Blood Loss Research Articles

Outcome Analysis of Transperitoneal Laparoscopic Nephrectomy in Children: Experience from a Developing Country.

To analyse the outcome of laparoscopic nephrectomy among children. An observational study. Place and Duration of the Study: Department of Paediatric Urology, Children's Hospital Lahore, from September 2021 to June 2023. During the study, 100 children aged 5-180 months were included. Data regarding age, gender, cause, side, intraoperative and postoperative outcomes such as number of ports, estimated blood loss, need of transfusion, operative time, hospital stay, analgaesia requirement and complications were recorded. Data were collected through proforma which were entered and analysed through computer software SPSS version 16.0. Among 100 children, 58.0% were males and the mean age was 79.54 ±4.427 months while the major cause of laparoscopic nephrectomy was PUJO (Pelvi-Ureteric Junction Obstruction) for 47.0% of children. The mean blood loss was 19.93±65.556 ml and the majority of the children (96.0%) did not require blood transfusion. The mean operative time was 125.31 ± 43.365 minutes and the mean hospital stay was 2.82 ± 1.258 days. Most of the children (90.0%) had no complications while 3.0% had ileus which was managed conservatively and 3.0% were converted to open surgery while 4.0% had wound infection. Laparoscopic nephrectomy is an effective technique with regard to insignificant blood loss, operative time, hospital stay, and rate of complications. Laparoscopy, Nephrectomy, Children, Operative time, Hospital stay, Complications.

Hemodynamic analysis on the flow characteristics around abdominal aortic hemorrhage site

The hemodynamic characteristics of blood flow around the site of abdominal aortic hemorrhage can serve as a valuable indicator for identifying the location of hemorrhage. In this research, we conducted numerical simulations to analyze the flow fields in the patient-specific abdominal aorta with and without hemorrhage. We quantitatively compared differences in flow field patterns, blood loss, and branch vessel perfusion between hemorrhagic and non-hemorrhagic cases. Our numerical results demonstrate that there is a distinct hemodynamic characteristic observed around the hemorrhage site, characterized by continuous abnormal high-velocity (>0.7 m/s) and high-Rortex (>200) zone. Additionally, we evaluated the amount of blood loss and time to moderate shock for different cases of abdominal aortic hemorrhage, while statistically analyzing variations in branch vessel perfusion along the abdominal aorta. These findings provide quantitative estimations for blood loss, branch perfusion, and potential indicators to assess rescue time window as well as evaluate the extent of distal tissue damage and organ injury.

Outcome Analysis of Transperitoneal Laparoscopic Nephrectomy in Children: Experience from a Developing Country.

To analyse the outcome of laparoscopic nephrectomy among children. An observational study. Place and Duration of the Study: Department of Paediatric Urology, Children's Hospital Lahore, from September 2021 to June 2023. During the study, 100 children aged 5-180 months were included. Data regarding age, gender, cause, side, intraoperative and postoperative outcomes such as number of ports, estimated blood loss, need of transfusion, operative time, hospital stay, analgaesia requirement and complications were recorded. Data were collected through proforma which were entered and analysed through computer software SPSS version 16.0. Among 100 children, 58.0% were males and the mean age was 79.54 ±4.427 months while the major cause of laparoscopic nephrectomy was PUJO (Pelvi-Ureteric Junction Obstruction) for 47.0% of children. The mean blood loss was 19.93±65.556 ml and the majority of the children (96.0%) did not require blood transfusion. The mean operative time was 125.31 ± 43.365 minutes and the mean hospital stay was 2.82 ± 1.258 days. Most of the children (90.0%) had no complications while 3.0% had ileus which was managed conservatively and 3.0% were converted to open surgery while 4.0% had wound infection. Laparoscopic nephrectomy is an effective technique with regard to insignificant blood loss, operative time, hospital stay, and rate of complications. Laparoscopy, Nephrectomy, Children, Operative time, Hospital stay, Complications.

