Intraoperative Bleeding Research Articles

The impact of anti-thrombotic therapy on bleeding outcomes and thrombosis following laparoscopic cholecystectomy: a meta-analysis.

Acute cholecyctitis is a common condition which requires immediate or elective surgical interventions and this condition is one among the common causes for emergency hospitalization among the elderly population. However, controversies have been observed with the use of anti-thrombotic agents in patients undergoing laparoscopic cholecyctectomy. Few studies have reported increased risk of bleeding in patients with anticoagulants whereas other studies have reported no significant bleeding outcomes. Nevertheless, the lack of evidence-based guidelines further complicates decision-making. In this analysis we aimed to systematically assess the impact of anti-thrombotic therapy on bleeding outcomes and thrombosis following laparoscopic cholecystectomy. MEDLINE, EMBASE, Cochrane database, Google scholar, Web of Science and http://www.ClinicalTrials.gov were searched for relevant publications based on anti-thrombotic therapy among patients who underwent laparoscopic cholecystectomy. The endpoints in this analysis included: intra-operative bleeding, post-operative bleeding, blood loss, patients requiring blood transfusion and thrombotic complications. The Revman 5.4 software was used to analyze data in this analysis. Risk ratio (RR) with 95% confidence intervals (CIs) were used to represent the data following analysis. A total number of 4008 participants (enrollment period 2002-2019) were included in this analysis whereby 756 participants were assigned to an anti-thrombotic therapy and 3592 participants were in the control group. Our results showed that antithrombotic therapy was associated with significantly higher risk of intra-operative bleeding (RR: 2.23, 95% CI: 1.77-2.79; P = 0.00001), post-operative bleeding (RR: 4.77, 95% CI: 1.13-20.10; P = 0.03), and blood loss (RR: 3.01, 95% CI: 1.13-8.06; P = 0.03). Patients requiring blood transfusion (RR: 4.80, 95% CI: 1.90-12.13; P = 0.0009) were also significantly higher in the anti-thrombotic group. However, thrombotic complications (RR: 2.17, 95% CI: 0.50-9.42; P = 0.30) were not significantly higher. Through this analysis, we concluded that anti-thrombotic therapy was associated with significantly increased risks of intra-operative and post-operative bleeding events following laparoscopic cholecystectomy. Patients requiring blood transfusion were also significantly higher. Therefore, stopping anti-thrombotic agents prior to laparoscopic cholecystectomy could significantly minimize bleeding risks.

Clinical application of retroauricular hairline approach in submandibular gland resection assisted by endoscope

Objective:To investigate the clinical effect of retroauricular hairline approach in submandibular gland resection assisted by endoscope. Methods:A total of 18 patients with submandibular gland benign tumors treated in our hospital from September 2022 to September 2023 were selected. A 5 cm incision was designed in the retroauricular hairline, and the flap was turned over directly to the anterior edge of sternocleidomastoid muscle, then the flap was turned over to build the cavity through endoscopic surgery, and submandibular gland resection was completed with the assistance of endoscope. After operation, a negative pressure drainage was placed into the hairline, and the wound was closed by continuous intracutaneous suture. The clinical effect was evaluated after 3-6 months follow-up. Results:All patients underwent submandibular gland resection with endoscopic assistance as planned, and none of them converted to submaxillary incision during operation. The operation time was 65-97 min, with an average of 75 min. Intraoperative bleeding was 10-20 mL, with an average of 14 mL.No tongue numbness, wound infection, or tumor recurrence occurred after operation. However, there were 10 patients with ear numbness and discomfort of auricle after surgery, which gradually recovered after 6-9 months of follow-up. Two patients had crooked mouth after surgery, and the symptoms were gradually relieved after follow-up. All incisions healed in stage I and were concealed. Conclusion:Endoscopic retroauricular hairline approach is a choice for submandibular gland resection with good cosmetic effect, less trauma and fewer complications.

Comparative Analysis of Three Surgical Instruments in the Treatment of High Critical Enucleation of Prostate.

