Mean Duration Of Surgery Research Articles

Full Endoscopic Decompression for Single Level Lumbar Stenosis: A Clinical Evaluation

Objective: This study aimed to evaluate the outcomes of full endoscopic decompression for single level lumbar spinal canal stenosis. Methods:This observational study was conducted on a total of 370 patients selected by purposive sampling from January 2022 and December 2023, presenting with symptoms more than 3 months and non-responding to conservative treatment. The procedure was performed by placing the patient on a radiolucent Wilson frame with single-shot epidural analgesia. Outcome was measured in terms of pain reduction using Visual analog scale (VAS) before and after surgery, at 3rd, 6th month, and functional outcome was assessed using the Modified MacNab criteria at 6th month, Results: The mean age of the patients was 56.1 years, with 63% male. The most common stenosis level was L4-L5 (36.5%). The mean operation duration was 53 minutes, and the postoperative complications were minimal. Significant improvement in pain levels was observed, with back pain reduced from a preoperative mean of 3.2 to 1.1 at six months, and leg pain from 7.2 to 1.0 (p < 0.001). According to the Modified MacNab criteria, 91.1% of patients reported excellent outcomes at six months, and 8.4% reported good outcomes. Conclusion: Full endoscopic decompression is a highly effective and safe method for treating lumbar spinal stenosis, providing substantial pain relief and excellent functional outcomes with minimal complications. J Shaheed Suhrawardy Med Coll 2023; 15(1): 3-7

Computer-Aided Design and Manufacturing in Free Fibula Reconstruction of the Mandible: Comparison of Long-Term Outcomes with the Conventional Technique.

Pre-operative computer-aided design and manufacturing (CAD/CAM) revolutionized head and neck reconstruction after extirpative surgery. However, studies performing head-to-head comparison to the conventional technique have limited long-term follow-up. We aimed to compare short and long-term outcomes between conventional and CAD/CAM approaches for mandibular reconstruction with free fibula flaps. Patients undergoing free flap reconstruction from 2012 to 2021 were included. Data regarding patient demographics, past medical history, surgical details, complications, and reconstructive outcomes were collected. Patients who had CAD/CAM were compared with the patients who underwent reconstruction with the conventional technique. The cumulative incidence of hardware maintenance was displayed using the Kaplan-Meier method. A total of 215 patients (n=79 conventional, n=136 CAD/CAM) were included. Both cohorts had similar demographics except the CAD/CAM cohort was younger (p=0.043). The mean operative duration was 54 minutes shorter with the use of CAD/CAM (p=0.014). Total and partial flap loss rates were similar. Patients with CAD/CAM had significantly lower rates of early wound dehiscence (p=0.037). Median [interquartile range] follow-up duration was similar (931 [1854] days in conventional vs 728 [841] days in CAD/CAM, p=0.084). After excluding patients with major surgical complications in the first 30-days, CAD/CAM cohort had a lower hardware removal rate (28.8% vs 13.9%, p=0.011). The significance persisted after including only the patients with more than 2 years of follow-up. The use of preoperative CAD/CAM may reduce operative duration, while allowing for longer maintenance of hardware with reduced removal rates due to complications.

Robotic-assisted laparoscopic modified ureteroplasty using lingual mucosa grafts or appendiceal flaps for the management of complex ureteral strictures: a retrospective cohort study

ObjectiveTo evaluate the feasibility, safety and efficacy of robot-assisted laparoscopic modified ureteroplasty using a lingual mucosa graft (LMG) or an appendiceal flap (AF) for complex ureteral strictures and summarize our experience.MethodsA total of 16 patients with complex ureteral strictures (range: 1.5–5 cm) who underwent robotic-assisted laparoscopic-modified ureteroplasty and were admitted to our hospital from May 2022-October 2023 were retrospectively analyzed. We used modified presuture methods in patients who needed the posteriorly augmented anastomotic technique to reduce anastomotic tension. Perioperative variables and outcomes were recorded for each patient.ResultsThe operation under robot-assisted laparoscopy was successfully performed in all sixteen patients (12 with LMG ureteroplasty and 4 with AF ureteroplasty) without conversion to open surgery. The mean length of the ureteral structure was 2.90 ± 0.90 cm (range: 1.5–5 cm), the mean operation duration was 209.69 ± 26.74 min (range: 170–255 min), the median estimated blood loss was 75 (62.5) ml (range: 50–200 ml), and the duration of postoperative hospitalization was 10.44 ± 2.10 d (range: 7–14 d). The follow-up time in this group was 6 ~ 21 months. The success rate of the surgery was 100%.ConclusionRobot-assisted laparoscopic modified ureteroplasty using AF or LMG is a safe and feasible operation for complex ureteral strictures and deserves to be popularized.

