Duration Of Drainage Research Articles

Comparison of robotic-assisted and laparoscopic partial nephrectomy based on the PADUA score and the predictive value of the PADUA score and the Mayo Adhesive Probability score for postoperative complications: a single-center retrospective study

PurposeThis study compared perioperative outcomes of robot-assisted partial nephrectomy (RAPN) and laparoscopic partial nephrectomy (LPN) through the PADUA score as well as assessed the predictive value of the PADUA score and the Mayo Adhesive Probability (MAP) score for postoperative complications.MethodsTotally 196 patients suffering from RAPN or LPN for renal tumors were reviewed retrospectively. Patients were categorized by PADUA score (low-, moderate-, high-complexity) and MAP score (low-, intermediate-, high-grade). Evaluated outcomes included operative time (OT), warm ischemia time (WIT), estimated blood loss (EBL), drainage duration, postoperative length of stay, and absolute change in estimated glomerular filtration rate (eGFR) at three months post-surgery, along with intra- and postoperative complications.ResultsRAPN outperformed LPN in the low-complexity group by lowering WIT (P = 0.022) and absolute eGFR change (P = 0.011). For moderate-complexity group, RAPN reduced WIT (P = 0.021), absolute eGFR change (P = 0.027), and postoperative length of stay (P = 0.008). In the high-complexity group, RAPN reduced OT (P = 0.015), WIT (P = 0.023), EBL (P = 0.036), absolute eGFR change (P = 0.024), and postoperative length of stay (P = 0.019). Drainage duration showed no significant differences across groups (P = 0.442, P = 0.327, P = 0.260). RAPN incurred significantly higher total costs than LPN across groups (P < 0.001). ROC analysis suggested PADUA and MAP scores as reliable predictors of postoperative complications in RAPN (AUC = 0.880,0.828) and LPN (AUC = 0.757,0.702).ConclusionRAPN provides significant advantages over LPN in managing complex renal tumors (PADUA score ≥ 10), significantly in reducing OT, WIT, EBL, and absolute eGFR change at three months post-surgery, while minimizing postoperative stay. The PADUA and MAP scores are valuable in predicting postoperative complication.Trial registration number and date of registrationRetrospectively registered.

Efficacy and Safety of LigaSure in Breast Surgery With Axillary Lymph Node Dissection in Patients With Breast Cancer: A Systematic Review and Meta-Analysis.

Conventional axillary lymph node dissection (ALND) is associated with significant post-operative morbidity in patients undergoing breast surgery due to increased lymphatic leakage. LigaSure, an electrothermal bipolar vessel sealing system, provides better closure of the leakage. This study aims to compare the efficacy and safety of LigaSure against conventional techniques in patients with breast cancer underwent ALND and breast surgery. We conducted a comprehensive search across the databases to identify relevant studies. The search results were imported into Covidence for article eligibility screening, and all relevant outcomes data were synthesized using odd ratios (ORs) or standardized mean differences (SMDs) with 95% confidence intervals (CIs) in meta-analysis models using RevMan 5.4. Twelve studies with the total of 895 patients (LigaSure = 441; Conventional technique = 454) with breast cancer underwent breast surgery with ALND were included. LigaSure was associated with significantly lower post-operative drain volume (SMD: -0.39, 95% CI [-0.53, -0.24], P < 0.00001), shortened duration of drain (SMD: -0.51, 95% CI [-0.67, -0.34], P < 0.00001), and reduced hospital stay length (SMD: -0.57, 95% CI [-0.96, -0.18], P = 0.004) compared to conventional techniques. However, no difference observed in total operation time, intra-operative blood loss, seroma related outcomes and post-operative complications between the two groups. LigaSure significantly reduced the lymphorrhea, duration of drain and hospital stay, however, it did not prove be effective in seroma-related outcomes.

Prophylactic surgical drain placement with irrigation reduces abscess formation in patients with severe, uncontained, perforated appendicitis.