We conducted a study to assess the effectiveness and safety of three different surgical instruments for enucleation in treating high-risk benign prostatic hyperplasia (BPH). These instruments include red laser, green laser, and plasma surgical equipment for enucleation of the prostate. In a retrospective analysis, 237 patients diagnosed with high-risk benign prostatic hyperplasia (BPH) underwent prostate enucleation using three different groups of surgical instruments at the Department of Urology, the First Affiliated Hospital of Jinzhou Medical University. These groups included the red laser device group (n = 67), the green laser device group (n = 61), and the plasma device group (n = 109). The study evaluated changes in prostate mass, blood loss, operation time, and postoperative efficacy at 1- and 6-month intervals, as well as any associated complications. The red and green laser surgical instrument groups demonstrated superiority over the plasma group in several aspects. (1) Operation Time: *1* Red laser group: 87.9 ± 14.7 minutes; *1* Green laser group: 86.1 ± 15.3 minutes. (2) Blood Loss: *1* Red laser group: 30.1 ± 5.9 mL; *2*Green laser group: 30.9 ± 6.1 mL. (3) Temporary Urinary Incontinence: *1*Red laser group: 3 cases (4.48%); *2*Green laser group: 2 cases (3.28%). These differences were statistically significant. Additionally, postoperative indicators such as IPSS(International Prostate Prostate Symptom Score), QoL(Quality of Life), Q max(The Maximum Flow Rate), and RUV(Residual Urine Volume) showed significant improvement in all three groups compared to the preoperative state. Red laser, green laser and plasma surgical devices were safe and effective in the treatment of high critical benign prostatic hyperplasia; laser surgical devices showed better performance in terms of operation time, intraoperative bleeding and complications.

806. MINIMALLY INVASIVE REVISION FUNDOPLICATION, IS IT SAFE AND FEASIBLE? SINGLE CENTER EXPERIENCE

Abstract Introduction Laparoscopic fundoplication has become standard of care for patients with refractory gastroesophageal reflux disease, large and symptomatic hiatal hernia. Failure rate for laparoscopic fundoplication was between 2 to 17%. Doing Revisional Antireflux surgery is technically difficult. Our aim is to analyse symptomatic improvement post surgery, safety and durability of procedure in patients who underwent revision fundoplication at our centre Patients and Methods 22 patients underwent Minimally invasive revision fundoplication between January 2019 to January 2022 were taken into study, of them 12 gentlemen and 10 women were noted. Modified DeMeester score was calculated in all patients preoperatively and on 6 months follow up. Results All patients underwent primary surgery laparoscopically. 14 patients (63.6%)had recurrent reflux symptoms and 8 patients (36.3%) had severe dysphagia. Revision fundoplication was done laparoscopically in 20 patients and 2 patients Robotic surgery was done. Intraoperatively 11 patients had wrap migration, 8 patients had tight wrap, 3 patients had twist of wrap. In the re-do anti-reflux surgery (ARS) procedure, floppy Nissen fundoplication was performed in 86.4% of the patients, which amounts to 19 patients., and 3 patient underwent a 270-degree Toupet fundoplication. In 2 patients, additional composite mesh reinforcement was employed. 13.6 % of patients had intraoperative complications, 9.09 % of patients had pleural injury, 4.7 % had intraoperative bleeding, 9.09% of patients had gallstone disease, for which cholecystectomy was done. All patients anterior and posterior vagus identified and preserved. On follow up 80% of patients had resolution of symptoms, 18% needed intermittent PPI. At a median follow up of 18 months, no surgical failure was noted in endoscopy. Conclusion Laparoscopic revision fundoplication is a safe procedure when operated in a high volume centre by an expert surgeon.

The application and effect of bispherical augment in acetabular defects reconstruction

Objective: To evaluate the clinical effect of bispherical augment in acetabular defects reconstruction in hip revision. Methods: This is a retrospective case series study. A retrospective analysis of 119 patients (124 hips) patients who underwent hip revision surgery and reconstructed with bispherical augment for acetabular bone defects from January 2019 to December 2023 was performed. There were 57 males (58 hips) and 62 females (66 hips), aged (65.0±11.8) years (range:40 to 102 years). The body mass index was (23.9±3.5) kg/m2 (range:16.1 to 32.2 kg/m2). Acetabular bone defects were typed as follows: 2 hips in Paprosky type ⅡA, 29 hips in type ⅡB, 34 hips in type ⅡC, 31 hips in type ⅢA, and 28 hips in type ⅢB, of which 9 patients (9 hips) were combined with pelvic discontinuity. Differences in Harris hip score (HHS) and lower limb discrepancy (LLD) were compared between preoperatively and final follow-up. The height of the hip center of rotation and the horizontal distance from the center of rotation to the teardrop were measured by radiographs before and after surgery, and prothesis stability and the occurrence of postoperative complications were evaluated. Data were compared using the paired sample t test. Results: All patients successfully completed the operation. The operation time was (167.0±53.4) minutes (range:90 to 380 minutes) and the intraoperative bleeding was (345.3±124.2) ml (range:100 to 1 200 ml). The height of the hip center of rotation decreased from (39.7±13.0) mm preoperatively to (21.8±7.1) mm postoperatively and the horizontal distance from the center of rotation to the teardrop increased from (34.0±10.1) mm preoperatively to (38.5±5.9) mm postoperatively, and the differences were statistically significant (t=15.859, P<0.01; t=5.266,P<0.01). All the patients were followed up for (26.1±15.4) months (range:6 to 60 months). At the last follow-up, HHS improved from (35.2±10.0) points preoperatively to (85.5±9.5) points, and the difference was statistically significant (t=50.723,P<0.01). LLD decreased from (2.1±1.1) cm preoperatively to (0.5±0.5) cm, and the difference was statistically significant (t=13.767, P<0.01). All acetabular components were stable and free of displacement on imaging during follow-up. Three patients suffered dislocation and received closed reduction, all prosthesis were in good position during follow-up. No dislocation, loosening, fracture, recurrence of infection and vascular nerve injury occurred in other patients. Conclusion: Bispherical augment can effectively reconstruct acetabular bone defects, restore the hip center of rotation, and improve hip joint function scores at short and mid-term follow-up.

