Increase In Duration Of Operation Research Articles

Comparison of results among UBE-TLIF, MIS-TLIF and open TLIF for Meyerding grade I lumbar spondylolisthesis: a retrospective study

BackgroundThe unilateral biportal endoscopic (UBE) technique has garnered significant attention for its little paraspinal iatrogenic damage, expedited recovery, and low complication rates. This method is also applicable to open transforaminal lumbar interbody fusion (TLIF). Therefore, this study aimed to conduct a comparative analysis of the outcomes associated with unilateral biportal endoscopic transforaminal lumbar interbody fusion (UBE-TLIF), minimally invasive transforaminal lumbar interbody fusion (MIS-TLIF), and TLIF for Meyerding grade I lumbar spondylolisthesis.MethodsThe study examined the outcomes of 79 patients with Meyerding grade I lumbar spondylolisthesis who underwent single-level intervertebral fusion. Clinical assessments included the measurement of pain levels using the Visual Analogue Scale (VAS) for low back and leg pain, the Oswestry Disability Index (ODI), surgical data, and demographic information. Imaging techniques were utilized to evaluate the fusion rate.ResultsThe VAS-Back demonstrated a statistically significant improvement in Group UBE-TLIF compared to the other groups at the one-week postoperative evaluation (p < .05). Additionally, the UBE-TLIF group exhibited a significantly longer total operative time compared to the other groups (p < .05). However, it was noted that the Postop Hemovac drain were significantly greater in the MIS-TLIF and TLIF groups compared to the UBE-TLIF group (p < .05).ConclusionsThe present research demonstrated the effectiveness of UBE-TLIF, MIS-TLIF, and TLIF as surgical approaches for treating Meyerding grade I lumbar spondylolisthesis. Among these methods, UBE-TLIF demonstrated a reduction in Postop Hemovac drain, and an increase in operative duration.

Association of omental pedicled flap with anastomotic leak following low anterior resection for rectal cancer.

Anastomotic leak following colorectal anastomosis adversely impacts short-term, oncologic, and quality-of-life outcomes. This study aimed to assess the impact of omental pedicled flap (OPF) on anastomotic leak among patients undergoing low anastomotic resection (LAR) for rectal cancer using a multi-institutional database. Adult rectal cancer patients in the US Rectal Cancer Consortium, who underwent a LAR for stage I-III rectal cancer with or without an OPF were included. Patients with missing data for surgery type and OPF use were excluded from the analysis. The primary outcome was the development of anastomotic leaks. Multivariable logistic regression was used to determine the association. A total of 853 patients met the inclusion criteria and OPF was used in 106 (12.4%) patients. There was no difference in age, sex, or tumor stage of patients who underwent OPF versus those who did not. OPF use was not associated with an anastomotic leak (p = 0.82), or operative blood loss (p = 0.54) but was associated with an increase in the operative duration [β = 21.42 (95% confidence interval = 1.16, 41.67) p = 0.04]. Among patients undergoing LAR for rectal cancer, OPF use was associated with an increase in operative duration without any impact on the rate of anastomotic leak.

Assessment of Team Dynamics and Operative Efficiency in Hip and Knee Arthroplasty

