Length Of Surgical Incision Research Articles

Video assisted minimally invasive mitral valve replacement in rheumatic valve disease.

Objective:
 Assessment early outcome of video assisted minimally invasive mitral valve replacement, in rheumatic valve disease. Also, to evaluate early postoperative quality of life by SF 36 questionnaire.
 Methods: This is a prospective single center study which was conducted on 20 rheumatic heart patients, in Egypt; during the period from October 2015 to June 2018. The main pathological lesion was sever mitral regurgitation (MR), mitral stenosis (MS) or both. Patients underwent video assisted minimally invasive mitral valve replacement, through a right mini thoracotomy. 13 patients (65%) were via infra-mammary incision, 4 patients (20%) were via periareolar incision and 3 patients (15%) were via limited right anterolateral mini-thoracotomy.
 Results: Mean length of surgical incision was (6.60 ± 1.35 cm). Mean duration of operation, cardiopulmonary bypass, and cross clamp times were (4.32 ± 1.08 hr.), (2.85 ± 0.75 hr.) and (1.78 ± 0.47 hr.) respectively.
 ICU stay was 2.35 ± 1.14 days and Hospital stay was 6.45 ± 1.43 days.
 The mean amount of blood loss was 398.50 ± 245.79 ml with two patients of bleeding requiring re-opening.
 At discharge, all patients had normal mitral prosthetic valve function with no or trivial regurgitation, as shown by echocardiographic studies. The postoperative quality of life revealed faster recovery of usual activities.
 Conclusions: Video assisted minimally invasive mitral valve surgery in the surgically challenging rheumatic valve disease has less surgical trauma, blood loss and pain, which translates into short hospital stay, rapid return to normal activities, less use of resources.

A comparative study on short-term therapeutic effects of percutaneous transforaminal endoscopic discectomy and microendoscopic discectomy on lumbar disc herniation.

Objective:To find out the short-term effects of percutaneous transforaminal endoscopic discectomy (PTED) and microendoscopic discectomy (MED) on lumbar disc herniation (LDH).Methods:Ninety LDH patients treated in PLA Army General Hospital from July 2015 to July 2016 were selected and randomly divided into an MED group and a PTED group. Length of incision, amount of intraoperative bleeding, surgical time, number of times using intraoperative fluoroscopy, postoperative bedridden time, hospital stay, together with visual analogue scale (VAS) and Oswestry disability index (ODI) scores before surgery, three days, three months and six months after surgery were analyzed.Results:As regards the length of surgical incision, amount of bleeding, postoperative bedridden time and hospital stay, the PTED group was significantly superior to the MED group ((P=0.000, 0.000, 0.000, 0.001, respectively)). Compared with the PTED group, the MED group used less fluoroscopy and had shorter surgical time (P=0.001, 0.000, respectively). The postoperative VAS and ODI scores of both groups were significantly improved compared with those before surgery (P<0.000, 0.000, respectively). The short-term postoperative low back pain (LBP) VAS score of PTED group was lower than that of MED group (P=0.001). The two groups had similar leg pain (LP) VAS score three and six months after surgery, postoperative and follow-up LP VAS and ODI scores, and surgical improvement rate (P=0.093, 0.097, respectively).Conclusion:LDH was effectively treated by both PTED and MED. Compared with MED, PTED had less trauma, less blood loss, and faster recovery after surgery.

Using 3D models in orthopedic oncology: presenting personalized advantages in surgical planning and intraoperative outcomes

BackgroundThree Dimensional (3D) printed models can aid in effective pre-operative planning by defining the geometry of tumor mass, bone loss, and nearby vessels to help determine the most accurate osteotomy site and the most appropriate prosthesis, especially in the case of complex acetabular deficiency, resulting in decreased operative time and decreased blood loss.MethodsFour complicated cases were selected, reconstructed and printed. These 4 cases were divided in 3 groups of 3D printed models. Group 1 consisted of anatomical models with major vascular considerations during surgery. Group 2 consisted of an anatomical model showing a bone defect, which was intended to be used for substantial instrumentation, pre-operatively. Group 3 consisted of an extra-compartmental bone tumor which displayed a deteriorated cortical outline; thus, using CT and MRI fused images to reconstruct the model accurately. An orthopedic surgeon created the 3D models of groups 1 and 2 using standard segmentation techniques. Because group 3 required complex techniques, an engineer assisted during digital model construction.ResultsThese models helped to guide the orthopedic surgeon in creating a personalized pre-operative plan and a physical simulation. The models proved to be beneficial and assisted with all 4 cases, by decreasing blood loss, operative time and surgical incision length, and helped to select the appropriate acetabular supporting ring in complex acetabular deficiency, pre-operatively.ConclusionQualitatively, using 3D printing in tumor cases, provides personalized advantages regarding the various characteristics of each skeletal tumor.