20-25% of perforated appendicitis cases are complicated by abscess formation. This study assesses whether prophylactic closed-suction surgical drain (SD) placement after irrigation can decrease postoperative abscess formation in patients with extensively contaminated, perforated appendicitis.Affiliations: Journal instruction requires country for affiliations; however, these are missing in all affiliations. Please verify if the provided country names are correct and amend if necessary.They're correct METHODS: A multicenter retrospective review was performed on pediatric patients with uncontained perforated appendicitis from January 1, 2020 to August 1, 2023. Limited irrigation was performed. All SDs were oriented towards the pelvis. Data were analyzed in four groups: (G1) SD and irrigation, (G2) only SD, (G3) only irrigation, (G4) neither SD nor irrigation. One hundred and fifteen patients (44 in G1, 3 in G2, 21 in G3, 47 in G4) were included. The abscess rate was 5.1% (G1), 33.3% (G2), 33.3% (G3), and 37.0% (G4) (p = 0.001). No interventional radiology (IR) drains were placed in G1 and G2. SD duration was 4.1 ± 2.1days in G1 and 2.7 ± 0.6days in G2. IR drain duration was 14 ± 10.7days in G3 and 8.3 ± 3.9days in G4 (p < 0.001). There were no significant differences in total length of stay and antibiotic duration. Irrigation with prophylactic SD placement may prevent postoperative abscesses in patients with severe, uncontained, perforated appendicitis, but prospective data are needed.

HPB SO13 - Comparative analysis of cost and clinical benefit of Robotic Surgery (RS) vs Laparoscopic Surgery (LS) for the treatment of symptomatic liver cysts

Abstract Background The treatment for symptomatic liver cysts involves the removal of a large portion of the cyst wall (deroofing/fenestration). Robotic surgery (RS) is now used more commonly to treat liver cysts. It is unclear whether RS or laparoscopic surgery (LS) results in superior clinical or economic outcomes. The objective of this study is to compare the cost and clinical benefit of RS vs LS in adults with liver cyst(s). Method Patients meeting inclusion criteria were identified from operating notes and a prospectively held hospital database between 2019 to 2024. Eligible candidates were further investigated for post-operative outcome, length of stay (LOS), subsequent in-person clinic follow-ups for review and removal of drain, and further treatment in patients with recurrence of liver cyst. Financial data for all surgical equipment in RS and LS were provided by sales representatives from the relevant industries. Results Forty-four LS and seven RS patients were analysed. Neither approach recorded a return to theatre. There was no mortality in either group. There was a significantly shorter LOS for RS vs LS patients (median LOS=1 vs 2 days, p&amp;lt;0.05). There was no significant difference in bile leak, drain duration or cyst recurrence between LS and RS. The economic analysis revealed that without taking into account reduced LOS, the costs of RS and LS was £1261.70 and £1733.61 per procedure, respectively. The increased cost in LS was primarily due to multiple stapler firings (median staplers used=5) vs zero staplers in RS. Conclusion Robotic liver cyst surgery is cheaper and provides better clinical outcomes in terms of shorter LOS and reduced complications. Further studies are warranted to examine the long-term cost-effectiveness of RS.

Prevalence of surgical site infections in a tertiary care teaching hospital in Goa, India: a cross-sectional study

Background: Surgical site infections (SSIs) are a major category of healthcare-associated infections (HAIs), particularly in surgical settings. They lead to extended hospital stays, increased morbidity, and financial burden. The study was conducted in the surgical wards of Goa medical college, a tertiary care hospital, to assess the prevalence of SSIs and identify the key bacterial pathogens and associated risk factors. Methods: A cross-sectional, prospective study design was employed, involving 378 patients aged over 18 years admitted for surgical procedures. Data collection included daily follow-up for signs of infection, identification of bacterial pathogens, and analysis of potential risk factors such as age, type of surgery, duration of postoperative drain, length of hospital stays, and wound classification. Statistical analyses were conducted using SPSS software, with significance set at p&lt;0.05. Results: The study identified an SSI prevalence of 12.69% among the participants, with Pseudomonas being the most common causative agent. Significant risk factors included extended postoperative drain duration, longer hospital stays, emergency surgical procedures, and surgeries involving contaminated or clean-contaminated wounds. Patients with prolonged postoperative drains had a markedly higher incidence of SSIs (63.63%). Conclusions: The findings reveal a considerable burden of SSIs in the studied setting, with high infection rates in patients undergoing prolonged drain usage, emergency surgeries, and surgeries on contaminated wounds. Strengthening infection prevention measures, particularly in high-risk cases, and enforcing strict adherence to hygiene and sterilization practices are critical. Enhanced infection surveillance programs and targeted interventions could help reduce SSI rates, improve patient outcomes, and minimize healthcare costs.

Incidence and Risk Factors of Infection After Fracture Fixation: A Multicenter Cohort Study.

