Evaluation Of Surgical Procedures Research Articles

Common Design and Data Elements Reported on Idiopathic Intracranial Hypertension Trials: A Systematic Review.

There are an increasing number of controlled clinical trials and prospective studies, ongoing and recently completed, regarding management options for idiopathic intracranial hypertension (IIH). We present a Common Design and Data Element (CDDE) analysis of controlled and prospective IIH studies with the aim of aligning essential design and recommending data elements in future trials and enhancing data synthesis potential in IIH trials. We used PubMed and ClinicalTrials.gov to screen for ongoing and published trials assessing treatment modalities in people with IIH. After our search, we used the Nested Knowledge AutoLit platform to extract pertinent information regarding each study. We examined outputs from each study and synthesized the data elements to determine the degree of homogeneity between studies. The most CDDE for inclusion criteria was the modified Dandy criteria for diagnosis of IIH, used in 9/14 studies (64%). The most CDDE for outcomes was change in visual function, reported in 12/14 studies (86%). Evaluation of surgical procedures (venous sinus stenting, cerebrospinal fluid shunt placement, and others) was more common, seen in 9/14 studies (64%) as compared with interventions with medical therapy 6/14 (43%). Although all studies have similar focus to improve patient care, there was a high degree of inconsistency among studies regarding inclusion criteria, exclusion criteria, and outcomes measures. Furthermore, studies used different time frames to assess outcome data elements. This heterogeneity will make it difficult to achieve a consistent standard, and thus, making secondary analyses and meta-analyses less effective in the future. Consensus on design of trials is an unmet research need for IIH.

Central perforated VRAM flap and neurostimulated levator augmentation for functional and aesthetical reconstruction after abdominoperineal excision in cancer.

Preservation of quality of life regarding fecal continence after abdominoperineal excision (APE) in cancer is challenging. Simultaneous soft tissue coverage and restoration of continence mechanism can be provided through an interdisciplinary collaboration of colorectal and plastic reconstructive surgery. Evaluation of surgical procedure and outcome combining soft tissue reconstruction using a central perforated vertical rectus abdominis myocutaneous flap (VRAM), implementing a perineostoma and restoring anorectal angle augmenting the levator ani by neurostimulated graciloplasty. 14 Patients underwent APE due to cancer. In all patients coverage was achieved by pedicled VRAM and simultaneous pull-through descendostomy (perineostoma). 10 of those patients received a levator augmentation additionally. Postoperative complications, functional measures of continence as well as quality of life were obtained. Perineal minor complication rate was 43% without need of surgical intervention. All but one VRAM survived. Continence measures and disease specific life quality showed a good preservation of continence in most patients. The results present a complex therapy option accomplished by a collaboration of two highly specialized partners (visceral and plastic surgery) after total loss of the sphincter function and consecutive fecal insufficiency after APE.

Evaluation of Surgical Procedures Needed for Refugees in Turkey:Retrospective study

ABSTRACT Objective: Surgical procedures are critical components of healthcare services; however, they are usually neglected during public health interventions due to misperceived high costs and limited benefits. Estimating surgical needs for refugee individuals in the host country would help humanitarian aid planning and strategical development of national surgery capacity for resource allocation. The present research aimed to analyze the surgical procedures of refugees. Methods: 2703 of 15725 hospitalized refugee patients, underwent a surgical procedure during February 2015 and December 2018. Demographic data of the patients such as age and gender, risk classification according to the American Society of Anesthesiologists (ASA), the anesthesia type, type of the surgical procedures, intraoperative blood transfusion rates, admission incidence to intensive care unit (ICU), and mortality rates were recorded. The surgical procedures divided into groups according to the surgical branches and analyzed. Results: Distribution of two-thirds of the surgical procedures among medical branches was obstetrics and gynecology, orthopedics and traumatology, general surgery and plastic, reconstructive, and aesthetic surgery. The most common surgical procedures were C-section, appendectomy, disorders of bone integrity, and wrist injuries. Conclusion: Approximately one sixth of the refugee patients treated in our hospital underwent various surgical procedures. Our results should be taken into account by governments in planning humanitarian assistance, budgeting sources, and improving surgical capacity for the rapidly growing number of refugees worldwide.

