Mean Drainage Research Articles

Robotic-assisted costectomy using a Gigli saw for fibrous dysplasia

BackgroundFibrous dysplasia (FD) is the most common benign tumor of the ribs, with surgical resection being the preferred treatment modality for rib FD, leading to enhanced quality of life and favorable outcomes. The complexity of surgical intervention varies depending on the location of costal FD, presenting challenges for both open surgical and thoracoscopic approaches. In this study, we present a novel technique for three-port robotic-assisted costectomy utilizing a Gigli saw, detailing our initial findings and outcomes.MethodsWe reviewed five patients with benign rib tumors who underwent three-port robotic-assisted rib resection using a Gigli saw between May 2021 and December 2022. Data on patient characteristics, relevant short-term surgical outcomes and clinical long-term treatment effects were collected.ResultsThe surgery was successful in all five patients without any need for an additional port and emergency conversion to open surgery. Median operative time was 76.8 min (range, 73–116 min), and the median intraoperative blood loss volumes was 75 ml (range, 40– 105 mL). On average, chest tubes were removed 1.2 days postoperatively (range, 1–2 days), with a mean drainage volume of 93 ml on postoperative day 1 (range, 70–135 ml). Patients were discharged between the 2nd and 4th postoperative day. During 1-year follow-up period, no recurrence was observed in either patient.ConclusionsThe utilization of a three-port robotic-assisted costectomy in conjunction with a Gigli saw represents a viable, secure, and efficient approach for treating isolated benign rib lesions. Our aim is to provide clinical guidance on this technique and promote its broader application.

Value of using ultrasonic shears in reducing seroma formation after axillary lymph node dissection in breast cancer patients

BackgroundAxillary lymph node dissection (ALND) is an essential step in the management of breast cancer. ALND is conventionally performed using radio frequency electrosurgery. The post-operative complications of utilizing such energy (such as prolonged drainage time, seroma, or infection) lead to prolonged recovery. Hence, it may delay the initiation of adjuvant chemo/radiotherapy for this critical category of patients. Using ultrasound shears provides a wide spectrum of tissue effects via mechanical oscillation. The absence of an electric circuit in ultrasound shears reduces thermal injury and accordingly cellular damage.ObjectiveComparing utilization of ultrasound shears in axillary lymph node dissection to conventional radio frequency electrosurgery in terms of operative time, post-operative drainage amount and days, post-operative pain, the incidence of seroma or infection, and lymph node yield.MethodsThis study is a randomized control trial. It includes 56 breast cancer ALND cases performed in conjunction with either BCS or MRM; being upfront surgery cases or post-neoadjuvant therapy cases, 28 patients underwent ALND using ultrasound shears and 28 underwent ALND using radio frequency electrosurgery.ResultsThe mean age of the study population was 51 ± 11.7 years, with a mean BMI of 39. The mean operative time in the ultrasound shear group was 29.4. ± 7.6 min and 31.6 ± 5.1 min in the conventional group. The mean amount of drainage in the ultrasound shear group was 319.6 ± 75.4 ml and 407.5 ± 75.2 ml in the conventional group. The mean drainage days in the ultrasound shear group were 8 ± 1 day and 12 ± 2.2 days in the conventional group. Seroma formation was recorded in 6 of the ultrasound shear groups and 9 in the conventional group. Seroma followed by infection was found in 10% of the ultrasound shear group versus 21% in the conventional group. Seroma formation and wound infection were significantly related to the conventional group (p-value = 0.01).ConclusionOur study recommends the utilization of ultrasound shears in ALND as it is a safe and accurate method that allows faster post-operative recovery with shorter drainage time and lower incidence of seroma or infection, without affecting operative time or lymph node yield.Trial registrationTrial no.: PACTR202402831197428. Date of approval: 19/02/2024

Use of Oral and Intravenous Tranexamic Acid in Total Knee Arthroplasty and Total Hip Arthroplasty Procedures.

