Operative Procedure Time Research Articles

Use of the tabbed expander in latissimus dorsi breast reconstruction

Latissimus dorsi (LD) myocutaneous flap breast reconstruction with a tissue expander/implant is a post-mastectomy option often used as a salvage procedure for a failed tissue expander (TE). The patient is traditionally placed in the lateral decubitus position for flap dissection and is re-prepped and re-draped in the supine position for placement of the tissue expander. A new generation of anatomically-shaped, tabbed tissue expanders are increasingly being used in place of traditional untabbed expanders. The innovative suture tabs allow for more predictable and controlled expander placement while the patient is in the lateral decubitus position, eliminating the need to reposition the patient intraoperatively. The objective of this study was to evaluate the use of tabbed tissue expanders in latissimus dorsi breast reconstruction, with respect to total operative time, complication rates, and aesthetic outcomes. The outcomes of 34 LD breast reconstruction procedures with tissue expanders were evaluated. Eight patients received tabbed tissue expanders with no position change, while 26 patients underwent an intraoperative position change. Demographic information, total operative time, and follow-up complication data were collected. Aesthetic outcomes were evaluated by three blinded individuals using a validated scoring scale. The mean operative time for procedures with no position change was 107 minutes. The mean operative time for position change cohort was 207 minutes. There was no statistical difference in complication rates or aesthetic outcomes between the two groups. In conclusion, tabbed tissue expanders decrease operative time by eliminating the need for an intraoperative position change without influencing complication rates while maintaining equivalent aesthetic outcomes.

Natural orifice specimen extraction in laparoscopic colorectal surgery: transanal and transvaginal approaches

This study was designed to evaluate the outcomes of patients who underwent various laparoscopic colorectal procedures with natural orifice specimen extraction (NOSE) at our institute over a 20-year period. Specifically, the study aimed to investigate whether transanal and transvaginal approaches are safe and effective alternatives for extracting the specimen during laparoscopic colorectal surgeries. We analyzed a prospectively designed database of a consecutive series of patients who underwent various laparoscopic colorectal surgeries for different rectal pathologies between April 1991 and May 2011 at the Texas Endosurgery Institute. The selection criteria for the NOSE approach were based on disease entities, site and size of tumors, and distance of colorectal lesions from the anal verge. A total of 303 patients underwent laparoscopic colorectal procedures with the NOSE approach for specimen extraction, including 277 transanal and 26 transvaginal extractions. The operative time for procedures with transanal specimen extraction was 164.7 ± 47.5 min, the estimated blood loss was 87.5 ± 46.7 ml, and the rate of postoperative complications was 3.6 %. For laparoscopic right hemicolectomy with transvaginal specimen extraction, the operative time was 159 ± 27.1 min and the estimated blood loss was 83.5 ± 14.4 ml. Intraoperatively, transvaginal extraction was associated with 2 complications (7.7 %); however, this procedure was not associated with any postoperative complications. The length of hospital stay was 6.9 ± 2.8 and 5.5 ± 2.5 days for patients who underwent transanal extraction and transvaginal extraction, respectively. Both transanal and transvaginal specimen extractions in laparoscopic colorectal surgeries are safe and effective approaches with comparable postoperative complication rates. In comparison with transanal specimen extraction, transvaginal extraction is more complicated due to the anatomy of the pouch of Douglas. The transvaginal approach thus needs more effective extraction devices for preventing injury to adjacent organs, especially the sigmoid colon and rectum.

Relationship between Timing of Emergency Procedures and Limb Amputation in Patients with Open Tibia Fracture in the United States, 2003 to 2009