Evaluation of Surgical Procedures in Emergency Cases during Pandemic of Covid 19

Evaluation of Surgical Procedures in Emergency Cases during Pandemic of Covid 19

A New Active Osseointegrated Implant System in Patients with Single-Sided Deafness

Objective: The Cochlear™ Osia® System (Osia) is an active transcutaneous bone conduction implant system intended for patients with conductive and mixed hearing loss but can also be used in cases of single-sided deafness (SSD) for the contralateral routing of signal (CROS). The Osia implant is placed subcutaneously under the intact skin behind the ear with the piezoelectric actuator connected to an osseointegrated BI300 implant – a titanium screw used for a 2-stage Baha surgery – on the mastoid. The external processor is magnetically attached to the subcutaneous implant receiver coil. As the Osia has recently been CE certified and is new on the market, with limited patient outcome data for SSD available, the objective of this study was the evaluation of surgical procedure, audiological results, and patient satisfaction for the Osia in SSD patients. Study Design: In a prospective, monocentric clinical observation study, 6 patients (18 years of age or older) with SSD and bone conduction thresholds pure tone average 0.5, 1, 2, and 4 kHz ≤25 dB HL on the contralateral side were implanted with an Osia. Analysis of clinical outcome data with respect to surgical technique, adverse events, audiological measurement, and subjective benefit for SSD patients was conducted. Audiological measurements performed included hearing thresholds, sound field thresholds, word recognition scores (WRS; in %) in quiet, and speech recognition thresholds in noise (in dB SNR). All tests were performed unaided and aided with the Osia. The subjective benefit with the Osia was determined by using 2 questionnaires; the Abbreviated Profile of Hearing Aid Benefit (APHAB) and the Bern Benefit in Single-Sided Deafness (BBSSD). Results: Preliminary results indicate a straightforward surgical procedure with a low rate of complications and an improvement in speech perception in quiet, listening performance in everyday situations and patient satisfaction. However, in one of 6 subjects, a revision surgery had to be performed. Conclusion: Provided that SSD patients are open for CROS hearing, they can benefit from the Osia by reduced head shadow effects and better speech recognition. Special caution should be given to the skin at the site of implantation to avoid complications.

Evaluation of Surgical Procedures that Affect the Hemodynamics Using the FloTrac System in Esophageal Cancer Patients.

Esophagectomy is more invasive compared to other gastrointestinal surgery types. Perioperative circulatory management is important to avoid postoperative heart complications. The FloTrac sensor along with the Vigileo monitor is a minimally invasive haemodynamic monitoring device. Here, we examined different surgical procedures affecting hemodynamics using the FloTrac system in esophageal cancer patients following esophagectomy. Thirty-one patients undergoing postoperative monitoring with the FloTrac sensor/Vigileo monitor system following esophagectomy were included. Evaluation of cardiac index (CI) and stroke volume variation (SVV) measurements were performed by analyzing the number of aberrant values. We evaluated the correlation between the number of aberrant values of CI, SVV and surgical methods of esophagectomy and perioperative factors. There was no significant correlation between the number of aberrant values of CI, SVV and operative approach or fields of lymphadenectomy. Regarding the reconstruction route following esophagectomy, there was a significant correlation between the number of aberrant values of CI, SVV and retrosternal route compared with other routes. There was a significant correlation between the number of aberrant values of SVV and preoperative heart complication. Hemodynamic stability management using FloTrac/Vigileo system following esophagectomy is useful for safe performance of postoperative management of esophageal cancer patients.

Evaluation of surgical procedures in primary mediastinal cysts and tumors: single-center experience.

