Mean Operative Time In Minutes Research Articles

A Simple 3D Printed Model for Intracranial Vascular Anastomosis Practice and the Rochester Bypass Training Score.

Surgical simulation models in cranial neurosurgery are needed to allow affordable, accessible, and validated practice in resident education. Current bypass anastomosis practice models revolve around basic tube tying or complex animal and 3-dimensional models. This study sought to design and validate a 3-dimensional printed model for intracranial anastomosis training. A computer-aided design (CAD) generic skull was uploaded into Meshmixer (v.3.5), and a 55-mm opening was created on the right side, mimicking a standard orbitozygomatic craniotomy. The model was rotated 15° upward and 35° left, before a 10-mm square frame was added 80-mm deep to the right orbit. The CAD model was uploaded to GrabCAD and printed using a J750 PolyJet 3D printer before being paired with a vascular anastomosis kit. The model was validated with standardized assessments of residents and attendings by simulating an "M2 to P2" bypass. The Rochester Bypass Training Score (RBTS) was created to assess bypass patency, back wall suturing, and suture quality. Postsimulation survey data regarding the realism and usefulness of the simulation were collected. Five junior residents (Postgraduate Year 1-4), 3 senior residents (Postgraduate Year 5-7), and 2 attendings were participated. The mean operative time in minutes was as follows: junior residents 78, senior residents 33, and attendings 50. The RBTS means were as follows: junior residents 2.4, senior residents 4.0, and attendings 5.0. Participants agreed that the model was realistic, useful for improving operative technique, and would increase comfort in bypass procedures. There are a few different printing options, varying in model infill and printing material used. For this experiment, a mix of Vero plastics were used totaling $309.09 per model; however, using the more common printing material polylactic acid brings the cost to $17.27 for a comparable model. This study presents an affordable, realistic, and educational intracranial vascular anastomosis simulator and introduces the RBTS for assessment.

Development and clinical application of a new sternal zenithal traction system in video-assisted percutaneous thoracoplasty

IntroductionVideo-assisted percutaneous thoracoplasty involves a complex surgical access with risk of damaging vital structures during the procedure. Historically, different traction and sternal elevation systems have been applied during the intervention to minimize the risk associated with the passage of the instruments between the sternum and the pericardium. Material and methodsA new sternal traction system is presented by means of an illustrated description. Clinical and sociodemographic data were extracted from the 36 patients operated in our center for Pectus Excavatum between July 2017 and August 2021. The Haller index was not applied as a criterion to determine the use or not of the sternal traction system. Patients were classified according to whether the sternal traction system (TE) or not (ST) had been employed. Statistical analysis of the data collected was performed with STATA, version 15.0 (StataCorp). ResultsBoth groups were comparable. Haller's Index was 4.19 ± 0.7 for the sternal traction (TE) group and 3.79 ± 0.3 for the no sternal traction (ST) group. In 25 of the patients the described traction system was used, and in 11 no traction system was used. All patients were operated on by the same surgeon. The mean operative time in minutes was 97.73 ± 46.2 for the ST group and 88.13 ± 18.1 for the TE group (p = 0.87). The mean total days of admission was 7.67 ± 0.82 (TE) and 7.73 ± 1.35 (ST). Mean days of intravenous PCA was 6.08 ± 0.72 (TE) and 5.89 ± 1.45 (ST). The mean number of epidural PCA days was 3.79 ± 0.5 (TE) and 3.36 ± 0.5 (ST) (p = 0.01). All patients presented a favorable postoperative evolution. None of the patients presented discomfort at the level of the sternal wounds during hospitalization. Cosmetic evolution was favorable in all patients. ConclusionsThe sternal traction system presented provides safety when performing retrosternal dissection and placement of the thoracoplasty bar, leading to a decrease in surgical time in cases with a Haller Index higher than 3.5. There have been no complications associated with its use, nor has there been an increase in the number of days of hospitalization or analgesic requirements. There are no aesthetic sequelae for the patients.