Infection after fracture fixation (IAFF) is a severe complication. There are few multicenter studies targeting IAFF. This paper identifies independent risk factors associated with IAFF by analyzing multicenter clinical data. Appropriate interventions should be implemented to reduce the risk of IAFF. This is a multicenter retrospective cohort study. This study screened medical records of patients who underwent internal fixation for fractures at participating medical institutions from January 1, 2011, to December 31, 2020. Data extraction included demographic characteristics, disease features, surgical variables, and laboratory indicators. Logistic regression analysis was employed to identify the relationship between relevant risk factors and IAFF. Research data were sourced from the hospital's electronic medical record system and self-constructed databases. In our study, 202 patients who underwent internal fixation for fractures experienced postoperative infections, which corresponds to an overall incidence rate of approximately 1.7%. The predominant pathogen identified in these infections was Staphylococcus aureus. A multifactorial analysis indicated that several factors were independently associated with the occurrence of IAFF. These factors included BMI ranges of 24.0-27.9 and 28.0-31.9, smoking, a high ASA score, high-energy trauma, diabetes, open fracture, seasonal timing of the surgery (summer), bone grafting, drainage duration, surgical duration ≥ 180 min, and A/G ratio < 1.2. We strongly recommend that orthopedic surgeons perform comprehensive preoperative assessments on fracture patients to identify factors that may increase the risk of infection. Through the implementation of targeted interventions and beneficial modifications to these modifiable risk factors, it is possible to lower the incidence of IAFF. Additionally, proactive screening, risk stratification, and thorough patient education should be prioritized for patients with high risk but nonmodifiable factors.

Subcutaneous emphysema in patients undergoing robotic cardiac surgery: risk factors and clinical outcome.

Little is known about the incidence of subcutaneous emphysema (SE) after robotic cardiac surgery. The aim of this study was to describe the incidence, identify risk factors, and assess its influence on postoperative outcomes. Patients undergoing robotic mitral valve repair (n = 63, 54.3%), robotic minimally invasive direct coronary artery bypass grafting (n = 23, 19.8%), and robotic totally endoscopic coronary artery bypass grafting (n = 30,25.9%) were included in the analysis (total n = 116). Subcutaneous emphysema occurred in 53/116 patients (45.7%). It was mild in 30/53 patients (56.6%), moderate in one patient (1.9%), and severe in 22/53 patients (41.5%). Low body weight (p = 0.009), low BMI (p = 0.006), small body surface area (p = 0.01), and older age (p = 0.041) significantly correlated with SE. Patients undergoing robotic mitral valve repair were affected more often than patients undergoing robotic coronary artery bypass grafting (p = 0.04). Severe subcutaneous emphysema resulted in an increased need for CT-chest imaging (p = 0.026), and additional chest tubes (p = 0.029). Severe emphysema was highly associated with pneumothorax (p < 0.001) and increased duration of chest tube drainage (p = 0.003). Subcutaneous emphysema after robotic heart surgery occurs preferentially in patients with low body weight, low BMI, a small body surface area, and older age and is more common in robotic MVR than in robotic coronary artery bypass surgery. It leads to an increased need for thoracic imaging and additional chest tube insertion. Clinical outcomes are not affected.

T-Tube Drainage Versus Primary Duct Closure After Open Common Bile Duct Exploration In Management of Choledocholithiasis

Objective: To determine the outcomes of T-Tube drainage versus Primary Duct Closure after open common bile duct exploration in management of choledocholithiasis. Study Design: Quasi-Experimental study. Place and Duration of Study: Department of Surgery, Combined Military Hospital, Kharian Pakistan, from Aug 2019 to Jul 2022. Methodology: All patients aged 26-64 years of either gender and undergoing open Common Bile Duct exploration for choledocholithiasis, were recruited in the study. Group-A consisted of 30 patients who underwent T-tube drainage, while Group-B consisted of 30 patients who underwent primary ductal closure. Results: Total 60 patients were included in the study ranging from 26–64 years. There were 49(81.6%) females and 11(18.3%) males. Operative time in Group-A was 118.2±5.06 minutes, whereas, in Group-B it was 100.37±2.93 minutes. The duration of sub hepatic drain in Group-A was 16.37±1.75 days, and in Group-B was 7.47±2.71 days. In Group-A, hospital stay was 17.07±1.92 days, and in Group-B, the average hospital stay was 9.61±2.63 days. The total number of complications in Group-A was 05(16.7%). Total complications in Group-B were 02(6.67 %). Conclusion: Primary closure of CBD is a safe and effective alternative to T-tube drainage in selective patients. Our study recommends the use of the primary closure technique strongly except for cases where the distal patency of CBD is doubtful.

