with a parahisian focus experienced higher degree AV block and 1 patient with an LV summit focus had a pericardial tamponade. Conclusion Catheter ablation of PVCs with LVOT origin can be performed with similarly high success and low complication rates compared to PVCs with RVOT origin, and therefore could be considered as first-line therapy like RVOT PVCs. On the other hand, identification of PVCs with a parahisian or CS/LV summit focus should be aspired before an ablation procedure, as these localizations are associated with poorer ablation outcome and higher complication rates.

MP66-03 LEARNING CURVE OF ROBOTIC-ASSISTED TRANSPERINEAL MRI/ULTRASOUND FUSION-GUIDED PROSTATE BIOPSY

You have accessJournal of UrologyCME1 Apr 2023MP66-03 LEARNING CURVE OF ROBOTIC-ASSISTED TRANSPERINEAL MRI/ULTRASOUND FUSION-GUIDED PROSTATE BIOPSY Vitkor Alargkof Anagnostou, Christian Engesser, Pawel Trotsenko, Hanns-Christian Breit, David Winkel, Helge Seifert, and Christian Wetterauer Vitkor Alargkof AnagnostouVitkor Alargkof Anagnostou More articles by this author , Christian EngesserChristian Engesser More articles by this author , Pawel TrotsenkoPawel Trotsenko More articles by this author , Hanns-Christian BreitHanns-Christian Breit More articles by this author , David WinkelDavid Winkel More articles by this author , Helge SeifertHelge Seifert More articles by this author , and Christian WetterauerChristian Wetterauer More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000003329.03AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: Robotic-assisted fusion prostate biopsy platforms promise precision, while offering user-friendliness, short procedure times and low complication rates. To date, there is no study investigating the learning curve (LC) of robotic-assisted transperineal MRI/Ultrasound fusion-guided prostate biopsy (RA-TP-FBx). A LC is essential to facilitate efficient training, maintain institutional biopsy quality and assess potential for widespread use. Herein, we are the first to assess the learning curve of RA-TP-FBx using the iSR’obot MonaLisa device (Biobot). METHODS: We prospectively analyzed consecutive RA-TP-FBx performed at the University Hospital Basel from January to October 2022. Cases were randomly assigned to the urology chief resident, a first-year biopsy-naive resident and an expert in RA-TP-FBx senior consultant. All resident cases were supervised by the expert. We used multiple parameters to define the LC: 1) efficiency – measured by time for completion of individual procedure steps, 2) accuracy – defined as detection rate of prostate cancer (PCa) and clinically significant PCa (csPCa) stratified by PI-RADS score, 3) operator and supervisor performance evaluation – measured by entrustable professional activities (EPA) questionnaires, 4) workload assessment – measured by the NASA task load index and 5) complication rates. RESULTS: We collectively performed 75 procedures. Procedure time reduction is shown in Graphic 1. The major difference in procedure time between residents and expert stemmed from probe positioning and biopsy time. PCa was detected in 62% and csPCa in 44%. csPCA detection for PI-RADS 4 was 46%. PCa detection rate for PI-RADS 4 lesions was similar between operators and over time. 13 biopsies were necessary before stable independent completion of all procedure steps. The most difficult skill for residents was ultrasound probe positioning. A transition point for workload reduction was observed at 13 biopsies. Complications rates were similar among operators and over time. CONCLUSIONS: Urology residents can quickly acquire skills to independently perform RA-TP-FBx regardless of previous biopsy experience. RA-TP-FBx is a procedure with low workload stress. Safety and accuracy are ensured during the LC when supervised by an expert. Source of Funding: Department of Surgery, University Hospital Basel © 2023 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 209Issue Supplement 4April 2023Page: e932 Advertisement Copyright & Permissions© 2023 by American Urological Association Education and Research, Inc.MetricsAuthor Information Vitkor Alargkof Anagnostou More articles by this author Christian Engesser More articles by this author Pawel Trotsenko More articles by this author Hanns-Christian Breit More articles by this author David Winkel More articles by this author Helge Seifert More articles by this author Christian Wetterauer More articles by this author Expand All Advertisement PDF downloadLoading ...

Percutaneous Dilatational Tracheostomy in Patients with COVID-19 Supported by Extracorporeal Membrane Oxygenation.

Pneumonia caused by severe acute respiratory syndrome coronavirus 2 can cause acute respiratory distress syndrome, often requiring prolonged mechanical ventilation and eventually tracheostomy. Both procedures occur in isolation units where personal protective equipment is needed. Additionally, the high bleeding risk in patients with extracorporeal membrane oxygenation (ECMO) places a great strain on surgeons. We investigated the clinical characteristics and outcomes of percutaneous dilatational tracheostomy (PDT) in patients with coronavirus disease 2019 (COVID-19) supported by ECMO, and compared the outcomes of patients with and without ECMO. This retrospective, single-center, observational study included patients with severe COVID-19 who underwent elective PDT (n=29) from April 1, 2020, to October 31, 2021. The patients were divided into ECMO and non-ECMO groups. Data were collected from electronic medical records at Ajou University Hospital in Suwon, Korea. Twenty-nine COVID-19 patients underwent PDT (24 men [82.8%] and 5 women [17.2%]; median age, 61 years; range, 26-87 years; interquartile range, 54-71 years). The mean procedure time was 17±10.07 minutes. No clinically or statistically significant difference in procedure time was noted between the ECMO and non-ECMO groups (16.35±7.34 vs. 18.25±13.32, p=0.661). Overall, 12 patients (41.4%) had minor complications; 10 had mild subdermal bleeding from the skin incision, which was resolved with local gauze packing, and 2 (6.9%) had dislodgement. No healthcare provider infection was reported. Our PDT approach is safe for patients and healthcare providers. With bronchoscopy assistance, PDT can be performed quickly and easily even in isolation units and with acceptable risk, regardless of the hypo-coagulable condition of patients on ECMO.

Improved hospital discharge and cost savings with esophageal cooling during left atrial ablation

BackgroundLeft atrial ablation to obtain pulmonary vein isolation (PVI) for the treatment of atrial fibrillation (AF) is a technologically intensive procedure utilizing innovative and continually improving technology. Changes in the technology utilized for PVI can in turn lead to changes in procedure costs. Because of the proximity of the esophagus to the posterior wall of the left atrium, various technologies have been utilized to protect against thermal injury during ablation. The impact on hospital costs during PVI ablation from utilization of different technologies for esophageal protection during ablation has not previously been evaluated.ObjectiveTo compare the costs of active esophageal cooling to luminal esophageal temperature (LET) monitoring during left atrial ablation.MethodsWe performed a time-driven activity-based costing (TDABC) analysis to determine costs for PVI procedures. Published data and literature review were utilized to determine differences in procedure time and same-day discharge rates using different esophageal protection technologies and to determine the cost impacts of same-day discharge versus overnight hospitalization after PVI procedures. The total costs were then compared between cases using active esophageal cooling to those using LET monitoring.ResultsThe effect of implementing active esophageal cooling was associated with up to a 24.7% reduction in mean total procedure time, and an 18% increase in same-day discharge rate. TDABC analysis identified a $681 reduction in procedure costs associated with the use of active esophageal cooling after including the cost of the esophageal cooling device. Factoring in the 18% increase in same-day discharge resulted in an increased cost savings of $2,135 per procedure.ConclusionsThe use of active esophageal cooling is associated with significant cost-savings when compared to traditional LET monitoring, even after accounting for the additional cost of the cooling device. These savings originate from a per-patient procedural time savings and a per-population improvement in same-day discharge rate.