Duration Of Surgical Intervention Research Articles

Assessment of the Diagnosis-To-Needle Times for Patients Admitted to the Emergency Department with Acute ST-Segment Elevation Myocardial Infarction

Abstract Background Coronary artery disease is one of the most common causes of death in the world. The outcome of patients with ST-elevation myocardial infarction is influenced by many factors, and the time elapsed from symptom onset to diagnosis and reperfusion have a critical role in this regard. Aim The aim of this study was to investigate the differences in the diagnosis-to-needle times of patients with STEMI presenting to the hospital during and outside of working hours, and the effect of this relationship on in-hospital clinical events. Methods This retrospective study analyzed the data of 50 patients admitted for emergency primary percutaneous coronary intervention. We assessed pain onset-to-diagnosis times and diagnosis-to-needle times, and evaluated their relationship with troponin values at admission and after 48 h. Results The mean age of the patients was 55.64 ± 13.72 years. In total, 60% of the patients presented outside of working hours. Mean patient delay time from the onset of chest pain to seeking medical help was 2.64 ± 2.47 h. Mean troponin values were 4.39 ± 5.26 ng/ml at admission and 36.50 ± 12.95 ng/ml after 48 h. Mean post-angiography ejection fraction values were 47.36 ± 6.53%. We found a statistically significant difference in the pain onset-to-diagnosis and diagnosis-to-needle times of patients who presented to the hospital during and outside of working hours. We found a positive correlation between diagnosis-to-needle times and the troponin values of patients, and a statistically significant difference between pain onset-to-diagnosis times of patients who presented during and outside of working hours (p < 0.05). Although the relationship between the diagnosis-to-needle time and troponin elevation after 48 h was strong (97%), the relationship between pain onset-to-diagnosis time and troponin elevation after 48 h was weak (8%), suggesting that the duration of surgical intervention is much more important than the time until the first medical contact. Conclusions In this study, there was a statistically significant difference in the pain onset-to-diagnosis and diagnosis-to-needle times of patients who presented to the hospital during and outside of working hours.

A comprehensive approach to the prevention and treatment of massive obstetric hemorrhage

In the case of progression of obstetric haemorrhage (OH) and non-effective preventive and therapeutic measures during childbirth and after delivery, the volume of blood loss can increase and exceed > 1.5% of body weight (25–30% of circulating blood volume – CBV). In such cases that we are talking about massive obstetric haemorrhage (MOH), which leads to an increase in the frequency of maternal morbidity and mortality.The objective: determine the effectiveness of various approaches to the restoration of blood loss in the cases of MOH development, which occurred to various etiological factors, with the introduction of the modern concept of damage control resuscitation (DCR) and innovative methods of surgical hemostasis.Materials and methods. During 2015–2023 years at five clinical bases of the Department of Obstetrics and Gynecology N1 of Shupyk National Healthcare University of Ukraine we analyzed 165 cases of MOH. In all MOH cases, an integrated approach was used to stop haemorrhage using both drug therapy and modern methods of surgical hemostasis in accordance with the regulatory documents of the Ukrainian Ministry of Healthcare.In main group of 59 women in labor with the MOH (2020–2023 years) an integrated approach to stop haemorrhage and restore the blood loss according to DCR concept with the priority of high-quality and rapid CBV restoration with blood products and minimization of infusion therapy was used. The comparison group consisted of 106 women in labor with MOH (2015–2019 years) and similar methods of haemorrhage termination to restore blood loss in accordance with the order N 205 of the Ukrainian Ministry of Healthcare «Obstetric haemorrhage» with the priority of rapid restoration of blood loss by crystalloids (during 2015–2019 years).Results. The mean blood loss, time till haemorrhage is stopped, and the duration of surgery in the main group were significantly lower than in the comparison group (p<0.05). In the postpartum period the number of cases with severe anemia was significantly more often in the comparison group – 47.2% versus 11.9% in the main group (OR 6.6 CI 2.7–15.9; p<0.01), as well as the frequency of hysterectomy – 50.9% versus 28.8% (OR 2.6 CI 1.3–5.1; p<0.01).An early onset and a significantly higher rate of transfusions of fresh frozen plasma and erythrocyte mass were found in the main group – respectively 88.1% versus 38.7% in the comparison group (OR 11.7, CI: 4.8–28.4; p<0.001). This resulted in a significantly lower volume of blood loss, duration of surgical intervention, and average time for haemorrhage stop in the main group compared to the comparison group (p<0.05).Conclusions. The use of modern uterotonic agents (carbetocin), tranexamic acid preparations, innovative surgical technologies and early initiation of transfusion therapy with blood preparations with minimization of crystalloid infusion and according to the DCR concept for the development of MOH allows to reduce the volume of blood loss, the frequency of severe postpartum complications, and to prevent maternal morbidity and death.