Factors affecting lymphedema after neoadjuvant chemotherapy and axillary dissection in female breast cancer patients: a retrospective cohort study based on the Chinese population.

Breast cancer-related lymphedema (BCRL) is a common complication among breast cancer survivors. Most BCRL studies have focused on patients receiving adjuvant chemotherapy, with relatively little attention paid to BCRL in patients undergoing neoadjuvant chemotherapy (NAC). This study aimed to investigate the risk factors associated with BCRL in Chinese women undergoing NAC and axillary lymph node dissection (ALND). At our institution, this cohort study collected data from 336 women with breast cancer and documented axillary nodal metastasis at diagnosis, who received NAC and ALND surgery between 2015 and 2020. BCRL was assessed through both objective limb circumference measurements and subjective self-reported symptoms. Multivariate logistic regression was employed to identify risk factors for BCRL, considering clinical, demographic, and lifestyle-related characteristics. The cumulative incidence of BCRL within 2.5 years was 43.75%. Factors independently associated with BCRL included radiotherapy (versus no radiotherapy; hazard ratio (HR) = 1.611; P = 0.020), NAC duration of 105 days or shorter (versus 105-143 days; HR = 0.471; P = 0.020), removal of more than 15 lymph nodes (versus 15 or fewer lymph nodes; HR = 1.593; P = 0.036), drainage duration of 20-29 days (versus 10-19 days; HR = 1.568; P = 0.028), and sleeping biased toward the affected arm (versus sleeping biased toward the healthy arm; HR = 2.033; P = 0.019). This study identified several risk factors for BCRL in breast cancer patients following NAC and ALND. Patients presenting with one or more of these factors should be monitored closely for early detection and intervention. Further research is warranted to explore the impact of drainage duration and sleep position on the development of BCRL.

Identify and map coastal aquaculture ponds and their drainage and impoundment dynamics

Sustainable management of coastal aquaculture ponds could achieve win-win between food and economic benefits and ecological conservation including waterbird. In this study, 5790 Harmonized Landsat and Sentinel-2 images from July 2021 to June 2022 and 498 Sentinel-1 images from July 2021, August 2021, and June 2022 as supplementary data were collected to calculate multiple water indices. Based on Otsu algorithm to distinguish between water and non-water region and Savitzky-Golay filtering to optimize time series, coastal aquaculture ponds were identified using the SNIC. Furthermore, their drainage and impoundment phases were determined using the Dynamic Time Warping-Kmeans++ method. Finally, a new 30-m resolution dataset at the national scale of China was generated with an overall accuracy greater than 90 % for both the pond map and the drainage and impoundment phases. Our observations revealed that the total area was 7919.53 km2, with the largest pond area in Shandong Province. Among the coastal aquaculture ponds, 27.95 % were seasonal aquaculture ponds, 70.32 % were yearlong aquaculture ponds, and 1.49 % were abandoned aquaculture ponds. Drainage start dates, end dates, and durations were calculated based on abrupt changes in the water proportion time series. Drainage start dates were concentrated from September to December, while drainage end dates were from January to April. Drainage durations of coastal aquaculture ponds ranged from two weeks to six months, with Shanghai Municipality having the longest drainage durations and Taiwan Province having the shortest drainage durations. The findings could provide scientific support for modifying the drainage and impoundment phases of coastal aquaculture ponds to achieve the win–win goal of improving economic development and protecting waterbirds or improving offshore water quality.

Optimizing lung cancer surgery in the elderly: sublobar resection versus lobectomy for early-stage non-small cell lung cancer patients aged 80 and above

