Minimal Intraoperative Complications Research Articles

Powered versus conventional endoscopic sinus surgery instruments in management of sinonasal polyposis

To conduct a prospective randomized controlled trial investigating the efficacy and safety of powered versus conventional endoscopic sinus surgery instruments in the management of sinonasal polyposis. Two hundred patients with sinonasal polyposis who failed conservative therapy were included in the study. They were equally randomized into powered and conventional instruments groups. A subjective visual analogue scale (VAS), endoscopic examination, saccharine clearance time and coronal CT were done preoperatively. Intraoperatively, the operative time, the surgical conditions and degrees of dryness of the operative field were carefully rated and recorded. Postoperatively, VAS, polyp grades, saccharine clearance time, the number of endoscopic debridement and time to mucosalization were recorded. Complications, smoothness of postoperative course were reported. Both groups experienced a significant improvement in the VAS with no statistically significant difference in symptom improvement between the two groups except for olfaction where there was significant improvement in the powered group. Similarly, the two groups demonstrated a significant improvement in the objective parameters including polyp grade and saccharine clearance time changes, but no significant difference between the two groups was found. The operative time as well as the surgical conditions and dryness of the operative field score were significantly better in the powered group. There was a tendency for improvement in the number of endoscopic debridement and time to mucosalization in powered group when compared to conventional instruments group, but this did not reach statistical significance. The incidence of postoperative synechiae was significantly lower in powered endoscopic group. Powered endoscopic sinus surgery offers a better therapeutic approach for patients with sinonasal polyposis when compared to endoscopic surgery with the conventional instruments. It provides a bloodless dry operative field with better visualization for a more precise, less traumatic procedure with minimal intraoperative complications and shorter operative time. Additionally, patients have a smoother postoperative course, less incidence of synechiae, with a tendency for a faster healing.

Vaginal-Assisted Laparoscopic Radical Hysterectomy: Rationale, Technique, Results

Total laparoscopic radical hysterectomy (TLRH) makes it difficult to resect adequate vaginal cuff according to tumor size and to avoid tumor spread after opening the vagina. Laparoscopic-assisted radical vaginal hysterectomy (LARVH) is associated with higher risk for urologic complications. The vaginal-assisted laparoscopic radical hysterectomy (VALRH) technique comprises 3 steps: (1) comprehensive laparoscopic staging, (2) creation of a tumoradapted vaginal cuff, and (3) laparoscopic transsection of parametria. We retrospectively analyzed data of 122 patients who underwent VALRH for early stage cervical cancer (n=110) or stage II endometrial cancer (n=12) between January 2007 and December 2009 at Charité University Berlin. All patients underwent VALRH without conversion. Mean operating time was 300 minutes, and mean blood loss was 123cc. On average, 36 lymph nodes were harvested. Intra- and postoperative complication rates were 0% and 13.1%, respectively. Resection was in sound margins in all patients. After median follow-up of 19 months, disease-free survival and overall survival for all 110 cervical cancer patients was 94% and 98%, and for the subgroup of patients (n=90) with tumors ≤pT1b1 N0 V0 L0/1 R0, 97% and 98%, respectively. VALRH is a valid alternative to abdominal radical hysterectomy and LARVH in patients with earlystage cervical cancer and endometrial cancer stage II with minimal intraoperative complications and identical oncologic outcomes.

LASIK Flap Creation With the Ziemer Femtosecond Laser in 787 Consecutive Eyes

To present the flap characteristics and short-term efficacy and safety of 787 consecutive LASIK procedures with the FEMTO LDV femtosecond laser (Ziemer Ophthalmic Systems) for the treatment of refractive errors. Seven hundred eighty-seven consecutive eyes of 405 previously non-operated patients were treated with the FEMTO LDV. Intended flap thickness was 110 microm and intended flap diameter varied from 8.5 to 9.5 mm. Refractive treatment was performed with the WaveLight ALLEGRETTO WAVE Concerto 500 Hz excimer laser. All eyes were wavefront-optimized. The mean flap thickness, measured by ultrasound pachymetry, was 90.0+/-5.5 microm (range: 67 to 107 microm) in right eyes and 90.1+/-4.6 microm (range: 77 to 106 microm) in left eyes. Mean flap diameter was 9.1+/-0.2 mm (range: 8.4 to 9.9 mm) in right eyes and 9.1+/-0.2 mm (range: 8.0 to 10.0 mm) in left eyes. Increasing flap thickness was correlated with increasing corneal thickness in right eyes and flatter keratometric value K(1) in left eyes. The most common complication was minor bleeding during the procedure (12.7%). All other complications were rare (8.4%), and none prevented further laser ablation. The Ziemer FEMTO LDV laser created thinner LASIK flaps than intended but with a low standard deviation and minimal intraoperative complications.

Renal Masses Herniating Into the Hilum: Technical Considerations of the “Ball-valve Phenomenon” During Nephron-sparing Surgery

To describe our technique to recognize and resect renal tumors "ball-valving" into the sinus. Partial nephrectomy (PN) offers a functional advantage over radical nephrectomy for many cases of localized renal cell carcinoma. However, PN is underutilized particularly in anatomically challenging cases. Often unrecognized is the tendency for central renal tumors to herniate into the renal sinus. From our prospective kidney cancer database, we identified 36 patients who underwent open, laparoscopic, or robotic PN for solitary localized renal cell carcinoma herniating into the renal sinus. Axial and reformatted radiographs were reviewed for all renal hilar lesions. Intraoperative techniques include hilar dissection, establishment of a sinus plane allowing tumor and parenchymal retraction, reduction of the tumor out of the sinus, resection, and repair. Mean preoperative lesion size was 3.8 cm. Indications for PN included 15 of 36 (42%) absolute, 13 of 36 (36%) relative, and 2 of 36 (6%) reoperative PN. No procedure was converted to radical nephrectomy. Of the 36 PN, 5 (14%) were performed using a minimally invasive approach and no minimally invasive surgery procedures were converted to open. No patient required renal replacement. Recognition of the tendency for hilar masses to herniate or "ball-valve" into the renal sinus is essential for effective PN of central tumors. By using our technique, we have demonstrated success in nephron-sparing surgery with minimal intraoperative complications and favorable postoperative outcomes in patients with central tumors herniating into the renal sinus.

Beyond Minimally Invasive Total Hip Surgery with the Anterior Approach

There has been controversy about the benefits of minimally invasive total hip arthroplasty. There cannot be any logical argument against any type of surgery performed with the least amount of soft tissue damage, be it muscles, nerves, blood vessels, or skin. The anterior approach through one or two short incisions and surgery through internervous planes seems to be the most logical. Our series of this approach with an incision as short as possible but as long as necessary has demonstrated its effectiveness in terms of few dislocations, thromboembolic events, minimal intraoperative complications, and minor transient nerve problems. With some modifications and standardization of the procedure, it should be reproducible and safe at other centers. Modular femoral components should make it even more effective.