Proximal lumbar anterior column realignment for iatrogenic sagittal plane adult spinal deformity correction: a retrospective case series

Anterior column realignment (ACR) is a powerful minimally invasive surgery (MIS) technique to restore sagittal alignment in adult spinal deformity (ASD). This can accomplish similar segmental lordosis restoration as 3-column osteotomy with less blood loss and comparable complication rates. ACR can be performed at adjacent disease segments in the proximal lumbar spine in revision cases. However, two-thirds of physiologic lordosis occurs between L4-S1, and concerns remain about altered lumbar morphology. We evaluated patients who underwent proximal lumbar ACR for iatrogenic flatback deformity. A total of 19 consecutive patients who underwent L1-2 or L2-3 ACR were retrospectively analyzed. All patients were treated with lateral MIS interbody technique, followed by posterior reconstruction with Smith-Peterson osteotomy (SPO). Pre- and post-operative radiographic and clinical outcomes were obtained. Mean follow-up was 19-months. All but one patient had a history of prior lumbar or lumbo-sacral fusion. SVA and PI-LL decreased from 11.9 cm to 6.1 cm (p<0.0001) and 34.2° to 12.8° (p<0.0001). Segmental lordosis increased from -2.7° to 21.9° (p<0.0001). Proximal lumbar lordosis (PLL) increased from -0.4° to 22.6° (p<0.0001), and lordosis distribution index (LDI) decreased from 79.5% to 48.9% (p<0.0001). Mean ODI and NPRS back pain decreased from 58.0 to 36.2 (p=0.0041) and 7.9 to 3.4 (p<0.0001). PROMIS-10 Physical and Mental Health T-scores increased from 34.1 to 43.3 (p=0.0049) and 40.4 to 45.0 (p=0.0993). Major complication rate was 15.8%. One patient required revision for mechanical failure. There were no permanent neurological or vascular injuries. Proximal lumbar ACR plus SPO can achieve sagittal correction with low major complication rates in patients with ASD and prior distal fusion. Differentially increasing PLL and lowering LDI did not have deleterious effects on radiographic or clinical outcomes. Further work is needed to understand the effect of proximal ACR in the surgical management of ASD.

Clinical and Radiologic Comparisons Between Oblique Lumbar Interbody Fusion Combined with Percutaneous Pedicle Screw Fixation and Transforaminal Lumbar Interbody Fusion for Adult Isthmic Spondylolisthesis: A 2-year Follow-Up Study

Adult isthmic spondylolisthesis(AIS) results in the anterior translation of the vertebral body with neural encroachment. Although oblique lumbar interbody fusion(OLIF) is minimally invasive technique that use a retroperitoneal plane to achieve indirect decompression compared to transforaminal lumbar interbody fusion(TLIF), research on OLIF for AIS remains limited. Therefore, we aimed to compare the clinical and radiological outcomes of these two surgical techniques for AIS. We analyzed the details of 62patients with AIS who were treated with either OLIF(n=26) or TLIF(n=36) between 2019 and 2022, with a minimum 2-year follow-up. The two surgical techniques were compared in terms of perioperative surgical, radiological, and clinical outcomes. The correlation between the severity of foraminal stenosis and clinical outcomes was evaluated. The OLIF group experienced significantly less blood loss, shorter operative times, and shorter hospital stay than the TLIF group. Radiological assessments showed no significant preoperative differences in disc height or slippage ratios, but postoperative slippage correction was significantly greater in the OLIF group than in the TLIF group(13.5±8.0 versus 5.0±8.9; p<0.001). The clinical outcome improvement ratios did not differ significantly between the two groups. The correlation between preoperative severity of foraminal stenosis and clinical outcomes in the OLIF group was not significant. OLIF is more advantageous than TLIF in terms of blood loss, operative time, hospital stay and anterolisthesis correction. In addition, good clinical outcomes were obtained with indirect decompression alone, regardless of the severity of foraminal stenosis. Therefore, OLIF is a good surgical option for the treatment of AIS.

Different minimally invasive surgical methods to hysterectomy for benign gynecological disease: A systematic review and network meta-analysis.

