Increase In Operative Time Research Articles

Influence of degradation disease on tunnel stability based on a time-dependent constitutive model

The surrounding rock and lining of tunnels deteriorate with increasing operation time, which causes changes in the mechanical parameters of the lining material and then affects the stability of tunnels. According to the time degradation law of the lining proposed in this paper, the mechanical parameters of lining materials corresponding to different operation years of the tunnel can be obtained. Model tests of the lining without degradation and degradation for 10, 30, and 50 years were carried out. Based on the realistic failure process analysis (RFPA2D) system, the time-dependent failure constitutive model is introduced to simulate the degradation of the surrounding rock and lining. Based on the model test and numerical analysis, the influence of degradation on the mechanics and failure features of tunnel were studied. It was found that the degradation would impact the structural stress and the stability of the surrounding rock. The failure mode of the model and the loading stress were different with the degradation time. The longer the degradation time, the more serious the deformation of the vault, and the larger the damage area of the surrounding rock. The research results play an important theoretical guiding role in analysing the progressive failure process of the surrounding rock and lining and have great value in engineering applications for reinforcing and treating tunnel defects.

Experimental Study on the Effect of Hydraulic Deterioration of Different Drainage Systems on Lining Water Pressure

With the increasing operation time of tunnels, the drainage system cannot fulfil its proper function as a result of the deterioration of traditional waterproof and drainage systems (TWDS), such as the blockage of drainage blind pipes and the failure of drainage boards. Therefore, the lining bears a high water pressure and even causes disasters such as tunnel leakage and lining cracking. An effective solution to mitigate these issues is to adjust the tunnel drainage scheme. In view of this, a composite waterproof and drainage system (CWDS) is proposed in this paper. To verify the effectiveness of the proposed system, a series of model experiments were conducted to study the change law of the seepage field of two drainage systems under different blockage conditions. The study results showed that longitudinal blind pipe blockage caused a more significant increase in water pressure than circular blind pipe blockage. In the case of blind pipe blockage, the water pressure of the TWDS tunnels rise rapidly, while the CWDS tunnels could effectively drain and reduce pressure.

Optimization of tissue adhesive curing time for surgical wound closure.

AimsTissue adhesives (TAs) are a commonly used adjunct to traditional surgical wound closures. However, TAs must be allowed to dry before application of a surgical dressing, increasing operating time and reducing intraoperative efficiency. The goal of this study is to identify a practical method for decreasing the curing time for TAs.MethodsSix techniques were tested to determine which one resulted in the quickest drying time for 2-octyle cyanoacrylate (Dermabond) skin adhesive. These were nothing (control), fanning with a hand (Fanning), covering with a hand (Covering), bringing operating room lights close (OR Lights), ultraviolet lights (UV Light), or prewarming the TA applicator in a hot water bath (Hot Water Bath). Equal amounts of TA were applied to a reproducible plexiglass surface and allowed to dry while undergoing one of the six techniques. The time to complete dryness was recorded for ten specimens for each of the six techniques.ResultsUse of the Covering, OR Lights, and Hot Water Bath techniques were associated with a 25- (p = 0.042), 27- (p = 0.023), and 30-second (p = 0.009) reduction in drying time, respectively, when compared to controls. The UV Light (p = 0.404) and Fanning (p = 1.000) methods had no effect on drying time.ConclusionUse of the Covering, OR Lights, and Hot Water Bath techniques present a means for reducing overall operating time for surgeons using TA for closure augmentation, which can increase intraoperative efficiency. Further studies are needed to validate this in vivo.Cite this article: Bone Jt Open 2022;3(8):607–610.

Robotic surgery in gynaecology: Scientific Impact Paper No. 71 (July 2022).

The use of robotic-assisted keyhole surgery in gynaecology has expanded in recent years owing to technical advances. These include 3D viewing leading to improved depth perception, limitation of tremor, potential for greater precision and discrimination of tissues, a shorter learning curve and improved comfort for surgeons compared with conventional keyhole and open abdominal surgery. Robotic-assisted keyhole surgery, compared with conventional keyhole surgery, improves surgical performance without increasing operating time, minimises blood loss and intra- or postoperative complications, while reducing the need to revert to abdominal surgery. Moreover, surgeons using a robot experience fewer skeletomuscular problems of their own in the short and long term than those operating without a robot as an additional tool. This Scientific Impact Paper looks at the use of a robot in different fields of gynaecological surgery. A robot could be considered safe and a more effective surgical tool than conventional keyhole surgery for women who have to undergo complex gynaecology surgery or have associated medical issues such as body-mass index (BMI) at 30 kg/m2 or above or lung problems. The introduction of the use of robots in keyhole surgery has resulted in a decrease in the number of traditional open surgeries and the risk of conversion to open surgery after traditional keyhole surgery; both of which should be considered when examining the cost-benefit of using a robot. Limitations of robotic-assisted surgery remain the associated higher costs. In womb cancer surgery there is good evidence that introducing robotics into the service improves outcomes for women and may reduce costs.

