Intraoperative Time Research Articles

Management of the Inflatable Penile Prosthesis Reservoir at time of revision surgery: remove, retain, or recycle?

Abstract Background Three common strategies exist for managing the inflatable penile prosthesis reservoir during revision surgery: the original reservoir can be (a) removed, (b) deactivated and left in situ, sometimes referred to as “drain and retain” (DR), or (c) validated and reconnected to new cylinders, which we have termed “reservoir recycling” (RR). Aim To compare the efficacy and safety of the RR approach to penile prosthesis revision against DR and the recommended approach of complete device removal and replacement. Methods A retrospective chart review of our single-surgeon inflatable penile prosthesis database between 2007 and 2022 was performed, identifying revision surgeries. Cases were stratified by reservoir management technique. Patients who had undergone at least 1 follow-up visit and had complete documentation regarding reservoir handling were included. Reservoir-related complications necessitating surgical intervention such as infection and device failure were compared between the 3 groups using a chi-square test. Mean follow-up duration, time to revision, and operative time were also assessed. Outcomes The primary outcome was the incidence of reservoir-related complications requiring surgical intervention and secondary outcomes included time to revision surgery and operative time. Results Among 140 patients meeting inclusion criteria, 62 underwent full reservoir replacement (FR), 48 DR, and 30 RR. Compared to FR, DR and RR groups had similar mean time to revision and intraoperative time. Follow-up duration was similarly limited for all 3 groups at a median of approximately 4.5 months. There were no postoperative infections in the RR cohort. However, when compared to the DR and FR groups, this did not reach significance (P = .398). There was no difference in mechanical failure rate between the 3 groups (P = .059). Nonmechanical failure was also similar between all 3 groups (P = .165). Clinical Implications These results suggest that RR exhibits comparable outcomes to DR and FR, making it a viable option during select penile prosthesis revision surgeries, potentially decreasing morbidity without compromising outcomes. Strengths and Limitations This is the first study to evaluate outcomes after RR. Limitations include small sample size, limited follow-up, and single-surgeon experience. Conclusion There was no difference in reservoir-related complications when comparing the 3 methods. These preliminary results suggest that reservoir recycling may provide a safe and effective reservoir-handling alternative in inflatable penile prosthesis revision surgery.

“Tension band wiring first” —an easy, fast and reproducible technique to reduce patellar fractures, a retrospective comparative study with traditional reduction technique

ObjectiveTo evaluate intraoperative and early postoperative clinical outcomes using the “tension band wiring first technique” to reduce C type patellar fractures.MethodsSixty-four patients with C type fractures were enrolled in this study. Thirty-four patients underwent open reduction and internal fixation (ORIF) surgeries using the traditional reduction technique by pointed clamps (TRT group). The other thirty patients received the patellar fracture reduction using the “Tension band wiring first technique” (TBWFT group). All patellar fractures were treated with a cable tension band and a cerclage cable. The duration of intraoperative procedure and X-ray exposure times were recorded. All patients were followed up at 1, 3, 6, and 12 months. Bone union time was recorded. The articular surface steps of the patellas were measured. After surgery, range of motion (ROM) of the knee, and complications were evaluated, and patellar function was evaluated using the Lysholm knee scores and Böstman scores.ResultsWhen compared to TRT group, the “Tension band wiring first technique” significantly reduced the intraoperative time and X-ray exposure times and tended to reduce the articular surface steps, though without statistical significance. In the two groups, there was no significant difference in bone union time, ROM, complications and patellar function.ConclusionThe utilization of “Tension band wiring first technique” proved to be a straightforward, expeditious, and reproducible technique for reducing patellar fracture in comparison to the conventional reduction technique utilizing pointed clamps. Further studies are required to ensure the generalizability of these findings to additional patient populations at other institutions.

Effect of warm and cold ischemia on pancreaticoduodenectomy specimen following robotic pancreaticoduodenectomy

