Invasive Surgical Therapies Research Articles

A novel amnion-chorion allograft membrane combined with a coronally advanced flap: a minimally invasive surgical therapy to regenerate interdental papillary soft tissue recession - a six-month postoperative image analysis-based clinical trial.

ObjectivesLoss of the interdental papilla is multi-factorial and creates a multitude of problems. Autogenous connective tissue/biomaterial-based regeneration has been attempted for decades to reconstitute the black space created due to the loss of papilla. The aim of this present study was to regenerate papillary recession defects using an amnion-chorion membrane (ACM) allograft and to evaluate the clinical outcome up to six months postoperatively.Materials and MethodsTwenty patients with 25 Nordland and Tarnow’s Class I/II interdental papillary recession defects were treated with ACM and coronal advancement of the gingivo-papillary unit via a semilunar incision on the labial aspect followed by a sulcular incision in the area of interest. A photographic image analysis was carried out using the GNU Image Manipulation software program from the baseline to three and six months postoperatively. The black triangle height (BTH) and the black triangle width (BTW) were calculated using the pixel size and were then converted into millimeters. The mean and standard deviation values were determined at baseline and then again at three and six months postoperatively. The probability values (P˂0.05 and P≤0.01) were considered statistically significant and highly significant, respectively. An analysis of variance and post hoc Bonferroni test were carried out to compare the mean values.ResultsOur evaluation of the BTH and BTW showed a statistically and highly significant difference from the baseline until both three and six months postoperatively (P=0.01). A post hoc Bonferroni test disclosed a statistically significant variance from the baseline until three and six months postoperatively (P˂0.05) and a non-significant difference from three to six months after the procedure (P≥0.05).ConclusionAn ACM allograft in conjunction with a coronally advanced flap could be a suitable minimally invasive alternative for papillary regeneration.

Successful management of a large mucosal fenestration at 18-months follow-up.

Mucosal fenestrations are infrequent and often challenging to treat depending on the extent of soft and hard tissue destruction. This article presents the successful management of a relatively larger mucosal fenestration associated with complete absence of buccal bone plate in a mandibular incisor secondary to trauma-induced periapical pathosis. After non-surgical endodontic therapy, surgery was performed for debridement of the osseous defect, root resection/shaping, connective tissue graft (CTG) placement on the affected root surface and platelet rich fibrin (PRF) in periapical osseous defect rather than use of bone graft and/or barrier membrane. Healing was uneventful, however, a small mucosal defect remained at 2 weeks follow-up. After 3months of primary surgery, a corrective surgery was performed utilizing an "incision-free" approach i.e. tunnel technique with CTG in contrast to the contemporary flap approach. At 18 months follow-up, complete closure of the mucosal defect with a thick gingival biotype, normal sulcus depth, and good esthetic outcome were achieved. No recurrence and any clinical signs of infection or inflammation were observed. Based on the outcomes of present case, an early intervention utilizing the minimally invasive surgical therapy and autologous biomaterials may be considered a viable approach to treat such complex lesions. Endodontic therapy in combination with PRF and CTG appears to provide successful outcomes in treatment of a large mucosal fenestration with periapical osseous defect.

MRI Evaluation of Patients Before and After Interventions for Benign Prostatic Hyperplasia: An Update.

Transurethral resection of the prostate is the most commonly performed procedure for the management of patients with lower urinary tract symptoms attributed to benign prostatic hyperplasia (BPH). However, in recent years, various minimally invasive surgical therapies have been introduced to treat BPH. These include laser-based procedures such as holmium laser enucleation of the prostate and photoselective vaporization of the prostate as well as thermal ablation procedures such as water vapor thermal therapy (Rezūm), all of which result in volume reduction of periurethral prostatic tissue. In comparison, a permanent metallic device (UroLift) can be implanted to pull open the prostatic urethra without an associated decrease in prostate size, and selective catheter-directed prostate artery embolization results in a global decrease in prostate size. The goal of this article is to familiarize radiologists with the underlying anatomic changes that occur in BPH as visualized on MRI and to describe the appearance of the prostate on MRI performed after these procedures. Complications encountered on imaging after these procedures are also discussed. Although MRI is not currently used in the routine preprocedural evaluation of BPH, emerging data support a role for MRI in predicting postprocedure outcomes.