The optimal surgical approach for elderly patients with early-stage non-small cell lung cancer (NSCLC) remains a topic of debate. A retrospective analysis was conducted on patients who underwent pulmonary resection for early-stage NSCLC at our single institution between January 2018 and December 2022. Propensity score matching was used to balance baseline characteristics between the sublobar resection and lobectomy groups. Perioperative outcomes, pulmonary function recovery, postoperative quality of life, and survival were compared between the two groups. A total of 151 patients were included, with 42 undergoing sublobar resection and 109 undergoing lobectomy. After propensity score matching, baseline characteristics were well-balanced between the two groups. Sublobar resection was associated with shorter operative time (125.83 ± 33.56 min vs. 161.14 ± 61.54 min, p = 0.048), less intraoperative blood loss [65 (30, 75) ml vs. 120 (70, 170) ml, p < 0.001], shorter drainage duration [3 (2, 5) days vs. 5 (3, 6) days, p < 0.001], shorter hospital stay [6 (4, 8) days vs. 10 (7, 13) days, p < 0.001], and fewer postoperative complications (11.9% vs. 47.6%, p < 0.001), compared to lobectomy. Moreover, sublobar resection led to better pulmonary function recovery and higher postoperative quality of life scores, with no significant difference in overall and disease-free survival between the groups. Sublobar resection in patients aged 80 and above with early-stage NSCLC offered comparable oncological outcomes to lobectomy while preserving more lung function and providing better postoperative recovery and long-term quality of life. These findings have important implications for treatment decision-making in elderly NSCLC patients.

Irrigation with fibrinolytic agents versus saline for percutaneous drainage of abdominal abscesses: A meta-analysis with trial sequential analysis of randomized trials.

Fibrinolytic agents (FA) activate the fibrinolytic system, converting plasminogen into plasmin to break down fibrin. Their use for irrigation of abdominal abscesses is debated, and this meta-analysis evaluates their efficacy. We searched PubMed, Embase, and Cochrane Central for randomized controlled trials (RCTs) comparing FA and saline in percutaneous drainage of abdominal abscesses. Outcomes included length of hospitalization, duration of drainage, and drainage volume. We pooled mean differences (MD) and 95% confidence intervals (CI) using a random-effects model. We also performed a trial sequential analysis (TSA). We included six RCTs encompassing 299 patients. In the overall analysis, FA increased drainage volume (MD 104.25mL; 95% CI 35.72-172.77mL; p=0.003; I2=0%). In children, saline reduced hospitalization duration (MD -1.26days; 95% CI -1.98 to -0.55days; p=0.0006; I2=0%), whereas FA increased drainage volume (MD 84.66mL; 95% CI 5.77-153.54mL; p=0.04; I2=0%). In adults, FA significantly reduced hospitalization duration (MD -11.12days; 95% CI -15.16 to -7.08days; p<0.00001; I2=0%) and duration of drainage (MD -6.53days; 95% CI -9.25 to -3.81days; p<0.00001; I2=0%) while increasing drainage volume (MD 164.47mL; 95% CI 26.16-302.78mL; p=0.02; I2=0%). On TSA, the required information size was achieved only for the adult subgroup's hospitalization and drainage duration. In adults, FA reduce hospitalization and drainage duration and increase drainage volume. In children, saline seems more effective in reducing hospitalization duration, while FA increase drainage volume. These findings underscore the need for age-specific treatments and further research, especially in the pediatric population.

Impact of pleural reconstruction on postoperative outcomes in rib tumor resection: a decade-long retrospective study.

This study aims to evaluate the effects of pleural reconstruction during rib compartment tumor resection surgery on postoperative outcomes, including drainage volume, drainage duration, hospital stay, complications, and pain control. A retrospective analysis was conducted on 142 patients who underwent rib compartment tumor resection surgery at Beijing Jishuitan Hospital from January 2013 to October 2023. The patients were divided into two groups: those who received pleural reconstruction and those who did not. Data were collected from hospital medical records and outpatient care records, focusing on postoperative drainage volume, total drainage time, length of hospital stay, complications, and pain scores. Continuous variables were compared using t-tests or nonparametric tests, while categorical variables were analyzed using chi-square tests or Fisher's exact tests. The analysis showed no significant differences between the two groups in terms of postoperative complications and pain thresholds. However, patients who underwent pleural reconstruction had significantly lower postoperative drainage volume (937.74 ± 855.97 vs. 1,595.26 ± 1,054.50 ml, p < 0.05), shorter drainage duration (5.5 ± 2.39 vs. 8.43 ± 2.87 days, p < 0.05), and reduced length of hospital stay (7.32 ± 3.30 vs. 10.99 ± 6.83 days, p < 0.05). Pleural reconstruction during rib compartment tumor resection surgery reduces postoperative drainage volume, drainage duration, and hospital stay without increasing complications or short-term pain. Further large-scale studies are recommended to validate these findings.

The Effect of Evaluating Perfusion with Infrared Fluorescent Angiography on Flap Survival in Head and Neck Free Flap Reconstruction.