Experiece of laparoscopic appendicectomy versus open appendicectomy in Babylon

To compare laparoscopic appendectomies versus open and to evaluate the level of efficacy of both surgical approach . The predictor variables explored in this study were:age,gender,ultrasound procedure,operative time,post operative stay, number of hours required for the return of bowel function, use of narcotic analgesia ,any postoperative complications and regaining of routine activities: A total of 119 patients clinical records were reviewed, of these 22 patients had had laparoscopic appendectomies and 97 had open appendectomies.All the operations had done by a general surgeons in Babylon.The mean operative time in minutes was relatively shorter for open appendectomy (48) compared to laparoscopic appendectomy (84).The average time for the return of bowel movement was remarkable less for laparoscopic appendectomy (12) hours versus open appendectomy(24) hours.the mean post operative stay in hours was relatively shorter for laparoscopic appendectomy (18)compared to open appendectomy (30).Hence our study found that laparoscopic appendectomy is a safe and effective procedure for the removal of appendix over open appendectomy.

Desarrollo y aplicación clínica de nuevo sistema de tracción cenital esternal en la toracoplastia percutánea videoasistida

IntroductionVideo-assisted percutaneous thoracoplasty involves a complex surgical access with risk of damaging vital structures during the procedure. Historically, different traction and sternal elevation systems have been applied during the intervention to minimize the risk associated with the passage of the instruments between the sternum and the pericardium. MethodsA new sternal traction system is presented by means of an illustrated description. Clinical and sociodemographic data were extracted from the 36 patients operated in our center for Pectus Excavatum between July 2017 and August 2021. The Haller index was not applied as a criterion to determine the use or not of the sternal traction system. Patients were classified according to whether the sternal traction system (TE) or not (ST) had been employed. Statistical analysis of the data collected was performed with STATA, version 15.0 (StataCorp). ResultsBoth groups were comparable. In 25 of the patients the described traction system was used, and in 11 no traction system was used. Haller's index was 4.19±0.7 for the TE group and 3.79±0.3 for the ST group. All patients were operated on by the same surgeon. The mean operative time in minutes was 97.73±46.2 for the ST group and 88.13±18.1 for the TE group (P=.87). The mean total days of admission was 7.67±0.82 (TE) and 7.73±1.35 (ST). Mean days of intravenous PCA was 6.08±0.72 (TE) and 5.89±1.45 (ST). The mean number of epidural PCA days was 3.79±0.5 (TE) and 3.36±0.5 (ST) (P=.01). All patients presented a favorable postoperative evolution. None of the patients presented discomfort at the level of the sternal wounds during hospitalization. Cosmetic evolution was favorable in all patients. ConclusionsThe sternal traction system presented provides safety when performing retrosternal dissection and placement of the thoracoplasty bar, leading to a decrease in surgical time in cases with a Haller index higher than 3.5. There have been no complications associated with its use, nor has there been an increase in the number of days of hospitalization or analgesic requirements. There are no aesthetic sequelae for the patients.

Laparoscopic Inguinal Hernia Repair; Sohag Experience

Background: Laparoscopic inguinal hernia repair is widely adopted and well accepted in many centers. Objective: We aimed with this study to evaluate the technique regarding its advantages and disadvantages in Sohag University Hospital. Patients and Methods: This was a prospective observational study included 50 patients suffering from inguinal hernia admitted electively to Sohag University Hospital between September 2019 and April 2020. Patients were enrolled for laparoscopic Trans Abdominal Pre Peritoneal (TAPP) repair. Patients were evaluated regarding demographic criteria, clinical picture, operative, and postoperative course after an outpatient follow-up period of 6 months. Results: The mean operative time in minutes ±SD was (125±12.5) for the early 10 patients while it was (69.8± 24) for the last 25 patients. Intraoperative complications were encountered in two cases of visceral injury and one case of bleeding arising from the inferior epigastric artery that was managed laparoscopically without surgical sequelae. The duration of hospital stay ranged from 24-48 hours. Postoperative complications were encountered in 3 patients whom had surgical emphysema which resolved conservatively. Patients returned to full activities in 7.14 ± 0.96 days and returned to their work in 14 ±2.5 days. On follow-up, recurrence was not encountered allover the period of 6 months postoperatively. Conclusion: TAPP repair for inguinal hernias is justified as a feasible, reproducible, and safe technique with rapid recovery and early return to work as well as comparable morbidities to other techniques. It is recommended as the procedure of choice in elective groin hernia repair especially in bilateral cases, with short learning curve requiring little facilities in the center.