Surgical Complications and Management Strategies in Endoscopic Endonasal Transsphenoidal Surgery for Pediatric Craniopharyngiomas

Endoscopic endonasal transsphenoidal surgery (EETS) has emerged as an effective method for the resection of craniopharyngiomas in pediatric patients, offering minimally invasive access and enhanced visualization. This literature review examines the surgical complications and management strategies associated with EETS for pediatric craniopharyngiomas. Common complications include cerebrospinal fluid (CSF) leaks, intraoperative hemorrhage, hypopituitarism, and visual disturbances. The incidence of these complications is influenced by factors such as tumor size and location, patient age, comorbidities, and surgeon experience. Effective management strategies involve meticulous preoperative planning, advanced imaging techniques, intraoperative monitoring, and comprehensive postoperative care. Detailed preoperative imaging is crucial for surgical planning, while intraoperative neuronavigation and neurophysiological monitoring help mitigate risks. Postoperative care, including endocrine evaluation and rehabilitation, is essential for addressing complications and improving patient outcomes. This review underscores the critical aspects of managing surgical complications to enhance the safety and efficacy of EETS in treating pediatric craniopharyngiomas.

Percutaneous endoscopic interlaminar discectomy for high-grade migrated lumbar disc herniation: clinical efficacy and safety assessment.

This study aimed to assess the clinical effectiveness and safety of percutaneous endoscopic interlaminar discectomy (PEID) in the management of high-grade migrated Lumbar disc herniation (LDH). A total of 328 patients who underwent PEID for high-grade migrated LDH between May 2020 and January 2023 in our hospital were selected. Patients were categorized into high-grade migrated group and low-grade migrated group according to preoperative MRI findings. The preoperative and postoperative evaluations of clinical outcomes, such as Visual Analogue Scale (VAS) for lower backs and legs, Oswestry Disability Index (ODI), and modified MacNab criteria for surgical success, were compared between groups. No statistically significant differences were found in hospitalization time, surgery time, intraoperative hemorrhage, number of intraoperative fluoroscopies, or incision length between the two groups. The lower back and leg VAS scores and ODI exhibited a statistically significant decrease in both groups across all postoperative time intervals. However, the difference between the two groups was not statistically significant. Postoperative nerve root stimulation symptoms were reported in two and three cases in the high-grade migrated group and low-grade migrated group, respectively. One patient in the high-grade migrated group underwent reoperation due to re-herniation at the same segment. There was no significant difference in the rate of excellent-good cases between the two groups, with an overall rate of 94.7%. In treating high-grade migrated disc herniation, PEID offers advantages such as reduced trauma, small incision, quicker recovery and satisfactory clinical safety and efficacy.

Postoperative Outcomes of the Awake Colorectal Surgery with Neuraxial Anaesthesia.

