Port Insertion Research Articles

Prolonged Umbilical Port Insertion Time Increases the Incidence of Umbilical Surgical Site Infection in Laparoscopic Percutaneous Extraperitoneal Closure for Inguinal Hernia in Children.

Introduction: Umbilical surgical site infection (U-SSI) is the most common complication of laparoscopic percutaneous extraperitoneal closure (LPEC) for the treatment of inguinal hernia in children. Prolonged operative time is known to increase the risk of SSI in general pediatric surgery; however, the association between prolonged operative time and post-LPEC U-SSI is unclear. The present study aimed to elucidate the association between umbilical port insertion time and the incidence of U-SSI. Materials and Methods: The present study included all patients <16 years of age who underwent LPEC for the treatment of inguinal hernia between June 2018 and May 2023 at our institution. Those who underwent umbilical hernia repair or other procedures were excluded. We retrospectively collected and analyzed the following: patient demographics; operative data; and U-SSI data. The cutoff value for the umbilical port insertion time was determined using receiver operating characteristic analysis, and the incidence of U-SSI was compared based on the cutoff value, determined to be 8 minutes. Results: A total of 232 patients (133 boys; mean age, 4.6 ± 3.3 years) were eligible for the present study, 7 (3.0%) of which developed superficial incisional post-LPEC U-SSI within a median of 7.5 [4-19] days. The incidence of U-SSI was 20.0% in the long (≥8 minutes) versus 2.3% in the short (<8 minutes) umbilical port insertion time group (P = .03). Conclusion: Prolonged umbilical port insertion time (≥8 minutes) increases the incidence of post-LPEC U-SSI during the treatment of inguinal hernia in children.

Surgical step recognition in laparoscopic distal gastrectomy using artificial intelligence: a proof-of-concept study.

Laparoscopic distal gastrectomy (LDG) is a difficult procedure for early career surgeons. Artificial intelligence (AI)-based surgical step recognition is crucial for establishing context-aware computer-aided surgery systems. In this study, we aimed to develop an automatic recognition model for LDG using AI and evaluate its performance. Patients who underwent LDG at our institution in 2019 were included in this study. Surgical video data were classified into the following nine steps: (1) Port insertion; (2) Lymphadenectomy on the left side of the greater curvature; (3) Lymphadenectomy on the right side of the greater curvature; (4) Division of the duodenum; (5) Lymphadenectomy of the suprapancreatic area; (6) Lymphadenectomy on the lesser curvature; (7) Division of the stomach; (8) Reconstruction; and (9) From reconstruction to completion of surgery. Two gastric surgeons manually assigned all annotation labels. Convolutional neural network (CNN)-based image classification was further employed to identify surgical steps. The dataset comprised 40 LDG videos. Over 1,000,000 frames with annotated labels of the LDG steps were used to train the deep-learning model, with 30 and 10 surgical videos for training and validation, respectively. The classification accuracies of the developed models were precision, 0.88; recall, 0.87; F1 score, 0.88; and overall accuracy, 0.89. The inference speed of the proposed model was 32 ps. The developed CNN model automatically recognized the LDG surgical process with relatively high accuracy. Adding more data to this model could provide a fundamental technology that could be used in the development of future surgical instruments.

Diagnostic accuracy of preoperative adhesion mapping by ultrasonography for laparoscopic surgery in patients with past abdominal surgery with special reference to loose adhesion.

