Intraoperative Bleeding Research Articles

Comparative Analysis of the Efficacy of Four Different Surgical Modalities in the Treatment of Cesarean Scar Pregnancy: A Multicenter Retrospective Study.

This study explored the effects of four different surgical methods in the treatment of cesarean scar pregnancy (CSP). In this multicenter retrospective analysis of 359 patients, the surgical indices, the time taken for the serum human chorionic gonadotropin level to return to normal, the recovery time of menstruation, and the incidence of postoperative adverse reactions were comparatively analyzed. The clinical efficacies of various preoperative treatment methods to block the blood supply to CSP tissues and those of four different surgical methods to treat CSP, namely, curettage, hysteroscopic surgery, laparoscopic surgery, and vaginal surgery, were evaluated in this study. Hysteroscopic pregnancy tissue removal in patients with typeI CSP was found to be associated with low cost, rapid postoperative recovery, and a low incidence of postsurgical complications. Among patients with typeII-III CSP, the operation success rate (96.97% for typeII and 88.46% for typeIII) in those who underwent uterine artery embolization + curettage was lower than that in patients from the other groups (all 100%). Among patients with typeIII CSP who underwent transvaginal ligation of the descending uterine artery + hysteroscopic removal of the pregnancy tissues, three patients (12.5%) underwent hysteroscopic surgery under transumbilical single-port laparoscopic surveillance so as to avoid uterine perforation considering that the pregnancy tissue was only 1mm away from the uterine plasma membrane layer. Hysteroscopic surgery without pretreatment can be adopted for patients with typeI CSP. In contrast, patients with typeII and III CSP should be initially pretreated with vascular ligation to prevent intraoperative bleeding, followed by laparoscopic or vaginal surgery. Clinical Trial Registry Number ChiCTR2000040357.

The learning curve of totalrobotic jejunojejunostomy duringcholedochal cystexcision in pediatrics: a retrospective study.

We conducted this retrospective study to investigate the characteristics of the learning curve of totalrobotic jejunojejunostomy duringcholedochal cystexcision in pediatrics. The study analyzed a database of medical records from the first 54 consecutive patients who underwent total robotic jejunojejunostomy during choledochal cyst excision by a single surgeon. Baseline information and postoperative outcomes were collected, and learning curves were assessed using the cumulative sum (CUSUM) method. Patients were then divided into two groups (A and B) based on the learning curve's cut-off points, and the intraoperative characteristics and postoperative outcomes were compared between the two groups. CUSUM plots revealed that the cut-off point of the learning curve was 17 cases. The operative time of jejunojejunostomy in group A was (61.71 ± 13.47min), which was longer than that of group B (42.43 ± 2.97min) (p < 0.0001). No statistically significant differences were found in terms of the intraoperative bleeding, time to start diet after surgery, hospital stay, and total complications between the two groups (p > 0.05). The learning curve for total robotic jejunojejunostomy during choledochal cyst excision in pediatrics is 17 cases, which can serve as the basis for performance guidance during future training.

Effect of tranexamic acid dissolved in warm, cold, and room-temperature irrigation fluid on complications during and after TURP surgery: a double-blind, randomized clinical trial

BackgroundTransurethral resection of the prostate (TURP) surgery, as a common surgical technique for cases of benign prostatic hyperplasia, can often lead to various complications during and after the procedure. Among these, intraoperative bleeding and postoperative shivering are highly prevalent. Accordingly, the present study aimed to compare three combinations of tranexamic acid (TXA) dissolved in warm, cold, and room-temperature irrigation fluids to determine their greater effectiveness in reducing bleeding and postoperative complications, such as shivering, following TURP.MethodsThis prospective, double-blind clinical trial was conducted from April to November 2023 at Imam Khomeini Hospital in Alashtar, Iran. 100 patients scheduled for TURP were selected via convenience sampling and randomly assigned into four groups using a four-block and permutation design. The groups were as follows: Intervention Group A (TXA dissolved in cold irrigation fluid), Intervention Group B (TXA dissolved in room-temperature irrigation fluid), Intervention Group C (TXA dissolved in warm irrigation fluid), and the Control Group (room-temperature irrigation without TXA). Intraoperative bleeding was measured using a photometer, hemoglobin levels were assessed with the Cell-Dyn3200 hematology analyzer, and postoperative shivering was evaluated using the Crossley and Mahajan scale.ResultsPostoperative bleeding was significantly lower in Intervention Group A compared to the other groups (P < 0.05). Hemoglobin levels decreased significantly over time (P < 0.05), but no significant inter-group differences in hemoglobin changes were observed (P > 0.05). Postoperative shivering was lowest in Intervention Group C and highest in Intervention Group A (P < 0.05).ConclusionsCombining TXA in a cold irrigation fluid potentially reduces intraoperative bleeding, but is associated with a higher incidence of postoperative shivering than the other groups.

