Incomplete Procedures Research Articles

The Legal Validity of Incomplete Procedures for Labor-Management Meetings

The Legal Validity of Incomplete Procedures for Labor-Management Meetings

Laparoscopic Versus Open Ladd Procedure for Midgut Malrotation

IntroductionIntestinal malrotation is an uncommon developmental anomaly that can lead to duodenal obstruction and midgut volvulus. The standard correctional operation, Ladd's operation, is traditionally performed using an open approach, but providers are increasingly performing the procedure laparoscopically. However, there remains concern that the reduced adhesive burden associated with laparoscopy could predispose to recurrent volvulus. MethodsWe queried our institutional database from 2012 to 2022 for patients <18 years who underwent Ladd's operation for malrotation. We analyzed baseline characteristics and outcomes including post-operative volvulus, adhesive small bowel obstruction (SBO), duodenal obstruction, and overall abdominal re-operation. ResultsWe identified 226 patients, of whom 90 (40%) underwent a laparoscopic operation. Those undergoing open surgery were younger and had a higher rate of volvulus compared to laparoscopic patients. There were no differences in surgical history or underlying comorbidities. Laparoscopic patients were less likely to develop a post-operative adhesive SBO [1/90 (1%) vs 14/136 (10.0%); OR 9.4 (1.7–176.4), p = 0.036] with no increased rate of volvulus [1/90 (1%) vs 1/136 (0.7%), p = 0.778]. However, there were four laparoscopic patients that required re-operation for a duodenal stricture or kink, which led the overall rate of abdominal re-operation to not be different [7/90 (8%) vs 16/136 (12%); OR 1.6 (0.6–4.8), p = 0.371]. Median follow up was 2.3 years [IQR 1.0–5.0]. ConclusionLaparoscopic correction of midgut malrotation demonstrates no increased risk of post-operative volvulus and may reduce the rate of adhesive SBO. These benefits must be weighed against the potential increased risk of duodenal stricture or obstruction secondary to an incomplete Ladd's procedure. Level of EvidenceIII.

Abdominal Parietal Metastasis from Cervical Cancer: A Review of One of the Most Uncommon Sites of Recurrence Including a Report of a New Case.

Cervical cancer is the fourth most common cancer in women, the highest mortality being found in low- and middle-income countries. Abdominal parietal metastases in cervical cancer are a very rare entity, with an incidence of 0.1-1.3%, and represent an unfavorable prognostic factor with the survival rate falling to 17%. Here, we present a review of cases of abdominal parietal metastasis in recent decades, including a new case of a 4.5 cm abdominal parietal metastasis at the site of the scar of the former drain tube 28 months after diagnosis of stage IIB cervical cancer (adenosquamous carcinoma), treated by external radiotherapy with concurrent chemotherapy and intracavitary brachytherapy and subsequent surgery (type B radical hysterectomy). The tumor was resected within oncological limits with the histopathological result of adenosquamous carcinoma. The case study highlights the importance of early detection and appropriate treatment of metastases in patients with cervical cancer. The discussion explores the potential pathways for parietal metastasis and the impact of incomplete surgical procedures on the development of metastases. The conclusion emphasizes the poor prognosis associated with this type of metastasis in cervical cancer patients and the potential benefits of surgical resection associated with systemic therapy in improving survival rates.

#858 The efficacy of preoperative ultrasound mapping prior to arteriovenous fistula creation: a meta-analysis and systematic review