Surgical team communication is a critical component of operative efficiency. The factors underlying optimal communication, including team turnover, role composition, and mutual familiarity, remain underinvestigated in the operating room. To assess staff turnover, trainee involvement, and surgeon staff preferences in terms of intraoperative efficiency. Retrospective analysis of staff characteristics and operating times for all total joint arthroplasties was performed at a tertiary academic medical center by 5 surgeons from January 1 to December 31, 2018. Data were analyzed from May 1, 2021, to February 18, 2022. The study included cases with primary total hip arthroplasties (THAs) and primary total knee arthroplasties (TKAs) comprising all primary total joint arthroplasties performed over the 1-year study interval. Intraoperative turnover among nonsurgical staff, presence of trainees, and presence of surgeon-preferred staff. Incision time, procedure time, and room time for each surgery. Multivariable regression analyses between operative duration, presence of surgeon-preferred staff, and turnover among nonsurgical personnel were conducted. A total of 641 cases, including 279 THAs (51% female; median age, 64 [IQR, 56.3-71.5] years) and 362 TKAs (66% [238] female; median age, 68 [IQR, 61.1-74.1] years) were considered. Turnover among circulating nurses was associated with a significant increase in operative duration in both THAs and TKAs, with estimated differences of 19.6 minutes (SE, 3.5; P < .001) of room time in THAs and 14.0 minutes (SE, 3.1; P < .001) of room time in TKAs. The presence of a preferred anesthesiologist or surgical technician was associated with significant decreases of 26.5 minutes (SE, 8.8; P = .003) of procedure time and 12.6 minutes (SE, 4.0; P = .002) of room time, respectively, in TKAs. The presence of a surgeon-preferred vendor was associated with a significant increase in operative duration in both THAs (26.3 minutes; SE, 7.3; P < .001) and TKAs (29.6 minutes; SE, 9.6; P = .002). This study found that turnover among operative staff is associated with procedural inefficiency. In contrast, the presence of surgeon-preferred staff may facilitate intraoperative efficiency. Administrative or technologic support of perioperative communication and team continuity may help improve operative efficiency.

Quantifying Complications: An Analysis of Operative Time and Intraoperative Factors in Microsurgical Breast Reconstruction.

Analysis of operative flow has been shown to improve efficiency in breast microsurgery. Both complex decision-making skills and technical mastery are required to overcome intraoperative challenges encountered during microsurgical reconstruction. Effects of intraoperative complications on operative time have not yet been reported. A retrospective chart review of microsurgical breast reconstructions by three surgeons between 2013-2020 analyzed operative variables and duration. Intraoperative complications were determined from the operative report. Correlations between continuous variables were determined using Spearman correlation coefficients. Nonparametric testing was used when comparing operative duration between groups. Operative duration was analyzed for 547 autologous breast reconstruction cases; 210 reconstructions were unilateral and 337 were bilateral. Average operative duration was 471.2 SD 132.2 minutes overall (360.1 SD 100.5 minutes for unilateral cases and 530.5 SD 110.5 minutes for bilateral cases). Operative duration decreased with surgeon experience (r = -0.17, p< .001).Regarding intraoperative complications, difficult donor dissection was correlated with an average operative duration increase of 91.7 minutes (n = 43, 7.9%, p< .001), pedicle injury with an additional 67.7 minutes (n = 19, 3.5%, p = .02) and difficult recipient vessel dissection with an increase of 63.0 minutes (n = 35, 6.4%, p = .003). Complications with anastomosis also showed a statistically significant increase in operative duration, with arterial complications resulting in an increase of 104.3 minutes (n = 41, 7.5%, p< .001) and venous complications resulting in an increase in 78.8 minutes (n = 32, 5.8%, p< .001). Intraoperative thrombus resulted in an increase of 125.5 minutes (n = 20, 3.7%, p< .001), and requiring alternative venous outflow added an average of 193.7 minutes (n = 8, 1.5%, p< .001). Intraoperative complications in autologous breast reconstruction significantly increase operative time. The greatest increase in operative time is seen with intraoperative thrombosis or requiring alternative venous outflow. As these complications are rarely encountered in breast microsurgery, opportunities for simulation and case-based practice exist to improve efficiency.