Endoscopic evacuation of supratentorial hematoma: A hemostatic strategy for surgeons.

Endoscopic hematoma evacuation has become well received for its high evacuation rate in patients with intracerebral hematoma. Effective hemostatic procedure is the key to the success of the procedure. Any single method cannot solve all kinds of intraoperative bleeding, The key to hemostasis is to identify the type of bleeding and take the best hemostasis method during endoscopic surgery. In our study, sixty-two intracerebral hemorrhage patients who underwent endoscopic hematoma evacuations were analyzed. Intraoperative bleeding was graded as Grades 0, 1, 2, and 3 based on characteristics of bleeding. A hemostatic strategy was created from the grading system. The efficiency was evaluated by operation time, evacuation rate, and re-bleeding rate after surgery. Procedure safety was evaluated by mortality rate and postoperative complications. We found that endoscopic removal of putamen hematoma was more prone to intraoperative bleeding (P = .00). Active bleeding occurred in early operative stage and errhysis happen in later stage (P = .00). Average evacuation rate was 95.61% and the mortality rate was 3.23%. The mean Glasgow outcome scale (GOS) score at 6-month follow-up was 3.77 ± 1.12. No patient experienced postoperative re-bleeding. These findings indicated that most patients will experience different degrees of intraoperative bleeding during endoscopic hematoma evacuation. A hemostatic strategy based on intraoperative bleeding grade resulted in efficiency and safety.

Proposal of a Machine Learning Based Prognostic Score for Ruptured Microsurgically Treated Anterior Communicating Artery Aneurysms.

Background: Aneurysmal subarachnoid hemorrhage (aSAH) carries significant mortality and disability rates, with rebleeding posing a grave risk, particularly in anterior communicating artery (AcoA) aneurysms. This retrospective study aims to analyze preoperative and intraoperative variables of patients with ruptured AcoA aneurysms, evaluating the association of these variables with patient outcomes using machine learning techniques, proposing a prognostic score. Materials and Methods: A retrospective study was conducted on 50 patients who underwent microsurgical clipping for a ruptured AcoA aneurysm at San Giovanni Bosco Hospital, Turin, Italy. The clinical and aneurysmal data-including clinical evaluations, risk factors, aneurysmal characteristics, and intra- and postoperative details-were examined. The study population was analyzed using machine learning techniques such as the MRMR algorithm for feature selection, and the LASSO method was employed to construct linear predictive models based on these features. Results: The study cohort had a mean age of 54 years, with 26 female and 24 male patients. Temporary clipping of main vessels was performed in 96% of procedures, with a mean duration of 3.74 min. Postoperatively, the mean Intensive Care Unit (ICU) stay was 7.28 days, with 14% mortality at 30 days and 4% within the first week. At the six-month follow-up, 63% of discharged patients had a Glasgow outcome scale (GOS) of 5, with radiological confirmation of complete aneurysm exclusion in 98% of cases. Machine learning techniques identified the significant predictors of patient outcomes, with LASSO algorithms generating linear models to predict the GOS at discharge and at 6 months follow-up. Conclusions: Preoperative factors like the BNI score, Vasograde, and preoperative cerebral edema demonstrate significant correlations with patient outcomes post-clipping. Notably, intraoperative bleeding and extended temporary clipping durations (over 3 min) emerge as pivotal intraoperative considerations. Moreover, the AcoA prognostic score shows promise in predicting patient outcomes, discharge plans, and ICU duration.

A Successful Control of the Intraoperative Bleeding from McConnell's Artery during Fully Endoscopic Resection of Planum Sphenoidale Meningioma Using Bone Chip and Bioglue : A Case Report.

The endoscopic transsphenoidal approach is a common approach used in skull base neurosurgery to reach the sellar region. One of the intraoperative risks of this approach is intraoperative bleeding out of the carotid artery. Gentle drilling can prevent carotid artery injury. However, injury to smaller branches, such as the McConnell's capsular artery, which is located within the surgical corridor, is more difficult to prevent. If such an injury is within the junction to the main trunk of the carotid artery, there will be a small circular defect in this area. This can result in massive blood loss and should be closed surgically immediately. We describe a clinical case of intraoperative bleeding from the McConnell's artery originating from the carotid arterial segment (C4) in a 78-year-old female patient operated on for planum sphenoidale meningioma via endoscopic transsphenoidal approach, as well as provide a technical note on a possible technique for bleeding control in such cases. Pinpoint carotid bleeding as a result of intraoperative injury can be stopped by wedging a bone fragment in the carotid canal and fixing it in that position with histoacryl glue at the defect site.

