Operative Complication Rate Research Articles

Exploring the impact of pupil expansion techniques on cataract surgery: unveiling key complications and clinical outcomes: a comparative analysis of 1266 eyes.

In cataract surgery, inadequate pupil dilation presents a major surgical challenge by narrowing the operation field and restricting visibility and movement. We aim to compare cataract surgery complication rates and clinical outcomes using different pupil expansion methods. This retrospective cohort study grouped patients according to four techniques of mechanical pupil expansion techniques: sphincterotomy (N = 339), iris stretching (N = 242), iris hooks (N = 391) and expansion rings (N = 294). Incidences and odds ratios for major complications and outcomes were compared between the groups. This single-center study included 1266 adult patients who underwent routine cataract surgery with mechanical pupil dilatation. The mean (± SD) age was 75.5 (± 13.0) years and 727 (57%) patients were male. The risk of pseudophakic cystoid macular edema (PCME) did not differ between the groups. Iris hooks were associated with the highest incidence of posterior capsular rupture (PCR) (3.3%) as compared to sphincterotomy, stretching and expansion rings (0.9%, 0.4% and 1.4%, respectively, P = 0.016). However, this effect was not supported by multivariable analysis. Zonular dialysis tended to be higher among eyes operated with iris hooks and pupil expansion rings, compared with iris stretching and sphincterotomy (2.0% and 1.7%, respectively, P = 0.058) and was found to be independently associated with a specific mechanical pupil expansion method on multivariable analysis (P = 0.050). No differences were observed for other complications, intraocular pressure or best-corrected visual acuity (VA) gain. Surgeon seniority was a significant protective factor from postoperative uveitis on multivariable analysis (P = 0.032). Our large cohort study found no difference between the groups regarding major complications or clinical outcomes, suggesting that all four methods may be equally safe. WHAT IS KNOWN : • In cataract surgery, inadequate pupil dilation presents a major surgical challenge by narrowing the operation field and restricting visibility and movement. • Different pupil dilation methods have been used, ranged from topical and intracameral mydriatics and visco-mydriasis to mechanical dilation maneuvers. • Four principal techniques of mechanical pupil expansion, including sphincterotomies, manual iris stretching, iris retracting hooks and pupil expansion rings, are available. • This single-center study included 1266 adult patients found no difference between the groups regarding major complications or clinical outcomes such as pseudophakic cystoid macular edema (PCME), posterior capsular rupture, zonular dialysis, intraocular pressure, uveitis or best-corrected visual acuity gain. • Surgeon seniority was a significant protective factor from postoperative uveitis.

Complication rates in cataract surgery before and during the COVID-19 pandemic.

To assess the cataract surgery (CS) complication rates before and during the COVID-19 pandemic. Retrospective, cross sectional study. Medical records of patients undergoing CS at two surgery centers in Winnipeg from January 2018 to April 2022 were reviewed. The study periods were pre-COVID-19 (January 1, 2018 to March 31, 2020) and COVID-19 (April 1, 2020 to April 30, 2022). Complication rates for endophthalmitis, sulcus-positioned intraocular lens (IOL) implant, anterior chamber IOL (ACIOL) implant, capsular tension ring (CTR) insertion, cumulative dissipated phacoemulsification energy (CDE), posterior capsular rupture (PCR), unplanned anterior vitrectomy, and return to the OR within one month of surgery were compared. 45,559 patients were included. Pre-COVID-19 rates were compared to COVID-19 rates and stated as per 100 cataract surgeries. Endophthalmitis rates increased from 0.008 to 0.028 (RR 0.27, p=0.09). Sulcus IOL implant rates increased from 0.61 to 1.00 (RR 0.61, p<0.0001). ACIOL implant rates increased from 0.53 to 0.68 (RR 0.78, p=0.05). CTR usage rates increased from 0.48 to 0.75 (RR 0.63, p=0.001). Average CDE increased from 4.6 to 6.7 (p=0.0030). PCR rates decreased from 0.49 to 0.38 (RR 1.3, p=0.14). Unplanned anterior vitrectomy rates decreased from 0.43 to 0.36 (RR 1.18, p=0.35). Return to OR rates remained unchanged at 0.59 and 0.58 (RR 1.01, p=0.93). Our study found significant increases in some CS complication rates when comparing the defined pre-COVID interval to the COVID interval.

Outcomes and Challenges of Transumbilical Single-Port Sleeve Gastrectomy: A Retrospective Analysis Based on Height and BMI.