Evaluation of Postoperative Electrolyte Imbalance of Oral Squamous Cell Carcinoma Patients: A Study in a Tertiary Level Hospital

This cross-sectional observational study was performed to evaluate the post-operative electrolyte imbalance in oral squamous cell Carcinoma patients, and it was conducted at the Department of Oral & Maxillofacial Surgery in Dhaka Dental College & Hospital, Dhaka, Bangladesh during June 2022 to June 2023. A total of 100 patients who were clinically and histo-pathologically diagnosed as OSCC patients were enrolled in this study. The collected data were edited, coded processed for computer data entry. The data were analyzed using Statistical Package for Social Sciences (SPSS) software, version-23.0. Descriptive analysis was performed and the results were presented as tables and graphs. Unpaired t tests, Chi-square, Spearman’s rho correlation tests were performed to compare the mean and ratio correlation of the study variables where P<0.05 with 95%CI. The ethical clearance of this study was obtained from the Ethics Committee of Department of Oral & Maxillofacial Surgery in Dhaka Dental College & Hospital, Dhaka, Bangladesh. A total of 100 oral squamous cell carcinoma (OSCS) patients were enrolled in this study. The mean age of the patients was 56.63 ± 9.54 years. The mean BMI of the patients was 18.20 ± 0.60 kg/m2. The majority of the patients were male and it was 54% while female was 46%. 64% patients belonged to lower socio-economic class. 52% patients had the habit of betel nut which was the highest while 39 % had the habit of betel nut with tobacco. The majority, 32% of patients had Stage-I. The mean surgery duration was 5.45± 0:91 hours and 7.2±: 0:15 minutes. The mean blood required for the surgery 1.44±0.68 units. According to the distribution of the post-operative variations of electrolyte imbalances, Sodium (Na+) was observed, hypo 25(25%) and hyper0(0%) on day-1 and hypo 31(31%), and hyper 4(4%) was observed on day 3 and followed by Potassium (K+) hypo 5(5%) and hyper 2(2%) on day- 1 and hypo 7(7%) and, hyper2(25) on day- 3. In comparison of ratio between hypo and hyper of day1 and day-3, showed statistically significant relationship observed (p<0.05). According to postoperative electrolyte distribution, on day-1, mean Sodium (Na+) was observed 136.68±2.69 mmol/L whereas on day-3, mean Sodium (Na+) was observed 133.81±4.21 mmol/Land followed by on day-1 mean Potassium (K+),3.86±0.46mmol/L, day-3, mean Potassium (K+),3.74 ±0.45 mmol/L on day-1. Among the postoperative electrolyte, except, Potassium (K+), all were observed statistically significant (P<0.05). In conclusion, hypocalcaemia, hyponatremia, and hypomagnesaemia are the relatively common after maxillofacial surgeries. Beside this BMI could affect electrolyte abnormalities after maxillofacial surgery.

Organisms Causing Postoperative Implant Infection in Orthopedic Patients Presenting at a Tertiary Care Hospital.

Introduction Infections pose a significant challenge in orthopedics related to implant failure. In orthopedic surgeries, surgical site infections (SSIs) extend the patient's hospital stay by an average of two weeks and also increase morbidity, double hospitalization rates, and triple the financial burden on the patient. This study aims to determine the common organism in patients with postoperative implant infections presenting at a tertiary care hospital. Methods A cross-sectional study was conducted in the Department of Orthopedic Surgery at JPMC Karachi over a six-month period, from November 24, 2022, to May 25, 2023. All patients of both genders aged 18-65 years presenting with postoperative implant infection within six hours of the development of symptoms were enrolled. Baseline demographic details and clinical histories were recorded at the time of presentation. A swab for culture and sensitivity was taken from the implant site using a sterile swab stick in patients with confirmed or suspected infections. Results Of 196 patients, the mean age of the patients was 48.47±5.19 years. Gender distribution showed that 49% of patients were females and 51% were males. The mean duration of surgery was 1.71±0.49 hours (100 minutes approximately);Klebsiella species 26% and Staphylococcus aureus25.5% were the most common organisms isolated from infected surgical wounds, followed by Pseudomonas species in 32 patients (16.3%), Acinetobacter species in 27 patients (13.8%), Escherichia Coliin 23 patients (11.7%), and coagulase-negativeStaphylococcusin 13 patients (6.6%). Conclusion In our cohort, Staphylococcus species and Klebsiella species were the most common pathogens isolated from postoperative implant infections. The rise in Klebsiella species suggests that changes in prophylactic antibiotic practices may have contributed to this trend. Therefore, there is an urgent need to reassess current prophylactic strategies in light of the increasing incidence of infections caused by gram-negative bacteria.