The "CUPCAKE" technique (coiled underlying pseudoaneurysm contained by a woven endobridge device) for treating intracranial aneurysms with atypical morphology.

Intrasaccular flow diversion using the woven endobridge device (WEB; MicroVention, Aliso Viejo, CA, USA) for the treatment of intracranial aneurysms has demonstrated large scale safety and efficacy. However, limitations arise from its structural configuration, restricting its application to specific aneurysm sizes and shapes. We introduce the CUPCAKE technique, a combination of conventional coiling followed by WEB intrasaccular flow disruption in select cases of atypical aneurysms with technically challenging morphology not typically treatable by WEB alone. A retrospective analysis of a prospectively-maintained dataset from three Australian neurovascular tertiary referral centers, identifying patients treated with the CUPCAKE technique between April 2018 and September 2023. Evaluation of patient and aneurysm characteristics, procedure parameters, complications, radiological and clinical outcomes at follow-up was performed. The CUPCAKE technique was used for the treatment of 22 intracranial aneurysms of total 169 treated with WEB. Overall successful immediate flow stagnation was observed in 95.5% (n = 21) of aneurysms with no cases of perforation or intraoperative hemorrhage. Imaging confirmed thromboembolic complications occurred in two patients, one patient had persistent flow requiring re-treatment during initial admission. Follow-up imaging demonstrated 88.2% complete aneurysm conclusion with no delayed aneurysm expansion or rupture. Synergistic use of conventional coiling with WEB intrasaccular flow disruption presents a viable solution for technically difficult aneurysm treatment. In our series, 13% of all patients treated with WEB received CUPCAKE treatment, resulting in high technical success and no increase in thromboembolic complications with the union of two methods.

Safety Analysis of Visual Percutaneous Tracheostomy in Neurocritical Care Patients with Anticoagulation and Antithrombosis.

This study aims to evaluate the safety of visual percutaneous tracheostomy (vPDT) in neurologic intensive care unit (NICU) patients who are under anticoagulant and antithrombotic therapy. A retrospective cohort study was conducted on 54 NICU patients who underwent vPDT at Tai'an Central Hospital from September 2022 to September 2023. The cohort included 36 men and 18 women aged 36-90years (mean age 62.24 ± 12.24years). Patients were divided into two groups based on their treatment: an anticoagulant and antithrombotic group (22 patients) and a non-anticoagulant and non-antithrombotic group (32 patients). Clinical data, including demographic information, comorbidities, Glasgow Coma Scale (GCS) score before vPDT, time from NICU admission to vPDT, laboratory indicators, and vPDT complications, were analyzed. The incidence of vPDT complications in the anticoagulant and antithrombotic group was 18.2%, involving three cases of minor intraoperative bleeding and one case of posterior airway wall injury. The non-anticoagulant and non-antithrombotic group had an 18.8% complication rate, including four cases of minor intraoperative bleeding, one case of subcutaneous emphysema with local infection, and one unrelated death. No significant difference in vPDT complications was observed between the two groups (P > 0.05). However, the anticoagulant and antithrombotic group had a higher average age, higher GCS scores, and longer time intervals from NICU admission to vPDT and from intubation to vPDT (all P < 0.05). vPDT appears to be a safe and feasible procedure for NICU patients receiving anticoagulant and antithrombotic therapy, with no significant increase in complications compared to those not on such therapies.

A Novel Method for Hemorrhage Control During Laparoscopic Distal Pancreatectomy with Splenic Vessel Preservation: Triple Occlusion.