Minimally Invasive Osteosynthesis of Distal Tibia Fractures using Anterolateral Locking Plate.

Introduction: Plating in distal tibia fractures are associated with higher rate of soft tissue complications. As adequate soft tissue cover is available over anterolateral surface of the tibia, use of anterolateral plate fixation in distal tibia fractures has increased. The purpose of our research is to evaluate the outcomes of anterolateral locking plate fixation in distal tibia fractures using ORIF.Materials and Methods: A retrospective analysis of 25 patients, who had distal tibia fractures and underwent open reduction and anterolateral plating. Bone and soft tissue healing and complications encountered were analysed.Result: Full weight bearing was allowed at an average of 5.4 months (range: 3-12 months) after seeing radiological union. We have observed superficial wound infection in four cases. Two cases had marginal necrosis, two cases had sensory disturbance over dorsolateral aspect of foot and two cases had delayed non-union. Mean length of surgical incision was 9cm (range: 5-12 cm).Conclusion: Open reduction internal fixation of distal tibia fractures with anterolateral plating is a reliable way of fracture fixation and stabilisation with proper surgical technique and aseptic precautions.

Comparison of hook plate with versus without double-tunnel coracoclavicular ligament reconstruction for repair of acute acromioclavicular joint dislocations: A prospective randomized controlled clinical trial

PurposeThis study was designed to compare the surgical outcomes of a hook plate with double-tunnel coracoclavicular (CC) ligament reconstruction by conjoined tendon transfer versus single hook plate surgery for the repair of acute type of Rockwood type III and V acromioclavicular (AC) joint dislocations. MethodsThe study cohort included 62 patients with acute (within 6 weeks after trauma) Rockwood type III and V AC joint dislocations who underwent surgery from February 2012 to September 2015. The patients were randomly allocated to the ligament reconstruction group (LR group, n = 31) or the single hook plate group (HP group, n = 31). In both groups, reduction of the AC joint by hook plate and repair of the ruptured AC ligament with absorbable Vicryl sutures were performed homoplastically. The lateral half of the short tendon of the biceps brachii muscle and the lateral half of the flexor tendon were used to reconstruct the trapezoid and conoid ligaments, respectively. Differences in surgical duration, intraoperative blood loss, incision length, and total cost were compared between the two groups. Furthermore, the preoperative and postoperative visual analogue score (VAS), postoperative American Shoulder and Elbow Surgeons (ASES) score, Constant–Murley score (CMS), Karlsson score, complication rates, and patient satisfaction at the last follow-up were compared to evaluate the curative effects of the surgical treatments. Magnetic resonance imaging (MRI) after hook plate removal was used to evaluate the reconstructed ligaments and tendon-bone interface. ResultsIn total, 25 patients in the LR group and 26 in the HP group completed the follow-up. There were no statistically significant differences in age, sex, Rockwood type, placing time, total cost, and follow-up duration between the LR and HP groups (p > 0.05). However, as compared with the HP group, the surgical duration and incision length were longer in the LR group (92.08 ± 19.25 vs. 56.54 ± 21.29 min and 13.64 ± 0.90 vs. 6.65 ± 1.01 cm, respectively, p < 0.05). In addition, there was no significant difference in preoperative VAS scores, but the postoperative VAS score was lower in LR group than in the HP group (2.52 ± 1.19 vs. 4.12 ± 1.45, respectively, p < 0.05). Moreover, patients in LR group had a remarkable higher CMS and ASES score (89.56 ± 2.80 vs. 79.31 ± 4.97 and 92.60 ± 2.79 vs. 82.35 ± 3.44, respectively, p < 0.05). The overall excellent or good result rate, as evaluated by the Karlsson score, was 92.00% (23/25) and 50.00% (13/26), respectively (p < 0.05). MRI findings revealed good condition of the reconstructed ligaments and tendon-bone interface. The incidence of complications was lower and the satisfaction rate was higher in the LR group than in the HP group (1/25 vs. 16/26 and 23/25 vs. 14/26, respectively, p < 0.05). ConclusionsThe overall surgical effect of the use of a hook plate combined with double-tunnel CC ligament reconstruction is superior to single hook plate surgery for the repair of acute Rockwood type III and V AC joint dislocations.