Laparoscopic Versus Open Closure of Duodenal Perforations: A Retrospective Comparative Study in a Rural Hospital, Andhra Pradesh, India

Abstract Introduction: Evidence on the outcomes of laparoscopic surgeries, especially in emergency conditions such as peptic ulcer, remains unknown. A retrospective study was conducted in a rural surgical unit in Andhra Pradesh to compare morbidity, mortality, and duration of hospital admission in patients undergoing laparoscopic (Group L) and open (Group O) closure of duodenal perforations. Methods: Retrospective data of adult patients with peptic ulcer perforation treated by surgical approach during January 2012 and December 2017 were scrutinized. Pre- and postoperative records were abstracted for clinical conditions. Mortality was compared between the two groups with appropriate statistical tests. Results: A total of 120 patients, 60 in each group, were recruited for the study. The preoperative clinical characteristics of the two groups were similar. The mean duration of surgery was significantly higher in Group L (212.8 ± 29 min) compared to Group O (107 ± 16 min) (P < 0.001). Wound discharge (n = 3, 5%) and postoperative leak (n = 2, 3.3%) were the only complications noted in the L group. Several complications were noted in the O group including wound discharge (n = 51, 85%), wound dehiscence (n = 12, 20.0%), postoperative leak (n = 8, 13.3%), pneumonia (n = 1, 1.7%), and need for ventilation (n = 6, 10.0%). Three (5%) patients died in the hospital in Group O while none died in Group L. The average duration of hospital admission was 7.1 days (standard deviation [SD] =1.0 days) for Group L and 11.7 days (SD = 2.2 days) for Group O (mean difference: 4.6 days; 95% confidence interval: 4.6–5.2 days). Conclusion: Laparoscopic correction of duodenal ulcer perforation is both feasible and effective in reducing morbidity and mortality and overall treatment duration at peripheral centers.

Endoscopic and percutaneous denervation of facet joints in the treatment of patients with degenerative lumbar deformities: comparative analysis

Background. At present, degenerative lumbar scoliosis is considered as the severest form of degenerative diseases of the spine. As a rule, it occurs at the final stage of the disease development. Advanced age of the patients, high comorbidity and poor bone tissue quality increase risk of complications development at any stage of the treatment. All things considered, the majority of specialists continue their search for minimally invasive surgeries able to improve the life quality of patients with such pathology. Aim of the study — comparative analysis of the surgical treatment results of patients with degenerative lumbar deformities operated using percutaneous and endoscopic denervation techniques. Methods. The study enrolled 58 patients: 42 (72.4%) women and 16 (27.6%) men. Median age accounted for 64 (60-69) years, minimum follow-up period — 2 years. In 28 cases, we performed endoscopic denervation of the lumbar facet joints at the apex of the deformity on both sides (group A), in 30 cases — percutaneous radiofrequency denervation in the appropriate volume (group В). Evaluation of the treatment effectiveness was based on the dynamics of pain syndrome (VAS), patients’ quality of life (ODI), as well as on the frequency of complications and repeated surgical interventions. Results. Mean operative duration and radiation exposure were significantly higher in endoscopic intervention (p0.001). Group A showed an earlier reduction in back pain syndrome compared to group B (p0.001). Assessment of patients’ life quality by ODI showed a high degree of correlation with the level of back pain syndrome. Significant complications of the surgical treatment were not revealed in any patient of both groups. Repeated denervation was performed during the two-year follow-up period in 18 patients (60%) of group B and in 2 patients (7.1%) of group A (p0.001). Analysis of the factors associated with the efficacy of percutaneous denervation showed the significance of deformation magnitude in the frontal plane. Efficiency of percutaneous treatment decreased at the deformity value of 30° and more with a sensitivity of 77% and specificity of 67%. Conclusions. A more pronounced decrease in the intensity of back pain syndrome with preservation of the effect during the whole period of follow-up was noted in patients after endoscopic denervation. However, this was accompanied by a longer duration of intervention and radiation load. According to our data, low efficacy of percutaneous denervation is due to the use of this technique in patients with severe deformity of the lumbar spine.

Dry Liposculpture of the Calves and Ankles-A Novel Technique for Sculpting the Lower Legs.

Liposuction of the calves and ankles was historically described as a "taboo" procedure and linked with higher postoperative pain and unpleasing aesthetic results. This study presents a Novel technique for dry liposculpture of the calves and ankles using a tourniquet, as a safe and less painful procedure, which achieves better aesthetic results. This single surgeon, retrospective study included 70 women who underwent surgery based on the technique described. Details regarding the surgical outcomes and pain levels were collected, and patients completed 2 years of follow-up. A mean of 1395 cc fat was aspirated from both legs, combined, and the mean duration of surgery was 98 minutes. No major complications were observed, and postoperative pain levels were low. Pre- and post-surgery pictures were evaluated by 8 certified senior plastic surgeons for aesthetic results. The findings suggest that dry liposculpture is suitable for reshaping the calves and ankles. This technique is safe, with precise and satisfactory aesthetic results, low levels of postoperative pain, and may take less time to perform than wet liposuction. This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266 .