Laparoscopic distal pancreatectomy (LDP) has the advantages of reduced blood loss, shorter hospital stays, and a better postoperative quality of life compared with open distal pancreatectomy (ODP).1 Meanwhile, spleen-preserving laparoscopic distal pancreatectomy is the preferred technique for low-grade malignant and benign tumors located in pancreatic body and tail, since it preserves the immune function of the spleen. The splenic-vessel-preserving (SVP) Kimura technique and splenic vessel resection Warshaw technique are the two primary procedures. Although the Kimura procedure and the Warshaw procedure were comparable in most postoperative outcomes, the former was superior to the latter in reducing the risk of gastric varices and splenic infarction.2,3 However, in cases of large tumors in the distal pancreas or those with tight adhesions of the tumor to the splenic vessels, laparoscopic Kimura procedure is technically challenging because of the higher risk of intraoperative hemorrhage.4 Herein, we present an effective surgical approach to laparoscopic SVP that minimizes the chances of vascular injury and maximizes the chances of a successful splenic preservation-triple occlusion strategy. A 46-year-old woman was admitted to our department owing to vague pain in the upper abdomen lasting for 6 months. Enhanced computed tomography (CT) scan revealed a 3.9 ✕ 4.3 cm cystic tumor in the distal pancreas, which has a smooth cystic wall without wall nodules; despite poor demarcation of the tumor from the splenic vein, tumor markers were all within normal limits (CA19-9, 5.78 U/ml; CEA, 1.14 ng/ml), so a benign tumor was considered. We present the triple-occlusion strategy during laparoscopic Kimura operation. This approach, as demonstrated in the video, includes triple occlusion of the proximal splenic artery, proximal splenic vein, and splenic pedicle; In addition, we use cold scissors to carefully dissect the tumor from the splenic vein, which minimizes the possibility of splenic vein injury and tumor rupture caused by thermal damage of ultrasonic scalpel, thus improving the safety of the surgery and the chances of spleen preservation. The operation lasted for 136 min with 10ml of estimated blood loss. Multiple sites of the cystic wall were sampled (including the margins of the splenic vein), and intraoperative freezing was conducted to consider mucinous tumors, with no cancer cells detected. The amylase in the drainage fluid on postoperative day (POD) 3 was 1410 U/l, and the drainage tube was removed on POD 4. The patient showed an uneventful recovery and was discharged on POD 5. Finally, mucinous cystadenoma with mild atypical hyperplasia was diagnosed by pathological examination. The laparoscopic triple-occlusion strategy may be helpful for selected patients with tumors located at the distal pancreas, especially for those with large tumor or tumors with tight adhesion to splenic vessels.

S8 Navigation system combined with an ultrasonic osteotome for three-dimensional real-time dynamic visualization decompression to reduce postoperative neurological deterioration in thoracic ossification of the ligamentum flavum.

Posterior laminectomy is a standard treatment for thoracic ossification of the ligamentum flavum (TOLF), but it often leads to neurological deterioration during surgery. This study aimed to reduce iatrogenic neurological deterioration by using an S8 navigation system combined with an ultrasonic osteotome for three-dimensional real-time dynamic visualization decompression. A retrospective analysis was conducted on patients who underwent laminectomy and internal fixation for TOLF in our centre from January 2016 to January 2023. Patients were divided into a visualization group (S8 navigation + ultrasonic bone scalpel) and a control group (ultrasonic bone scalpel) based on the use of three-dimensional real-time dynamic visualization decompression technology. Intraoperative multimodal neuroelectrophysiological monitoring (IONM) was used to collect somatosensory evoked potential and motor evoked potential data. We compared the incidence of intraoperative neurological deterioration indicated by IONM alarms between the two groups. Neurological and motor functions were assessed via the American Spinal Injury Association (ASIA) classification system and the modified Japanese Orthopaedic Association (m-JOA) score for thoracic myelopathy. Follow-ups were conducted at 1, 3, 6, and 12months postsurgery, and the data from both groups were compared. Other clinical indicators included decompression time per laminectomy segment, intraoperative blood loss, intraoperative dural ossification, hospitalization duration, and drainage tube placement time. We also analysed intraoperative and postoperative complications. A total of 91 patients with thoracic ossification of the ligamentum flavum were included, with a follow-up period of 12-18months. The visualization group consisted of 41 patients, and the control group included 50 patients. The incidence of neurological deterioration indicated by IONM in the visualization group (9.8%) was significantly lower than that in the control group (30.0%) (P = 0.014). The immediate postoperative ASIA grade change value ≤ - 1 was lower in the visualization group (9.8%) than in the control group (34.0%) (P = 0.006); A similar trend was observed at the 12month follow-up (2.4% vs. 20.0%, P = 0.022). The m-JOA scores at 1, 3, 6, and 12months postsurgery were higher in the visualization group than in the control group (P < 0.05). The visualization group also had shorter lamina decompression times per segment and less intraoperative blood loss (P < 0.05). The incidence of nondural ossification cerebrospinal fluid leakage was lower in the visualization group (2.4%) than in the control group (18.0%) (P = 0.018). Additionally, nerve root injury was lower in the visualization group (0%) than in the control group (10.0%) (P = 0.037). Postoperative CT scans revealed no ossification residue in the visualization group, whereas 7 cases (14.0%) were observed in the control group (P = 0.013). The S8 navigation system combined with an ultrasonic osteotome for three-dimensional real-time dynamic visualization decompression significantly reduces the incidence of intraoperative neurological deterioration, improves postoperative motor function recovery, and reduces decompression time per vertebral segment, intraoperative bleeding, and complications such as cerebrospinal fluid leakage. This technology is safe and reliable and offers a promising option for spinal surgeons in treating thoracic ossification of the ligamentum flavum.