BackgroundThe adoption of robotic pancreaticoduodenectomy (PD) has increased in recent years for the treatment of pancreatic head tumors and periampullary lesions. Some potential benefits seem to be demonstrated; however, obtaining specimens through this method can potentially compromise the diagnosis depending on the timing of the specimen retrieval, and the impact of longer perioperative time on ischemia and autolysis of the surgical specimen has not been analyzed. The aim of this study is to evaluate the histological changes associated with timing of specimen retrieval during robotic PD.MethodsA review of histopathology files was performed for all pancreatic specimens collected at our hospital from January 2022 to March 2024. Both warm ischemia time (WIT) and cold ischemia time (CIT) were collected. Histological features related to ischemic damage were evaluated in normal duodenal and pancreatic parenchyma as well as pancreatic tumor, and were graded as: absent, mild, moderate and severe. Univariate and multivariate analyses were performed to determine which variables were associated with moderate and severe ischemic changes.ResultsSixty surgical specimens were analyzed: 20 open PD, 17 robotic PD with cold ischemia, and 23 robotic PD. Median total WIT was 182 min (open PD 57 min vs. RPD 190 min vs. RPD-CI 198 min; p < 0.001). Median CIT was 760 min (740–835) in samples stored at 4ºC. Univariate analysis showed that longer intraoperative time, male gender and cold ischemia were associated with pancreatic tissue ischemic changes. In multivariate analysis, cold ischemia was the only independent factor associated with normal pancreatic tissue and tumor tissue moderate and severe ischemic changes.ConclusionsProlonged ischemia time, especially in the case of cold storage, has a strong effect on the degradation of normal and tumor tissue without affecting pathological evaluation. Operative teams should aim to optimize both the duration and efficiency of the surgical procedure, ensuring minimal ischemic time. Simultaneously, pathology departments must be equipped to process pancreatic specimens promptly, with protocols in place to minimize the time between resection and analysis.

A Novel Unilateral Bi/Multi-Portal Endoscopic Transforaminal Interbody Fusion Utilizing Uniaxial Spinal Endoscope Instead of Arthroscope: Technical Note and Preliminary Clinical Results.

Currently, traditional UBE surgery, which is based on arthroscope, has been increasingly employed for complex lumbar degenerative diseases. However, this approach is associated with complications such as intraoperative dural sac tears, nerve root injuries, and postoperative epidural hematomas. In response to these challenges, we propose a novel technique utilizing uniaxial spinal endoscope to replace arthroscope-Unilateral Bi/Multi-Portal Endoscopy (UME). This new method has successfully treated complex lumbar disc herniation and spinal stenosis, resulting in improved postoperative outcomes and a reduction in complications. Based on the previous findings, we utilized uniaxial spinal endoscopy as the primary operating method, with the assistance of multi-portal endoscopic techniques (UME-TLIF), to perform transforaminal lumbar interbody fusion. The feasibility and preliminary clinical results have been presented in this paper. A total of 18 patients (8 men and 10 women, aged 52.6 ± 15.29 years) diagnosed with lumbar degenerative diseases, such as giant lumbar disc herniation, severe lumbar spinal stenosis, or lumbar spondylolisthesis, were included in this study from January 2022 to March 2023. Various parameters including operation time, ambulatory time, intraoperative fluoroscopy times, hospitalization days, and complications were recorded during the perioperative period. Clinically relevant symptoms were evaluated and documented 1, 3, 6, and 12 months postoperatively. Visual analogue scale (VAS) scores for lower back pain and leg pain, as well as the Oswestry disability index (ODI), were measured. The extent of lumbar interbody fusion was assessed using lumbar X-ray and CT scans at the 12-months follow-up. MRI was performed to assess the degree of nerve decompression in patients at the same time points. The paired t-test or Wilcoxon signed-rank test were used as statistical methods. The single-segment UME-TLIF procedure had an average operation time of 211 ± 53.3 min, and the average number of X-rays taken during the operation was 11.78 ± 5.32. Patients were able to walk and perform functional exercises approximately 35.11 ± 8.41 h post-surgery, and the average duration of hospital stay was 8.5 ± 2.27 days. The VAS and ODI values at each time point post-surgery were significantly lower than the respective pre-surgery values (p < 0.05). Two patients developed postoperative sensory disturbances which significantly improved with conservative treatment. Furthermore, a follow-up CT scan conducted 12 months post-surgery showed 100% fusion rate of the surgical segments in all patients. UME-TLIF is an endoscopy-assisted fusion procedure that minimizes muscle damage in patients and allows early rehabilitation. This technique broadens the surgical applications of uniaxial spinal endoscope as a surgical tool, particularly benefitingpatients diagnosed with severe lumbar disc herniation and lumbar instability.

Comparison of outcome of Simple Excision vs Limberg Flap of pilonidal sinus in terms of post operative pain, operative time, wound infection and hospital stay.