The Length of Surgical Skin Incision in Postoperative Inflammatory Reaction.

Background and Objectives:Surgery provokes inflammatory and immune responses, so efforts have been made to reduce host response by using less invasive techniques. The purpose of this experimental study was to investigate the surgical stress induced by skin incision and the role of liver response in this process.Methods:Seventy male anesthetized Wistar rats were subjected to a midline incision confined strictly to the skin (dermis) of either 1 cm long (n = 20), 10 cm long (n = 20), or no incision (n = 20) or served as controls (n = 10). Skin trauma was left open for a 20-minutes period, and then was meticulously sutured. At 3 and 24 hours later, laparotomy was performed on half the rats of each group, for blood and liver sampling. In serum and liver homogenates, cytokine-induced neutrophil chemoattractant (CINC)1/interleukin (IL)-8 and tumor necrosis factor (TNF)-α levels were measured with enzyme-linked immunosorbent assays and nitric oxide (NO) using a Griess reaction.Results:Skin trauma was found to significantly (P < .01) increase all inflammatory mediators tested (CINC1/IL-8, TNF-α, NO) in serum of operated rats versus controls, the increase being proportionally dependent on the length of skin incision. In liver homogenates, CINC1/IL-8 was significantly (P < .01) increased in operated animals versus controls, similarly to serum levels. In contrast, liver TNF-α levels were inversely related to serum levels, and a significant (P < .01) decrease in TNF-α was observed in liver homogenates of operated animals compared with the controls, indicating that the increased TNF-α in blood reflects liver TNF-α secretion.Conclusion:Our findings suggest that inflammatory and immune reactions induced by skin-only surgical trauma are closely correlated to the length of skin incision.

Advances and challenges in laparoscopic surgery in the management of hepatocellular carcinoma.

Hepatocellular carcinoma is the fifth most common malignancy and the third most common cause of cancer-related mortality worldwide. From the wide variety of treatment options, surgical resection and liver transplantation are the only therapeutic ones. However, due to shortage of liver grafts, surgical resection is the most common therapeutic modality implemented. Owing to rapid technological development, minimally invasive approaches have been incorporated in liver surgery. Liver laparoscopic resection has been evaluated in comparison to the open technique and has been shown to be superior because of the reported decrease in surgical incision length and trauma, blood loss, operating theatre time, postsurgical pain and complications, R0 resection, length of stay, time to recovery and oral intake. It has been reported that laparoscopic excision is a safe and feasible approach with near zero mortality and oncologic outcomes similar to open resection. Nevertheless, current indications include solid tumors in the periphery < 5 cm, especially in segments II through VI, while according to the consensus laparoscopic major hepatectomy should only be performed by surgeons with high expertise in laparoscopic and hepatobiliary surgery in tertiary centers. It is necessary for a surgeon to surpass the 60-cases learning curve observed in order to accomplish the desirable outcomes and preserve patient safety. In this review, our aim is to thoroughly describe the general principles and current status of laparoscopic liver resection for hepatocellular carcinoma, as well as future prospects.