This network meta-analysis aimed to compare the perioperative efficacy of various minimally invasive hysterectomy procedures for treating benign gynecological diseases and to assess whether vaginal natural orifice transluminal endoscopic hysterectomy (VNOTEH), a recently emerging procedure, is inferior to traditional laparoscopy. We searched PubMed, Cochrane Library, Embase, China National Knowledge Infrastructure (CNKI), China Biology Medicine disc (CBM), Wanfang Data, and China VIP Database from inception to August 2022 and updated in June 2023. We included randomized controlled trials (RCTs) comparing different minimally invasive hysterectomy techniques in patients with benign gynecological conditions. The intervention measures included nine minimally invasive hysterectomies. The two researchers used the Cochrane risk-of-bias assessment tool for study appraisal. All statistical analyses and drawings were performed using STATA 17.0 and R 4.4.1. A network meta-analysis (NMA) was conducted to compare the effectiveness of minimally invasive hysterectomy and rank its relative impact probabilistically. A total of 78 RCTs involving 7640 patients and nine minimally invasive hysterectomy methods with 16 intervention combinations were included in this study. Among these, 2, 63, and 13 studies were deemed to have a low, medium, and high risk of bias, respectively. Based on the Surface Under the Cumulative Ranking (SUCRA) probability ranking results of NMA, laparoendoscopic single-site surgery-laparoscopic-assisted vaginal hysterectomy (LESS-LAVH) demonstrated superior outcomes in terms of complications, infections, and 24-h postoperative pain scores. LAVH exhibited better performance in injuries and hospital stays, total laparoscopic hysterectomy showed the least blood loss, and vaginal hysterectomy had the shortest operation time. LESS-LAVH and LAVH are recommended options, if feasible. Meanwhile, VNOTEH can achieve comparable results to traditional laparoscopy but requires careful attention to the risk of injury and infection. Future research should aim to broaden the search scope by including high-quality, large-scale, multicenter RCTs.

Risk factors for symptomatic lymphocele in patients undergoing robot-assisted radical prostatectomy with pelvic lymphadenectomy: What we learned after more than 350 cases

ObjectiveWe investigated patients who underwent robotic radical prostatectomy with lymphadenectomy, analyzing the prevalence and risk factors associated with symptomatic lymphoceles (SLCs). MethodsWe evaluated 354 consecutive patients who underwent robotic radical prostatectomy with lymphadenectomy by our team between June 2018 and June 2023. After analyzing the prevalence of SLCs, patients were divided into two groups, with and without SLCs. The variables were age, body mass index (BMI), prostate-specific antigen, surgery time, blood loss, length of stay, pathological International Society of Urological Pathology grade and the number of removed lymph nodes. These variables were compared between these groups using Chi-square and Student's t-tests, according to the type of the variable. In all analyses, a significance level of <0.05 was considered. ResultsThe prevalence of SLCs in this sample of patients undergoing radical prostatectomy with lymphadenectomy was 1.98% (7/354), which is slightly lower than the minimum rate reported in the literature. In our analysis, BMI (p=0.041), number of lymph nodes removed (p=0.007) and length of stay (p=0.007) were factors associated with the presence of SLCs. ConclusionThe prevalence of SLCs in patients undergoing robotic radical prostatectomy with lymphadenectomy is approximately 2%. Higher BMI, number of lymph nodes removed, and length of stay are factors associated with the presence of SLCs.

Tranexamic Acid in Rhinoplasty and Septoplasty: A Systematic Review and Meta-analysis of Randomized Controlled Trials.

Perioperative bleeding is a challenge in rhinoplasty and septoplasty. Tranexamic acid (TXA) may help reduce this, but its effectiveness is unclear. This systematic review and meta-analysis aimed to evaluate TXA's impact on bleeding in these procedures. The protocol was registered a priori to PROSPERO (CRD42023393458). PubMed, Embase, Google Scholar, and Web of Science were searched from inception to October 2023. Eligible studies were randomized controlled trials of adult patients undergoing rhinoplasty or septoplasty. Primary outcomes were intraoperative blood loss, surgery duration, and surgeon satisfaction. A random-effects model was used. Methodological quality was assessed using GRADE. The risk of bias was assessed using Cochrane's RoB 2 tool for randomized studies. The search yielded 154 results; 11 randomized controlled trials, with 968 patients, were included. The meta-analysis showed a significant reduction in intraoperative blood loss with TXA (MD -39.67; 95% CI: -15.10 to -64.24; P = 0.002) and superior surgeon satisfaction in favor of TXA use (SMD -2.73; 95% CI: -5.33 to -0.12; P = 0.04). Subgroup analyses for intraoperative blood loss, according to administration routes, were also in favor of intravenous TXA (MD -13.02; 95% CI: -1.65 to -24.38; P = 0.02) and oral TXA (MD -44.98; 95% CI: -83.66 to -6.31; P = 0.02); no statistical difference was noted in surgery duration (MD -0.99; 95% CI: 0.63 to -2.81; P = 0.23). All studies were found to be of high quality, with low bias. The findings support TXA's efficacy in reducing blood loss during rhinoplasty and septoplasty, with high surgeon satisfaction.