Office-based therapies for benign prostatic hyperplasia: Update on new minimally invasive surgery therapies

Several minimally invasive surgical therapies have been developed for the treatment of Lower Urinary Tract Symptoms (LUTS) associated with Benign Prostate Hyperplasia (BPH). The objective was to report an update on these new office-based therapies. This simple review is based on the data available in the literature on office-based minimally invasive surgical techniques for treating BPH. A PubMed search and narrative review of the data were performed in July 2021. Only articles in French or English were reviewed. The most studied office-based minimally invasive treatments for BPH are water vapor thermal therapy (Rezum® system, Boston Scientific Corporation, Marlborough, MA), prostatic urethral lift (UroLift® system, NeoTract, Inc., Pleasanton, California, USA) and the Temporarily Implanted Nitinol Device (iTind®, Medi-Tate Ltd, Hadera, Israel). Each treatment appears to provide rapid and lasting improvement in LUTS and quality of life, preservation of sexual and ejaculatory functions, rapid postoperative recovery with a minimal adverse event profile, thus allowing outpatient care. Compared to conventional BPH surgeries, these benefits would be offset by higher retreatment rates and less overall improvement in LUTS. New minimally invasive therapies are promising options that are well tolerated and preserve sexual and ejaculatory functions in men with BPH. Although standard surgical approaches may be more effective, these benefits are valuable for certain patient populations.

Do Minimally Invasive Benign Prostatic Hyperplasia Treatments Preserve Sexual Function? A Contemporary Review of the Literature.

The aim of this study is to compare the sexual function outcomes related to minimally invasive surgical therapies (MISTs) (UroLift®, Rezum™, Aquablation®, prostate artery embolization, and iTind®) for the treatment of benign prostatic hyperplasia (BPH). Clinical trials and retrospective data evaluating MISTs for BPH have demonstrated improved or stable sexual function outcomes when compared to sham control or transurethral resection of the prostate. Outcomes were assessed at baseline and following treatments using patient-reported outcome measures. Rezum and Aquablation demonstrated preservation of overall ejaculatory function and erectile function at 36-month follow-up. Similar outcomes occurred with UroLift after a 60-month follow-up. Erectile function was preserved following prostate artery embolization and iTIND up to 12months. MIST for the management of BPH has been demonstrated to be effective in improving urinary function and appears to minimize potential collateral damage on sexual function following treatment.

Tumor irradiation combined with minimally invasive surgery (vascular-targeted photodynamic therapy) enhances anti-tumour effects in preclinical prostate cancer

Hanna T Sjoberg, Yiannis Philippou, Anette L Magnussen, Iain DC Tullis, Esther Bridges, Andrea Chatrian, Joel Loefebvre, Ka Ho Tam, Emma A Murphy, Jens Rittscher, Dina Preise, Lilach Agemy, Tamar Yechezkel, Sean C Smart, Paul Kinchesh, Stuart Gilchrist, Danny P Allen, David A Scheiblin, Stephen J Lockett, David A Wink, Alastair D Lamb, Ian G Mills, Adrian Harris, Ruth J Muschel, Boris Vojnovic, Avigdor Scherz, Freddie C Hamdy, Richard J Bryant.
 
 Introduction There is an important clinical need to improve the treatment of high risk localised and locally advanced prostate cancer (PCa), and to reduce the side effects of these treatments. We hypothesised that multi-modality therapy combining radiotherapy and vascular-targeted photodynamic therapy (VTP) could PCa tumour control compared against monotherapy with each of these treatments alone. This could provide proof-of-concept to take to the clinic. VTP is a minimally invasive focal surgical therapy for localised PCa, which rapidly destroys targeted tumours through vascular disruption. Tumour vasculature is characterised by vessel immaturity, increased permeability, aberrant branching and inefficient flow. Fractionated radiotherapy (FRT) alters the tumour microenvironment and promotes transient vascular normalisation.
 Materials and Methods We investigated whether sequential delivery of FRT followed by VTP 7 days later improves PCa tumour control compared to monotherapy with FRT or VTP alone.
 Results FRT induced vascular normalisation changes in PCa flank tumour allografts, improving vascular function as demonstrated using dynamic contrast enhanced magnetic resonance imaging. FRT followed by VTP significantly delayed tumour growth in flank PCa allograft pre-clinical models, compared with monotherapy with FRT or VTP alone, and improved overall survival.
 Conclusion Taken together, these results suggest that combining FRT and VTP could become a promising multimodal clinical strategy in PCa therapy. This provides proof-of-concept for this multi-modality therapy approach to take forward to early phase clinical trials.