Clinical efficacy of laparoscopic surgery for pelvic radiation induced enteritis

Objective To investigate the clinical efficacy of laparoscopic surgery for pelvic radiation induced enteritis (PRIE). Methods The retrospective cross-sectional study was conducted. The clinical data of 66 patients with PRIE who were admitted to the Nanjing General Hospital of Nanjing Military Command from January 2012 to December 2015 were collected. Laparoscopic surgery will be applied to patients based on patients′ clinical manifestations after completing relative examinations. Observation indicators: (1) surgical situations: surgical method, conversion to open surgery, reoperation, surgical incision length, grade of abdominal adhesions, surgical time, volume of intraoperative blood loss, duration of postoperative hospital stay; (2) occurrence of surgical complications; (3) follow-up situations. Follow-up using telephone interview was performed to detect patients′ survival and recurrence of PRIE up to April 2016. Measurement data with normal distribution were represented as ±s. Results (1) Surgical situations: ① of 59 patients with small intestinal obstruction, 11 underwent laparoscopic small intestinal resection or enterostomy, including 2 with conversion to open surgery due to dense adhesions, 1 due to uncertainty of tumor recurrence and 1 due to intestinal canal dilatation affected vision; 48 underwent laparoscopic resection of ileocecum, including 11 with conversion to open surgery due to dense adhesions, 2 due to iliac vessels injury and 4 due to injuries of sigmoid colon, rectum and bladder. Four patients with colonic obstruction and proctitis underwent laparoscopic colostomy, without conversion to open surgery. One patient received conversional open surgery and underwent intestinal resection of internal fistula+ exclusion of rectal stump due to intestine-rectum fistula induced dense adhesions. One patient with anal atresia underwent laparoscope-assisted resection of pelvic tissues and rectal stump. One patient with localized peritonitis underwent laparoscope-assisted ileostomy. ② Among 66 patients, 4 received reoperations, including 2 with cervical cancer and 2 with rectal cancer, reoperations of 4 patients were respectively caused by intestine-rectum fistula, rectovaginal fistula, anastomotic fistula and ostomy + stoma reversion. Of 4 patients with reoperations, 1 received conversion to open surgery due to dense adhesions and then underwent intestinal resection of internal fistula+ exclusion of rectal stump, 1 with rectovaginal fistula underwent laparoscopic colostomy, 1 with anastomotic fistula underwent resection and anastomosis of small intestine due to dense adhesions and 1 underwent laparoscopic ileostomy and stoma reversion. ③ Sixty-six patients received 70 operations, including 46 laparoscopic surgeries and 24 conversion to open surgeries. Surgical incision length and average length were respectively 3.0-6.0 cm, 4.0 cm in 46 laparoscopic surgeries and 8.0-25.0 cm, 15.5 cm in 24 conversion to open surgeries. Grade 0, 1, 2 and 3 of abdominal adhesions were detected respectively in 7, 13, 13, 13 laparoscopic surgeries and in 1, 1, 12, 10 conversion to open surgeries. Operation time, volume of intraoperative blood loss and duration of postoperative hospital stay were respectively (128±50)minutes, (108±56)mL, (30±15)days in 46 laparoscopic surgeries and (173±44)minutes, (222±105)mL, (38±19)days in 24 conversion to open surgeries. (2) Occurrence of surgical complications: 1 patient was complicated with bladder injury in 46 laparoscopic surgeries, and 2, 4 and 2 patients in 24 conversion to open surgeries were respectively complicated with bladder injury, colorectal injury and injury of right iliac vessels, they received intraoperative symptomatic treatment. Two, 3, 3, 6 and 1 patients were respectively complicated with pleural effusion, wound infection or dehiscence, venous catheter infection, anastomotic fistula and cholestatic cholecystitis after 46 laparoscopic surgeries. One, 5, 1, 4, 2 and 1 were respectively complicated with pleural effusion, wound infection or dehiscence, venous catheter infection, anastomotic fistula, cholestatic cholecystitis and abdominal wall hemorrhage after 24 conversion to open surgeries. They were improved by symptomatic treatment. (3) Follow-up situations: all the 66 patients were followed up for 4-50 months, with a median time of 26 months. During the follow-up, 3 patients died of intraperitoneal infection, short bowel syndrome and pulmonary infection, and 3 patients had PRIE. Conclusion The appropriate surgical method is selected based on clinical manifestations of patients, and laparoscopic surgery is safe and feasible for PRIE. Key words: Radiation enteritis; Intestinal obstruction; Surgical procedures, operative; Laparoscopy

Thoracolumbar Cortical Screw Placement with Interbody Fusion: Technique and Considerations.

A surge in interest in cortical bone trajectory (CBT), first described by Santoni in 2009, may be a result of its numerous advantages, including reduced surgical incision length and lateral dissection, limited disruption of the facet joints, and decreased blood loss. In addition, CBT offers improved screw pullout strength and the ability to perform hybrid constructs with pedicle screws using minimally invasive approaches. However, one of the main limitations of the technique involves the small screw size, which limits the potential for long-segment constructs. We describe a technique involving a more in-line anatomical trajectory, allowing for larger screw diameters. A feasibility study using a cadaveric model was performed and evaluated. Moreover, a focused review of the literature on the use of CBT was performed. Screw entry points are located along the inferomedial aspect of the facet and angled superolaterally. The use of this technique allows for the placement of larger screws (4.5 to 6.5 mm diameter) without pedicle breaches along with the alignment of screw heads from L1 to S1. In addition, the technique can be performed using stereotactic navigation or fluoroscopy. A direct, more in-line technique allows for larger screws to be placed using CBT. This technique can be combined with minimally invasive approaches. The potential advantages of the CBT technique support its use as a probable alternative to traditional pedicle screw fixation techniques.