Intraoperative Assessment of Reduction of the Ankle Syndesmosis.

Postoperative malreduction of the ankle syndesmosis is common, poorly defined, and its assessment is controversial. In the absence of a gold standard method to evaluate the ankle syndesmosis, a variety of techniques have been described. As the knowledgebase expands, data illustrating caveats for such techniques has become available. The purpose of this review is to highlight literature-sourced technical pearls and their related caveats for the intraoperative assessment of the ankle syndesmosis. Although numerical criteria are commonly used to assess syndesmotic reduction, anatomical variation in the healthy population frequently exceeds proposed cutoffs. Patient-specific uninjured anatomy can be defined by comparing to the uninjured contralateral ankle; however, side-to-side variation is present for many anatomical relationships. Advanced imaging (e.g., lateral radiographs, 3-dimensional radiography) can influence intraoperative surgeon decision-making and improve syndesmosis reduction, but minute improvements in syndesmosis reduction may not outweigh increased operating time and costs. Intraoperative imaging is an adjunct, not a replacement for direct visualization or palpation when reducing the syndesmosis. Arthroscopy may benefit younger patients with high physical demands by improving identification of intra-articular pathology absent on MRI. Although anatomical reduction is important to restore pre-injury biomechanics, it is unclear whether differences in reduction quality influence patient-reported outcomes. In the absence of a gold standard, awareness of the options for intraoperative assessment of the syndesmosis and their respective accuracy and limitations reported herein could enhance surgeons' ability to intraoperatively reduce the syndesmosis with the tools currently available.

Increasing warning resistance of engine valves by gas nitrogenization method

The article presents the results of tribological research on the most promising way to restore and increase the wear resistance of engine valves by developing a method of gas nitriding. It is established that with increasing operating time the guide bushings of the outlet connections wear out with the displacement of the axis of the forming surfaces of the hole. Characteristic significant displacement of the axes of the inlet connections is not detected, ie. their wear on the diameter of the hole is 1.5 ... 3 times less than the wear of the exhaust bushings, the values of the displacement of the axes are within the error of the measuring instrument. The average value of ovality is greater in the exhaust seats - the maximum beating values of the intake seats are 0.34 mm, exhaust - 0.22 mm. It is proved that the non-uniformity of the wear of the sleeve hole is determined by the balance of acting forces, which, in turn, are determined by deviations from the optimal ratios μ and e. the side of the rocker arm axis. Distortions of the valve in the longitudinal axis of the engine contribute to an earlier reduction in the tightness of the valve pairs. Redistribution of the valve end material with the formation of a wavy concentric surface, the shape of the contact spot on the rocker arm and the corresponding direction of wear of the saddle chamfer was observed in 43% of the studied connections. Technological means and methods for improving the quality of repair, measuring instruments for accurate study of the parameters of parts and connections of the valve group are given. The results of laboratory and operational tests are presented. A method of gas nitriding with an installation for its implementation has been developed, which provides an environmentally friendly method of low-temperature and high-temperature hardening, obtaining deeper and well-developed layers of the diffusion near-surface zone and reduces training, technological time in the process of strengthening and reducing energy consumption

Does Intraoperative Blood Loss Affect the Short-Term Outcomes and Prognosis of Gastric Cancer Patients After Gastrectomy? A Meta-Analysis.

PurposeThe purpose of the current meta-analysis was to analyze whether intraoperative blood loss (IBL) influenced the complications and prognosis of gastric cancer patients after gastrectomy.MethodsWe systematically searched the PubMed, Embase and Cochrane library databases on November 29, 2021. The Newcastle-Ottawa scale was used to evaluate the quality of included studies. This meta-analysis uses RevMan 5.3 for data analysis.ResultsA total of nine retrospective studies were included in this meta-analysis, involving 4653 patients. In terms of short-term outcomes, the Larger IBL group has a higher complication rate (OR = 1.94, 95% CI, 1.44 to 2.61, P < 0.0001) and a longer operation time (OR = 77.60, 95% CI, 41.95 to 113.25, P < 0.0001) compared with the smaller IBL group, but the Larger IBL group had higher total retrieved lymph nodes (OR = 3.68, 95% CI, 1.13 to 6.24, P = 0.005). After pooling up all the HRs, the Larger IBL group has worse overall survival (OS) (HR = 1.80, 95% CI, 1.27 to 2.56, P = 0.001) and disease-free survival (DFS) (HR = 1.48, 95% CI, 1.28 to 1.72, P < 0.00001).ConclusionLarger IBL increased operation time and postoperative complications, and decreased OS and DFS of gastric cancer patients. Therefore, surgeons should be cautious about IBL during operation.

