Low Incidence Of Intraoperative Complications Research Articles

Comparative Analysis of Surgical Techniques for Wisdom Tooth Extraction.

Wisdom tooth extraction often requires various surgical techniques due to differences in tooth position, root morphology, and patient characteristics. This research aims to compare traditional surgical extraction with minimally invasive techniques such as piezo surgery and laser-assisted extraction, as well as extraction with the aid of 3D imaging and navigation systems. Patients requiring wisdom tooth extraction were randomly assigned to one of the surgical technique groups. Preoperative imaging assessed tooth position and root morphology. Intraoperative variables and postoperative outcomes were recorded, including pain levels, swelling, and healing time. Patient-reported outcomes were assessed using standardized questionnaires. Piezo surgery, 3D imaging, and navigation-guided extraction techniques demonstrated a shorter mean duration of surgery and lower incidence of intraoperative complications compared to traditional extraction and laser-assisted extraction. Postoperative outcomes were superior in the 3D imaging and navigation-guided extraction group, with lower pain scores, reduced swelling, and faster healing time. Advanced imaging-guided techniques, particularly 3D imaging and navigation-guided extraction, offer significant benefits for patients undergoing wisdom tooth extraction by improving surgical precision, minimizing complications, and enhancing postoperative outcomes. Incorporating these technologies into routine practice can optimize patient care and outcomes in oral surgery.

Outcome of video-assisted thoracoscopic treatment of idiopathic chylothorax in 15 cats.

To evaluate the outcomes and complications of video-assisted thoracoscopic (VATS) treatment of chylothorax in cats. Multi-institutional retrospective study. Fifteen client-owned cats. The medical records of cats undergoing thoracoscopic thoracic duct ligation (TDL) for treatment of idiopathic chylothorax were reviewed. Cats undergoing additional procedures including thoracoscopic pericardectomy and/or laparoscopic cisterna chyli ablation (CCA)_were included. Follow up was obtained through communication with the referring veterinarian or owner. All cats underwent thoracoscopic TDL. Thirteen cats underwent simultaneous pericardectomy and two cats underwent laparoscopic CCA without pericardectomy. Conversion from a thoracoscopic to open approach was necessary in 2/15 (13%) of thoracic duct ligations and 1/11 (9%) of pericardectomies. The most common postoperative complication was persistent pleural effusion in five cats (33%). Four of 15 cats (27%) died or were euthanized prior to hospital discharge following surgery. Recurrence of effusion occurred in 1/7 (14%) of cats that sustained resolution of the effusion at the time of surgery with a median follow up of 8 months. The overall mortality attributed to chylothorax was 47%. Thoracoscopic treatment of idiopathic chylothorax resulted in a low incidence of intraoperative complications or conversion in the study population; however, mortality related to feline idiopathic chylothorax remained high. While VATS treatment of idiopathic chylothorax is technically feasible, further consideration of the underlying pathology and current treatment algorithm is needed to improve outcomes as this remains a frustrating disease to treat in the feline population.

Single-layer versus double-layer renorrhaphy technique during robot-assisted partial nephrectomy: impact on perioperative outcomes, complications, and functional outcomes.

The debate between single-layer and double-layer renorrhaphy techniques during robot-assisted partial nephrectomy (RPN) represents a subject of ongoing discourse. The present analysis aims to compare the perioperative and functional outcomes of single- versus double-layer renorrhaphy during RPN. Study data were retrieved from prospectively maintained institutional database (Jan2018-May2023). Study population was divided into two groups according to the number of layers (single vs. double) used for renorrhaphy. Baseline and perioperative data were compared. Postoperative surgical outcomes included type and grade of complications as classified according to Clavien-Dindo. Serum creatinine and estimated glomerular filtration rate were used to measure renal function. Three hundred seventeen patients were included in the analysis: 209 received single-layer closure, while 108 underwent double-layer renorrhaphy. Baseline characteristics were not statistically different between the groups. Comparable low incidence of intraoperative complications was observed between the cohorts (P=0.5). No difference was found in terms of mean (95% CI) Hb level drop postoperation (single-layer: 1.6 g/dL [1.5-1.7] vs. double-layer: 1.4 g/dL [1.2-1.5], P=0.3). Overall and "major" rate of complications were 16% and 3%, respectively, with no difference observed in terms of any grade (P=0.2) and major complications (P=0.7). Postoperative renal function was not statistically different between the treatment modalities. At logistic regression analyses, no difference in terms of probability of overall (OR 0.82 [0.63-1.88]) and major (OR 0.94 [0.77-6.44]) complications for the number of suture layers was observed. Single-layer and double-layer renorrhaphy demonstrated comparable perioperative and functional outcomes within the setting of the present study.