Abstract Background and Aims Current literature presents conflicting evidence regarding the benefits of Color Doppler Ultrasound (DUS) in the preoperative vascular mapping of arteriovenous fistula (AVF) for haemodialysis. Thus, we conducted a systematic review and meta-analysis of RCTs to evaluate differences in primary AVF failure between patients randomly assigned to routine preoperatory DUS and those randomly assigned to physical examination assessment alone or combined with DUS when physical examination provides limited information. Method We systematically searched PubMed, Google Scholar, Web of Science, and Scopus databases from their inception to November 30, 2023. The accessible text search terms were: “fistula” AND “arteriovenous” AND “dialysis” OR “haemodialysis” AND “Doppler” OR “ultrasound” OR “ultrasonography” AND “preoperative” OR “perioperative” OR “mapping”. No language restriction was applied. We also reviewed references from original papers and review articles to identify additional suitable studies not covered by our original database searches. Exclusion criteria were: (1) meeting abstracts, case reports, reviews, practice guidelines, case-control or cross-sectional or longitudinal studies; (2) RCTs that did not report any estimates of the outcomes of interest; (3) RCTs conducted in the paediatric population (&amp;lt;18 years of age). Two authors independently extracted data from eligible RCTs. Disagreements at this level were resolved by consensus and a third author if needed. The outcome was categorized into three groups: primary AVF failure within 48 hours, within six weeks or 40 months from the vascular procedure. AVF Failure was defined as intraoperative inadequate vessels, incomplete surgical procedure, absence of thrill, thrombosis detection, AVF unsuitability for cannulation at 90 days, inability to achieve Qb 200-300 ml/min at six months, or lack of maturation at 40 months. Statistical analysis was performed using STATA 17.0 software with the metanalysis package and R (version 4.2.2.) for all statistical analyses. This study was performed according to the updated Preferred Reporting Items for Systematic Reviews and Meta-Analysis statement. Results We included 6 RCTs involving 802 patients. Fig. 1 summarizes the results of the literature search and study selection. Table 1 shows the main clinical characteristics of RCTs. Compared to controls, the use of routine preoperative DUS was associated with a reduction in the risk of AVF failure within 48 hours [5 RCTs; OR 0.27, confidence interval 95% 0.16-0.45 for the common effect model (CEM); OR 0.27, CI 95% 0.16-0.46 for the random effects model (REM), no heterogeneity (I2 = 0%)]; within six weeks [2 RCTs (OR 0.33, CI: 95% 0.18-0.61 for CEM, and OR 0.34, CI 95% 0.18-0.63 for REM with I2 = 0%]; and within 40 months [4 RCTs, OR 0.51, CI 95% 0.35-0.75 for CEM; and OR 0.51, CI 95% 0.35-0.76 for the REM, with I2 = 0%] from surgical intervention (Figs 2–4). Conclusion Routine use of DUS in preoperative vascular mapping improves the survival AVF in the immediate to 40 months post-surgery, compared to relying solely on physical examination or using DUS only in cases of insufficient physical examination.

Rusa deer microbiota: the importance of preliminary data analysis for meaningful diversity comparisons.

The microbiome is an important consideration for the conservation of endangered species. Studies provided evidence of the effect of behavior and habitat change on the microbiota of wild animals and reported various inferences. It indicates the complexity of factors influencing microbiota diversity, including incomplete sampling procedures. Data abnormality may arise due to the procedures warranting preliminary analysis, such as rarefaction, before downstream analysis. This present study demonstrated the effect of data rarefaction and aggregation on the comparison of wild rusa deer's gut microbial diversity. Eighty-five feces samples were collected from 11 deer populations inhabiting three national parks in Java and Bali islands. Using the Illumina Nova-Seq platform, fragments of 16s rRNA gene were sequenced, and raw data of 51,389 reads corresponding to 2 domains, 22 phyla, 45 classes, 83 orders, 182 families, and 460 genera of bacteria were obtained. Data rarefaction was applied at two different library sizes (minimum and fixed) and aggregation (11 populations into 3 research sites) to investigate its effect on the microbial diversity comparison. There are significant differences in alpha diversity between populations, but not research sites, at all library sizes of rarefaction. A similar finding is also found in beta diversity. Moreover, data rarefaction and aggregation result in different values of the diversity metrics. This present study shows that statistical analysis remains a substantial concern in microbiome studies applied to conservation biology. It suggests reporting a more detailed data normalization in microbiome studies as an inherent control of suboptimal sampling, particularly when involving feces.

Complete versus incomplete caries removal procedures and their effects on dental pulp in primary teeth - An in vivo study.