ULTRASONIC DISSECTION VERSUS CONVENTIONAL LIGATION COAGULATION IN THYROIDECTOMY

ULTRASONIC DISSECTION VERSUS CONVENTIONAL LIGATION COAGULATION IN THYROIDECTOMY Abdulameer Muhsin Aldaraji MB, ChB, FICMS, General Surgeon, Al-Faiha General Hospital, Basrah, IRAQ. Abstract Ligation and diathermy coagulation was the standard method of hemostasis in thyroid surgery for more than a century. New hemostatic techniques were developed in the 1990th. Ultrasonic dissector used for the first time in thyroidectomy in 1999 by Tokami. Many studies compared the conventional method of thyroidectomy with new ultrasonic dissector technique. These studies found many advantages of the new method including reduction of operative time, shorter incision, decrease blood loss, decrease post operative drainage, shorten hospital stay and decrease complications. This study compared the two methods of hemostasis regarding incision length, operative time and complications. Between March 2012 and March 2015, 143 patients underwent open thyroidectomy involved in a prospective study at Al-Faiha General Hospital. The patients were divided into 2 groups: Group 1, conventional thyroidectomy technique(clamp, tie and diathermy coagulation) included 104 patients. Group 2, ultrasonic dissection technique (sutureless thyroidectomy) included 39 patients. The patient characteristic and postoperative complications were reported. The incision length and the operative time was measured. All patients underwent surgery by the routine pre tracheal strap muscle cutting transeversly (not splitting). In group 2, the ultrasonic dissector was used in strap muscle cutting, sealing §ion of the blood vessels and in the final resection of the gland. The surgical incision length and operative time were compared in both groups. In lobectomy, there was no significant reduction in the length of incision with use of ultrasonic dissector( z value0.05), while in subtotal, total or near total thyroidectomy there was significant reduction in the length of incision (p value

Retrospective study of partial superficial parotidectomy and superficial parotidectomy on superficial parotid benign tumor

Objective:To compare the clinical effect between partial superficial parotidectomy (PSP) and superficial parotidectomy (SP) through a retrospective analysis and to provide evidence for the benign tumor surgical strategy. Method:According to different surgical strategies performed, 168 patients with superficial parotid benign tumor were reviewed and divided into PSP group and SP group. Clinical data was compared between two groups from different aspects, including operation condition, complications, recurrence rate, as well as parotid function. SPSS 22.0 software was used in statistical analysis. Result:PSP group has an average operative incision length of (6.65±1.17)cm, and average operation time of (82.25±11.56)min, while SP group is (10.86±1.65)cm and (121.42±17.32)min. So, compared with the SP group, PSP has obvious advantages in operation conditions (P<0.01). Furthermore, PSP group also presents an advantage over SP group in occurrence of postoperative complications (P<0.05), while there is no significant difference between two groups in palindromia rate (P>0.05). As for the maintenance of parotid gland functions, PSP group could retain most of parotid functions, but no function would be retained in SP group. Statistical analysis confirms the significance (P<0.05). Conclusion: Compared with SP, in PSP there is declined complication incidence but no increased palindromia recurrence. However, PSP has an apparent advantage on decreased surgical incision length, downscaled operation scope, reduced operation time and retained original functions of gland. All these advantages present the reliability and feasibility of PSP in treating superficial parotid benign tumor.

Effect of peritoneal lavage solution temperature on body temperature in anaesthetised cats and small dogs

A prospective, randomised, non-blinded, clinical study to assess the effect of peritoneal lavage using warmed fluid on body temperature in anesthetised cats and dogs of less than 10 kg body...