Structured training curricula for robotic colorectal surgery in China: does laparoscopic experience affect training effects?

Robotic surgery has been widely adopted for colorectal cancer (CRC). Many surgeons in China have completed structured training programs and have performed robotic colorectal surgeries. This multicenter study aimed to evaluate the training effects of structured training curricula in China for surgeons with different laparoscopic experiences during their initial implementation of robotic colorectal surgery. Ten surgeons from five high-volume centers participated in this retrospective study. The baseline characteristics, perioperative data, and pathological outcomes were compared between the first 15 robotic surgeries performed by five surgeons with extensive laparoscopic experience (group A) and the first 15 robotic surgeries performed by five surgeons with limited laparoscopic experience (group B) at each center. Compared with group B, group A showed shorter operation time (200.9 vs. 254.2 min, P<0.001), less blood loss (100.0 vs. 150.0 mL, P=0.025), and a lower incidence of intraoperative complications (2.7% vs. 21.4%, P=0.015). The reoperation rate (1.3% vs. 5.3%, P=0.036) and postoperative complication rate (6.7% vs. 22.7%, P=0.025) were significantly lower in group A than in group B. There were no statistically significant differences in baseline characteristics (e.g., age, sex, and tumor location) and pathological information (e.g., tumor stage, lymph node count, and tumor size) between the two groups. Radical resection (R0) was performed in all cases. In China, structured training curricula can help surgeons with extensive laparoscopic experience make a smooth transition from laparoscopic to robotic surgery. However, the higher intraoperative and postoperative complication rates indicate that structured training curricula still require further refinement for surgeons with limited laparoscopic experience.

The Transobturator Tape Versus Retropubic Tension-Free Vaginal Tape in the Treatment of Comorbid and Elderly Women With Stress Urinary Incontinence: A Retrospective Analysis of Over 800 Women.

Background and objective The first-line surgical treatment for female stress urinary incontinence (SUI) involves midurethral slings (MUS), including the transobturator tape (TOT) and the retropubic tension-free vaginal tape (TVT). However, whether offering these procedures to older and comorbid womencould lead to increased complications is a question that needs to be seriously addressed. In this retrospective cohort study, we aimed to compare the two procedures and evaluate the impact of age, BMI, and comorbidities on complications. Materials and methods A total of 873 procedures (306 TVTs/567 TOTs) performed between 2007 and 2017 were compared and correlated with regard to age, BMI, and comorbidities. Intraoperative complications includedbleeding >50 ml, bladder injury, and anesthesia-associated complications. Postoperative complications includedpost-void residual volume, pain, hematoma, lower urinary tract infection, revision for loosening tape, and bladder infections. The comorbidities were evaluated based on theAmerican Society of Anesthesiologists (ASA) and Charlson scores. Results A total of 873 MUS were conducted during the study period: 306 TVTs and 567 TOTs. Groupwise comparison between these procedures showed that women in the TOT group were older(p<0.001) with a higher BMI (p<0.001) and a higher ASA score (p<0.001) compared to the TVT group. Nevertheless, significantly more intraoperative complications, especially bladder injuries, were recorded in the TVT group.Postoperative complications occurred in 19.4% of the entire cohort, especially increased post-void residual volume. Postoperative hematoma and tape loosening were significantly more frequent in the TOT group. Age, BMI, and comorbidities showed no significant impact on intraoperative complications; however, the TOT procedure was associated with significantly fewer intraoperative complications [p=0.001, odds ratio (OR): 0.281]. Conclusions Overall,both procedures were associated with a low number of perioperative complications. The TOT technique had a lower incidence of intraoperative complications. It must be highlighted that age and comorbidities had no influence on either the intra- or postoperative complication rates. Hence, we recommend that TOT is employed to treat SUI in older, more obese, and comorbid women.

Deep Neuromuscular Block for Endolaryngeal Surgery: A Systematic Review and Meta-Analysis.