Comparative Study between Lichtenstein Repair and Trans Abdominal Pre Peritoneal Repair of Inguinal Hernia (TAPP)

Abstract Background Inguinal hernia repair is one of the most widely performed surgical procedure. Among the techniques used, the open Lichtenstein repair is still the most widely performed. However, in the last decade there has been an increased interest in the laparoscopic approach for inguinal hernia repair, mainly represented as the trans-abdominal pre- peritoneal (TAPP) technique. As described in recent studies, TAPP approach entails the benefits of minimally invasive surgery, such as less pain and early recovery. Objective s: This study aims to compare between lichtenstein repair of inguinal hernia and trans-abdominal pre-peritoneal repair of inguinal hernia (TAPP) as regard their hospital stay, cost, intra-operative &amp; post-operative complications and short term recurrence. Patients and Methods Our study was carried out on (50) male patients with inguinal hernia, 25 patients underwent laparoscopic TAPP repair and 25 patients underwent open Lichtenstein repair. We found a highly significant difference of laparoscopic TAPP Repair in decreasing post-operative pain than in open repair. Results Comparative study between the 2 groups revealed non-significant difference as regards age and sex of the patients. Comparative study between the 2 groups revealed non-significant difference as regards all socio-demographic data. Comparative study between the 2 groups revealed non-significant difference as regards type and side of hernia. Comparative study between the 2 groups revealed; highly significant increase in operative duration in laparoscopic group; compared to open group of patients; with highly significant statistical difference. Comparative study between the 2 groups revealed; highly significant decrease in post-operative pain score and post-operative hospital stay; in laparoscopic group; compared to open group of patients; with highly significant statistical difference. Comparative study between the 2 groups revealed; highly significant decrease in intra-operative complications in laparoscopic group; compared to open group of patients; with highly significant statistical difference. Conclusion Our study showed that laparoscopic TAPP approach for inguinal hernia repair reduces early post-operative pain. Furthermore, it is related to less complications, although it takes a longer operative time and higher cost.

A 15-Minute Incremental Increase in Operative Duration Is Associated With an Additional Risk of Complications Within 30 Days After Arthroscopic Rotator Cuff Repair.

Background:Operative time is a risk factor for short-term complications after orthopaedic procedures; however, it has yet to be investigated as an independent risk factor for postoperative complications after arthroscopic rotator cuff repair.Purpose:To determine whether operative time is an independent risk factor for complications, readmissions, and extended hospital stays within 30 days after arthroscopic rotator cuff repair.Study Design:Descriptive epidemiology study.Methods:The American College of Surgeons National Surgical Quality Improvement Program was queried for all hospital-based inpatient and outpatient arthroscopic rotator cuff repairs (Current Procedural Terminology code 29827) from 2005 to 2016. Concomitant procedures such as subacromial decompression, biceps tenodesis, superior labrum anterior and posterior (SLAP) repair, labral repair, and distal clavicle excision were also included, whereas patients undergoing arthroplasty were excluded from the study. Operative time was correlated with patient demographics, comorbidities, and concomitant procedures. All adverse events were correlated with operative time, while controlling for the above preoperative variables, using multivariate Poisson regression with a robust error variance.Results:A total of 27,524 procedures met inclusion and exclusion criteria. The mean age of patients was 58.4 ± 10.9 years, the mean operative time was 86.9 ± 37.4 minutes, and the mean body mass index was 30.4 ± 7.0 kg/m2. Concomitant biceps tenodesis, glenohumeral debridement, SLAP repair, labral repair, and distal clavicle excision significantly increased operative time (P < .001) but not the risk of adverse events (P > .05). The overall rate of adverse events was 0.88%. After adjusting for demographic and procedural characteristics, a 15-minute increase in operative duration was associated with an increased risk of anemia requiring transfusion (relative risk [RR], 1.27 [95% CI, 1.14-1.42]; P < .001), venous thromboembolism (RR, 1.17 [95% CI, 1.02-1.35]; P = .029), surgical site infection (RR, 1.13 [95% CI, 1.03-1.24]; P = .011), and extended length of hospital stay (RR, 1.07 [95% CI, 1.00-1.14]; P = .036).Conclusion:Although the rate of short-term complications after arthroscopic rotator cuff repair is low, incremental increases in operative time are associated with an increased risk of adverse events such as surgical site infection, pulmonary embolism, transfusion, and extended length of hospital stay. Efforts should be made to maximize surgical efficiency in the operating room through optimal coordination of the staff or increased preoperative planning.