Prevalence and Risk Factors of Acute Kidney Injury After Colorectal Cancer Surgery.

Acute kidney injury is a sentinel event affecting colorectal cancer patients either as a consequence of surgery or systemic chemotherapy. It is highly correlated with both short and long-term adverse outcomes. This work aimed to study the prevalence, risk factors, and impact on survival of postoperative (PO-AKI) and post-chemotherapy (PC-AKI) after colorectal cancer (CRC) surgery in Egyptian patients. Data of the patients with CRC who underwent surgery over the previous 5 years was retrieved from an internet-based medical system. The incidence of PO-AKI and PC-AKI was calculated, the rate and time to resolution of PO-AKI were recorded, and the possible predictors of AKI were assessed using univariate and multivariate analysis; also, the impact of AKI on patients' survival was tested using survival curves. Five hundred sixty-one cases fulfilled the inclusion criteria and were included in the study. PO-AKI was detected in 10.5% of the patients. Significant risk factors included intraoperative hypotension, sepsis, hypoalbuminemia, amount of intraoperative bleeding, neoadjuvant therapy, and preoperative chronic kidney disease (CKD). However, only neoadjuvant treatment (hazard ratio (HR) 2.2) and CKD (HR 3.3) maintained significant risk in the multivariate analysis. PC-AKI was observed in 18.7% of the patients treated. Significant risk factors were previous CKD and the chemotherapy type, mainly affecting those who received Irinotecan-based therapy. The hazard ratio was 8.5 and 2.4 respectively, in multivariate analysis. The overall survival was significantly worse in those who developed PO- or PC-AKI (p < 0.001). AKI affects more than 25% of CRC patients after surgery and/or chemotherapy. Modifiable risk factors include preoperative hypoalbuminemia, intraoperative bleeding, and/or intraoperative hypotension. While, the more important risk factors were non-modifiable including CKD, neoadjuvant therapy, and Irinotecan-containing regimens. Most kidney injuries are stage I; however, they are associated with shorter overall survival.

The Application of the Posterior Atlanto-Occipital Membrane Tension Release Technique for Surgical Exposure of the Horizontal Part of the Vertebral Artery's Third Segment: An Anatomical and Clinical Investigation.

This study aims to elucidate the anatomical principles governing the surrounding venous structures (VS) of the horizontal part of the third segment of the vertebral artery (V3h) and develop a safe and bloodless surgical technique for exposing V3h. This study used 10 formalin-infused cadaveric head specimens. The dissections were performed stepwise to simulate the far lateral approach process, exposing the V3h with a novel technique. Additionally, we applied this technique to 10 patients undergoing far or extreme lateral approaches. The VS surrounding V3h is divided into 3 components: the vertebral venous plexus, suboccipital cavernous sinus, and the anastomotic vein. The posterior atlanto-occipital membrane (PAOM), a resilient fascial layer in the craniovertebral junction, extends from the periosteum of the occipital squama to the posterior arch of the atlas. It adheres ventrally to the VS within the suboccipital triangle (SOT), forming a tent-like structure that maintains tension and ensures fullness of the VS around V3h. We discovered that by releasing tension in this membrane and reducing strain on this tent-like structure, the collapse of the venous sinus within the SOT can be achieved, resulting in reduced intraoperative bleeding and improved surgical efficiency. Additionally, we successfully managed 10 clinical cases employing the PAOM tension release technique in clinical cases, with no reported incidents of intraoperative vertebral artery injury. The application of the PAOM tension release technique effectively collapses the tent-like structure within the SOT, significantly reducing bleeding during V3h exposure in craniovertebral junction.

The Role of Tranexamic Acid in Oculoplastic Surgery: A Systematic Review and Meta-Analysis of Randomized Clinical Trials