Tranexamic acid (TXA) is an antifibrinolytic drug commonly used in total knee arthroplasty (TKA). Intravenous (IV) and topical TXA therapy have been extensively studied and shown to reduce blood loss, length of hospital stay, and blood transfusion rates following TKA. Despite the extensive literature regarding IV and topical TXA in orthopedics, there is a current dearth of studies analyzing oral usage. The primary purpose of this randomized controlled study is to compare post-surgical blood loss with the use of IV and oral TXA following a TKA. In this multicenter, prospective, controlled, randomized study, patients were randomized to receive 1.95 grams of oral TXA two hours preoperatively or 15 mg/kg (1 gram max) of IV TXA mixed in 100 mL of normal saline preoperatively. Intraoperatively, each patient received a combination of 500 mg TXA mixed with 25 mL of normal saline injected into the suction drain and clamped for 30 minutes postoperatively. The primary outcome was absolute (g/dL) change in hemoglobin levels at 24 hours postoperatively. Secondary outcomes included a percent change in hematocrit levels and total drain output at 24 hours postoperatively. Power analysis determined that 40 patients were required in each group. About 24 patients received IV TXA and 14 patients received oral TXA. The mean decrease in hemoglobin 24 hours postoperatively was not greater (p=0.12) with the use of oral TXA compared to IV TXA (1.70 g/dL vs. 2.50 g/dL, respectively). The mean decrease in hematocrit 24 hours postoperatively in the treatment (oral TXA) group was not greater (p=0.18) than the control (IV TXA) group (5.3% vs. 7.0%, respectively). Both changes in hemoglobin and hematocrit resulted in a normal distribution of data and satisfactory one-sided T-test values (p=0.98 and p=0.92, respectively). The mean drain output measured 24 hours postoperatively in the treatment group was significantly (p=0.04) less than the control group (47.5 mL vs. 170 mL, respectively). All tests performed were one-sided T-tests. Compared to IV TXA, we found oral administration to have no significant difference in hemoglobin (p=0.12) or hematocrit (p=0.18) loss. These findings may support the utilization of oral TXA as a valid alternative to the IV route. We found that patients who received oral TXA produced significantly lower drainage output when compared to IV (47.5 mL and 170 mL, respectively; p=0.04). Persistent wound drainage following TKA has been correlated with increased rates of periprosthetic joint infections, residual pain, and reoperation. Further work is needed to assess the effect of postoperative drainage quantity on the recovery of TKA. Based upon the data gathered, oral TXA does not result in greater loss of hemoglobin or hematocrit within 24 hours following surgery. However, total drain output was significantly less in the oral group after 24 hours following a TKA. With more subjects, we would expect to see the mean values between groups move closer to each other and fit well with the current literature. This suggests that oral TXA is non-inferior to IV TXA when comparing these variables following TKA. Our current study has limitations, including a small sample size and no blinding. Therefore, this study provided a limited quality of evidence. Confirmation with a blinded, randomized controlled trial and meta-analysis is required to report a higher quality of evidence.

The“Overlapping”Lymphaticovenous Anastomosis: an overlapped end-to-end anastomosis supermicrosurgical technique

ObjectiveLymphaticovenular anastomosis (LVA) is increasingly utilized in the treatment of lymphedema. This study aims to assess the efficacy and safety of the “Overlapping” LVA technique, which addresses the size mismatch between lymphatic and venous vessels in lymphedema treatment.MethodsBetween August 2022 and April 2023, seventeen patients diagnosed with lymphedema were enrolled in this study. The severity of lymphedema in these patients was classified according to the International Society of Lymphology (ISL) staging system.All patient underwent LVA procedures, anastomosis techniques including the Overlapping, end-to-end and octopus anastomosis. The techniques of anastomosis, anastomosis time, patency rate, and volume of limb lymphedema were evaluated.ResultsOur study enrolled 17 lymphedema patients who underwent the LVA procedure. All patients showed significant postoperative improvement in limb edema. The mean drainage volume was 472.29 ml. The Overlapping technique demonstrated a 100% success rate as assessed by clinical observation and intraoperative Indocyanine Green (ICG) lymphography. The average anastomosis time was 5.3 min, reducing operative time compared to traditional methods.ConclusionsThese findings suggest that the Overlapping technique could serve as a valuable addition to the current LVA technique. This Overlapping anastomosis technique provides a wide range of applications for lymphatic anastomosis treatment and prevention of lymphedema.

Comparison of axillary Exclusion versus No Exclusion on seroma formation after Modified Radical Mastectomy.