Objective: To compare post operative pain, wound infection, intraoperative time and length of hospital stay in both groups of simple excision and Limberg flap. Study Design: Comparative Prospective study. Setting: CMA Teaching and Research Hospital/Azra Naheed Medical and Dental College, Lahore, Pakistan. Period: 1st September 2021 to 1st September 2023. Methods: After approval from the Institutional review board of Azra Naheed Medical &amp; Dental College/CMA Hospital, the sample was 120 patients was raised using non-convenience probability sampling divided into 2 groups. Group A patients underwent simple excision while Group B patients underwent Limberg flap Inclusion criteria include all the patients with age more than 13 years and diagnosed as case of pilonidal sinus. All the data was entered and processed by using SPSS 26. Comparison of two groups was done by apply independent sample t-test. A p-value of ≤ 0.05 was considered significant. Results: The average age of the patients was 45.88 ± 9.78 years with minimum and maximum ages were 15 &amp; 59 year respectively. Mean post operative pain was 2.6 ± 1.9 in group A while 3.9 ± 2.7 in group B (p value = &lt;0.05). Similarly wound infection, duration of surgery and length of hospital stay were also less in group A patients as compared to group B patients. Conclusion: Simple excision of pilonidal sinus is better from Limberg flap in terms of post operative pain, wound infection, duration of surgery and length of hospital stay.

Promoting application of enhanced recovery after surgery protocols during perioperative localized abdominal and thoracic neuroblastomas.

To investigate the safety and efficacy of the application of enhanced recovery after surgery (ERAS) protocols in the perioperative period of abdominal and thoracic localized neuroblastomas (NBs). In this retrospective study, 68 children with NBs who underwent surgical resection of the tumor were enrolled. The ERAS protocols for NB excision were implemented in the ERAS group (n = 39) and the consequences were compared with children treated with traditional care (n = 29, TRAD group). The main outcomes of our interest included the incidence of surgery-related complications, the postoperative length of stay (LOS), and the Face/Legs/Activity/Cry/Consolability (FLACC) quantitative table from postoperative days (POD) 1-5. We also evaluated the median intraoperative fluid volume and anesthesia recovery time; blood glucose levels at the beginning of anesthesia, POD1, and 3; WBC counts, CRP values, and the concentration of plasma nutritional indicators on POD1 and 3; time of early ambulation, first anal exhaust, total enteral nutrition (TEN), and discontinue intravenous infusion postoperatively; usage proportion and duration of abdominal and thoracic drainages, nasogastric decompression tubes and urinary catheters; cost of hospitalization, parental satisfaction rate, and readmission rate of surgery ward within 30days. Compared to the TRAD group, the ERAS group had lower surgery-related complications, albeit not significantly (P > 0.05); the median postoperative LOS decreased from 11.0 to 8.0days (P < 0.001), the LOS of abdominal NB was significantly shortened (P < 0.001) compared to thoracic NB (P = 0.07) between the two groups; the FLACC scores decreased significantly from POD1-5 (all P < 0.01). The ERAS group had an improved median intraoperative infusion speed (5.0mL/kg/h vs 8.0mL/kg/h), time of early ambulation (1.0days vs 3.0days), first anal exhaust (2.0days vs 2.0days), TEN (5.0 vs 7.0days), discontinuation of intravenous infusion (5.0days vs 8.0days), and total cost of hospitalization (33,897.2 Yuan vs 38,876.3 Yuan); (all P < 0.01). The usage proportion and duration of surgical drainages and tubes were apparently reduced. The mean blood glucose level was higher at the beginning of anesthesia but lower on POD1 and 3 in the ERAS group (P < 0.01). No statistically significant difference was detected in WBC counts and concentrations of hemoglobin and albumin between the two groups of patients (P > 0.05), while the concentrations of prealbumin on POD3 were higher and the CRP level on POD1 was lower in the ERAS group than the TRAD group (P < 0.01). The satisfaction rate of parents was only slightly higher, but the difference was not statistically significant (P = 0.730). No obvious differences were observed in the aspects of NB resection (P = 0.462) and 30-day readmissions of surgery ward (P = 1.000). The application of ERAS protocols has a significant potential to accelerate perioperative rehabilitation in children undergoing abdominal and thoracic NBs' surgical resection.

Predictive value and model construction of preoperative nutritional indexes for postoperative leakage in gastric cancer

Objective: We aimed to explore the predictive significance of the nutritional indexes in the occurrence of postoperative leakage after gastrectomy, aiming to develop and validate a predictive nomogram for assessing the risk of these complications.Methods: Patients undergoing radical gastrectomy for gastric cancer were studied, using data from The Sixth Affiliated Hospital of Sun Yat-sen University (2019-2022, n=1075) for nomogram development and an external cohort from Sun Yat-sen University Cancer Center (2022, n=286) for validation. The model, focusing on postoperative leakage, was constructed through univariate and backward stepwise regression. The performance of nomogram was assessed using the receiver operating characteristic (ROC) curve, calibration plots, decision curve analysis (DCA), and clinical impact curves (CIC).Results: The incidence rates of postoperative leakage were 6.51% in the training cohort and 6.71% in the external validation cohort, respectively. The nomogram effectively identifies critical factors influencing postoperative leakage risk, including NRS-2002 score, SFMAI, VSR, blood loss, intraoperative time, type of reconstruction, and Lauren type. The areas under the curve (AUC) for the development and external validation cohorts were 0.763 and 0.761, respectively, demonstrating acceptable predictive accuracy. The validation study showed the nomogram's satisfactory calibration, and both DCA and CIC confirmed its significant clinical utility.Conclusions: The nomogram offers an efficient and precise tool for initial screening, effectively identifying individuals at elevated risk for postoperative leakage.