Transumbilical single-port sleeve gastrectomy (SPSG) is a minimally invasive bariatric surgery that offers cosmetic benefits. However, the procedure's feasibility in patients with higher BMI or taller stature remains debated. This study evaluates the outcomes of SPSG based on patient height and BMI. We conducted a retrospective analysis of 753 patients who underwent stand-alone SPSG at our hospital between January 2021 and August 2024. Patients' preoperative characteristics, intraoperative data, and postoperative outcomes were collected. We compared operative times, complication rates, and postoperative length of stay between patients with different height and BMI categories. The mean operative time was significantly longer for patients with a height ≥ 1.8m (77.5 ± 32.5min) compared to those < 1.8m (63.1 ± 26.0min) (p < 0.05). Similarly, patients with a BMI ≥ 50kg/m2 had a longer operative time (79.2 ± 32.0min) than those with a BMI < 50kg/m2 (62.9 ± 25.9min) (p < 0.005). No significant difference was observed in the postoperative complications rate and length of stay between the height and BMI groups. The mean 1year percentage of total weight loss (%TWL) was 31.1 ± 7.1%. SPSG is a feasible procedure for patients with varying heights and BMIs, though it may require longer operative times for certain groups. The procedure's success hinges on the surgeon's expertise and a thorough understanding of patient anatomy. Further research is necessary to optimize single-port techniques and assess long-term outcomes.

GLP-1 Agonist Use Increases the Incidence of Adhesive Capsulitis and Odds of Requiring Operative Management in Type 2 Diabetes Patients: A Matched Propensity Score Analysis.

The incidence of adhesive capsulitis (AC) is higher in patients with diabetes mellitus. While AC is usually treated non-operatively, diabetic patients are more likely to require more extensive treatments such as manipulation under anesthesia (MUA) or arthroscopic capsular release. Despite the recent surge in popularity of GLP-1 agonists ("GLP-1s") for the treatment of type 2 diabetes (T2DM), there is a lack of literature describing the effect of GLP-1 use on the incidence and management of AC in patients with T2DM. We aimed to compare T2DM patients with and without GLP-1 use, and determine differences in rates of AC, rates of operative AC management, and rates of 90-day postoperative complications among operatively managed AC patients. A retrospective cohort analysis of the PearlDiver database from 2010-2022 was performed to identify T2DM patients with AC. Exclusion criteria included patients <18 years old, type 1 diabetes, <2-year follow-up, and medical conditions that were a contraindication for GLP-1 use. Four cohorts were identified: 1) T2DM taking GLP-1s, 2) T2DM not taking GLP-1s, 3) T2DM with AC taking GLP-1s, and 4) T2DM with AC not taking GLP-1s. The primary outcome was the proportion of T2DM patients who developed AC. Secondary outcomes included rates of operative management and 90-day postoperative medical complications. A 1:1 propensity score match was performed, controlling for age, gender, Charlson Comorbidity Index, obesity, tobacco use, hypothyroidism, metformin use, insulin use, and the presence of complicated diabetes. Chi-square and Multivariable Linear Regression analyses were performed. 100,000 T2DM patients taking GLP-1s, and 100,000 T2DM patients not taking GLP-1s were randomly sampled. After matching, GLP-1 patients were more likely to develop AC (odds ratio [OR]=1.28, p<0.001). 253,717 T2DM patients with AC were then identified, of which, 46,156 (18.2%) were taking GLP-1s. After matching, GLP-1 users had higher odds of requiring operative management for AC compared to non-GLP-1 users (OR=1.18, p<0.001). The odds of undergoing MUA were significantly higher among GLP-1 users (OR=1.20, p<0.001), however, there was no difference in the odds of undergoing capsular release (OR=0.68, p=0.29). Among a national cohort of T2DM patients, patients taking GLP-1 agonists had higher odds of developing AC and requiring operative management for AC when compared to those not taking GLP-1s. These results can be useful when counseling T2DM patients who develop AC while taking GLP-1s to better inform these patients of the increased chance of requiring more extensive treatment.

Minimum 24-Month Outcomes of Minimally Invasive Paratenon Protection Repair vs Open Giftbox Repair of Ruptured Achilles Tendon.