Mussel-inspired modified regenerated cellulose as tissue adhesive and antibacterial gauze: A promising approach for rapid hemostasis in non-compressible hemorrhage

Uncontrollable hemorrhage leads to high mortality rates; thus, engineering effective hemostatic materials is crucial for rapid hemostasis. Developing hemostatic materials for rapid coagulation, antibacterial activity, and easy removal without compromising clot integrity remains a challenge. Herein, a multifunctional hemostatic gauze was engineered by modifying regenerated cellulose textile through multiple sequential chemical reactions, including carboxymethylation, crosslinking with CaCl2/ZnCl2 solution, oxidation, and polymerization with dopamine. Provided gauze demonstrated remarkable wet-tissue adhesion (890 kPa) that physically sealing the area to prevent blood loss. The engineered gauze exhibits excellent antibacterial activity (against S. aureus and E. coli) and enhanced hemostatic ability (clotting time (20S), attachment of red blood cells (~93 %) and platelets (~80 %)). The complete hemostasis and stable clot formation without secondary bleeding were achieved by synthesized gauze in 20s, 50s, and 100s for the rat and rabbit liver, and rat femoral artery injury models, respectively. That was significantly faster hemostasis (4–14-fold reduction in time) and lower blood loss (3-fold reduction) compared to the commercial hemostatic textiles (p < 0.001). Biochemical, hematological, and pathological examinations revealed no evidence of systemic and local inflammation or toxic effects in the rat organs. The engineered hemostatic gauze exhibits outstanding characteristics of a hemostatic material for clinical applications.

Effective method of pedicle screw fixation in patients with neurologically intact thoracolumbar burst fractures: a systematic review of studies published over the last 20 years

ObjectiveTo conduct a systematic review of studies on various posterior pedicle screw fixation (PSF) methods used for treating neurologically intact thoracolumbar burst fractures and to identify the most effective and safe approaches. MethodsWe conducted a systematic review adhering to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines, with the study registered in PROSPERO (CRD42024531093). The inclusion criteria were: (1) publication dates from January 1, 2004, to December 31, 2023; (2) availability of full-text articles in English; (3) thoracolumbar burst fractures without neurological deficits; (4) patients aged over 18; (5) reports on treatment outcomes or complications; (6) a mean follow-up period of at least 12 months. ResultsA total of 69 articles covering 116 patient groups were included. Our analysis highlighted the advantages of short-segment fixation without fusion over monosegmental, short-segment and long-segment fusion in terms of shorter operation times and reduced intraoperative blood loss (p = 0.001 and p < 0.001, respectively). Extensive fusion was associated with a significantly higher frequency of deep surgical site infections compared to other PSF methods (p = 0.043). Percutaneous pedicle screw fixation, applied to patients with lower body compression rates and kyphotic deformities, led to less potential for correction (p = 0.004), yet significantly decreased blood loss (p = 0.011), operation duration (p < 0.0001), and hospitalization duration (p < 0.0001). No significant benefits were observed with the use of additional intermediate screws in short-segment PSF. ConclusionsShort-segment pedicle screw fixation could be the optimal surgical treatment method for neurologically intact thoracolumbar burst fractures. The use of posterior lateral fusion in this context may increase the deep surgical site infection rate without reducing the frequency of implant-related complications or improving long-term treatment outcomes. The percutaneous approach remains the preferred technique; however, its limited reduction capabilities should be carefully considered during surgical planning for patients with severe kyphotic deformities. The application of intermediate screws in such patients has not demonstrated significant advantages. Removing the fixation system has not led to a significant decrease in implant-related complications or improvement in quality of life. The data obtained from the systematic review may assist surgeons in selecting the most appropriate surgical treatment method for patients with neurologically intact thoracolumbar burst fractures, thereby avoiding ineffective procedures and improving both short-term and long-term outcomes.