Endoscopic surgery is widely accepted for both elective and emergent abdominal surgery. This study was performed to assess the accuracy of preoperative adhesion mapping by abdominal ultrasonography (US). Intra-abdominal intestinal adhesions on the abdominal wall in 50 patients with a history of abdominal surgery were prospectively assessed by the visceral slide test with US before laparoscopic surgery from 2019 to 2022. Adhesion was assessed in six separate abdominal zones during US. Actual adhesion on the abdominal wall was confirmed during laparoscopic surgery. The sliding distances in upper right, upper central, upper left, lower right, lower central, and lower left zones in patients with versus without intestinal adhesion were 4.4 versus 1.4 cm (P = .004), 3.4 versus 2.5 cm, 4.3 versus 1.3 cm (P = .011), 3.1 versus 1.5 cm (P = .0014), 3.3 versus 1.1 cm (P = .013), and 3.4 versus 0.8 cm (P = .0061), respectively. Receiver operating characteristic analysis revealed the optimal value of sliding distance as 2.5 cm and the area under the curve as 0.86. The specificity of US assessment of adhesion was lower in the central zone than in lateral zones. Loose adhesion mostly seen around the scar was attributed to either filmy tissue or omental adhesion, leading to visceral sliding during US. This study revealed the reason for insufficient accuracy of preoperative US assessment of intestinal adhesion around the scar area because of loose adhesion. The upper lateral area might be optimal for first port insertion.

Surgical procedures and complications in placement of totally implantable venous access port in pediatric hemophilia patients: A retrospective analysis

This retrospective study at Beijing Children's Hospital (2020–2023) analyzed surgical procedures and complications in 24 pediatric hemophilia patients undergoing Totally Implantable Venous Access Port (TIVAP) insertion, primarily in the right jugular vein (RJV). We detailed the surgical process, including patient demographics and intraoperative imaging use. The choice of the RJV for TIVAP placement was influenced by its larger diameter and superficial anatomical position, potentially reducing risks like thrombosis and infection. Our findings support the RJV as a safer alternative for port placement in pediatric patients, aligning with current literature. Statistical analysis revealed no significant correlation between complications and baseline characteristics like weight and diagnosis type. However, the length of hospital stay and implant brand were significant risk factors for catheter or port displacement and removal. The limited patient number may introduce bias, suggesting a need for further studies with larger samples. Despite a 14.7 %–33 % complication rate and 5 port removals, the advantages of TIVAP, including reliable venous access, reduced discomfort, and treatment convenience, were evident. Most complications improved with symptomatic treatment, and there were no deaths due to port-related complications, underscoring the impact of TIVAP on improving pediatric hemophilia treatment.

The Role of Multilevel Intercostal Nerve Block in Local Anesthetic Thoracoscopy.

Intercostal nerve block (ICNB) has long been used in thoracic surgery. Local anesthetic thoracoscopy (LAT) is performed under conscious sedation with local anesthesia at the port insertion site. This alone, however, does not anesthetize the parietal pleura from where biopsies are taken and patients can experience pain. To compare LAT with multilevel ICNB versus standard care to determine whether it reduces pain during and post-LAT, its effect on analgesia use, the hospital length of stay (LOS), and related complications. Prospective analysis of patients undergoing LAT between January and June 2021. In the ICNB group, levobupivacaine/xylocaine is administered at the angle of the rib immediately before LAT (up to 5 rib spaces). Visual Analog Score for pain (0 to 100mm) was measured at 1 and 2 hours post-LAT and daily including analgesia use. Twenty patients (10 ICNB vs. 10 standard care group). The mean age is 68 years with 70% males. Visual Analog Score for pain in the ICNB group reduced by 55mm at 1 and 2 hours post-LAT and 45mm at day 1 ( P <0.05) (minimal clinically important difference >16mm]. Median LOS was reduced by 50% in the ICNB group ( P <0.05). Paracetamol use reduced by 56% ( P <0.05). ICNB not only significantly reduces postprocedure pain but also reduces LOS.

Internal thoracic vein cannulation for venous port insertion

Internal thoracic vein cannulation for venous port insertion

How-I-do-it: laparoscopic intragastric submucosal dissection (LISD) for gastric and gastro-oesophageal junction early lesions.