Compliance of enhanced recovery after surgery (ERAS) protocol in emergency and elective colorectal cancer surgery with a perspective from a developing country.

To evaluate compliance with enhanced recovery after surgery protocol of patients undergoing colorectal carcinoma surgery, and to compare its effect on outcomes. The retrospective study was conducted at the Maroof International Hospital, Islamabad, Pakistan, and comprised data from July 15, 2016, to March 20, 2022, of patients of either gender undergoing elective or emergency colorectal carcinoma surgery. Data included age, gender, tumour site, type of surgery, surgical approach, compliance with each of the 25 components of the enhanced recovery after surgery protocol, length of hospital stay, surgery duration, 30-day readmission rate and perioperative mortality. Data was analysed using SPSS 23. Of the 96 patients with mean age 50.03±14.86 years (range: 20-79 years), 65(67.7%) were males, 70(72.91%) were aged at least 40 years, and 75(78.12%) underwent elective surgery. Most common tumour site was rectum and sigmoid 49(51%). Laparoscopic surgery was performed in 17(17.7%) patients. No compliance was seen with carbohydrate loading of patients or limiting use of opioids in standard anaesthesia protocol. No nutritional supplementation was started from postoperative day 1. Mean compliance with all the protocol components was 74.9%±37.652 for both elective and emergency cases. Mean duration of surgery was 192.50±75.33 minutes, while mean length of hospital stay was 5.52±1.57 days. Re-admission within 30 days was needed in 2(2.1%) cases. There was no perioperative mortality. Better compliance with enhanced recovery after surgery protocol resulted in better perioperative outcomes.

Clinical effect of posterior-only approach debridement, intervertebral fusion, and internal fixation for upper thoracic tuberculosis.

This study aimed to evaluate the effectiveness and feasibility of the posterior-only approach for debridement, interbody fusion, and internal fixation in treating upper thoracic tuberculosis. This study retrospectively analysed the clinical and radiographic data of 8 patients diagnosed with upper thoracic tuberculosis. All patients underwent posterior approach debridement, interbody fusion, and internal fixation. We conducted pre- and postoperative assessments of the visual analog scale (VAS), Oswestry disability index (ODI) scores, erythrocyte sedimentation rate (ESR), C-reactive protein (CRP), ASIA score, and kyphotic Cobb angle. Back pain and lower limb weakness were the most common presenting symptoms. The mean duration of surgery, amount of blood loss, and volume of postoperative drainage were 262.5 ± 43.3 min, 625.0 ± 333.8 mL, and 285.0 ± 118.1 mL, respectively. Patients were followed up for 36 to 48 months. Three months after surgery, there was a significant improvement in VAS and ODI scores, which further improved until the final follow-up. A statistically significant difference was observed between the preoperative and postoperative periods (P < .05). At the final follow-up, lower extremity function had fully returned to normal in all 5 paralyzed patients. The ESR and CRP returned to normal, 18.1 ± 7.3 mm/h and 9.95 ± 5.41 mg/L, respectively, within 3 months postoperatively. There were statistical differences between the preoperative and postoperative periods (P < .05). The average kyphotic correction rate was (71.5 ± 7.3)%, and the average loss of correction angle was (3.5 ± 1.4)°. Intervertebral bone fusion was achieved by all patients within 15 months (mean 8.3 ± 3.2 months) postoperatively. The posterior-only approach seems an effective, safe, and reliable treatment method for upper thoracic tuberculosis, with favourable clinical and radiological outcomes. Level IV, Therapeutic study.

Analysis of operative duration of image-guided brachytherapy for cervical cancer.

The present study aimed to analyze the operative duration of image-guided brachytherapy (IGBT) for cervical cancer performed at our institution. We enrolled cervical cancer patients who had undergone tandem and ovoid-based intracavitary brachytherapy (ICBT) or intracavitary and interstitial brachytherapy (IC/ISBT) between 2020 and 2024. Cone beam computed tomography (CBCT), CT, or CT + MRI were used for IGBT. For each IGBT session, we retrospectively reviewed the following: application time (AT-defined as the duration from entry into the operating room to the initial image acquisition); planning time (PT-defined as the duration from the initial image acquisition to the start of irradiation); and total operation time (TOT- defined as the duration from entry to exit of the operating room). We analyzed atotal of 126 sessions in 36patients, consisting of 99ICBT-only sessions and 27IC/ISBT sessions. The IC/ISBT sessions had asignificantly longer mean operative duration than the ICBT-only sessions. The IC/ISBT sessions with three or more interstitial needles had significantly longer AT and TOT. However, the IC/ISBT sessions with one needle showed no significant difference in operative duration compared to ICBT-only sessions. CBCT, CT, and CT + MRI were used in 42, 76, and 8sessions, respectively. In the ICBT patients, CT + MRI had the longest PT. However, there was no significant differences in TOT among CBCT, CT, and CT + MRI. IC/ISBT sessions with one needle had no significant difference in operative duration compared to ICBT-only sessions. There was no significant difference in TOT between CT + MRI-based IGBT and CT-based IGBT.

