Ease Of Surgery Research Articles

Microdebrider-assisted uvulopalatoplasty

This report describes 3 years’ experience with the microdebrider as a safe and reasonable alternative to CO 2 laser for uvulopalatoplasty. The cost and compact size of the equipment, as well as the ease of surgery, are the main advantages for microdebrider-assisted surgery. (Otolaryngol Head Neck Surg 1998;119:131-3.)

A Randomized Comparison of Gasless Laparoscopy and CO2 Pneumoperitoneum

Objective: To determine if the theoretic advantages of gasless laparoscopy are realized in direct comparison to laparoscopy with pneumoperitoneum.Methods: Fifty-seven patients undergoing laparoscopic surgery chose to participate in this trial and were randomized after the induction of general anesthesia. Twenty-nine of the 57 patients were randomized to the pneumoperitoneum group. Of the 28 patients in the gasless group, six were converted to pneumoperitoneum because of inadequate exposure. The adequacy of exposure and ease of surgery were assessed with a subjective score, and the times to exposure and for incision closure were recorded. Various anesthetic factors were measured. Patients completed an analog pain score in the recovery area and for the first 5 postoperative days. Analgesic and antiemetic use also was recorded, as was the number of days to return to normal activity.Results: Times to achieve exposure and close incisions were longer, and exposure and ease of surgery were worse in the gasless group. Patients in the gasless group had lower diastolic blood pressure, minute ventilation, peak inspiratory pressures, and end tidal pCO2. There were no differences in body temperature, systolic blood pressure or heart rate, postoperative pain scores, analgesic or antiemetic use, or times to hospital discharge or return to activity between the groups.Conclusion: Performing laparoscopy using the Laparolift device compromised surgical exposure and thus increased technical difficulty. Patients realized no benefits from its use in terms of postoperative discomfort or return to activity. Eliminating the pneumoperitoneum allowed lower minute ventilation and peak inspiratory pressures, and end tidal pCO2 was lower. Although the concept of gasless laparoscopy holds appeal, the current prototype is not well-suited for infertility procedures.

A transvesical approach to mullerian duct remnants

Surgical extirpation is the treatment of choice for symptomatic müllerian duct remnants (prostatic utricle, PU), and several surgical approaches have been described for the treatment of this pathology. A group of 11 patients with symptomatic PU were observed and treated. Associated anomalies included proximal or penoscrotal hypospadias in all patients and cryptorchidism in 9 (81.8%). In all cases the PU needed surgical correction, as the patients had recurring symptomatology. Surgery was carried out transvesically in 10 (91%) cases and in 1 a perineal approach was used. There were no surgical complications, and at follow-up all patients showed complete resolution of the symptoms. We believe the transvesical approach, compared to other techniques, is more advantageous in the treatment of this pathology, as it permits excellent exposure, ease of surgery, good reconstruction, and good functional results with no sequelae.

Surgery for Wilms' tumour

A total of 101 patients presenting for nephrectomy for Wilms′ tumour were non-randomly offered primary surgery or pre-operative treatment and were subsequently assessed to determine the effect of the primary treatment on surgical morbidity and mortality. Ease of surgery as indicated by tumour mass and extent of resection was improved in the patients receiving neoadjuvant treatment. Intra-operative complications were also reduced in this group. Significant pre-existing disease compounded both surgical and anaesthetic risk in 20% of patients. No effect of pre-operative treatment on histological grading was evident. Overall operative mortality was 1%.

Gasless laparoscopic assisted hysterectomy with epidural anesthesia

Gasless laparoscopy is an evolving technique which can offer significant advantages to both patient and surgeon. A variety of major laparoscopic operations can be performed with gasless surgery including oophorectomy, myomectomy, and hysterectomy. The use of conventional instrumentation and open ports significantly improves the ease of surgery and greatly facilitates techniques such as endosuturing. For those patients with a contraindication, or a fear of general anesthesia, gasless laparoscopy under a regional anesthetic is now a reasonable alternative. A laparoscopic-assisted vaginal hysterectomy was performed with gasless technique under continuous epidural anesthesia. The surgery was completed without complication, and the patient expressed a high degree of satisfaction. Subsequently, three additional patients have successfully undergone major laparoscopic operations using a gasless technique and epidural anesthesia. With careful patient selection and attention to proper technique, gasless laparoscopy under regional anesthesia is a safe and viable alternative to conventional CO2 laparoscopy.

Rapid preoperative preparation in hyperthyroidism

We have evaluated an alternative method of preparation of hyperthyroid patients for surgery, using betamethasone, iopanoic acid and propranolol. Betamethasone (0.5 mg every 6 hours), iopanoic acid (500 mg every 6 hours) and propranolol (40 mg every 8 hours) were given orally for 5 days; thyroidectomy was performed on the 6th day. We analysed patient acceptability, clinical and hormonal effects, ease of surgery and final outcome. Thirteen females and 1 male, aged 16-59 years, ten with diffuse goitre and four with nodular goitre were submitted to subtotal thyroidectomy because antithyroid drugs had failed to control thyrotoxicosis or because hyperthyroidism coexisted with other conditions (pregnancy, hypertensive disease). Daily clinical assessments were made together with T3, T4 and rT3 serum concentrations before and while on drug treatment, during the surgical procedure and post-operatively. Daily assessment showed progressive clinical improvement so that on day 5 the patients were considered clinically euthyroid. Serum levels of T3 (mean +/- SD) showed significant decrease (by 38.2 +/- 24.9%, P less than 0.01) as early as 24 hours after medication was started, reaching almost euthyroid levels on day 3; on the day of operation T3 had diminished by 64.5 +/- 16.6% (P less than 0.0001). Serum T4 concentration showed a slight but significant decrement only from day 4 on and never reached euthyroid levels. Serum rT3 values exhibited a brisk increment at 24 hours (+333 +/- 194%, P less than 0.0001) and remained elevated between 8 and 10 nmol/l until medication was stopped. Drug tolerance was considered as excellent since no serious side-effects were noted, even in pregnant patients. There were no anaesthetic incidents or postoperative complications and patients were discharged 48-72 hours after operation. The final outcome has been satisfactory and pregnant patients continued their pregnancies without incident, bearing normal children. Pharmacological combination of betamethasone, iopanoic acid and propranolol has proved to be safe and effective and is of low cost. Provided there is adequate supervision of the patients, it may be used in patients requiring urgent thyroidectomy or in those who for reasons of non-compliance need a short preoperative regime.

Carbon Dioxide Laser Treatment of Erythroplasia of Queyrat

We present a case of erythroplasia of Queyrat in a 77-year-old man involving the distal two-thirds of the penis. There was no urethral or periurethral involvement. Due to the location of the lesion, its recognition as carcinoma in situ, and the technical difficulty of cold-steel excision in this area, we used the carbon dioxide (CO2) laser to selectively destroy the tumor. In this case the laser provided controllable tissue destruction, ease of surgery, and excellent cosmesis.

Transvesical approach to utricular cysts

Utricular cyst is an uncommon problem, mainly encountered in intersex conditions and is usually asymptomatic. These lesions have been classified in three main groups following the degree of masculinization by Howard. Three of our patients nevertheless have presented with very severe utricular and urinary infections, one of these having developed a scrotal fistula. Another was incontinent due to intra-utricular trapping. The first patient was operated upon by a perineal approach which we found extremely difficult. The next two patients were operated by a transvesical approach which offered many advantages: excellent exposure, ease of surgery, good reconstruction, and no sequellae.