AimIn this study, we aimed to evaluate the results of our patients with a primary mediastinal mass and the surgical techniques applied in our clinic retrospectively.Material and methodsBetween March 2015 and March 2019, the results and treatment protocols of 32 patients with a primary mediastinal mass or cysts who were followed up and treated in our clinic were evaluated retrospectively. Twenty-six patients who underwent surgery for biopsy or resection were included in the study.ResultsSixteen of our patients were male and 10 were female. The mean age was 39 years. 80.2% of our patients were symptomatic and 19.2% were asymptomatic and a mediastinal mass was incidentally detected in these asymptomatic patients. The most common symptom was dyspnea with frequency of 38.4%. In terms of localization, the mass was lateralized on the right side in 7 patients, on the left side in 5 patients. In 13 patients, the tumor was located in the posterior mediastinum. 8 patients underwent anterior mediastinotomy and 1 patient underwent biopsy with video-assisted thoracoscopic surgery (VATS). Most commonly a thymus-derived mass was seen. Fifteen patients underwent excision with VATS, 3 thoracotomy, 2 sternotomy and in 1 patient VATS assisted anterior minithoracotomy was performed.ConclusionsMediastinal tumors and cysts have different histopathological features. Robotic surgery and VATS-assisted surgery are increasingly used in surgical excision.

The experience of Robot-assisted Sacrocolpopexy at our hospital and the evaluation of surgical procedure by surgeon.

The experience of Robot-assisted Sacrocolpopexy at our hospital and the evaluation of surgical procedure by surgeon.

SimCEC

Traditionally, the evaluation of surgical procedures in virtual reality (VR) simulators has been restricted to their individual technical aspects disregarding the procedures carried out by teams. However, some decision models have been proposed to support the collaborative training evaluation process of surgical teams in collaborative virtual environments. The main objective of this article is to present a collaborative simulator based on VR, named SimCEC , as a potential solution for education, training, and evaluation in basic surgical routines for teams of undergraduate students. The simulator considers both tasks performed individually and those carried in a collaborative manner. The main contribution of this work is to improve the discussion about VR simulators requirements (design and implementation) to provide team training in relevant topics, such as users’ feedback in real time, collaborative training in networks, interdisciplinary integration of curricula, and continuous evaluation.

Clinical Evaluation of Surgical Procedures for Corneal Ulcer in Dogs

The present study was conducted on 12 dogs, irrespective of age sex and breed, having corneal ulcer to evaluate the response of surgical procedures on corneal ulcer. The animals were randomly divided into two groups, in group I temporary tarsorrhaphy and in group II third eyelid flap surgery was performed along with pre and post-operative systemic and local medication. Preoperative ophthalmoscopic examination was performed before starting the treatment, i.e. day 0, to check the general health status of the animals, followed by day 15, 30, 45 and 60 post-operative examination to record the healing of corneal ulcer. In group I lesser complications were observed as compared to group II and 66.66% and 50.00% dogs recovered without scar formation on 60th post-operative day in group I and II, respectively. Thus temporary tarsorrhaphy was observed superior then the third eyelid flap surgery as well as combination of moxifloxacin and flurbiprofen was found satisfactory for the healing of corneal ulcer.

Machine learning applied to neuroimaging for diagnosis of adult classic Chiari malformation: role of the basion as a key morphometric indicator.