The authors aimed to characterize patterns in the timing of initial emergency procedures for patients with open tibia fracture and examine the relationship between initial procedure timing and in-hospital amputation. Data were analyzed from the Nationwide Inpatient Sample, 2003 to 2009. Adult patients were included if they had a primary diagnosis code of open tibia fracture. Patients were excluded for the following reasons: they were transferred from or to another hospital, an immediate amputation was performed, more than one amputation was performed, no emergency procedure was documented, or they were treated at a facility that did not perform any amputations. The authors evaluated the association between timing of the first procedure and the outcome of amputation using multiple logistic regression, controlled for patient risk factors and hospital characteristics. Of 7560 patients included in the analysis, 1.3 percent (n=99 patients) underwent amputation on hospital day 2 or later. The majority (52.6 percent) underwent the first operative procedure on day 0 or 1. In adjusted analyses, timing of the first operative procedure beyond the day of admission was associated with more than three times greater odds of amputation (day 1, odds ratio, 3.81; 95 percent CI, 1.80 to 8.07). Delay of the first operative procedure beyond the day of admission appears to be associated with a significantly increased probability of amputation in patients with open tibia fracture. All practitioners involved in the management of these patients should seek a solution for any barrier, other than medical stability of the patient, to achieving early operative intervention. Risk, II.

Cordotomy by Coblation in Bilateral Vocal Fold Immobility

Objective: 1) Understand the presentation, etiology, and management of bilateral vocal fold immobility. 2) Understand the utility, technique, and advantage of endoscopic coblation vocal cordotomy for patients with bilateral vocal fold immobility. 3) Compare the use of the laryngeal coblator with the laser. Method: Case series using endoscopic coblation to perform vocal cordotomy in patients with bilateral vocal fold immobility is presented. Seven patients underwent suspension microlaryngoscopy with either initial or revision vocal cordotomy with or without partial arytenoidectomy. Routine follow-up was performed and wound healing was documented via distal chip videolaryngoscopy. Results: Seven patients underwent suspension microlaryngoscopy with vocal cordotomy as part of airway management for bilateral vocal fold immobility. The laryngeal coblator was used to perform a transverse cordotomy. The procedure was completed in approximately 5 minutes. No laser protection is required reducing operative set-up and procedure time versus the laser. Two patients had a prior tracheotomy. No patients required a tracheotomy with this procedure. Patients were seen between 1 day and 1 month postoperatively. Patients had minimal granulation tissue at the cordotomy site and appeared to have quicker healing. The glottic airway and stridor were improved in all patients. Conclusion: Initial outcomes of endoscopic coblation vocal cordotomy reveal this technique to be safe and efficient. Coblation increased the glottic airway with minimal granulation tissue and rapid healing. This represents the first described use of coblation for bilateral vocal fold immobility. Long-term data will be forthcoming.

Subtle changes in renal function are associated with differences in late survival following adult cardiac surgery

To determine the predictors of post-operative renal function following adult cardiac surgery, and to assess the influence of this on late survival. Prospectively collected data were analysed on 8032 patients who underwent coronary artery bypass grafting, valve surgery or combined procedures from 1 January 1998 until 31 December 2008, who did not require preoperative renal replacement therapy. The estimated glomerular filtration rate (eGFR) was calculated by the Modification of Diet in Renal Disease formula accounting for ethnicity pre-operatively, post-operatively on the fourth post-operative day, and the post-operative nadir based upon the peak post-operative creatinine within 30 days of surgery. Late survival data were obtained from the UK Central Cardiac Audit Database (CCAD). Appropriate frailty analyses were conducted in R and model fit was compared using Aikaike's Information Criterion. Initial analysis intended to determine predictors of post-operative renal function including pre-operative eGFR, EuroSCORE and surgical procedure including the operative procedure and bypass time. Further analysis examined its influence on late survival. Median follow-up was 72 months (IQR 48-105) during which there were 904 late deaths. The most powerful predictor of the day 4 eGFR was the pre-operative eGFR but other factors contributed including increasing EuroSCORE and bypass time. The pre-operative eGFR was shown to be a strong and independent predictor of late outcome (P = 0.0001, HR 0.497 95%CI 0.434-564); however, model fit was significantly improved using the day 4 eGFR (P = 0.0001, HR 0.43 95%CI 0.385-0.482). No specific change in individual renal function was identified as a predictor of adverse late survival, and neither the pre-operative nor day 4 eGFR was predictive of the nadir of renal function. Subtle early changes in renal function at the time of surgery are powerful predictors of adverse late outcome and can be predicted by pre-operative renal function.