To determine the safety and efficacy of deep neuromuscular block (NMB) for endolaryngeal surgery. PubMed, Web of Science, Cochrane Library, Ovid Medline, Embase, China National Knowledge Infrastructure, Wanfang, VIP databases, and trial registry database. Inclusion criteria followed the PICOS principles: Participants, adults undergoing endolaryngeal surgery; Intervention, deep NMB performed during the surgery; Control, no-deep NMB performed; Outcomes, primary outcome: the incidence of clinically acceptable surgical conditions. the incidence of intraoperative complications (including vocal fold movement and coughing) and total incidence of postoperative complications [including postoperative residual curarization (PORC), postoperative sore throat (POST), and postoperative nausea and vomiting (PONV)]. Study design, randomized controlled trials (RCTs). Duplicate publications, editorials, letters, abstracts, and reviews were excluded. Four articles with 242 patients were identified for analysis. The results indicated that compared with no-deep NMB, deep NMB provides a higher incidence of clinically acceptable surgical conditions (98.36% vs. 76.67%; relative ratio [RR]=1.29, 95% CI: 1.07-1.56), a lower incidence of intraoperative complications (10.83% versus 37.16%; RR=0.32; 95% CI: 0.21-0.49) (lower incidence of vocal fold movement [1.85% vs. 34%; RR=0.08, 95% CI: 0.02-0.41] and coughing [15.53% vs. 38.78%; RR=0.42, 95% CI: 0.27-0.66]). There were no differences in the overall incidence of postoperative complications (RR=2.10, 95% CI: 0.12-36.40). Based on current published evidence, deep NMB provides better surgical conditions with a higher incidence of clinically acceptable surgical conditions and a lower incidence of intraoperative complications (lower incidence of vocal fold movement and coughing) without increasing the overall incidence of postoperative complications. 1 Laryngoscope, 133:2055-2065, 2023.

SP6.1.8Fundus-first laparoscopic cholecystectomy for complex gallbladders: A systematic review

Abstract Aims Retrograde ‘fundus-first’ cholecystectomy is when the dissection starts from the fundus of the gallbladder to the infundibulum, in case structures of Calot's triangle cannot be identified. Although feasible in laparoscopic cholecystectomy, it remains an underutilized approach. We aimed to systematically review the fundus-first laparoscopic cholecystectomy and study its safety and feasibility. Methods A systematic review was performed in compliance with PRISMA guidelines. A literature search was performed using PubMed/MEDLINE, ScienceDirect and Cochrane-Library for articles published from 2010 to 2020. Search keywords included ‘retrograde cholecystectomy’, ‘fundus-first cholecystectomy’ and ‘fundus-down cholecystectomy’. Quality assessments were applied using the Medical Education Research Quality Instrument (MERSQI) score. The protocol was registered with PROSPERO register. Results A total of 3503 studies formed the base for evidence evaluations. 12 studies with 1978 fundus-first cholecystectomies were assessed. Three citations were scored high and 5 moderate quality. Endpoints included blood loss, rate of conversion to open, bile duct injury, gallbladders perforations, postoperative pain and hospital stay. Nine studies provided both strong and moderate scientific evidence for a positive outcome of the fundus-first approach. Conclusion The fundus-first cholecystectomy was associated with a reduced need for intraoperative cholangiography, shorter operating time, lower incidence of intra-operative complications, bile duct injury and reduced incidence of conversion to open cholecystectomy.

Endovascular myocardial revascularization in patients with multivessel coronary artery disease with chronic total occlusion and high surgical risk

The main reason for incomplete myocardial revascularization is the presence of chronic coronary total occlusion (CTO), which is detected in every fourth patient during coronary angiography. At the same time, a generally accepted approach to the treatment of CTO has not yet been developed.Aim. To assess the rationale of complete myocardial revascularization in patients with multivessel coronary artery disease (CAD) with chronic total occlusion and high surgical risk.Material and methods. This retrospective, open-label, non-randomized clinical trial was carried out included 180 patients multivessel CAD and CTO. The patients underwent endovascular surgery for complete myocardial revascularization. Depending on the success of surgery, the patients were divided into groups of complete and incomplete myocardial revascularization. Endpoints were death, acute coronary syndrome, re-revascularization after 1-year follow-up. Left ventricular (LV) contractility and clinical status of patients in the study groups after 1 year of observation was assessed.Results. The median follow-up was 12,1 months. The successful rate of revascularization was 79,4%. The incidence of main composite endpoint in the group of complete myocardial revascularization was 5,59%, while in the group of incomplete revascularizations — 21,6% (p=0,005).Conclusion. The study showed that low incidence of intraoperative complications and a high successful rate of revascularization are characteristic of complete myocardial revascularization in patients at high surgical risk with multivessel CAD and CTO. Complete myocardial revascularization leads to a significant decrease in the incidence of major coronary events.