Dental caries results from an ecologic shift within the dental biofilm from a balanced population of microorganisms to an acidogenic, aciduric, and cariogenic microbiological population developed and maintained by frequent consumption of fermentable dietary carbohydrates. Total caries removal (TCR) of deep lesion may result in pulpal exposure requiring more invasive treatment. Hence, current pediatric dentistry has shifted to minimally invasive treatment that avoids more complex, time-consuming procedure, and the child's discomfort. The aim of this study is to evaluate and compare clinical performance and radiographic changes after complete and incomplete caries removal procedures. The study was conducted on 60 primary molars in children aged 6-9 years. Selected 60 primary molars were randomly divided into two groups. Group 1 (PCR): infected dentin was removed, while the affected dentin was maintained on the pulpal wall. Group 2 (TCR): both infected and affected dentin were removed through low-speed carbide bur and hand excavator. Teeth were evaluated at 4 and 6 months clinically and radiographically. The proportion was compared using Fisher's exact test. The Statistical Package for the Social Sciences version 21 was used for analysis. The level of significance was kept at 5%. The clinical and radiographic success rates of ICR and CCR in primary teeth with deep carious lesions were high and did not differ significantly, indicating that the retention of carious dentin does not interfere with pulp vitality. Thus, ICR is a reliable minimally invasive approach that might replace the CCR in primary teeth when correctly indicated.

Struktur, Isi, dan Kebahasaan Teks Posedur Siswa Kelas VII SMP Negeri 1 Sutera

The purpose of this research is to describe the structure, to describe the contents, and to describe the language of procedure text for seventh-grade students of SMP Negeri 1 Sutera. This research applied qualitative with descriptive methods. The source of the data is written procedure text for seventh-grade students of SMP Negeri 1 Sutera. The data are collected through documentation studies. The data validation technique in this study is a triangulation technique (cross-check). The data were analyzed based on the aspects of structure, content, and linguistics of the procedure text. The results of the study concluded as follows. First, all the procedure texts have titles, only 23 have objectives, all 30 texts have tools or materials and steps, and on the closing part, students were not able to write a good closing of a procedure text. Second, in terms of content, it was found that there are 20 complete procedure texts and 10 incomplete procedure texts. Third, there are 113 appropriate imperative and 45 inappropriate imperative sentences, 63 correct adverbs, and 3 incorrect adverbs, and there are 385 correct conjunctions and 19 incorrect conjunctions.

To cut or not to cut - that is the question: a comparative analysis of long-term follow-up after complete and incomplete electroconization of the cervix due to high-grade squamous intraepithelial lesion.

Electroconization of the uterine cervix (LEEP/LLETZ) is an appropriate and sufficient procedure for high-grade squamous epithelial lesion - HSIL. Negative margins are considered fundamental for confirming the absence of residual disease. Further management after incomplete excision among women who have not completed their procreative plans is difficult because subsequent cervical procedures may cause issues with carrying a pregnancy to term. Since almost one-third of the untreated patients with HSIL will develop cervical carcinoma, it is essential to balance the desire to radicalize treatment with its obstetric consequences. We compared the further clinical course of the patients after complete and incomplete procedures to observe whether completeness of excision is necessary for a successful outcome. We aim to identify risk factors that influence persistent or recurrent HSIL. The study has comprised 781 patients aged 18-85 - the research group was composed of 140 (17.93%) patients after incomplete conization and the control group of 641 (82.17%) patients after the complete one. Patients were scheduled for follow-up examinations every 6 months - including cytology, HPV typing, and colposcopy with tissue sampling. The Chi-square test or Fisher's exact test was performed as a tool for group comparisons for variables on the qualitative scale. Univariable and multivariable logistic regression models have been used to determine factors associated with the risk of persistent or recurrent HSIL. To evaluate the discriminatory ability of the logistic regression models, the Area Under the Curve (AUC) was calculated. The statistical analysis results don't indicate a statistical significance between the frequency of HSIL in groups. HPV infection has increased the risk of persistent/recurrent lesions by 38 times, constituting the most important factor. Close follow-up instead of inconsiderate repeat procedures should be taken under consideration among patients of reproductive age after incomplete conization of the cervix. HPV typing may be an essential method to predict recurrent cervical dysplasia. Promoting HPV typing and vaccination can reduce the number of invasive procedures and improve quality of life and obstetrics outcomes.

Mean platelet volume as a prognostic factor in ovarian lesions

Even nowadays the diagnostic of ovarian cancer is difficult to be established preoperatively, and therefore a significant number of patients are submitted to a too extensive or to an incomplete surgical procedure. Therefore attention was focused on identifying more reliable markers which might help the clinician to distinguish between benign and malignant ovarian lesions. The aim of the current paper is to analyze the differences between benign and malignant ovarian tumors based on the preoperative levels of the mean platelet volume.