USE OF MEDICAL ADHESIVES FOR CLOSING SCHNEIDER MEMBRANE PERFORATION DURING OPEN SINUS LIFTING (LITERATURE REVIEW)

The open sinus lifting procedure during dental implantation can cause perforation of Schneiderian membrane. Nowadays there are many methods of closing perforation of the sinus membrane. However, frequent intraoperative and postoperative complications require to search new methods and materials for increasing the productivity of the operation and reducing the duration of surgical treatment of patients.
 The purpose of the research: to analyze of modern Ukrainian and foreign scientific literature about the use of medical adhesives for closing the perforation of Schneiderian membrane during open sinus lifting surgery and to assess their effectiveness.
 Scientific information on the research topic was obtained from the resources of search engines: the electronic library of abstracts and dissertations of Vernadsky V.I. National Library of Ukraine, PubMed, Medline, MedNet, Embase, BMJ Group, Free Medical Journals, Free Medical Book, Scirus.
 Based on the analysis of the literature data, it has been found that medical bioadhesives are the newest materials used in dental practice, have the advantages of fast and painless application, resistance to infection, hemostatic properties, lack of toxicity, good sealing of wound surfaces, high tissue strength and are comfortable for patients. The use of compounds with new positive qualities in maxillofacial surgery, along with the introduction of modern technologies, equipment and tools, will increase the productivity of open sinus lifting surgery during dental implantation, reduce the number of intraoperative and postoperative complications, the duration of surgical interventions, and will allow performing operations with the least risk to the patient at a high professional level.

Effect of Adding Dexamethasone to Bupivacaine in Ultrasound Guided Adductor Canal Block for Post-operative Analgesia Following Knee Arthroscopy

Abstract Background Arthroscopic knee surgery refers to a large variety of surgical interventions in the knee, and numerous analgesic regimens have been investigated in order to find the best combination of analgesics for these procedures. The post-operative pain response depends on the type and duration of surgical intervention, and it can be challenging to predict which analgesic regimen will be the most appropriate for each patient until after surgery. Aim of the Work Assessing the effect of adding dexamethasone perineurally to bupivacaine in adductor canal block for post operative analgesia following knee arthroscopy under spinal anaesthesia regarding; duration of postoperative analgesia as a primary objective and one-day postoperative analgesic and opioid consumption as a secondary objective. Patients and Methods The type of study was a randomized prospective double blinded controlled clinical trial at Ain Shams University Hospitals, Cairo, Egypt. Study Period: Six months, Adult patients undergoing Knee Arthroscopy under Spinal Anaesthesia will be randomly assigned into one of the following groups using computer generated codes and opaque sealed envelopes: Group A (study group): The patients received ACB with 20 ml plain bupivacaine (0.25%) + 8 mg dexamethasone (2 ml), Group B (control group): The patients received ACB with 20 ml plain bupivacaine (0.25%) + 2 ml of Normal saline. Results There was a highly statistically significant difference between groups according to analgesic duration (time of first call for analgesics) (min) with p-value (p < 0.001). The highest value was found in group A(study) and group B(control) (241.02±36.15 and 188.49±28.27) respectively, this indicates that that the needs of analgesic in the group B were earlier compared to group A. There was a highly statistically significant difference between groups according to cumulative morphine consumption “mg” with p-value (p < 0.001). The highest value was found in Group B and Group A 4 (3-4) and 2 (1-2) respectively, this indicates much higher needs of analgesic in the Group B than group A. Conclusion We concluded that ACB is a good postoperative analgesic choice for arthroscopic knee surgery under spinal anaesthesia. However, adding (8 mg)dexamethasone to(0.25%) bupivacaine in ACB provided better prolonged postoperative analgesia and less analgesic consumption than bupivacaine alone.

Stapes surgery for otosclerosis: Comparison of two techniques

Abstract BACKGROUND. Otosclerosis is a primary disease of the human otic capsule and stapes stage, being a frequent cause of conductive hearing loss in our country. The surgical treatment of choice is stapes surgery and prosthesis placement, performed in a conventional way, with a surgical microscope, for 30 years in our hospital. Recently, the option of performing stapes surgery endoscopically was introduced in our centre. OBJECTIVE. To evaluate the results in stapes surgery for otosclerosis between the conventional microscopic versus endoscopic procedure. MATERIAL AND METHODS. An observational, analytical and retrospective study on patients undergoing stapes surgery with microscopic and endoscopic technique was conducted. Data such as age, sex, state of origin, affected ear, as well as the technique used, duration of surgical intervention, hearing gain and postsurgical complications were taken. Data were taken from the records of patients admitted to the hospital. Descriptive statistics, Mann-Whitney U and Pearson’s Ji2, were used, considering a value of p≤ 0.05 as significant. RESULTS. No significant differences were found in surgical time or postoperative hearing between the two surgical techniques. The female sex was the most intervened. There was no significant difference between the post-surgical complications of both groups. CONCLUSION. Both procedures appear to be effective, with similar risks and postoperative results for the surgical treatment of otosclerosis.