Intraoperative fluid management is one of the most important factors affecting optimal perfusion in the microcirculatory area in patients that undergo flap surgery. While insufficient fluid administration in the intraoperative period leads to flap complications and organ dysfunction, volume load can cause complications such as edema in the denervated flap tissue, the opening of the sutures, or fat necrosis. The Infrared Fluorescent Angiography Perfusion Evaluation Device (SPY) is one of the many noninvasive techniques that evaluate the well-being of microcirculation at the tissue level. This device monitors and scores the perfusion distribution in the flap area. This retrospective study aimed to investigate the effect of fluid resuscitation in head and neck free flap transfer surgery on flap quality and patient outcomes according to the change in SPY scores. This study included 39 ASA I-II patients who were aged 18-60 years and underwent simultaneous free flap reconstruction of the head and neck between 2015 and 2021. Patients' blood pressure, body temperature, hemoglobin, pH, and lactate values were recorded at both baseline and end of the operation. Also, the SPY "Infrared Fluorescent Angiography Perfusion Evaluation Device" scores, the amount of intraoperative fluid and transfusion, bleeding and urine output, and the duration of mechanical ventilation, anesthesia and surgery, and the duration and amount of drainage, the length of stay in hospital and intensive care unit, and the presence of flap infection, detachment, necrosis and loss, and re-exploration rate were recorded for the patients. The difference between the first and last measured SPY values was observed to be positively correlated with the length of stay in the hospital and intensive care unit and the duration of drainage. There was a positive correlation between the length of stay in the hospital and intensive care unit and the duration of drainage, the amount of drainage, as well as the duration of anesthesia and the duration of surgery (p < 0.001). A positive correlation was found between the amount of drainage and the amount of crystalloid solution administered (r = 0.36, p < 0.05). In patients with flap infection, the difference between SPYfirst and SPYlast, the duration of anesthesia, and the duration of surgery were significantly higher. The amount of crystalloid solution given and bleeding and the duration of anesthesia and surgery were found to be significantly higher in mechanically ventilated patients (p < 0.05). It has been concluded that SPY-guided fluid management can be beneficial in preventing morbidities, such as extended hospital and intensive care stay, by reducing flap infection, mechanical ventilation duration, and drainage, with early diagnosis of insufficient perfusion.

Clinical analysis of robotic-assisted surgery in the treatment of large pheochromocytoma/paraganglioma: a study of 29 cases

This study aimed to compare the safety and clinical efficacy of Da Vinci robotic surgery (control group) versus traditional laparoscopic surgery in the treatment of large (tumor size >6 cm) pheochromocytomas/paragangliomas. The evaluation was based on intraoperative metrics such as operative time, blood loss, conversion to open surgery rates, postoperative drain duration, and length of postoperative hospital stay. A retrospective analysis was conducted on 29 patients (14 males and 15 females) who underwent Da Vinci robotic surgery for large (greater than 6 cm) pheochromocytomas/paragangliomas from October 2019 to September 2023. The average maximum tumor diameter was (7.2±1.6) cm. During the same period, 32 patients underwent laparoscopic resection of challenging pheochromocytomas/paragangliomas.Data showed no significant differences between the two groups, except for the norepinephrine levels. Operative time, blood loss, conversion rate, postoperative drainage duration, and length of hospital stay were recorded and compared between the two groups. The differences between the groups were analyzed using the t-test, and the conversion rates were compared using the chi-square (χ²) test. All surgeries were successfully performed. One patient underwent a one-stage bilateral tumor resection. In the Da Vinci robotic surgery group, the average operative time was (76±32) minutes, compared to (106±45) minutes in the control group (P=0.003). The average intraoperative blood loss was (95±75) ml, compared to (160±90) ml in the control group (P=0.019). The conversion rate to open surgery was 2 cases (6.9%) in the robotic group compared to 5 cases (15.6%) in the control group (P=0.031). The average postoperative drainage duration was (3.0±1.0) days, compared to (3.5±1.5) days in the control group (P=0.128). The average length of hospital stay was (4.5±1.2) days, compared to (4.7±2.2) days in the control group (P=0.657). Postoperative pathological diagnosis confirmed pheochromocytoma or paraganglioma. Blood pressure normalized within 1 to 3 months postoperatively, with an average systolic blood pressure of (116±13) mmHg(1 mmHg=0.133 kPa）and diastolic blood pressure of (73±5) mmHg in the robotic surgery group. Follow-up for 3 to 40 months showed normal levels of blood catecholamines and no recurrence or metastasis on follow-up imaging studies, including chest, abdominal, and pelvic CT scans. The average levels of 3-methoxy-norepinephrine, 3-methoxy-epinephrine, and 3-methoxy-tyramine were (0.42±0.21) nmol/L (normal value≤1.05 nmol/L), (0.11±0.07) nmol/L (normal value≤0.32 nmol/L), and (0.017±0.006) nmol/L (normal value≤0.036 nmol/L), respectively. This study demonstrates that for the treatment of large pheochromocytomas/paragangliomas, the Da Vinci robotic technique offers advantages such as high-definition visualization, precise operation, and flexibility. These advantages enable the safe and efficient completion of surgeries, as evidenced by shorter operative times, less blood loss, and lower conversion rates.