Investigation of the usefulness of fluorescein sodium fluorescence in stereotactic brain biopsy.

Intraoperative frozen section assessment, to confirm acquisition of pathological tissues, is used in stereotactic brain biopsy to minimise sampling errors. Limitations include the dependence on dedicated neuro-oncology pathologists and an increase in operative duration. We investigated the use of intraoperative fluorescein sodium, and compared it to frozen section assessment, for confirming pathological tissue samples in the stereotactic biopsy of gadolinium-contrast-enhancing brain lesions. This prospective observational study consisted of 18 consecutive patients (12 men; median age, 63years) who underwent stereotactic biopsy of gadolinium-contrast-enhancing brain lesions with intravenous fluorescein sodium administration. Twenty-three specimens were obtained and examined for the presence of fluorescence using a microscope with fluorescence visualisation capability. Positive and negative predictive values were calculated based on the fluorescence status of the biopsy samples with its corresponding intraoperative frozen section and definitive histopathological diagnosis. Nineteen specimens (83%) were fluorescent and four (17%) were non-fluorescent. All 19 fluorescent specimens were confirmed to be lesional on intraoperative frozen section assessment and were suitable for histopathological diagnosis. Three of the non-fluorescent specimens were confirmed to be lesional on intraoperative frozen section assessment. One non-fluorescent specimen was non-diagnostic on frozen section and histological assessments. The positive predictive value was 100% and the negative predictive value was 25%. Fluorescein sodium fluorescence is as accurate as frozen section assessment in confirming sampling of pathological tissue in the stereotactic biopsy of gadolinium-contrast-enhancing brain lesions. Fluorescein sodium fluorescence-guided stereotactic biopsy is a useful addition to the neurosurgical armamentarium.

Resident impact on operative duration for elective general surgical procedures

BackgroundResident involvement in operations increases operative duration. This study investigated resident impact on operative time for a single general surgeon in an outpatient surgical setting. MethodsA retrospective review was performed of index general surgical operations meeting inclusion criteria. Operative duration, patient demographics, 30-day complication/readmission rates, and degree of resident involvement were collected. Results625 cases were analyzed. Patient demographics were similar for all procedural comparison groups. Operative time increased with resident involvement for each operation—umbilical hernia repairs were associated with a 19% increase (22.3 ± 6.7 versus 26.5 ± 7.5 min, p = 0.002), laparoscopic cholecystectomies demonstrated a 15% increase (25.8 ± 8.7 versus 29.7 ± 10.2 min, p = 0.001), and laparoscopic inguinal hernia repairs demonstrated a 25% increase (32.1 ± 11.3 versus 40.2 ± 8.9 min, p < 0.001). ConclusionsEach surgeon must decide if the increase in operative duration caused by resident involvement is justified by the intangible benefits residents provide.

Product Temperature Response of a Locally Developed Extruder to Maize Processing

Product temperature is a very important system parameter as well as an indicator of extrusion process. In this study, the product temperature response of a single screw extruder developed locally was investigated for the extrusion process of the flour and starch of maize. A factorial experiment in completely randomized design was employed to study the effect of extrusion variables: feed moisture (30, 40, 50 %), extruder temperature (40, 70, 100oC) built up by varying the duration of sampling and screw speed (100, 150, 200 rpm) on product temperature. Product temperature increased with increase in duration of operation. A maximum temperature of 150oC was attained in 30 minutes through viscous dissipation Also, the study revealed that the product temperature is strongly related to the extrusion process parameters under study and the proximate composition of samples. Also, Product temperature increased at 100 and 150 rpm but decreased at 200 rpm. The equations relating the various dependent and independent variables were established to predict the extruder’s performance for maize processing. Quadratic coefficients fit the extrusion data very well, better than linear models.