To determine the outcome of awake surgery with combined spinal epidural in geriatric colon cancer patients with advanced comorbidity. Quasi-experimental study. Place and Duration of the Study: Department of Anaesthesiology and Reanimation, Ankara Bilkent City Hospital, Ankara, Turkiye, from April 2022 to 2023. Twenty-four American Society of Anaesthesiologists (ASA) I-II patients, aged 25-65 years and scheduled for colon cancer surgery were included in this research. All patients were observed preoperatively, at the operation room and at the postoperative surgery service. Spinal anaesthesia was planned for Group I and general anaesthesia for Group II. Ketofol (1:1) was administered to the combined spinal-epidural group, with a Ramsay sedation score of 3 after the spinal block. Epidural analgesia was planned for all patients. Patients' age, gender, weight, comorbidities, ASA risk scores, intraoperative haemodynamic parameters, bleeding amounts, colloid, crystalloid, and blood products were collected. There was no significant difference between the demographic characteristics of both anaesthesia groups (p >0.05). The amount of bleeding was statistically lower in Group I than in the general anaesthesia group (p = 0.004). Oral intake, drain withdrawal, mobilisation, discharge times, and costs were similar in all groups (p >0.05). The regional anaesthesia applications facilitate compliance with routine mobilisation, discharge procedures and prevent complications in abdominal surgery and its positive perioperative effects in patients with poor respiratory parameters, poor general condition, and high comorbidity in advanced age. Regional anaesthesia, Spinal-epidural, Mobilisation, Pain, Colon cancer.

Efficacy of Sternum Guard vs. bone wax in post-cardiac surgery patients: a randomized controlled trial.

Median sternotomy offers the main access during cardiac surgery. However, a surgical site infection (SSI) of the sternum is a distressing complication following this procedure. The incidence of postoperative superficial and deep SSI in cardiac surgery varies from 1.3% to 12.8%. Bone wax, a nonabsorbable substance applied as a mechanical barrier following a median sternotomy, can increase the risk of postoperative sternal dehiscence. Sternum Guard (Vygon, Ecouen, France), a sternal protection device used to cover the sternum after a median sternotomy, offers mechanical protection to prevent lesions on the sternum. The aim of this study was to compare the effectiveness of Sternum Guard (Vygon) and bone wax in reducing SSI and facilitating hemostasis in post-cardiac surgery patients. This single-blinded, single center randomized controlled trial comprised 414 adult patients who underwent cardiac surgery. The postoperative outcomes assessed were SSI and the quantity of blood lost from the sternal edges in the Sternum Guard (Vygon; treatment) and bone wax (control) groups. The superficial SSI prevalence in the Sternum Guard group was lower than that in the bone wax group (2.9% vs. 8.2%, respectively; P=0.018). The incidence of deep SSI was also lower in the Sternum Guard group (1%) compared to the control group (2.9%) although this was not statistically significant (P=0.284). In terms of intraoperative sternal bleeding, Sternum Guard (Vygon) absorbed more than the sterile drapes used in the control group (84.97±115.99 vs. 81.18±14.62, respectively; P=0.012). Sternum Guard (Vygon) had a significantly lower incidence of postoperative infection and bleeding from the sternum compared to bone wax.

An innovative minimally invasive approach for hypertrophic obstructive cardiomyopathy: Transaortic septal myectomy via right infra-axillary incision

ObjectiveTo assess the short-term outcomes of the transaortic modified Morrow procedure when performed via a minimally invasive right infra-axillary incision. MethodsWe conducted a retrospective observational study at a single center of patients diagnosed with hypertrophic obstructive cardiomyopathy from September 2021 to July 2023. ResultsThe cohort comprised 148 patients (mean age 47.2 ± 15.0 years; 59.5% male). A majority (137/148, 92.6%) presented with systolic anterior motion. All procedures were successfully completed through a 4- to 5-cm right infra-axillary incision, without requiring conversion to sternotomy. Transthoracic echocardiography demonstrated a significant reduction in maximum septal thickness from 20.9 ± 5.0 mm to 14.4 ± 3.5 mm (95% confidence interval, 5.66-7.28; P < .001), and in left ventricular outflow tract gradient from 85.1 ± 50.9 mm Hg to 11.7 ± 10.3 mm Hg (95% confidence interval, 65.1-81.6; P < .001). The systolic anterior motion phenomenon was completely eliminated, with no severe mitral regurgitation was observed postoperatively. No iatrogenic ventricular septal defects occurred. One hundred twenty-four (83.8%) patients were extubated in the operating room. Eight (5.4%) patients received permanent pacemaker implantation. Unfortunately, 1 patient (0.7%) died of an intraoperative subarachnoid hemorrhage. ConclusionsThe transaortic modified Morrow procedure, performed through a minimally invasive right infra-axillary incision, shows favorable short-term outcomes.