Application of Multi-Slice Spiral CT Renal Angiography Combined with Intraoperative Ultrasound in Laparoscopic Partial Nephrectomy.

This study aimed to evaluate the clinical significance of multi-slice spiral CT renal angiography combined with intraoperative ultrasound in laparoscopic partial nephrectomy. Eighty patients were seen at the Affiliated Hospital of Hebei University from January 2021 to December 2022. The patients were divided into two groups, the experimental group and the control group, with 40 cases in each group. The experimental group received laparoscopic partial nephrectomy combined with intraoperative ultrasound, while the control group received only conventional laparoscopic partial nephrectomy. The experimental group had significantly shorter operative time and intraoperative thermal ischaemia time (p <0.05) and had significant advantage in the detection of microscopic cancer foci (p = 0.04). The experimental group also had significantly lower of positive rate of postoperative incisal margin (p = 0.01). The experimental group had significantly lower of recurrence rate (p = 0.03). The study concluded that multi-slice spiral CT renal angiography combined with intraoperative ultrasound boasts various benefits in the treatment of patients with renal cell carcinoma, it is safe and effective with no significant impact on renal function. Key Words: CT renal angiography, Intraoperative ultrasound, Laparoscopic partial nephrectomy, Renal cancer.

High-Risk Biliary Anastomosis During Robotic Pancreaticoduodenectomy: Initial Experience with Biodegradable Biliary Stent

Background and Objectives: Biliary fistulas (BFs) occur in approximately 3–8% of patients undergoing pancreaticoduodenectomy (PD), and the bile duct diameter ≤ 5 mm is the most important risk factor. The aim of this study was to evaluate the efficacy of biodegradable biliary stents (BSs) in reducing complications in patients undergoing robotic pancreaticoduodenectomy (RPD) with a bile duct diameter of ≤5 mm. Materials and Methods: A retrospective single-centre observational study was conducted. Patients undergoing RPD after the completion of the robotic biliary anastomosis learning curve were included in this study. Only patients with a bile duct diameter ≤ 5 mm were included in the analysis. A prospectively held database was used. The intraoperative time for biliary anastomosis was extracted from surgical videos. Results: Of 30 patients, 20 received no biliary stent (nBS) and 10 received a biodegradable stent (BS). The decision to use a stent was based on product availability. The median operative time for biliary anastomosis was significantly shorter in the BS group compared to the nBS group, at 15 min versus 24 min (p &lt; 0.001). Three patients in the nBS group developed a BF, whereas none were observed in the BS group. No stent migration was observed in any of the patients. Conclusions: The use of biodegradable biliary stents in high-risk biliary anastomosis in RPD appears to effectively reduce the incidence of BFs and may serve as a viable strategy to mitigate early biliary complications. The use of biodegradable stents facilitates a faster and easier biliary anastomosis. These findings suggest a potential benefit of using biodegradable stents in complex biliary reconstruction. However, larger studies are needed to confirm these results.

Intraoperative Cost Comparison of Endoscopic Carpal Tunnel Release With WALANT Versus MAC Anesthesia.

The cost of endoscopic carpal tunnel release (ECTR) has historically been shown to be significantly higher than the cost of open carpal tunnel release (OCTR). Setting and anesthetic technique drive costs in hand surgery; ambulatory surgical center (ASC) settings demonstrate lower costs when compared to hospital-based settings and local-only anesthetic techniques demonstrate savings over general anesthesia. The purpose of this study is to compare wide awake local-only anesthesia technique (WALANT) to monitored anesthetic care (MAC) for ECTR performed in an ASC setting. This study includes 481 ECTR under WALANT and 405 ECTR under MAC, performed between January 2019 and December 2021 in an ASC. Utilizing previously reported direct operating room costs, overhead, and material costs, we calculated a final cost for each procedure. We also report our complication rates: intraoperative conversion to OCTR and late revision to OCTR. Intraoperative times were shortest for ECTR performed under WALANT (22 min) versus ECTR under MAC (25 min). The total cost for ECTR under WALANT was most cost-effective at $1341.28 versus ECTR under MAC at $1634.00. Both techniques demonstrated a low complication profile. Our intraoperative process flow, staffing model, and ASC setting resulted in cost savings making ECTR an economically feasible option.