Evaluating the role of intra articular injection of platelet‐rich fibrin in the management of temporomandibular joint osteoarthritis: A STROBE compliant retrospective study

AbstractOsteoarthritis (OA) is a debilitating disease. A number of treatments like conservative approach, minimally invasive procedures and surgical therapy have proved to be beneficial. However, there is no consensus regarding the use of a single modality of treatment. Our current study evaluates the role of intra articular injection iPRF along with arthrocentesis for the management of temporomandibular joint osteoarthritis (TMJ‐OA). A total of 130 patients were selected and divided into two groups, Group A (arthrocentesis only group) and Group B (arthrocentesis +i‐PRF). Patients were evaluated for pain scores and maximal mouth opening (MMO). After 1 year, mouth opening in arthrocentesis‐only group was 32.13 ± 1.46 mm compared with 36.48 ± 0.89 mm in the i‐PRF group (p‐value <0.0001). There was a significant reduction in mouth opening in Group A from 6 months to 1 year compared with Group B (p‐value <0.001).There was no statistical difference in mean VAS scores at the end of 6 months (p‐value 1.00). Addition of iPRF to arthrocentesis did not improve joint pain after 6 months. Nevertheless, repeated injections did have a beneficial effect in MMO. Within the limitations of the study repeated injections of iPRF in conjunction with arthrocentesis might be recommended for the treatment of mild TMJ‐OA.

MP01-09 REZŪM FOR RETENTION - A RETROSPECTIVE ANALYSIS OF REZŪM FOR BENIGN PROSTATIC HYPERPLASIA IN MEN WHO PRESENT WITH CATHETER-DEPENDENT URINARY RETENTION

You have accessJournal of UrologyBenign Prostatic Hyperplasia: Surgical Therapy & New Technology I (MP01)1 Sep 2021MP01-09 REZŪM FOR RETENTION - A RETROSPECTIVE ANALYSIS OF REZŪM FOR BENIGN PROSTATIC HYPERPLASIA IN MEN WHO PRESENT WITH CATHETER-DEPENDENT URINARY RETENTION Daniel Bassily, Vincent Wong, John Phillips, Mitchell Fraiman, Ross Bauer, Christopher Dixon, and Nathan Wong Daniel BassilyDaniel Bassily More articles by this author , Vincent WongVincent Wong More articles by this author , John PhillipsJohn Phillips More articles by this author , Mitchell FraimanMitchell Fraiman More articles by this author , Ross BauerRoss Bauer More articles by this author , Christopher DixonChristopher Dixon More articles by this author , and Nathan WongNathan Wong More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000001962.09AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: Rezūm is a minimally invasive treatment for benign prostatic hyperplasia (BPH) that uses injections of sterile water vapor directly into the prostate for ablation. Although Rezūm is currently indicated for use in men with prostate sizes ≥30mL and ≤80mL, it is unclear how effective Rezūm is for men in acute or chronic urinary retention. Our objective is to determine whether Rezūm vapor ablation is effective in the treatment of acute/chronic catheter-dependent urinary retention. METHODS: A retrospective chart review was conducted on 49 consecutive patients who presented for acute/chronic urinary retention and were treated with Rezūm. We evaluated procedural details including type of anesthesia, operating room time, treatment time, number of steam treatments, length of hospital stay and catheter duration. We examined details pre- and post-Rezūm including International Prostate Symptom Score (IPSS), IPSS quality of life (IPSS-QOL), maximum flow (Q max), post void residual volume (PVR), PSA, rate of retention, and use of alpha blockers and 5-alpha reductase inhibitor (5ARI). RESULTS: The median age of treated patients was 73 years with a median prostate volume of 73cc (Interquartile range (IQR) 50, 103). All patients were in urinary retention prior to treatment with a median PVR of 900mL (IQR 566, 1146). Following treatment, IPSS (17 pre-Rezūm, 4 post-Rezūm) and IPSS-QOL (4 pre-Rezūm, 1 post-Rezūm) both improved (p <0.01). Qmax increased from 3mL/s to 6mL/s (p=0.03) and PVR decreased from 900mL to 78mL (p <0.01). Only 17/38 patients taking alpha-blockers required continued alpha blocker therapy and 7/15 patients on 5ARIs required continued 5ARI therapy (p <0.01). Of the 49 patients treated, 10 remained in catheter dependent urinary retention following the procedure, and 6 remained in retention at 6 months even after further, more invasive surgical therapies for BPH (p <0.01). CONCLUSIONS: Rezūm is an effective therapy for treating acute/chronic urinary retention in patients with BPH. As a minimally invasive therapy, it can be used in patient who cannot tolerate general anesthesia. Source of Funding: None © 2021 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 206Issue Supplement 3September 2021Page: e3-e4 Advertisement Copyright & Permissions© 2021 by American Urological Association Education and Research, Inc.MetricsAuthor Information Daniel Bassily More articles by this author Vincent Wong More articles by this author John Phillips More articles by this author Mitchell Fraiman More articles by this author Ross Bauer More articles by this author Christopher Dixon More articles by this author Nathan Wong More articles by this author Expand All Advertisement Loading ...