Purpose: This study investigates the role of tranexamic acid in oculoplastic surgery. Methods: We searched PubMed, Embase, and Cochrane for randomized clinical trials comparing tranexamic acid (TXA) with placebo. We used the R software, applying mean difference for continuous outcomes and standard mean difference for continuous outcomes assessed on different scales. Results: We included 9 randomized clinical trials totaling 897 patients. Tranexamic acid did not reduce intraoperative bleeding, with a mean difference of −14.83 mL (95% confidence interval [CI]: −36.65 to 6.98). In the subgroup of patients undergoing dacryocystorhinostomy, there was a more pronounced trend, with a mean difference of −29.65 mL (95% CI: −61.07 to 1.76), though without statistical significance. In addition, TXA reduced the degree of periorbital ecchymosis, with a mean difference of −0.69 (95% CI: −1.13 to −0.25), and this reduction was more notable and only statistically significant with intravenous administration (mean difference of −0.78, 95% CI: −1.34 to −0.22). Regarding the surgeon’s satisfaction with hemostasis and the visibility of the surgical field, only 2 studies demonstrated statistically significant results, both using intravenous TXA administration. The other 4 studies did not report any improvement: 2 used the subcutaneous route, and the remaining 2 used the intravenous route for TXA administration. Finally, no reduction in the surgical time was observed with the use of TXA in oculoplastic procedures. Conclusions: In conclusion, TXA did not reduce intraoperative bleeding. However, despite the weak evidence in this outcome, the drug significantly decreased the degree of periorbital ecchymosis in patients undergoing blepharoplasty using intravenous administration.

Effect of central sensitization on postoperative cognitive dysfunction in total knee arthroplasty patients: a retrospective study

BackgroundPostoperative cognitive dysfunction (POCD) is a common complication after total knee arthroplasty (TKA), impacting recovery and quality of life. This study aims to investigate central sensitization (CS) as an independent risk factor for POCD to improve preoperative screening and postoperative interventions.MethodsA retrospective analysis was conducted on 142 TKA patients from January 2020 to May 2024 across three hospitals. Data were collected at six time points: preoperatively (T0), intraoperatively (T1), and postoperatively on days 1 (T2), 3 (T3), 7 (T4), and 30 (T5). Patients were classified into CS (CSI ≥ 40) and non-CS (CSI &amp;lt; 40) groups according to Central Sensitization Inventory (CSI) score. Cognitive function and POCD incidence were assessed with the Mini-Mental State Examination (MMSE), and knee recovery with the Knee Injury and Osteoarthritis Outcome Score (KOOS). Logistic regression was used to identified risk factors for POCD.ResultsThe overall incidence of POCD at T5 was 19.72%, with a significantly higher rate in CS group (30.91%) compared to non-CS group (12.64%) (p = 0.008). MMSE scores declined significantly in both groups at T2 and T3 compared to T0 (p &amp;lt; 0.05), with CS group showing consistently lower scores than non-CS group at T2-T5 (p &amp;lt; 0.05). KOOS scores revealed that CS group had worse pain and quality of life scores at T0, T4, and T5 compared with non-CS group (p &amp;lt; 0.05). Logistic regression revealed that CS, cerebrovascular disease, intraoperative hemorrhage, and preoperative MMSE were associated with the risk of POCD (p &amp;lt; 0.05).ConclusionCS is a significant risk factor for POCD following TKA, adversely affecting recovery in terms of pain and quality of life. Prospective studies are warranted to validate findings and develop targeted interventions.

Optimizing Closed Approach Preservation Rhinoplasty by Ultrasonic-Assisted Techniques for Enhanced Precision.

Preservation rhinoplasty, particularly dorsal preservation, has gained prominence with the advent of piezoelectric instruments, which minimize trauma and enhance precision in bone reshaping. This approach presents unique challenges, especially in closed techniques, where spatial limitations complicate the use of piezotomes. To evaluate outcomes of piezo-assisted preservation rhinoplasty using specialized instrumentation to enhance visibility, precision, and postoperative recovery in closed rhinoplasty procedures. In a cohort of 734 patients undergoing primary rhinoplasty, piezoelectric instruments facilitated closed preservation techniques between May 2021 and April 2023. Cases were documented with a focus on instrument adaptation, bone reshaping precision, and the mitigation of postoperative complications. A 6% revision rate was observed, predominantly for dorsal contour adjustments, with minimal intraoperative bleeding, swelling, and postoperative pain, demonstrating the effectiveness of piezoelectric assistance. The SS18 and SS4 inserts by Woodpecker were specifically optimized to enhance cutting efficiency for PPE removal and lateral and transverse osteotomies. Piezo-assisted rhinoplasty improves precision and reduces trauma, supporting advanced closed preservation rhinoplasty techniques. Despite nowadays all the osteotomies can be done using the ultrasonic piezotome, enhanced instrument design may further refine outcomes, facilitating minimally invasive, aesthetically superior results.