Infections in Surgery of Primary Tumors of the Sacrum

Retrospective case series. To evaluate the risk of infection, related treatment, and outcome after surgery of the 2 most common primary sacral tumors. Rarity of sacral tumors has limited the number of population-based studies. Treatment depends on malignancy or local aggressiveness: wide resection is indicated for malignant lesions, intralesional surgery for benign. We studied 82 patients with sacral chordomas (55 cases) or giant cell tumor (GCT) (27 cases) treated between 1976 and 2005. All patients had IV antibiotic therapy with amikacin and teicoplanin. Surgery of chordoma was resection; surgery of GCT was intralesional excision. Infections were classified as immediate postoperative, early (within 6 months), and late (more than 6 months from surgery). Mean follow-up was 9.5 years (range: 3-27 years). Some factors possibly influencing the risk of infection were statistically analyzed by Kaplan Meier curves and log-rank test. No deep infections were observed in the GCT series. Three patients with sacral chordoma died for postoperative complications and were excluded from this analysis. Of the remaining 52 patients with chordoma, 23/52 had deep wound infection (44%) that required 1 or more surgical debridements combined with antibiotics, according to cultures. In 16 patients (70%), infection occurred within 4 weeks postoperatively, and in 7 within 6 months. Most frequent bacteria were Enterococcus (23%), Escherichia coli (20%), and Pseudomonas aeruginosa (18%). In 74% of cases, infection was multimicrobial. Level of resection, previous intralesional treatment elsewhere, tumor volume, and age did not statistically influence risk of infection. Type of surgery was the prominent factor related to a major risk of infection. Operating procedure time correlated as well. Resections of sacral chordoma imply a high risk of deep infection, while intralesional excision of GCT does not. All infections healed with surgical debridements and antibiotic therapy.

Selective approach to radionuclide-guided sentinel lymph node biopsy in high-risk ductal carcinoma in situ of the breast

Ductal carcinoma in situ (DCIS) currently represents approximately 15-25% of all breast cancers detected. Although inherently a noninvasive disease, occult invasive disease can be found at definitive histology. The role of sentinel lymph node (SLN) biopsy in DCIS is still unclear. The aim of this study was to evaluate the clinical usefulness of SLN biopsy and the incidence of SLN metastases in selected patients with high-risk DCIS, who are at highest risk for being upstaged to invasive carcinoma. Twenty-three high-risk patients with DCIS proven on core biopsy (mean age, 50 years; median age, 48 years; age range, 37-78 years) were included in the study. SLN scintigraphy was performed 2-4 h before surgery by injecting Tc-99m-labeled nanocolloid intradermally in the periareolar region. The first lymph node to appear on the scan was labeled as SLN and was marked on the skin by using a γ probe. The lymph node was explored in the axilla using a γ probe. The SLN was identified in all patients (100% success rate). Of 23 cases of DCIS on core biopsy, seven patients (30%) were shown to have invasive ductal carcinoma on final histological specimen. Among these seven patients, three had minimal invasive carcinoma (<1 cm) and none of these patients had positive SLN for metastases. Among 23 cases, only one patient with (4%) SLN was positive for metastasis despite histopathological diagnosis of pure DCIS. Although the study population is small, our findings suggest that patients with high-risk DCIS have an increased risk of invasive disease, as approximately one-third of these patients had invasive component at the time of definitive operative procedure. Furthermore, the study also suggests that SLNB appears to be reliable in identifying axillary lymph nodes status of these patients.

Assessing Trainee Impact on Operative Time for Common General Surgical Procedures in ACS-NSQIP