Feasibility, safety, and efficacy of ultrasound-guided transperineal laser ablation for the treatment of benign prostatic hyperplasia: a single institutional experience.

To evaluate the feasibility, safety, and efficacy of ultrasound-guided transperineal laser ablation (TPLA) as a new minimally invasive surgical therapy (MIST) for the treatment of lower urinary tract symptoms (LUTS) secondary to benign prostatic hyperplasia (BPH). Under local anesthesia and conscious sedation up to two laser fibers for each prostatic lobe were inserted under US-guidance by a percutaneous approach. TPLA was performed using a continuous wave diode laser (SoracteLite-EchoLaserX4) able to generate a light-induced thermal heating and subsequent coagulative necrosis of the prostatic tissue. Patients were evaluated at 3, 6, and 12months after TPLA. Twenty-two consecutive patients were prospectively enrolled (median age 61.9years). All procedures were well tolerated and no procedural complications were recorded. Median catheterization time was 7days, while the median hospitalization time was 1day. Three out of twenty-two patients (13.6%) experienced acute urinary retention and two (9.1%) of them urinary tract infection requiring major antibiotic treatment. At 3, 6, and 12months, median prostate volume significantly decreased by a -21.3%, -29%, and -41%, respectively. At the same time point, median IPSS was 8 (-63.6%), 5 (-74%), and 6 (-75%), while median QoL score was 1 in all the scheduled timepoints of follow-up. The median postoperative Qmax at 3, 6, and 12months improved by + 57.8%, + 98%, and + 115.8%, respectively. Ejaculatory function was preserved in 21 out of 22 patients (95.5%). TPLA of the prostate appears to be a promising MIST for BPH. Long-term results and comparative studies against standard treatments are warranted before implementations of this technique in the urologist's armamentarium.

Robotic mitral valve surgery: a review and tips for safely negotiating the learning curve.

Totally endoscopic robotic mitral valve repair represents the least invasive surgical therapy for mitral valve disease. Comparative results for robotic mitral valve surgery against sternotomy are impressive, repeatedly demonstrating shorter hospital stay, faster return to normal activities, less morbidity and equivalent mortality and mid-term durability. We lack data comparing robotic approaches to totally endoscopic minimally invasive mitral valve surgery using 3D vision platforms. In this review, we explore the advantages and disadvantages of robotic mitral valve surgery and share technical tips that we have learned to help teams embarking on their robotic journey. We consider factors necessary for the successful implementation of a robotic programme including the importance of training a dedicated team, with the common goal to avoid any compromise in either patient safety or repair quality during the learning curve. As experience grows with robotic techniques and more cardiac surgeons become proficient with this innovative technology, the volume of robotic cardiac procedures around the world will increase helped by the introduction of new robotic systems and patient demand. Well informed patients will increasingly seek out the opportunity of robotic valve reconstruction in reference centres in the hands of a few highly experienced robotic surgeons.

Putting Patients Ahead by Leaving Nothing Behind: An Emerging Treatment Paradigm in Minimally Invasive Surgical Therapy for Benign Prostatic Hyperplasia.