Predictor Variables of Intraoperative Blood Loss during Cleft Palate Surgery

Study design: Cross-sectional study Objectives: To determine the predictor variables associated with blood loss during cleft palate surgery. Method: This was carried out for 12 months. Pre-operative records of each participant were taken including the age, sex, BMI, haematocrit, haemoglobin concentration, the length of the cleft defect and the width. Blood loss was determined using colorimetric method of measurement. The blood loss was calculated using the appropriate formula. Multiple regression analysis was done to determine the predictors of increased blood loss. Statistical analysis was carried out with IBM SPSS version 23.0 (2015) with statistical significance assessed at a p-value of ≤ 0.05, and a 95% confidence interval. Result: A total of 39 participants were recruited for this study, with a median age of 24 (IQR: 21–48) months. The mean length of the defects was 32.1±2.6 mm while the mean duration of surgery was 118.1±38.1 mm. The median value of the intra-operative blood loss was 40.2(IQR: 26.7–60.5). The duration of surgery and the age of the patient were the only statistically significant variables in regression analysis (p&lt;0.0001). Conclusion: Predictor variables of increased intra-operative blood loss were the duration of surgery and the age of the patient.

Primary retroperitoneal lymph node dissection in testicular germ cell cancer in clinical stage IIA/B-renaissance of an established treatment?

The guideline-recommended treatment of choice for clinical stage IIA/B testicular germ cell tumors is chemotherapy with three cycles of PEB/four cycles of PE or, alternatively, radiation for seminomas. Despite their high curative efficacy, both options are associated with significant long-term toxicities. We evaluated the functional and oncological outcomes of primary retroperitoneal lymph node dissection (RPLND) as atherapeutic alternative. Between 2018 and 2022, 76patients (n = 34 seminomas, n = 42 nonseminomas) underwent primary RPLND for marker-negative clinical stage IIA/B testicular germ cell cancer. All patients underwent nerve-sparing RPLND with a unilateral or bilateral template dissection and had a follow-up ≥ 3months. None of the patients received adjuvant chemotherapy. In 24patients, the serum concentration of miR371a-3p was evaluated preoperatively. Follow-up was performed according to EAU guidelines. Median age and median follow-up were 30.1 (17-62)years and 29.3 (3-72)months, respectively. Mean operation time, blood loss, and duration of hospitalization were 131 (105-195) min, < 150 ml, and 4.5 (3-9) days, respectively. AClavien-Dindo IIIa complication was experienced by 8 (10.9%) patients. Antegrade ejaculation was preserved in 90.8%. Amean number of 19(7-68) lymph nodes were dissected. The mean number of positive lymph nodes was 1.1 (1-5), and the mean diameter of positive lymph nodes was 2.4 (0.8-4.6)cm. Eleven (14.5%) patients had stage pN0 (3/34 seminomas, 8/42 nonseminomas). In 24/27patients (88.9%) miR371 was positive, and it was negative in 4/4 with pN0 and 3/3 (100%) with teratoma. An outfield relapse was experienced by 7patients (9.2%), who then received salvage chemotherapy. Primary RPLND for marker-negative clinical stageIIA/B germ cell tumors results in high cure rates without adjuvant chemotherapy and is associated with alow rate of complications if performed in experienced hands. Therefore, primary RPLND should be included in the management of these patients.

Comparison of supine and prone mini percutaneous nephrolithotomy in obese patients: a retrospective study.

To compare the safety and effectiveness of Mini Percutaneous Nephrolithotomy (m-PNL) operations performed in the supine and prone positions in obese patients. We retrospectively analysed data from obese patients (BMI ≥ 30) who underwent prone or supine mPCNL between January 2014 and June 2021 in our clinic. Kidney anomalies, coagulopathy, solitary kidney, skeletal deformity, and patients under 18 were excluded. Outcomes measures included operation time, fluoroscopy time, duration of hospitalisation, stone-free rate, and complications classified by Clavien-Dindo. Statistical analysis was performed using SPSS version 26. The study included 338 patients (100 supine, 238 prone). Supine mPCNL had a shorter mean operation time (89.6 vs. 100.3 minutes, p=0.001), fluoroscopy time, and duration of hospitalisation (60.7 vs. 112.0 hours, p=0.001). Overall complication rates were comparable, but major complications were higher in the prone group (p=0.041). Logistic regression identified stone size >25 mm and prone position as significant risk factors for major complications. Supine and prone mPCNL are both effective for treating kidney stones in obese patients. Supine mPCNL offers benefits, such as shorter operation time, reduced radiation exposure, and fewer major complications. Careful monitoring is recommended for patients with high CCI scores or larger stones due to increased complication risks.