Factors associated with and impact of open conversion on the outcomes of minimally invasive left lateral sectionectomies: An international multicenter study

BackgroundDespite the rapid advances that minimally invasive liver resection has gained in recent decades, open conversion is still inevitable in some circumstances. In this study, we aimed to determine the risk factors for open conversion after minimally invasive left lateral sectionectomy, and its impact on perioperative outcomes. MethodsThis is a post hoc analysis of 2,445 of 2,678 patients who underwent minimally invasive left lateral sectionectomy at 45 international centers between 2004 and 2020. Factors related to open conversion were analyzed via univariate and multivariate analyses. One-to-one propensity score matching was used to analyze outcomes after open conversion versus non-converted cases. ResultsThe open conversion rate was 69/2,445 (2.8%). On multivariate analyses, male gender (3.6% vs 1.8%, P = .011), presence of clinically significant portal hypertension (6.1% vs 2.6%, P = .009), and larger tumor size (50 mm vs 32 mm, P < .001) were identified as independent factors associated with open conversion. The most common reason for conversion was bleeding in 27/69 (39.1%) of cases. After propensity score matching (65 open conversion vs 65 completed via minimally invasive liver resection), the open conversion group was associated with increased operation time, blood transfusion rate, blood loss, and postoperative stay compared with cases completed via the minimally invasive approach. ConclusionMale sex, portal hypertension, and larger tumor size were predictive factors of open conversion after minimally invasive left lateral sectionectomy. Open conversion was associated with inferior perioperative outcomes compared with non-converted cases.

Effect of Time of Year on Surgical Outcomes in Patients Undergoing Minimally Invasive Sacral Colpopexy or Uterosacral Ligament Suspension.

Academic urogynecologists incorporating fellows/residents into operative cases must ensure safety and quality outcomes throughout the learning curve of the academic year. We evaluated if the month of year relative to fellow/resident promotions in July affects operating time, complications, and prolapse recurrence for minimally invasive sacral colpopexy (MISC) or uterosacral ligament suspension (USLS). This was a retrospective study comprising MISC and USLS from January 2009 to August 2015. Patient demographics, clinical, and surgical data were compared between months with July as month 1. Linear regression assessed operating time. Logistic regression assessed prolapse recurrence (composite of any POP-Q point beyond the hymen, pessary use, or reoperation) and complications. One thousand seven participants had a mean age of 59.9 ± 9.4, body mass index of 27.6 ± 4.2, gravity of 3.0 ± 1.5, and parity of 2.6 ± 1.1. Most had stage III (67.7%) or II prolapse (25.6%). Minimally invasive sacral colpopexy represented 81.0% (58.8% laparoscopic, 41.2% robotic). Uterosacral ligament suspensions were 68.1% vaginal versus laparoscopic/robotic. Median follow-up was 34 weeks (interquartile range, 11-82). Mean operating time was 199.8 ± 66.4 minutes with no impact by month ( P = 0.26). Minimally invasive sacral colpopexy (vs USLS, β = 36.4 minutes), conversion to laparotomy (β = 112.9 minutes), and concomitant hysterectomy (β = 33.4 minutes) increased operating time ( P < 0.001). Complications ranged 7.9% (January) to 23.8% (March) with mean of 17.1%. Complications were unaffected by month (odds ratio [OR], 0.99; 95% confidence interval [CI], 0.95-1.04), but USLS had more complications than MISC (OR, 1.55; 95% CI, 1.05-2.28). Prolapse recurred in 9.4% with no impact by month (OR, 0.95; 95% CI, 0.88-1.02). Minimally invasive sacral colpopexy had less recurrence than USLS (OR, 0.33; 95% CI, 0.18-0.60). Month of year relative to resident/fellow promotion did not affect operating time, complications, or recurrence, debunking the myth of worse outcomes earlier in the academic year.