Lower urinary tract symptoms (LUTS) secondary to benign prostatic hyperplasia (BPH) are highly prevalent in older men. The long-term clinical utility of lifestyle modification and oral medications for LUTS is limited. There is a great clinical need for safe, effective, and durable BPH therapies for men who unsuccessfully attempt conservative measures. Enthusiasm for transurethral resection of the prostate has declined due to surgical risk, high rates of postoperative sexual dysfunction, and the perceived invasive nature therein. Consequently, interest has grown in developing minimally invasive surgical treatments (MISTs) that are efficacious but with a more favorable risk profile in order to better align with patient preferences. This review evaluates currently available MISTs for BPH. Further, we critically examine a “Leave Nothing Behind” philosophy in MIST for BPH since implantation of permanent metallic devices may be associated with increased long-term failure rates.

An Indirect Comparison of Newer Minimally Invasive Treatments for Benign Prostatic Hyperplasia: A Network Meta-Analysis Model.

Objective: This study was designed to provide an indirect comparison of the urinary and sexual domain outcomes and complications after newer minimally invasive surgical therapy (MIST) of Aquablation, Rezum, and UroLift for benign prostatic hyperplasia (BPH) for transurethral resection of prostate (TURP). Methods: We searched Embase, Medline, and Cochrane in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses statement, in December 2019. Only randomized clinical trials (RCTs) that reported outcomes after treatment of BPH for prostate less than 80 g with Aquablation, Rezum, or UroLift were included in the analysis. Results: A total of four RCTs reporting the outcomes after treatment with newer MIST for BPH were identified. Patients undergoing the resective procedures, that is, TURP and Aquablation, had greater improvement in urinary domain outcomes: International Prostate Symptom Score, quality of life, peak flow rate, and postvoiding residual compared to patients undergoing nonresective procedures: UroLift and Rezum. Patients in UroLift group maintained a higher sexual function domain score compared to TURP, but not Aquablation. Our multiple comparison analysis did not reveal a significant difference in urinary and sexual domain scores between patients undergoing UroLift and Rezum at 24 months of follow-up. Conclusions: Aquablation and TURP necessitate general or regional anesthesia and both produced significantly better urinary domain scores compared to Rezum and UroLift. On the other hand, UroLift demonstrated better sexual function domain scores compared to TURP, but not Aquablation. There was no significant difference in urinary domain scores between UroLift and Rezum at 24 months of follow-up.

Online interest in surgical treatment for benign prostatic hyperplasia using Google trends.

Online health information-seeking behavior has increased over the past 15years; however, little is known about the online interest for surgical treatment of men with benign prostatic hyperplasia. We used Google Trends to evaluate online interest for various surgical procedures for benign prostatic hyperplasia in the US and worldwide. Transurethral resection of the prostate, photoselective vaporization of the prostate, Holmium laser enucleation of the prostate, Urolift, and Rezum were selected as search terms of interest within Google Trends. Google Trends normalizes the popularity of search terms on a 0-100 scale. ANOVA and the average rate of change in popularity scores were conducted from July 2015 to February 2019. From 2004 to 2019, online interest in transurethral resection of the prostate and photoselective vaporization of the prostate remained stable in the US and worldwide; meanwhile, there was an upward trend for Urolift and Rezum. There was a statistically significant increase in the online interest for Holmium laser enucleation of the prostate in the US and worldwide; however, the mean popularity score was significantly higher worldwide. A shift in online interest towards minimally invasive surgical therapies for benign prostatic hyperplasia was demonstrated in the US and worldwide and parallels clinical practice patterns, such as HoLEP and Urolift surgical volumes in Indiana and Australia, respectively. Google Trends can be used in real-time to gauge online interest for surgical procedures and help guide physician-patient counseling.

Keyhole Approach Endoscopic Surgery versus Stereotactic Aspiration plus Urokinase in Treating Basal Ganglia Hypertensive Intracerebral Hemorrhage