Uniportal Laser-Assisted Video-Assisted Thoracoscopy (U-LA-VATS) for Lung Metastasectomy: Technical Description, Peri-Operative Results and Pertinent Literature Review.

Pulmonary metastasectomy (PM) is a well-established treatment that is able to contribute to the cure of oligometastatic cancer. Surgery should adopt the most lung-sparing approach possible to preserve pulmonary function (and, consequently, the quality of life) and to spare the lung for potential additional lung resections. In this framework, laser technology has been introduced in recent decades, but only few experiences combining laser technology with VATS approaches have been reported till now. The main focus of this manuscript is to report our institutional experience in performing lung-sparing laser-assisted PM by uniportal VATS (uniportal laser-assisted VATS: U-LA-VATS). The surgical technique and peri-operative results from our series of patients were herein presented and compared with the pertinent literature. Methods: Between March 2021 and November 2023, among 98 patients who underwent PM, a total of 24 patients (18 men (75%); 6 women (25%); mean age 61.4 years; age range 13-83 years) were treated with laser-assisted PM at our institution. Patients who underwent anatomical resection were excluded for the purpose of the analysis. The U-LA-VATS procedure adopted a modified laser-assisted lung resection technique for performing PM via VATS. Dedicated instruments are used, characterized by a long shape and a curved shape, with distal and proximal articulations. A surgical laser system (Thulium + Diodo OUTPUT 30-10 W, Quanta System S.p.a., Solbiate Olona, Italy) was used, and a 550-μm sterile optical fibre conducted through a specific thoracoscopic handpiece was introduced in the lowest part of the incision. Peri-operative results were analysed in all cohort and compared according to the surgical technique. Moreover, these results were compared with those reported in the literature. Comprehensive research of the literature was conducted on PubMed from 2000 to 2024. A review was performed and reported in line with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) statement. Results: In 12 cases (50%), thulium laser-assisted resection was performed using uniportal video-assisted thoracic surgery (VATS), and in the other cases (12, 50%), a (mini)thoracotomy access was adopted. In the thoracotomy group, the mean duration of surgery was 95 ± 57.7 min; meanwhile, it was 73.5 ± 35.5 in the uniportal VATS group. At the univariate analysis, this difference resulted to be statistically significant (p value 0.025). We did not observe intra-operative complications or remarkable malfunction of the laser system. We also did not report major complications after surgery; also the air-leak rate was 8.3% and 0% after thoracotomic and VATS procedures, respectively. Surgical margins were free from disease in all cases. Major and minor post-op complication rates were similar in both groups. The mean hospitalization after surgery was 2.9 ± 0.3 days for the uniportal VATS group and 3.7 ± 0.9 days for the thoracotomy group, this difference being statistically significant at the univariate analysis (p value = 0.015). Conclusions: U-LA-VATS is a safe and effective procedure, able to combine a parenchymal sparing exeresis with a mini-invasive approach. This procedure is associated with a shorter hospital stay compared with PM performed by a thoracotomic approach. Compared with the selected works for the review, our series is the only one describing the use of laser resection combined with a uniportal VATS approach.

Supraclavicular Brachial Plexus Block with and without Dexamethasone as Local Anaesthetics