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

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

Tumour Load in Advanced Ovarian Cancer Patients and Its Validation by Radiological Peritoneal Cancer Index (PCI) Score.

To compare the radiological peritoneal cancer index (PCI) score to the surgical PCI score for validating it as a non-invasive method to predict surgical outcomes. A descriptive study. Place and Duration of the Study: Department ofObstetrics and Gynaecology of the Aga Khan University Hospital, Karachi, Pakistan from September 2021 to May 2022. All successive patients diagnosed with advanced-stageovarian cancer were enrolled in the research. Prior to surgery, the severity of ovarian cancer was evaluated using the Sugarbaker Peritoneal Cancer Index score derived from radiological imaging. The score was compared to the surgical PCI score determined during the surgery. The correlation between the scores and residual tumour status was confirmed. The study included a total of 26 patients. The mean age of patients was 50.17 years, with a standard deviation of 11.04. Five (19.2%) patients underwent surgery first, whereas 21(80.8%) needed interval debulking surgery after receiving chemotherapy in the neoadjuvant setting. The interclass correlation value among radiological and surgical (PCI) was 0.52, with a 95% confidence interval ranging from 0.17 to 0.75. The Bland-Altman plot displays the agreement amongst the PCI scores, indicating a bias of 1.115 with a 95% confidence interval of 4.61. Surgical exploration revealed zero residual disease in 90% of persons with a PCI score <10. Patients with a PCI score <10 had significantly brief operative time and reduced blood loss compared to those with a score >10. Patients with a PCI score below 10 had also fewer complications. PCI is an efficient means for anticipating the success of surgery and the existence of residual disease without invasive measures. This can be very helpful in deciding the best time for surgery. Peritoneal cancer index, Advanced ovarian cancer, Carcinomatosis, Prognosis, Tumour load.

Anesthetic management for aspiration thrombectomy using the Penumbra Indigo System® in pediatric patients with congenital heart disease

ObjectivesDescribe clinical characteristics and outcomes including transfusion requirements of pediatric patients with congenital heart disease undergoing aspiration thrombectomy DesignRetrospective chart review SettingQuaternary academic children's hospital ParticipantsPatients < 18yrs with congenital heart disease undergoing aspiration thrombectomy from November 2017-February 2022. Measurements and main results13 patients underwent mechanical thrombectomy with the Penumbra Indigo System®. Median age was 3.8 years and median weight was 15.2kg. Seven patients had palliated single ventricle and 6 had biventricular circulation. Nine patients were receiving ICU care pre-procedure and 12 required ICU care post-procedure. Indications for thrombectomy included systemic venous thrombus (n=7), pulmonary arterial thrombus (n=3), systemic arterial thrombus (n=2), and systemic to pulmonary shunt occlusion (n=1). Median estimated blood loss was 7.7ml/kg (interquartile range 1.4ml/kg-15.8ml/kg, range 0.5ml/kg-51.5ml/kg). Seven patients required intraoperative transfusion of pRBCs (n=4), FFP (n=2), platelets (n=3), and/or cryoprecipitate (n=1). In those requiring transfusion, median transfusion volume was 22ml/kg (interquartile range 15.5ml/kg-76.5ml/kg, range 9.3ml/kg-132.8ml/kg). Thrombectomy was successful in 8 of 13 patients, although 3 experienced recurrent thrombosis. ConclusionsMechanical aspiration thrombectomy is increasingly used to treat critically ill pediatric patients and presents unique anesthetic considerations particularly related to the need for volume and blood product resuscitation

Comparison of gauze packing, sponge-based, and hemostatic Surgicel wound stasis dressings to treat hemorrhages from grade IV liver injuries: An experimental study