Objective To compare the short-and long-term effect of two minimal invasive surgical therapies including keyhole approach endoscopic surgery(KAES)and stereotactic aspiration plus urokinase(SAU)in treating basal ganglia hypertensive intracerebral hemorrhage(hICH). Methods The clinical data of 117 hICH patients(63 received KAES and 54 received SAU)were retrospectively analyzed.The operation time,blood loss during surgery,and drainage time were compared between two groups.The residual hematoma volume,hematoma clearance rate(HCR),Glasgow coma scale(GCS)score,and National Institute of Health Stroke Scale(NIHSS)score were recorded at baseline and in the ultra-early stage,early stage,and sub-early stage after surgery.The 30-day mortality and serious adverse events were assessed and the 6-month modified Rankin scale(mRS)score was rated.Results Baseline data showed no significant difference between these two groups.Compared with the SAU group,the KAES group had significantly longer operation time,more intraoperative blood loss,and shorter drainage time(all P<0.001).In the ultra-early stage after surgery,HCR was significantly higher in the KAES group(P<0.001),whereas in the early and sub-early stage,HCR showed no significant differences(all P>0.05).In the ultra-early and early stage,the GCS and NIHSS scores showed no significant differences between two groups(all P>0.05),whereas in the sub-early stage,the NIHSS score was better in the SAU group(P=0.034).The 30-day mortality and incidences of serious adverse events showed no significant difference(all P>0.05).The good recovery(mRS≤3)at 6-months follow-up showed no significant difference between the two groups(P=0.413).Conclusions Both KAES and SAU are safe and effective in treating basal ganglia hICH.In the ultra-early stage after surgery,KAES achieves better residual hematoma volume and HCR,and patients undergoing SAU quickly catch up.The short-and long-term effectiveness of SAU is comparable or even superior to KAES.

Rezum water vapour therapy: promising early outcomes from the first UK series.

The management of symptomatic BPH is evolving and there is now an expanding portfolio of minimally invasive surgical therapies (MIST). These provide an attractive option for men looking for meaningful improvement in urinary symptoms whilst avoiding the risks of adverse effects, particularly with regards to maintaining sexual function.

Hybrid coronary revascularization: are we there yet?

With advances in minimally invasive surgical and percutaneous coronary therapies, hybrid coronary revascularization (HCR) is well positioned to be an ideal strategy for revascularization in selected patients with multivessel coronary artery disease (CAD). The purpose of this review is to highlight recent outcomes and comparative effectiveness studies of HCR. Patients undergoing HCR have comparable outcomes compared with coronary artery bypass grafting (CABG) and percutaneous coronary intervention (PCI). The major benefits compared with CABG appear to be related to short-term morbidity and resource utilization. Compared with PCI, HCR may decrease repeat revascularization rates by decreasing reintervention of the left anterior descending coronary artery. Although HCR is associated with a significant learning curve, specifically with minimally invasive CABG techniques, the early outcomes remain promising and should be considered as a viable option for revascularization in select patients with multivessel CAD.

Factors associated with unfavourable outcome after Burr Hole drainage in Subdural Hematoma (SDH) at Sanglah General Hospital, Bali, Indonesia

Background: Subdural hematoma is a neurosurgical disorder that often occurs in the elderly with simple, relatively fast and minimally invasive surgical therapy, but has a high postoperative mortality rate due to unfavourable outcome. This study aims to evaluate factors associated with unfavourable outcome after burr hole drainage in a subdural hematoma (SDH) at Sanglah General Hospital, Bali, Indonesia.Method: A prospective cohort study was conducted among 60 respondents to determine factors influencing the outcome of patients with subdural hematoma after burr hole drainage. The independent variables in this study included age, comorbid factors, trauma onset, GCS, hematoma thickness, and midline shift. Dependent variables include the Glasgow Outcome Scale (GOS), which is divided into 2 groups, favourable outcome, and unfavourable outcome. Data were analyzed using SPSS version 17 for Windows.Results: There were 19 respondents (31.7%) had unfavourable outcomes and 41 respondents (68.3%) had favourable outcomes. From the bivariate analysis, significant associated risk factors were found in the onset of trauma (p=0.048), GCS (p=0.000), hematoma thickness (p = 0.000), and midline shift (p=0.000). From the multivariate analysis, it was found that low GCS was the most dominant risk factor for the unfavourable outcome following burr hole drainage (OR=22.30; 95% CI= 2.22-223.80; p=0.008) Conclusion: This study concludes that low GCS was the most dominant risk factor for unfavourable outcome in patients with subdural hematoma after burr hole drainage

Evaluation of Minimally Invasive Surgical Therapies for Ulcerative Colitis.