Objective: To determine the effectiveness of axillary exclusion technique versus no axillary exclusion in Modified Radical Mastectomy in terms of mean drain output. Study Design: Randomized Control Trial. Setting: Department of Surgery, Allied Hospital Faisalabad Pakistan. Period: 8th August, 2018 to 8th February, 2019. Methods: A request for authorization was made to the Hospital Ethical Review Committee. The research had 60 individuals in all who were admitted. General Surgery Department from outside the Allied Hospital in Faisalabad. For the sixty patients receiving modified radical mastectomy, written informed consent was obtained. A computer-generated database of random numbers was used to split them into two equal groups of thirty patients each at random. Following a modified radical mastectomy, group A received axillary exclusion, but group B did not. Total volume of accumulated fluid) following a modified radical mastectomy. After surgery, until the drain was removed, the total quantity of fluid collection in the drainage bag was recorded and compared across groups. Data was input into a template form. Results: In our study, the mean + SD was determined as 43.73+5.64 years in Group B. Of the two groups, 63.33% (n=19) in Group A and 70% (n=21) in Group B were between 41 and 70 years old, while 36.67% (n=11) in Group A and 30% (n=9) in Group B were between 20 and 40 years old. (First Table-I). Following a modified radical mastectomy with drainage, axillary exclusion procedures were compared with no exclusion, and the results indicated that the mean total drainage output (+SD) in Group B was 642.1 ml (+117.06). (Table-II). The total volume of seroma fluid drained between the two groups was significantly lower, as indicated by the p value of ˂0.001. Conclusion: In comparison to individuals who do not undergo axillary exclusion, we find that axillary exclusion procedures considerably reduce drainage expense in patients undergoing modified radical mastectomy.

External lumbar drainage for the management of refractory intracranial hypertension in pediatric severe traumatic brain injury: a retrospective single-center case series.

Guidelines for the management of pediatric severe traumatic brain injury (TBI) recommend external ventricular drainage for CSF drainage as a first-tier treatment in the intracranial pressure (ICP) pathway. However, ventriculostomy in children can sometimes be challenging because of the small size of the lateral ventricles. External lumbar drainage (ELD) may be a useful alternative; therefore, the authors analyzed the outcome of a cohort of pediatric patients who underwent ELD to manage intracranial hypertension (ICH). This study retrospectively enrolled pediatric patients with ICH following severe TBI who underwent ELD. Radiological and clinical severity scores (Marshall classification, Rotterdam score, Injury Severity Score, and Pediatric Trauma Score) were noted. ICP and cerebral perfusion pressure (CPP) curves were analyzed 12 hours before and after the procedure. Any change in medical therapy was recorded, as well as the total volume and duration of drainage. Cerebellar tonsillar position according to the McRae line was noted before and after ELD. Glasgow Outcome Scale-Extended score at follow-up was also noted. Thirty patients were included, with a mean age of 8 ± 4.4 years, and a median admission Glasgow Coma Scale score of 7 ± 4 (range 3-13). ELD was performed after a median delay of 1 day (range 0-7 days), mean drainage volume/day was 296 ± 129 ml, and median duration of drainage was 7 ± 5 (range 2-12) days. Forty-three percent of the patients underwent ELD as a part of the first-tier therapy. ICP decreased after ELD (mean difference 13.4 ± 6.2 mm Hg, p < 0.001), whereas CPP increased (mean difference 10.6 ± 6.4 mm Hg, p < 0.001). Fifty-three percent of the cohort did not need any further second-tier therapy after ELD. The study found 1 case of drain revision and 3 cases of cerebellar tonsil herniation. These preliminary data suggest ELD is a valuable option to treat ICH in severely head-injured children, limiting the use of second-tier treatments. This pilot study should lay the foundation for a multicenter prospective trial.

Comparative Study between Continuous and Interrupted Suturing in Laparoscopic Pyeloplasty

Background: Ureteropelvic junction obstruction (UPJO) is a common cause of symptomatic ureteral obstruction. Dismembered pyeloplasty is the most commonly employed procedure for the repair of UPJO. Both interrupted and continuous suturing is being practiced in laparoscopy. As satisfactory anastomosis determines the success of dismembered pyeloplasty and recovery of renal function, the success rate and the complications associated with the suturing technique need to be evaluated. Objective: To compare the outcome between continuous and interrupted suturing in laparoscopic pyeloplasty. Methods: This hospital-based, quasi-experimental study was done in the Department of Urology, Dhaka Medical College Hospital (DMCH), Dhaka and the National Institute of Kidney Diseases &amp; Urology (NIKDU), Dhaka from July 2022- June 2023. A total of 60 patients were purposively selected for the study. According to the suture method for ureteropelvic anastomosis, patients were divided into two groups: 30 patients (group A) underwent surgery with the continuous suture method, and 30 patients (group B) underwent surgery with the interrupted suture method. Data on suturing time, post-operative drain output, post-operative hospital stay and post-operative complications were collected. Patients were followed up at 01, 03 and 06 months. At 06 months, a DTPA renogram with split GFR was done to evaluate the patients. Results: The mean ages were 30.0 (±8.3) years for Group A and 33.9 (±9.3) years for Group B, with males comprising 56.7% and 63.3% of each group, respectively. Group B had significantly higher mean suturing time, post-operative drain output, and hospital stay compared to Group A (p&lt;0.001). No significant differences in GFR were noted between the groups (p&gt;0.05). Post-operative complications were observed in 10.0% of Group A and 23.3% of Group B (p=0.166). Conclusion: Continuous suturing technique for pyeloplasty is found to have a lower mean suturing time, mean drain output and post-operative hospital stay.