The paratenon has been shown to promote Achilles tendon healing, but the evidence supporting the role of paratenon protection technique in Achilles tendon repair is sparse. We retrospectively assessed the results of a paratenon-sparing repair technique vs an open giftbox repair of Achilles tendon ruptures. Patients with Achilles tendon rupture who underwent surgical treatment at our hospital between January 2015 and August 2021 were retrospectively reviewed. Among them, 61 patients underwent surgical repair using the minimally invasive paratenon protection technique (MI group) and 67 patients using the open repair giftbox technique (OR group). The postoperative rehabilitation protocol was identical in both groups. The operation time, complication rate, length and cross-sectional area (CSA) of Achilles tendon, shear wave elastography (SWE), CSA of the calf triceps muscle, isokinetic strength, Achilles tendon Total Rupture Score (ATRS), and the Victorian Institute of Sports Assessment-Achilles (VISA-A) score were compared between the 2 groups. The average follow-up time was 40.0 ± 10.2 months. The operation time and complication rate in the MI group were significantly lower than in the OR group (P < .001, P = .031). The ATRS score (P = .015), VISA-A score (P = .002), isokinetic strength (60 degrees/second: P = .006; 180 degrees/second: P = .036), SWE values (P = .007), and CSA of Achilles tendon (P = .043) in the MI group were significantly higher than the OR group. SWE values were significantly positively correlated with the ATRS score (r = 0.294, P < .001) and the VISA-A score (r = 0.304, P < .001). And a significant negative correlation was found between Achilles tendon extension length and peak torque (60 degrees/second: r = -0.309, P < .001; 180 degrees/second: r = -0.218, P = .013). Compared with the open repair giftbox technique, the minimally invasive paratenon protection technique was associated with likely marginally clinically significant improved clinical outcome scores, greater isokinetic strength, and better mechanical properties of the Achilles tendon.

Hemostatic effect of oxidized regenerated cellulose vs. topical tranexamic acid in total knee arthroplasty-a prospective randomized controlled trial.

This study compared the hemostatic effects and complications of oxidized regenerated cellulose (ORC) and topical TXA in total knee arthroplasty (TKA), thus providing a reference for the use of ORC as an alternative hemostatic agent to TXA in TKA. A total of 105 patients were included in this study and randomized into blank control, ORC, and TXA groups. The primary outcomes were total blood loss, hemoglobin drop (Hb drop), transfusion rates, and incidence of thrombosis. The secondary outcomes included operation time, tourniquet duration, coagulation parameters, inflammation markers, and complication rates. Total blood loss was 1,002.47 ± 308.58 ml and 964.68 ± 273.00 ml in the ORC and TXA groups, respectively, both significantly lower than that in the blank control group (1,168.94 ± 405.04 ml) (P 1 = 0.043 and P 2 = 0.014, respectively). Hb Drop was statistically insignificantly different between the ORC (36.03 ± 12.17 g/L) and TXA (34.32 ± 10.19 g/L) groups (P = 0.555). There was no statistically significant difference in transfusion rate, operation time, tourniquet duration, coagulation parameters, inflammation markers, and complication rates among the three groups. In conclusion, our prospective randomized controlled trial (RCT) highlights that, oxidized regenerated cellulose (ORC) can reduce postoperative invisible blood loss in total knee arthroplasty and achieve a hemostatic effect similar to topical tranexamic acid (TXA). This provides a safe and effective hemostatic option for patients with severe underlying diseases or contraindications to tranexamic acid. https://www.chictr.org.cn/bin/project/edit?pid=186370, identifier (ChiCTR2200066633).

The Impact of a Resident, Fellow, or Physician Assistant on Operative Time and Complication Rate in Closed Reduction and Percutaneous Pin Fixation of Pediatric Distal Humerus Supracondylar Fractures

We sought to compare operative times and complications for attending surgeons operating alone or with an assistant including an orthopedic resident, fellow, or physician assistant (PA) for closed reduction and percutaneous pinning (CRPP) of pediatric supracondylar humerus fractures (SCH), an archetypal procedure integral to the education of orthopedic trainees. Using a retrospective database collected following institutional review board approval, a 1-way ANOVA (non-parametric) was used to assess the effect of assistant absence or presence by type of assistant on mean operative time. We analyzed the association between the attending surgeon assistant categories and the complication rate using Fisher's Exact Test. The study was performed at Gillette Children's Specialty Healthcare, St. Paul, Minnesota, and Children's Minnesota in St. Paul and Minneapolis. These three affiliated metropolitan hospitals, the last of which is a level 1 trauma facility, all share the same group of orthopedic surgeons, trainees, and physician assistants. All patients under 14 years of age treated with CRPP for Gartland type 2, 3, 4 and flexion type closed supracondylar fractures between April 2006 and September 2016 were analyzed. Of 1053 patients identified by Current Procedure Terminology code 24358, data was available for 888 patients. Out of the 888 patients, 44.1% were operated on by a surgeon alone, 48.4% with a resident, 4.8% with a fellow and 2.6% with a physician assistant. The ANOVA revealed a statistically significant increase (p < 0.001) in operative times when a resident participated compared to the other categories. The shortest mean surgery time (34.7 minutes) occurred when an attending surgeon and PA were present. The longest mean time (44.3 minutes) occurred with a surgeon and resident. This difference, at 9.6 minutes, constituted 28% more time. There were 40 patients with a complication, a rate of 4.5%. The rate for each of the assistant categories was surgeon alone 5.6%, with a resident 3.3%, with a fellow 4.7%, with a PA 8.7%. The Fisher's Exact Test results showed no statistically significant association between the type or absence of assistant and the complication rate. Differences in operative times were observed across assistant categories although the mean time difference was statistically insignificant between the surgeon unassisted versus assisted by the fellow or a PA. The finding of statistically increased operative times with resident participation in this study for this specific procedure is consistent with results for most other reported orthopedic surgeries. Complication rates did not vary based on the participating personnel.