To examine the effect of surgical trainee involvement on operative time for common surgical procedures. Laparoscopic appendectomy, laparoscopic cholecystectomy, and open inguinal hernia repair comprise 17.7% of the total cases sampled in the American College of Surgeons National Surgical Quality Improvement Program (ACS-NSQIP) database. These cases are commonly performed by residents at varying levels of surgical training. A cross-sectional study was performed using American College of Surgeons National Surgical Quality Improvement Program data from 2005 through 2008 selecting patients undergoing laparoscopic appendectomy, laparoscopic cholecystectomy, and open inguinal hernia repair. The primary outcome was operative time and predictive variables were resident involvement and training level. Linear regression analysis was used to compare operative times between cases performed by an attending alone and those assisted by junior (postgraduate year 1-2) or senior (postgraduate year 3-5) trainees, adjusting for patient and operative factors. A total of 115,535 surgical cases were included, with 65,364 (59%) performed with junior or senior surgical residents. Resident participation was associated with higher operative times with no significant differences between the junior and senior cohorts; this effect persisted after controlling for potential confounding factors. Operative time increased by 16.6 minutes (95% confidence interval, 16.2-17.0) for junior residents and also by 16.6 minutes (95% confidence interval, 16.2-16.9) for senior residents. Surgical trainees' participation in common surgical procedures is associated with an increase in total operative time, with no difference between trainee seniority levels. This finding may be significant in assessing the impact of residency training programs on hospital efficiency.

Revision Surgery for Incidentally Detected Early Gallbladder Cancer in Laparoscopic Era

Incidentally detected early gallbladder cancer (IDEGB) is an early carcinoma first diagnosed on microscopic examination after a cholecystectomy for symptomatic benign gallbladder disease. After diagnosis of IDEGB it is often necessary a completion of treatment by a second tailored revision procedure. Despite early reports contraindicating laparoscopic approach because of high risk of neoplastic seeding, recent data seem to demonstrate that this approach per se does not influence clinical outcomes. We refer our experience in revision surgery by a totally laparoscopic approach that includes hepatic resection, lymphadenectomy, and port-sites excision. From January 2006 to March 2008, four patients with IDEGB were carried out to revision procedure by a totally laparoscopic approach. The mean operative time of procedure has been 162 minutes, whereas blood loss has been <100 mL (mean 85.1±23.3 mL). The postoperative course has been uneventful in all patients and perioperative mortality (within 40 days from intervention) 0. Hospital stay has been, respectively, 4, 5, 5, and 6 days (mean 5 days). During follow-up, at the last fluorine-18-labeled fluordesoxyglucose-positron emission tomography (FDG-PET) scan examination, respectively, 4, 3, and--for 2 patients--2 years after revision laparoscopic procedure, pathologic FDG accumulation was not reported. Totally laparoscopic revision surgery for IDEGC seems to be a legitimate procedure, and, in our experience, reports satisfactory clinical outcomes in terms of perioperative and middle term oncological results. Larger and prospective studies are needed to support definitively oncological safety of this approach.

Perioperative, functional and oncological outcomes after open and minimally invasive prostate cancer surgery: experience from Australasia

• To systematically review the current literature concerning perioperative, functional and oncological outcomes reported after open and minimally invasive prostate cancer surgery specifically from institutions within Australasia. • Four electronic databases were searched to identify studies reporting outcome after open and minimally invasive prostate cancer surgery. Studies were sought using the search term 'radical prostatectomy'. • In all, 11,378 articles were retrieved. For the purpose of this review, data were only extracted from studies reporting Australasian experience. • A total of 28 studies met final inclusion criteria. • Overall, the data are limited by the low methodological quality of available studies. • Only two comparative studies evaluating open radical prostatectomy (ORP) and robotic-assisted laparoscopic RP (RALP) were identified, both non-randomized. • The mean blood loss, catheterization time and hospital stay was shorter after RALP than with ORP. In contrast, mean operative procedure time was significantly longer for RALP. • Overall adverse event rates were similar for the different surgical approaches although the rate of bladder neck stricture was significantly higher after open RP. • Incorporation of patient outcomes achieved by surgeons still within their learning curve resulted in a trend towards higher positive surgical margin rates and lower continence scores after RALP. However, there was equivalence once the surgeons' learning curve was overcome. Given the limited follow-up for RALP and laparoscopic RP (14.7 and 6 months vs 43.8 months for ORP) and the lack of data concerning erectile function status, comparison of biochemical failure and potency was not possible. • Few comparative data are available from Australasia concerning open and minimally invasive prostate cancer surgery. • While perioperative outcomes appear to favour minimally invasive approaches, further comparative assessment of functional and long-term oncological efficacy for the different surgical approaches is required to better define the role of minimally invasive approaches.