BackgroundUncontrolled bleeding is still the major factor leading to preventable deaths following trauma. This study sought to assess the effectiveness of mini sponge-based wound stasis, cellulose-based local hemostatic, and traditional gauze dressings for the control of hemorrhages resulting from grade 4 liver injuries in rats. MethodsThirty Sprague-Dawley rats were divided into three equal groups. In the first group, a liver laceration was treated with gauze packing. The second group received XStat minisponge dressing (MDS), and the third group was administered a combination of MDS dressing and Surgicel hemostatic agent. After gaining access to the intra-abdominal cavity, a liver laceration measuring 10 mm in length, 5 mm in depth, and extending to the middle lobe was created. The dressings were removed after 2 and 10 minutes to assess the amount of bleeding, and any bleeding was documented again after 48 hours. Intraperitoneal adhesions were evaluated during euthanasia. ResultsAt 2 minutes post-injury, the gauze packing group had an average bleeding volume of 0.97±0.15 mL, compared to 1.08±0.25 mL in the MDS group (P=0.26) and 1.02±0.18 mL in the MDS+Surgicel group (P=0.69). At 10 minutes, the bleeding volumes were 0.13±0.05 mL, 0.22±0.01 mL (P=0.09), and 0.14±0.05 mL (P=0.19), respectively. At 48 hours, significant differences were observed in bleeding volumes (gauze: 0.55±0.18 mL, MDS: 1.15±0.21 mL, MDS+Surgicel: 0.82±0.06 mL, P<0.001). Mortality rates after 14 days were 0% in the gauze packing group, 60% in the MDS group (P=0.001), and 60% in the MDS+Surgicel group (P=0.001). The gauze packing group displayed no adhesions, while the other groups exhibited adhesions in the liver, bowel, omentum, and abdominal wall. ConclusionOur results indicate that, when it comes to managing bleeding in severe liver injuries, traditional gauze packing remains the tried-and-true method, showing superior effectiveness in terms of blood loss and mortality when compared to XStat minisponge dressings and the fibrillar Surgicel hemostatic agents.

A Cohort Study Comparing Cost-Efficiency of Abdominal and Robotic Sacrocolpopexy

ObjectivesTo compare cost and reimbursement of robotic and abdominal sacrocolpopexy procedures to evaluate which approach may minimize costs while improving the hospital profit margin-. MethodsWe performed an IRB-exempt retrospective cohort study investigating all patients who underwent robotic or abdominal sacrocolpopexy at our hospital between July 1, 2018 and May 31,2022. Patient demographic, procedural, and post-operative course data were extracted via chart review including duration of procedure, time in operating room, complications, and length of hospital stay. The billing department provided information on estimated cost of stay and reimbursement rates. ResultsA total of 203 robotic and 291 abdominal cases were included in analysis. The groups had significant differences in demographics, including race and insurance status. Abdominal procedures were associated with lower costs ($7675.99 versus 8747.48, p<0.0001) and higher reimbursement rates ($16210.48 versus $10102.28, p<0.0001), with the total collected (reimbursement minus cost), or profit margin, differing significantly ($8534.50 versus $1354.80, p<0.0001). Discrepancies in reimbursement and profit remained after controlling for secondary procedures. Abdominal cases also had shorter average duration (129.9 vs. 168.4 minutes, p<0.0001). Abdominal sacrocolpopexy was associated with higher estimated blood loss (EBL) (109.2 vs. 97.9, p<0.0001) and longer hospital stay (26.3 versus 15.9 hours, p<0.0001). ConclusionsDespite longer hospital stays and slightly higher EBL, abdominal sacrocolpopexy appears to have lower costs and higher reimbursement rates than robotic sacrocolpopexy, with a higher profit margin for the hospital.