One-stage revision for reconstructing acetabular defects by trabecular metal acetabular revision system in periprosthetic joint infection

Objective: To investigates the clinical efficacy of the trabecular metal acetabular revision system (TMARS) in one-stage reconstruction of acetabular deficiencies associated with periprosthetic joint infection (PJI). Methods: This is a retrospective case series study,including the data of 59 patients with PJI underwent acetabular defect reconstruction by TMARS during one-stage revisions in the Department of Orthopaedics, the First Affiliated Hospital of Xinjiang Medical University from January 2013 to December 2021. There were 32 males and 27 females, aged (59.5±14.6) years (range: 26 to 84 years). Among them, 29 cases used tantalum cups, 13 cases used tantalum cups and tantalum reinforcing blocks, 9 cases used cup-cage, and 8 cases used multi-cup reconstruction techniques. The surgery procedure, Harris Hip score (HHS), recovery of the hip rotation center, implant survival rate, postoperative reinfection rate, and complications were recorded. Data were compared using the Wilcoxon rank-sum test. Results: All of the 59 patients underwent the operations successfully. Operation time was (188.9±48.4) minutes (range: 110 to 340 minutes), and intraoperative bleeding volume was (M(IQR)) 1 000(400)ml (range: 600 to 1 800 ml). After a postoperative follow-up of 5.1 (2.6) years (range: 2.0 to 10.5 years), the prosthesis survival rate was 94.9% (56/59). Recurrence of infection occurred in 3 cases (5.1%), aseptic loosening in 1case(1.7%), and hip dislocation in 4 cases (6.8%). At the last follow-up, HHS improved significantly(84 (12) vs. 44 (9), Z=-6.671, P<0.01), and the center of rotation of the hips were recovered in all cases. Conclusions: In one-stage revision surgeries aimed at reconstructing acetabular defects, utilizing the TMARS can provide stable initial fixation, restore a more natural center of rotation, significantly enhance early postoperative hip joint function, and reduce the likelihood of infection recurrence. This approach stands as a reliable choice for addressing acetabular defects during revision surgeries for infected hip joints.

559. SURGICAL PROCEDURE AND CLINICAL OUTCOME OF TRANSMEDIASTINAL ESOPHAGECTOMY FOR ESOPHAGEAL CANCER

Abstract Background We started performing esophagectomy by a laparoscopic transhiatal approach in 2009, and 577 patients had undergone to date. Furthermore, we started performing single-port mediastinoscopic cervical approach in 2014, and developed a technique for total mediastinal lymph node dissection (390 patients). Methods The upper and middle mediastinal lymph node dissection including lymph nodes along the left recurrent laryngeal nerve, using a left cervical approach, was performed with a single-port mediastinoscopic technique. This approach with pneumomediastinum by AirSeal System improved the visibility and handling in the deep mediastinum around the aortic arch. We recently performed intraoperative monitoring of the recurrent laryngeal nerve using Nerve Integrity Monitor system. For dissection of upper and middle mediastinal lymph nodes, the left recurrent laryngeal nerve was sometimes compressed by the shaft of the sealing device or the retractor. We used continuous monitoring with the Automatic Periodic Stimulation electrode for the left recurrent laryngeal nerve, and immediately recognized dangerous procedures. Frequency of recurrent laryngeal nerve palsy was dramatically reduced to half by the introduction of Nerve Integrity Monitor system. Furthermore, to understand the anatomy of bilateral bronchial arteries, we performed 3-dimensional computed tomography angiography preoperatively, which was crucial to avoid intraoperative bleeding. Results The outcome of patients performed transmediastinal radical esophagectomy was compared with those performed the right thoracotomy by using propensity score matching. The operative time, the operative bleeding, and postoperative respiratory complications were significantly decreased by transmediastinal radical esophagectomy. Conclusion Our surgical procedure resulted in a good surgical view, safe en-bloc mediastinal lymph node dissection, and the decrease of postoperative respiratory complications. https://intconferenceservices-my.sharepoint.com/:v:/g/personal/barbarav_icsevents_com/ER9oAGbon3xJvdMGlJ2EUbIBgaq_8XDlKNA-wzVH3-7Hcg?nav=eyJyZWZlcnJhbEluZm8iOnsicmVmZXJyYWxBcHAiOiJPbmVEcml2ZUZvckJ1c2luZXNzIiwicmVmZXJyYWxBcHBQbGF0Zm9ybSI6IldlYiIsInJlZmVycmFsTW9kZSI6InZpZXciLCJyZWZlcnJhbFZpZXciOiJNeUZpbGVzTGlua0NvcHkifX0&amp;e=KbAfDr

Cystic plate approach combined with ICG fluorescence in laparoscopic anatomical hepatectomy.