OBJECTIVE The current diagnostic criterion for Chiari malformation Type I (CM-I), based on tonsillar herniation (TH), includes a diversity of patients with amygdalar descent that may be caused by a variety of factors. In contrast, patients presenting with an overcrowded posterior cranial fossa, a key characteristic of the disease, may remain misdiagnosed if they have little or no TH. The objective of the present study was to use machine-learning classification methods to identify morphometric measures that help discern patients with classic CM-I to improve diagnosis and treatment and provide insight into the etiology of the disease. METHODS Fifteen morphometric measurements of the posterior cranial fossa were performed on midsagittal T1-weighted MR images obtained in 195 adult patients diagnosed with CM. Seven different machine-learning classification methods were applied to images from 117 patients with classic CM-I and 50 controls matched by age and sex to identify the best classifiers discriminating the 2 cohorts with the minimum number of parameters. These classifiers were then tested using independent CM cohorts representing different entities of the disease. RESULTS Machine learning identified combinations of 2 and 3 morphometric measurements that were able to discern not only classic CM-I (with more than 5 mm TH) but also other entities such as classic CM-I with moderate TH and CM Type 1.5 (CM-1.5), with high accuracy (> 87%) and independent of the TH criterion. In contrast, lower accuracy was obtained in patients with CM Type 0. The distances from the lower aspect of the corpus callosum, pons, and fastigium to the foramen magnum and the basal and Wackenheim angles were identified as the most relevant morphometric traits to differentiate these patients. The stronger significance (p < 0.01) of the correlations with the clivus length, compared with the supraoccipital length, suggests that these 5 relevant traits would be affected more by the relative position of the basion than the opisthion. CONCLUSIONS Tonsillar herniation as a unique criterion is insufficient for radiographic diagnosis of CM-I, which can be improved by considering the basion position. The position of the basion was altered in different entities of CM, including classic CM-I, classic CM-I with moderate TH, and CM-1.5. The authors propose a predictive model based on 3 parameters, all related to the basion location, to discern classic CM-I with 90% accuracy and suggest considering the anterior alterations in the evaluation of surgical procedures and outcomes.

Therapeutic evaluation of surgical procedure in treatment of secondary hyperparathyroidism

To analyze the short-term and long-term outcomes of the three operation methods in treatment of secondary hyperparathyroidism. Clinical data of 88 patients who underwent parathyroidectomy for secondary hyperparathyroidism from October 2004 to October 2014 were reviewed retrospectively. Patients were divided into three subgroups, including subtotal parathyroidectomy (group I), total parathyroidectomy with autotransplantation (group II) and intraoperative ⁹⁹Tc(m)-MIBI radioguided total parathyroidectomy with autotransplantation (group III). Their serum calcium, phosphorus, serum iPTH results in the pre-operation, short-term (≤ 6 months) and long term (> 6 months) of post-operation were collected and compared. The improvements of clinical symptoms together with the postoperative recurrence rate and the complication data were observed and analyzed. The symptoms of all patients were improved after the operation.The short-term postoperative serum calcium, serum iPTH and recurrence rate of Group I and group II were all not statistically significant. The short-term postoperative serum calcium, iPTH and recurrence rate of group III were significantly lower than those of group I and group II (P < 0.05). Postoperative serum phosphorus values of the three groups had no statistical difference. The operation time of group III was significantly shorter than that of group II ((77 ± 13) vs (108 ± 17) min, P < 0.05). The positive rates were more accurate in group III than in group II (98.5% vs 88.7%, P < 0.05). For the long term follow-up, the postoperative serum calcium, phosphorus, serum iPTH and recurrence rate of group I and group II were not statistically different. The postoperative recurrence rate of group III was lower than that of group I and group II (3.6% vs 31.6% and 21.4% respectively, P < 0.05). Total parathyroidectomy with autotransplantation has a good efficacy to treat secondary hyperparathyroidism. The intraoperative ⁹⁹Tc(m)-MIBI radioguided total parathyroidectomy with autotransplantation can find the ectopic and supernumerary glands to improve the success rate of operation. And it also can permit omission of frozen section to reduce the operative time.In the postoperative follow-up, the recurrence rate is low, so it is a safe and effective treatment.