Pediatric Robotic-assisted Laparoscopic Pyeloplasty: Defining Mastery Over a 15Year Experience.

Robotic-assisted laparoscopic pyeloplasty (RALP) has been widely utilized within pediatric urology as RALP provides additional advantages to laparoscopic pyeloplasty including a more manageable learning curve. We aim to describe the maturation and mastery of pediatric RALP through our proposed trifecta of operative time, complication rates, and surgical success rates. We retrospectively reviewed 148 patients who underwent RALP between 2007 and 2022. Primary outcomes included operative time, Clavien-Dindo Grade (CDG) III complications, and surgical success rate. Patients were retrospectively divided into three cohorts (learning phase, competency phase, and mastery phase) based upon a cumulative sum (CUSUM) analysis of operative time. Three learning phases were differentiated at case 13 and case 41 per CUSUM analysis. Operative time significantly decreased from a mean of 261.33±42.52min in the learning phase to 140.61±25.87min in the mastery phase (p<0.001). CDG III complications were significantly different between phases as well, decreasing from 27.3% to 5.75% (p=0.045). Success rates were significantly different and increased from 83% in the learning phase to 98% in the mastery phase (p=0.015). Successful RALP implementation, and the achievement of surgical mastery, is multifaceted and multi-phasic. Our data suggests that learning is established within the first 12 cases and mastery and maximal outcomes are achieved after 41 cases. More specifically, operative time, complication rates, and success rates become increasingly optimized at each phase of learning. Our work can be used to establish clinical goals, design training curriculums, and inform patient counseling. Level III.

Total neoadjuvant therapy based on short-course radiotherapy versus standard long-course chemoradiotherapy for locally advanced rectal cancer: a systematic review and meta-analysis of randomized controlled trials.

We conducted the meta-analysis to compare the therapeutic effects of total neoadjuvant therapy (TNT) based on short-course radiotherapy followed by consolidation chemotherapy (SCRT/CCT) and long-course chemoradiotherapy (LCCRT) for locally advanced rectal cancer (LARC) according to certain significant randomized controlled trials (RCTs). The researchers retrieved several databases, including PubMed, Embase, Web of Science, and the Cochrane Library, to collect all the relevant literature published since the establishment of the databases until July 30, 2024, and then screened to determine the qualified literature and extracted the relevant information. Finally, RevMan 5.4 software was utilized to conduct the meta-analysis for determining the 95% confidence interval (CI) and pooled risk ratio (RR). There were 9 study indicators, including the pathologic complete remission (pCR) rate, tumor downstaging rate, R0 resection rate, sphincter preservation rate, disease-free survival (DFS), overall survival (OS), acute ≥3 grade toxicity rate, surgery complication rate, and distant recurrence rate. When moderate, even severe, heterogeneity was found, a random-effect model was applied; otherwise, a fixed-effect model was used for the analysis. A total of 6 eligible RCTs and 2259 participants were included in this meta-analysis. Compared with the standard LCCRT, TNT treatment on the basis of SCRT/CCT increased the pCR rate significantly [RR = 1.67, 95% CI (1.36, 2.04), P < 0.00001], especially in ≥ 4 cycles of the CCT arm [RR = 1.77, 95% CI: (1.41-2.23), p < 0.00001], and led to a similar tumor downstaging rate [RR = 0.99, 95% CI (0.85, 1.15), P = 0.92]. Moreover, survival outcomes, distant recurrence rate, and surgical indicators were comparable between the two groups. For LARC patients, the SCRT/CCT regimen not only has a higher pCR rate, equivalent OS, and comparable additional indicators versus standard LCCRT but also shortens the treatment time, costs less, and improves patients' adherence to the innovative anti-tumor therapy; hence, with the concept of acute toxicity control, it could be further widely and safely utilized, especially in resource-limited settings. https://www.crd.york.ac.uk/prospero/, identifier CRD42024600180.

Goal-directed fluid therapy on the postoperative complications of laparoscopic hepatobiliary or pancreatic surgery: An interventional comparative study.