Clinical characteristics, diagnostic methods and results of surgically treated histologically benign cardiac myxomas.

Myxomas are primary cardiac tumours that may be detected incidentally due to embolic events, intracardiac obstructive features or non-specific structural symptoms. The aim of this study was to share our experience of clinical features, diagnostic methods, surgical procedures and postoperative follow up of surgically treated cardiac myxomas. Data of 34 patients who underwent surgery for a cardiac myxoma between January 2006 and June 2022 were retrospectively analysed. Group 1 (n = 19) consisted of patients who were symptomatic and group 2 ( n = 15) patients were asymptomatic. The medical records of the patients, their clinical status, diagnostic methods, operation information and postoperative course data were collected and recorded. A total of 34 patients (16 female; mean age 54.5 ± 8.8 years) underwent cardiac myxoma resection with cardiopulmonary bypass. Fifteen (44.1%) patients were diagnosed incidentally with asymptomatic myxoma. An additional cardiac surgical procedure was performed in six patients (17.7%). The 34 cardiac myxomas that were surgically resected were localised in the left atrium in 25 patients (73.5%) and in the right atrium in nine patients (26.5%). Patients' most common symptoms were dyspnoea (42.1%), palpitations (21.1%), ischaemic stroke (15.8%) and syncope (10.5%). There was no incident of 30-day mortality and no recurrence was observed in any patient during the follow-up period. The duration of surgical intervention in symptomatic patients was significantly shorter than in asymptomatic patients (p = 0.0001), but there was no statistical difference in terms of characteristics. Myxomas are benign tumours, but they are serious pathologies that require early treatment because of signs of obstruction, embolic complications and confusion, with left atrial thrombus in the differential diagnosis.

Association between insulin resistance indices and perioperative functional status and immediate prognosis in patients with carbohydrate metabolism disorders undergoing coronary artery bypass grafting

Highlights. Patients with coronary artery disease undergoing coronary artery bypass grafting have a high prevalence of type 2 diabetes mellitus and prediabetes. The frequency of postoperative stroke and hospital stay is significantly higher in patients with impaired carbohydrate metabolism.Insulin resistance markers are associated with a variety of perioperative characteristics, but according to multivariate analysis, only free fatty acids and HOMA-IR were independent predictors of hospitalacquired complications and long-term hospital stayAim. To analyze insulin resistance markers and their association with the preoperative outcome and in-hospital complications of coronary bypass grafting (CABG) in patients with type 2 diabetes mellitus (DM 2), prediabetes and normoglycemia.Methods. The study included 383 consecutive patients undergoing CABG at the same center. Glycemic status, free fatty acids (FFA), fasting insulin, glucose, lipid profile of all patients were determined before surgery and the following insulin resistance indices (IR) were calculated: HOMA-IR (Homeostasis Model Assessment of Insulin Resistance), QUICKI (Quantitative Insulin Sensitivity Check Index), Revised QUICKI, McAuley. Patients were divided into 2 groups: the group that included patients with carbohydrate metabolism disorders (CMD), type 2 diabetes mellitus and prediabetes (n = 192), and the group of patients without CMD (n = 191). Perioperative characteristics of patients, postoperative complications and their association with insulin resistance markers were analyzed.Results. FFA and calculated indices of insulin resistance such as HOMA-IR, QUICKI, RevisedQUICKI, and McAuley correlated with the following perioperative characteristics: the duration of surgical intervention and cardiopulmonary bypass, lipid levels, coagulation index, left ventricular dimension and myocardial diastolic function, etc. The analysis of in-hospital complications revealed that the frequency of postoperative stroke (p = 0.044) and hospital stay after CABG >30 days (p = 0.014) was significantly higher in patients with CMD. According to the results of multivariate analysis, the predictors of the composite endpoint (hospital stay after CABG>10 days and/or significant perioperative complication) were as follows: female sex (odds ratio (OR) 2.862, 95% confidence interval (CI) 1.062-7.712, p = 0.036); age (OR 1.085, 95%CI 1.027–1.147, p = 0.003); duration of cardiopulmonary bypass (OR 1.146, 95%CI 1.008–1.301, p = 0.035); body mass index (OR 1.125, 95% CI 1.035–1.222, p = 0.005), left atrial dimension (OR 5.916 95% CI 2.188–15.996, p<0.001); any CMD (OR 1.436, 95%CI 1.029–2.003, p = 0.032), type 2 DM (OR 2.184, 95%CI 1.087–4.389, p = 0.027), FFA levels (OR 5.707, 95%CI 1.183–27.537, p = 0.029) and HOMA–IR index (OR 1.164, 95%CI 1.025–1.322, p = 0.019).Conclusion. FFA, HOMA-IR, QUICKI, Revised-QUICKI, and McAuley correlate with a variety of perioperative characteristics of patients undergoing CABG, but multivariate analysis revealed that only FFA levels and the HOMA-IR can be used as predictors of in-hospital complications and prolonged hospital stay.