The effect of pleural drainage on pulse oximetry in a post-operative thoracic surgery population

BackgroundPleural effusions in post-operative thoracic surgery patients are common. Effusions can result in prolonged hospitalizations or readmissions, with prior studies suggesting mixed effects of pleural drainage on hypoxia. We aimed to define the impact of pleural drainage on pulse oximetry (SpO2) in post-thoracic surgery patients. MethodsA retrospective study of post-operative thoracic surgery patients undergoing pleural drainage was performed. SpO2 and supplemental oxygen (FiO2) values were recorded at pre- and post-procedure. The primary outcome was difference in pre-procedural and post-procedural SpO2. ResultsWe identified 95 patients with a mean age of 65 (SD – 13.8) years undergoing 122 pleural drainage procedures. Mean drainage volume was 619 (SD–423) mL and the majority of procedures (88.5 %) included a drainage of <1000 mL. SpO2 was associated with an increase from 94.0 % (SD-2.6) to 97.3 % (SD-2.0) at 24-h (p < 0.0001). FiO2 was associated with a decrease from 0.31 (SD-0.15) to 0.29 (SD-0.12) at 24-h (p = 0.0081). SpO2/FiO2 was associated with an increase from 344.5 (SD-99.0) to 371.9 (SD-94.7) at 24-h post-procedure (p < 0.0001). ConclusionsPleural drainage within post-operative thoracic surgery patients offers statistically significant improvements in oxygen saturation by peripheral pulse oximetry and oxygen supplementation; however the clinical significance of these changes remains unclear. Pleural drainage itself may be requested for numerous reasons, including diagnostic (fevers, leukocytosis, etc.) or therapeutic (worsening dyspnea) evaluation. However, pleural drainage may offer minimal clinical impact on pulse oximetry in post-operative thoracic surgery patients.

Robot-assisted laparoendoscopic single-site retroperitoneal nephroureterectomy with bladder cuff excision for upper tract urothelial carcinomas: Preliminary experience

ObjectiveTo present a modified technique for robot-assisted laparoendoscopic single-site retroperitoneal nephroureterectomy (RLESS-RNU) with bladder cuff excision and evaluate its effectiveness as a minimally invasive approach for managing upper tract urothelial carcinoma (UTUC). MethodsFifteen patients who underwent RLESS-RNU for UTUC between April 2020 and June 2021 were reviewed by our medical institution (The Second Affiliated Hospital of Nanjing Medical University), from our prospectively maintained institutional database. The da Vinci® Xi system (Intuitive Surgical, Sunnyvale, CA, USA) was utilized for surgical procedures on all patients. An in-depth analysis was conducted on their baseline demographic characteristics, pathological factors, and perioperative details. The complete surgical process and details are elaborated. ResultsThe median age of 15 patients was 67 years. The final pathology demonstrated 46.67% (7/15) patients with the pT1 stage or lower and 46.67% (7/15) with the pT3 stage; one patient could not undergo pathological staging because of preoperative chemotherapy. The perioperative outcomes revealed that the mean operative time was 185 (standard deviation [SD] 23.05) min. The time for the trocar placement including primary docking was 15 (SD 0.85) min and the time of second docking was 8 (SD 0.52) min. The median of estimated blood loss was 55 mL. The mean drainage tube duration and postoperative stay were 7.50 days and 11.00 days, respectively. After a mean follow-up period of 24.20 months, the relapse-free survival rate was 86.67%. Two patients experienced disease progression; one patient exhibited multifocal evidence of non-muscle invasive bladder cancer, and another patient developed systemic recurrence. ConclusionsThis study demonstrates the modified technique for RLESS-RNU is safe and satisfactory for UTUC.

Dose Comparison of Flowable Gelatin Hemostatic Matrix for Bleeding Loss in Primary Total Knee Arthroplasty.