Supercapsular percutaneously-assisted total hip approach for the elderly with femoral neck fractures: study protocol for a prospective, open-label, randomized, controlled clinical trial

Background: Artificial hip replacement by the posterolateral approach is generally introduced as a treatment for femoral neck fracture in the elderly, but it is limited by the need for a large incision, cutting off the extortor, and postoperative hip dislocation. The supercapsular percutaneously-assisted total hip (SuperPATH) approach was developed based on the original lateral approach. The SuperPATH approach for hip replacement is characterized by the reduced chance of damaging blood vessels and nerves, reducing intraoperative blood loss, retaining all the joint capsules and supinator, and significantly reducing the incidence of postoperative hip dislocation. Given these advantages, we hypothesized that the SuperPATH approach for hip replacement can achieve better efficacy in the elderly with femoral neck fractures and promote the recovery of postoperative hip function compared with the posterolateral approach. Methods/Design: This is a prospective, single-center, open-label, randomized controlled clinical trial that will be completed at the Pudong Hospital of Fudan University, Shanghai, China. Forty patients with femoral neck fractures were randomly divided into two groups to undergo femoral head replacement by the SuperPATH approach in the experimental group, and by the conventional posterior approach in the control group. The follow-up period is 1 week and 6 months. The primary outcome measure is Harris hip scores at baseline, and at 1 week and 6 months postoperatively to assess functional recovery of the hip. Secondary outcome measures to evaluate the advantages of the SuperPATH approach include the length of surgical incision, intraoperative blood loss, operative time, 24-hour postoperative drainage, and hospital stay. Other outcome measures include the incidence of adverse events at 1 week and 6 months after surgery. Discussion: The aim of this trial is to test our hypothesis that the SuperPATH approach is safer and more reliable for hip functional recovery compared with the posterolateral approach for the artificial hip replacement in femoral neck fractures of the elderly. Trial registration: ClinicalTrials.gov identifier: NCT03134664. Ethics: The study protocol was approved by the Ethics Committee of the Pudong Hospital of Fudan University, China, and performed in accordance with the guidelines of the Declaration of Helsinki, formulated by the World Medical Association. Informed consent: Written informed consent was obtained from all participants prior to the trial commencement.

Clinical efficacy of laparoscopic and open method in the treatment of gastric cancer radical surgery

Objective To compare the clinical efficacy of laparoscopic and open method in the treatment of gastric cancer radical surgery. Methods 110 patients who underwent radical surgery for gastric cancer were selected.According to its different operation method, they were divided into observation group and control group, 55 cases in each group.The observation group received laparoscopic surgery, and the control group received open operation treatment.The general surgery situation, the C-reactive protein (CRP) levels at preoperation and postoperative 1, 7, 10d were compared in the two groups. Results The surgical incision length, intraoperative blood loss, postoperative bowel movements and postoperative hospital stay in the observation group were (24.6±3.7)cm, (99.9±31.8)mL, (5.8±2.7)d, (12.8±7.7)d respectively, which were significantly lower than (5.6±1.4)cm, (61.3±13.6)mL, (4.5±0.7)d, (9.2±3.9)d in the control group(t=31.472, 5.289, 3.194, 2.398, all P 0.05). CRP level at 1d preoperation, 1d postoperation, 7d postoperation, 10d postoperation of the control group were (18.21±3.67)mg/L, (42.96±7.28)mg/L, (22.88±4.35)mg/L, (15.89±4.34)mg/L respectively, which of the observation group were (17.82±3.57)mg/L, (29.97±4.58)mg/L, (16.01±3.16)mg/L, (8.65±1.77)mg/L respectively, it had no significant difference between the two groups at preoperative 1d (P>0.05), postoperative 1d both elevated obviously, postoperative 7 d, 10 d both significantly dropped than postoperative 1d, and the differences between the two groups were significant (t=7.497, 6.521, 8.339, all P<0.05). The incidence rate of complications was 5.45%(3/55) in the observation group, which of the control group was 18.18%(10/55), the difference between the two groups was statistically significant(χ2=6.371, P<0.05). Conclusion Compared with the traditional laparotomy, laparoscopic gastric cancer radical has mild trauma, rapid recovery, the effect is good, quite cure degree, which is worthy of clinical popularization and application. Key words: Stomach neoplasms; Laparoscopy; Surgical procedures, operative; Comparative study

Endoscopic thyroid surgery: the past, the present, and the future

Thyroid diseases are much more common in women than in men. The traditional open thyroidectomy brings almost patients significant visible scars in the anterior neck. The demand for cosmesis after surgery promotes the occurrence and development of endoscopic techniques. Various endoscopic techniques were designed to minimize the visible scar and promote the rehabilitation after surgery. In order to achieve these, two distinct ideas have developed. One is committed to shorten the length of surgical incision as much as possible. The other is to develop external cervical approaches, using endoscopy and(or) robotic assisted techniques, leaving the original visible neck scar in easily and well hidden area of the body. For strictly selected patients, these techniques achieve both therapeutic and cosmetic results. Although the indication of endoscopic thyroid surgery has been expanding constantly, the surgical trauma and the radical effect of malignant tumor are also controversial.

