Mean Operative Time Research Articles

Safe Implementation of Robotic Surgery for Gynecologic Diseases at a Tertiary Center: Retrospective Analysis of 149 Cases and Review of the Literature

Abstract Objectives: The initial learning curve is a barrier to introducing robotic surgery. Evidence regarding appropriate simulation programs that allow for a smooth introduction of gynecological robotic surgery remains limited. Materials and Methods: We retrospectively analyzed 149 patients who underwent robotic surgery for gynecologic diseases. Before their first procedure, the surgeons completed a robotic surgery training program. Assistant surgeons also completed simulation programs, including setup procedures and manipulation of the robotic arm. Results: The mean (± standard deviation) operative, setup, and console times were 170 ± 54 min, 22 ± 8 min, and 126 ± 51 min, respectively. No patient required blood transfusion or conversion to laparoscopy or laparotomy. Patients undergoing surgery by the same surgeon were divided into three groups (first-third, middle-third, and last-third of patients undergoing surgery) to assess chronological changes. No statistically significant differences were found between the operative and console times among these groups. The setup times for the middle and last third of patients were 20 ± 7 min and 18 ± 7 min, respectively, which were statistically significantly shorter than those for the first third of patients. No significant differences in the operative and console times done by five physicians who completed programs were observed between the first 75 and the latter 74 procedures; however, the setup times of the latter 74 procedures were significantly shorter than those of the first 74 procedures (25 ± 9 min vs. 19 ± 6 min; P < 0.001). Conclusion: The setup time was influenced by clinical experience. An appropriate simulation program allowed a safe implementation of robotic surgery.

Minimally invasive tubular versus conventional open microsurgery of the lumbar spine for degenerative disorders

BackgroundThe aim of this study was to investigate patient-related variables, hospital-related variables and surgeon-related variables of minimally invasive tubular microsurgery (MITM) compared to conventional open microsurgery (COMS) in patients undergoing microsurgery for lumbar degenerative disorders (LDD).Results403 included patients were treated microsurgically for LDD between 09/2018 and 09/2021. Mean blood loss (44 vs. 72 ml), surgery time (76.2 vs. 85.7 min) and mean Rx-Dosis (1.1 mGy vs. 1.6 mGy) were lower in the MITM group (all p < 0.05). The Macnab criteria and VAS pain scale (VAS Leg/VAS Back) of the MITM group were better at 6 weeks as well as 1 year postoperatively (Macnab at 6W: 1.5 vs. 1.7 (p = 0.02), at 1y: 1.2 vs. 1.4 (p = 0.002); VAS Leg at 6W: 1.4 vs. 1.9 (p = 0.005), at 1y: 0.4 vs. 0.9 (p < 0.001), VAS Back at 6W 1.4 vs. 3.2 (p < 0.001), at 1y: 1.2 vs. 1.4 (p < 0.001)).ConclusionThe patient-related variables, hospital-related variables and surgeon-related variables are equivalent or better in MITM compared to COMS. MITM showed more favourable clinical outcomes in both short- and long-term follow-up, albeit small between-group differences in our single-center study and can be considered for various microsurgical indications for LDD.

Modified endoscopic mucosal resection for the treatment of early gastrointestinal lesions

Objective: To evaluate the clinical efficacy of modified endoscopic mucosal resection (EMR) in the management of early gastrointestinal lesions. Methods: Upon endoscopic identification of the lesion, normal saline is injected into the submucosa to establish a fluid cushion, which elevates the lesion's mucosa. Methylene blue may also be applied to improve visualization of the relationship between the submucosa and muscular layer. A snare with a tip diameter of 2-3 mm is utilized to circumferentially incise the mucosal layer at the lesion's edge, forming a circular groove. The snare is anchored within this groove, allowing for complete resection of the lesion in a single step. The procedure involves a slow and alternating technique of electrosurgical cutting and coagulation to minimize bleeding risks, while upward tension on the snare during cutting reduces perforation risks. Direct coagulation of exposed blood vessels is performed using the snare tip, and hemostatic clips are applied to larger defects; nylon sutures may be utilized for substantial wounds. Results: Between June 2015 and April 2024, modified EMR was performed on 65 patients with early gastrointestinal lesions at Dongguan Children's Hospital, Guangdong Medical University. The mean operative time was (15.2 ± 3.1) minutes, with a complete resection rate of 100% and negative margins confirmed. Postoperative complications included one case each of delayed bleeding and electrosurgical syndrome. The average cost of consumables was (1887.2±187.6) yuan. Follow-up colonoscopies at 3 and 6 months postoperatively indicated no recurrences. Conclusions: Modified EMR demonstrates a short operative time, high safety and efficacy, and reduced material costs in the treatment of early gastrointestinal mucosal lesions.

