Prone Decubitus Position Research Articles

A case report of robotic-guided prone transpsoas lumbar fusion in a patient with lumbar pseudarthrosis, adjacent segment disease, and degenerative scoliosis.

BackgroundSurgical treatment of scoliosis includes long and invasive multi-level instrumentation and correction which may result in high rates of postoperative complications, especially in elderly patients with osteopenia or multiple comorbidities. Minimally invasive surgical options may benefit these patients.Case descriptionA 73-year-old female patient with a history of degenerative lumbar scoliosis, L4–5 pseudarthrosis, and resulting L5-S1 adjacent segment following prior unsuccessful lateral L4–5 interbody fusion presented to the clinic with severe lower back pain and lower extremity radiculopathy. The decision was made to proceed with surgical correction via a robotic-guided prone transpsoas (PTP) approach, which is a novel approach similar to lateral lumbar interbody fusion (LLIF) with the patient in a prone decubitus position. Excellent spinal alignment was achieved with no complications. On two-month follow-up, imaging revealed pedicle screws at the L3, L4, L5 levels and at the sacrum without change and continued interbody cages position with no signs or symptoms of infection.DiscussionMinimally invasive procedures have demonstrated benefit in spine surgery especially for at risk populations. The LLIF procedure has been well established for use in a wide range of spinal pathologies given its noted benefits in increasing spinal column stability through posterior fixation and indirect decompression. However, only marginal improvements in segmental lordosis are expected and there are reports of neurological complications. The PTP procedure has emerged as an alternative to LLIF for the treatment of spinopelvic pathologies. This approach enables greater improvements to spinal lordosis through single-position surgery while simultaneously reducing intraoperative repositioning and providing the known benefits of lateral interbody surgery.ConclusionOur experience suggests that the PTP approach is safe and effective because it does not require patient repositioning, easily interfaces with robotic guidance, and achieves increased lordosis gains via the prone positional effect compared to LLIF and comparable approaches.

Ultrasound-Guided Central Venous Access Insertion in Prone Decubitus Position in Severe Covid-19 Patients: Case Report

Ultrasound-Guided Central Venous Access Insertion in Prone Decubitus Position in Severe Covid-19 Patients: Case Report

Arthroscopic Tibiotalocalcaneal Arthrodesis

Introduction: Arthrodesis is still the gold standard for severe ankle and hindfoot osteoarthritis. The arthroscopic tibiotalocalcaneal arthrodesis technique has been described and developed in the past decade. Tibiotalocalcaneal arthrodesis (TTCA) is the election procedure for combined severe ankle and subtalar osteoarthritis after failure of conservative treatment. The arthroscopic technique is more respectful to the surrounding soft tissues and the vascular supply; hence, it provides a theoretical benefit in terms of consolidation, and it is suitable for cases in which the open surgery is not desirable. We perform the surgery with the patient in prone decubitus position, and we use conventional arthroscopic instruments. We use the posterior portals described by van Dijk to access both tibiotalar and posterior subtalar joints and perform the cartilage denudation. We aim to have a healthy, well-vascularized subchondral bone and obtain a good coaptation of the articular surfaces. The retrograde tibiotalocalcaneal nail is the implant of choice for the TTCA. We consider that the lower surgical aggression of the arthroscopic procedure compared with the open technique should allow a satisfactory union rate without bone grafting. The global consolidation rate reported is 67% to 100%. The global complication rate reported is 7% to 33%. Most are related to osteosynthesis material and superficial wound infections. Arthroscopic TTCA offers excellent results in selected patients. A protocolized surgical technique using posterior endoscopic portals is mandatory. Level of Evidence: Diagnostic Level V. See Instructions for Authors for a complete description of levels of evidence.

The important role of positioning in nasogastric tube insertion in unconscious patients: A prospective, randomised, double-blind study.