The in-depth understanding of the fine anatomy of the liver has promoted the development of modern liver surgery. With the rapid popularity of laparoscopic hepatectomy, the membrane structure of the liver and its ability to dissect the intrahepatic and extrahepatic vascular system more conveniently and accurately has been gradually emphasized. Exploring the value of extrahepatic sheath dissection of the hepatic pedicle in minimally invasive anatomical hepatectomy with cystic plate approach. This study aims to assess the benefits of integrating the cystic plate approach with real-time guided laparoscopic anatomical hepatectomy, in comparison with conventional laparoscopic anatomical hepatectomy. Based on the theory of cystic plate and hepatic portal plate, the authors have pioneered the fluorescence real-time guided cystic plate approach in hepatectomy. The article focuses on the anatomical knowledge and technical difficulties of anatomical hepatectomy with fluoroscopic laparoscopic cystic plate approach and explores the safety and practicality of the cystic plate approach in laparoscopic anatomical hepatectomy. Additionally, a retrospective cohort study was also conducted to compare the operation time, intraoperative blood loss, and postoperative complications between the cystic plate approach and the conventional approach during fluoroscopic laparoscopic hepatectomy. A total of 38 patients who met the inclusion criteria underwent laparoscopic hepatectomy between January 2019 and November 2022. No significant disadvantages were found in terms of operation time and intraoperative blood loss during the surgeries. Furthermore, the postoperative indications, including liver function indexes on the first postoperative day, WBC, and the postoperative hospital stay, were also not affected, thus proving the safety of the cystic approach. Importantly, through the cystic plate approach, the target liver pedicle was fully freed, and then the segments to be resected were precisely marked by positive or negative staining, followed by hepatectomy under real-time fluoroscopic guidance. This approach is extremely advantageous in anatomical liver segment resections, especially in right posterior lobe or hemi-hepatectomy, without increasing intraoperative bleeding or postoperative complication rates. This technique allows for easy and safe freeing of the target liver pedicle using membrane structures, and also allows for precise anatomical hepatectomy in combination with real-time fluoroscopic laparoscopic navigation.

Infusion of 20% Human Albumin Reduces the Requirement of Intraoperative Intravenous Fluids in Patients Undergoing Open Gastrointestinal Oncosurgeries – A Randomised Controlled Study

Background and Aims: The optimal strategy for intraoperative fluid management in patients undergoing major abdominal oncosurgery remains undecided. The present study was undertaken to determine the effect of 20% intravenous (IV) albumin on the requirement of IV fluids (IVFs) during open gastrointestinal (GI) cancer surgeries. Methods: This randomised, double-blinded, controlled trial was conducted in a tertiary care centre from August to October 2022 after obtaining approval from the institutional ethics committee and informed written consent from the study subjects. Forty patients were randomised to either Group A (n = 20), receiving an IV infusion of 25 mL/h of 20% albumin, or Group C (n = 20), receiving an IV infusion of 25 mL/h of plasmalyte for 4 h (total 100 mL). Fluid and vasopressor administration was guided by systemic and pulse pressure variations. The primary outcome was the intraoperative requirement for IVF in the two study groups. The secondary outcomes included intraoperative IV vasopressor requirement, serum lactate levels, incidence of post-operative complications and length of hospital stay. Results: After the exclusion of three patients due to intraoperative bleeding, 37 patients were included in the final analysis. Patients in Group A (n = 19) required less IVF (3.92 ± 0.54 mL/kg/h) as compared to Group C (n = 18) (5.03 ± 1.20 mL/kg/h) (P &lt; 0.001). Four patients (22%) in Group C required intraoperative noradrenaline IV infusion (P = 0.040). There was no significant difference between the two groups, regarding the mean intraoperative serum lactate values, incidence of post-operative complications and mean length of hospital stay (P &gt; 0.05). Conclusions: A 100 mL of 20% human albumin as an IV infusion over 4 h reduced the requirement of IV fluid and vasopressor intraoperatively in patients undergoing open GI cancer surgery.

To introduce a new method of resection of carotid body tumor with preservation of the internal carotid artery ----microscopic coagulation method