Is distal locking with short intramedullary nails necessary in stable pertrochanteric fractures? A prospective, multicentre, randomised study

We investigated whether a proximal femoral nail can be implanted without a distal locking screw in AO/OTA 31-A1 and 31-A2 pertrochanteric stable femur fractures. A multicentre, randomised study was conducted in six level-two trauma centres in our area (Puglia, Italy). A total of 333 patients received their allocated intervention (162 in the locking group [LG] and 171 in the unlocking group [UG]) and 266 patients were included in the final analysis at 1year. Our data showed no statistically significant difference between the two groups at 1-year follow-up for ability to walk, SF-36 questionnaire results, residual pain (visual analogue scale [VAS] score) and level of overall satisfaction. There were also no statistically significant differences between groups for mortality and length of hospital stay. Conversely, the UG was associated with shorter operation and fluoroscopy times, shorter surgical incision length, and less blood loss and residual thigh pain. Pertrochanteric stable fractures (31-A1, 31-A2) can be treated successfully with intramedullary nails without distal locking, reducing patient and clinical personnel radiation exposure and sanitary costs (surgery time and screws costs).

The superiority of paracostal endoscopic-assisted gastropexy over open incisional and belt loop gastropexy in dogs: a comparison of three prophylactic techniques.

Prophylactic gastropexy is a procedure that prevents the occurrence of a life threatening condition known as gastric dilation and volvulus (GDV) in dogs. The objective of this study was to compare incisional, belt loop and minimally invasive endoscopically assisted gastropexy by evaluating different parameters such as surgical time, length of scar and score of pain in dogs. Twenty-one healthy, mixed-breed adult dogs weighting 14.3 ± 2.6 kg were randomly divided into three groups. Three gastropexy techniques applied in the following order: incisional (group I), belt loop (group B), and endoscopically assisted gastropexy (group E). Surgical time, anesthetic time, length of surgical incision and score of pain 3 h after surgery were recorded for all dogs. Two weeks after the surgery, positive-contrast gastrography was used to evaluate stomach position and total gastric emptying time. Ultrasonography was also used to evaluate the gastropexy two months after the surgery. Adhesion was confirmed two months after the surgery between the stomach wall at the pyloric antrum and the right side of the body wall in all dogs by ultrasound. The mean surgical time, length of surgical incision and score of pain were significantly lower in group E compared to group I and B (P<0.05). No significant differences were found in total gastric emptying time and gastropexy thickness post-operatively (P>0.05). Due to advantages observed in the current study, the endoscopically assisted technique seems to be a suitable alternative to open incisional and belt loop gastropexies for performing prophylactic gastropexy, especially when performed by skilled surgeons.

DEVELOPMENT OF A METHOD FOR ADAPTING THE SIZE OF LAPAROTOMY TO TOPOGRAPHIC-ANATOMICAL PARAMETERS OF THE ABDOMEN OF PATIENTS WITH SMALL BOWEL OBSTRUCTION

Background: Optimization of the size of the surgical access exerts a positive effect on recovery dynamics. The size of median laparotomy in operations for small bowel obstruction is usually determined without consideration of specifics of the abdominal cavity anatomy of the patient. Aim: To improve the results of treatment of patients with acute small bowel obstruction by adapting the parameters of the median laparotomy to constitutional characteristics of the patient. Materials and methods: The results of treatment of 101 patients with acute small bowel obstruction were analyzed. In 49 patients of the group I, laparotomy was performed with the newly developed method to determine the size of laparotomy. Fifty two patients of the group II were treated at the time when the method was still in the process of development. To identify optimal parameters of the laparotomy, we performed anatomical experiments in 90 cadavers with dolicho-, mesoand brachymorphic constitution. Results: During the anatomical experiments, we found that in individuals with dolychomorphic constitution, the average depth of the abdominal cavity amounted to 58.07% of the distance between the upper anterior iliac spines, in those with mesomorphic body build, this parameter was 42%, and in individuals with brachymorphic constitution, 37.67% of this distance. Based on the analysis of surgical accessibility parameters, we found that the optimal length of median laparotomy in individuals with dolichomorphic body build was 63.877% of the distance between the front upper iliac spines, in mesomorphic ones, 46.2%, and in brachymorphic, 41.437% of this distance. The described method of determination of the surgical incision length was applied in 49 patients from the group I. The average size of laparotomic incision was 121.74 ± 10.4 mm. The use of the proposed method for determination of the length of surgical incision allowed for reduction of the mean duration of hospitalization from 13.32 ± 3.4 to 10.02 ± 2.1 hospital days. On average, patients from group I could defecate without stimulation one day earlier than those from group II, with abdominal pain intensity being much lower. Conclusion: A differentiated approach to laparotomy depending on the constitution of a patient with acute small bowel obstruction allows to reduce operational trauma and improve the recovery dynamics.