Background: Brachial plexus block is good alternative to general anesthesia for upper limb surgery. This avoids the unwanted effect of anesthetic drugs used during general anesthesia and the stress of upper airway instrumentation. Peripheral nerve blocks can be used for anesthesia, postoperative analgesia, diagnosis and treatment of chronic pain disorders. This study was carried out to compare onset and duration of sensory and motor blockade and duration of postoperative analgesia on addition of dexamethasone to local anestheic and local anesthetic alone in supraclavicular brachial plexus block. Methods: In this prospective randomized, controlled, double blinded study which was conducted at Department of Anesthesia, 250 Beded Hospital, Lalmonirhat, Rangpur, Bangladesh from January to June 2023. We included 70 ASA I &amp; II patients who were aged between 18 years &amp; 60 years, underwent elective upper limb surgeries. They were divided into two equal groups. Group 1 (cases) who received 15 milliliter of 2% lignocaine with adrenaline and 15 milliliter of 0.5% bupivacaine + dexamethasone 8mg (2ml). Group 2 (controls) who received 15 milliliter of 2% lignocaine with adrenaline and 15 milliliter of 0.5% bupivacaine + 0.9% normal saline (2ml). We observed the Onset of sensory and motor blockade, duration of sensory and motor blockade and postoperative analgesia between the two groups. Results: In this study of patients according to their age and weight. 37.26±15.55 years were mean age in group 1 and in group 2 it was 36.56±16.86 with p value being 0.8678. 58.466± 3.9642 kg was the mean weight in group 1 and in group 2 it was 60.4±4.95 kg with p value of 0.1002. So both the groups were comparable in terms of age and weight. In this study out of 70 patients, group1 consisted of 68.6% males whereas there were 60% in group 2 and group 1consisted of 31.4% of females and 40% in group2, hence males’ outnumbered females in both the groups. The mean duration of surgery in group 1 was 50±19.95 minutes and in group 2 were 46.6±15.55 minutes with p value of 0.4646. There was no statistical difference between both the groups. The onset of sensory blockade was within 7.3 min in group 1. In group 2 the onset of sensory blockade was 13.66 minutes. The onset of motor blockade was within 3.93 min in group 1. In group 2 the onset of motor blockade was 18.66 min. The duration of intra operative analgesia was 654.33 minutes in group 1. In group 2 the duration of intra operative analgesia was 292.6 minutes. The duration of post-operative analgesia was 815±13.57 minutes in group 1. The duration of post-operative analgesia in group 2 was 393.8±42.88 minutes. There were no complications in both the groups in intra operative period and post-operative period. Conclusion: Dexamethasone, when added to 15 millilitre of 0.5% bupivacaine and 15 millilitre of 2% lignocaine plus adrenaline, very effectively enhances the onset of sensory and motor blockade. It dramatically prolongs the duration of sensory and motor blockade and duration of analgesia. There were no untoward side effects with the use of dexamethasone as an additive in the brachial plexus block.

Management of Large Ovarian Tumors in Elderly Patients Using the Aron Alpha Method and Principles of Enhanced Recovery after Surgery

Abstract Objectives: We performed preoperative evaluations of giant ovarian tumors in older adult patients using the comprehensive geriatric assessment (CGA) and estimation of physiologic ability and surgical stress (E-PASS) scoring systems. We report a case in which the Aron Alpha method was performed, and perioperative management was performed using enhanced recovery after surgery (ERAS). Materials and Methods: We performed preoperative evaluations using the E-PASS scoring system and CGA on older adult patients with giant ovarian tumors, followed by the minimally invasive Aron Alpha method and perioperative management using ERAS. Results: The mean patient age was 75.8 ± 8.8 years; comorbidities included hypertension in three patients, hyperlipidemia in two, angina pectoris in one, cholecystitis in one, and lower extremity varicose veins in one. The mean tumor size was 21.0 ± 5.4 cm. The E-PASS scoring system showed a preoperative risk score of 0.7 ± 0.4, a surgical stress score of 0, and a comprehensive risk score of 0.3 ± 0.3. CGA showed that two patients had problems with activities of daily living and cognitive function. The mean duration of surgery was 89.0 ± 16.6 min, and the mean blood loss was 56.0 ± 65.4 mL. No surgery-associated complications were observed. No patients had prolonged hospitalization or a decline in activities of daily living. Conclusion: We showed the usefulness of performing detailed preoperative evaluations using CGA and the E-PASS system, followed by the minimally invasive Aron Alpha surgical method and perioperative management using ERAS in improving surgical outcomes in older adult patients with giant ovarian tumors.

Medially Based “Abdominal Rotation Advancement Flap”: A Promising Technique for Mastectomy Defect Reconstruction in “High-Risk Patients” Awaiting Adjuvant Radiotherapy

Abstract Background Extensive postmastectomy defects and soft-tissue defects often require some additional flap cover of reconstruction after excision. The reconstruction aim in this group should be a diligent and easy closure with a quality skin cover, early recovery, and brief stay in hospital so that the patients can receive early postoperative radiotherapy/chemotherapy. Medially based abdominal transposition flap is a type C fasciocutaneous flap based on medial perforating vessels. We present our experience in significant postmastectomy defects, especially in high-risk morbid patients. Materials and Methods This is a retrospective study conducted by the department of plastic surgery, from an analysis of the breast cancer database maintained by our hospital from 2019 to 2023. A total of 826 breast cancer patients underwent surgery, of which 547 were locally advanced breast cancer (LABC) patients and 138 (32.5%) LABC patients needed flap cover for mastectomy defect. Medially based abdominal transposition flap was used in 56 of 138 (40.5%) LABC patients for defect closure, and 42 of the 56 patients were stage IIIB patients. Upfront surgery was primarily done in 20 patients and 36 patients underwent surgery after neoadjuvant chemotherapy. This analysis aimed to assess the operative duration, postoperative morbidity, hospital stay, and time taken to start adjuvant treatment by analyzing the medical records of patients who underwent this procedure. Results Fifty-six patients with breast cancer underwent surgical intervention, whereby 8 patients presented with tip and edge necrosis, and 3 patients were infected. The mean duration of operation was 58.852 minutes, and the average length of hospital stay was 5.39 days. It took 24.57 days for the patients to stabilize sufficiently for adjuvant therapy. The average age of the patients in the study was 48.73 years. Conclusion Our clinical experience has demonstrated that the medial abdominal transposition fasciocutaneous (MATF) flap represents a straightforward, reliable, and cost-effective method for managing extensive postmastectomy soft-tissue defects in a subset of patients with LABC. This group typically consists of high-risk and comorbid patients. The procedure holds considerable promise for developing countries with limited infrastructure and expertise, owing to its ease of execution and short learning curve. By its simplicity and affordability, the MATF flap offers a viable and sustainable solution for treating LABC-associated soft-tissue defects.