The Safety and Efficiency of Percutaneous Nephrolithotomy in Managing Renal Stones in A Single Solitary Kidney

Background: Urologists have significant challenges when treating individuals with a solitary functional kidney who have renal stones. Various therapeutic approaches are employed to treat renal stones in people with just one working kidney, such as shock wave lithotripsy, retrograde intrarenal surgery, and percutaneous nephrolithotomy (PCNL). Objective: To assess the safety and efficiency of PCNL in patients with a solitary kidney. Patients and Methods: A percutaneous nephrolithotomy (PCNL) procedure was conducted on 20 patients who had a solitary kidney and were experiencing renal stone issues. The upper calyceal route was utilized. Factors such as the duration of the operation, full removal of the stone, presence of any remaining stone fragments, decrease in hemoglobin levels, requirement for a blood transfusion, necessity for any follow-up procedures, and length of hospital stay were all taken into account. Patients were monitored for a period of 6 months after the surgical procedure to identify any potential problems. Results: The mean age of the patients was 45.45±7.49 years (range: 34–61 years). About two-thirds of the patients (65%) were male. The mean stone size was 3.81 ± 1.57 cm. The mean operative time was 53.3±15.57 min (range: 30-90 min). Secondary puncture was required only in one case (5%). Residual stones were reported in 3 patients. Four patients (20%) needed blood transfusions. The mean duration of hospital stay was 36.3±16.51 hrs. Serum creatinine had dropped from 2.2±0.88 mg/dL preoperation to 1.54±0.31 mg/dL after 6 months postoperation, with a significant difference. Conclusion: PCNL is a safe and effective method for the removal of renal stones in patients with a solitary kidney, especially when other management options are not feasible. The procedure is associated with acceptable rate of residual stone, blood transfusion and postoperative hospital stay. Keywords: Solitary functional kidney, percutaneous nephrolithotomy, renal stone.

Outcomes following laparoscopic adrenalectomy: Experience of more than two decades at a tertiary care centre.

Laparoscopic transperitoneal adrenalectomy was first described by Gagner M et al . Here, we present our experience of more than two decades of laparoscopic adrenalectomy performed in a single surgical unit at a tertiary care centre. A prospectively collected database of patients undergoing laparoscopic adrenalectomy from December 1994 to May 2020 was analysed retrospectively. The demographic profile, details of clinical workup and laboratory parameters were recorded in a pre-structured pro forma. Functional workup and anatomical imaging were performed for all the patients. Patients were taken up for surgery after adequate pre-operative optimisation using a multidisciplinary approach. All the patients were operated by a single surgical team of experienced laparoscopic surgeons. A total of 158 patients underwent laparoscopic transperitoneal adrenalectomy. The majority patients were females (64.5%). The median tumour size was 5 cm (range, 1-18 cm). The diagnosis in the majority of the patients was pheochromocytoma (56.3%). The mean operative time was 80 min (range: 45-210 min). The most common complication was bleeding in 6 (3.7%) patients, which required laparotomy. The median duration of post-operative hospital stay was 3 days (range: 1-13). There was no 30-day mortality. The mean follow-up period was 15 months (range: 6-72 months), during which two patients developed local recurrence. The advantages of laparoscopic surgery are well established and have been extensively explored for the management of adrenal lesions. A multidisciplinary approach to management, consisting of endocrinologists, surgeons and anaesthesiologists is preferred. Pre-operative evaluation, optimisation and accurate selection of patients are crucial for successful laparoscopic adrenalectomy.