Туберкулезный спондилит грудопоясничной локализации: выбор оптимального метода хирургического лечения на основе систематизированного обзора литературы

Introduction Tuberculous spondylitis is the most common extrapulmonary tuberculosis. The thoracolumbar lesion due to tuberculous spondylitis is one of the most difficult locations for surgical treatment. Analysis of the recent literature shows a limited amount of data on the results of various current surgical reconstruction techniques. Purpose To review the literature on surgical treatment of thoracolumbar tuberculous spondylitis published during the last five years and judge upon an optimal method. Materials and methods A systematic literature review was performed of the sources from eLibrary, PubMed, Cochrane Library databases. Inclusion criteria: etiologically verified tuberculous spondylitis of thoracolumbar location, follow-up ≥ 1 year, patients older than 18 years. Twenty-one studies that summarize 1,209 cases were selected. Patients were divided into three groups depending on the method of spinal reconstruction (group 1 – ventral approach, group 2 – combined approach, group 3 – dorsal approach). Surgical indicators, correction of kyphotic deformity and its dynamics in the long-term period, rates of complications and the length of hospital stay were analyzed. Results and discussion Blood loss and duration of the intervention were significantly lower in the reconstruction of the thoracolumbar spine from the dorsal approach (599.6 ± 195.1 ml and 196.3 ± 35.6 min). Correction of kyphotic deformity from posterior and combined approaches was higher than in the reconstruction from the ventral approach (64 and 69 %, respectively). At the same time, an inverse proportional dependence of the degree of correction loss in the long-term period was revealed, which was higher with anterior fusion (7.3° ± 1.7° according to Cobb). The duration of hospital stay was shorter in patients with reconstructions from the dorsal approach (13.7 ± 8.2 days). The rate of complications in group 3 was significantly lower (p < 0.0001), while the assessment of their structure indicates prevalence of neurological deficits in dorsal reconstructions, while in ventral and combined reconstructions, infectious complications, pneumothorax, and chronic pain syndrome in the area of autologous costal graft harvesting. Conclusion The optimal method of surgical treatment of thoracolumbar tuberculous spondylitis is a three-column reconstruction from the dorsal approach. The advantages of the method are a decrease in the rate of postoperative complications, a reduction in the duration of inpatient treatment, surgical blood loss and duration of surgical intervention.

Incidence and risk factors of venous thromboembolism in the perioperative period of spine surgery at a tertiary care hospital

Objectives: Spine surgery is considered a moderate risk for developing venous thromboembolism (VTE). To the best of our knowledge, no study has been done to determine the incidence of VTE in our local population. We aimed to study the incidence of VTE and determine the factors associated with developing VTE post-spine surgery. Methods: A retrospective study analyzed 800 adult patients who had undergone elective or emergency spine surgery. The variables included were demographic data, diagnosis, “or trauma if applicable,” type and duration of surgical intervention, and length of hospital stay. In addition, two procedures were used to diagnose VTE, whether it was a pulmonary embolism (PE) or deep vein thrombosis (DVT) pre- and postoperatively. Spiral computed tomography was used to detect PE, whereas duplex ultrasonography was used to confirm DVT. Finally, all patients received post-operative DVT prophylaxis except for cervical spine patients. Results: Eight hundred patients were included in the study. The overall incidence of VTE was 4.1%. The lumbar spine was the most common location operated on. Increasing age and length of hospital stay were both significantly associated with the development of VTE. Furthermore, cervical spine surgery had a lower incidence of VTE than other locations, with a statistically significant difference. Finally, non-ambulatory patients had a higher risk of VTE than patients who could ambulate postoperatively, with a statistically significant difference. Conclusion: The incidence of VTE after spine surgery is considered low but carries high morbidity and mortality rates. Increased age and prolonged hospital stay increase its risk, while early ambulation lowers it. Prophylactic measures against VTE are highly recommended, especially amongst high-risk patients.