Laparoscopic intragastric submucosal dissection (LISD) is a novel approach to the resection of gastric lesion that are not amenable to conventional endoscopic approaches. The technique permits favourable access to lesions situated at the cardia and angular notch of the stomach, enables en-bloc resection of large areas of tissue, and can prevent the need of formal gastrectomy or oesophagectomy in selected patients. All cases were deemed suitable for LISD by a multidisciplinary team panel following endoscopic assessment (using white light enhancement, chromoendoscopy and magnification endoscopy) that was integrated when needed with EUS, CT scan or PET scan. The surgical technique consisted in a 3-port laparoscopic approach; after establishment of pneumoperitoneum, three gastrotomies were performed to enable port insertion into the stomach. Following establishment of stable pneumogastrium, the area of interest was identified, submucosal hyaluronic acid injection performed to provide a cushion in the plane of dissection, and the excision area was circumferentially marked with cautery. Resection was completed using cautery hook, along a plane parallel to the muscolaris propria. After the specimen was extracted in a retrieval bag, intracorporeal single layer running suture closure of gastrotomies was performed. The abdominal wall closed by layers and tap block performed along with local anaesthetic injection on skin incision. Measures were taken to ensure correct orientation of resected specimens prior to fixation. During the study period that spans from 2014 and 2022, a total of 11 patients underwent LISD for limited lesions of the stomach, 10 were located at gastro-oesophageal junction and one at the angular incisura. Four patients were female, seven males. The median age was 74 (46-79) years. R0 resection rate was 54.5%. Mean operative time was 109min with very low blood loss (10ml). Mortality rate was 0%, no immediate major complications (Grade II-V Clavien Dindo), including haemorrhage or perforation, occurred in these cases. Two patients developed dysphagia later that was successfully treated with endoscopic balloon dilatations. Median hospital stay was 3days and median oral intake was on day 1 post-procedural. Laparoscopic intragastric submucosal dissection is shown to be a safe and effective intervention for the treatment of early gastric cancers in selected patients having undergone deemed not amenable for endoscopic submucosal resection for their technically challenging location. Its application can serve as route to avoid formal surgery and the associated morbidity.

High-fidelity, low-cost synthetic training model for fetoscopic spina bifida repair

Fetoscopic spina bifida repair is increasingly being practiced, but limited skill acquisition poses a barrier to widespread adoption. Extensive training in relevant models, including both ex vivo and in vivo models may help. To address this, a synthetic training model that is affordable, realistic, and that allows skill analysis would be useful. This study aimed to create a high-fidelity model for training in the essential neurosurgical steps of fetoscopic spina bifida repair using synthetic materials. In addition, we aimed to obtain a cheap and easily reproducible model. We developed a 3-layered, silicon-based model that resemble the anatomic layers of a typical myelomeningocele lesion. It allows for filling of the cyst with fluid and conducting a water tightness test after repair. A compliant silicon ball mimics the uterine cavity and is fixed to a solid 3-dimensional printed base. The fetal back with the lesion (single-use) is placed inside the uterine ball, which is reusable and repairable to allow for practicing port insertion and fixation multiple times. Following cannula insertion, the uterus is insufflated and a clinical fetoscopic or robotic or prototype instruments can be used. Three skilled endoscopic surgeons each did 6 simulated fetoscopic repairs using the surgical steps of an open repair. The primary outcome was surgical success, which was determined by water tightness of the repair, operation time <180 minutes and an Objective Structured Assessment of Technical Skills score of ≥18 of 25. Skill retention was measured using a competence cumulative sum analysis of a composite binary outcome of surgical success. Secondary outcomes were cost and fabrication time of the model. We made a model that can be used to simulate the neurosurgical steps of spina bifida repair, including anatomic details, port insertion, placode release and descent, undermining of skin and muscular layer, and endoscopic suturing. The model was made using reusable 3-dimensional printed molds and easily accessible materials. The 1-time startup cost was €211, and each single-use, simulated myelomeningocele lesion cost €9.5 in materials and 50 minutes of working time. Two skilled endoscopic surgeons performed 6 simulated, 3-port fetoscopic repairs, whereas a third used a Da Vinci surgical robot. Operation times decreased by more than 30% from the first to the last trial. Six experiments per surgeon did not show an obvious Objective Structured Assessment of Technical Skills score improvement. Competence cumulative sum analysis confirmed competency for each surgeon. This high-fidelity, low-cost spina bifida model allows simulated dissection and closure of a myelomeningocele lesion. VIDEO ABSTRACT.