Application of robot-assisted laparoscopic isthmectomy for the treatment of symptomatic horseshoe kidney

The current study aimed to investigate the feasibility and safety of robot-assisted laparoscopic resection of the isthmus in patients with symptomatic horseshoe kidney. A retrospective analysis of clinical data from four patients with symptomatic horseshoe kidney treated between January 1, 2021 and December 31, 2023 at Guizhou Provincial People's Hospital was conducted. The main surgical procedures included robot-assisted laparoscopic resection of the isthmus, kidney fixation, pyeloplasty, and pyelolithotomy. All four patients underwent successful surgery. One patient had concomitant calculi. The mean operative time was 179.8 minutes, with an average blood loss of 49.5 ml. In patients followed up for 3 months, 6 months, 1 year, and 2 years postoperatively, renal anatomy remained normal, significant improvement in hydronephrosis was observed compared to preoperative status, serum creatinine levels returned (maintained) to normal status, and no surgery-related complications occurred during the perioperative period. This study reports the safety and feasibility of robot-assisted laparoscopic resection of the isthmus in patients with symptomatic horseshoe kidney. This surgical approach effectively restores the abnormal anatomical structure of the horseshoe kidney, reestablishes the natural course of the ureter, and prevents compression of the ureter by the isthmus of the horseshoe kidney.

Efficacy Analysis of Modified Single-Incision Surgery for Repair of Pediatric Chest Wall Defects: A Retrospective Cohort Study.

This study aims to compare the efficacy of modified single-incision surgery with that of traditional modified Ravitch surgery for the repair of pectus excavatum in pediatric patients. In this retrospective study, we included patients who underwent surgical correction for sternal depression from January 2015 to December 2020 across four major medical centers. Patients were categorized into two specific groups on the basis of the surgical technique employed: the modified single-incision surgery group, which comprised patients treated using the novel single-incision approach, and the traditional modified Ravitch surgery group, which included patients who received the conventional Ravitch surgery with multiple incisions. This study only included patients in the age range of 10 to 18 years, diagnosed with moderate to severe pectus excavatum, and lacked remarkable comorbid conditions that could influence surgical outcomes. Comprehensive data on preoperative characteristics, intraoperative variables, and postoperative results were collected for analysis. The modified single-incision surgery group showed significantly lower mean blood loss, mean operating time, mean hospital stay, postoperative drainage rate, postoperative mean Haller index and mean Haller index after bar removal compared to the traditional modified Ravitch surgery group (p < 0.05). Furthermore, the surgical outcomes were significantly better in the modified single-incision surgery group (p = 0.010) than in the traditional modified Ravitch surgery group. The modified single-incision surgery group also had a significantly lower incidence of postoperative complications, including pneumothorax, pleural effusion, pulmonary infection, bar rejection, and bar flipping and displacement (p < 0.05), than the traditional modified Ravitch surgery group. The modified single-incision surgery group showed significantly greater improvement in sternal depression depth compared to the traditional modified Ravitch surgery group (p = 0.031). Corrected symmetry was significantly better in the modified single-incision surgery group (p = 0.037). The overall satisfaction of patients in the modified single-incision surgery group was significantly higher than that in the traditional modified Ravitch surgery group (p = 0.011). The modified single-incision procedure for the treatment of pectus excavatum offers considerable advantages over the traditional modified Ravitch surgery. The findings of this study suggest that the modified single-incision procedure is a safe and effective alternative for the correction of pectus excavatum.

Stapler Versus Manual Suturing for Pharyngeal Closure in Total Laryngectomy.

Laryngeal carcinoma is not uncommon worldwide. We conducted this study to comprehensively compare the outcome of stapler versus conventional suturing in total laryngectomy primary or salvage. This is a retrospective study conducted in our tertiary institute from 2015 to 2022 involving patients diagnosed with laryngeal carcinoma who underwent total laryngectomy either primary or salvage. We divided patients into 4 groups: primary or salvage laryngectomy, closed with stapler or manual suturing. The reported outcomes included : operative time, length of hospital stay, start of oral feeding, incidence of pharyngocutaneous fistula, positivity of surgical margins, and surgical site infection. Patients with multiple comorbidities and those requiring a flap for pharyngeal closure were excluded . A total of 91 patients were included in our study. Pharyngocutaneous fistula rate was 19% in conventional patient group in comparison to 6.7% in stapler group for primary total laryngectomy while it was 12.5% for salvage with stapler and 25% for salvage with conventional. Hospital stay was 6 ± 1.5 days for stapler and 11.4 ± 2.9 days for conventional suturing in primary laryngectomy. It was 8.8 ± 1.3 days for stapler and 13.1 ± 1.8 for conventional suturing in salvage laryngectomy. There was highly significant difference found as regard mean operative time, start of oral feeding and hospital stay in favor of stapler use. Stapler use in total laryngectomy is is a simple, fast, and effective technique with tension free watertight closure, better hemostasis, less contamination of surgical field than manual suturing.