Role of prophylactic intravenous calcium in prevention of post-spinal hypotension among women with preeclampsia undergoing caesarean delivery: a placebo controlled randomized clinical trial: Randomized clinical trial of calcium vs placebo for prevention of post-spinal hypotension

BackgroundPreeclamptic women, in addition to traditional anti-hypertensive medications, often receive magnesium supplementation and are at increased risk of post-spinal hypotension Post-spinal hypotension increases the risk of fetomaternal morbidity. Calcium is a physiological antagonist of magnesium in vascular smooth muscle. Therefore, the study hypothesized that calcium is better suited for preserving systemic vascular resistance and preventing post-spinal hypotension during cesarean delivery. ObjectivesThe study aimed to evaluate the effect of prophylactic calcium administration on post-spinal hypotension in preeclamptic women receiving magnesium supplementation. MethodsThis prospective, randomized, placebo-controlled, double-blinded, two-arm parallel trial was conducted in preeclamptic women receiving magnesium sulfate supplementation undergoing cesarean delivery. The women were randomized to receive intravenous calcium or a placebo (normal saline) before spinal anesthesia. The study drug (calcium gluconate 500 mg or normal saline) was administered over 15 minutes and ended immediately before spinal anesthesia. The primary outcome measure was the incidence of post-spinal hypotension, and secondary outcome measures were postpartum blood loss and maternal and neonatal outcomes. Results100 women (50 each calcium and placebo arm) completed the study. The baseline demographic variables, mean blood pressure and heart rate were comparable. The incidence of post-spinal hypotension was significantly lower in the calcium arm compared to the placebo arm {(32% vs 60%; Relative risk (95% CI); 1.87 (1.18-2.97); p=0.007)}. The mean phenylephrine requirement (5.60±14.59 vs 14.80 ±22.42 mcg; p=0.01) and mephentermine requirement (3.30 ±5.11 mg vs 5.82 ±4.97 mg; p=0.008) was significantly lower in the calcium group. Furthermore, the calcium group's mean postpartum blood loss was significantly lower (406.90 ±94.34 vs 472.20±122.49 ml, p= 0.004). However, the Neonatal Intensive Care Unit admission rate, Apgar score, umbilical artery PH, and maternal serum calcium were comparable. ConclusionProphylactic calcium infusion significantly reduces the incidence of post-spinal hypotension during cesarean delivery in preeclamptic women receiving magnesium supplementation. Furthermore, the effect of prophylactic calcium in decreasing postpartum blood loss is encouraging. However, large trials are required to validate the findings of this study.

Positioning for Emergency Laparoscopic Splenectomy for Traumatic Splenic Rupture.

To determine whether the right-lateral decubitus or supine position is superior for emergency laparoscopy for traumatic splenic rupture. Descriptive study. Place and Duration of the Study: Department of General Surgery, Central Hospital of Shaoxing, Affiliated Hospital of China Medical University, Zhejiang, China, from January 2015 to December 2022. Clinical data of 96 patients who underwent laparoscopic surgery (LS) for traumatic splenic rupture were analysed. The patients were divided into two groups according to surgical position. Group A (n = 42) patients were placed in the right-lateral decubitus position and Group B (n = 54) patients were placed in the supine position. The operation time, intraoperative blood loss, conversion to laparotomy rate, postoperative length of hospital stay, and complications rates were compared between the two groups. Compared with Group B, Group A had a shorter operation time (145.5 ± 24.4 min vs. 169.0 ± 15.3 min, p = 0.0001), less intraoperative blood loss (75.3 ± 35.3 ml vs. 110.3 ± 50.6 ml, p = 0.0002), fewer conversions to laparotomy (2.4% vs. 16.7%, p = 0.023), fewer cases of postoperative pancreatic leakage (7.1% vs. 24.1%, p = 0.027), and fewer complications (23.8% vs. 53.7%, p = 0.003); all differences were significant. There was no statistically significant difference in the postoperative length of hospital stay, hospital cost, or rate of complications such as fever, postoperative abdominal infection, postoperative bleeding or venous thrombosis between the two groups. For patients with traumatic splenic rupture, the right-lateral decubitus position is best for LS. Laparoscopy, Traumatic splenic rupture, Splenectomy, Surgical position.