A comparison of operating room toric placement tools: CALLISTO eye vs. e Wavetec AnalyzOR (CORTCO)

BackgroundTo evaluate procedure times for two cataract planning systems (ZEISS CALLISTO eye and the Wavetec AnalyzOR) in predicting residual astigmatism (prediction error) and other visual outcomes in patients with corneal astigmatism (maximum allowable up to 3.0D) at postoperative month 1.MethodsThis was a prospective, single center, parallel treatment group, bilateral and unilateral, randomized, 1-month study on patients scheduled to undergo routine, small-incision cataract surgery with a toric intraocular lens implantation. Both groups underwent preop measurements with the IOLMaster 700 (Zeiss, Jena, Germany) and surgery with the LenSx device (Alcon). Lens selection in the CALLISTO eye group was based on Zeiss VERACITY Surgery Planner (a web-based tool) and on the Wavetec AnalyzOR component of the ORA system (a real-time intraoperative aberrometer) for those eyes in the ORA group. All procedure and intraoperative times were measured with a stopwatch. Postoperative visual outcomes were evaluated between 1 and 2 months after surgery.ResultsThere were 23 eyes in the CALLISTO group and 28 eyes in the ORA group. The mean surgical time for the CALLISTO group was 28.09 ± 1.72 min compared to 34.41 ± 1.52 min for the ORA group (P = 0.01). Toric lens placement mean time in the CALLISTO group was 2.47 ± 0.34 min compared to 3.88 ± 0.29 min in the ORA group (P = 0.0034). At month 1 postoperatively, the manifest refractive spherical error (MRSE) in the CALLISTO eye group 0.022 ± 0.388 diopters (D) compared to -0.174 ± 0.322 D in the ORA group; these were not statistically different. There was a higher percentage (75%) of eyes with an MRSE within 0.25D in the ORA group compared to the CALLISTO eye group (56.5%); at all other levels outcomes were numerically higher in the CALLISTO eye group.ConclusionsLess surgical time was needed when using the CALLISTO eye than the ORA when performing cataract surgery with toric lens implantation. There were similar visual outcomes between the groups and no statistical differences.

Effectiveness of robotic metabolic and bariatric surgery in patients with BMI ≥ 50-59.9 and BMI ≥ 60 for the treatment of severe obesity in a national medical center in Mexico.

Obesity is a global health issue that significantly increases morbidity and mortality when the Body Mass Index (BMI) reaches values ≥ 50. While metabolic and bariatric surgery (MBS) is the most effective treatment for severe obesity, it carries risks. Robotic surgery is promising but not extensively studied in Mexico, which presents an opportunity for research at a National Hospital with an academic program. This retrospective study reviewed 44 patients who underwent robotic MBS using the da Vinci surgical system from January 2018 to August 2023 at Centro Médico Nacional 20 de Noviembre, ISSSTE. Data collected included surgery type, duration, complications, and weight loss metrics over 54months post-operatively. The study involved 44 patients with severe obesity including BMI ≥ 50-59.9kg/m2 for group 1 and BMI ≥ 60kg/m2 for group 2. The average initial BMI was 54.7kg/m2 for group 1 and 68kg/m2 for group 2. The average operative times for group 1 were 10.09min for docking, 86.23min for robotic console time, and 95.73min for total intraoperative time. Group 2 had average times of 9.80min for docking, 82.4min for robotic console time, and 92.2min for total intraoperative time. Follow-up showed significant weight loss initially, with weight recurrence after 24months due to different factors. No serious complications or mortality were observed. Robotic MBS at a national academic medical center in Mexico shows promising outcomes for patients with BMI ≥ 50-59.9 and BMI ≥ 60, with significant weight and BMI improvements at 54month follow-up. Further studies with larger cohorts and longer follow-up are needed to strengthen these findings.