Laser-guided percutaneous microwave ablation for lung nodules: a promising approach with reduced operation time

BackgroundPulmonary nodule ablation is an effective method for treating pulmonary nodules. This study is based on the traditional CT-guided percutaneous microwave ablation (MWA) of pulmonary nodules. By comparing laser guidance technology with freehand method, this study aims to explore the safety and efficacy and patients’ pain scores of these two approaches.MethodsThis study retrospectively analyzed 126 patients who underwent CT-guided percutaneous lung ablation at the First Affiliated Hospital of Soochow University from April 2020 to April 2024. Based on the guidance method, we divided those patients into the laser guidance group and the freehand group. The primary outcome such as operation time, the number of ablation needle adjustments, postoperative pain scores, postoperative hospital stay, and postoperative complications were analyzed.ResultsThe laser guidance group had a significantly shorter mean operation time compared to the freehand group (39.3 ± 13.65 min vs. 43.82 ± 19.12 min, p < 0.01), and in the laser guidance group, fewer ablation needle adjustments were required than in the freehand group (3.3 ± 1.34 time vs. 4.37 ± 1.39 times, p < 0.001). As compared to the freehand group, the laser guidance group had fewer cases of mild pneumothorax (13.16% vs. 38.33%, p < 0.05). The postoperative pain score at 1 h and 1 day of the two groups showed no statistical difference.ConclusionBoth methods are safe and effective. The laser guidance technology significantly reduces the number of puncture adjustments and the operation time compared to the freehand method. Laser guidance technology effectively reduces the incidence of mild pneumothorax.

Temporal Changes in PROMs Improvement and Recovery Kinetics Following Transforaminal Endoscopic Lumbar Discectomy.

Retrospective cohort study. to analyze trends in PROMs improvement and recovery kinetics following transforaminal endoscopic lumbar discectomy and foraminotomy (TELD). As TELDs become an increasingly common alternative to fusions for lateral disc herniations, it is important to understand patients' postoperative recovery timelines to manage patient expectations. Although studies have shown improvement after TELD compared to preoperative baseline, there is a paucity of information regarding rate of postoperative improvement. Patients who underwent primary one- or two-level TELD for far lateral disc herniations with a minimum of 6-month follow-up were included. Outcomes included: patient reported outcome measures (PROMs), including Oswestry Disability Index (ODI), 12-Item Short Form Survey Physical Component Score (SF-12 PCS), and Visual Analog Scale (VAS) for back and leg; PROMs minimally clinically important difference (MCID); global rating of change (GRC); and return to activities. Timepoints included were preoperative, 2 weeks, 6 weeks, 12 weeks, 6 months. Trends in improvement were plotted on graphs and with P values displayed in tables. 51 patients were included. Mean operative time was 68.4±23.0 minutes and mean length of stay was 9.6±10.5 hours. There were statistically significant improvements in VAS back and leg at 2 weeks and 6 weeks, with a plateau after 6 weeks. ODI and SF-12 PCS did not experience statistically significant improvement until 6 weeks, which was also the point of plateau. VAS leg MCID and GRC peaked at 6 weeks. All patients returned to driving and discontinued opioids, and most patients returned to work. Median days to return to driving, work, and discontinue opioids were 8, 35, and 1, respectively. Patients can expect the majority of postoperative improvement to occur within 6 weeks, after which improvements tend to plateau. Around 75% of patients feel better compared to preoperative at 6 months. TELD may therefore spare some patients of a more invasive fusion initially. 3.

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

Robot-Assisted Pyelolithotomy in Pelvic Kidney.