Introduction Intraoperative and postoperative bleeding in total knee arthroplasty (TKA) affects postoperative outcomes. Although the hemostatic effect of a flowable gelatin hemostatic matrix (FGHM) is known across several surgical fields, its effectiveness on TKA remains controversial. This study aimed to compare the amount of bleeding across three groups treated with different doses of FGHM in TKA. Methods Overall, 122 knee joints of patients who underwent unilateral primary TKA were included and divided into three groups according to FGHM dose: absence of FGHM (control group, N=48), administration of 5 mL of FGHM (5 mL group, N=46), and administration of 8 mL of FGHM (8 mL group, N=38). Total hemoglobin (Hb) loss, drain output, hidden blood loss (HBL), calculated total blood loss (TBL) on the first postoperative day (POD1) and one week postoperatively (POD7), postoperative flexion angle at one week and discharge, and incidence of postoperative deep venous thrombosis (DVT) were assessed. Results At POD1, the mean total Hb losses were 6.3±3.1g (control group), 5.5±3.3g (5 mL group), and 5.3±2.5g (8 mL group), with no significant differences. At POD7, the mean Hb losses were 9.1±4.6g (control), 8.7±3.6g (5 mL), and 8.3±4.0g (8 mL), also with no significant differences. Mean drain outputs and HBLs showed no significant differences among groups. While there was a decreasing trend in TBL with higher FGHM doses, it was not statistically significant at either POD1 or POD7. There were no statistically significant differences in the mean postoperative flexion angle at POD7 or discharge among the groups (99.7±12.6°, 95.7±12.5°, 98.3±13.8° at POD7; 115.9±9.7°, 113.8±9.6°, 116.6±9.2° at discharge). Of these, only one patient in the 8 mL group developed proximal DVT. Conclusion Despite a trend towards decreased bleeding with FGHM, no significant differences were found among the three groups. However, the clinical utility of this hemostatic agent for reducing blood loss after primary TKA remains still unclear.

Venous resection increases risk of chyle leak after total pancreatectomy for pancreatic tumors

BackgroundExisting research on chyle leak (CL) after pancreatic surgery is mostly focused on pancreaticoduodenectomy and lacks investigation on total pancreatectomy (TP). This study aimed to explore potential risk factors of CL and develop a predictive model for patients with pancreatic tumor undergoing TP.MethodsThis retrospective study enrolled 90 consecutive patients undergoing TP from January 2015 to December 2023 at Peking Union Medical College Hospital. According to the inclusion criteria, 79 patients were finally included in the following analysis. The LASSO regression and multivariate logistic regression analysis were performed to identify risk factors associated with CL and construct a predictive nomogram. Then, the ROC analysis, calibration curve, decision curve analysis (DCA), and clinical impact curve (CIC) were performed to assess its discrimination, accuracy, and efficacy. Due to the small sample size, we adopted the bootstrap resampling method with 500 repetitions for validation. Lastly, we plotted and analyzed the trend of postoperative drainage volume in CL patients.ResultsWe revealed that venous resection (OR = 4.352, 95%CI 1.404–14.04, P = 0.011) was an independent risk factor for CL after TP. Prolonged operation time (OR = 1.473, 95%CI 1.015–2.237, P = 0.052) was also associated with an increased incidence of CL. We included these two factors in our prediction model. The area under the curve (AUC) was 0.752 (95%CI 0.622–0.874) after bootstrap. The calibration curve, DCA and CIC showed great accuracy and clinical benefit of our nomogram. In patients with CL, the mean drainage volume was significantly higher in venous resection group and grade B CL group.ConclusionVenous resection was an independent risk factor for chyle leak after TP. Patients undergoing vascular resection during TP should be alert for the occurrence of CL after surgery. We then constructed a nomogram consisted of venous resection and operation time to predict the odds of CL in patients undergoing TP.

Prolonged prophylactic antibiotic use following megaprosthesis surgery may reduce periprosthetic infection