To investigate whether positioning the body in a lateral decubitus position will facilitate nasogastric tube insertion in unconscious patients. Inserting a nasogastric tube into unconscious patients can be challenging because these patients cannot cooperate with the operator. The piriform sinus and arytenoid cartilage are the most commonly reported impaction sites. However, we found that the first impaction site was the backward displaced tongue when inserting a nasogastric tube in unconscious patients who often exhibited glossoptosis. Performing an intubation in the lateral decubitus position could make this procedure easy. This prospective, double-blind, parallel, randomised controlled trial was conducted in Hengshui City, Hebei Province, China. A total of 110 cases of unconscious patients were enrolled. The patients were randomly assigned to a conventional group (group C) or a lateral decubitus position group (group L). In group C, the nasogastric tube was inserted while the patients were in a supine position using the conventional technique, and in group L, the tube was inserted in a lateral decubitus position or further tilting the body to a prone decubitus position 20-30°. We discussed reasonable intubation methods in unconscious patients by comparing the success rate on first insertion, the overall success rate, the intubation time and the complication rates between the two groups. Group L had a higher success rate on first insertion and overall success rate than group C (p<.05). The intubation time in group L was shorter than that in group C (p<.001), and the complication rate in group L was lower than that in group C (p<.05). The differences were statistically significant. The backward displaced tongue blocks the pharyngeal passage. Nasogastric tube insertions in the lateral decubitus position are recommended in unconscious patients because of the higher success rate, reduced intubation time and lower complication rate. This study provides an effective method for nasogastric tube insertions in unconscious patients.

Distal-third diaphyseal fractures of the humerus: choice of approach and surgical treatment.

Distal-third diaphyseal fractures of the humerus are often hard to treat due to location and pattern of the fractures, radial nerve injury, and quality of bone and age of patients. The aim of this retrospective study is to propose the best approach and the best surgical technique according to the pattern of extra-articular fracture of the distal humerus. We have treated 37 fractures of the distal humerus between January 2010 and July 2015 classified according to the AO classification. There were 2 open fractures. We treated all fractures with open reduction and internal fixation with plates and screws. In 20 cases, we performed a posterior midline triceps-splitting approach, with patients in prone decubitus position; in 2 cases, the triceps-splitting approach with the patients in supine decubitus position; in 3 cases, the olecranon osteotomy approach in prone decubitus position; and in 12 cases, the lateral approach in supine decubitus position. Thirty cases had a medium follow-up of 6months. We observe 2 post-operative radial nerve palsies healed in 5months and 2 cases of non-union. The average time to union of remaining cases was 16weeks (range 12-24). Elbow motility was complete in 25 cases, in 4 cases there was an extension loss of 5°, and in one case there was an extension loss of 10°. The use of plates allows an anatomical fracture reduction, a better control of alignment of humerus and, with a rigid fixation, an early elbow mobilization. The best approach and the best surgical technique depend on the pattern of the fracture of distal humerus.

Video-assisted thoracolaparoscopic esophagectomy: the experience of Shanghai Chest Hospital.

The traditional open esophagectomy is associated with higher morbidity, while minimally invasive procedures could be accompanied with a lower one. In this case, the patient is placed in the prone-decubitus position and the surgeon stands in front of the patient. The "four ports" approach is adopted in the thoracoscopic procedure with CO2 insufflation, and the esophagus and lymph nodes are dissected. In the laparoscopic procedure, "hand assistant technique" is employed. The esophagogastric anastomosis is similar with McKeown procedure.

Profundizando en el conocimiento sobre el manejo del dispositivo para control de la eliminación fecal en el paciente crítico

ObjectiveTo describe the general characteristics of the patient and device use. To know retention balloon pressure (RBP) and related factors. To identify rate of leakage incidence, relocation and perineal damage due to the device (PSD) and related risk factors. Material and MethodsAn analytical observational, cross-sectional study conducted in a polyvalent ICU from June-December 2010 was performed. The sample included Flexi-Seal® carriers. Variables evaluated were patient and device use characteristics, RBP, leakage and quantity, relocation and reason, PSD, sedoanalgesia infusion, neuromuscular block, patient position, Flexi-Seal type catheter, ventilatory mode (VM), intra-abdominal pressure (IAP), mean intrathoracic pressure (MITP), PEEP, Glasgow, color-aspect, fecal consistency and volume. Significance P<.05. ResultsTwenty-one patients were included, 52% male, aged 54±17 with 30 insertion episodes, Flexi-Seal-Signal® 33%, 10±8 days permanency, main indication 33% «diarrhea and injured skin»,” 30% device removal «intolerance and/or spontaneous expulsion». Median (Me) PGR =40; RI (61-19) cmH2O. Factors associated to higher PGR: SCI absence, prone-decubitus position, leakage, relocation, conventional Flexi-Seal®, MV, lower PEEP and IMP, Color-aspect, higher MITP. Leakage, relocation and PSD incidence density 43, 30 and 2 cases/100 days of catheter, respectively. Leakage and relocation risk factors: higher PGR, Glasgow and fecal volume, lower MITP, MV, assisted-spontaneous mode OR 2.5 CI (1.6-3.8) and OR 1.7(1.1-2.7), absence SCI OR 3.3 (2.2-5.1) and OR 2.4(1.5-3.8), absence neuromuscular block OR 2.4 (1.4-3.9) and OR 1.8 (1.1-3.1), Flexi-Seal® conventional OR 2.7(1.7-4.1) and OR 2 (1.2-3.3), respectively. Leakage risk factors: color-aspect, supine position, lower IMP and PEEP. ConclusionsMonitoring RBP may alert us about leakage presence and relocation need. Knowing associated risk factors to RBP, leakage and relocation would help to develop strategies to reduce their high incidence rate such as decreasing RBP by reducing inflated volume.