Short-term effectiveness of uni-portal non-coaxial spinal endoscopic surgery via crossing midline approach in treatment of free lumbar disc herniation

To investigate the short-term effectiveness of uni-portal non-coaxial spinal endoscopic surgery (UNSES) via crossing midline approach (CMA) in the treatment of free lumbar disc herniation (FLDH). Between March 2024 and June 2024, 16 patients with FLDH were admitted and treated with UNSES via CMA. There were 9 males and 7 females with an average age of 55.1 years (range, 47-62 years). The disease duration was 8-30 months (mean, 15.6 months). The pathological segments was L 3, 4 in 4 cases, L 4, 5 in 5 cases, and L 5, S 1 in 7 cases. The preoperative pain visual analogue scale (VAS) score was 6.9±0.9 and the Oswestry disability index (ODI) was 57.22%±4.16%. The operation time, intraoperative bleeding volume, postoperative hospital stay, and incidence of complications were recorded. The spinal pain and functional status were evaluated by VAS score and ODI, and effectiveness was evaluated according to the modified MacNab criteria. CT and MRI were used to evaluate the effect of nerve decompression. All 16 patients underwent operation successfully without any complications. The operation time was 63-81 minutes (mean, 71.0 minutes). The intraoperative bleeding volume was 47.3-59.0 mL (mean, 55.0 mL). The length of hospital stay after operation was 3-4 days (mean, 3.5 days). All patients were followed up 1-3 months, with 15 cases followed up for 2 months and 14 cases for 3 months. The VAS score and ODI gradually decreased over time after operation, and there were significant differences between different time points ( P<0.05). At 3 months after operation, the effectiveness was rated as excellent in 12 cases and good in 2 cases according to the modified MacNab criteria, with an excellent and good rate of 100%. CT and MRI during follow-up showed a significant increase in the diameter and cross-sectional area of the spinal canal, indicating effective decompression of the canal. When using UNSES to treat FLDH, choosing CMA for nerve decompression has the advantages of wide decompression range, large operating space, and freedom of operation. It can maximize the preservation of the articular process, avoid fracture and breakage of the isthmus, clearly display the exiting and traversing nerve root, and achieve good short-term effectiveness.

Perioperative Management of Patients with Preeclampsia: A Comprehensive Review.

Preeclampsia is a common condition of pregnancy characterized by hypertension complicated by cerebral, cardiac, hepatic, renal, hematologic, and placental dysfunction. Patients with preeclampsia frequently undergo cesarean delivery, the most common major surgical procedure in the world. They represent a high-risk perioperative cohort suffering significant preventable morbidity and mortality. This review focuses on the anesthesiologist's role, through a perioperative lens, in reducing maternal complications through management of hypertension and strategies for preserving the function of the brain, heart, liver, kidney, hematologic and coagulation systems, and placenta in patients with preeclampsia undergoing cesarean delivery. Preeclampsia-specific resuscitation, individualized fluid administration, safe neuraxial and general anesthesia, and management of intraoperative bleeding are discussed along with strategies for postoperative analgesia, thromboprophylaxis, and antihypertensive agents in patients who breastfeed. This review discusses recently recognized postoperative deterioration in maternal mental health, the possibility of myocardial injury after cesarean delivery, and the need for long-term cardiometabolic follow-up.

The Use of Knives With Versus Without Integrated Water-jet Function During Peroral Endoscopic Myotomy for Patients With Achalasia: A Meta-analysis.

Peroral endoscopic myotomy (POEM) is a well-established endoscopic treatment for achalasia, utilizing an endoscopic knife for dissection. Recently, new knives with an integrated water-jet (WJ) function have been introduced. This study aims to compare the technical, perioperative, and late postoperative outcomes between WJ knives and conventional (C) knives, which lack the WJ function, through a pairwise meta-analysis of published comparative studies. We conducted a systematic literature review following PRISMA guidelines to identify studies directly comparing knives with versus without a WJ function in POEM for achalasia. A random-effects model was employed, using odds ratios for dichotomous data and mean differences for continuous data as effect size metrics. The use of WJ knives demonstrated statistically significant reductions in the mean number of intraoperative instrument exchanges, mean intraoperative use of coagulation forceps, and operative times compared to the use of C knives. There were no significant differences in terms of the incidence of adverse events, subcutaneous emphysema, or mean hospital length of stay (LOS). Clinical success, defined as a postoperative Eckardt score <3, mean postoperative Eckardt scores, and the incidence of GERD requiring proton pump inhibitors (PPI) also showed no significant differences. The use of water-jet (WJ) knives demonstrates comparable efficacy to conventional (C) knives, with superior efficiency reflected in reduced operative time and fewer intraoperative instrument exchanges. In addition, in terms of safety, the lower use of coagulation forceps with WJ knives suggests reduced intraoperative bleeding. However, no significant differences were observed between the groups in terms of length of stay (LOS) and adverse events, despite a trend toward reduction. A larger number of studies with greater sample sizes is required to better assess potential differences in safety between the use of WJ and C knives.