Efficacy, Safety, and Acceptability of Manual Vacuum Aspiration with Para Cervical Block as a Management of Incomplete Abortion

Limited access to safe abortion is a leading cause of maternal mortality and morbidity in the developing world, overwhelming hospitals with a large number of women seeking treatment for complications of unsafe abortion. In many cases, more than half of all gynecological admissions are due to incomplete or septic abortions. The primary aims were to assess the efficacy and cost-effectiveness of the manual vacuum aspiration (MVA) procedure for managing incomplete abortion, considering completeness, procedure, duration, and hemorrhage. Additionally, safety aspects, such as complications (hemorrhage, perforation, and cervical injury), pain relief, patient satisfaction, and factors like reduced hospital stays and waiting times, were evaluated. This descriptive cross-sectional study was conducted at Dhaka Medical College and Hospital, focusing on women with incomplete abortions up to 12 weeks of gestation. It took place over six months from July to December 2013, with a purposive sample of 100 cases selected based on specific criteria to represent the study's objectives. Statistical analysis was done by using SPSS (version 16.0, SPSS Inc., Chicago, Illinois, USA). Out of 100 respondents, more than two-third of the patients (68%) were in 21-30 years age group. Half of the patients (50%) came from lower middle class family and most of them were housewives (80%). Majority (58%) of the patients had average gestational age 6-10 weeks. More than two-third (70%) of the patients had incomplete abortion, with 47% having attempted to terminate pregnancy. Abdominal pain was reported among 64% of patients, and the average bleeding period was 5-7 days for 62% of them. More than two-third (68%) of patients had no palpable uterus, and active bleeding was also found among two-third 66.0% of cases. Nearly one-third of the patients (32%) received injectable oxytocin and 13% received blood transfusion. Method of para-cervical block was applied for pain management in all patients (100%), while pethidine was used in only 3% of cases. Almost all of the patients 97%) were given sedatives (diazepam) and oral non-steroidal anti-inflammatory drugs (NSAIDs). Duration for the procedure was 10-15 minutes for 46% of patients, and excessive hemorrhage was found in 2% of cases. The average hospital stay ranged from 2-11 hours. Treatment cost in the majority of cases was only 75-150 Bangladeshi taka (BDT), which was statistically significant. The MVA with paracervical block was found to be efficient for treatment of incomplete abortions during the first trimester of pregnancy, with few complications. MVA procedure had less blood loss, less time consuming, safe and effective with shorter hospital stay. Bangladesh Med J. 2022 May; 51(2): 21-29

Long-term follow-up of patients with complex coronary artery disease treated with minimally invasive direct coronary artery bypass.

Patients with complex coronary artery disease (CAD) may benefit from surgical myocardial revascularization but weighing the risk of peri-operative complications against the expected merit is difficult. Minimally invasive direct artery bypass (MIDCAB) procedures are less invasive, provide the prognostic advantage of operative revascularization of the left anterior descending artery and may be integrated in hybrid strategies. Herein, the outcomes between patients with coronary 1-vessel disease (1-VD) and patients with 2-VD and 3-VD after MIDCAB procedures were compared in this single-center study. Between 1998 and 2018, 1363 patients underwent MIDCAB at the documented institution. 628 (46.1%) patients had 1-VD, 434 (31.9%) patients 2-VD and 300 (22.0%) patients suffered from 3-VD. Data of patients with 2-VD, and 3-VD were pooled as multi-VD (MVD). Patients with MVD were older (66.2 ± 10.9 vs. 62.9 ± 11.2 years; p < 0.001) and presented with a higher EuroScore II (2.10 [0.4; 34.2] vs. 1.2 [0.4; 12.1]; p < 0.001). Procedure time was longer in MVD patients (131.1 ± 50.3 min vs. 122.2 ± 34.5 min; p < 0.001). Post-operatively, MVD patients had a higher stroke rate (17 [2.3%] vs. 4 [0.6%]; p = 0.014). No difference in 30-day mortality was observed (12 [1.6%] vs. 4 [0.6%]; p = 0.128). Survival after 15 years was significantly lower in MVD patients (p < 0.01). Hybrid procedures were planned in 295 (40.2%) patients with MVD and realized in 183 (61.2%) cases. MVD patients with incomplete hybrid procedures had a significantly decreased long-term survival compared to cases with complete revascularization (p < 0.01). Minimally invasive direct coronary artery bypass procedures are low-risk surgical procedures. If hybrid procedures have been planned, completion of revascularization should be a major goal.