IntroductionMegaprostheses provide a reconstructive option for patients with bone loss after musculoskeletal tumor resection. However, the postoperative surgical site infection (SSI) risk is significant. This study aims to evaluate outcomes of extended postoperative antibiotic regimens in patients after megaprosthesis surgery and gather insight into strategies to minimize SSI. MethodsThis retrospective cohort study evaluated patients who underwent megaprosthesis surgery by a single surgeon at a single center from 2014 to 2022. Patient demographics, comorbidities, cancer treatment details, and antibiotic regimens were collected. Excluded were patients with less than 1 year of follow-up, active infection at time of surgery, non-healing wounds unrelated to SSI, and preoperative antibiotic regimens secondary to being immunocompromised. Measures of interest included the development of SSI within 1 year of surgery and development of antibiotic-related complications. ResultsIncluded were 49 patients, with a mean age of 61.2 ± 2.0 years and a mean BMI of 29.4 ± 7.0. The mean drain duration was 6.5 days (standard deviation [SD], 6.9 days), and the mean intravenous antibiotic administration duration was 6.4 days (SD, 6.9 days). The median time to drain removal was five days, and the median time for intravenous antibiotic cessation was five days. The mean total antibiotic administration duration (intravenous and oral) was 25.4 days (SD, 13.4 days). Only 1 patient in the included cohort (2.04 %) developed an SSI requiring operative intervention. No other patient within the cohort experienced an antibiotic-related complication. DiscussionThis study suggests that the site's current protocol for managing post-megaprosthesis antibiotic prophylaxis based on drain duration and incision healing status has resulted in a low rate of SSI and antibiotic-related complications. Further research is needed to validate these findings and gain additional insights into managing antibiotic prophylaxis after megaprosthesis surgery.

(062) BIPOLAR ELECTROSURGICAL SCISSORS IN OPEN ANDRO-SURGERY. THE HUNT FOR HEMOSTASIS AND HASTE

Abstract Introduction Controlling hemostasis is a main part of any surgery, and can be time consuming in some. Electro-surgical cautery is a fundamental way to control bleeding. Bipolar electro-cautery limits tissue devitalization by limiting energy spread. Bipolar Scissors (BPS) combine scissor-cutting process and bipolar diathermy in one instrument and one surgical step. Preserving tissue viability and a short operative time improve surgical outcome. Objective To study the outcome of using BPS in inflatable penile prosthesis (IPP), Shaeer’s corporal rotation for correction of severe ventral penile curvature (SCR) and suprapubic dermo-lipectomy (DL) for revealing the concealed penis. Methods The BPS group was compared to a control group where BPS was not utilized. BPS were used to cut through Dartos and Buck’s fascia, mobilize the neurovascular bundle and excise suprapubic fat. Operative time and drain output were evaluated. Results Mean operative time was significantly shorter in BPS group by 13.6% for IPP surgery, 18.7% for SCR and 23.6% for DL. Mean drain output was significantly less in BPS group by 50.5% in IPP and 35.4% in DL. Peno-scrotal edema was less pronounced and resolved faster when BPS was used. Conclusions Bipolar scissors offer better hemostasis and a shorter operative time in penile prosthesis, penile curvature and pubic lipectomy surgeries. Disclosure No.

Management of renal sinus angiomyolipoma: modified robotic nephron-sparing surgery in a single center

BackgroundRenal sinus angiomyolipoma (RSAML) is a rare and typically complex renal tumor. The objective is to present our single-center experience with a modified technique of robotic nephron-sparing surgery (NSS) for treating RSAML.MethodsWe retrospectively evaluated 15 patients with RSAMLs who were treated with robotic NSS at the Department of Urology of Tongji hospital, ranging from November 2018 to September 2022. Renal vessels and ureter were dissected. The outer part of RSAML was resected. The rest of tumor was removed by bluntly grasp, curettage and suction. Absorbable gelatin sponges were filled in the renal sinus. The preoperative parameters, operative measures and postoperative outcomes were all collected. Follow-up was performed by ultrasonography and estimated glomerular filtration rate (eGFR).ResultsRobotic NSS was successfully performed in all the patients, without any conversion to open surgery or nephrectomy. The mean operation time was 134.13 ± 40.56 min. The mean warm ischemia time was 25.73 ± 3.28 min. The median estimated blood loss was 100 [50, 270] ml and 1 patient required blood transfusion. The mean drainage duration was 5.77 ± 1.98 days. The median postoperative hospital stay was 6.90 [5.80, 8.70] days. Two patients experienced postoperative urinary tract infection (Clavien-Dindo Grade II). During the median follow-up of 25.53 ± 15.28 months, patients received 91.18% renal function preservation. No local recurrence occurred in all the patients.ConclusionsRobotic NSS for RSAML is a complicated procedure that demands technical expertise and a well-designed strategy is critical in the operation. Treating RSAML with modified robotic NSS is safe, effective and feasible.

Totally Endoscopic Replacement of the Ascending Aorta and the Aortic Root including the Aortic Valve via Right Mini-Thoracotomy: A Multicenter Study.