Randomised trial, Minimally Invasive Oesophagectomy versus open oesophagectomy for patients with resectable oesophageal cancer.

In 1991, Dallemagne introduced the right thoracoscopic approach for oesophageal cancer with total lung block, thereby mimicking the conventional approach (1). Initial reports showed a high conversion rate to thoracotomy of 10% to 17% and a high respiratory morbidity of 17% to 42% (2-3). Searching for reduction of the conversion rate and the respiratory infection rate, Cuschieri et al. designed the thoracoscopic approach in prone decubitus position so that a total collapse of the lung was no longer necessary for dissecting the oesophagus and thereby possibly reducing the rate of respiratory infections (4).

The oblique supine decubitus position: technical description and comparison of results with the prone decubitus and dorsal supine decubitus positions

Our objective was to analyze the advantages of the percutaneous nephrolithotomy in oblique supine decubitus compared to the prone and dorsal supine position. In 87 patients diagnosed with urolithiasis (495.5-530.8 mm(2)), percutaneous nephrolithotomy (PNL) was performed from 2000 to 2011. The patients were divided into three groups: Group A, 32 patients, PNL in the prone decubitus position; Group B, 24 patients, PNL in the dorsal supine position; Group C, 31 patients, PNL in the oblique supine position. We analyzed intraoperative parameters, complications, and results among the three groups. The three procedures were performed with a single access, 24-30 Ch. No statistically significant differences were found among the three groups regarding the patients' characteristics, or the morphology or size of the kidney stone treated. The operation time was shorter in the cases of PNL in dorsal supine and oblique supine compared to the prone position. The complication rate was very similar in the three groups. The main advantage of the PNL in oblique supine compared to the dorsal supine was that the puncture could in all cases be directed by ultrasonography, with greater precision, more safety, and more control of the percutaneous renal access. The oblique supine decubitus position is a safe position for the percutaneous treatment of urolithiasis and it becomes easier when the puncture is guided by ultrasound.

Encuesta sobre el tratamiento anestesiológico de los pacientes sometidos a neurocirugía de fosa posterior

ObjectivesTo find out, by means of a questionnaire, the procedures used by Spanish anaesthetists in peri-operative management of patients subjected to neurosurgery of the posterior cranial fossa. Material and methodsA closed-question type questionnaire was sent to Anaesthesiology Departments with a Neurosurgery Department on the participation of anaesthetists in the peri-operative treatment of patients subjected posterior fossa surgery. ResultsThe questionnaire was completed by 42 (57.5%) of the 73 national public hospitals with a Neurosurgery Department. The posterior fossa surgery was performed in the sitting position in 36 hospitals, although it was less frequently used than the lateral decubitus or prone decubitus position. There was little specific neurological monitoring, as well as little use of precordial and/or transcranial Doppler for detecting vascular air embolism. Nitrous oxide was used in less than 10% of the centres, and 15% avoided neuromuscular block when neurophysiological monitoring was used during the surgery. Cardiovascular problems were mentioned as being the most frequent in 29% of the centres, while in the post-operative period the most common complications were, cranial nerve déficit, airway oedema (23%), and post-operative vomiting (47%). ConclusionsThe results obtained from the questionnaire showed that the sitting position was less used than the prone position in posterior fossa surgery, and that neurophysiological monitoring is during surgery is hardly used.

Lavado broncoalveolar bilateral secuencial: caso clínico, método y discusión

Bronchoalveolar lavage is the most effective treatment of alveolar proteinosis. We describe a variant of the usual technique. In a clinical case, we performed bronchoalveolar lavage sequentially in both lungs, without needing to stop the technique after completing the lavage of the first lung, with significant clinical improvement of the patient (pulmonary compliance and saturation). Given the amount of protein-like material lavaged, it was more effective and better tolerated in prone decubitus position. This variant permitted a shorter hospital stay. It avoided new sedation and intubation. The patient could be extubated at a few hours with good clinical tolerance. Lavage of both lungs permitted discharge to ward in less than 24 hours. The result at middle term was similar to the conventional technique. Lavage could be performed again on several occasions with the same clinical tolerance.