Oblique Lateral Interbody Fusion vs. Minimally Invasive Transforaminal Lumbar Interbody Fusion for Lumbar Spinal Stenosis: A Retrospective Cohort Study.

BackgroundMinimally invasive transforaminal lumbar interbody fusion (MIS-TLIF) is an effective surgical option for lumbar spinal stenosis (LSS) with spondylolisthesis. However, few studies have discussed oblique lateral interbody fusion (OLIF) with MIS-TLIF.ObjectiveTo evaluate postoperative improvements, complications, and reoperation rates between patients with LSS undergoing OLIF or MIS-TLIF.MethodsWe retrospectively studied 113 LLS patients who underwent OLIF (53) or MIS-TLIF (60) with percutaneous pedicle screw fixation between January 2016 and December 2018. We measured estimated blood loss, operative time, hospital stay, reoperation, and complication incidence, visual analog scale (VAS), Oswestry Disability Index (ODI), Japanese Orthopedic Association (JOA), and Short Form-36 (SF-36) scores, discal and foraminal height and lumbar lordotic angle.ResultsThe mean age was 58.81 ± 0.9 years. The TLIF group had increased operation time, blood loss, and hospital stays (p = 0.007, 0.001, and 0.016, respectively). Postoperatively, VAS and ODI scores significantly decreased while JOA and SF-36 scores significantly increased. The postoperative differences in main outcomes between the groups were insignificant (all p > 0.05). The OLIF group had the lowest rates of overall (9.8% OLIF vs. 12.9% MIS-TLIF), intraoperative (3.9% OLIF vs. 4.8% MIS-TLIF), and postoperative complications (5.9% OLIF vs. 8.1% MIS-TLIF), but the differences were insignificant (p = 0.607, 0.813, and 0.653, respectively). The reoperation rate did not differ significantly (3.8% OLIF vs. 3.3% MIS-TLIF) (p = 0.842). OLIF restored disc height (74.4 vs. 32.0%), foraminal height (27.4 vs. 18.2%), and lumbar lordotic angle (3.5 vs. 1.1%) with greater success than did MIS-TLIF.ConclusionPatients undergoing OLIF with LSS improved similarly to MIS-TLIF patients. OLIF restored disc height, foraminal height and lumbar lordotic angle more successfully than did MIS-TLIF.

Surgeons’ physical workload in open surgery versus robot-assisted surgery and nonsurgical tasks

BackgroundMusculoskeletal disorders (MSDs) are common among surgeons, and its prevalence varies among surgical modalities. There are conflicting results concerning the correlation between adverse work exposures and MSD prevalence in different surgical modalities. The progress of rationalization in health care may lead to job intensification for surgeons, but the literature is scarce regarding to what extent such intensification influences the physical workload in surgery. The objectives of this study were to quantify the physical workload in open surgery and compare it to that in (1) nonsurgical tasks and (2) two surgeon roles in robot-assisted surgery (RAS).MethodsThe physical workload of 22 surgeons (12 performing open surgery and 10 RAS) was measured during surgical workdays, which includes trapezius muscle activity from electromyography, and posture and movement of the head, upper arms and trunk from inertial measurement units. The physical workload of surgeons in open surgery was compared to that in nonsurgical tasks, and to the chief and assistant surgeons in RAS, and to the corresponding proposed action levels. Mixed-effects models were used to analyze the differences.ResultsOpen surgery constituted more than half of a surgical workday. It was associated with more awkward postures of the head and trunk than nonsurgical tasks. It was also associated with higher trapezius muscle activity levels, less muscle rest time and a higher proportion of sustained low muscle activity than nonsurgical tasks and the two roles in RAS. The head inclination and trapezius activity in open surgery exceeded the proposed action levels.ConclusionsThe physical workload of surgeons in open surgery, which exceeded the proposed action levels, was higher than that in RAS and that in nonsurgical tasks. Demands of increased operation time may result in higher physical workload for open surgeons, which poses an increased risk of MSDs. Risk-reducing measures are, therefore, needed.