The impact of topical tranexamic acid on drain duration and seroma volume in axillary lymph node dissection for breast cancer: A randomized controlled trial.

Seroma is the most common complication after breast surgery. Some studies showed that tranexamic acid (TA) can be used in breast surgery to reduce seroma formation and drain volume. We studied the effect of intra-operative and postoperative topical TA on the duration of drain and volume of seroma in patients undergoing axillary lymph node dissection (ALND) for breast cancer. Breast cancer patients planned for ALND were enrolled in the study between July 2020 and July 2021. Patients were randomized into three groups where one group (n=50) received a single intraoperative dose of diluted topical TA, the second group, in addition, received daily postoperative doses till day 5 through the suction drain, and the third group (n=50) did not receive any dose. Chi-square tests and ANOVA were used to analyze the primary outcomes-the total volume of drain fluid and total drain duration, and secondary outcomes-daily drain output till postoperative-day-5, wound infection, and seroma rates. Patients receiving multiple doses of topical TA had a decreasing trend in total drain volume, although this was not statistically significant (1597 vs. 1763 vs. 1773mL: p=0.269). There was no significant change in the duration of the postoperative drain (21.6 vs. 19.2 vs. 19.55days: p=0.54). There was no statistically significant difference in complications between the groups. There is no significant reduction in drain duration, total drain volume, or the rate of complications with the use of single or multiple doses of topical TA.

Short-Term Bed Rest is not a Risk Factor for Venous Thromboembolism After Endoscopic Skull Base Surgery

IntroductionDeep venous thromboembolisms (DVT) increase morbidity in postoperative patients, and no current guidelines identify which patients undergoing endoscopic endonasal approach (EEA) to the skull base may be at increased risk. Postoperative care for these patients often includes a period of inactivity to prevent transient ICP shifts which may impact skull base reconstruction. We seek to characterize if postoperative bedrest puts EEA patients at increased risk of developing thromboembolic complications. MethodsRetrospective chart review of patients undergoing intradural surgery with primary skull base reconstruction for intraoperative CSF leak via EEA for any skull base pathology between July 2018 and May 2024 was performed yielding 221 patients who met inclusion criteria. Univariate and multivariable regression were performed with patient demographics, extent of approach, intraoperative leak flow rate, bedrest duration, presence and length of postoperative lumbar drainage (LD), and use of postoperative mechanical VT prophylaxis. ResultsThe mean age of included patients was 52.6 ± 16.8 years, 48% were male, and 3.6% of patients had DVTs. Age (OR 1.01, 95% CI 0.96-1.06, p=0.83), sex (OR 0.40, 95% CI 0.05-2.19, p=0.31), BMI (OR 0.98, 95% CI 0.87-1.07, p=0.74), extended approach (OR 0.80, 95% CI 0.13-4.36, p=0.80), CSF leak flow rate (OR 5.71, 95% CI 0.77-118.90, p=0.14), bedrest duration (OR 1.06, 95% CI 0.77-1.27, p=0.60), and presence of LD (OR 1.10, 95% CI 0.55-2.02, p=0.76) were not significant predictors of postoperative VTE incidence on multivariable analysis. ConclusionShort-term bedrest after EEA is not a risk factor for development of VTE in the immediate postoperative period.