Objective:To introduce the surgical experience of carotid body tumor（CBT） resection with preservation of internal carotid artery. Methods:The clinical data of 109 patients with CBT were retrospectively analyzed. The key points of surgical techniques were summarized, the imaging and pathological results were comprehensively analyzed, and the postoperative complications were observed. Results:Of the 109 patients, 28 were Shamblin Ⅰ, 46 were Shamblin Ⅱ, and 35 were Shamblin Ⅲ. Synaptophysin（SYN） and soluble protein-100（S-100） were positive in all cases. There was a positive correlation between the average expression area percentage of S-100 and SYN in pathological tissue of 17 patients（r=0.48）, and the difference was statistically significant（P<0.05）. The average operation time was（148.4±46.2） minutes, the average intraoperative blood loss was（64.7±22.8） mL, and the average hospital stay was（15.2±2.6） days. Three patients underwent tumor resection combined with external carotid artery ligation, 1 patient underwent tumor resection combined with internal carotid artery ligation, and the remaining patients underwent tumor resection alone. The overall rate of intraoperative vascular ligation was 3.7% and the rate of nerve injury was 6.4%. According to preoperative CTA, intraoperative situation and postoperative pathological results, a new classification of CBT was proposed, which could intuitively reflect the gap between the tumor and the carotid artery and the nature of the tumor. Conclusion:Surgical resection of CBT is recommended after diagnosis. The potential gap between the tumor and the blood vessels was found under the microscope. Low energy bipolar electrocoagulation was used to coagulate and cut off the fibrous connective tissue between the tumor and gradually separated along the adventitia of the artery. The carotid artery could be preserved in most cases while the tumor was completely removed, and the amount of intraoperative bleeding and the incidence of complications were reduced. It is particularly important to identify the difficult cases before operation.

Comparison of Extracorporeal and Intracorporeal Urinary Diversion after Robot-Assisted Radical Cystectomy for Bladder Cancer: A Meta-Analysis.

To explore the therapeutic efficacy of intracorporeal urinary diversion (ICUD) and extracorporeal urinary diversion (ECUD) after robot-assisted radical cystectomy for bladder cancer through systematic review. This study systematically retrieved electronic databases of PubMed, Web of Science, Cochrane Library, CNKI, and Wanfang to include peer-reviewed studies comparing ICUD and ECUD after robot-assisted radical cystectomy for bladder cancer. Relative risk (RR) and mean difference (MD) were used to represent the pooled effect size and estimate its 95% confidence interval (CI). This study included 15 studies with good quality, involving 5,370 patients undergoing robot-assisted radical cystectomy for bladder cancer. Meta-analysis showed that ICUD reduced intraoperative bleeding volume by 64.12 ml (95% confidence interval [CI]: [-100.95, -27.29]), significantly decreased the risk of blood transfusion (RR: 0.40; 95% CI: [0.24, 0.68]) and gastrointestinal complications (odds ratio [OR]: 0.61; 95% CI: [0.47, 0.80]), with shorter postoperative time of exhaust (MD: -9.27; 95% CI: [-18.47, -0.08]) and oral intake (MD: -0.92; 95% CI: [-1.30, -0.54]). However, ICUD had a relatively longer surgical duration (MD: 30.84 min, 95% CI: [5.03, 56.66]). In addition, there was no statistically significant difference concerning the impact of ICUD and ECUD on the length of stay in the hospital (MD: -0.68d; 95% CI: [-1.79, 0.42]), overall complications (30-day: RR: 1.16; 95% CI: [0.93, 1.46]; and 90-day, RR: 0.85; 95% CI: [0.69, 1.04]) and readmission rate (30-day: RR: 0.96; 95% CI: [0.72, 1.27]; and 90-day: RR: 1.15; 95% CI: [0.80, 1.64]). ICUD after robot-assisted laparoscopic radical cystectomy for bladder cancer exhibits obvious positive effects, especially in reducing the risk of blood transfusion and gastrointestinal complications, and shortening postoperative time of exhaust and oral intake. The findings in this meta-analysis should be confirmed by multiple high-quality studies in the future.

Combining transcatheter arterial embolization with endoscopic debulking for hypervascular airway tumor management: a retrospective single center study.