Background/Objectives: Pelvic kidney is a congenital anomaly characterized by the kidney's failure to ascend to its normal anatomical location during early embryonic development. This anomaly complicates traditional surgical approaches for renal calculi due to the kidney's atypical positioning and associated anatomical challenges. We sought to summarize our experience with robotic-assisted pyelolithotomy (RPPK) for pelvic kidney stones. Methods: A retrospective review of patients who underwent RPPK was conducted between 2014 and 2023. Demographic data on stone characteristics, operative details, and postoperative outcomes were analyzed. Results: Four patients (three male; mean age-51.2 years with a range of 45-54; mean BMI-26.6 with a range of 22.3-32.2) underwent RPPK. All had a right-sided pelvic kidney; two had prior failed ureteroscopy. The mean stone diameter was 27.7 mm (range: 17-35); the mean density was 1207.5 HU (range: 905-1500). The mean operative time was 265 min (range: 200-323); the time from incision to closure was 142.2 min (range: 95-225). No ureteral stents or drains were used. Blood loss was negligible. The mean hospital stay was 2.2 days. No immediate complications were recorded. The mean follow-up was 11.75 months (range: 3-30). Conclusions: RPPK is safe and effective for managing pelvic kidney stones. Challenging renal anatomy stone size and density are not obstacles to the robotic approach unlike other fragmentation methods.

Posterior cricoid plate drill enlargement in idiopathic subglottic stenosis.

Idiopathic subglottic stenosis(ISS) is an airway stricture between larynx and trachea, within 1 cm from the vocal cords. Resection-reconstruction presents technical issues because of the need to resect the anterior portion of the cricoid cartilage, but not the posterior plate beyond which the recurrent laryngeal nerves access the vocal cords. The main surgical challenge consists of the minute airway caliber short below the cords, ensuing after the resection. We propose drill posterior cricoid plate molding to obtain antero-posterior and lateral amplification of the laryngo-tracheal anastomosis. This is a retrospective study of patients who underwent laryngo-tracheal resection with drill enlargement between January 2023 and June 2024. Laryngo-tracheal resection was performed according to Pearson. At this point airway caliber is gauged by endotracheal tubes of increasing size. To enlarge the air space, the inner surface of the posterior plate was molded by drill. Breathing, complications, voice and swallowing function were recorded. Our study includes 23 consecutive patients with ISS. No mortality described. Fifteen patients(65.2%) described voice alteration and 7(30.4%) experienced transient swallowing impairment. The mean operative time was 94.56(±28.72) min. All patients breathed well at discharge. Overall early success rate was excellent (no sequelae) in 7(30.4%) patients, and good(grade A: voice/breathing changes not influencing the quality of life; grade B: abnormal voice and shortness of breath, not hindering normal activities) in 15(65.2%). At the mean follow-up of 10.5 ± 5.5 months definitive success was achieved. This is the first study describing this technique. The results of our early experience with drill molding of the posterior cricoid plate are promising. It is an innovative, simple, safe, and effective method for subglottic airway enlargement in ISS, resulting in low post-operative complications, and in good to excellent results. Prot. n. Prot. n. C. 139/December 2023.

Preliminary clinical study on the treatment of acetabular quadrilateral fractures with a novel anatomical locking plate