Precipitation behavior and mechanical properties of IN 617 superalloy during operating at 850 °C

In the present paper, microstructural evolutions and their effects on mechanical properties of IN617 superalloy were investigated in as-received and operated samples. Samples had been operated at 850 °C, under a medium working stress for operating times of 24,000, 35,000 and 66,000 h. Microstructural characterization was performed using SEM, TEM and XRD analysis of samples. Mechanical properties of the samples were evaluated using tensile, impact and hardness tests. An important change in the microstructure is the increase in volume fraction of carbides with increasing operating time. Initially, carbides are formed as discrete particles along the grain boundaries and then with increasing the operating time, they continue to be formed as continuous phases along the grain boundaries, twin boundaries, and as scattered particles within the grains. A small percentage of carbides with dimensions of more than one micron are plate-like and rod-shaped and other quasi-spherical and irregular shapes. The shapes of the particles smaller than one micron are blocky, spherical and regular polygons. In addition to carbides and Ti(C,N) compound, a very small amount of γ′ phase was also detected in the sample operated for 24,000 h, based on X-ray diffraction analysis of the particles extracted from this sample. Based on the analysis of the extracted particles, the weight percentage of M23C6 carbide increases from 63% in the 24,000 h sample to 80% in the 66,000 h sample; while that of M6C carbide decreases from 23 to 8%. In other words, a part of M6C carbide is converted to M23C6, which is the stable carbide at 850 °C. The strength and hardness of the alloy increase after operating for up to 24,000 h, but then they start to decrease by increasing the operating time, and after operating for 66,000 h, the strength and hardness become less than the properties of the as-received alloy. Changes in strength and hardness values are consistent with microstructural changes in samples. Impact energy is reduced by 75% in 24,000 h compared to the as-received sample, and after that time, the decrease in the impact energy continues with a small rate.

Anterior Cervical Discectomy and Fusion—Can a Standalone Zero-Profile Titanium Cage a Better Alternative Option to Traditional Cervical Plate-Titanium Cage Combination?: A Prospective Observational Study

Abstract Introduction Anterior cervical plating in anterior cervical discectomy and fusion (ACDF) has inherent drawbacks like plate loosening, screw pullout, breakage, trachea-esophageal irritation and fistula, increased operation time, and increased duration of hospital stay. Due to low profile and in-built screw fixation slots, Zero-profile (Zero-P) cages are becoming popular among spine surgeons since they are supposed to minimize drawbacks that are associated with anterior cervical plates. Aims In our study, we evaluated two different fixation methods: (1) anterior cervical plate plus titanium cage and (2) zero-P titanium cages with respect to duration of surgery, length of hospitalization, rate of fusion, and postoperative complications. Materials and Methods This was a comparative prospective observational study with a sample size of 30 patients. Patients with cervical compressive disease (radiculopathy/myelopathy or combined symptoms) who require ACDF and fit in inclusion criteria were divided in two groups: group A—anterior cervical plate and titanium cage and group B—Zero-P titanium. Statistical Analysis Used Mann–Whitney U test was used for the duration of stay, and Student's t-test was used for the duration of surgery. Results C4–5 level was most commonly involved followed by C5–C6 level and C3–C4 level. The mean duration of surgery in group A was 141.3 minutes and group B was 111.3 minutes. The mean duration of stay in group A was 4.40 days and group B was 2.0 days. Two patients in group A and one patient in group B had dysphagia. One each in both groups had developed hoarseness of voice after surgery. Two patients in group A and one in group B had persistent donor site pain till 6 weeks to 2 months. One patient each of both groups had cage subsidence. Almost all patients in both groups achieved fusion by 6 months. Conclusion ACDF with standalone Zero-P cage is equally good. Duration of surgery and duration of stay were shorter in standalone Zero-P cage group. We feel it is good for patients and healthcare since it reduces overall financial burden.

Effect of endoscopic urethral procedures applied after robotic radical prostatectomy on urinary incontinence: A prospective cohort pilot study.

The most common complications after radical prostatectomy (RP) are erectile dysfunction (ED) and urinary incontinence (UI). After RP, patients may require endoscopic urethral procedures (EUP) for other urological diseases such as hematuria, urinary system stone disease, and suspicion of bladder tumor. In clinical practice we observed that EUP performed after robot assisted RP (RARP) can cause an increase in the UI level. In this study, we investigated whether there is a change in the UI level in patients that underwent EUP after RARP and whether this change was affected by the duration of the procedure and type of endoscopic device used. Twenty-six patients were included who underwent EUP after RARP in this study. The patients were divided into three groups based on the endoscopic device used: group 1 rigid cystoscopy (n = 9), group 2 flexible cystoscopy (n = 7), and group 3 semi-rigid ureterorenoscopy (URS) (n = 10). The Turkish version of the International Consultation on Incontinence Questionnaire-Urinary Incontinence Short Form (ICIQ-SF) and the number of pads used daily was questioned before the EUP and 1 month after the procedure. While a significant increase in ICIQ-SF score was observed in group 1 (p = 0.027), no significant increase was observed in group 2 and group 3 (p > 0.05). No significant difference was observed between the number of pads used preoperatively and the postoperative first month in all groups (p > 0.05). There was no significant correlation between increased operation time and both the pad usage and ICIQ-SF score (p > 0.05). The use of small diameter endoscopic instruments and flexible instruments is important for patient comfort and to avoid damage to urethrovesical anastomosis in patients who need to undergo EUP after RP.