Unlocking the Potential of Left Cardiac Sympathetic Denervation: A Scoping Review of a Promising Approach for Long QT Syndrome.

Left cardiac sympathetic denervation (LCSD) has emerged as an alternative therapy for individuals diagnosed with long QT syndrome (LQTS), a genetic disorder characterized by abnormal electrical activity in the heart and sudden cardiac death (SCD). This review examines the history and rationale behind LCSD in LQTS treatment, as well as the procedure, its efficacy, and indications along with the adverse effects that may be associated with it. LQTS presents with prolonged QT intervals on an electrocardiogram and can manifest asseizures, fainting, and SCD. Beta-blockers are the primary treatment for LQTS but some patients do not respond well to these medications or experience side effects. Additionally, implantable cardioverter-defibrillators (ICDs) are not always effective in preventing arrhythmias and can lead to complications. LCSD might offer an alternative approach by disrupting sympathetic activity in the heart. In humans, LCSD reduces the release of norepinephrine, normalizes the QT interval, and decreases the likelihood of life-threatening heart rhythms. The procedure does not impair heart rate or cardiac function due to the compensatory effects of the right cardiac sympathetic nerves. The surgical procedure for LCSD involves the removal of the lower half of the stellate ganglion and thoracic ganglia. Complete denervation is essential for optimal outcomes, while incomplete procedures are considered unacceptable. Traditional and minimally invasive approaches, such as video-assisted thoracic surgery (VATS), are available, with VATS offering shorter hospital stays and fewer complications. In conclusion, LCSD provides a viable treatment option for individuals with LQTS who do not respond well to beta-blockers or require additional protection beyond medication or ICDs. Further research and clinical experience are needed to enhance its acceptance and implementation in routine practice.

Flying endoscopists in the Arctic: initiatives for quality assurance of endoscopies in Greenland

BackgroundSurgical coastal expeditions (SCEs) have been organized in Greenland for many years. They aim to provide small coastal hospitals with specialist services, such as endoscopies (SCEEs), by deploying specialist personnel, surgeons, and the necessary equipment to the hospital temporarily. The purpose of this program is to increase accessibility for patients, while simultaneously reducing the costs associated with patient transport to the central hospital.MethodsThis retrospective pilot review of medical records identified quality indicators, such as bowel cleansing (BP), cecal intubation rate (CIR), and adenoma and advanced adenoma detection rates (ADR, AADR), to investigate the status and establish a system for quality monitoring of SCEsE in Greenland.ResultsDuring two SCEs (8 working days), 89 SCEE were performed at Qaqortoq and Sisimiut Hospitals. The 60 patients who underwent colonoscopy included 32 men and 28 women with a mean age of 61 years (range 24–80 years). The unadjusted CIR was 91.7%. In eight (13.3%) examinations, bowel preparation was rated as unsatisfactory, resulting in two incomplete procedures. The ADR and AADR were 35% and 11.7%, respectively, and one cancer was detected (1.7%).ConclusionThe results showed satisfactory ADR, AADR, and CIR levels. However, the review also highlighted the need for increased attention to BP by developing a new procedure that considers differences due to specific eating habits in Greenland and provides much better information for patients. The review provided a snapshot of the quality of colonoscopies in Greenland, highlighting the necessity to continue this process to ensure that the quality is up to standard. Furthermore, SCE helps reduce the environmental footprint of gastrointestinal endoscopy by avoiding the need for patient air transport; instead of 77 round trips (61,830 km), only 8 (6440 km) were required.

FTP2.8 The impact of implementation of a colon capsule endoscopy (CCE) service on demand for lower GI endoscopy: A retrospective analysis in a large district general hospital