Intraoperative fluid balance significantly affects patients' outcomes. Goal-directed fluid therapy (GDFT) has reduced the incidence of major postoperative complications by 20% for 30 days after open abdominal surgery. Little is known about GDFT during laparoscopic surgery. We investigated whether GDFT affects the postoperative outcomes in laparoscopic hepatobiliary or pancreatic surgery compared with conventional fluid management. This interventional comparative study with a historical control group was performed in the tertiary care center. Patients were allocated to one of two groups. The GDFT (n = 147) was recruited prospectively and the conventional group (n = 228) retrospectively. In the GDFT group, fluid management was guided by the stroke volume (SV) and cardiac index (CI), whereas it had been performed based on vital signs in the conventional group. Propensity score (PS) matching was performed to reduce selection bias (n = 147 in each group). Postoperative complications were evaluated as primary outcome measures. The amount of crystalloid used during surgery was less in the GDFT group than in the conventional group (5.1 ± 1.1 vs 6.3 ± 1.8 ml/kg/h, respectively; P <0.001), whereas the amount of colloid was comparable between the two groups. The overall proportion of patients who experienced any adverse events was 57.8% in the GDFT group and 70.1% in the conventional group (P = 0.038), of which the occurrence of pleural effusion was significantly lower in the GDFT group than in the conventional group (9.5% vs. 19.7%; P = 0.024). During the postoperative period, the proportion of patients admitted to the intensive care unit (ICU) was lower in the GDFT group than that in the conventional group after PS matching (4.1% vs 10.2%; P = 0.049). GDFT based on SV and CI resulted in a lower net fluid balance than conventional fluid therapy. The overall complication rate in laparoscopic hepatobiliary or pancreatic surgery decreased after GDFT, and the frequency of pleural effusion was the most affected.

Intraoperative complication rates in cataract surgery performed by women and men surgeons in a tertiary eye care centre in Hungary

AbstractPurposeThe aim of our study was to compare intraoperative complication rates in cataract surgeries performed by women and men surgeons and to analyse the possible impact of surgeon–patient gender difference on intraoperative complication rates in a tertiary eye care centre in Hungary.Materials/MethodsThis retrospective study looked at cases of cataract surgery involving phacoemulsification performed between January and December 2019. There were no exclusion criteria. In each case, patient demographics, patient clinical history, surgeon gender, case complexity, and operative details were reviewed. Primary outcomes included intraoperative complication rates.ResultsA total of 2,156 operations were included in the study, 1,295 (60.1%) of which were performed by men surgeons and 861 (39.9%) by women surgeons. The overall complication rate was 4.7% (n = 101). There was no significant difference (P = 0.728) in the intraoperative complication rate between the surgeries performed by women (n = 42, 4.9%) and men (n = 59, 4.6%) in either the simple (P = 0.214) or the complex (P = 0.508) cataract cases. Intraoperative complication rates were analysed in the two surgeon gender groups among both women and men patients. No significant difference was found in any of the compared groups.ConclusionsIntraoperative complication rates were similar in the surgeries performed by women and men specialists. Our study showed that neither surgeon–patient gender difference nor surgeon–patient gender concordance had a significant impact on complication rates during phacoemulsification cataract surgery.

Systematic review and meta-analysis of the pelvic organ prolapse and vaginal prolapse among the global population.

Pelvic organ prolapse (POP) occurs when one or more pelvic organs (uterus, bowel, bladder or top of the vagina) descend from their normal position and bulge into the vagina. Symptoms include pelvic discomfort, fullness, and changes in bladder or bowel function. Treatment ranges from conservative approaches to surgery, depending on symptom severity. Surgical methods include vaginal wall repair, with or without hysterectomy, or via laparoscopic, robotic or open techniques. Common complications include bleeding, infection, and urinary or bowel dysfunction. A systematic review was conducted, and a protocol was registered with PROSPERO (CRD42022346051). Publications from 30 April 1980 to 30 April 2023 were retrieved from multiple databases. Data were analysed using random-effects and common-effects models with subgroup and sensitivity analyses. Forty-four studies met the inclusion criteria, with 29 studies used for meta-analysis of vaginal prolapse surgery outcomes. Sixteen studies focused on patients who had undergone hysterectomy alongside prolapse repair. Patients who underwent vaginal prolapse surgery with hysterectomy experienced higher operative and postoperative complication rates than those without hysterectomy. Increased risks included hospital readmission, POP recurrence and re-operation. The review highlighted a lack of diversity in terms of ethnicity, age and comorbidity status, which are essential to fully understanding the impact of POP. Future research should focus on these underrepresented factors.

Comparison of suction technique and non-suction technique in retrograde intrarenal stone surgery: a systematic review and meta-analysis.