Prophylactic Antibiotic Use Prior to Port Placement and Its Effect on Insertion-Related Infection Rates: A Five-Year Retrospective Review

Abstract Purpose The aim of this study was to compare insertion-related port infection rates between patients who received intraprocedural prophylactic antibiotics versus those who did not. Materials and Methods All patients who underwent port insertion by interventional radiology from 7/1/ 2015 through 7/1/2020 at a single U.S.-based Health System were identified using electronic medical records database. During this period, 2,099 patients underwent port placement at three hospitals within the same health system. One-thousand sixty-three patients who underwent port placement at one hospital received periprocedural antibiotics and 1,036 patients at the two other hospitals did not receive antibiotics. Retrospective data were reviewed on each patient including demographics, reason for port insertion, and evidence of port infection. All relevant data up to 30 days postinsertion were reviewed, including blood cultures, unplanned readmissions, emergency room visits, and clinic visits. Qualitative trends were evaluated for various subgroups including presence of bacteremia, time from insertion, and demographics. Patients with an obvious external source of infection were excluded. Results Insertion-related infection rate was 0.9% for the entire cohort, 1.23% for the antibiotic group, and 0.68% for the nonantibiotic group. The insertion-related infection for adult patients was 0.88% for the antibiotic group and 0.68% for the nonantibiotic group. The pediatric insertion-related infection rate was 7.69%, all of whom received intravenous antibiotics. No other clear qualitative differences were noted for analyzed subgroups. Conclusion This study demonstrates low insertion-related port infection rate with no clinically significant difference between the groups that did or did not receive antibiotics. Subgroup analysis showed an exceptionally high infection rate in the pediatric population despite receiving preprocedure antibiotics.

Modified thoracoabdominal nerves block through perichondrial approach for laparoscopic cholecystectomy.

A new block, namely, modified thoracoabdominal nerves block through perichondrial approach, is administered below the costal cartilage. We sought to compare the analgesic efficacy of the modified thoracoabdominal nerves block through perichondrial approach block with local anesthetic infiltration at the port sites in an adult population who underwent laparoscopic cholecystectomy. Patients who will undergo laparoscopic cholecystectomy were randomized to receive bilateral ultrasound-guided modified thoracoabdominal nerves block through perichondrial approach blocks or local anesthetic infiltration at the port insertion sites. The primary outcome was the total amount of tramadol used in the first 12 h postoperatively. The secondary outcomes were total IV tramadol consumption for the first postoperative 24 h and visual analog scale scores. The modified thoracoabdominal nerves block through perichondrial approach group had significantly less tramadol use in the first 12 h postoperatively (p<0.001). The modified thoracoabdominal nerves block through perichondrial approach group's visual analog scale scores at rest (static) and with movement (dynamic) were significantly lower compared with the port infiltration group (p<0.05). Patients who received modified thoracoabdominal nerves block through perichondrial approach block had significantly less analgesic consumption and better pain scores than those who received port-site injections after laparoscopic cholecystectomy.

Pacemaker leads as a potential source of problems in patients who might need a central venous access port.