Safety and efficacy of using the stone cone and an entrapment and extraction device in ureteroscopic lithotripsy for ureteric stones

ObjectiveTo assess the safety and efficacy of using a stone cone and an entrapment and extraction device (N-Trap®, Cook Urological, Bloomington, IN, USA) to avoid stone retropulsion during ureteroscopic lithotripsy for ureteric stones. Patients and methodsThis retrospective comparative study included 436 patients treated with ureteroscopic lithotripsy for a single ureteric stone from February 2011 to January 2014. The diagnosis of a stone was confirmed by plain spiral computed tomography in all cases. Patients were divided according to the ureteric occlusion device applied to avoid stone retropulsion during pneumatic lithotripsy into three groups; group 1 (156) had no instruments used, group 2 (140) in whom the stone cone was applied, and group 3 (140) in whom the N-Trap was used. Patient demographics, stone criteria, operative duration and complications, and success rates (complete stone disintegration with no upward migration) were reported and analysed statistically. ResultsThe stone was in the lower ureter in >55% of patients in all groups. The mean (SD) of maximum stone length was 9.8 (2.5), 10.4 (2.8) and 9.7 (2.9) in groups 1–3, respectively. The use of the stone cone or N-Trap did not significantly increase the operative duration (P=0.13) or complication rates (P=0.67). There was a statistically significant difference (P<0.001) favouring groups 2 and 3 for retropulsion and success rates, being 83.3% in group 1, 97.1% in group 2 and 95.7% in group 3. ConclusionThe stone cone and N-Trap gave high success rates in preventing stone retropulsion during ureteric pneumatic lithotripsy. Both devices caused no increase in operative duration or complications when used cautiously.

Laparoscopic Ladd's Procedure: Treatment of Choice for Midgut Malrotation in Infants and Children

Rotational anomalies of the midgut encompass a broad spectrum of incomplete rotational events with malfixation of the intestines during fetal development. Ladd's procedure, as a correction of these anomalies, has traditionally been performed by laparotomy. In our institution, the laparoscopic Ladd's (LL) procedure was introduced in May 2004 and soon became the standard approach. A retrospective analysis of all Ladd's procedures in children in our institution between September 1998 and June 2008 was performed. Outcomes between the open (OL) and LL procedures were compared. A total of 156 children underwent Ladd's procedure during the study period. There were 120 open and 36 laparoscopic procedures. Overall, 75% of patients in each group were symptomatic, most commonly with emesis and pain. Duration of surgery was similar in both groups. Time to starting feeds, and amount of time to attain full feeding, was significantly less in the LL group. Postoperative length of stay was significantly less in the patients having LL. Conversion rate to OL from LL was 8.3%. LL can be performed safely in selected patients with no increase in complications. Short-term results are superior to OL and can be achieved without any increase in operative duration.

Routine early laparoscopic cholecystectomy for acute cholecystitis after conclusion of a randomized controlled trial

The aim of this retrospective review was to assess the clinical outcomes of laparoscopic cholecystectomy for acute cholecystitis since the conclusion of a randomized controlled trial in 1997. Records of all patients admitted for acute cholecystitis in whom early laparoscopic cholecystectomy was attempted between July 1997 and December 2004 were reviewed. A total of 209 patients were recruited to this study. Forty-three surgeons performed the procedures. The conversion rate increased significantly in the early period after the trial from 21 per cent to 42 per cent (39 of 92 patients) and decreased significantly to 24 per cent (13 of 54 patients) in the later period. The proportion of operations performed by higher surgical trainees increased significantly from 17 per cent in the early period to 56 per cent in the later period. This increase was associated with a fall in conversion rate without any significant increase in duration of operation or complication rate. This study has demonstrated that the results achieved in a randomized trial can be translated into clinical practice by the entire surgical unit. A structured training programme with the inclusion of an experienced surgeon assisting both trainees and specialists should minimize this learning curve.