Transaxillary hemithyroidectomy and parathyroidectomy: mastering the technique

Background. The relevance of endoscopic interventions on the thyroid and parathyroid glands is beyond doubt, and this explains the interest in this promising choice of surgical approach both among surgeons and patients who want to avoid a scar on the neck.Aim. To evaluate the first results of own endoscopic interventions in patients with diseases of the thyroid and parathyroid glands.Materials and methods. In the Research Institute of KCH N 1 named after prof. S.V. Ochapovsky from December 2020 to April 2022, 23 hemithyroidectomies and 8 paraadenomectomies were performed using endoscopic techniques for benign neoplasms of the thyroid and parathyroid glands. All patients in the preoperative period underwent ultrasound, TAPB + CI (for thyroid pathology), and the hormonal background was studied. Indications for endoscopic hemithyroidectomy in 18 cases were colloid goiter, in 5 cases — follicular adenoma. The indication for endoscopic paraadenomectomy in all cases was primary hyperparathyroidism. We used endoscopic three-port axillary-mammary gas access. Under the ETN, an incision was made along the outer edge of the pectoralis major muscle (m. pectoralis major). Carbon dioxide was injected into the pancreas using a Verish needle. A 5 mm port was inserted along the edge of the areola. Another 10 mm trocar was installed at the attachment points (m. pectoralis major).Results. The average operation time was 190.4 minutes for endoscopic hemithyroidectomy and 78.6 minutes for endoscopic paraadenomectomy. With the increase in the number of performed operations, there was a decrease in the duration of surgical interventions. In two cases in patients after hemithyroidectomy, seromas up to 20 ml in volume were noted in the postoperative period, which required puncture interventions (once).Conclusion. Endoscopic interventions on the thyroid and parathyroid glands from axillary access are a safe method of surgical intervention, and the cosmetic result is an indisputable advantage of this method.

Experience of liver transplantation in the regional clinical hospital

The purpose of the study is to summarize the first experience of liver transplants. Material and methods. Liver transplantation was performed at the Regional Clinical Hospital. 5 liver transplants from a posthumous donor were performed. Based on the available data, the analysis was carried out according to the following criteria: gender, age, MELD- Na index, cause of liver cirrhosis, method of liver transplantation, duration of surgery, postoperative complications, average bed-day, outcome. Results. In total, 5 liver transplants were performed from a posthumous donor. Among the patients there was 1 man and 4 women. The age of men is 41 years, women are 55.4 ± 9.2 years on average. The MELD- Na index is from 15 to 28, on average 17.8 ± 5.1. When transplanting a cadaveric liver, the method of classical orthotopic liver transplantation was used in 4 cases, in one the piggyback technique was used. The duration of surgical intervention in minutes averaged 394 ± 17.4. Postoperative complications on the Clavien-Dindo scale ranged from I to IIIb. The average bed-day of the patient’s stay in the hospital is 20.2 ± 8.9, including 6.2 ± 1.7 days in the intensive care unit. In all 5 cases, the outcome of liver transplantation is satisfactory. Conclusion. The first results of liver transplantation on the basis of the Regional Clinical Hospital showed that performing such a level of operations is possible in a multidisciplinary medical institution.

Comparative analysis of the results of correction of congenital spinal deformity in isolated semivertebrae in preschool and primary school-age children

BACKGROUND: Despite a detailed study of the natural development of congenital spinal deformity in isolated semivertebrae and methods of surgical correction of this pathology, some issues remain unclear. The age at which surgical correction of congenital spinal deformity should be performed is a debated issue among specialists.
 AIM: To conduct a comparative analysis of the effectiveness of correction of spinal deformity in children with congenital kyphoscoliosis with isolated semivertebrae of preschool and primary school-age children.
 MATERIALS AND METHODS: We included 26 patients aged 21 months to 69 months (10 girls and 16 boys) with congenital kyphoscoliosis caused by an isolated semivertebra. The patients underwent partial or complete resection of the semivertebral disk with adjacent intervertebral disks from dorsal or combined access, correction and stabilization of congenital spinal deformity with a posterior multisupport metal structure. Participants were sectioned into two age groups: the first group children under 4 years (14 children), the second group children 6 years and older (12 children).
 RESULTS: Metal fixation during surgical treatment in children of primary school age as well as in preschool children was carried out in the majority of cases polysegmentarily. Regarding the choice of surgical treatment access, dorsal surgical access was more often preferred in the second group of patients. The duration of surgical intervention and volume of blood loss between different age groups were similar with dorsal and combined access. In the group of preschool children, destabilization of the metal structure was noted in the early postoperative period when performing control radiographs after surgical treatment in three cases. In the second group, spinal deformity of dysplastic genesis after surgical treatment was detected in three cases.
 CONCLUSIONS: The effectiveness of surgical treatment of congenital deformity is significantly higher in younger children compared to that in school-age patients.