Outcome of Single Shot versus Serial Dilatation Technique for Percutaneous Nephrolithotomy

Background: Percutaneous nephrolithotomy (PCNL) is a common procedure for the removal of renal stones larger than 2 cm size with the advantages of lower morbidity rates, decrease in post-operative pain with faster post-operative recovery & thereby less duration of postoperative hospital stay. One of the fundamental steps of PCNL is the creation of the nephrostomy access. It can be done either by single shot dilatation or by multi-increment serial dilatation technique. Objectives: To compare the outcome of PCNL done by single versus serial dilatation technique with specific reference to renal access time, total operative time, stone clearance rate, postoperative haematuria and duration of postoperative hospital stay. Methods: It was a prospective interventional study with a sample size of sixty where odd number patients were included in group A (PCNL by single shot dilatation technique) & even number patients were in group B (PCNL by serial dilatation technique). After meticulous checking and rechecking, collected data were compiled and statistical analysis was done using computer based software SPSS (statistical package for social science, Version- 16) and Students t-test and Chi-square test were applied for hypothesis testing. ‘P’ value <0.05 was considered as significant. Results: Comparison between the two groups regarding stone size, stone clearance rate, postoperative haematuria and postoperative hospital stay were not statistically significant (p> 0.05). But mean renal access time in minutes (group A was 3.43 ± 1.14 and group B was 4.20 ± 1.37) and the mean operative time in minutes (group A was 91.13 ± 19.08 and group B was 101.67 ± 15.81) between the groups were statistically significant (p < 0.05). Conclusion: Percutaneous nephrostomy access can be successfully performed by single shot dilatation technique during PCNL with the advantages of shorter renal access time and total operative time. Bangladesh Journal of Urology, Vol. 23, No. 2, July 2020 p.124-128

Laser Hemorrhoidoplasty: Experience at Aga Khan University Hospital

Background: Hemorrhoidal disease is the commonest benign anal condition diagnosed in the outpatient setup. Interventional treatment options range widely, from office-based procedures to hemorrhoidectomy. Laser technology increasingly is in use in the field of proctology. We present our index clinical outcomes following laser haemorrhoidoplasty (LHP).
 Methodology: Retrospective cross-sectional study of 21 consecutive patients who underwent LHP between 2015 and 2018 under a single surgeon. Their outcomes were compared with a group of patients who underwent the standard open hemorrhoidectomy over the same period of time.
 Results: Postoperatively, 85.7% of patients post-LHP had a better pain score (mild) compared with 66.7% in the open hemorrhoidectomy group. The mean operative time in minutes was shorter for LHP, 29.67±17.50 versus 39.20±20.77 in the open group. Duration of hospital stay in days between the two groups were similar; LHP group median=1(1–3), open group median =1(1–3). Rates of infection, recurrence and urinary complications were however higher in the laser group, 4.8%, 9.5% and 9.5% respectively compared with the open hemorrhoidectomy group that were 0%, 6.7% and 6.7 % respectively. Both groups had no reported cases of stool or flatus incontinence.
 Conclusion: Laser haemorrhoidoplasty is associated with reduced pain scores and shorter operative time than open hemorrhoidectomy. Duration of hospital stay was similar in both groups. The rate of complications was high in the study group.
 Keywords: Laser haemorrhoidoplasty, Pain score, Complications, Open hemorrhoidectomy

Association of operative time with outcomes in minimally invasive and abdominal myomectomy