Ulcerative colitis (UC) is a chronic inflammatory intestinal disorder that can be managed surgically with a proctocolectomy. Minimally invasive techniques such as laparoscopic or robotic-assisted surgery are available based on the surgeon's preference and familiarity. To date, there is a paucity of literature evaluating the safety of these techniques in comparison to the open approach in patients with UC. We surveyed the National Surgical Quality Improvement Program (NSQIP) database to select patients with the diagnosis of UC who underwent either robotic, laparoscopic, or open proctocolectomy between 2012 and 2017. A total of 2129 patients were included in the study. The 30-day postoperative outcomes were compared using multivariable logistic regression models after adjusting for confounding variables. The confounding variables were defined as any preoperative variable that was associated with the type of procedure. The 30-day postoperative outcomes reported in the NSQIP database were reviewed for each of the treatment groups (open, laparoscopic, and robotic). The anastomotic leak rate was significantly higher in the open group (P = .022). The robotic and laparoscopic groups had significantly fewer occurrences of postoperative ileus (P = .0006) and wound infections (P < .0001). There were significantly more strokes, cardiac events, and pulmonary events in the open surgical group. Operative time was significantly shorter in the open group (P < .0001). Reintervention rates were not significantly different among the groups. Minimally invasive proctocolectomy has significantly fewer postoperative complications compared with open proctocolectomy for UC. There is no significant difference in the postoperative outcomes between robotic-assisted and laparoscopic proctocolectomy.

State of Evidence in Minimally Invasive Management of Gastroesophageal Reflux: Findings of a Scoping Review

Endoscopic management of gastroesophageal reflux disease (GERD) is being employed increasingly. The aim of this scoping review was to assess the volume of available evidence on the benefits of endoscopic and minimally invasive surgical therapies for GERD. criteria were used to perform an extensive literature search of data regarding the reported benefit of endoscopic therapies in GERD. Randomized controlled studies were utilized when available; however, data from observational studies were also reviewed. A formal review of evidence was performed in 22 studies. Inclusion and exclusion criteria and study duration were noted and tabulated. Assessment of outcomes was based on symptoms and objective criteria reported by investigators. Reported outcomes for the interventions were tabulated under the heading of subjective (symptom scores, quality of life metrics, and change in proton pump inhibitor use) and objective metrics (pH parameters, endoscopic signs, and lower esophageal sphincter pressure changes). Adverse events were noted and tabulated. The majority of studies showed symptomatic and objective improvement of GERD with the device therapies. Adverse events were minimal. However, normalization of acid exposure occurred in about 50% of patients and, for some modalities, long-term durability is uncertain. This scoping review revealed that the endoluminal and minimally invasive surgical devices for GERD therapy are a promising alternative to proton pump inhibitor therapy. Their place in the treatment algorithm for GERD will be better defined when important clinical parameters, especially durability of effect, are better understood.

Management of benign prostatic hyperplasia in the 21st century: temporal trends in Australian population-based data.

To examine national trends in the medical and surgical treatment of benign prostatic hyperplasia (BPH) using Australian Medicare Benefits Schedule (MBS) and Pharmaceutical Benefits Scheme (PBS) population data from 2000 to 2018. Annual data was extracted from the MBS, PBS and Australian Institute of Health and Welfare databases for the years 2000-2018. Population-adjusted rates of BPH procedures and medical therapies were calculated and compared in relation to age. Cost analysis was performed to estimate financial burden due to BPH. Overall national hospital admissions due to BPH declined between 2000 and 2018, despite an increased proportion of admissions due to private procedures (42% vs 77%). Longitudinal trends in the medical management of BPH showed an increased prescription rate of dutasteride/tamsulosin combined therapy (111 vs 7649 per 100000 men) and dutasteride monotherapy (149 vs 336 per 100000 men) since their introduction to the PBS in 2011. Trends in BPH surgery showed an overall progressive increase in rate of total procedures between 2000 and 2018 (92 vs 133 per 100000 men). Transurethral resection of the prostate (TURP) remained the most commonly performed surgical procedure, despite reduced utilisation since 2009 (118 vs 89 per 100000 men), offset by a higher uptake of photoselective vaporisation of prostate, holmium:YAG laser enucleation of prostate, and later likely due to minimally invasive surgical therapies including prostatic urethral lift and ablative technologies (including Rezūm™). Financial burden due to BPH surgery has remained steady since 2009, whilst the burden due to medical therapy has risen sharply. Despite reduced national BPH-related hospitalisations, overall treatment for BPH has increased due to medical therapy and surgical alternatives to TURP. Further exploration into motivators for particular therapies and effect of medical therapy on BPH progression in clinical practice outside of clinical trials is warranted.