Arm port vs chest port: a systematic review and meta-analysis.

BackgroundTwo prevailing, totally implantable venous access ports are routinely utilized in oncology: chest port or arm port. This systematic review with meta-analysis was conducted to compare safety and efficiency of the two techniques.MethodsWe performed evidence acquisition intensively from PubMed, Embase, and Cochrane Library. Available comparative studies that evaluated both techniques were identified. The outcomes of interest included total complication events, procedure-related infections, thrombosis, intra-operative complications, mechanical complications, conversion rate, early port removal, and operating time.ResultsThirteen comparative studies including 3,896 patients (2,176 for chest ports, and 1,720 for arm ports) were identified. The present study showed that arm port was associated with higher procedure conversion rate (2.51% in chest port group and 8.32% in arm port group; odd ratios [OR] 0.27, 95% confidence interval [CI] 0.15-0.46; p<0.001), but lower incidence of intra-operative complications (1.38% in chest port group and 0.41% in arm port group; OR 2.38, 95% CI 1.07–5.29; p=0.03). There were no between-group differences with respect to total complication events, procedure-related infections, thrombosis, mechanical complications, early port removal, and operating time. Subgroup analysis of patients under 60 years revealed that no significant difference was detected in intra-operative events (1.19% in chest port group and 0.02% in arm port group, OR 2.59, 95% CI 0.74–9.08; p<0.14), indicating that age may be a risk factor for intra-operative events. Sensitivity analysis did not change conclusions of all endpoints of interest.ConclusionArm port is associated with higher procedure conversion rate, but lower incidence of intra-operative complications, and age may be a risk factor for intra-operative events.

Arthroscopic double bone block augmentation is a salvage procedure for anterior and posterior shoulder instability secondary to glenoid bone loss.

The aim of this study was to describe a one-step arthroscopic anterior and posterior bone block augmentation technique for bidirectional shoulder instability and to present preliminary results. Seven consecutive patients who underwent a concomitant anterior and posterior bone block procedure between 2007 and 2015 were retrospectively reviewed. Clinical scores, return to sport rate, and complications were assessed. Radiological outcome, with CT scan at 6months and plain radiographs at final follow-up were reviewed. Patient reported functional outcomes were also assessed via phone or email interview. Seven consecutive patients were included in the study with a median age at surgery of 27years. Median clinical and radiological follow-up was 7months (4-72months). Walch-Duplay score and Rowe scores were improved. Four patients were able to return to sport. One patient experienced recurrent dislocation, and one subjective instability/subluxation without confirmed recurrence. CT scan showed union in all cases, with one case of anterior bone block osteolysis and one case of partial posterior bone block osteolysis. Radiographs showed no detectable progression of osteoarthritis using the Samilson and Prieto classification. At final follow-up the median WOSI score was 187 (100-1140). An all-arthroscopic technique for the treatment of combined anterior and posterior glenoid bone loss as a cause of shoulder instability can provide fair to good clinical outcomes, with a low incidence of intra-operative complications. The rate of failure in our series remains higher than that seen in primary stabilization procedures. As such we consider this largely as a salvage procedure for cases in which alternative treatments have failed or are unlikely to succeed. IV.

A meta-analysis of complications during sinus augmentation procedure.

The purpose of this systematic review was to assess the difference in the incidence of intraoperative and postoperative complications between the conventional and alternative surgical techniques, during sinus floor augmentation surgery. Electronic databases were searched for publications related to sinus floor augmentation surgery performed with different techniques (ie, conventional lateral window, piezosurgery, osteotome, trephine) and the incidence of complications. The articles were evaluated by independent reviewers, according to predetermined inclusion/exclusion criteria and processed for meta-analysis, following the PRISMA protocol. Initial search returned 3,940 articles, after inclusion/exclusion criteria, and quality assessment 11 articles were included in the meta-analysis: five randomized clinical trials and six retrospective studies. All the 11 included studies compared the incidence of complications in conventional lateral window sinus augmentation surgery versus alternative techniques, including: osteotome (five articles), piezosurgery (four articles), sonic surgery (one article), and trephine (one article). Meta-analysis of the incidence of intraoperative and postoperative complications during conventional lateral window sinus floor augmentation surgery versus alternative techniques, showed a significantly lower incidence of intraoperative complications for the retrospective studies. However, when data from the clinical trials alone were included in the meta-analysis, a statistically significant difference could not be detected for the incidence of intraoperative and postoperative complications. The use of alternative techniques for sinus floor augmentation surgery (ie, piezosurgery, sonic surgery, osteotome, and trephine) does not necessarily reduce the incidence of intraoperative and/or postoperative complications compared to the conventional technique.