Background: Recently, minimally invasive access via right anterolateral mini-thoracotomy (RAMT) has been gaining popularity in cardiac surgery. This approach is also an option for surgeons performing aortic surgery. The aim of this study is to present our surgical method, highlighting the total endoscopic minimally invasive approach via RAMT for replacement of the ascending aorta (AAR) with or without involvement of the aortic root and the aortic valve. Methods: Clinical data of 44 patients from three participating institutions with AAR with or without involvement of the aortic valve or aortic root via RAMT between April 2017 and February 2024 were retrospectively analyzed. According to surgical procedure, patients were divided into two groups, in the AAR and in the Wheat/Bentall group with concomitant valve or root replacement. Operative time, length of ventilation, perioperative outcome, length of intensive care unit (ICU) as well as postoperative hospital stay, and mid- and long-term results were retrospectively analyzed. Results: Mean age was 61.4 ± 10.7 years old with a frequency of male gender of 63.6%. Mean cardiopulmonary bypass (CBP) time and aortic cross-clamping time was 94.9 ± 32.5 min and 63.8 ± 25.9 min, respectively. CPB and aortic clamp time were significantly lower in AAR group. In the first 24 h, the mean drainage volume was 790.3 ± 423.6 mL. Re-thoracotomy due to bleeding was zero. Sternotomy was able to be avoided in all patients. Patients stayed 35.9 ± 23.5 h at ICU and were discharged 7.8 ± 3.0 days following surgery from hospital. Mean ventilation time was 5.8 ± 7.6 h. All patients survived and 30-day mortality was 0.0%. At a median follow-up time of 18.2 months, all patients were alive. The results were similar in both groups. Conclusions: The full endoscopic RAMT approach with 3D visualization is a safe, feasible and promising technique that can be transferred in the field of aortic surgery without compromising surgical quality, postoperative outcomes, or patient safety when performed by an experienced team in a high-volume center.

Evaluation of outcome of systemic tranexamic acid injection in drain output in ventral hernia repair

The primary objective of the study was to determine the mean drain output after systemic tranexamic acid injection in patients undergoing ventral wall hernia repair. This was a descriptive cross-sectional study conducted in the Department of General Surgery, Hamdard University Hospital Karachi, Pakistan for a period of six months from Oct 2020 to April 2021. The patients undergoing ventral hernia repair were included. Injection tranexamic acid 1gm intravenous twice a day for 1st post-operative day and then capsule Tranexamic acid 500mg per oral three times a day for two consecutive days was given and drain output was measured for 3 days. A total of 63 patients with ventral hernia were included, mean age of patients was 41.476 (±SD= 8.693). There were 41 male patients (65.1%) and 22(34.9%) females. The mean drain output on first day, second and third day was 115.047+14.678 ml/day, 91.919+9.947 ml/day, 66.914+7.070 ml/day and 273.254+29.165 ml/day respectively. The results showed overall reduction in postoperative drain output after oral and intravenous tranexamic acid for 72 hours. However further large scale randomized controlled trials are recommended for confirmation of these findings.

Impact of microporous polysaccharide haemostatic agent on patients undergoing mastectomy or axillary dissection on seroma formation and timing of drain removal

Background: Seroma formation is a known complication following mastectomy and axillary lymph node dissection (ALND) leading to morbidity and financial implications for patients. ARISTATM AH has been designed to prevent postoperative seromas formation in vitro. Methods: We performed a single institution, single surgeon retrospective study from January 2017 to December 2022 in patients undergoing mastectomy/axillary dissection to evaluate seroma formation rates and timing of drain removal. Results: A total of 72 cases were included in our retrospective review of electronic medical records. Of these, 40 patients underwent ipsilateral mastectomies with sentinel node biopsies, 8 patients underwent bilateral mastectomies, and 18 patients underwent axillary dissections without concurrent mastectomy. Our analysis showed a non-significant decrease in seroma formation when ARISTATM AH was used intra-operatively (10%) compared to standard care (24%), (p=0.14). The ARISTATM AH group had a statistically significantly longer mean drain removal time than the standard care group (12.9 vs 7.6 days, p=0.002). Conclusions: There was a trend towards lower seroma formation and a significantly longer requirement for drain placement after mastectomy in ARISTATM AH group. Further research including randomised controlled multi-centre study evaluating the benefit of topical haemostatic agents in reducing seroma formation in breast surgery is warranted.