ABSTRACT Background: This study aimed to investigate the surgical approaches, clinical efficacy, and indications of a novel acetabular anatomical locking plate for acetabular fractures involving quadrilateral plate. Methods: Acetabular fracture patients treated with the novel acetabular quadrilateral anatomical locking plates in our department from December 2017 to June 2020 were collected. According to the fracture types, a 1:1 matched-pair analysis was carried out and patients treated with reconstruction plates were selected. These two groups of patients were included in the observation group and control plate group respectively, and ultimately each group included 11 patients. The time between injury and definitive surgery, surgical approaches, operation time, intraoperative blood loss volume, intraoperative blood transfusion volume, postoperative blood transfusion volume, fracture union time, reduction loss, and postoperative complications were recorded. The fracture reduction quality and hip function were respectively evaluated by Matta’s grading system and the modified Merle D’Aubigne-Postel grading system. A comparison was made to observe whether the two groups had differences in the above clinical parameters. Results As for the observation group, the mean operation time was 327.82±137.46min(range: 120~580min; median: 323min), the mean intraoperative blood loss volume was 1745.46±2103.98ml(range: 300~7000ml; median: 1000ml), and the mean intraoperative blood transfusion volume was 1526.18±1617.46ml(range: 0~5130ml; median: 900ml), and the mean postoperative blood transfusion volume was 254.55±439.01ml（range：0~1400ml; median：0ml）. During the follow-up period ranging from 9 to 28 months, 1 incision lipoliquefaction, 1 heterotopic ossification, and 1 traumatic arthritis were recorded; According to Matta’s grading system, 4 anatomic reduction, 6 imperfect reduction, and 1 poor reduction were recorded, and the rate of satisfactory reduction quality was 90.91%; According to modified Merle D’Aubigne-postel grading system, 5 excellent, 4 good, 1 fair, and 1 poor were recorded, and the rate of satisfactory hip function was 81.82%. As for the control group, the mean operation time was 273.18±99.15min(range: 120~450min; median: 270min), the mean intraoperative blood loss volume was 1122.73±469.77ml(range: 300~1500ml; median: 1500ml), and the mean intraoperative blood transfusion volume was 608.55±363.71ml(range: 0~1086ml; median: 758ml), the mean postoperative blood transfusion volume was 281.82±430.86ml（range：0~1000ml; median：0ml）. During the follow-up period ranging from 9 to 42 months, 2 traumatic arthritis and 1 femoral head necrosis were recorded; According to Matta’s grading system, 2 anatomic reductions, 6 imperfect reductions, and 3 poor reductions were recorded, and the rate of satisfactory reduction quality was 72.73%; According to modified Merle D’Aubigne-postel grading system, 1 excellent, 7 good, 0 fair, and 3 poor were recorded, and the rate of satisfactory hip function was 72.73%. All the patients obtained fracture union, and no reduction loss was recorded. According to statistical analysis, there were no significant differences between the two groups in the time between the injury and definitive surgery, surgical approaches, intraoperative blood loss volume, intraoperative blood transfusion volume, postoperative blood transfusion volume, rate of satisfactory reduction quality, hip function score, and rate of satisfactory hip function. Conclusion: Through three kinds of anterior approaches, the novel anatomical locking plate can be used to fix the acetabular fractures involving quadrilateral plate including anterior wall fractures, anterior column fractures, transverse fractures, and double-column fractures, which can obtain satisfactory fracture reduction quality, limit the medial displacement of the quadrilateral plate effectively, restore the postoperative hip function well, and obtain a comparable clinical efficacy as the reconstruction plate.

New purse-string suture clamp and multi-functional seal cap: a simple intracorporeal circular-stapled oesophagojejunostomy after laparoscopic total gastrectomy.

Laparoscopic total gastrectomy (LTG) is still limited because intracorporeal oesophagojejunostomy is technically demanding and difficult in laparoscopic gastrectomy. Circular-stapled anastomosis is considered the "gold standard" method for oesophagojejunostomy in open total gastrectomy. A purse-string suture instrument is used to create a purse-string suture along the distal oesophagus as a standard technique for classic circular-stapled oesophagojejunostomy in the open total gastrectomy. However, a simple and optimal laparoscopic purse-string suture device or instrument with an appropriate and optimal tube in the abdomen remains to be developed as a standard procedure for simple intracorporeal oesophagojejunostomy. Between May 2023 and October 2023, a new laparoscopic purse-string suture clamp (Lap-PSC) and multi-functional seal cap (MSC) were applied to obtain a simple intracorporeal circular-stapled oesophagojejunostomy after laparoscopic total gastrectomy in 21 patients with gastric cancer in our hospital. The surgical details and postoperative outcomes were analyzed to evaluate this method. The mean operation time was 203.8 ± 39.1min. The mean time for the purse-string suture was 6.6 ± 2.8min. An average of 13min was required for purse-string creation and anvil placement. Tumor-free margins were obtained in 21 patients, with a median proximal margin length of 2cm (range, 1.5-5cm). Four postoperative complications occurred in this study. There was no mortality. During the median follow-up periods of 11 months, no anastomosis-related complications were observed. The standardized single-stapling end-to-side oesophagojejunostomy in open surgery can be easily and safely performed during LTG using both Lap-PSC and MSC. The procedure using Lap-PSC with MSC may be considered as a better procedure to option in LTG.

Optimizing Surgery for Idiopathic Scoliosis: Does a Dual Approach Help Young Surgeons?