Valveless Trocar Versus Standard Pneumoperitoneum Insufflation System in Minimally Invasive Surgery: Impact on Postoperative Pain. A Systematic Review and Meta-Analysis.

Background: The benefits of a valid pneumoperitoneum in laparoscopic surgery are counterbalanced by the possible negative effects of increased abdominal pressure and carbon dioxide (CO2) insufflation, which are crucial factors in causing postoperative pain. The purpose of this work is to evaluate the effectiveness of the valveless trocar (VT) insufflation system in decreasing postoperative pain and influencing operative time, compared to a standard insufflation system. Methods: A systematic research was performed using MEDLINE, EMBASE, Central Cochrane Library, and CINAHL Plus for studies published up to June 2020. Randomized controlled trials (RCTs) on adult population evaluating the effects of VT versus a standard insufflation system in laparoscopic surgery and reporting postoperative pain level and operative time were included in the analysis. Data and study quality indicators were extracted independently by 2 authors using a standardized form. Statistical analysis was based on a random effect model, using the inverse variance method. Results: We identified 3 RCTs for a total of 245 patients. The meta-analysis showed a statistically significant reduction in shoulder pain with the use of VT at 24 hours: mean difference (MD) -7.9% (95% confidence interval [95% CI]: -1.29 to 0.29; z = 3.08; P = .002) and a nonstatistically significant increase in operation time: MD 5.80 (95% CI: -8.93 to 20.54; P = .44). Conclusion: Our study suggests a better shoulder pain control at 24 hours postoperation using new-generation VT for laparoscopic surgery compared to standard insufflation system. Weak evidence of increased operating time with the VT was observed considering only two of the three RCTs. PROSPERO registration number: CRD42020191835.

Posterior Antiglide Plating vs Lateral Neutralization Plating for Weber B Distal Fibular Fractures: A Systematic Review and Meta-analysis of Clinical and Biomechanical Studies

Distal fibular fractures are extremely common, yet there remains controversy about which type of plating technique is the most appropriate. We aimed to compare clinical and biomechanical outcomes following posterior antiglide plating and lateral neutralization plating for Weber B distal fibular fractures. A systematic review and meta-analysis of the literature was conducted by two independent reviewers according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. We included all comparative studies of distal fibular fracture fixation with either a posterior antiglide plate or a lateral neutralization plate. Our primary outcome of interest was reoperation for hardware removal. Secondary outcomes included hardware discomfort, peroneal tendon irritation, infection, wound complications, and mechanical torque to failure. A total of 1122 patients with Weber B ankle fractures were included across nine eligible clinical studies, and 76 cadaveric ankles were subject to testing across three eligible biomechanical studies. Meta-analyses revealed a two-fold greater odds of requiring removal of hardware in the lateral plating group compared to the posterior plating group (odds ratio [OR] 2.48, 95% CI 1.58 to 3.91, P < .0001), and a three-fold greater odds of experiencing hardware discomfort in the lateral plating group compared to the posterior plating group (OR 2.96, 95% CI 1.83 to 4.80, P < .0001). There were no significant differences in rates of peroneal tendon irritation, infection, wound complications, operative time, and torque to failure when comparing the two plating methods. The results of this review indicate that using posterior antiglide plating for distal fibular Weber B-type fractures is associated with significantly fewer reoperations due to hardware complications and less hardware discomfort compared to lateral neutralization plating. This technique does not appear to increase the risk of peroneal tendon irritation or increase operative time.

Does prior failed shock-wave lithotripsy impact outcomes of ureterorenoscopy? A systematic review and meta-analysis.