To evaluate the clinical efficacy of retrograde intrarenal stone surgery (RIRS) using the vacuum suction technique for the treatment of upper urinary calculi. A comprehensive literature search was conducted across multiple databases, including PubMed, Embase, Sino Med, CNKI, WANFANG DATA, and Cochrane. We included studies comparing vacuum suction RIRS with non-vacuum RIRS. Following the PRISMA guidelines, we performed a meta-analysis of the selected studies. Inclusion criteria were randomized controlled trials (RCTs), case-control studies, and retrospective studies evaluating the efficacy of these techniques. Key outcomes analyzed included operative time, hospitalization duration, stone-free rates, and complication rates. Statistical analyses were conducted using mean differences (MD) for continuous variables and odds ratios (OR) for dichotomous outcomes, with corresponding 95% confidence intervals (CI). Sixteen studies (6 RCTs, 1 case-control study, and 9 retrospective studies) involving a total of 2029 patients were included. Meta-analysis revealed that the vacuum suction technique significantly reduced operative time (MD = -14.45min, 95% CI [-18.45; -10.44], P < 0.00001) and hospital stay (MD = -0.54days, 95% CI [-0.80; -0.28], P < 0.00001). In addition, patients in the vacuum suction group had a higher stone-free rate (OR = 3.57, 95% CI [2.57; 4.95], P < 0.00001) and lower complication rates, particularly in reducing postoperative fever. The application of the vacuum suction technique in RIRS significantly improves clinical outcomes by reducing operative time and hospitalization duration, enhancing stone-free rates, and lowering postoperative complication rates. This technique demonstrates a clear clinical advantage over non-vacuum RIRS and should be considered a preferred option for the management of upper urinary tract stones.

Comparative Analysis of da Vinci® Xi and hinotori™ SRS Robot-Assisted Surgery Systems for Gynecologic Disorders: A Retrospective Study.

Background and Objectives: This study aims to evaluate and compare the safety and efficacy of the da Vinci® Xi and hinotori™ SRS robot-assisted surgical systems for gynecologic disorders. Materials and Methods: We conducted a retrospective study of 401 cases (43 benign uterine tumors; 88 pelvic organ prolapses; 270 low-risk endometrial cancers) of robot-assisted surgery performed at Kagoshima University Hospital between January 2017 and October 2024. Surgical factors such as the operative time, blood loss, and complication rates were analyzed and compared between the da Vinci® Xi (332 cases) and hinotori™ SRS (69 cases) systems. Complications were classified according to the Clavien-Dindo classification, with Grade 2 or higher considered significant. Results: Significant differences were observed between the two groups in terms of age, body mass index, cockpit/console time, and median time from roll-in to cockpit/console start. The cockpit/console time was significantly longer for the hinotori™ SRS system (173 min) compared to the da Vinci® Xi (156 min; p = 0.047). No significant differences were observed in the total operative time, blood loss, or length of hospital stay. Intraoperative complications were minimal, with one case of bladder injury and one case of vascular injury recorded for the da Vinci® Xi. The overall postoperative complication rate was approximately 4%. Conclusions: Robot-assisted surgery using both the da Vinci® Xi and hinotori™ SRS systems was found to be safe, with minimal blood loss and a low complication rate. The hinotori™ SRS system demonstrated operative outcomes comparable to those of the da Vinci Xi® system, suggesting that it may serve as a viable alternative. Further prospective studies are warranted to evaluate the efficacy and safety of these systems.

Renal Pelvis Urine Sampling in Patients with Obstructed, Infected Ureterolithiasis: A Retrospective Quality Improvement Initiative.

Purpose: Patients who present with urinary tract infections secondary to obstructing stones occasionally fail to improve on treatment based on midstream urine culture (MUSCx). Varying microbiomes between the bladder and the renal pelvis may account for this. In this study, we sought to investigate the utility of obtaining a renal pelvis urine culture (RPUCx) at the time of stenting to guide antibiotic treatment prior to definitive stone operation. Materials and Methods: RPUCx was obtained in 257 patients presenting with obstructive ureteral stones undergoing emergent stenting. Concordance rates of RPUCx to MUSCx and blood cultures were examined. Operative time and infectious complication rates after definitive stone management between the two groups were studied. A comparison of those who received an intraoperative RPUCx with those who did not was carried out. Results and Conclusions: RPUCx was obtained in patients undergoing emergent stenting from 2018 to -2021; 31% (52/168) of patients had pathogens in the renal pelvis that were absent in the MUSCx. RPUCx had a greater concordance rate with blood culture results compared with MUSCx (95% vs 50%). Drawing RPUCx intraoperatively did not significantly change operative time (15.9 vs 13.6 minutes, p = 0.15). Treatment tailored to RPUCx resulted in lower rates of post-stone management complications (odds ratio 0.26, 95% confidence interval = 0.08-0.83; p = 0.01). RPUCx at the time of stenting can guide treatment and decrease post-treatment complications without additional operative time, confirming utility in the treatment of patients with infection secondary to obstructing stones.