Enhanced recovery after surgery for hip and knee arthroplasty: A systematic review and meta-analysis on randomized control trials

ObjectivesThis review aimed to compare the efficacy and safety of enhanced recovery after surgery (ERAS) versus traditional care in patients who underwent total hip arthroplasty (THA) and total knee arthroplasty (TKA). MethodsAll randomized controlled trials (RCTs) were acquired via a comprehensive search of multiple databases. A meta-analysis was performed using Cochrane Collaboration's RevMan 5.4 software to calculate effect sizes. ResultsThis meta-analysis included 850 patients in the ERAS group and 845 patients in the control group (patients who received traditional care). The outcomes suggested no significant difference in operative time, intraoperative blood loss, visual analogue scale, 30-day readmission rate, and mortality rate between the two groups. However, the ERAS group was associated with a significant decrease in transfusion rate, hospital length of stay, and postoperative complications. Moreover, the ERAS group had higher Hospital for Special Surgery scores and satisfaction rates. ConclusionsPatients who underwent THA and TKA would benefit more from ERAS than traditional care.

Precise Thoracoscopic Pneumonectomy Using Fluorescence Imaging After Aerosolized Indocyanine Green Inhalation: A Novel Strategy for Treating Congenital Pulmonary Airway Malformation

BackgroundLobectomy resection is the standard treatment for patients with congenital pulmonary airway malformation (CPAM). However, accurate localization of CPAM lesions and avoiding excessive resection of normal lung tissue are one of the critical issues that can impact postoperative pulmonary function. Indocyanine green (ICG) can be adopted in lung preservation surgery, to minimize damage to normal lung tissue during thoracoscopic pneumonectomy. ObjectiveTo demonstrate the potential benefits of aerosol inhalation of ICG followed by thoracoscopic precision pneumonectomy for the treatment of CPAM. MethodsFrom January 2023 to March 2024, we prospectively collected clinical data from 34 pediatric patients diagnosed with CPAM and treated with thoracoscopic surgery. Patients inhaled ICG aerosol solution (0.5 mg/kg) approximately 30-60 minutes before the operation. During surgery, fluorescence thoracoscopy was used to clearly locate the lesion boundaries and achieve precise resection. ResultsAll patients successfully underwent thoracoscopic precise resection of CPAM lesions without conversion to open surgery. The mean operation time was 100.3 ± 24.6 minutes, and the mean intraoperative blood loss was 30.5 ± 25.6 mL. The mean total length of hospital stay (tLOS) was 6.6 ± 3.2 days. No adverse reactions to ICG were observed. Postoperative complications included one case of pneumothorax (5.9%) and three cases of subcutaneous emphysema (17.6%), all of which resolved without special intervention. Follow-up CT scans and pulmonary function tests conducted 6 months post-surgery demonstrated the absence of residual or recurrent lesions and notable enhancement in pulmonary function. ConclusionPreliminary results indicated that the treatment of CPAM with aerosolized ICG followed by thoracoscopic precise pneumonectomy is safe and feasible.

[Artículo traducido] La instilación preoperatoria de epinefrina y lidocaína puede reducir el tiempo quirúrgico del tratamiento endoscópico del SDTM

Introduction: Greater Trochanteric Pain Syndrome (GTPS) is a multifactorial clinical condition affecting the lateral area of the hip. Although conservative treatment shows good results, some patients may still require surgical bursectomy, which can be performed either openly or endoscopically. One of the main technical difficulties of the endoscopic procedure is intraoperative bleeding, which can hinder the medical team's vision and increase the operation time for endoscopic treatment of GTPS. Hypothesis: An instillation of vasoconstrictors and local anaesthetics before endoscopy will cause less intraoperative bleeding, which will translate into shorter surgical time.Materials and methods: A prospective cohort was retrospectively divided based on the use or absence of a preoperative instillation of physiological saline solution with epinephrine and lidocaine. Surgical time was measured in each procedure and compared between the two groups.Results: One hundred thirty-nine hips from 139 patients were included in the analysis. One hundred two patients were included in the instillation group versus 37 in the control group. The surgical time was significantly shorter in the instillation group than in the control group, with an average (standard deviation) of 52.01 (14.71) and 72.30 (11.70) minutes, respectively (P<.001).Conclusion: The instillation of a physiological saline solution with epinephrine and lidocaine prior to the surgical treatment of GTPS is effective in reducing surgical times, likely due to a reduction in intraoperative bleeding. Future research should focus on more direct outcomes such as intraoperative blood loss and between different instillation protocols.