The feasibility and short-term safety of single-site hysterectomy: a retrospective cohort study of a novel robotic platform.

Robotic-assisted laparoscopic single-site hysterectomy is popular among patients and surgeons due to good cosmetic outcomes and fast recovery. However, questions remain such as loss of triangulation and instrument collision. Our aim is to test the feasibility and safety of a purpose-designed single-site robotic surgical platform mainly in hysterectomies. We retrospectively collected patients who had undergone hysterectomy by SHURUI (SR-ENS-600) robotic surgical system in the First Affiliated Hospital of Xi'an Jiaotong University. Initial cases as control were also collected including da Vinci single-site (IS4000) and multi-port (IS3000 and IS4000) hysterectomies performed by the same surgical team. The main outcome was surgical feasibility rate (valid surgeries/total cases × 100%). Short-term post-operative outcomes and complications were recorded and compared between three groups. From Dec, 2nd, 2023 to Mar, 1st, 2024, 19 cases of hysterectomies were enrolled, including 6 myomas, 2 adenomyosis, 9 cervical high-grade squamous intraepithelial lesion/stage Ia1 cancers, and 2 stage Ia endometrial cancers. Seventeen cases of da Vinci single-site surgeries and 20 cases of multi-ports surgeries were also included for comparation. Intra-operative bleeding volume was significantly lower in SHURUI group compared with da Vinci single-site and multi-ports groups (40.5mL vs 47.4mL vs 58.5mL, P = 0.046 and 0.028). Post-operative time to flatus was also shorter in SHURUI group compared with da Vinci single-site and multi-port surgeries (22.9h vs. 33.5h vs. 28.6h, P = 0.054 and 0.001). Follow-up for SHURUI group lasted for 3months with no complications. SHURUI robotic surgery was feasible and safe in hysterectomies. It also had comparable outcomes with da Vinci robotic platform and approaches.

Pre-surgical Embolization of Meningiomas: Analysis of Safety and Efficacy in a Mexican National Center And Proposal for a Classification of Preoperative Embolization of Meningiomas Based on Embolic Agent Penetration.

Meningiomas are the most common primary central nervous system tumors, often requiring surgical resection. Presurgical embolization (PSE) is used to reduce intraoperative bleeding, although its effectiveness varies. This study evaluates the safety and efficacy of PSE using ethyl-vinyl alcohol (EVOH) in meningioma surgeries. This study included 48 patients with intracranial meningiomas treated between January 2022 and August 2024. Patients were divided into two groups: Group A (n=24) underwent surgery without PSE, while Group B (n=24) underwent surgery with PSE using EVOH. Outcomes assessed included anesthetic and surgical times, resection bleeding, total bleeding, and transfusion requirements. Meningioma size and bleeding per cm³ were also evaluated. PSE was classified into four grades based on embolic liquid (LE) penetrability, and its relationship with bleeding during resection was analyzed. PSE significantly reduced anesthetic (270 vs. 372 minutes) and surgical times (222 vs. 348 minutes). Group B exhibited less resection bleeding (450 vs. 1,400 ml) and total bleeding (650 vs. 1,700 ml) compared to Group A, with statistically significant differences (p < 0.01). Bleeding per cm³ was significantly lower in Group B (9.33 ml/cm³) than Group A (31.39 ml/cm³). No complications related to PSE were observed. LE penetrability grades correlated with resection bleeding, where higher-grade embolizations led to reduced bleeding. This study highlights five advantages: 1) objective measurement of resection time and bleeding based on precise and standardized parameters, including strict quantification of aspirator container content (subtracting saline solution used during the procedure), bleeding assessment from gauze and cottonoids, and dedicated personnel tracking surgical, anesthetic, and resection times; 2) accurate correlation between meningioma size and bleeding; 3) absence of PSE complications; 4) standardized PSE grading based on LE penetrability; and 5) established relationship between PSE grades and resection bleeding. The results suggest that PSE with EVOH is a safe and effective method to minimize intraoperative bleeding and reduce surgical time in meningioma resection. Presurgical embolization using EVOH significantly decreases surgical bleeding and time in meningioma resections without associated complications. The proposed PSE grading system (Preoperative Embolization of Meningiomas, Mexican Classification (PEMMCO)) may enhance the predictability of intraoperative bleeding control. While we acknowledge the relatively small sample size of 48 cases, we believe this study serves as a foundation to encourage the inclusion of more patients and collaboration with additional centers, aiming to further validate and standardize the classification.