Application of CUSUM analysis in assessing learning curves in robot-assisted sacrocolpopexy performed by experienced gynecologist

BackgroundThe aim of this study was to assess the learning curve of robotic-assisted sacrocolpopexy by applying CUSUM analysis based on operation time, complication rate and conversion rate to open laparotomy.MethodsA retrospective study was conducted with 50 consecutive robotic-assisted sacrocolpopexy surgeries performed from June 2018 and June 2023 by a single experienced gynecologist. Baseline patient demographics, intraoperative parameters and postoperative outcomes were collected. Cumulative sum (CUSUM) of robotic-assisted sacrocolpopexy operation time was analyzed to determine breakpoints between learning phases using piecewise linear regression. This allowed the detection of subtle shifts in surgical parameters and ultimately surgeon proficiency and competency. Continuous variables, such as age, length of hospitalization and op time, were reported as mean (standard deviation). One-way analysis of variance was employed to compare continuous variables. Categorical variables were expressed as percentages and analyzed using the chi-square test.ResultsThe regression identified breakpoints at case 8.47 (95% CI 8.0, 9.0) and case 34.41 (95% CI 32.7, 36.1), with an R2 value of 0.87, which agrees with that of the second-order polynomial equation. The breakpoints were rounded to the next whole number at case 9 and 35. The Learning, Proficiency, and Competency phases consisted of 9, 26, and 15 cases, respectively in this consecutive series. This suggests that the surgeon achieved proficiency after the first 9 cases and competency after 35 cases. There were no intraoperative nor short-term post-operative complications during the span of this study. Furthermore, there were no conversions to open laparotomy. CUSUM analysis based on complication and conversion rate, therefore, was not available.ConclusionAccording to CUSUM analysis, surgical proficiency of robotic-assisted sacrocolpopexy was attained after the first 9 cases, and stabilization of operation time was achieved after 35 cases. This statistical tool has proven to be useful in objectively assessing learning curves for new surgical techniques, and the transition from laparoscopic sacrocolpopexy to robotic-assisted sacrocolpopexy seems achievable. This, however, may vary with each surgeon’s manual dexterity and experience level. Further investigation with several surgeons and institutions is needed to define a more accurate and generalized learning curve of robotic-assisted sacrocolpopexy.

Corpus callosotomy for intractable epilepsy: a contemporary series of operative factors and the overall complication rate.

Corpus callosotomy is an effective treatment for atonic seizures in patients with medically refractory epilepsy. A large modern series of corpus callosotomies performed via open craniotomy highlights the importance of establishing contemporary complication rates for this operation as a benchmark for comparison with newer methodologies. The authors' study, therefore, examined operative factors and complication rates for a sample of patients who underwent open microsurgical craniotomy for corpus callosotomy to determine current metrics regarding safety and effectiveness for this procedure. The authors retrospectively reviewed institutional data for patients who underwent first-time open callosotomy from 2005 to 2022. Demographic and clinical variables were collected and analyzed with a focus on operative factors and complication rates. A total of 105 patients were included in the study (mean [range] age 9.39 [0.67-24.17] years); 58.1% (n = 61) were male. One surgeon performed a majority of the operations (n = 80 [76.20%]); 2 other surgeons performed the remaining surgical procedures (21.9% and 1.90%, respectively). In total, 66 complete, 38 subtotal (anterior 70%-99%), and 1 posterior (40%) callosotomies were performed. Blood loss was available for 102 (97.1%) patients (mean [range] 96.67 [10-500] ml). The mean [range] operative time was calculated as 226.76 (45-386) minutes in 76 (72.4%) patients by excluding those patients who underwent concurrent vagal nerve stimulator placement or revision. The operative complication rate was determined to be 6.7% and was comprised of 3 cases of transient pseudomeningocele, 3 wound infections, and 1 delayed intraparenchymal hemorrhage. No venous infarcts were observed on postoperative MRI. This is the largest single-center series of open callosotomy patients thus far in the literature and describes important updated metrics to help evaluate new techniques being developed for the surgical treatment of atonic seizures in medically intractable epilepsy.

The Relationship Between Hospital Safety-Net Burden on Outcomes for High-Volume Thyroid Cancer Surgeons.