To determine the association of operative time (ORT) with perioperative morbidity and whether there is an ORT at which minimally invasive myomectomy becomes inferior to laparotomy. Retrospective cohort study. Not applicable. Myomectomy cases identified by CPT code from 2005 to2016. Cases were stratified and analyzed by surgical approach and 90-minute intervals. Thirty-day postoperative morbidity. A total of 11,709 myomectomies were identified; 4,673 (39.9%) were minimally invasive, 6,997 (59.8%) were abdominal, and 39 (0.3%) were conversions. The incidence of complications significantly increased with ORT. After adjusting for confounders, mean ORT in minutes (95% confidence interval) was 113 (111-115) for abdominal, 156 (153-159) for minimally invasive, and 172 (148-200) for conversions. Despite shorter ORT, morbidity was greater in abdominal cases (16% vs. 5.7%), with the highest rates in converted cases (20.5%). The minimally invasive approach in general had lower odds of complications (odds ratio, 0.23; 95% confidence interval, 0.19-0.26). However, when minimally invasive surgery ORT reached ≥ 270minutes, the odds of a composite complication variable increased compared with abdominal cases <90minutes (odds ratio, 2.30; 95% confidence interval, 1.69-3.13). Of minimally invasive cases, 88% were completed in <270minutes. ORT was predictive of complications for both minimally invasive and abdominal myomectomies. Despite longer ORTs, minimally invasive procedures generally had superior 30-day outcomes up to 270minutes. Careful patient counseling and preparation to increase surgical efficiency should be prioritized for either approach.

Value of measurement of maternal serum alpha fetoprotien in diagnosis of pathologically adherent placenta in cases of placenta pravia

Objective: to investigate the significance of elevated MSAFP in diagnosing pathologically adherent placenta among women with placenta previa and its predictive value for pregnancy outcome. Study Design: A retrospective study involved eighty women with placenta praevia divided into 4 equal groups according the degree of invasion as suspected by TAS, Doppler and MRI studies and confirmed postoperatively by histo-pathological examination. G1; included those with placenta pravia alone G2; those with placenta accreta, G3; those with increta degree while G4 contained those with placenta percreta. MSAFP level were evaluated for all patients between 34-36 weeks gestational age. Results: Baseline characteristics of the study group showed no significant difference among groups 1, 2, 3 as regard maternal age, gravidity, parity, fetal gestational age and body mass index (p>0.05) but when compared separately with group 4, there was significant increased mean (+SD) (P <0.05) but not in the body mass index. Maternal risk factors of placenta praevia and abnormal placental adherence proved more previous uterine scars in groups 3 and 4, (P < 0.002). MSAFP levels represented a remarkable increase in groups 2 and 3 and shooting up in group 4 (mean+SD, 91.3+19.1, 153.2+38.1, 178.3+25.2, 263.3+36.1 respectively, P value 0.001). Fetal and maternal outcomes as well as intraoperative findings showed some statistical significant differences between the studied groups as maternal intraoperative blood loss was found more evident in G4 (mean + SD 931± 312) compared to G1, 2 and 3 (640 ± 191, 767 ± 331, 834± 284; respectively, P value 0.02) with more liability for postpartum hemorrhage, 7 cases (35%) versus 0, 2 and 3 cases in G1, 2, 3. respectively (P 0.003).IIAL was resorted to in 7 cases in G4 compared to nothing in G1 and G2 while in 2 cases only in G3. Bladder injuries were reported in 5 cases in G4 and 1 case in G3 but not in G1 and 2 (P 0.002). The mean operative time in minutes (SD) was found relatively shorter in G1 but longer in G2 and 3 but longest in G4 (34 ± 9.1, 44 ± 5.1, 49 ± 9.2, 55 ± 8.1, respectively, P value 0.01). There were more need for intra and postoperative blood transfusion in cases of G4, 7 cases versus 2 cases only in G2 and 3. Again, there was more requested emergent caesarean hysterectomy in G4 (4 cases versus one case in G3, P 0.01). The postoperative data confirmed that there was evident longer duration of hospital stay in G4 (5 +2.3) compared to other groups 1, 2 and 3 (3.2 + 1.1, 3+ 1.2, 3.5+1.3, P value 0.01). Admission to intensive care unit was recorded higher in G4, 5 cases compared to 1 case only in G3 (P 0.002). No maternal mortality recorded as well as neonatal intensive care unit admission.ROC analyses finds elevated MSAFP stated the maximum sum of sensitivity and specificity for the significant test and showed the AUC was 0.752 (95% CI: 0.505–0.979)with 83.54% sensitivity and 71.53% specificity (p = 0.042). Conclusion: Increased third trimester MSAFP levels can predict morbidly adherent placenta in placenta previa patients, with no other obvious cause, as well as intraoperative complications.