Robotics as a Support Tool for Experimental Optimisation of Surgical Strategies in Orthopaedic Surgery

Robotics has shown its potential not only in assisting the surgeon during an intervention but also as a tool for training and for surgical procedure's evaluation. Thus, robotics can constitute an extension of simulators that are based on the high capabilities of computer graphics. In addition, haptics has taken a first step in increasing the performance of current virtual reality systems based uniquely on computer simulation and their corresponding interface devices. As a further step in the field of training and learning in surgery, this work describes a robotic experimental workstation composed of robots and specific measuring devices, together with their corresponding control and monitoring strategies for orthopaedic surgery. Through a case study, humerus arthroplasty, experimental evaluation shows the possibilities of having a test bed available for repetitive and quantifiable trials, which make a reliable scientific comparison between different surgical strategies possible.

Robotics as a support tool for experimental optimisation of surgical strategies in orthopaedic surgery

Robotics has shown its potential not only in assisting the surgeon during an intervention but also as a tool for training and for surgical procedure's evaluation. Thus, robotics can constitute an extension of simulators that are based on the high cap

Evaluation of surgical procedures for sex reassignment: a systematic review

6. Weyers S, Selvaggi G, Monstrey S, et al. Two-stage versus onestage sex reassignment surgery in female-to-male transsexual individuals. Gynecol Surg 2006;3:190e4. 7. Felici N, Felici A. A new phalloplasty technique: the free anterolateral thigh flap phalloplasty. J Plast Reconstr Aesthet Surg 2006 Feb;59:153e7. 8. Hage JJ, van Turnhout AA. Long-term outcome of metaidoioplasty in 70 female-to-male transsexuals. Ann Plast Surg 2006 Sep;57:312e6. 9. Dabernig J, Chan LK, Schaff J. Phalloplasty with free (septocutaneous) fibular flap sine fibula. J Urol 2006 Nov;176:2085e8. 10. Revol M, Servant JM, Banzet P. Surgical treatment of male-tofemale transsexuals: a ten-year experience assessment. Ann Chir Plast Esthet 2006 Dec;51:499e511 [Epub 2006 Apr 19]. 11. Selvaggi G, Monstrey S, Ceulemans P, et al. Genital sensitivity after sex reassignment surgery in transsexual patients. Ann Plast Surg 2007 Apr;58:427e33. 12. Vesely J, Hyza P, Ranno R, et al. New technique of total phalloplasty with reinnervated latissimus dorsi myocutaneous free flap in female-to-male transsexuals. Ann Plast Surg 2007 May; 58:544e50. 13. Ranno R, Veselý J, Hýza P, et al. Neo-phalloplasty with reinnervated latissimus dorsi free flap: a functional study of a novel technique. Acta Chir Plast 2007;49:3e7.

Editorial Comment on: Treatment of Bladder Pain Syndrome/Interstitial Cystitis 2008: Can We Make Evidence Based Decisions?

the urothelial coating may be defective or even lost in IC/PBS patients, as shown recently [2], urinary compounds would infiltrate into the vesical wall and trigger inflammatory reactions and/or nerve stimulation that would ultimately account for most of the clinical manifestations of IC/PBS [1,2]. In line with its physiological role in the urothelium, GAG or physicochemically similar polymers, such as pentosanpolysulfate, have been used to repair the putatively defective coating. Often these polymers are administered singly, and they remain a mainstay in IC/PBS therapy, as well discussed by Fall, Oberpenning, and Peeker [3]. However, a GAG may also be used as an adjuvant to another polymer, such as pentosanpolysulfate, especially when the latter does not adequately improve symptoms [4]. The present review [3] is a useful critical appraisal of the many different therapies currently available for the treatment of IC/PBS, enabling the clinician to make more objective decisions. Of special interest is the inclusion of alternative treatments, a more comprehensive evaluation of surgical procedures, and the classification of the various treatments according to their level of evidence and recommendation. Although there are other recent reviews on this subject, these usually focus on pharmacologic treatments and only a few evaluate in greater detail other available therapies, notably the surgical ones [5].