Total laparoscopic hysterectomy versus da Vinci robotic hysterectomy: is using the robot beneficial?

ObjectiveTo compare the outcomes of total laparoscopic to robotic approach for hysterectomy and all indicated procedures after controlling for surgeon and other confounding factors.MethodsRetrospective chart review of all consecutive cases of total laparoscopic and da Vinci robotic hysterectomies between August 2007 and July 2009 by two gynecologic oncology surgeons. Our primary outcome measure was operative procedure time. Secondary measures included complications, conversion to laparotomy, estimated blood loss and length of hospital stay. A mixed model with a random intercept was applied to control for surgeon and other confounders. Wilcoxon rank-sum, chi-square and Fisher's exact tests were used for the statistical analysis.ResultsThe 124 patients included in the study consisted of 77 total laparoscopic hysterectomies and 47 robotic hysterectomies. Both groups had similar baseline characteristics, indications for surgery and additional procedures performed. The difference between the mean operative procedure time for the total laparoscopic hysterectomy group (111.4 minutes) and the robotic hysterectomy group (150.8 minutes) was statistically significant (p=0.0001) despite the fact that the specimens obtained in the total laparoscopic hysterectomy group were significantly larger (125 g vs. 94 g, p=0.002). The robotic hysterectomy group had statistically less estimated blood loss than the total laparoscopic hysterectomy group (131.5 mL vs. 207.7 mL, p=0.0105) however no patients required a blood transfusion in either group. Both groups had a comparable rate of conversion to laparotomy, intraoperative complications, and length of hospital stay.ConclusionTotal laparoscopic hysterectomy can be performed safely and in less operative time compared to robotic hysterectomy when performed by trained surgeons.

Laparoscopic liver resection for hepatocellular adenoma.

To investigate the role of laparoscopy in the surgical management of hepatocellular adenoma (HA). We reviewed a prospectively collected database of consecutive patients undergoing laparoscopic liver resection for HA. Thirteen patients underwent fifteen pure laparoscopic liver resections for HA (male/female: 3/10; median age 42 years, range 22-72 years). Two patients with liver adenomatosis required two different laparoscopic operations for ruptured adenomas. Indications for surgery were: symptoms in 12 cases, need to rule out malignancy in 2 cases and preoperative diagnosis of large HA in one case. Symptoms were related to bleeding in 10 cases, sepsis due to liver abscess following embolization of HA in one case and mass effect in one case (shoulder tip pain). Five cases with ruptured bleeding adenoma required emergency admission and treatment with selective arterial embolization. Laparoscopic liver resection was then semi-electively performed. Eight patients (62%) required major hepatectomy [right hepatectomy (n = 5), left hepatectomy (n = 3)]. No conversion to open surgery occurred. The median operative time for pure laparoscopic procedures was 270 min (range 135-360 min). The median size of the excised lesions was 85 mm (range 25-180 mm). One patient with adenomatosis developed postoperative bleeding requiring embolization. Mortality was nil. The median hospital stay was 4 d (range 1-18 d) with a median high dependency unit stay of 1 d (range 0-7 d). The laparoscopic approach represents a safe option for the management of HA in a semi-elective setting and when major hepatectomy is required.

Does Arterialisation Time Influence Biliary Tract Complications After Orthotopic Liver Transplantation?

Background In the cardiac death donor era, many reports deal with biliary tract complications and concerns about ischemic reperfusion injury owing to the exclusive arterial vascularization of the biliary tree, the warm ischemia time has been implicated as responsible for biliary lesions during organ procurement. We defined the arterialization time as the second warm ischemia time. Our purpose was to study the correlation between the arterialization time during liver implantation and the appearance of biliary lesions. Methods We retrospectively collected data from the last 5-years of orthotopic liver transplantation: namely, indications, cold perfusion fluid, cold ischemia time, operative procedure times, and acute rejection events. We excluded split-liver transplantations, retransplantations, pediatric patients, transplantations for cholestatic disease, cases where hepatic artery thrombosis happened before biliary complications, or patients with posttransplant cytomegalovirus infection. We defined 2 groups: A) without biliary complications; and B) with biliary complications. We compared the mean arterialization time using Student t test to define whether the warm ischemic time during implantation was responsible for biliary tract complications. A P value of <.05 was considered to be significant. Results Between 2004 and the end of 2008, we grafted 402 patients among whom 243 met the inclusion criteria: 198 in group A and 45 in group B. Only the cold ischemia time was significantly different between the 2 groups ( P = .039). Conclusion After the anhepatic time, the surgeon may take time for the arterial anastomosis without fearing increased biliary damage.