Comparison of Endoscopic Tympanoplasty to Microscopic Tympanoplasty.

ObjectivesThis study aimed to compare the outcome of endoscopic and microscopic tympanoplasty.MethodsThis was a retrospective comparative study of 73 patients (35 males and 38 females) who underwent type I tympanoplasty at Samsung Medical Center from April to December 2014. The subjects were classified into two groups; endoscopic tympanoplasty (ET, n=25), microscopic tympanoplasty (MT, n=48). Demographic data, perforation size of tympanic membrane at preoperative state, pure tone audiometric results preoperatively and 3 months postoperatively, operation time, sequential postoperative pain scale (NRS-11), and graft success rate were evaluated.ResultsThe perforation size of the tympanic membrane in ET and MT group was 25.3%±11.7% and 20.1%±11.9%, respectively (P=0.074). Mean operation time of MT (88.9±28.5 minutes) was longer than that of the ET (68.2±22.1 minutes) with a statistical significance (P=0.002). External auditory canal (EAC) width was shorter in the ET group than in the MT group (P=0.011). However, EAC widening was not necessary in the ET group and was performed in 33.3% of patients in the MT group. Graft success rate in the ET and MT group were 100% and 95.8%, respectively; the values were not significantly different (P=0.304). Pre- and postoperative audiometric results including bone and air conduction thresholds and air-bone gap were not significantly different between the groups. In all groups, the postoperative air-bone gap was significantly improved compared to the preoperative air-bone gap. Immediate postoperative pain was similar between the groups. However, pain of 1 day after surgery was significantly less in the ET group.ConclusionWith endoscopic system, minimal invasive tympanoplasty can be possible with similar graft success rate and less pain.

Percutaneously assisted total hip (PATH) and Supercapsular percutaneously assisted total hip (SuperPATH) arthroplasty: learning curves and early outcomes.

A new family of micro-posterior approaches, percutaneously assisted total hip (PATH), SuperCapsular (SuperCap) and Supercapsular percutaneously assisted total hip (SuperPATH) allow preservation of the short external rotators. This study assesses early outcomes and learning curves of the PATH and SuperPATH approaches. Early outcomes of the first consecutive 49 PATH and 50 SuperPATH cases performed by a non-developer surgeon were evaluated. Analysis of variance (ANOVA) was used to compare age, body mass index (BMI), and pre-operative hemoglobin. Gender was compared using a Chi-square test. Clinical outcomes were compared using a nonparametric Wilcoxon test or a Chi-square test. Learning curves were assessed using operative time as a surrogate. Acetabular cup abduction and anteversion were compared using the first post-operative radiograph and a modified protractor. Both cohorts were similar with respect to diagnosis, gender, and BMI. Mean operative time in minutes was recorded for the PATH (114.5±17.5) and SuperPATH (101.7±18.3) cohorts (P value =0.0002). PATH operative time reached a plateau by case 40, but SuperPATH operative time continued to decrease by case 50. Transfusion rates were low in the PATH (4%) and SuperPATH (6%) cohorts. Mean length of stay (LOS) in days for the SuperPATH and PATH cohorts were 2.2 and 3.0, respectively (P value <0.0001). Complication rates were low in the SuperPATH (4.0%) and PATH (4.1%) cohorts. Acetabular cups in the SuperPATH cohort (anteversion: 23.5°±8.2°, abduction: 39.0°±8.4°) were significantly more anteverted (P value <0.0001) and less abducted (P value <0.05) than in the PATH cohort (anteversion: 13.1°±7.1°; abduction: 42.9°±7.6°). Early results demonstrate that the PATH and SuperPATH approaches can be adopted with minimal complications and outcomes consistent with innovator outcomes, even during the learning curve. The SuperPATH technique was associated with shorter operative time that continued to decrease, suggesting that proficiency continues to decrease beyond the first 50 cases. In this author's experience, acetabular cups implanted using the SuperPATH technique were more anteverted than those implanted using the PATH technique. Greater use of the transverse acetabular ligament to guide cup alignment reduced this effect.