Lead-dependent venous occlusion may impede the insertion of a central venous access device (CVAD). The aim of this retrospective, cohort study was to assess the chance of implantation of CVAD in patients with cardiac implantable electronic devices (CIEDs). We reviewed and analyzed 3,075 venograms of patients with CIEDs undergoing transvenous lead extraction (TLE) between June 2008 and July 2021. Relationship between venous patency and the chance of CVAD placement was estimated. In 2,318 (75.38%) patients, venography showed no potential obstacles to venous port implantation on the ipsilateral side. In patients with leads on the left side, significant narrowing more often affected the subclavian vein than the brachiocephalic vein [1,595 (55.29%) vs. 830 (28.63%), respectively] or the superior vena cava (SVC) [21 (0.73%) cases]. Furthermore, the subclavian and brachiocephalic veins on the opposite side were also narrowed [35 (2.35%) and 27 (1.24%), respectively]. The chances of port insertion were assessed as easy on CIED side or opposite side in 2,318 (75.38%) and 2,291 (97.91%) patients, respectively), as difficult insertion/questionable performance in 246 (8.00%) and 22 (0.94% patients) and doubtful or impossible insertion/questionable performance in 511 (16.62%)/27 (1.15%) patients with CIED. (I) Varying degrees of lead-dependent venous obstruction (LDVO) is a frequent finding in patients with CIEDs; (II) the major thoracic veins on the opposite side of the chest may also be significantly narrowed; (III) venography should be considered before attempted CVAD insertion in patients with long lead dwell times or in patients after CIED removal, including planned contralateral port placement.

Transversus Abdominis Plane Block VS. Local Wound Infiltration for Elective Minimally Invasive Cholecystectomy in Children: A Prospective Randomized Trial

BackgroundThe efficacy of transversus abdominis plane (TAP) block versus local anesthetic wound infiltration (LWI) in pediatric laparoscopic surgery is largely unknown. The objective of this study was to prospectively analyze this in minimally invasive cholecystectomy. We hypothesized that TAP block would be superior to LWI in terms of pain control and post-operative complications. MethodsWe conducted a prospective, randomized, single-blinded, controlled trial between 2017 and 2022 after obtaining Institutional Review Board (IRB) approval. After randomization, patients received a standard amount of ropivacaine via either 1) ultrasound-guided TAP block after general anesthesia induction or 2) local injection at port insertion by the operating surgeon. We collected data including operative time, pain scores, and medication usage post-operatively. We used descriptive statistics to report all endpoints and compared data with t-tests and Fisher's exact tests. A p-value less than 0.05 was considered statistically significant. ResultsWe enrolled 85 patients (43 LWI, 42 TAP). Mean [standard deviation] age and body mass index (BMI) in the LWI and TAP groups were 14.8 [1.9] and 14.7 [2] years and 29.9 [7.2] and 27.4 [8.2] kilogram/meter2 (kg/m2) respectively. We did not find any significant differences in postoperative opioid use, pain scores, and gastrointestinal symptoms. TAP patients had significantly longer time between anesthesia-start and procedure-start (p < 0.001), although total time under anesthesia was not significantly different (p = 0.540). ConclusionThere are no significant differences between equal administration of local anesthetic by TAP block and surgeon administered LWI during minimally invasive cholecystectomy. Type of StudyRandomized clinical trial. Level of EvidenceLevel II.

Efficacy of Ultrasound Guided Bilateral Erector Spinae Block in Attenuating Pneumoperitoneal Stretch Response in Patients Undergoing Laparoscopic Abdominal Surg

Background: Increase in heart rate and blood pressure in response to pneumoperitoneum produced during laparoscopic abdominal surgeries is a challenging situation to anesthesiologists. Without adequate control of sympathetic response there is a chance of increase in morbidity of the patient during perioperative period. Aim of the study is to evaluate the efficacy of bilateral erector spinae plane block in attenuating pneumoperitoneal stretch response in patients undergoing laparoscopic abdominal surgeries under general anesthesia. Methodology: A randomised control trial was conducted among 70 patients, who underwent laparoscopic abdominal surgeries. Under general anesthesia, 35 patients received ESP block with 20 ml of 0.25 levobupivacaine bilaterally (Group B) and 35 patients without block (Group R). This study compared requirement of opioids and response of hemodynamic parameters (Heart Rate, Mean Arterial Pressure) during pneumoperitoneal stretch. Statistical tests were applied. Results: The intra-operative fentanyl requirement in Group B was 100.85+ and in Group R 119.375 + P value &lt;0.001, statistically significant. The intra-operative heart rate at the time of port insertion, at 5 min, 10 min of pneumoperitoneum and at the end of surgery in Group B (91.97 ±12.09, 90.82±10.7, 92.08±10.9 and 90.857±12.5) were significant when compared to Group R (R 99.9±10.5, 94.48±13.08, 96.68±14.14 and 95.35±14.14 and same is proven statistically. (p &lt; 0.05). Conclusion: Ultrasound guided bilateral Erector spinae block with Levobupivacaine results in intra-operative hemodynamic stability during port insertion and pneumoperitoneum.