Outcome of repeated stapler haemorrhoidopexy for recurrent prolapsing haemorrhoids

Stapled haemorrhoidopexy (SH) is associated with minor postoperative pain and high overall satisfaction rates. Some patients will have persistent or recurrent symptoms requiring re-intervention. All patients who underwent SH for grade III internal haemorrhoids and required a second SH (2005-2008) were studied. Grade IV patients were excluded. Data on surgical technique, postoperative pain, complications, time to first bowel movement, functional recovery and suspected reason for first SH failure were retrieved from medical records. Similar data were collected for the second procedure at four postoperative follow-up visits. Twelve patients were enrolled. The mean time to recurrent symptoms was 15 months. The indications for repeated surgery were bleeding, prolapse, and pruritus w/wo discharge. Recurrence was attributed to a too high staple line in the first procedure (n = 4) and an incomplete resected ring (n = 1). The median operative time of the second procedure was 24 min (17-29) and the median follow up was 20 ± 4.3 months (15-30). Repeat SH was associated with higher pain scores, more analgesic requirements, and longer recovery period compared to the first procedure. There were no early or late postoperative complications. Histological examination of the 12 tissue doughnuts resected during the second SH showed no smooth muscle fibres in any of the patients. After 12 months of follow up, 10 patients with repeated SH remained asymptomatic, while 2 had recurrent bleeding. Repeat SH can be performed safely and reliably without risk of complications, but the second SH is associated with more pain and longer recovery time.

Robotically assisted atraumatic coronary artery bypass: a feasible option for off-pump coronary surgery.

This retrospective study of the largest single center experience (100 patients) with off-pump robotically assisted coronary procedures in the United Kingdom (April 2002-June 2008) aimed to rationalize patient selection, describe the technique, and determine the learning curve, technical feasibility and operative outcome of robotically assisted Atraumatic Coronary Artery Bypass (ACAB). Selected patients underwent either a robotic Totally Endoscopic Coronary Artery Bypass (12) or robotically assisted ACAB (88) using a standard Da Vinci robot with three arms. A fifth of all cases had percutaneous interventions as part of a hybrid strategy. The majority of patients were overweight men. After one hundred robotic coronary procedures, this operation is now performed as part of a routine theatre list. The mean operative and total procedure times for robotically assisted atraumatic procedures were 157 and 238min, respectively. These measurements were significantly less in the atraumatic than the totally endoscopic group with a 34.3 and 20.6% reduction, respectively (P<0.001; equal variance not assumed). The procedural learning curve was short and independent from internal thoracic artery harvesting. We have proven conclusively that robotically assisted ACAB is feasible, more so than the totally endoscopic procedure in this particular setting. Even in the absence of an ideal stabilizer device, this procedure causes minimal disruption to the daily operating room schedule. We have also proven that body mass index is a weak predictor of the ease of robotic internal thoracic artery harvesting and should not affect patient selection.