Assessment of the safety and efficacy of intravenous versus topical tranexamic acid in patients undergoing primary total hip and knee arthroplasty surgeries with respect to decreasing peri-operative blood loss and blood transfusion rates: a prospective and comparative study

Background: Synthetic antifibrinolytic agent like tranexamic acid has been increasingly used in Arthroplasty surgeries to decrease the peri-operative blood loss. The current study was undertaken to compare the efficacy between the intravenous and Topical route of TXA in deceasing the blood loss and transfusion rate in patients undergoing primary total hip and knee arthroplasty (THR and TKR) surgeries. Methods: A total of 120 patients were enrolled in the study with 60 each undergoing THR and TKR surgeries with 30 each given TXA in IV and Topical routes. Outcomes were assessed in terms of mean 24 hours drain output, mean blood loss, mean drop in hemoglobin blood transfusion rate. Results: The mean drain output was more in the IV group in both THR and TKR patients (p&gt;0.05). The mean blood loss was more in the Topical group in both THR and TKR patients (p&gt;0.05). The mean drop in hemoglobin was more in the Topical group, with the difference being significant in the THR patients (p&lt;0.05) and being insignificant in TKR patients (p&gt;0.05). In IV group 9 patients (15%) and in Topical group 25 patients (41.67%) needed blood transfusions, the difference being statistically significant. Conclusions: Both IV and Topical routes of TXA are equally effective in decreasing the peri-operative blood loss and transfusion rates in patients undergoing primary arthroplasty surgeries, with IV route having slightly upper hand as compared to the Topical route.

ROLE OF QUILTING TECHNIQUE IN REDUCING SEROMA FORMATION AFTER MODIFIED RADICAL MASTECTOMY

Objectives: The objective of the study was to evaluate the efficacy of mastectomy flap quilting sutures in reducing post-modified radical mastectomy seroma formation. Methods: The prospective study was conducted by the Department of Surgery Sardar Patel Medical College and A.G. Hospitals, Bikaner, from December 2021 to December 2022. Fifty control and 50 cases of carcinoma breast in the general surgery department were recruited in the study. Results: The mean age of the patients in the cases group was 51.00±12.93 years and control group was 54.16±13.39 years. Mean drain volume of the patients in the cases group was 489.00±10.54 mL and control group was 586.00±22.67 mL and the drain duration of surgery of the patients in the cases group was 8.30±0.44 days and the control group was 12.60±0.80 days. Two (4.00%) patients in cases group and eight (16.00%) patients in control group seroma formation was present (p&lt;0.05). Conclusion: Flap fixation is a surgical technique that obliterates the dead space in patients undergoing modified radical mastectomy. It appears to reduce the total volume of fluid drained, the development of seroma, and the need for seroma aspirations.

Validation of Urostomy Parastomal Herniation Incisional Prevention Strategies

ObjectiveTo evaluate simulated parastomal herniation forces in in vitro abdominal fascial models. Our group previously illustrated how incision type may play a consequential role in bowel herniation force generated across an incision using several abdominal fascia models. We sought to 1)Confirm findings in fresh human tissue 2)Assess correlation between herniation force and incision size 3)Determine whether incision type impacts drainage in a simulated ex vivo ileal conduit. Materials and MethodsAxial tension force(N) of herniation was measured using our previously published protocol, pulling a Foley catheter balloon 3.8cm diameter affixed to a dynamometer through silicone/fascial incisions ranging 3cm-5.8cm. We simulated ileal conduits using bovine small intestine with stoma matured through human fascia using 3.0 cm linear or cruciate incisions. The conduit’s caudal end was catheterized and filled at 20mL/minute. Drainage was measured by pad weight change. Two-sided α<0.05 was used to reject the null hypothesis. ResultsMean(±SD) herniation forces in fresh human fascia varied significantly across linear longitudinal, linear transverse, and cruciate incisions (20.9±3.7, 23.3±8.8, and 8.9±3.8N, respectively[p=0.011]). Fresh human fascial linear incisions 3cm in diameter had a herniation force of 22.1±6.3 vs 3.5±0.7N for 5.8cm incisions when herniating a 3.8cm balloon(p=0.002). All observations were similar in silicone. In simulated ileal conduit, mean drainage: 70.8±3.6 vs 82.1±9.7mL (linear vs cruciate) after 100mL instilled, respectively(p=0.05). ConclusionsThis ex-vivo study further suggests incision type has predictable influence on herniation force. These data support standardization of urostomy construction techniques and evaluating the clinical impact of stomal maturation techniques on parastomal hernia rates.