Accuracy and efficiency of 2D/3D single-vertebra spine navigation registration method based on dual-view feature fusion

Objective: To investigate the accuracy and efficiency of spine 2D/3D preoperative CT and intraoperative X-ray registration through a framework for spine 2D/3D single-vertebra navigation registration based on the fusion of dual-position image features. Methods: The preoperative CT and intraoperative anteroposterior (AP) and lateral (LAT) X-ray images of 140 lumbar spine patients who visited Huashan Hospital Affiliated to Fudan University from January 2020 to December 2023 were selected. In order to achieve rapid and high-precision single vertebra registration in clinical orthopedic surgery, a designed transformation parameter feature extraction module combined with a lightweight module of channel and spatial attention (CBAM) was used to accurately extract the local single vertebra image transformation information. Subsequently, the fusion regression module was used to complement the features of the anterior posterior (AP) and lateral (LAT) images to improve the accuracy of the registration parameter regression. Two 1×1 convolutions were used to reduce the parameter calculation amount, improve computational efficiency, and accelerate intraoperative registration time. Finally, the regression module outputed the final transformation parameters. Comparative experiments were conducted using traditional iterative methods (Opt-MI, Opt-NCC, Opt-C2F) and existing deep learning methods convolutional neural network (CNN) as control group. The registration accuracy (mRPD), registration time, and registration success rate were compared among the iterative methods. Results: Through experiments on real CT data, the image-guided registration accuracy of the proposed method was verified. The method achieved a registration accuracy of (0.81±0.41) mm in the mRPD metric, a rotational angle error of 0.57°±0.24°, and a translation error of (0.41±0.21) mm. Through experimental comparisons on mainstream models, the selected DenseNet alignment accuracy was significantly better than ResNet as well as VGG (both P<0.05). Compared to existing deep learning methods [mRPD: (2.97±0.99) mm, rotational angle error: 2.64°±0.54°, translation error: (2.15±0.41) mm, registration time: (0.03±0.05) seconds], the proposed method significantly improved registration accuracy (all P<0.05). The registration success rate reached 97%, with an average single registration time of only (0.04±0.02) seconds. Compared to traditional iterative methods [mRPD: (0.78±0.26) mm, rotational angle error: 0.84°±0.57°, translation error: (1.05±0.28) mm, registration time: (35.5±10.5) seconds], registration efficiency of the proposed method was significantly improved (all P<0.05). The dual-position study also compensated for the limitations in the single-view perspective, and significantly outperforms both the front and side single-view perspectives in terms of positional transformation parameter errors (both P<0.05). Conclusion: Compared to existing methods, the proposed CT and X-ray registration method significantly reduces registration time while maintaining high registration accuracy, achieving efficient and precise single vertebra registration.

Damage control thoracic surgery: What you need to know.

Damage control surgery in trauma prioritizes patient stabilization through an initial temporizing surgical approach to rapidly control hemorrhage and contamination, minimizing intraoperative time to allow for resuscitation and the correction of hypothermia, coagulopathy, and acidosis in the intensive care unit. This is followed by definitive repair of injuries once physiological parameters have improved. While damage control techniques for traumatic intra-abdominal and extremity injuries are well established and frequently utilized, the same cannot be said for damage control thoracic surgery. The complexity of thoracic injuries, the intricate decision making process, the level of surgical expertise required, and potential complications make damage control thoracic surgery particularly challenging. However, advances in surgical techniques, improvements in perioperative care, and the emergence of adjuncts such as extracorporeal membrane oxygenation have significantly enhanced decision making and underscored the importance of timely and decisive intervention in damage control thoracic surgery to optimize patient outcomes. This review aims to provide a comprehensive overview of damage control thoracic surgery, detailing the principles, indications, operative techniques, perioperative management, and the integration of advanced therapies to improve outcomes in patients with severe thoracic injuries.