Safety and feasibility of single-port surgery for posterior retroperitoneal adrenalectomy using the da Vinci SP robotic system: a retrospective cohort study.

This study demonstrates our experience of single-port robotic posterior retroperitoneal adrenalectomy (RPRA) using the da Vinci SP robot system and evaluates its technical feasibility and surgical outcomes. We conducted a retrospective analysis of 250 RPRAs, including 117 conventional 3-port RPRAs, 103 reduced 2-port RPRAs, and 30 single-port RPRAs. Each RPRA type was compared by analyzing 30 patients in the early phase of surgery. All patients who underwent single-port RPRA showed excellent surgical outcomes. Age, sex, BMI, and tumor location site did not significantly differ between the three groups. In the early phase, the size of the adrenal tumor was similar between three groups, and it tended to increase as the number of ports increased (p < 0.001). The mean operation time was shorter for patients who underwent single-port RPRA than those who underwent RPRA types (p < 0.001). The numeric rating scale score did not significantly differ between the groups on most days. No major complications were observed, and no patients were converted to open surgery or required additional port insertion. Single-port RPA using the da Vinci SP robotic system showed the effectiveness of the surgical procedure and improved cosmetic outcomes for patients, while also enabling surgeons to perform operations with greater ease and convenience. Therefore, single-port RPRA could be a good alternative option for the treatment of adrenal tumors in selected situations.

605 Whose Operation Is It Anyway? Is There Consensus on Supervision Codes Use for General Surgical Procedures?

Abstract Aim Operative numbers are critical in applications to Core and Higher Surgical training, ARCP and CCT requirements. However, instructions for the use of supervision codes on the surgical eLogbook and ISCP are ambiguous. This study seeks to determine if there is a consensus for supervision coding for common general surgical operations. Method A survey of 10 operative vignettes was distributed to doctors who used the eLogbook. Participants were asked to indicate if they would code the operation Assisted (A) or Supervised Trainer Scrubbed (STS) from the vignette provided. Results The survey received 258 responses from doctors across all grades. In one appendicectomy vignette describing involvement at each key step but no dissection, 55% coded it as Assisted and 40% STS. For a laparoscopic cholecystectomy vignette which described dissecting the gallbladder off the liver and closing the ports, 59% coded it as Assisted and 37% STS. By including port insertion in this vignette 25% coded it as assisted and 72% as STS. Only 20% agreed with the statement “I find it easy to understand what supervision code I should record in my logbook”. Conclusions This study shows little consensus on supervision codes for general surgical operations and considerable ambiguity in the system. The description of the codes on eLogbook is not fit for purpose with minimal supporting guidance on ISCP. Clearer guidelines are required to enable trainees to use consistent coding to ensure validity in the use of indicative numbers in applications and as a marker of progress.