V1540 THE LAPAROSCOPIC BOARI FLAP

You have accessJournal of UrologyReconstruction1 Apr 2010V1540 THE LAPAROSCOPIC BOARI FLAP Mahmoud Shalaby, Ahmed Shoma, Fathy Elanany, Nashwa Barakat, and Magdy El-Akkad Mahmoud ShalabyMahmoud Shalaby Assiut, Egypt More articles by this author , Ahmed ShomaAhmed Shoma Mansoura, Egypt More articles by this author , Fathy ElananyFathy Elanany Assiut, Egypt More articles by this author , Nashwa BarakatNashwa Barakat Mansoura, Egypt More articles by this author , and Magdy El-AkkadMagdy El-Akkad Assiut, Egypt More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2010.02.1292AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail INTRODUCTION AND OBJECTIVES Laparoscopic ureteroneocystostomy in humans was first described by Ehrlich and colleagues in 1994 for management of vesicoureteral reflux. Loss of distal ureteral segment may interfere with tension-free ureteroneocystostomy. In this particular situation, the Boari flap is a solution, which stood the test of time. Objective: to test the feasibility of laparoscopic Boari flap ureteroneocystostomy in an experimental setting before clinical application. METHODS This video describes the technique of laparoscopic Boari flap to restore the patency of an experimentally ligated ureter of a female Mongorel dog. Four dogs were subjected to this experiment. Partial obstruction of the ureter was performed three weeks before the procedure. Follow up IVU and retrograde cystogram were performed three weeks after removal of stents. RESULTS Operative time for the laparoscopic Boari flap procedures ranged from 230 to 360 minutes (mean 271 minutes) again with remarkable improvement after the first procedure (360 minutes for the first, 240 minutes for the second, 255 minutes for the third and 230 minutes for the fourth procedure). All dogs experienced smooth postoperative course. Intravenous urography was performed three weeks after removal of stents and all the four renal units showed normal secretion of the dye, normal size and patent, normal ureters. CONCLUSIONS Laparoscopic Boari flap is a feasible technique, which requires orientation with the principals of reconstructive laparoscopic surgery. © 2010 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 183Issue 4SApril 2010Page: e594 Peer Review Report Advertisement Copyright & Permissions© 2010 by American Urological Association Education and Research, Inc.MetricsAuthor Information Mahmoud Shalaby Assiut, Egypt More articles by this author Ahmed Shoma Mansoura, Egypt More articles by this author Fathy Elanany Assiut, Egypt More articles by this author Nashwa Barakat Mansoura, Egypt More articles by this author Magdy El-Akkad Assiut, Egypt More articles by this author Expand All Advertisement Advertisement PDF downloadLoading ...

Percutaneous Treatment of Varicocele with Microcoil Embolization: Comparison of Treatment Outcome with Laparoscopic Varicocelectomy

Successful treatment of a testicular varicocele, which can result in scrotal pain and swelling as well as male subfertility, can be accomplished via operative ligation of the varicocele or interventional treatment with coil embolization of the testicular vein. This study compared the treatment outcome of percutaneous embolization treatment versus laparoscopic varicocelectomy in patients with symptomatic varicoceles. Patients with varicoceles undergoing either laparoscopic varicocelectomy or percutaneous coil embolization of the testicular vein during a recent 5-year period were analyzed. Treatment outcome and hospital costs of these two minimally invasive treatment modalities were compared. Forty-one patients underwent percutaneous coil embolization of the testicular vein, which were compared with a cohort of 43 patients who underwent laparoscopic varicocelectomy. Technical success in interventional and laparoscopic treatment was 95% and 100%, respectively. The mean operative time or procedural time was 63 +/- 13 minutes and 52 +/- 25 minutes for interventional and laparoscopic cohorts (not significant), respectively. Embolization treatment resulted in two recurrent varicoceles (4.8%) compared to one patient following laparoscopic repair (2.3%, not significant). Embolization treatment was associated with a lower complication rate than laparoscopic repair (9.7% vs 16.3%, p = .03). Regarding cost analysis, no significant difference in hospital cost was noted between the interventional or laparoscopic treatment strategies. Both laparoscopic varicocelectomy and coil embolization are effective treatment modalities for varicoceles. With lower treatment complication rates in the interventional treatment group, coil embolization of the testicular vein offers treatment advantage compared with laparoscopic repair in patients with varicoceles.