Severe Rigid Scoliosis Deformity Correction Using Extended Posterior Release and Instrumentation: A Retrospective Study.

Sever rigid scoliotic deformity (magnitude of the curve >80° and <25% correction on bending film) correction is a great challenge to spine surgeons. Severe scoliosis when untreated or not treated properly, may lead to severe complications due to curve progression. The aim of operative management is to achieve significant correction of sagittal, coronal, and rotational deformity to avoid neurodeficit, maintain sagittal balance, and improve cardiopulmonary function. In this retrospective study, eight patients with severe rigid scoliosis who underwent through single-staged extended posterior release and spinal fusion between March 2022 and November 2023. The surgical procedures were the excision of the posterior ligament and spinous process, laminectomy, excision of ligament flavum, facetectomy, and posterior spinal fusion utilizing pedicle screws, rods, and sub-laminar wires. Patients were evaluated radiologically using posteroanterior and lateral X-rays of the whole spine and computed tomography scans. Demographic data, pre- and post-operative cobbs angle, osteotomized segment, instrumentation segments, blood loss, operation duration, follow-up duration, and complications were recorded. Pre-operative mean cobbs angle was 94.1° (range 83-110°) and post-operative mean cobbs angle was 33.3° (range 28-42°) with 64.6% scoliosis correction. The mean estimated blood loss was 517 mL (range 300-580 mL). The mean operation duration was 272.5 min (210-340 min). Mean spinal fixation fusion segments were 11.1 (range 8-14). No major complications were noted. Our study concluded that extended posterior-only release, facetectomy, and posterior spinal fusion by utilizing pedicle screws and pre-contoured rods significantly corrected severe and rigid scoliosis with a high correction rate and avoid complications of anterior release. Hence, we can achieve remarkable correction in rigid scoliosis using the proper choice of levels, proper implant, and extended posterior release.

Short-term and long-term results of odontoid screw fixation in patients with Type II and rostral Type III dens fractures

ObjectivesTo evaluate both the short-term and long-term outcomes of odontoid screw fixation (OSF), identifying potential risk factors for implant-related complications in patients with odontoid fractures. MethodsThis is a retrospective observational cohort study. Inclusion criteria were as follows: 1) Type II fractures and rostral Type III fractures, according to the Anderson and D’Alonzo classification; 2) patients older than 15 years. Exclusion criteria were: 1) other Type III injuries; 2) osteoporosis confirmed by densitometry or a CT bone density score below 100 Hounsfield units; 3) odontoid fractures related to tumors or aneurysmal bone cysts. ResultsIn total, 56 patients were considered for the analysis of short-term results, and 26 patients were evaluated for long-term outcomes. No significant differences were observed in the preoperative imaging data and intraoperative features of OSF between patients with Type II and rostral Type III fractures. The mean operative duration was 63.9 ± 20.9 min, and the mean intraoperative blood loss was 22.1 ± 22.9 ml.Screw cut-out was identified in four patients with rostral Type III fractures (p = 0.04). The rate of screw cut-out was found to correlate with the degree of dens fragment displacement. The bone fusion rate was 95.7%. CT scans identified stable pseudarthrosis in two cases. We observed C2–C3 ankylosis in all cases following partial disc resection. One third of patients with screws placed through the anterior lip of C2 showed no C2–C3 ankylosis. A strong trend towards lateral joint ankylosis formation in patients with a median lateral mass dislocation of 11.9 mm was observed. Most SF-36 scores either matched or exceeded the corresponding normal median values in the published reference database. ConclusionsOSF is a reliable treatment method of Type II and rostral Type III odontoid fractures with fragment displacement of 4 mm or less. The minimally invasive OSF through the anterior-inferior lip of C2, using monocortical screw placement and cannulated instruments, without rigid intraoperative head immobilization, is sufficient to achieve favorable clinical and fusion results. This technique reduces the risk of ankylosis in the C2–C3 segment. OSF restore the quality of life for patients with odontoid fractures to levels comparable to those of the general population norm.