Background: Higher center and surgeon volume correspond to better outcomes for patients with thyroid cancer. This study aims to investigate how a hospital's safety-net burden, the proportion of a hospital's patients who are insured by state Medicaid plans or are uninsured, influences the outcomes of high-volume (HV) surgeons. Methods: We performed a retrospective cohort study of all patients who underwent surgery for thyroid cancer in California from 1999 to 2017. We stratified treating facilities by the proportion of Medicaid-type and indigent payors into safety-net burden quartiles. We compared the perioperative and oncologic outcomes of HV surgeons (annual case volume ≥10) for patients undergoing total thyroidectomy across safety-net burden quartiles. A mixed-effects regression model controlled for surgeon random effects and fixed effects of patient and tumor characteristics. Results: Our sample comprised 42,347 patients (78% female, median age 50), of whom 13,848 (32%) were treated by HV surgeons (n = 276). Compared to patients of lower-volume surgeons, patients of HV surgeons were more likely to be White, from the upper quartiles of socioeconomic status and well insured (all p < 0.001). HV surgeons in each hospital's safety-net burden quartile displayed similar case number distributions. Compared to patients treated by HV surgeons at Q1 (lowest safety-net burden) hospitals, those treated by HV surgeons at Q4 (highest safety-net burden) hospitals had higher absolute risks of endocrine complications (+7%, p = 0.007), airway complications (+6%, p = 0.004), disease-specific mortality (+1.3%, p = 0.046), and all-cause mortality during the study period (+3%, p = 0.046) in multivariable analysis. Conclusion: The performance of HV thyroid cancer surgeons differs by a hospital's safety-net burden, with patients treated at high safety-net burden hospitals experiencing higher rates of operative complications, disease-specific mortality, and all-cause mortality. Having a HV surgeon alone may be insufficient to provide optimal short- and long-term outcomes for patients with thyroid cancer.

Application of 5G Remote Robotic-Assisted Laparoscopy in Urological Surgery: A Small Sample Analysis

ObjectiveTo evaluate the practical application and clinical safety of 5G remote robotics in urological surgery. MethodsWe conducted a comprehensive analysis of 14 cases of 5G remote domestic robot-assisted laparoscopic urological surgeries performed at our center from May 2023 to June 2024. Clinical data and network information were collected, and metrics such as operative time, blood loss, and complication rate were analyzed. We assessed the stability, accuracy, and safety of remote operations, as well as the acceptance and satisfaction of both doctors and patients with this technology. ResultsThe 14 surgeries conducted at our center involved a master-slave distance of 52 kilometers, with an average operative time of 83.3 minutes, an average blood loss of 23 milliliters, a conversion-to-open-surgery rate of 0%, and no complications. During the surgeries, the 5G remote robotic system functioned stably, with a clear field of vision, an average download speed of 216.5 Mbps, an average upload speed of 86.6 Mbps, an average maximum latency of 129.3 ms, an average minimum latency of 20.7 ms, and a packet loss rate of 0%. These results indicate that the system can provide a highly accurate operational view and effective transfer of surgical skills. Both doctors and patients expressed general satisfaction with this technology, recognizing its significant contribution to the safety and effectiveness of the surgery. ConclusionThe 5G remote robot-assisted laparoscopic urological surgeries conducted at our center demonstrate that combining 5G technology with robotic ensures the stability, real-time performance, and safety of remote surgeries.

Improved clinical and radiographic outcomes with expandable cages in transforaminal lumbar interbody fusion: a propensity-matched cohort analysis.

The restoration of sufficient overall lumbar lordosis (LL) and segmental LL (SL) is associated with achieving optimal sagittal balance, decreasing back pain, and enhancing functional outcomes for patients. Expandable cages were developed in hopes of improving radiographic parameters and clinical outcomes, although current clinical evidence is inconclusive. Here, the authors aimed to evaluate the clinical and radiographic outcomes in patients undergoing one- or two-level open transforaminal lumbar interbody fusion (TLIF) with expandable versus static cage placement, using propensity-matched cohorts. An institutional retrospective cohort of patients who underwent one- or two-level open TLIF with either expandable cage or static cage placement was identified. Using relevant preoperative covariates, including age, primary versus revision operation, number of cages implanted, and surgical level implanted, the authors built propensity-matched cohorts. They identified clinical outcomes in both cohorts, including operative characteristics and complication rates, along with pain, weakness, and sensory deficits over follow-up. Furthermore, they extracted and examined preoperative, postoperative, and last follow-up radiographic parameters. A total of 148 patients were included, and they were followed for a mean of 1.7 years (range 0.5-4.3 years). Propensity matching was used to create cohorts of patients who were similar with respect to age, surgical indication, revision status, number of cages implanted, surgical level implanted, and length of follow-up. Patients in both groups had similar preoperative radiographic parameters. Patients with expandable cages saw larger increases in SL, both postoperatively (5.3° ± 7.5° vs 1.6° ± 5.6°, p = 0.006) and at last follow-up (5.7° ± 7.4° vs 1.0° ± 6.1°, p = 0.003). They also saw significant improvements in pelvic incidence minus LL mismatch at last follow-up (-4.4° ± 13.2° vs 5.8° ± 13.8°, p = 0.009). No differences in intraoperative or perioperative complications were found, but patients with expandable cages were less likely to require readmission, develop adjacent-segment disease, or require revision surgery. They were also more likely to be symptom free at 1 month after surgery and at last follow-up. Expandable cages lead to better restoration of radiographic features, including SL and improvements in clinical outcomes, compared with static cages in propensity-matched cohorts in patients undergoing one- or two-level open TLIFs.