Airway obstruction due to tumor invasion or concurrent respiratory distress and hemoptysis poses a significant challenge in clinical management, often requiring prompt and effective intervention to alleviate symptoms and improve patient outcomes. This study aimed to evaluate the efficacy and safety of selective transcatheter arterial embolization (TAE) as a preparatory measure to mitigate airway obstruction before bronchoscopic debulking as an approach to address this clinical challenge. The data of patients with airway obstruction due to tumor invasion or concurrent respiratory distress and hemoptysis treated at The First Affiliated Hospital of Zhengzhou University from January 2018 to August 2022 were analyzed. After computed tomography (CT) scans and bronchoscopic findings were assessed, selective TAE was performed as a preparatory measure to alleviate airway obstruction before bronchoscopic debulking, and the occurrence of hemorrhage-related complications, Karnofsky Performance Status (KPS) score, breathlessness index, and the extent of airway obstruction were evaluated. All 22 patients underwent selective TAE before bronchoscopic tumor debulking. The overall efficacy rate was 100%, with a significant improvement in the KPS score from preoperative (60.45±14.63) to postoperative (74.55±9.63) levels (t=-6.891; P<0.001). Similarly, there was a considerable reduction in the shortness of breath score from preoperative (2.91±0.81) to postoperative (1.73±0.63) levels (t=6.973; P<0.001). Airway obstruction decreased substantially from preoperative (79.14%±14.56%) to postoperative (21.27%±7.19%) levels (t=26.857; P<0.001). Furthermore, the severity classification of airway obstruction decreased from preoperative (4±0.82) to postoperative (1.36±0.49) levels (t=18.794; P<0.001). Among the patients, only one experienced moderate bleeding necessitating prolonged mechanical balloon compression and intracavitary lesion removal, while the other patients had minor and negligible bleeding. TAE combined with endoscopic debulking can effectively control intraoperative bleeding and respiratory distress and achieve successful local resolution of endotracheal hypervascular tumors.

Evaluation of the Effectiveness of Cervical One-Hole Split Endoscopic Keyhole Surgery for Cervical Radiculopathy.

One-hole Split Endoscopy (OSE) is a newer surgical modality that can be applied to posterior cervical foraminotomy (PCF), lumbar discectomy, laminectomy, and decompression. It incorporates intervertebral foraminotomy, open surgery, and other lumboendoscopic techniques with a wide observation field, free space, and compatibility with various spinal surgical techniques and instruments. This study investigated the clinical efficacy of minimally invasive posterior cervical nucleus pulposus removal for cervical spondylotic radiculopathy (CSR) by OSE-Keyhole technique. This was a retrospective study of 63 patients treated with OSE keyhole treatment for CSR between May 2021 and September 2023 at Qilu Hospital of Shandong University, Qilu Hospital of Shandong University (Qingdao, China), and Second Hospital of Shandong University, respectively. Clinical outcomes included patients' preoperative and postoperative visual analogue scale (VAS) - arm and neck, Japanese Orthopaedic Association Assessment Treatment Score (JOA) - cervical spine, which were collected at baseline, two days postoperatively, one month postoperatively, and three months postoperatively after the last follow-up visit for evaluation, and perioperative indicators, including intraoperative bleeding, length of hospital stay, postoperative complications, and reoperations, which were also collected. Statistical analyses were performed for the baseline data and follow-up results of 63 patients. Compared to the preoperative baseline values, the follow-up results two days, one month and three months after surgery showed significant improvements in vas-arm, neck and JOA scores in the operated patients (P<0.05) as well as a reduction in all perioperative-related indices. In the treatment of cervical pain and disability due to radiculopathy, OSE keyhole removal of the posterior cervical nucleus pulposus is a better clinical option as it is less invasive and recovers better postoperatively.

401.7: Utilizing large language models for predictive analysis of intraoperative hemorrhage risks in lung transplant recipients.

401.7: Utilizing large language models for predictive analysis of intraoperative hemorrhage risks in lung transplant recipients.

A Comparative Study Between Coblation-Assisted Tonsillectomy and Conventional Dissection and Snare Tonsillectomy.

Background Tonsillitis is a vastly prevalent disease, accounting for the majority of outpatient visits. The dissection and snare method has been the predominant approach for tonsillectomy for centuries. Coblation-assisted tonsillectomy offers advantages such as faster healing, shorter surgery duration, minimal blood loss, and fewer postoperative complications. Therefore, a study was conducted to evaluate the distinctions and compare the efficacy of traditional dissection and coblation-assisted tonsillectomy. Materials and methods Patients were divided into two groups: Group I was operated on using the conventional method, and Group II was operated on using the coblation method. Both groups were then assessed for intraoperative time, intraoperative bleeding, postoperative pain, and postoperative complications. Results Coblation-assisted tonsillectomy patients had a significantly shorter mean duration for the procedure and significantly lower blood loss in comparison to the conventional method. There were no statistically significant variations in the incidence of postoperative complications. Coblation-assisted tonsillectomy patients experienced considerably higher pain scores on various postoperative days. Conclusion Coblation-assisted tonsillectomy had the added advantage of reduced intraoperative blood loss, shorter surgical time, and faster recovery postoperatively. Coblation-assisted tonsillectomy can be considered an effective alternative to conventional methods. However, it's important to consider factors such as cost-effectiveness and surgeon experience. Further research involving larger sample sizes and longer follow-up periods could yield more insightful knowledge of the outcomes of these two tonsillectomy techniques.