Association between Operative Time and Short-Term Radical Cystectomy Complications

Introduction: The aim of this study was to examine the relationship between duration of surgical intervention and postoperative complications in radical cystectomy (RC). We hypothesized that the complication rate increases with longer operative time. Methods: We analyzed the National Surgical Quality Improvement Program database 2011–2017 to identify all patients who underwent RC. Clinicodemographic characteristics, operative time, and perioperative complications using the Clavien-Dindo Classification (CDC) were abstracted. We fit a generalized linear model with linear splines for operative time to analyze if the relationship between operative time and probability of complication changed over time. Results: A total of 10,520 RC patients were identified with a mean operative time of 5.5 h (standard deviation 2.03). In 55% and 18.2%, any complication and major complications (CDC ≥3) occurred within 30 days postoperatively, respectively. The spline regression model for any complication showed an almost linear relationship between the complication rate and operative time, ranging from 55% at 2.5 h to 82% at 10 h. For major complications, the model revealed the inflection point (knot) at 4.5 h, which corresponds to the lowest complication rate with 15%. Operative times at the extremes of the distribution had higher complication rates: 17.5% if <2.5 h and 28% if >10 h. Discussion/Conclusion: Operative time of RC is associated with postoperative complications. Though many factors impact the duration of surgery, surgeries that lasted between 4 and 5 h had trend toward the lowest complication rates. Attention to factors impacting operative time may allow surgeons to identify strategies for optimizing surgical care and reducing complications after RC.

A new minimally invasive surgical technique for the treatment of ovarian cysts in children

The topical issue of pediatric surgery is the treatment of ovarian cysts based on the development of new technologies for surgical correction of the disease. Aim. To analyze the effectiveness of using a new minimally invasive method for removal of cystic ovarian neoplasms in children. Material and methods. A retrospective analysis of 77 female patients with ovarian cysts, aged from 3 months to 17 years, was carried out. The patients were divided into 3 groups depending on the various surgical techniques used for their treatment. Group I consisted of 32 (41 %) girls who underwent cystectomy according to the new transabdominal technique for removing ovarian cysts in children. Group II included 19 (25 %) children who underwent a laparoscopic surgery. Group III comprised 26 (34 %) children who underwent a hybrid laparoscopy-assisted cystectomy. The following indicators were analyzed: the age of patients, the nature and number of complications of the disease course, the size of cystic neoplasms, the duration of surgical interventions, the number of cases accompanied by cyst contents leaking into the abdominal cavity during surgical manipulations, and the length of hospital stay. Results. The mean age of all patients was 11.23 ± 0.57 years. Planned hospitalizations amounted to 46 (59.7 %) cases. The duration of surgery in group I was almost 1.5 times lower (P &lt; 0.05) than that in patients of group II and 2 times shorter than in children of group III (P &lt; 0.05). Free cyst contents leaking into the abdominal cavity was observed in 35 (91.4 %) patients of Group III, which required additional measures aimed at the abdominal cavity sanation. The proposed minimally invasive transabdominal surgical technique prevented this complication in all 32 patients of Group I. The length of hospital stay did not differ significantly (P &gt; 0.05) between children groups I and II and did not exceed 7.50 ± 0.35 (M ± SEM) days. This indicator was almost 1.5 times higher in Group III patients. Conclusions. The new minimally invasive transabdominal method for removing cystic ovarian neoplasms in children provided minimal trauma with maximum ablasticity and cosmetic effect of the operation. The proposed technique made it possible to prevent the development of intraoperative and postoperative complications, significantly reduce the duration of surgery and the recovery time of patients.

MP13-10 EXAMINING THE ASSOCIATION BETWEEN OPERATIVE TIME AND RADICAL CYSTECTOMY COMPLICATIONS

INTRODUCTION AND OBJECTIVE:To examine the relationship between duration of surgical intervention and postoperative complications in radical cystectomy. We hypothesized that the complication rate in...