Introduction Inidiopathic scoliosissurgery, studies have shown two attending surgeons have better curve correction, pain, and recovery time. There is conflicting evidence on operative time, blood loss, infection rate, and hospital length of stay. Limited literature examines the impact of surgeon experience on the dual approach. The purpose of this study was to evaluate the performance of two young orthopedic attendings compared to a senior-level attending in idiopathic scoliosis surgery. Methods We examined adolescent idiopathic scoliosis (AIS) patients undergoing posterior spinal fusion by a single or dual-attending approach. We performed a 1:1 propensity score match with the variables of age at surgery, sex, body mass index, Cobb angle, and number of levels fused. Peri- and postoperative outcomes were analyzed. Results There were 24 patients in each cohort. Patients having surgery by dual attendings had a shorter mean operative time overall (232 vs. 327 minutes, p<0.001) and per levels fused (19 vs. 26 minutes per level, p<0.001). Dual attendings had better percent curve correction (70% vs. 56%, p=0.001) and smaller overall final postoperative curve magnitude (17° vs. 25°, p<0.001). Estimated blood loss (421 vs. 989 mL, p=0.023) and cell saver volume transfused (59 vs. 178 mL, p<0.001) were lower in dual attending cases. Dual attending patients had a shorter length of stay (3 vs. 4 days, p<0.001). There were no differences in Hemovac blood loss, transfusion requirements, need for intensive care, or complications. Over time, the young dual attendings improved in hospital length of stay (R: -0.617, p=0.001) and hemovac blood loss (R: -0.474, p=0.019). Conclusion A dual attending approach in idiopathic scoliosis surgery may result in shorter operative time, greater curve correction, reduced operative blood loss, and shortened hospital length of stay. No differences were identified in postoperative blood loss or transfusion requirement, need for intensive care, or overall complication rate. Within the limitations of this study, we conclude that dual attending surgery in idiopathic scoliosis is safe and effective when conducted by two young orthopedic surgeons, with results that are similar to that of a more experienced senior surgeon.

A single center retrospective study of vNOTES hysterectomy, laparoscopic hysterectomy and vaginal hysterectomy operations.

In our study, we aimed to retrospectively compare vNOTES hysterectomy, a new method, with a vaginal hysterectomy (VH) and total laparoscopic hysterectomy (TLH). Our study included 186 hysterectomy cases (62 vNOTES hysterectomy, 62 VH, and 62 TLH) with benign indications diagnosed between 2021 and 2022. Our study is a retrospective and single-center study. Three surgical techniques were evaluated comparatively according to demographic characteristics and surgical results. The least hemoglobin (Hb) decline and the longest mean operation time were observed in the vNOTES hysterectomy group. When discharge times were compared, it was observed that the vNOTES hysterectomy group was discharged significantly shorter than the TLH group (P: .022 < .05). The lowest 6th-hour pain score of 1.53 was observed in the vNOTES hysterectomy group. History of pelvic surgery and cesarean section were higher in the vNOTES hysterectomy group than in the VH group. Also, oophorectomy and salpingectomy rates were higher in the vNOTES hysterectomy group than in the VH group. When intraoperative complications were evaluated, bladder perforation was encountered in one vNOTES hysterectomy and two VH operations, and bleeding was observed in one VH operation. The VH group was the least costly operation compared to vNOTES hysterectomy and TLH (P: .003 < .05, P: .01 < .05). Aesthetic results can be achieved for patients by using the vaginal route. With all these results, we believe that vNOTES hysterectomy is a safe alternative to TLH and VH.

Perioperative and short-term outcomes of cemented versus cementless total hip arthroplasty: a retrospective propensity-matched analysis.

Cement fixation for total hip arthroplasty (THA) remains a controversial topic. While cemented stems are associated with lower risk of periprosthetic fractures (PPF), cementless stems may offer superior biological fixation. This study analyzed peri-operative and short-term outcomes of cemented vs. cementless stem fixation in THA. A retrospective review was conducted on 15,012 patients who underwent primary elective THA at an academic medical center from 2011 to 2021. Of these patients, 429 were cemented. Patients were stratified into 3 age cohorts (25-69, 70-79 and ≥ 80 years). Cemented stem patients were 1:1 propensity-score matched to cementless stem patients for baseline characteristics. Perioperative and short-term outcomes were compared. The mean operative time for cemented cases was significantly longer across all age cohorts (25-69, P = 0.005; 70-79, P < 0.001; ≥80, P < 0.001). In the 70-79 and ≥ 80 cohorts, cemented patients demonstrated a significantly shorter length of stay (LOS) compared to cementless patients (2.2 vs. 2.6 days, P = 0.017; 3.0 vs. 3.4, P = 0.041, respectively). In the 70-79 and ≥ 80 cohorts, cemented patients were significantly more likely to be discharged home when compared to cementless patients (88.2 vs. 80.5%, P = 0.031; 64.0 vs. 54.2%, P = 0.046, respectively). Across age cohorts, there were no differences in all-cause revision rates (Cohort 1: 5.4% vs. 1.1%, P = 0.108; Cohort 2: 3.0% vs. 1.8%, P = 0.362; Cohort 3: 1.8% vs. 1.2%, P = 0.714). The ≥ 80 cohort demonstrated increased rates of PPF in the cementless cohort compared to cemented (1.2 vs. 0%, P = 0.082, respectively), but it did not reach significance. Patient age has a substantial impact on perioperative outcomes following cemented versus cementless stem THA. Patients > 70 with a cemented femoral stem had improved perioperative outcomes such as shorter LOS, increased discharge to home and reduced rates of PPF compared to their cementless stem counterparts. Patient age should be considered prior to selecting a stem fixation strategy. III, Therapeutic Study.