12410 Intra-operative Parathyroid Hormone Monitoring: Comparative Evaluation Of Sampling Sites And Assay Methods

Abstract Disclosure: R. Kwayess: None. S. Ajjour: None. M. Rahme: None. M. Assaad: None. J. Abbas: None. S. Jabbour-Khoury: None. R. Daher: None. E. Cavalier: None. O. Kreidieh: None. M. Chakhtoura: None. G. El-Hajj Fuleihan: None. Background: Primary hyperparathyroidism is a common endocrine disorder increasingly managed by minimally invasive parathyroidectomy (MIP) with intra-operative parathyroid hormone (IOPTH) monitoring using 2nd generation parathyroid hormone (PTH) assay. Objective: Compare the use of central sampling versus peripheral sampling, and of 3rd as opposed to 2nd generation PTH assays’ performance. Methods: We collected preoperative baseline characteristics and laboratory values for consenting participants undergoing parathyroidectomy at our center. We then measured IOPTH levels from peripheral and central venous sites using 2nd and 3rd generation assays at various intraoperative time points. We calculated the maximal intraoperative PTH drop from highest baseline (pre-incision or pre-excision) at peripheral site and pre-excision at central site for participants who were normocalcemic at ≥ 6 months post-operatively. We used paired t-test to compare the mean % drop in IOPTH by 2nd vs 3rd generation assays, and peripheral vs central sampling. Results: Out of 88 participants enrolled, 63 had follow-up data at 6 months or beyond and normal serum calcium level (9.41 ± 0.43 mg/dL). Mean age was 56.16 ± 11.5 years, 77.8% females and 47.6% had osteoporosis or osteopenia. Pre-operative mean values were: serum calcium 10.94 ± 0.73 mg/dL, ionized calcium 5.6 ± 0.68 mg/dL, PTH 131.93 ± 120.1 pg/mL and creatinine 0.77 ± 0.19 mg/dL. The majority of patients underwent excision of one abnormal gland (79.4%). On average, 57.3% of patients had the highest PTH drop at 10 mins, 32.7% beyond 10 minutes, and 9.7% at 5 minutes, regardless of assay type and site. Median PTH decrements were 81% and 83.8% for 2nd generation assay, and 86.5% and 89% for 3rd generation assays, at peripheral and central sites, respectively. There was no significant difference in the PTH drop comparing central to peripheral sites using either assay. However, 3rd generation assays displayed a higher drop compared to 2nd generation assay, for both central and peripheral sites (p-value &amp;lt;0.001). Discussion/Conclusion: Our study shows no difference in % drop between peripheral and central sampling, using either 2nd or 3rd generation assays. Central PTH sampling is commonly used by surgeons because of ease of access, while applying the Miami criterion. However, the drop in median 3rd generation PTH level was higher compared to the 2nd generation assay, regardless of the sampling site. Our findings suggest the necessity of defining larger PTH drop cut-off values for 3rd generation PTH assay than the commonly used Miami criterion.

A sub-study of the POISE-3 randomized trial examined effects of a perioperative hypotension-avoidance strategy versus a hypertension-avoidance strategy on the risk of acute kidney injury

In this pre-specified sub-study of the POISE-3 trial, we examined the effect of a perioperative hypotension-avoidance strategy versus a hypertension-avoidance strategy on the risk of postoperative acute kidney injury (AKI). Altogether, 7307 patients were included from 110 hospitals in 22 countries. Patients were 45 years and older, had or were at risk of atherosclerotic disease, took at least one antihypertensive medication, and were scheduled for noncardiac surgery. Hypotension-avoidance strategy: (i) target intraoperative mean arterial pressure (MAP) 80 mmHg or over, (ii) on day of surgery and for two days after, hold renin-angiotensin-aldosterone system inhibitors and use other antihypertensives in stepwise fashion if systolic blood pressure (SBP) 130 mmHg or more. Hypertension-avoidance strategy: (i) target intraoperative MAP 60 mmHg or more, (ii) continue all antihypertensives before and after surgery. Primary outcome: postoperative AKI, an increase in serum creatinine concentration of either 26.5 μmol/L or more (0.3 mg/dL or more) within 48 hours of randomization or 50% or more within seven days of randomization. The hypotension-avoidance group (3654 patients) used fewer antihypertensive medications than the hypertension-avoidance group (3653 patients); specifically, 6% vs. 38% used an ACEI or ARB on the day of surgery, and 6% vs. 47% and 7% vs. 50% one and two days after surgery, respectively. Patients also spent about half as much intraoperative time with a MAP under 80 mmHg (27 vs. 60 minutes, respectively), but had little difference in average BP before or after surgery. There was no significant difference in AKI risk (15.1% vs. 14.4%). Results were consistent with other definitions of AKI and in patients with preexisting chronic kidney disease. Thus, a hypotension-avoidance strategy targeting a MAP greater than 80 mmHg in the operating room and discontinued blood pressure medication during the perioperative period did not confer a lower risk of AKI compared to a hypertension avoidance strategy. Clinical trial registration number: NCT03505723.

Bilateral Ultrasound-Guided Erector Spinae Plane Block for Management of Acute Postoperative Surgical Pain After Pediatric Cardiac Surgeries Through a Midline Sternotomy.