Application of additive 3D printing technologies in neurosurgery, vertebrology and traumatology and orthopedics

Additive technologies are now widely used in various fields of clinical medicine. In particular, 3D printing is widely used in neurosurgery, vertebrology and traumatology-orthopedics. The article describes in detail the basic principles of medical 3D printing. The modern classification of 3D printers is presented based on the following principles of printing: FDM, SLA, SLS and others. The main advantages and disadvantages of the above-mentioned 3D printers and the areas of clinical medicine in which they are used are described. Further in the review, the authors discuss the experience with 3D printing applications, based on the data of the modern scientific literature. A special attention is paid to the use of 3D printing in the manufacture of individual implants for cranioplasty. 3D printing technologies in reconstructive neurosurgery make it possible to create high-precision implants, reduce the time of surgical intervention and improve the aesthetic effect of the operation. The article also presents the data of the modern literature on the use of 3D printing in vertebrology, where a special role is given to the use of guides for the installation of transpedicular screws and the use of individual lordosing cages. The use of individual guides, especially for severe spinal deformities, reduces the risk of metal structure malposition and the duration of surgical intervention. This technique is also widely used in traumatology and orthopedics, where individual implants made of titanium, a bone-substituting material, are created using 3D printing, thanks to which it is possible to replace bone defects of any shape, complexity and size and create hybrid exoprostheses. The role of 3D modeling and 3D printing in the training of medical personnel at the present stage is described. In conclusion, the authors present their experience of using 3D modeling and 3D printing in reconstructive neurosurgery and vertebrology.

Study of etiology and antibiotic sensitivity of leading pathogens of postoperative infectious complications

Summary. The problem of treatment and prevention of postoperative purulent complications in abdominal surgery in our time remains extremely urgent. This is due to an increase in the number of complex operations using modern technologies, an increase in the volume and duration of surgical interventions, as well as current antibiotic resistance problems. Objective: to study the structure of the leading causative agents of perioperative infectious complications in patients with surgical pathology and study their antibiotic sensitivity. Materials and methods - 576 patients, the average age of 45 ± 10.5 years, took part in the investigation, who were treated in the departments of surgery and intensive care unit of medical institutions of Vinnitsa region. A microbiological study of materials collected from patients was carried out (selection of secretions, fluid during drainage of superficial and deep surgical wounds). From the obtained biological material, a pure culture of the pathogen was isolated with its identification by morphological, tinctorial, cultural and biochemical properties according to generally accepted microbiological methods and using the Vitec automatic bacteriological analyzer (France). And a comparison was made of the profile of the sensitivity of the most significant pathogens to modern antibiotics. Results. According to the results of the study, it was revealed that the most common pathogens of surgical wound infections include opportunistic bacteria E.coli (22.0 %), S.aureus (19.0 %), S.epidermidis (13.0 %), E .faecalis (15 %), P.aeruginosa (10.0 %), A.baumanii (11.3 %). An analysis of the sensitivity to antibiotics of various classes of studied strains of the dominant causative agents of perioperative infectious complications showed that β-lactam antibiotics (meropenem (75–100 %), cefepime (65–100 %) and fluoroquinolones chemotherapeutic agents had the greatest antimicrobial activity. A slightly lower antimicrobial activity was found for third generation cephalosporins (70–85 %), amoxicillin-clavulanate (40–75%), aminoglycosides (tobramycin – 80 %, amikacin – 40 %). A high level of resistance of most grams of (-) microorganisms to ampicillin-sulbactam, cephalosporins of I–II generations in different ratios was determined. S.aureus resistance to azithromycin, clarithromycin is shown. Conclusions: the high prevalence of multiresistant isolates of pathogens (gram-positive (Staphylococcus aureus, enterococci), gram-negative pathogens (Escherichia, Klebsiella, enterobacteria, acinetobacteria, pseudomonads) emphasizes the need for dynamic microbiological monitoring in the surgical departments and the use of alternative antimicrobial drugs only.

Comparative assessment of the frequency and risk factors of purulent-septic infections in adult patients after various types of open and closed heart surgery

BACKGROUND: The widespread increase in the number and types of cardiac surgery necessitate the study of frequency and risk factors of postoperative purulent-septic infections (PSIs).&#x0D; AIM: to provide a comparative assessment of the PSI frequency and risk factors in adult patients after various types of cardiac surgery.&#x0D; MATERIALS AND METHODS: Based on the cardiac surgery hospital materials, medical records of 4.815 patients over 18 years of age, who underwent open (n = 1.540) and closed (n = 3.275) heart surgeries within 1 year, were analyzed. The typical and prenosological forms of PSIs were taken into account in accordance with the epidemiological standard of case definition.&#x0D; RESULTS: The incidence rates for typical and prenosological PSI forms amounted to 39.6 and 72.7 per 1000 surgeries after open heart surgery, respectively, and 3.1 and 3.9 after minimally invasive endovascular surgical interventions, respectively. The main clinical forms of PSI after open and closed heart surgeries were surgical site infections, nosocomial pneumonia, urinary tract infection, and bloodstream infection. In an open heart surgery, the maximum incidence rates for typical and prenosological forms of PSIs were recorded after surgeries on the aorta and less often after heart valve replacement or coronary artery bypass grafting. The increased incidence rate after aortic surgery was mainly due to urinary tract infection and nosocomial pneumonia. In the case of closed heart surgery, no statistically significant differences were detected between the incidence rates of PSIs after coronary artery stenting, cardiac arrhythmia and carotid artery stenosis surgery, and other interventions. The duration of both the surgery itself and the subsequent patient stay in the intensive care unit was found to be important as risk factors for PSIs after cardiac surgery.&#x0D; CONCLUSION: The incidence rate of PSIs after open heart surgery is significantly higher than after closed heart surgery, which is mostly associated with the duration of surgical intervention and the subsequent patient stay in the intensive care unit.