A retrospective analysis of simultaneous bilateral uniportal thoracoscopic surgeries for multiple primary bilateral pulmonary nodules

BackgroundThere are no standard treatment options for bilateral multiple pulmonary nodules requiring resection. This study aimed to summarize the experience of simultaneous bilateral uniportal video-assisted thoracoscopic surgery for the treatment of bilateral multiple primary pulmonary nodules.MethodsThe clinical data of 65 cases of simultaneous bilateral uniportal thoracoscopic surgery for bilateral multiple primary pulmonary nodules treated were retrospectively analyzed. These cases were treated within The Ninth Medical Center of PLA General Hospital between January 2018 and November 2020. Parameters related to the surgery, perioperative aspects, surgical techniques, pathology results, and postoperative complications were examined.ResultsAll surgeries were conducted through uniportal video-assisted thoracoscopic surgery, with no instances of intraoperative conversion to thoracotomy. Fifty-three patients further underwent CT-guided Hookwire localization for the localization of pulmonary nodules. A total of 189 nodules were resected using multiple surgical procedures, with a malignancy rate of 86.2%. The average operation time was 226 ± 77.4 min, the average thoracic drainage duration was 3.1 ± 1.5 days, the average 24 h pleural drainage was 385.9 ± 157.4 mL, the average postoperative hospital stay was 8.6 ± 2.4 days, and the average blood loss was 77.2 ± 33.8 mL. Post-surgery, all patients were transferred to the ward safely within 12 h. 15.38% of patients have prolonged drainage time, and 12.31% of patients experience complications such as lung infection, arrhythmia, and venous thrombosis.ConclusionThe selected cases undergoing simultaneous bilateral uniportal video-assisted thoracoscopic surgery for the management of bilateral multiple primary pulmonary nodules demonstrated favorable outcomes. Our observations indicate the safety and feasibility of this procedure, providing an individualized and precise treatment approach for affected patients.

Chest drainage outcomes by water seal versus low suction on digital drainage systems after lung resection: retrospective study.

Despite advances in chest drainage technology, such as the use of digital drainage systems (DDS), there is still no consensus on the most effective method for reducing air leaks after lung resection. To evaluate the optimal drainage method, we compared traditional water seal with low suction pressure settings on DDS. We retrospectively analyzed the postoperative data of patients between August 2015 and April 2023 who underwent anatomical lung resection at our hospital and who had postoperative chest drains managed with either a water seal or DDS set to low suction pressure. We excluded cases without air leak on the first postoperative morning from the consideration in this study. We divided the patients into two groups according to the chest drainage method on the first postoperative morning and we compared air leak and chest drainage durations of both groups. We retrospectively analyzed 116 patients. The groups (water seal: 59 patients; low suction: 57 patients) were well balanced for baseline and degree of air leakage on the first operative morning. The water seal group showed significantly shorter air leak duration (2 vs. 3 days, P<0.001) and chest drainage duration (3 vs. 5 days, P<0.001) compared with the low suction group. Pleurodesis (P=0.002) and conversion (P=0.001) were higher in the low suction group, with no significant differences in drain reinsertion. Water seal management was suggested to be safe and comparably effective to low suction on DDS in reducing air leak and chest drainage durations after lung resection.

Surgical Site Infection after Primary Open Surgery for Laryngeal Cancer in a Tertiary Hospital in Belgrade, Serbia: A 10-Year Prospective Cohort Study.

Surgical site infection (SSI) in laryngeal cancer (LC) patients significantly increases morbidity and may postpone adjuvant therapy. Additionally, SSI can prolong hospitalization, thus representing a burden for the healthcare system. Most of the published studies refer to SSI after salvage laryngectomy. The present prospective cohort study aimed to clarify the incidence and factors associated with SSI in patients after primary open surgery for LC. Through regular hospital surveillance of patients who underwent primary partial or total laryngectomy, we gathered 24 putative factors and identified SSI from 2013 to 2022. Patients with SSI were compared with patients without SSI. SSI was observed in 21 (6.6%) of 319 patients. ULRA showed that the occurrence of SSI was significantly associated with the American Society of Anesthesiologists (ASA) score, other postoperative healthcare-associated (HAI) infection, T classification, N classification, advanced clinical stage (III-IV), length of stay (LOS), duration of drainage, and the National Healthcare Safety Network (NHSN) risk index. Multivariate logistic regression analysis identified two independent factors associated with SSI occurring in these patients: duration of drainage (RR (relative risk) 1.593; 95% CI 1.159-2.189; p = 0.004) and LOS (RR: 1.074; 95% CI: 1.037-1.112; p < 0.001). Our study provided insight into the burden of SSI in LC patients, highlighting several priority areas and targets for quality improvement.