705 Assessment of a Novel Low-Cost Abdominal Box Simulator for Laparoscopic Skills Training

Abstract Aim To create a low-cost abdominal box simulator and assess its validity for Hassan’s entry technique and visiport. Method A low-cost abdominal box simulator was created using a metal box skeleton. This was covered in a layer of cling-film simulating the peritoneum. Red and blue tubing was placed over this creating the inferior epigastric vessels. A posterior rectus sheath was created on either side using a white cotton sheet whilst thick red woollen socks were used to simulate the rectus abdominus muscles. The entire surface was then wrapped in a thick canvas to simulate the anterior rectus sheath. Finally, a commercial skin with subcutaneous tissue was affixed and the umbilicus demarcated using a pen. This simulator was used by 30 surgical trainees (ST3 to ST7) attending a laparoscopic skills course who were asked to provide feedback on the simulator for both Hassan’s entry technique, visiport entry and the introduction of secondary ports. Results The simulator was rated 10/10 for validity as well as ease of use for Hassan’s open entry technique, visiport and secondary port insertion by all 30 of the trainees. Feedback highlighted that using the simulator trainees were able to see all layers of the abdomen and gain excellent haptic feedback. The model was described as realistic as trainees were able to identify each layer of the abdomen as they performed open or visiport entry. Conclusions A low-cost abdominal box simulator can easily be reproduced using our technique and used to train trainees effectively.

Role of Local Anesthetic Infiltration of Port Sites in Laparoscopic Cholecystectomy in Reducing Postoperative Pain and Opioid Consumption

Abstract Background Laparoscopic cholecystectomy is the gold standard for treating patients with cholelithiasis. It is a minimally invasive technique that reduces surgical trauma with small and more cosmetic incision, reduces blood loss and is associated usually with fewer postoperative complications and decreased length of hospital stay. Aim of the Work The aim of this study was to evaluate the efficacy of the long acting local anesthetic (bupivacaine) infiltrated at the port sites in laparoscopic cholecystectomy, in reducing postoperative pain and opioid consumption. Patients and Methods In the period from March 2021 to September 2021 fifty patients who underwent laparoscopic cholecystectomy were randomly allocated to one of two groups and comparative study was done. In the bupivacaine group (A), after skin preparation and before port insertion, 20 ml of 0.25% bupivacaine solution was infiltrated through the abdominal wall 4 ml around each port site. Postoperatively, pain score using VAS score, time of rescue analgesic and total rescue analgesic dose was calculated. Results The results showed that there a decrease in pain intensity in the bupivacaine group compared to control group with a significant difference, and there was delay in the time of rescue analgesia and total doses of rescue analgesia the bupivacaine group compared to control group with a statistically significant difference. Conclusion Port- site infiltration of bupivacaine in laparoscopic cholecystectomy successfully decrease post-operative pain during first 6 hour and delayed the time of rescue analgesia.

Right Information, Right Patient, Right Time: Utilizing the MyCareCompass Platform to Deliver Patient Education in the Oncology Setting

Patient education is an important part of cancer care as it increases patient activation and informed decision-making, reduces anxiety, and improves outcomes. However, challenges to providing appropriate education to patients exist on both the health provider and patient side of the equation, e.g., time constraints and health literacy issues. Digital health education is a fast-growing field of interest that has been shown to improve health outcomes, increase effectiveness of medical treatments and education, lower medical costs, and enhance both clinical diagnosis and research opportunities by streamlining data collection, sharing, and analysis. In 2019, Fox Chase Cancer Center was selected by ARCHES, an established patient education software company, to pilot its award-winning digital patient engagement system MyCareCompass. During the pilot, patients scheduled for port insertions were sent electronic messages inviting them to review various online educational materials related to their procedure and subsequent concerns. The invitations and resources were seamlessly integrated into the scheduling system and timed to arrive when patients would most need them. There was high usage of the port-related materials and patients reported a high level of satisfaction with the delivery system and the information. This automated process of delivering high-quality and relevant patient education was able to be implemented smoothly with IT involvement, had a positive impact on patients without adding any extra burden to the care team, and highlighted opportunities to integrate these types of interventions into routine care.

Thoracoscopic Assisted PleuralPortTM Application in Seven Dogs Affected by Chronic Pleural Effusion.