Analysis of age and associated pathology in patients with hip artoprosthesics

Objective. To analyze the presence of concomitant pathology in patients of different age categories who underwent hip arthroplasty by different methods.&#x0D; Materials and methods. The study retrospectively analyzed 555 case histories of patients (282 men and 273 women) for the presence of concomitant pathology in different age groups (from 20 to 95 years). The age category was determined according to the 2015 World Health Organization age classification. Statistical processing was performed according to StatPlus programs, the differences were considered significant at p&lt;0,05.&#x0D; Results and discussion. By age, patients were distributed as follows: juvenile (up to 25 years) – 2 patients (percentage of the total was 0,36 %); young (from 25 to 44 years) – 36 patients (6,49 %); middle-aged (from 45 to 59 years) – 132 patients (23,78 %); elderly (from 60 to 74 years) – 236 patients (42,52 %); senile (from 75 to 90 years) – 145 patients (26,13 %) and long-lived (over 90 years) – 4 patients (0,72 %). The average age of patients was 65.18±0.55 (M±m). Concomitant pathology was diagnosed in 484 patients (87,22 %). Depending on the existing concomitant pathology, patients were distributed as follows: no concomitant pathology – 71 patients (percentage of the total was 12,79 %); with hypertension – 38 patients (6.85 %); with diabetes – 11 patients (1.98 %); with coronary heart disease (CHD) – 104 patients (18,74 %); CHD + hypertension – 316 patients (56,94 %); with myocardial infarction – 3 patients (0,54 %); with a stroke – 2 patients (0,36 %); patients with encephalopathy of various genesis – 2 patients (0,36 %); with respiratory pathology – 3 patients (0,54 %); patients with systemic connective tissue diseases – 5 patients (0,90 %). Studies to date have shown a significant increase in comorbidities associated with the age of patients. One of the important predictors and unmodified risk factors for postoperative complications is the age of patients. The influence of age on the result of hip arthroplasty can be explained by a number of factors: the formation of endothelial dysfunction with impaired blood flow, changes in the blood coagulation system and more.&#x0D; Conclusions. With the development of medical practice, the average life expectancy of the population increases, the methods of arthroplasty and the anesthesiological support of operations are improved, the duration of surgical interventions is reduced. These factors contribute to the steady increase in the number of total joint arthroplasty, in the average age of patients undergoing arthroplasty and, accordingly, in the total comorbid load. That is why stratification of the degree of operative risk continues to be one of the most pressing problems in orthopedic patients.

Standard awake surgery versus hypnosis aided awake surgery for the management of high grade gliomas: A non-randomized cohort comparison controlled trial

Hypnosis could extend the time of Intraoperative Neuropsychological Testing and Brain Mapping in Awake Surgery. A clinical validation for the Hypnosis aided AS (HAs) is still ongoing and further evidences are required. The objective of the present study is to compare two homogeneous cohorts of patients undergoing AS, the first with the aid of the hypnosis and the second according to a standard AS (SAs) protocols. The clinical, radiological and surgical data of two comparable procedures cohorts were retrospectively examined for the present study. All surgeries in Group A were performed with a HAs protocol. Procedures belonging to Group B were performed with a SAs protocol. Endpoints: to compare 1. Incidence of complications in the immediate postoperative period, 2. Clinical and neurological status in the immediate postoperative period and 30 days after surgery, 3. Duration of surgical interventions, 4. Extent of Resection (EOR). The final cohort is composed of 15 procedures; 6 belonging to Group A and 9 to Group B. The different methods outline statistically comparable results from the clinical (Neurological outcomes) both in the postoperative period and one month after surgery and from the surgical point of view (comparable EOR). The incidence of complications is comparable either. The duration of the procedures was significantly longer in HAs group. Hypnosis is a promising approach to increasing the duration of intraoperative “testability” of patients at the price of a longer operative time. A specific professional is needed to induce hypnosis in the difficult intraoperative setting.