Sub-Tenon's anaesthesia versus topical anaesthesia for cataract surgery.

Local anaesthesia for cataract surgery can be provided by sub-Tenon's or topical anaesthesia. Both techniques offer possible advantages. This review, which originally was published in 2007 and was updated in 2014, was undertaken to compare these two anaesthetic techniques. Our objectives were to compare the effectiveness of topical anaesthesia (with or without intracameral local anaesthetic) versus sub-Tenon's anaesthesia in providing pain relief during cataract surgery. We reviewed pain during administration of anaesthesia, postoperative pain, surgical satisfaction with operating conditions and patient satisfaction with pain relief provided, and we looked at associated complications. We searched the Cochrane Central Register of Controlled Trials, MEDLINE and EMBASE (last search in November 2014) and the reference lists of published articles. We looked for conferences abstracts and trials in progress and placed no constraints on language or publication status. We included all randomized studies that compared sub-Tenon's anaesthesia versus topical anaesthesia for cataract surgery. We assessed trial quality and extracted data in the format allowing maximal data inclusion. We included eight studies in this updated review but could retain in the analysis only seven studies on 742 operated eyes of 617 participants. Two cross-over trials included 125 participants, and five parallel trials included 492 participants. These studies were published between 1997 and 2005. The mean age of participants varied from 71.5 years to 83.5 years. The female proportion of participants varied from 54% to 76%. Compared with sub-Tenon's anaesthesia, topical anaesthesia (with or without intracameral injection) for cataract surgery increases intraoperative pain but decreases postoperative pain at 24 hours. The amplitude of the effect (equivalent to 1.1 on a score from 0 to 10 for intraoperative pain, and to 0.2 on the same scale for postoperative pain at 24 hours), although statistically significant, was probably too small to be of clinical relevance. The quality of the evidence was rated as high for intraoperative pain and moderate for pain at 24 hours. We did find differences in pain during administration of local anaesthetic (low level of evidence), and indications that surgeon satisfaction (low level of evidence) and participant satisfaction (moderate level of evidence) were less with topical anaesthesia. There was not enough evidence to say that one technique would result in a higher or lower incidence of intraoperative complications compared with the other. Both topical anaesthesia and sub-Tenon's anaesthesia are accepted and safe methods of providing anaesthesia for cataract surgery. An acceptable degree of intraoperative discomfort has to be expected with either of these techniques. Randomized controlled trials on the effects of various strategies to prevent intraoperative pain during cataract surgery could prove useful.

Assessment of perioperative, early, and late postoperative complications of the inside-out transobturator tape procedure in the treatment of stress urinary incontinence