Chronic non-septic pleural effusion is a condition that frequently may occur because of lung or pleural neoplasia, or chylothorax refractory to surgical treatment, in dogs. Effusion management can be performed with multiple pleurocenteses or the application of chest drains. New modified vascular devices have been used for patients with chronic diseases; they offer the advantage of allowing home management and do not require hospitalization. Eight PleuralPortTM devices were applied in seven dogs during thoracoscopic exploration and biopsy procedures; five were affected by mesothelioma; one by lung metastases from a mammary carcinoma; and one by chronic chylothorax. The median time of surgical procedure was 51 min; one developed pneumothorax post-operatively that resolved within 12 h after repeated drainage; one device was obstructed after 45 days and was successfully managed by flushing. All patients were discharged after 24 h. The median duration of port insertion in cancer patients was 5 months and those dogs were euthanized because of tumor progression; in the dog with chylothorax, the device was removed after 1 year when the effusion had resolved.

A COMPARATIVE STUDY OF CHEMOPORT VERSUS PERIPHERAL VENOUS ACCESS IN BREAST CANCER PATIENTS IN GOA MEDICAL COLLEGE.

Background: Totally implantable venous access devices (TIVADs) considered standard of care for administration of intravenous chemotherapeutic drugs for patients needing long term chemotherapeutic drugs. Methodology: This prospective comparative study carried over a period 2 years in all patients diagnosed with breast cancer. Patients will be divided into 2 groups-1 group will receive chemotherapy using the chemoport and the other group through peripheral intravenous access. The group will be divided based on simple randomization on alternate basis. While the average dura Results: tion for the procedure of port insertion was 59mins, almost 90% patients were discharged within 24 hrs with no complications Of the 50 patients that underwent the procedure of chemoport implantation, 21 patients underwent by Internal Juglar Vein while the remainder by Subclavian vein out of which in 2 patients the procedure was abandoned owing to complications of migration of guide wire and hemothorax, both of which occurred while attempting subclavian catheterization. While the guide wire was retrieved under uoroscopic guidance, Intercoastal drainage tube was passed for patient with hemothorax. This complication can be avoided by using radiological guidance or under uoroscope. Of the remaining patients, 13 patients the port was removed as they had completed chemotherapy were termed disease free. While in 2 patients port was removed pre-maturely due local port site infection and generalized sepsis due to neutropenia. During the process of chemotherapy through port, 1 patient developed blockage of port as evidenced by no return ow by aspiration. This was managed by giving heparin ush and visualized under C-arm for patency. When it comes to morbidity of the port, majority of the people were in the opinion that the process of port insertion was painless, they had no sensation of foreign body, no itching/pain and did not interfere with day to day life.And on inquiring regarding the satisfaction by the patient, maximum people were of the opinion that port helped speed up chemotherapy sessions, satised with cosmesis, and preferred port over peripheral iv line. About 60% would agree to recommend port over peripheral iv line. In comparison to patients who received chemotherapy through peripheral iv line, out of 50, 11 patients had serious complication of extravasation and thrombophlebitis which required hospital admission and surgical debridement. In terms of patient morbidity, &gt;40% experienced difculty in initiation of chemotherapy in more than 50% of cycles, 26 patients were forced to receive multiple pricks, 34 patients required a second iv line to complete the session in half the cycles and 10 patients required iv at the leg/neck as others were inaccessible. High satisfaction rate Conclusion: observed in patients using chemoports for chemotherapy-it speeded up the sessions, less painful and only few people felt its presence affecting cosmesis/ day-to-day activities. It avoids the blunt of undergoing painful process of multiple pricks, use of 2nd line, thrombophlebitis and prolonged sessions seen in peripheral IV lines. Although the procedure of port implantation has got serious complications, the rate is minimal and with the help of radiological tools and surgical expertise, these can be made negligible. The only set-back by using a port is the maintenance part, which requires periodic ushing with heparinized saline to prevent blockage when not in use for prolong period (&gt;4weeks). And so, it is advisable to remove the port promptly after completion of treatment if patient is labelled cured. Complications like infection can be avoided by strict aseptic precautions taken while handling the port for chemotherapy sessions by trained personal. Above all patient education and compliance is utmost important to ensure proper functioning of the port.