Ultrasound (US) guided erector spinae plane block (ESPB) is a safe and effective technique in providing perioperative pain management in pediatrics with a high success rate. Was to compare the efficacy of bilateral ultrasound-guided erector spinae plane block for management of acute postoperative surgical pain after pediatric cardiac surgeries through a midline sternotomy. One hundred patients aged 4-12 years were randomly assigned into two groups, both groups received general anesthesia followed by bilateral sham erector spinae plane block at the level of T6 transverse process using 0.4 ml/kg normal saline on each side in the control group (group C) or bilateral ultrasound-guided erector spinae plane block at the level of T6 transverse process using 0.4 ml/kg ropivacaine 0.2% with a maximum dose of 2 mg/kg mixed with adrenaline 2 mcg/ml in erector spinae plane block group (group E). The postoperative pain scores were evaluated immediately post-extubation, at 1 hour, 2, 4, 6, 8, 10, 12, 14, 16, 18, 20, 22, and 24 hours after extubation, total consumption of intraoperative fentanyl and time to first rescue analgesic administration were also recorded. There was a statistically high significant delay in the group E (314.72 ± 45.94) compared with the group C (36.7 ± 7.22) as regards to the mean (SD) of the time of the rescue analgesia (P < 0.001) (with 95% CI), moreover; the number of rescue analgesic was significantly higher in the group C compared with the group E (P < 0.001) (with 95% CI) and the mean (SD) of total intraoperative and postoperative levels fentanyl requirements in the group C were significantly higher compared with the group E (6.47 ± 0.98 and 5.09 ± 0.83) (with 95% CI) in group C versus (4.69 ± 0.71 and 2.31 ± 0.66) (with 95% CI) in group E respectively (P < 0.001) (with 95% CI). Ultrasound-guided bilateral ESPB with ropivacaine and adrenaline delays the postoperative need of analgesia and reduces postoperative fentanyl consumption at 24 h in pediatric patients undergoing cardiac surgery through midline sternotomy.

Intraoperative hemodynamic instability during laparoscopic adrenalectomy for pheochromocytoma without preoperative medical preparation compared with nonsecreting tumor

BackgroundControl of hemodynamic features during adrenalectomy for pheochromocytoma is recommended to minimize perioperative cardiovascular complications. However, episodes of intraoperative hemodynamic instability have been observed during adrenalectomies with other indications than pheochromocytoma. The objective of this study was to compare the hemodynamic instability score assessed during unilateral adrenalectomy for pheochromocytoma without preoperative medical preparation to hemodynamic instability score in nonsecreting tumor. MethodsThis was an observational study with prospective intraoperative hemodynamic data collection (every 20 seconds) and retrospective analysis. ResultsDuring the study period, 60 consecutive patients (30 pheochromocytomas vs 30 nonsecreting tumors) were included with a median number of data collections during total procedure time of 318 (interquartile range, 257–388). Mean cumulative intraoperative time outside the target blood pressure range expressed as a percentage of total procedure time was 13.3% vs 6.8% for systolic blood pressure >160 mm Hg (P = .01) and 2.4% vs 2.8% for mean arterial pressure <60 mm Hg (P = ns), respectively. The median hemodynamic instability score during total procedure time was 33 (interquartile range, 27–43) and 20 (interquartile range, 11–26) in the pheochromocytoma and nonsecreting tumor group, respectively (P < .01). Hemodynamic instability score were similar in patients with compared with without long-term antihypertensive treatment in each patient group (P = ns). The mean length of hospital stay was 2.0 ± 1.5 days, and 30-day morbidity rate was 6.6% (4/60) with no significant difference observed between both groups. ConclusionAlthough intraoperative hemodynamic instability remains greater in the pheochromocytoma group without preoperative medical preparation, both groups have similar hypotensive episodes. These data highlight the need to better understand the role of preoperative medical preparation in pheochromocytoma patients.

Perioperative mortality of caesarean section in North-West Ethiopia: a prospective cohort study

ObjectiveThis study aimed to assess 7-day perioperative maternal mortality and risk factors at Tibebe Ghion Specialized Hospital.DesignA single-centre prospective cohort study.SettingA tertiary hospital in North-West Ethiopia, 01 June 2019 to...

Patient satisfaction of computer guided reduction of Zygomatico-Maxillary Complex (ZMC) fractures using Patient Specific Guide (PSG) versus conventional reduction: a randomized clinical trial

Background and objectives. This study was conducted to evaluate of the patient satisfaction of computer guided reduction of Zygomatico-Maxillary Complex (ZMC) fractures using Patient Specific Guide (PSG) Versus Conventional reduction. Materials and methods. In this clinical trial patients were classified into two groups; each group consist of eight patients where the study group represented the use of patient specific guide for reduction and fixation of zygomatic fracture while the Control group represents conventional reduction and fixation of zygomatic fracture. The primary outcome is patient satisfaction while intraoperative time is the secondary outcome. Results. There was no statistical significancy in the overall satisfaction level between CR and GR, also there was no significancy between time consumed in CR and GR as guided reduction technique could save only about 8 minutes. Conclusions. Patient-specific guided reduction is an satisfactory technique for the reduction of Zygomatico-Maxillary Complex (ZMC) fractures. Moreover, this technique decreased the operation time without a statistically significant difference from the conventional technique.