Objective: To evaluate the complications of urinary incontinence surgery with transobturator tape (TVT-O) system and to describe itsdiagnosis and management. Materials and Methods: A total of 156 patients who were diagnosed as having stress incontinence and mixedincontinence with stress predominance underwent a TOT operation under spinal anesthesia by one surgeon or two surgeons (MB, AEY) from the team. TVT-obturator inside out material was used in the operation. Urodynamic tests and pad tests were done on all the patients. This is a prospective and retrospective study of the complications of TVT- O. The operation was performed under regional anesthesia, asdescribed by Deval et al. Patients were excluded from the study if they had been operated under general or local anesthesia, had undergoneany vaginal operations except for anterior repair (cystocele), wanted to have a baby, had severe systemic diseases or had been diagnosedas having urge incontinence in urodynamic tests. These situations may affect the rate of complications, the authors also excluded slings thathad materials other than monofilament polypropylene, and patients who were suspected of having neurologic bladder conditions. The bladderand urethra were evaluated using cystoscopy. The durations of the TOT procedure, cystoscopy, and if performed, the cystocele operation,were recorded. Perioperative, early, and late postoperative complications were analyzed by follow-up visits (after two months to fouryears). Results: Of the 156 patients included in the study, 100 (64.1%) had pure stress urinary incontinence and 56 (35.9%) had mixed incontinence,20 (12.8%) had previous incontinence surgery. The mean duration of follow up was 30.3 &#x00B1; 7.4 (range 17-42) months. Themean age of the patients was found to be 48.43 &#x00B1; 6.24 years (range 42-68). The mean parity of the patients was 5.24 &#x00B1; 2.86 (range 2-13), and mean body mass index was found to be 23.7 &#x00B1; 4.8. Mean maximum detrusor pressure was 10.30 &#x00B1; 4.08 and the mean ALP value was80.80 &#x00B1; 25.57. Mean operative time was found to be 13.8 &#x00B1; 5.16 min in patients who underwent only TOT and TOT-anterior repair. Vaginalinjury including to the lateral fornix (4.4%), hemorrhaging of more than 200 ml (3.2%), vascular damage (1.9%), hematoma on the leg(1.9%), hemorrhaging of more than 500 ml (0.064%), and bladder perforation (1.2%) were detected as perioperative complications. Urethralinjury and perioperative nerve and intestinal injury did not occur. The most common complication in early postoperative period wasinguinal pain extending the legs (30.7%), followed by headaches (23.7%), fever (12.8%), urinary tract infection (5.7%), and urinary retention(3.2%), respectively. Late postoperative complications included vaginal erosion (4.4%), de novo urge incontinence (8.9%), de novo dyspareunia(7.1%), perineal pain (4.4%), and worsening urgency (8.9%). Conclusion: Although the TVT-O technique is a minimal invasivesurgery method applied to treat the urinary incontinence surgically, it does not imply that it is a complication-free surgical procedure. Despitethe low incidence of intraoperative complications, there is a mild risk of early and late postoperative complications. Fortunately thesecomplications can be taken under control by either conservative and simple medical treatments or surgical procedures.

Differences in Ureteroscopic Stone Treatment and Outcomes for Distal, Mid-, Proximal, or Multiple Ureteral Locations: The Clinical Research Office of the Endourological Society Ureteroscopy Global Study

BackgroundUreteroscopy has traditionally been the preferred approach for treatment of distal and midureteral stones, with shock wave lithotripsy used for proximal ureteral stones. ObjectiveTo describe the differences in the treatment and outcomes of ureteroscopic stones in different locations. Design, setting, and participantsProspective data were collected by the Clinical Research Office of the Endourological Society on consecutive patients treated with ureteroscopy at centres around the world over a 1-yr period. InterventionUreteroscopy was performed according to study protocol and local clinical practice guidelines. Outcome measurements and statistical analysisStone location, treatment details, postoperative outcomes, and complications were recorded. Pearson's chi-square analysis and analysis of variance were used to compare outcomes among the different stone locations. Results and limitationsBetween January 2010 and October 2012, 9681 patients received ureteroscopy treatment for stones located in the proximal ureter (n=2656), midureter (n=1980), distal ureter (n=4479), or multiple locations (n=440); location in 126 patients was not specified. Semirigid ureteroscopy was predominantly used for all stone locations. Laser and pneumatic lithotripsy were used in the majority of cases. Stone-free rates were 94.2% for distal ureter locations, 89.4% for midureter locations, 84.5% for proximal ureter locations, and 76.6% for multiple locations. For the proximal ureter, failure and retreatment rates were significantly higher for semirigid ureteroscopy than for flexible ureteroscopy. A low incidence of intraoperative complications was reported (3.8–7.7%). Postoperative complications occurred in 2.5–4.6% of patients and varied according to location, with the highest incidence reported for multiple stone locations. Limitations include short-term follow-up and a nonuniform treatment approach. ConclusionsUreteroscopy for ureteral stones resulted in good stone-free rates with low morbidity. Patient summaryThis study shows that patients who have ureteral stones can be treated successfully with ureteroscopy with a low rate of complications for the patient.

Separation of the Tip of a Coblation Wand within the Knee Joint: A Complication of Arthroscopic Adhesiolysis

Coblation devices are now widely used in arthroscopic surgery and they show a very low incidence of intraoperative complications. We experienced a case where the tip of the wand separated and migrated into the posterior knee compartment in an arthrofibrotic knee. The free wand tip was identified and then extricated from the popliteal hiatus of the knee with using C-arm fluoroscopic control. To the best of our knowledge, this is the first report of its kind involving coblation wands. We describe this complication to show that the use of coblation devices can lead to unexpected problems and it is imperative to inspect all instruments before and after each surgical use.