Laparoscopic partial myectomy

A number of different surgical procedures have been described for the treatment of gastroesophageal reflux disease. Moreover, modifications and completely new techniques are being introduced on a regular basis. Nonetheless, in most cases of novel laparoscopic techniques profound experimental data have not been collected prior to their clinical introduction. Due to the lack of an animal model of inadequate esophageal sphincter function, most experimental studies on antireflux procedures were done on normally functioning esophageal sphincters. It is well-known that myotomy alone cannot induce sphincter insufficiency in animal models. In addition, complete myectomy is associated with severe mortality and, therefore, is not useful as an experimental model. This study introduces a new model of laparoscopic partial in vivo myectomy. The procedure described here forms a myectomy of the esophagus using scissors and a sponge on the side of the greater gastric curvature. The size of the myectomy is approximately 6 x 1.5 cm and was successfully performed in a consecutive series of eight experimental animals (male German house pigs). Following an intensive team training on dead animals, the procedure was performed with success via the laparoscope in all study animals (n = 8). The sphincter pressure as determined by manometry was significantly reduced from 7.7 mmHg (range, 4.5-9.1; preoperative values) to 2.2 mmHg (range, 0-6.8; early postoperative values) and 2.3 mmHg (range, 0-3.7) at 8 weeks after surgery (p < 0.001). In addition, the length of the lower esophageal sphincter as well as the sphincter pressure vector volume were significantly reduced early as well as at 8 weeks after laparoscopic myectomy. Furthermore, endoscopy and reflux testing were pathologic compared with control animals. Laparoscopic partial myectomy results in complete sphincter insufficiency with only little procedure-related morbidity. This procedure allows for the experimental evaluation of surgical procedures on the gastroesophageal junction. Future modifications of surgical antireflux procedures can therefore be evaluated in an experimental setting prior to their clinical introduction.

Evaluation of surgical procedures gastric and duodenal ulcers.

Evaluation of surgical procedures gastric and duodenal ulcers.

Immediate post-operative procedure for identification of the rheological parameters of biological soft tissue

Computer simulations of minimal invasive procedures have been developed for surgery planning or training or for the evaluation of surgical procedure. In order to perform realistic and precise simulations of surgery on soft tissue, one key step consists in introducing accurate tissue-specific mechanical parameters. The goal of this work was to transfer an indentation procedure from the laboratory to the operating room using a new portable indentation device. The numerical simulations with 3D finite element software of the experiments allowed us to identify the characteristic rheological properties which minimize the gap between computed end measured physical quantities. The next step will be to extend this procedure to pathologic uterus and to other solid organs.

Unicoronal suture immobilization in the fetal rabbit.

Pre-clinical evaluation of surgical procedures aimed to correct craniosynostosis is ideally performed in species of small animals characterized by perinatal brain development, early skeletal maturation, and genuine synostosis in all newborns. It would be nearly impossible to breed such a colony to homozygosity, so most researchers have resorted to artificial postnatal suture immobilization. Our aim was to test the hypothesis that artificial immobilization of a unicoronal suture in the fetal rabbit (25 days of gestation) would result in neurocranial growth alterations similar to those seen in the 9-day postnatally immobilized or congenital synostotic rabbit models. The advantages of prenatal immobilization are that rabbits can undergo the tested corrective procedure at postnatal day 9. This age corresponds to a human age of 6 months and allows the deformity and the effects of its correction to be more readily detected. The heads of 25-day-old fetuses of five time-dated pregnant New Zealand white rabbits were exposed by hysterotomy. The left unicoronal suture of 4 fetuses in each litter was immobilized with a polyglactin suture piercing the frontal and parietal bone plates. The remaining two fetuses were sham-operated. Nine days after spontaneous delivery, all rabbits were marked with four titanium screws close to the sagittal and coronal sutures. Growth was recorded with dorsoventral cephalograms at 9 and 90 days. The group with the immobilized suture showed a small increase in growth across the sagittal sutures. However, the decreases in growth at the unicoronal suture in both the immobilized (5.41-mm difference with sham-treated group) and nonimmobilized (1.17-mm difference with sham-treated group) were significant. Fetal immobilization results in growth alterations similar to those observed after postnatal immobilization.