Abstract Aims Demand on endoscopy services have increased due to higher numbers of 2WW referrals and the COVID-19 backlog. Alternatives to endoscopy including CT colonography and colon capsule endoscopy (CCE) have been seen as a way to reduce pressure on endoscopy services. Our centre implemented a CCE service, for patients referred via 2WW colorectal pathway with FIT of 10-100μg Hb/g, or undergoing surveillance. We analysed the impact of this service. Methods We retrospectively analysed patients referred for CCE, from initiation of the service in July 2021 to October 2022. We analysed presenting symptoms, findings at CCE, completion of CCE, and further investigations/treatment required. A total of 198 patients were included. Results 68% (134/198) of CCE were complete, defined as full visualisation of the large bowel through to the anus. 66% (89/134) of these required no further investigations. Of those patients requiring further investigations, 21 underwent flexible sigmoidoscopy, 15 underwent colonoscopy and 6 underwent CT-AP. Only 1 required an operation for malignancy. Of the 64 patients with incomplete CCEs, 63 underwent further investigations, mostly endoscopic (17 colonoscopies, 31 flexible sigmoidoscopies). Conclusions The implementation of a CCE service resulted in 94/198 patients not requiring endoscopic investigations over a 14 month period, highlighting the role for CCE in reducing endoscopy demand. However, there was a high rate of incomplete procedures (32%). With a higher rate of completion, a greater number of endoscopies could be avoided, further reducing the pressure on endoscopy departments.

Comparing the resource implications of old and new colorectal adenoma surveillance guidelines in Australia.

The latest update to the Australian adenoma surveillance guideline in 2018 introduced a novel risk stratification system with updated surveillance recommendations. The resource implications of adopting this new system are unclear. To quanitfy the resource demands of adopting new over old adenoma surveillance guidelines. We studied data from 2443 patients undergoing colonoscopies, in which a clinically significant lesion was identified in their latest, or previous procedure(s) across five Australian hospitals. We excluded procedures with inflammatory bowel disease, new or prior history of colorectal cancer or resection, inadequate bowel preparation and incomplete procedures. Old and new Australian surveillance intervals were calculated according to the number, size and histological characteristics of lesions identified. We used these data to compare the rate of procedures according to each guideline. Based on the procedures for 766 patients, the new surveillance guidelines significantly increased the number of procedures allocated an interval of 1 year (relative risk (RR): 1.57, P = 0.009) and 10 years (RR: 3.83, P < 0.00001) and reduced those allocated to half a year (RR: 0.08, P = 0.00219), 3 years (RR: 0.51, P < 0.00001) and 5 years (RR: 0.59, P < 0.00001). Overall, this reduced the relative number of surveillance procedures by 21% over 10 years (25.92 vs 32.78 procedures/100 patient-years), which increased to 22% after excluding patients 75 or older at the time of surveillance (19.9 vs 25.65 procedures/100 patient-years). The adoption of the latest Australian adenoma surveillance guidelines can reduce demand for surveillance colonoscopy by more than a fifth (21-22%) over 10 years.

Revisiting bowel preparation: The quest for the optimal low‐residue diet duration

Revisiting bowel preparation: The quest for the optimal <scp>low‐residue</scp> diet duration

Accuracy of Time to Treatment Initiation Data in Musculoskeletal Soft Tissue Sarcoma.

Time to treatment initiation (TTI) is a quality metric in cancer care. The purpose of this study is to determine the accuracy of TTI data from a single cancer center registry that reports to the National Cancer Database (NCDB) for sarcoma diagnoses. A retrospective analysis of a single Commission on Cancer (CoC)-accredited cancer center's tumor registry between 2006 and 2016 identified 402 patients who underwent treatment of a musculoskeletal soft tissue sarcoma and had TTI data available. Registry-reported TTI was extracted from the tumor registry. Effective TTI was manually calculated by medical record review as the number of days from the date of tissue diagnosis to initiation of first effective treatment. Effective treatment was defined as oncologic surgical excision or initiation of radiation therapy or chemotherapy. Registry-reported TTI and effective TTI values were compared for concordance in all patients. In the entire cohort, 25% (99/402) of patients had TTI data discordance, all related to surgical treatment definition. For patients with a registry-reported value of TTI = 0 days, 74% (87/118) had a diagnostic surgical procedure coded as their first treatment event, with 73 unplanned incomplete excision procedures and 14 incisional biopsies. In these patients, effective TTI was on average 59 days (P < 0.001). For patients with a registry-reported value of TTI >0 days, only 4% (12/284) had discordant TTI values. Nearly three-fourths of patients with a registry-reported value of TTI = 0 days in a large, CoC-accredited cancer center registry had a diagnostic procedure coded as their first treatment event, though their effective treatment had not yet started. These data suggest that TTI is likely longer than what is reported to the NCDB. Redefinition of what constitutes surgical treatment should be considered to improve the accuracy of data used in measuring TTI in sarcoma.

Quality Standards in Upper Gastrointestinal Endoscopy: Can Deep Sedation Influence It?