Comparison of Sutureless and Sutured Aortic Valve Replacements in Patients with Redo Infective Endocarditis.

Background and Objectives: This study aims to assess the postoperative outcomes and complications of sutureless and sutured aortic valve replacement in patients with infective endocarditis. Materials and Methods: A total of 58 patients who underwent redo aortic valve replacement for bacterial or non-bacterial endocarditis between January 2018 and March 2023 were included in our study. Surgical procedures were performed through a full median sternotomy due to redo cases and to provide optimal access. Demographic characteristics, operative times, postoperative complications and some echocardiographic data were compared. All cases were meticulously evaluated preoperatively by a cardiac team to select the best treatment option. Results: The mean ICU length of stay was significantly shorter in the sutureless valve group at 5.4 ± 3.9 days compared to 7.9 ± 4.1 days in the sutured valve group (p = 0.029). However, the sutureless group had a mean operation time of 164.7 ± 37.3 min, while the sutured group had a mean operation time of 197.7 ± 45.6 min (p = 0.044). Again, the difference in cardiopulmonary bypass times between the two groups was statistically significant (p = 0.039). And again, four (14.2%) patients in the sutureless group underwent reoperation due to bleeding, while eight (26.6%) patients in the sutured group underwent postoperative bleeding control (p = 0.048). Conclusions: Our study suggests that sutureless aortic valve replacement may offer advantages in terms of operative efficiency and postoperative recovery compared to conventional sutured valves, with some significant differences in terms of some complications.

Total Laparoscopic Hysterectomy in Women with Previous Cesarean Section: An Observational Study

Background: Cesarean sections (CS) and hysterectomies are common gynecological surgeries, with CS rates increasing recently. Patients undergoing hysterectomy with a history of CS face higher risks, such as blood loss and urologic injuries, due to pelvic adhesions, which occur in 30%-90% of those with prior laparotomies. The choice of hysterectomy method is crucial, with options including abdominal, vaginal, laparoscopic, and robotic approaches. Laparoscopic hysterectomy, particularly total laparoscopic hysterectomy (TLH), offers benefits like reduced blood loss and faster recovery, though it remains challenging in patients with prior CS. Aim of the study: The study aims to evaluate how previous cesarean deliveries affect the outcomes of total laparoscopic hysterectomy (TLH). Methods: This cross-sectional observational study involved 110 patients undergoing total laparoscopic hysterectomy (TLH) at in the Department of Obstetrics and Gynecology, Bangabandhu Sheikh Mujib Medical University (BSMMU) and in two private Hospitals Dhaka, Bangladesh, from February 2019 to January 2023. Following ethical approval. Patients were divided into two groups: Group A (55 patients) had a previous cesarean section, and Group B (55 patients) did not. Inclusion criteria included women over 30 with a history of cesarean section, while exclusions were for those with laparotomy or genital malignancy. Data on surgery duration, complications, and recovery were analyzed using SPSS, with significance set at p&lt;0.05. Result: The study compared two groups of patients undergoing total laparoscopic hysterectomy, focusing on demographic, clinical, and intraoperative variables. The majority were aged 40-49 years, with similar BMI and parity. Common indications included abnormal uterine bleeding (27.27% in Group A vs. 30.91% in Group B; p=0.325). Chronic pelvic pain was more frequent in Group A (25.45% vs 9.09%; p=0.266). Mean operative time was longer in Group A (73.72±16.47 vs. 59.26±10.57 ...