The study aimed to compare the outcomes of patients undergoing ureterorenoscopy (URS) after failed shock-wave lithotripsy (SWL) (Salvage URS) with those undergoing URS without any history of SWL (Primary URS). PubMed, Embase, and CENTRAL databases were searched up to 10th January 2021 for studies comparing outcomes of salvage URS vs. primary URS. Odds ratios (OR) with 95% confidence intervals (CI) were calculated for procedure success and complications. Operating time was summarized using mean difference (MD). Seven retrospective studies were included. Meta-analysis indicated no statistically significant difference in the success rates of URS between the salvage URS and primary URS groups (OR: 0.83 95% CI: 0.65, 1.06 I2=0% p=0.13). On subgroup analysis, the success rate was significantly reduced in the salvage URS group for renal stones (OR: 0.55 95% CI: 0.34, 0.91 I2=0% p=0.02) but with no difference for ureter stones OR: 0.90 95% CI: 0.67, 1.21 I2=0% p=0.49). Pooled analysis demonstrated a tendency of longer operating time in the salvage URS group as compared to the primary URS group, albeit with a statistically non-significant difference (MD: 8.91 95% CI: -0.56, 18.38 I2=98% p=0.07). Meta-analysis indicated significantly increased complications in the salvage URS group as compared to the primary URS group (OR: 1.83 95% CI: 1.34, 2.49 I2=0% p=0.0001). Evidence from retrospective studies suggests that patients undergoing salvage URS for renal stones have significantly lower success rates which is not the case for ureteral stones. There is a non-significant tendency of increased operating times for salvage URS. Complication rates are significantly higher for salvage URS as compared to primary URS. Future studies with propensity-score matching are required to strengthen current conclusions.

An Updated Meta-Analysis of Randomized Controlled Trials on Total Hip Arthroplasty through SuperPATH versus Conventional Approaches.

The object was to conduct a systematic review and meta‐analysis of randomized controlled trials (RCTs) up to the present to draw reliable conclusions in the comparison between short‐term outcomes of total hip arthroplasty (THA) through supercapsular percutaneously assisted approach in THA (supercapsular percutaneously‐assisted total hip (SuperPATH)) versus conventional approaches (CAs). A systematic literature search was performed to identify RCTs comparing primary and secondary outcomes of THA through SuperPATH vs. CAs. Mean differences (MDs) were calculated for continuous outcomes and odds ratios (ORs) for dichotomous outcomes, using the DerSimonian and Laird method, the Mantel–Haenszel method and random effects model. A total of 14 RCTs involving 1021 patients met the inclusion criteria. Primary outcomes: SuperPATH reduced intraoperative blood loss (MD = −61.4, 95% CI −119.1 to −3.8). SuperPATH increased Harris hip score (HHS) 3, 6 and 12 months postoperatively (MD = 2.4, 95% CI 0.6–4.2; MD = 2.1, 95% CI 0.6–3.6; MD = 0.7, 95% CI 0.1–1.3; resp.). Both approaches did not differ in postoperative complication rates (OR = 0.7, 95% CI 0.2–3.3). Secondary outcomes: SuperPATH reduced pain visual analogue scale (VAS) 1 day and 3 days postoperatively (MD = −1.0, 95% CI −1.8 to −0.2; MD = −1.2, 95% CI −1.8 to −0.5; resp.). SuperPATH reduced incision length (MD = −5.2, 95% CI −7.0 to −3.4). SuperPATH increased operation time (MD = 14.3, 95% CI 3.7–24.8). Both approaches did not differ relevantly in acetabular cup inclination (MD = −1.8, 95% CI −3.8–0.2) and acetabular cup anteversion (MD = −0.6, 95% CI −1.2 to −0.1) angles. The overall findings of this meta‐analysis (Meta‐SuCAs‐2) suggested that the short‐term outcomes of THA through SuperPATH were superior to CAs. In the primary outcome, SuperPATH had a lower intraoperative blood loss and a higher HHS. Both approaches did not differ in postoperative complications. In the secondary outcome, SuperPATH had a lower pain VAS and a shorter incision length. Both approaches showed sufficient results in acetabular cup positioning. CAs had a shorter operation time than SuperPATH.

Alternative autologous and biologic conduits have worse outcomes than prosthetic grafts for infrainguinal bypass in patients with chronic limb-threatening ischemia