Introduction: According to the guideline published by ESGE/UEG, a high-quality esophagogastroduodenoscopy (EGD) implies the application of some criteria that enable better healthcare outcomes. Although intra-procedural performance measures are dependent on patient factors, there is no reference to sedation practices in the guideline mentioned above. Objective: This study aimed to evaluate whether deep sedation influences EGD performance measures established by ESGE/UEG. Methods: This was a cross-sectional study, with a prospective enrollment, that considered for inclusion consecutive patients referred for EGD. Two questionnaires were used to assess performance measures and patient satisfaction after EGD. Results: Sedation had a statistically significant impact on most quality indicators, including complete examination (77.2% without sedation vs. 97.8% with sedation), inspection time (6.17 ± 3.45 vs. 8.39 ± 2.67 min), photodocumentation (78% vs. 97.8%), biopsies (39.3% vs. 60.7%), and patient satisfaction (5.42 ± 2.93 vs. 9.1 ± 1.19). The main reason for an incomplete procedure was patient intolerance (82.6%). Discussion: Deep sedation of patients submitted to EGD proved to be a determinant in the applicability of the ESGE/UEG quality indicators. Patient intolerance was eliminated in the group with sedation, enhancing procedure completeness, adequate pathology identification, management, and consequently, the effectiveness of the exam. Conclusion: Sedation administration should be considered in patients undergoing EGD since it ensures a high-quality procedure.

Comparison of Needle Knife versus Scissors Forceps for Colorectal Endoscopic Submucosal Dissection: A Prospective Randomized Study

To evaluate the efficacy and safety of a grasping-type knife, called Clutch Cutter (CC), for colorectal endoscopic submucosal dissection (C-ESD). This was a randomized prospective study. Patients who underwent C-ESD for colorectal neoplasms >20 mm and <50 mm in size were enrolled, dividing into two groups: ESD using needle type of dual knife alone (D-group) and circumferential incision using dual knife followed by submucosal dissection using CC (CC-group). The primary outcome was the self-completion rate. The secondary outcomes were intraoperative complication rate, procedure time, and en bloc resection rate. A total of 45 patients were allocated to the D-group and 43 to the CC-group were allocated. The self-completion rate was higher in the CC-group (87% [39/45] vs. 98% [42/43]). All of the six patients with an incomplete procedure in the D-group were completely resected with CC use. The intraoperative complication rate was not significant in either group (D vs. CC: 2% vs. 0%). The mean procedure time was significantly shorter in the D-group than that in the CC-group (62.0 vs. 81.1 min; p = 0.0036). The en bloc resection rate was 100% in the D-group and 98% in the CC-group. While dual knife use is superior to CC in terms of time efficiency, the use of CC may be a safe and efficacious option for achieving complete C-ESD.

Clinical evaluation of a new hand-driven hysteroscopic tissue removal device, Resectr™ 5fr, for the resection of endometrial polyps in an office setting.

A first clinical evaluation of a new hand-driven hysteroscopic tissue removal device, Resectr™ 5fr, for office polypectomy without any anesthesia. Women with at least one small endometrial polyp were eligible. Hysteroscopic polypectomy was performed using the Resectr™ 5fr in an office setting, without any anesthesia. One hundred and two hysteroscopic polypectomies were included in the analysis. The median installation time was 1.9min (95% confidence interval (CI) 1.6-2.1). The median time to complete polyp removal was 1.2min (95% CI 0.8-1.6). The median surgeon's safety, practical, and comfort scores on a 5-point Likert scale were high (5 (5-5), 5 (4-5), and 5 (4-5), respectively). Women's pain score was low (median 1 (0-3)), whereas the satisfaction rate was high (median 5 (5-5)), both on a 5-point Likert scale. There were two conversions (hysteroscopic scissors (n = 1), a new Resectr™ 5fr device (n = 1)). There was one incomplete procedure (tissue hardness). Hysteroscopic removal of small polyps, using the [Formula: see text] 5fr in an office setting is feasible in terms of installation and resection time. Surgeon's practical, comfort, and safety scores are high, whereas women report low pain scores and high satisfaction rates. TRIAL REGISTRATION: Dutch Clinical Trial Registry (NTR 7119, NL6923): https://www.trialregister.nl/trial/6923 . Date of registration: 27/03/2018.