Randomized comparative study of Ligasure versus conventional (Milligan-Morgan) hemorrhoidectomy

Objectives The objective of this study was to evaluate the two approaches for hemorrhoid surgery - Ligasure hemorrhoidectomy and conventional (Milligan-Morgan) hemorrhoidectomy - in terms of operative time and blood loss, as well as postoperative pain, bleeding, analgesic requirement, urinary retention, discharge, stenosis, fecal incontinence, wound healing, and patient satisfaction. Background To compare the surgical outcome of hemorrhoidectomy performed using Ligasure bipolar diathermy with conventional hemorrhoidectomy. Patients and methods Twenty patients with grade III or IV hemorrhoids were randomized equally to conventional hemorrhoidectomy (group 1) and Ligasure (group 2) hemorrhoidectomy. Operative details were recorded, and patients recorded daily pain scores on a linear analogue scale. Follow-up was weekly for 2 months and then monthly for 6 months to evaluate complications, return to normal activity, ongoing symptoms, and patient satisfaction. Results The mean reduced intraoperative blood loss (±SD) was 1.2 ± 1.6 ml (ranging from 0 to 5 ml) in the Ligasure group (group 2) versus 22.2 ± 6.58 ml (ranging from 15 to 35 ml) in the conventional group (group 1) (P = 0.0001). The mean operative time in minutes in the Ligasure group was 6.6 ± 4.3 (ranging from 5 to 10 min) versus 21.7 ± 4.3 in the conventional group (ranging from 15 to 26 min) (P Conclusion Ligasure is an effective instrument for hemorrhoidectomy, which results in lower volume of blood loss, less postoperative pain, quicker wound healing, and earlier return to work.

Robotic surgical education: A systematic approach to training urology residents to perform robotic-assisted laparoscopic radical prostatectomy

Objectives Robotic-assisted surgery using the da Vinci Surgical System is gaining popularity among urologists. However, training residents to use this system presents new challenges for surgical educators. We describe a method for training residents to perform robotic-assisted radical prostatectomy. Methods Residents first received da Vinci certification training followed by table-side assistance with a second attending urologist present to provide real-time instruction. After demonstrating proficiency with assistance, residents performed segments of robotic prostatectomies as the console surgeon. The procedure was divided into five steps: (a) bladder take-down, (b) endopelvic fascia and dorsal venous complex, (c) bladder neck and posterior dissection, (d) neurovascular bundles, and (e) urethral anastomosis. Performance was rated using an analog scale (0, very poor to 5, outstanding). The resident was allowed to proceed to the next step once proficiency (score greater than 3 of 5) had been demonstrated on three separate occasions. In addition, each procedure was digitally recorded and reviewed with the attending physician after the operation. Results Two chief residents underwent this training regimen. All 83 cases with surgical console involvement during a 7-month period were reviewed. The combined residents’ mean operative time in minutes and overall performance (score 0 of 5 to 5 of 5) for each step were recorded. Using logistic regression analysis, a statistically significant trend was seen, with faster operative times and greater analog scores over time for both residents ( P <0.005). Conclusions A systematic approach can be used to safely and effectively train urology residents to perform robotic radical prostatectomy using the da Vinci robotic system.