Surgical treatment of Denis type B thoracolumbar burst fracture with neurological deficiency by paraspinal approach.

We aimed to describe the surgical technique and clinical outcomes of paraspinal-approach reduction and fixation (PARF) in a group of patients with Denis type B thoracolumbar burst fracture (TLBF) with neurological deficiencies. A total of 62 patients with Denis B TLBF with neurological deficiencies were included in this study between January 2009 and December 2011. Clinical evaluations including the Frankel scale, pain visual analog scale (VAS) and radiological assessment (CT scans for fragment reduction and X-ray for the Cobb angle, adjacent superior and inferior intervertebral disc height, and vertebral canal diameter) were performed preoperatively and at 3 days, 6 months, and 1 and 2 years postoperatively. All patients underwent successful PARF, and were followed-up for at least 2 years. Average surgical time, blood loss and incision length were recorded. The sagittal vertebral canal diameter was significantly enlarged. The canal stenosis index was also improved. Kyphosis was corrected and remained at 8.6±1.4o (P>0.05) 1 year postoperatively. Adjacent disc heights remained constant. Average Frankel grades were significantly improved at the end of follow-up. All 62 patients were neurologically assessed. Pain scores decreased at 6 months postoperatively, compared to before surgery (P<0.05). PARF provided excellent reduction for traumatic segmental kyphosis, and resulted in significant spinal canal clearance, which restored and maintained the vertebral body height of patients with Denis B TLBF with neurological deficits.

The clinical comprison on the influence of breast conserving operation and radical operation for the complications and effective of patients with early stage breast cancer

Objective To discuss the application of breast surgery with radical surgery in the therapeutic effect and complications in patients with early breast cancer. Methods 110 early breast cancer patients with surgical treatment were randomly divided into two groups, each group in 55 cases, the control group was given radical surgical treatment, the observation group was given breast conserving operation, surgery were recorded in patients of the two groups. Results The results of the observation group showed operative incision length (4.02±1.15)cm, operation time (58.93±13.25)min, intraoperative blood loss (10.11±2.87)mLand length of hospital stay (10.74±2.17)d.The datas of control group showed surgical incision length (11.87±2.44)cm, operation time (95.72±26.78)min, intraoperative blood loss (85.27±14.28)mL and length of hospital stay (15.86±4.43)d, the differences were statistically significant (t=21.582, 9.131, 5.714, 7.697, all P<0.05). Observation group occurred postoperative hand infection in 1 case, upper extremity edema in 2 cases, and no subcutaneous hemorrhage occurs.Control group had 6 cases of postoperative hand infection, 10 cases of upper limb edema, and subcutaneous hemorrhage in 5 cases, the differences were statistically significant (χ2=4.852, 5.986, 5.238, all P<0.05).3 months after operation, datas of observation group showed physiological state (54.18±6.28)points, psychological state (59.27±5.82)points, environmental conditions (68.45±7.68)points and social function (57.46±5.97)points.Physiological state of the control group after 3 month was (65.69±9.11)points, while psychological state was (68.31±7.33)points, environmental conditions was (78.17±10.54)points, social function was (68.77±7.15)points, the differences were statistically significant (t=7.714, 7.163, 5.527, 9.004, all P<0.05). Conclusion Breast surgery application in patients with early breast cancer can shorten the operation time, reduce intraoperative bleeding and flow rate, shorten the length of hospital stay, reduce complications and improve postoperative quality of life, it is worth popularizing in clinical application. Key words: Breast-conserving therapy; Radical operation; Breast neoplasms