ObjectiveSingle segment great saphenous vein (GSV) is the preferred conduit in infrainguinal bypass. Alternative autologous conduits (AAC) and nonautologous biologic conduits (NABC) are thought to be a better alternative to traditional prosthetic conduits (PC) in the absence of GSV. In this study we analyzed the outcomes of these alternative conduits in lower extremity bypasses (LEB) in patients with chronic limb-threatening ischemia. MethodsThe Vascular Quality Initiative LEB database from 2003 to 2020 was queried for this study, to identify LEB in patients with chronic limb-threatening ischemia. Primary outcomes were graft patency, major adverse limb events (MALE), and MALE-free survival at 1 year. Standard statistical methods were used as appropriate. ResultsWe identified 22,671 LEB procedures (12,810 GSV, 6002 PC, 1907 AAC, and 1952 NABC). Compared with the GSV group, the other conduit patients were significantly older, had more comorbidities, had an increased rate of prior lower extremity interventions, had a higher rate of infrageniculate bypass targets, and were less ambulatory at baseline. The PC, AAC, and NABC groups had significantly higher rates of postoperative morbidity compared with the GSV group. The PC group had a higher 30-day mortality compared with the GSV, AAC, and NABC groups (3% PC vs 2% GSV, 2% AAC, 2% NABC; P = .049). Both PC and NABC had higher 1-year mortality compared with GSV and AAC (13% PC and 13% NABC vs 10% GSV, 10% AAC; P = .02). In an adjusted Cox regression model (stratified by infrageniculate target and adjusted for age, comorbidities, and prior vascular interventions) PC was not significantly different from GSV, but AAC (hazard ratio [HR], 1.41; 95% confidence interval [CI], 1.19-1.67; P < .001) and NABC (HR, 1.9; 95% CI, 1.61-2.25; P < .001) were associated with an increased risk of loss of primary patency. A similar association with MALE was observed: both AAC (HR, 1.35; 95% CI, 1.15-1.58; P < .001) and NABC (HR, 1.8; 95% CI, 1.53-2.11; P < .001) were associated with an increased risk of MALE compared with GSV; PC was not significantly different from GSV. ConclusionsIn the absence of GSV, alternative conduits (autologous or nonautologous biologic) do not confer a benefit with regard to graft patency or MALE compared with PCs. Increased operating time or costs associated with the use of these conduits is not justified based on this study.

Surgical strategies for Mirizzi syndrome: A ten-year single center experience.

BACKGROUNDMirizzi syndrome (MS) remains a challenging biliary disease, and its low rate of preoperative diagnosis should be resolved. Moreover, technological advances have not resulted in decisive improvements in the surgical treatment of MS. Complex bile duct lesions due to MS make surgery difficult, especially when the laparoscopic approach is adopted. The safety and long-term effect of MS treatment need to be guaranteed in terms of preoperative diagnosis and surgical strategy.AIMTo analyze preoperative diagnostic methods and the safety, effectiveness, prognosis and related factors of surgical strategies for different types of MS.METHODSThe clinical data of MS patients who received surgical treatment from January 1, 2010 to December 31, 2020 were retrospectively reviewed. Patients with malignancies, choledochojejunal fistula, lack of data and lost to follow-up were excluded. According to preoperative imaging examination records and documented intraoperative findings, the clinical types of MS were determined using the Csendes classification. The safety, effectiveness and long-term prognosis of surgical treatment in different types of MS, and their interactions with the clinical characteristics of patients were summarized.RESULTSSixty-six patients with MS were included (34 males and 32 females). Magnetic resonance imaging/magnetic resonance cholangiopancreatography (MRI/MRCP) showed specific imaging features of MS in 58 cases (87.9%), which was superior to ultrasound scan (USS) in the diagnosis of MS and more sensitive to subtle biliary lesions than USS. The overall laparoscopic surgery completion rate was 53.03% (35/66), where the completion rates of MS type I, II and III were 69.05% (29/42), 42.86% (6/14) and zero (0/10), respectively. Thirty-one patients (46.97%) underwent laparotomy or conversion to laparotomy including 11 cases of iatrogenic bile duct injury which occurred in type I patients, and 25 of these patients underwent bile duct exploration, repair and T-tube drainage. In addition, 25 patients underwent intraoperative choledochoscopy and T-tube cholangiography. Overall, 21 cases (31.8%) were repaired by simple suturing, and 14 cases (21.2%) were repaired using the remaining gallbladder wall patch in the subtotal cholecystectomy. The ascendant of the Csendes classification types led to an increase in surgical complexity reflected by increased operation time, bleeding volume and cost. Gender, acute abdominal pain and measurable stone size had no effect on Csendes type of MS or final surgical approach. Age had no effect on the classification of MS, but it influenced the final surgical approach, hospital stay and cost. A total of 66 patients obtained a relatively high preoperative diagnostic rate and underwent surgery safely without serious complications, and no mortality was observed during the follow-up period of 36.5 ± 26.5 mo (range 13-76, median 22 mo).CONCLUSIONMRI/MRCP can improve the preoperative diagnosis of MS. The Csendes classification can reflect the difficulty of treatment. The surgical strategies including laparoscopic surgery for MS should be formulated based on full evaluation and selection.