Comparison of 30-day outcomes after non-LapBand primary and revisional bariatric surgical procedures from the Longitudinal Assessment of Bariatric Surgery study

Background The goals were to compare the morbidity and mortality between primary and revisional bariatric surgery and to identify the clinical predictors of adverse outcomes among patients undergoing revisional surgery in the Longitudinal Assessment of Bariatric Surgery consortium. The study was multi-institutional at university hospitals in the United States. Methods Data from the LABS-1 (safety) cohort were analyzed, excluding primary gastric banding patients. A total of 3802 LABS-1 patients were included: 3577 who underwent primary surgery and 225 who underwent revisional surgery. The demographic, clinical, operative, and 30-day outcome data were compared between the 2 groups. A nonlinear mixed effects logit model was used to identify independent risk factors for adverse outcomes (death, deep vein thrombosis, pulmonary embolism, reintubation, reoperation, or discharge after 30 days). Results Compared with those undergoing revisional surgery, the primary surgery patients were younger (median age 44 versus 49 years, P <.0001) and more likely to be male (20.5% versus 12.7%, P = .006) and heavier (median body mass index 47.3 versus 41.2 kg/m 2, P <.0001) and to have more co-morbidities ( P <.0001), including hypertension (56.0% versus 46.0%, P = .0044), diabetes (35.7% versus 20.0%, P <.0001), and sleep apnea (50.3% versus 27.2%, P <.0001). The operative time for the revisional procedures was longer (median 181 versus 135 min, P <.0001) and associated with greater blood loss (median 100 versus <50 mL, P <.0001). Adverse outcomes were more likely after revisional surgery (15.1% versus 5.3%, P <.0001, odds ratio 2.4, 95% confidence interval 1.6–3.6). After adjusting for patient characteristics previously shown to be associated with adverse outcomes, this difference remained statistically significant (odds ratio 2.3, 95% confidence interval 1.5–3.8). The 30-day mortality rate was similar in the 2 groups (.4%). Conclusion Revisional surgery was performed without substantial mortality but with a greater incidence of adverse outcomes than was primary bariatric surgery.

Single-port cholecystectomy with the TransEnterix SPIDER: simple and safe

IntroductionSingle-port or single-incision cholecystectomy with current rigid laparoscopic devices is limited by in-line visualization, restricting the ability to approach the surgical site with proper angles and instrumentation. A single-port access system with articulating arms and strong instrumentation should minimize these issues. The TransEnterix system may facilitate safe and straightforward single-port surgery.MethodsThe TransEnterix single-port surgery system was used in both survival and nonsurvival porcine laparoscopic cholecystectomies under animal use committee approval. Nonsurvival procedures compared four standard laparoscopic with four single-port cholecystectomies from a histologic perspective. Five single-port swine laparoscopic cholecystectomy procedures were completed in sterile conditions, and all animals survived for 1 week postoperatively. Standard surgical clips were used for both cystic duct and artery ligation. At sacrifice, both gross and microscopic histology were obtained for assessment of surgical complications.ResultsAll cholecystectomies were successfully completed with the TransEnterix single-port system. Operative time for the survival procedures averaged 39.4 (range 18–66) min. Histology of the acute specimens showed less inflammation at the single-port site compared with the trocar sites from the standard cholecystectomy. At sacrifice, no complications were identified.ConclusionsThe TransEnterix system is safe and straightforward for completing single-port cholecystectomy in this limited porcine series. Port site inflammation is reduced compared with standard laparoscopic trocars.

Minimally invasive osteosynthesis in stable trochanteric fractures: a comparative study between Gotfried percutaneous compression plate and Gamma 3 intramedullary nail

Our objective was to compare the results of PCCP (Percutaneous Compression Plate) device and Gamma 3 nail for the treatment of stable trochanteric hip fractures and to demonstrate that PCCP device is a minimally invasive system. Prospective, randomized trial. Eighty patients aged 60 and over with stable trochanteric fracture were selected and then randomized using a table of randomized numbers. Length of time of operative procedure, hemoglobin levels at 6 and 48 h after surgery, packed cells units administered, and hospital stay were recorded. In addition, the postoperative complications in the first year after the surgery was collected. No differences were found in hospital stay, surgical time, blood loss, functional outcome at 1-year follow-up, neck-shaft angle, fracture collapse, and mortality. PCCP and Gamma 3 have not presented significant differences in any measured parameter for treatment of stable trochanteric fractures. Therefore, the PCCP system is shown to be as minimally invasive as the Gamma 3.