Incidence of Complications During Flap Creation in LASIK Using the NIDEK MK-2000 Microkeratome in 26,600 Cases

To evaluate the incidence of intraoperative complications using the NIDEK MK-2000 microkeratome during flap creation in LASIK. The incidence of intraoperative flap complications during LASIK using the NIDEK MK-2000 microkeratome was retrospectively studied in 26,600 procedures performed in 5 outpatient excimer laser surgery centers. A total of 65 (0.244%) complications were identified: 23 (0.086%) eyes had free caps, 13 (0.049%) eyes had an incomplete pass, 13 (0.049%) eyes had an epithelial defect, 11 (0.041%) eyes had buttonhole, and 5 (0.019%) eyes had irregular flap. The remaining 26,535 (99.756%) eyes had uneventful flap creation. Use of the NIDEK MK-2000 microkeratome resulted in a low incidence of intraoperative complications, making it a safe and reliable device for creating flaps during LASIK.

Craniectomía descompresiva en ictus isquémico maligno de arteria cerebral media

Medically managed malignant infarction of the middle cerebral artery (MCA) is associated with an 80% mortality rate. However, several studies report a 40-50% increase in survival rates when decompressive craniectomy is performed. We present our experience with such surgical treatment and a literature review. Seven decompressive craniectomies were performed on five patients for spaceoccupying MCA infarctions. Age ranged from 33 to 57 years-old (three males and two females). Preoperative GCS score was 9-13. Cranial CT was performed within the first 12 hours. Intracranial pressure (ICP) was continuously measured in four patients. Two infarcts occurred in the dominant hemisphere and three in the non-dominant side. Wide fronto-parieto-temporal craniectomies were performed. The duramater was opened and a large heterologous dura graft was placed. Surgery was performed on the second day after the onset of symptoms (median: 47 hours). Preoperative ICP ranged from 27 to 50 mmHg (median: 30.5 mmHg), with immediate postoperative ICP under 15 mmHg in all patients. Two patients (both non-dominant side) survived with good (after reoperation) and excellent functional outcome. They remain stable after ten and five months of follow-up. Three patients died five, five and thirteen days after admission due to uncontrollable high ICP. In our experience, bone removal itself was more relevant than dural opening for ICP control. Initial wide craniectomies may spare reoperations. The significant mortality rate reduction, a wide therapeutic window (2-3 days) and a low incidence of intraoperative complications make decompressive craniectomy a relevant treatment in malignant cerebral MCA infarction.

Broken Blade in the Knee: A Complication of Arthroscopic Meniscectomy

Arthroscopic surgery has a very low incidence of intraoperative complications. However, while the authors were using a No. 11 blade to resect the anterior horn of a meniscus, the blade broke and the fragment flew into the posterior knee compartment. The only way to remove it was to make an incision over the popliteal area. We describe this complication to show that improvisation and use of inappropriate surgical instruments can lead to serious problems and the failure of arthroscopic procedures.

Operative Techniques in the Fetal Rabbit

The development of fetal surgical techniques has made the antenatal correction of congenital defects possible. These techniques have evolved from trials with animal models, permitting increasingly sophisticated operations with low morbidity and mortality. Experimental models range from large animals offering longer gestations but with single pregnancies and high cost, to smaller animals offering multiple pregnancies at reduced cost but with shorter gestations. This paper describes operative techniques in the fetal rabbit and its advantages as a fetal surgical model. Experience with the pregnant rabbit has shown it to be a suitable surgical model for several reasons. Pregnancies are multiple, increasing cost effectiveness and permitting operation on up to eight fetuses per litter without fetal loss. Techniques that promote fetal survival include local housing of does several days prior to operation and preoperative sedation. Spontaneous mask ventilation provides ease of anesthetic administration and titration. Overall surgery is well tolerated with a low incidence of intraoperative complications. Rabbit models have been used in the study of transamniotic fetal feeding, abdominal wall defects, and wound healing. These techniques have resulted in postoperative fetal viability approaching 90%, with negligible maternal mortality in over 4000 fetal operations, thereby making the rabbit a manageable cost-effective model of fetal surgery.